Indonesia has found traces of H5N1 bird flu in apparently healthy-looking poultry, making it tougher to detect the disease in the country hardest hit by the virus, officials said on Monday.

Sick or dead chickens are used as a sign of H5N1 infection, but the appearance of asymptomatic chickens means humans could become more easily infected with bird flu. Indonesia has the world's highest death toll from the disease, killing 79 people.

The poultry death rate is not so high, but there is a trend that chicken or poultry are infected by the virus but they don't die. So, the H5N1 virus is not fatal to poultry," Musny Suatmodjo, director of animal health at the agriculture ministry, told a news conference.

Bird flu is endemic in poultry in many parts of Indonesia, which has been struggling to contain the disease because millions of backyard chickens live in close proximity to people across the archipelago.

Contact with sick fowl is the most common way people become infected. Globally, 189 people have died of H5N1 infection since the virus reappeared in Asia in late 2003.

While bird flu is essentially a poultry disease, scientists are worried about the virus's ability to adapt to new environments and hosts. They fear this increases the chances of the virus mutating into a form that can jump easily between people, triggering a pandemic.

For the first six months of this year, 12,000 birds have died of bird flu or been culled, while last year about 1.75 million poultry either died of the disease or were culled, Suatmodjo said.

Authorities fear healthy-looking poultry could shed the virus in their feces, increasing the risk of spreading bird flu to people.

"The poultry deaths have come down. But there's something that we need to be cautious about. There is concern shedding may occur," Bayu Krisnamurthi, the bird flu commission chief, told reporters.

"There are some cases where humans were infected with the virus although there was no sick or dead poultry in their surroundings. But it can't be a general conclusion yet," he said, adding the commission was being cautious about this indication.

Hong Kong-based researchers have also detected such "asymptomatic" chickens and other poultry in mainland Chinese markets in recent years, which they believe were responsible for most of the H5N1 human infections there.

One published study of fecal samples taken from healthy poultry in markets in China in recent years found that one percent were infected with the virus.

The Indonesian Bird Flu Commission said last week the H5N1 bird flu virus in Indonesia might have undergone a mutation that allows it to jump more easily from poultry to humans.

(Additional reporting by Tan Ee Lyn in Hong Kong)

Oral supplementation with the probiotic Lactobacillus reuteri to the mother during pregnancy and to the infant after birth may help reduce the development of eczema and allergy associated with immunoglobulin E, a key protein involved in the allergic response, according to Swedish researchers.

Probiotics are small molecules that help maintain the natural balance of organisms, also referred to as microflora, in the intestines.

Altered microbial exposure may underlie the increase of allergic diseases in affluent societies. Probiotics may help, Dr. Thomas R. Abrahamsson of Linkoping University Hospital and colleagues note.

To investigate, the researchers enrolled families with a history of allergic disease. Expectant mothers were randomly assigned to receive L reuteri in an oil suspension or a placebo treatment, each day from week 36 until delivery.

Their babies continued with the same formulation from birth until 12 months of age and were followed up for another year. A total of 188 completed the study.

At 2 years, the incidence of eczema was 36 percent in the active treatment group and 34 percent in the placebo group. However, during the second year, only 8 percent of the L. reuteri group had IgE-associated eczema compared with 20 percent of the placebo group, a statistically significant difference.

Skin prick test reactivity was also less common in active treatment group than in the placebo group. The difference was statistically significant in infants with mothers with allergies (14 percent versus 31 percent). However, there was no effect on wheeze or other potentially allergic diseases.

Although the study failed to confirm an overall preventative effect on infant eczema, the investigators conclude that "the treated infants had less IgE-associated eczema at 2 years of age and therefore possibly run a reduced risk to develop later respiratory allergic disease."

SOURCE: Journal of Allergy and Clinical Immunology, May 2007.

A program targeting people most likely to be infected with HIV and offering counseling to prevent further infection would be far more effective than the government's recommendations for mass testing, U.S. researchers said on Monday.

They said the U.S. Centers for Disease Control and Prevention's recommendations for widespread HIV testing of those aged 13 to 64, regardless of risk, would cost $864 million a year.

The CDC's recommendations for mass screening would not require counseling, and patients could opt out of testing if they chose.

A plan that targets those at high risk and offers counseling services could pick up more than three times as many people with HIV and could prevent four times as many new infections -- all for the same price, according to an analysis by David Holtgrave, an expert on HIV prevention at the Johns Hopkins Bloomberg School of Public Health in Baltimore.

"It's really a question of which policy would be more effective," said Holtgrave, whose study appears in the June edition of the journal PLoS Medicine.

His analysis found that the CDC's new testing strategy -- announced in September -- could diagnose nearly 57,000 cases of HIV in a one-year period.

But a strategy that zeros in on likely targets of HIV infection -- by geography, health care setting or risky behavior -- would identify 188,000 people with the disease out of an estimated 250,000 to 300,000 people in the United States living with HIV but not knowing they are infected.

"You would do much better in terms of diagnoses," Holtgrave said in an interview.

'TARGETED SCENARIO'

He said the targeted approach would focus testing mainly on clinics and emergency departments that treat the uninsured who might lack access to regular health care, on areas with a higher-than-normal percentage of HIV infection or on a physician's assessment of risky behavior.

It also would use counseling as a means of preventing the spread of HIV infection.

"When we compared opt-out testing to the targeted scenario, it seems like the targeted scenario works better. The cost parameters are the same, but you wind up diagnosing more people and preventing more infections," Holtgrave said.

In September, the CDC replaced its 1993 recommendations on HIV testing in health-care settings in a bid to make HIV screening a part of routine medical care and to boost diagnosis of HIV infection among pregnant women.

CDC's previous HIV testing recommendations for health-care settings called for routine testing for people at high risk, and for everyone -- regardless of risk -- in settings with HIV prevalence above 1 percent.

CDC has said its revised recommendations are designed to simplify the testing process and remove barriers to testing.

"Our point of view is this is not a question of either-or. You really do need both approaches. You need targeted risk based-testing, and you need broader screening," said Dr. Bernard Branson of CDC's division of HIV/AIDS prevention.

"Risk-based screening misses about half of HIV-infected people in the health care setting," he said in a telephone interview.

"Providers are often unwilling to do risk assessments and patients are often unwilling to be labeled as at high risk for HIV. Those features have told us that risk-based screening will be insufficient to find all of the people that will be HIV-infected," he said.

CDC's new recommendations do not alter current recommendations on HIV counseling and testing in nonclinical settings, such as community centers or outreach programs.

Children who got antibiotics as babies had a higher risk of developing asthma by age 7, Canadian researchers said on Monday.

Antibiotics are commonly prescribed to children under age 1 for a host of reasons, most often for lower respiratory tract infections such as bronchitis and pneumonia or upper respiratory tract infections like ear and sinus infections.

Anita Kozyrskyj and colleagues at the University of Manitoba in Winnipeg and McGill University in Montreal studied antibiotic use in 13,116 children from birth to age 7.

Respiratory symptoms early on can be a sign of future asthma. To control for that, they sorted out infants who got antibiotics for non-respiratory tract infections, such as impetigo or urinary infections.

Of those, the risk for asthma before age 7 doubled compared to babies who got no antibiotics before age 1, according to the study, which appeared in the journal CHEST.

The researchers found that babies who were exposed early to antibiotics and who did not have a dog in the home before their first birthday were also at higher risk for asthma by age 7.

They said the presence of a dog likely increases the infant's exposure to germs, which can help kick-start the baby's immune system.

Asthma is an inflammation of the airways that makes breathing difficult. Symptoms can include wheezing, shortness or breath, coughing and chest tightness.

Japanese scientists have engineered an oral cholera vaccine encased in rice protein that has proved to be effective in mice, raising hopes it will offer humans better protection against the disease.

The vaccine in capsule form gives it an advantage over other oral cholera vaccines, the scientists said in the latest issue of the Proceedings of the National Academy of Sciences.

One advantage is refrigeration is no longer required, and it's more friendly (and safe) without the use of needles," said Hiroshi Kiyono at the University of Tokyo's Department of Microbiology and Immunology.

"It has proven effective in producing antibodies in mice, which have neutralizing activities against toxins," he said in a telephone interview.

Rice protein is also stable in an acidic environment and can withstand digestion in the stomach. This ensures the vaccine is delivered into the intestine where it is needed to trigger an immune response to fight cholera bacteria.

Cholera is an acute intestinal infection caused by the bacterium Vibrio cholerae, which has a short incubation period from less than a day to five days. It causes copious, watery diarrhea and vomiting that, without prompt treatment, can quickly lead to severe dehydration and death.

Currently there are oral and injectable vaccines but most of them require refrigeration, which is prohibitively expensive in the places that need the vaccine most.

Kiyono and his colleagues plan to test the efficacy of their vaccine next in primates, but they are unsure when human clinical trials may take place.

But Kiyono was hopeful that rice protein would prove an ideal vehicle to deliver other vaccines.

"Most infectious diseases occur during inhalation, ingestion and sexual contact, it can be applied for anthrax, influenza, HIV as well," he said.

The drug doxycycline delays dangerous aneurysm rupture in mice genetically engineered to have many of the clinical features of humans with Marfan syndrome, says a U.S. study.

In Marfan syndrome, a genetic flaw causes the walls of the heart's major arteries to weaken.

Thoracic aneurysms are the main cardiovascular complication in Marfan syndrome patients. This study found that doxycycline -- a non-specific matrix metalloproteinases (MMP) inhibitor -- blocked the proteins that break down the aorta and significantly delayed aneurysm rupture, tears and bleeding.

The researchers also found that doxycycline reduced elastin degradation and expression of two MMPs -- MMP-2 and MMP-9 -- believed to play an important role in aneurysms.

The Marfan syndrome mice who received doxycycline in their drinking water lived nearly twice as long as mice who did not receive doxycycline.

The study was to have been presented Saturday in Baltimore at the annual meeting of the Society for Vascular Surgery.

In the past, beta blockers have been used to lower blood pressure and slow the heart rate in an attempt to delay the aorta's enlargement, study author Dr. B. Timothy Baxter, a professor in the department of surgery at the University of Nebraska Medical Center in Omaha, said in a prepared statement.

However, beta blockers provide only modest benefit to patients and the side effects caused by drugs have a negative impact on a patient's quality of life.

"In patients with Marfan syndrome, the need for surgical intervention is determined by following the aortic enlargement with ultrasound or CT scans done at six- to 12-month intervals, until a specific threshold of growth is reached when surgery is recommended. This approach of watchful waiting is unsettling and stressful for patients," Baxter said.

He said more research is needed to determine whether treatment with doxycycline can delay or prevent the need for surgery in Marfan syndrome patients.

GlaxoSmithKline said on Tuesday that U.S. health regulators granted a priority review to a capsule form of its drug Hycamtin for the treatment of relapsed small cell lung cancer.

With priority review status, the U.S. Food and Drug Administration will make its decision on whether to approve the drug within six months, rather than the usual 10 month to 12 month review period.

The agency grants priority review to products that are considered to be potentially significant therapeutic advancements over existing therapies.

Hycamtin in its current intravenous formulation requires five consecutive days of therapy every three weeks. Oral Hycamtin, if approved, will allow patients to be treated at home, Glaxo said.

China played down the country's food-safety problems on Tuesday but at the same time showed off room after room of confiscated fakes, indicating the extent of the challenge it faces to clean up the industry.

Fresh scandals involving fake food and medicines are reported by Chinese media report almost every day, and the issue has burst into the international spotlight since tainted additives exported from China contaminated pet food in North America.

Yes, we have had some problems with the food safety of Chinese products. However, they are not that serious," said Li Dongsheng, vice minister of the State Administration for Industry and Commerce. "We should not exaggerate those problems.

"We are very concerned about food safety in China and we are very concerned about protecting the rights of consumers, but we do not want to cause panic among the people which may be unnecessary," Li told a news conference.

Li's administration works to ferret out the billions of dollars worth of counterfeit and substandard goods produced every year in China, from fake medicine to luxury handbags, and encourages consumers to call its hotline network with complaints.

The hotlines, which cover about 60 percent of urban areas and just under half of rural China, are usually headed by the head of the local government, Li said, raising questions about conflict of interest in a country whose Communist leaders openly warn about the extent of corruption.

Li said such problems existed, but they were rare.

"We have an expression in China: If you put a leaf in front of your eyes, you can't see the whole forest," he said.

"It's only a small problem, but it is a small problem we must pay great attention to."

BEAKERS AND TEST TUBES

It is also a problem that has extended to the highest levels of China's web of food safety bodies, which include the State Food and Drug Administration, the General Administration of Quality Supervision, Inspection and Quarantine, and the Health and Agriculture Ministries.

On Tuesday, Chinese media reported that the country's former food and drug safety chief, sentenced to death in May on charges of taking bribes from drug companies and dereliction of duty, would appeal.

At the Beijing branch of the Administration for Industry and Commerce, laboratory workers in white coats prodded beakers and filled test tubes on desks spread with packaged supermarket products pulled from the shelves for testing.

The centre, which is responsible for testing for the Beijing market, including food products to be sold during the 2008 Olympics, checks for heavy metals, pesticide residues and the safety of additives.

It also boasts an entire floor full of rooms that show the fruits of its detective work, counterfeit foods ranging from bottles of fake Chivas Regal to Doublemint bubble gum to chicken bullion and milk powder.

Despite the array of remarkably real-looking fakes -- not only food products, but also clothes, household appliances and skincare products, among others -- Li said the troubles facing China were no greater than those faced by many other countries.

Asked about the most common problem discovered by his staff, Li replied: "We should say that for the great majority, there is no problem.

EU ministers ended 18 months of squabbling on Tuesday over new rules for organic farming and came up with a labeling system that will tell consumers exactly what they are buying on the supermarket shelves.

Farmers who sell produce containing at least 95 percent organic ingredients will use a special EU logo, along with a label to indicate the product's origin. Below that, there will be labeling of the organic ingredients present.

This is an excellent agreement which will help consumers to recognize organic products throughout the EU more easily and give them assurances of precisely what they are buying, EU Agriculture Commissioner Mariann Fischer Boel said.

The labels can be accompanied by national and private logos, at the discretion of individual EU countries. Mass catering operations are excluded from the new rules although countries can choose to apply national rules if they wish.

Now, EU organic farmers have difficulty selling organic food in different EU countries as there is a patchwork of national and private logos that can be costly and complicated to obtain.

At present, the EU has two labeling categories: a "gold standard" where organic ingredients comprise at least 95 percent of the final product, and "emphasized labeling" where there is at least 70 percent organic material.

Although Europe saw its organic farming area jump nearly 70 percent in the late 1990s, growth has now slowed in several countries where it has reached a plateau.

In the 25 EU states, before the accession of Bulgaria and Romania, the amount of organic farmland stood at around 6.1 million hectares, or some 3.9 percent of total farm land.

But the average market share for organic products in the EU remains small at around two percent, with some exceptions such as vegetables at between five and 10 percent.

BIOTECH IN ORGANIC FOOD?

The main problem for many EU governments, and Europe's organic movement, was the issue of genetically modified (GMO) food -- specifically, the issue of setting an acceptable degree for the unavoidable presence of GMO material in organic farming.

The new law says products containing approved GMO material may not be labeled as organic, except those with up to 0.9 percent content of GMOs that are already authorized in the EU, via accidental or unavoidable contamination.

This is in line with current EU rules on biotech food and feed thresholds. It remains illegal to use GMOs in organic farming knowingly.

Fischer Boel has often said it would be too costly for farmers to achieve higher purity in their organic produce.

"We needed to clarify the rules on GMOs, to say they are not allowed in organic production. Before the agreement today, there were no limits. Everyone should know that we have tightened the rules," she told a news conference.

"It can be very tempting to say 'zero tolerance' but that wouldn't work in real life. To avoid accidental contamination it would be so expensive to produce organic products that it would damage the market completely. It would simply kill the sector."

Not all countries were impressed with the GMO provision.

"It is clear that this (GMO threshold) is not a license to contaminate. Any contamination would have to be involuntary and unavoidable," Austrian Agriculture Minister Josef Proell said.

"We cannot simply go on raising the threshold and pretend we are still on a path to organic farming," he told Reuters.

Environmental groups have been outraged by the idea, with one attacking it as the "thin end of a wedge which will allow the creeping contamination of organic food across Europe" and calling for cross-border EU laws to protect organic farmers.

"Now the EU has declared traces of genetic contamination in organic crops acceptable, organic farmers will find it increasingly difficult to keep their crops GM-free," said Helen Holder, GMO campaigner at Friends of the Earth Europe.

Doctors may soon have new tests to detect Alzheimer's early on, as well as better medications to help treat the mind-wasting disease, researchers say.

A number of advances against the disease were highlighted Monday at the Alzheimer's Association's International Conference on Prevention of Dementia in Washington, D.C.

In one presentation, researchers reported that a new test may spot Alzheimer's early. And as effective therapies become available, earlier diagnosis will be key, experts say.

"Alzheimer's disease is very difficult to diagnose when it is in its early stages," said lead researcher Geert De Meyer, a senior biostatistician at Innogenetics in Gent, Belgium. "That's a pity because therapy might be most effective when it is applied in an early stage."

In the study, De Meyer's team tested a new diagnostic test, called INNO-BIA, that detects and measures the amount of various forms of amyloid-beta protein in blood. A buildup of amyloid-beta in the brain is a hallmark, and possible cause, of Alzheimer's.

The Belgian group tried the early detection test on blood samples taken from 556 people who had come to memory clinics with the early symptoms of dementia, including mild cognitive impairment.

According to the researchers, people at risk for Alzheimer's had significantly different amyloid-beta levels in their blood compared with people who did not show risk of Alzheimer's. For example, the ratio of amyloid-beta 1-42/amyloid-beta 40 was decreased by about 20 percent in patients at risk for Alzheimer's, compared to those not at risk.

"This is really a first step," De Meyer said. "The test could be used as a screening test or a risk-factor-determining test for Alzheimer's disease that can be followed up with other tests."

Another report focused on a phase II trial that tested LY450139, a drug being developed by Eli Lilly and Company. The medication is a potential treatment for Alzheimer's because it inhibits an enzyme, known as gamma-secretase, which contributes to the formation of amyloid-beta.

The trial was led by Dr. Eric Siemers, medical director of the Eli Lilly Alzheimer's Disease Team in Indianapolis. Siemers and his colleagues randomly assigned 51 patients with mild to moderate Alzheimer's to either 100 milligrams or 140 milligrams of the drug for six to 12 weeks.

The result: Levels of amyloid-beta 1-40 were reduced by 58 percent for the 100 milligram group and by 64 percent for the 140 milligram group.

However, no differences were seen in patients' cognitive function. But Siemers isnt disheartened by that outcome, he said, since "this was too short of a period to see a disease-modifying effect."

"This is the most robust effect of amyloid-beta in blood of any drug that is currently under development," he added. "The drug was safe, but we found some things that we will continue to monitor as we go into phase III studies, which will start early next year."

A third study presented Monday tackled Alzheimer's disease from a whole different angle. Experts know that glucose is the primary energy source for brain cells. However, in people with Alzheimer's, scientists have now discovered that a dramatic dip in glucose use in certain brain areas starts 10 to 20 years before any symptoms of Alzheimer's appear.

Deprived of their primary energy source, these stricken neurons suffer irreparable damage.

"This is a very novel approach to the treatment of Alzheimer's disease," said lead researcher Lauren Costantini, vice president for clinical development at Accera, in Broomfield, Colo. "The problem that we are focusing on is reduced brain glucose metabolism that has been shown to be an early event in Alzheimer's disease."

To replace this loss, scientists at Accera have developed a milkshake-like drug called AC-1202 (Ketasyn) that provides glucose-deprived neurons with an alternative energy source, known as ketone bodies. The researchers believe that increasing the availability of ketone bodies will improve memory problems and other functional losses that occur with Alzheimer's.

Costantini's team found that, after 45 days, people who took AC-1202 had statistically significant improvement in cognition compared with people taking a placebo. The best response was seen among people who did not have the E4 variant of the apolipoprotein gene (ApoE4), which occurs in half of all Alzheimer's patients.

Those who continued to take the drug for nine months had very little disease progression, especially among the people without the E4 variant, Costantini reported.

"We see this as a potential co-therapy with other strategies," Costantini said.

Provided you don't have a drinking problem, are of legal age, and are not pregnant, the U.S. National Library of Medicine offers these suggestions for drinking alcohol responsibly:

* Never drive a car if you've been drinking.
* Drink alcohol with food -- never on an empty stomach.
* Drink slowly and in moderation to avoid severe impairment.
* If you are taking any medications, don't drink alcohol without checking first with your doctor.
* Alcohol is not safe -- even in moderation -- if you have a history of alcohol abuse.

Male U.S. military veterans are twice as likely to commit suicide as men who haven't served in the armed forces, a new study claims.

These findings suggest that doctors should look for signs of suicidal intentions among soldiers returning from service in Afghanistan and Iraq, the researchers said.

"Male veterans are twice as likely as their civilian counterparts to die by suicide," said study author Mark Kaplan, a professor of community health at Portland State University. "We don't understand why. But this finding may foreshadow what is going to come with the current cohort of military personnel who have served in Afghanistan and Iraq."

For the study, Kaplan's team collected data on 320,000 men over age 18 who participated in the National Health Interview Survey. The men were followed for 12 years.

The researchers found that men who had served in the military at some time between 1917 and 1994 were twice as likely to die from suicide than men in the general population.

Veterans were also more likely to own guns and commit suicide with a gun, Kaplan said. In fact, veterans were 58 percent more likely to use a gun to kill themselves.

According to Kaplan, the risk for suicide was highest among men whose activities were limited by health problems. In addition, veterans who killed themselves were more likely to be older, white, better educated and married.

However, overweight veterans were less likely to kill themselves than those of normal weight, the researchers also found.

The number of veterans who commit suicide is much larger than has been previously reported, Kaplan contended, adding that earlier studies were based on data from the U.S. Veterans Administration.

"Most veterans don't seek or receive medical care through the Veterans Administration system," Kaplan said. "So we have to be careful about earlier studies."

"The main finding of this study resolves an important and timely question of considerable importance," said Dr. Randall Marshall, director of Trauma Studies at New York State Psychiatric Institute in New York City.

Previous research had focused on veterans whose health-care needs were being served by VA centers, and also primarily on Vietnam veterans, Marshall explained.

"This study also brings to light the important, but rarely appreciated, fact that the majority of U.S. veterans are not in the VA system," he said.

"Health-care providers should take note of this finding now, and consider military service as a risk factor for suicide," Marshall added. "Assessing for suicide risk is a skill in itself, and professional organizations should offer training in how to ask about suicidal thoughts and, most importantly, treatable risk factors such as major depression, PTSD and substance use disorders."

Kaplan expects that suicide rates among veterans returning from Afghanistan and Iraq will follow a similar pattern to his research results.

"We are confident that these trends will continue," he said. "This is a population that needs to be screened and monitored upon their return to the United States."

In addition, primary-care doctors need to be on the lookout for signs of depression or suicidal thoughts or behaviors among veterans who served in Afghanistan and Iraq, Kaplan said.

The new study is published in the July issue of the Journal of Epidemiology and Community Health.

After an Indiana hospital introduced a new protocol to get heart attack patients into the cardiac catheterization lab more quickly for artery-opening procedures, patients received lifesaving care up to an hour sooner than before and suffered less heart damage, researchers report.

They also had shorter hospital stays, according to a study published in the June 11 issue of Circulation.

The study included patients with a type of heart attack called ST-segment elevation myocardial infarction (STEMI), which is caused by a completely blocked artery. The sooner the artery can be opened, the lower the risk of death or permanent heart damage.

Emergency angioplasty -- also called percutaneous coronary intervention (PCI) -- is the preferred treatment for this kind of heart attack, according to background information in the study.

"The benefit of emergency PCI depends on how quickly a patient receives treatment. However, only about a third of patients in the United States receive treatment within the recommended 90 minutes," study lead author Dr. Umesh N. Khot, a cardiologist at Indiana Heart Physicians/St. Francis Heart Center in Indianapolis, said in a prepared statement.

He and his colleagues made two major changes to the hospital's STEMI treatment protocol. First, the emergency department doctor who first sees the heart attack patient now immediately activates the cath lab. Next, an Emergency Heart Attack Response Team -- which includes an emergency department nurse, a critical care unit nurse, and a chest pain unit nurse -- moves the patient to the cath lab and prepares the patient for emergency PCI.

"Traditionally, most hospitals require the emergency department physician to contact a cardiologist who comes to see the patient. Only after the cardiologist sees the patient is the cath lab activated. Waiting for the cardiologist before activating the cath lab delays care without any clear benefit," Khot said.

Then, "patients have to wait in the emergency department for the catheterization team members to prepare the cath lab or arrive from home during nights and weekends."

Khot and his colleagues compared 60 STEMI patients who had emergency PCI before the new protocol was implemented and 86 STEMI patients treated after the new protocol was in place.

The median time it took for a patient to be treated after arriving at the hospital decreased by a third -- from 83.5 minutes to 64.5 minutes during regular hours and from 123.5 minutes to 77.5 minutes in off-hours. The proportion of patients who received emergency PCI within 90 minutes increased from 28 percent to 71 percent, the research team say.

If you want your mind to stay healthy into your golden years, don't worry, be happy.

That could be the message of new research that shows those prone to worry, anxiety or depression are more likely to develop mild cognitive impairment (MCI), a condition often considered a precursor to the more-debilitating Alzheimer's disease.

"MCI is now recognized as a very early sign of incipient Alzheimer's disease," said Robert S. Wilson, lead author of the study and a neuropsychologist at the Rush Alzheimer's Disease Center in Chicago. "We found that among healthy elderly people without evidence of cognitive dysfunction at the beginning of the study, chronic distress predicted the development of MCI."

"This is consistent with 20 years of literature on the subject," added Dr. Sam Gandy, chairman of the Alzheimer's Association's medical and scientific advisory council and director of the Farber Institute for Neurosciences at Thomas Jefferson University in Philadelphia.

But moving from these findings to knowledge that can really help individuals could be problematic.

"Quantifying stress is like quantifying mental activity," Gandy said. "These are things that are very difficult to standardize and quantify and measure from one human to the next. It's a big challenge to get to something specific."

"The most important implications are down the road," Wilson added.

For now, even stressed people shouldn't get more stressed by the research, another expert advised.

"Fifty percent of individuals who have mild cognitive impairment do not go on to develop dementia," said Dr. Gary J. Kennedy, director of geriatric psychiatry at Montefiore Medical Center in New York City. "It's not what's called a stable, highly reliable diagnosis. People should not be alarmed by the study."

The study findings are published in the June 12 issue of Neurology.

Wilson and his colleagues had hypothesized that distress might play a role in the beginnings of Alzheimer's.

The authors used data from two larger studies -- the Religious Orders Study and the Memory and Aging Project -- to explore the relationship between psychological distress and mild cognitive impairment.

At the beginning of the study, 1,256 participants with no signs of cognitive impairment completed a test designed to assess how prone they were to distress and negative emotions. They were asked their degree of agreement with such statements as "I am not a worrier," "I often feel tense and jittery," and "I often get angry at the way people treat me."

Participants were further evaluated every year for 12 years.

During that time, 482 people -- 38 percent -- developed mild cognitive impairment.

Those who most often experienced negative emotions were more than 40 percent more likely to develop mild cognitive impairment than those who were least prone to these emotions. This suggests that chronic psychological distress is a risk factor for mild cognitive impairment, the researchers said.

And the findings were independent of depression. "We do think depression is somehow associated with an increased risk of dementia, but this [study] controlled for depression," Kennedy said.

It's unclear why this might be the case.

"If this is a vulnerability factor for developing Alzheimer's, the big question is how is it working, what's the neurobiology connecting this," Wilson said. "If we could understand the mechanism, it could open up new avenues for preventing or at least delaying the onset of symptoms."

And scientists may have the answer one day. According to Wilson, all participants in the study have agreed to donate their brains for autopsy after they die.

The only development in the Sierra Health - UnitedHealth that can be called substantial is the apparent lack of continued, public, and motivated opposition of the merger from entities other than the AMA and its associated groups. Joining the AMA in recent weeks as opponents are the Nevada State Medical Association, American Hospital Association, and Clark County Medical Society -- organizations that tend to represent physicians more than the general public.

Conspicuously absent is opposition from politicians within Nevada who have remained absolutely silent to this point. As of this entry, there does not appear to be a single Nevada public figure that has openly stated opposition to the merger, which is somewhat surprising given the AMA's vocal opposition. This deal is clearly not encountering the resistance experienced in the Pacificare-UnitedHealth merger.

The Las Vegas Sun published this article on June 6 suggesting that the DOJ's second request and associated opposition may be more serious then generally assumed. Some excerpts from that article include that following:

The Justice Department or FTC rarely challenges a proposed merger. It happened in only four of 50 investigations in 2005.

(Interviewed attorneys) said the most recent health care challenge may be a bad omen for United and Sierra Health.

"In 2006 the Justice Department obtained a consent decree requiring United to divest holdings when it merged with PacifiCare Health Systems. The new company gave up about 6,000 members in Boulder, Colo., and 54,000 members in Tucson . United's market share would have been much smaller in those cities than it would be in Las Vegas if it merged with Sierra Health. The new entity would have controlled 33 percent of the market share for health insurance sold to small-group employers in Tucson , and would have been responsible for more than 30 percent of total payments to physicians in Boulder.

While the Pacificare-UnitedHealth analogy certainly has some relevance to the pending merger, there really is no direct comparison with respect to overlapping operations and local/regional impact of the deals. As is well-known at this stage (presumably by the DOJ), UNH's presence in Nevada is very small, and almost negligible when compared to the overlaps in the Pacificare transaction. Furthermore, the issues in the Pacificare deal were fairly obvious from the outset -- divestitures were a given and factored into the merger process very early on.

Similarly, the second request in this merger was fully anticipated and can not be perceive!
d as a major concern this early in the process, particularly when factoring in the actual dynamics of the markets involved. The bottom line remains fully intact: the Nevada healthcare market will not be significantly altered by this transaction when viewed objectively. It is more a transfer of SIE's operations in Nevada (and other areas) to UNH, rather than a merger of competing entities. The fact that UNH is outpacing its rivals on a broad regional scale may be a problem to certain groups, but it will have minimal affect on consumers.

In short, this publication remains extremely positive on the deal's chances for obtaining DOJ consent without major difficulties. Completion in a September / October time frame remains the projected outcome at this stage.

UnitedHealth Group (UNH (Charts, Fortune 500)) ranks no. 21 on FORTUNE's list of America's largest corporations.

The Minnetonka, MN-based company was ranked No. 37 on the 2006 list. Its 2006 revenues were up 57.7 percent from the previous year; profits were up 26.0 percent from the previous year.

Other companies in the Health Care: Insurance & Managed Care sector on this year's Fortune 500 include: Wellpoint (WLP (Charts, Fortune 500)) ranked No. 35; Aetna (AET (Charts, Fortune 500)) ranked No. 85; Humana (HUM (Charts, Fortune 500)) ranked No. 110; Cigna (CI (Charts, Fortune 500)) ranked No. 139 and Health Net (HNT (Charts, Fortune 500)) ranked No. 189.

Last year, Fortune 500 firms, which cover a large swath of the U.S. economy including 31 non-public companies, earned a record $785 billion, up 29 percent from 2005. "Put simply, American companies are enjoying the most sumptuously profitable period in the 500's 53-year history," said Shawn Tully, Fortune's editor at large. "Virtually every conceivable force, from mild labor costs to a falling dollar to soaring productivity, has favored big companies."

The Fortune 500 ranks companies based on revenues. New York boasts the most Fortune 500 firms this year with 57 companies, while Texas and California took the No. 2 and 3 spots, with 45 and 22 headquarters respectively. Top of page
See UnitedHealth Group's Fortune 500 details, including financial stats and contact information.

Last week, health insurer CIGNA (NYSE: CI) signed two contract extensions that will have a major effect on the diagnostics industry. On Wednesday, the provider renewed a multi-year clinical laboratory services contract with Laboratory Corp. of America (NYSE: LH) and followed it up by renewing a multi-year extension with Quest Diagnostics (NYSE: DGX) on Thursday.

Financial terms were not disclosed for either deal, and the agreements will have little impact on CIGNA's stock price, which has already turned the momentum from a strong finish to 2006 into a 24% return for its shareholders thus far in 2007. Quest shares, however, appreciated 5% last week when the market learned of the two contract signings.

The Quest agreement is a comfort to investors, who now know that Quest will continue to be a contracted provider for one of the nation's largest health insurers. The deal also quells the uncertainty about whether Quest would suffer a fate similar to what happened when it lost out to Lab Corp. last fall over a bid for UnitedHealth Group's (NYSE: UNH) business.

The Lab Corp. deal with CIGNA is a bit of a double-edged sword. The agreement allows Lab Corp. to continue as a contracted provider in all of CIGNA's markets and will also lift marketing restrictions for the company. The downside is that it will lack the advantage of being the exclusive recipient of CIGNA's business, as it is with UnitedHealth.

Regardless of the ultimate outcome of these two deals, Quest has done an exceptional job of making sure that it doesn't rely too much on any one of these major health insurers for business. In 2006, only three insurers accounted for more than 5% of the company's net revenues. Combined, they made up only 19%, and one of the three was UnitedHealth, topping the list at 7%. The diversification is making this company look good.

Lab Corp. and UnitedHealth are Stock Advisor selections. Interested in health-care stocks Tom and David Gardner have recommended? Then sign up for a free 30-day trial of Stock Advisor, which is beating the market by more than 37 percentage points.

A boom in HMOs for the neediest leads to litigation, controversy - and lots of profits, says Fortune's Bethany McLean.

Joyce Hines of Baltimore is 45 years old and weighs just 87 pounds. Years of illness that began in the late 1990s with a bleeding ulcer left her jobless and dependent on Medicaid. She has an intravenous line that delivers both nutrition and medication, takes eight prescriptions and has 11 doctors. But this is a radical improvement from a few years ago, when she was down to 67 pounds and spent over a third of the year in the hospital.

Today she lives mostly at home, thanks to a team of caregivers that includes a nurse, a social worker and a case manager. Hines credits Amerigroup (Charts), a publicly traded insurer that provides managed care for the Medicaid population. "No one seemed to know what was going on," she says. "But now we do."

Amerigroup, for its part, says that its approach to someone like Hines - whom it features in its annual report this year - can save taxpayers money by reducing hospital stays and emergency room visits. And saving money is critical for Medicaid, the $330 billion program that covers more than 50 million of the poorest Americans, including the elderly, the disabled and children and their mothers.

While Medicare gets most of the headlines, Medicaid - which funds over a third of all births in the U.S. and is paid for jointly by the states and the federal government - is just as apt to break the bank. On average, Medicaid now eats up the largest share of state budgets - around 22 percent, which is more than education - and is growing by 8 percent a year.

States have been putting their Medicaid populations into managed-care plans since the early 1990s, but in the past few years they have awarded contracts to a brand-new crop of companies - principally Amerigroup and three others, WellCare (Charts), Centene (Charts) and Molina (Charts) - all of which focus on insuring Medicaid patients.

While subsidiaries of multiline insurers like UnitedHealth (Charts, Fortune 500) and WellPoint (Charts, Fortune 500) are still the biggest players in Medicaid, the "pure plays," as they're called, have grown rapidly and now have 22 percent of the Medicaid managed-care market, up from 14 percent in 1999, according to Merrill Lynch analyst Doug Simpson.

The four upstart companies now manage the care of about five million Medicaid patients, collect some $9 billion in annual premiums, and have a combined market capitalization of roughly $7 billion. Their remarkable growth - Amerigroup's revenues have risen at an annual rate of over 60 percent in the past decade - has been accompanied by generally stellar stock performance.

Jeff McWaters, 50, Amerigroup's CEO, is a proselytizer for his industry. Amerigroup's new headquarters in Virginia Beach feature a picture of President Lyndon Johnson signing the 1965 legislation that created Medicare and Medicaid. "The greatest generation made housing affordable, built roads and sent a man to the moon," McWaters says. "The problem we have not figured out, and which is up to our generation to figure out, is this health-care problem."

Any business that is supposed to deliver a public good while maximizing profits for its shareholders invites skepticism. These companies "need to operate in a way that is squeaky-clean," says Dan Mendelson, who oversaw Medicaid at the Office of Management and Budget in the Clinton administration and is now president of consultant Avalere Health. But a close look reveals some blemishes - and more profits than anyone imagined.
A tricky business

There's a long-standing joke in the industry that when you've seen one Medicaid health plan, you've seen one Medicaid health plan. Policies and reimbursements vary wildly from state to state, and the population that Medicaid serves is incredibly diverse.

Medicaid has traditionally been a tricky business for insurers. In the late 1990s states slashed the premiums they pay, and large commercial players like Aetna began exiting the business.

But in 1997 the federal government abolished the requirement that health plans serving Medicaid patients get 25 percent of their members from the private sector, setting the stage for Medicaid-only plans.

Then states began to raise premiums again as they realized that they needed insurers to stay in business. In 2005 a federal budget resolution sought to cut billions from Medicaid, but even that is seen as positive for the managed-care industry, because it will push more states to try to save money.

Both Amerigroup and Centene grew by acquiring smaller plans on the cheap. Venture capitalists saw opportunity too. In 2002, George Soros's Soros Private Equity (which has since been spun off and renamed TowerBrook Capital Partners) bought WellCare, a small Florida operation, and began to expand it.

Molina, started in 1980 by a California emergency room doctor, also began to expand out of its home state, under the leadership of the founder's son, Dr. J. Mario Molina. By 2005 all four companies had gone public. Molina has struggled, in part because California has squeezed its insurers. Amerigroup and Centene both stumbled in 2005 and had to warn that profits wouldn't meet expectations, but their stocks have still trounced the S&P 500 since their IPO dates. WellCare, which also has a high-growth Medicare business, has been a Wall Street superstar: Its stock has more than quintupled since its IPO, to just over $90.

Investors and executives have made a ton of money. In August 2006, TowerBrook cashed out of the last of its $70 million investment in WellCare, reaping a total of almost $900 million. Since WellCare's IPO, CEO Doug Farha has sold over $37 million of stock, according to Thomson Financial. He still owns shares worth almost $100 million and has collected $3.5 million in cash compensation over the past four years. McWaters has received $6.5 million in cash over that period. He owns almost $25 million in stock. Centene's CEO, Michael Neidorff, has also gotten $6.75 million in cash and big helpings of stock, including a grant worth $24.6 million in November 2004.

Health Net, Inc. today announced a date change and now will hold its quarterly conference call to discuss second quarter 2007 results on Wednesday, August 1, 2007, at approximately 11:00 a.m. Eastern Time (8:00 a.m. Pacific Time). Earnings will be announced before the market opens on the same day.

To join the call, dial 800.811.8824, and give the operator the confirmation code 7178740. A recording of the call can be heard from August 1, 2007 (2:00 p.m. Eastern Time / 11:00 a.m. Pacific time) through August 5, 2007 (12:00 Midnight Eastern time) by dialing 888.203.1112, code 7178740.

This call is being webcast by Thomson/CCBN and can be accessed at Health Net's Web site at www.healthnet.com.

The webcast is also being distributed through the Thomson StreetEvents Network to both institutional and individual investors. Individual investors can listen to the call at www.fulldisclosure.com, Thomson/CCBN's individual investor portal, powered by StreetEvents. Institutional investors can access the call via Thomson's password-protected event management site, StreetEvents (www.streetevents.com).

About Health Net

Health Net, Inc. is among the nation's largest publicly traded managed health care companies. Its mission is to help people be healthy, secure and comfortable. The company's health plans and government contracts subsidiaries provide health benefits to approximately 6.6 million individuals across the country through group, individual, Medicare, Medicaid and TRICARE and Veterans Affairs programs. Health Net's behavioral health services subsidiary, MHN, provides mental health benefits to approximately 7.1 million individuals in all 50 states. The company's subsidiaries also offer managed health care products related to prescription drugs, and offer managed health care product coordination for multi-region employers and administrative services for medical groups and self-funded benefits programs.

For more information on Health Net, Inc., please visit the company's Web site at www.healthnet.com.


Contact:

Health Net, Inc.
David Olson, 818-676-6978
david.w.olson@healthnet.com
Angie McCabe, 818-676-8692
angeline.mccabe@healthnet.com

Source: Health Net, Inc.

Rani Resorts is to build a new island destination resort and spa on Paradise Island – also known as Ilha Santa Carolina – in the Bazaruto Archipelago in southern Mozambique.

The proposed Paradise Island resort will open to guests in 2009 and is a joint venture with the concession holders of the island, Echo Delta Holdings. It will include a spa, a 50-bedroom boutique hotel, and a dive and fishing centre.

The market research resource group Research and Markets has published a new report examining the growth rates and market opportunities available in the beauty, wellness and health therapy sectors in Europe.

Entitled the European Spa Market 2007, the report is structured around spa facilities defined in sectors including day, hotel, resort, medical and health spas.

Split into nine sections, the report details facilities country by country, summarising spa visitor numbers and annual revenues on available estimates.

As people's living standard improves, people pay much more attention to appearance and figure except for health. After 20 years of development since 1980s until now, China beauty industry's total output value has risen from RMB 2 billion to current RMB 200 billion, increasing by 100 times. During the evolvement, beauty industry experienced two ages: the first was from mid-1980s to later 1990s (the age of industrialized product economy) and the second was from later 1990s to 2004 (the age of sci-tech economy). The third age from 2005 until now (the age of operation-oriented knowledge-capital economy) is under the way.

In recent years, China beauty industry has been keeping a rapid growth at more than 15%. For China beauty industry in 2006, output value reached RMB 240 billion, population joining in this area exceeded 16 million and beauty institution amount approached 1.8 million which rose 20% from 2005 and 93% are private-operated. However, per capita spending on beauty stays at a lower level compared to the developed countries; China beauty industry still sees huge potentials. An estimate shows total output value of China beauty industry will exceed RMB 300 billion by 2010.

Market competition is mainly focused on traditional beauty & hairdressing services such as whitening, macula removing, and breast enlargement, weight loss, hair dyeing, hair dressing and SPA. These services are closely related to people's life, so they are in enormous potentials. Investors can capture market shares as long as they constantly seek innovation based on strength and actuality.

As woman beauty market sees an increasingly fierce competition, man beauty has become one of the popular trends internationally. At present, male cosmetics include perfume, after shave lotion, shaving cream, and hair-care & skincare products, etc. Men's product has a foothold in cosmetic markets in recent 2-3 years but brands are mainly from Europe and U.S. As men get to love beauty, their demands will continuously grow towards beauty, nutrition, physical therapy, multi-purpose services and raw material naturalized instead of single products.

As beauty education gets orderly and developed, the demands for beauty education professionals further grow. Either education on life beauty skills or training on medical beauty talents needs to cultivate professional high-qualification teachers, which is also the only way for beauty education organizations to get upgraded and developed. Beauty professionals are supposed to master modern knowledge & skills on beauty, to understand beauty industry's development orientation and to turn experienced in operation and management.

Similar with catering industry, beauty & hairdressing industry has an extremely high elimination rate. Among some 1.8 million professional beauty institutions, over 1/3 was forced to be closed down each year; but even though, there are still a large number of new ones opened annually.

Beauty salon will carry out "star-level" management in the future, just like what the hotels are doing, and such policy is expected to be implemented from 2007. This system aims to regulate current beauty market by assessing whether or not beauty & hairdressing salon can reach standard or certain star level based on beauty & hairdressing salon's skills, services, health conditions and facilities.

Since 2005, the edge industries of drug & healthcare, fast consumer goods, medical devices and automobile, etc are developing to be scale-oriented, diversified and segmented, which awakes beauty industry. Beauty industry has formed an integrated industrial chain that stays with beauty services as major, production of materials, professional instrument and cosmetics as support; ornament, color service and image design as matched industry; exhibition, beauty newspapers & news communication, information consulting as media; and beauty education as base of talent resources. The training, service, culture and conference industries derived from beauty & hairdressing industry start enjoying a boom and they will witness greater potentials in economic benefits generating in 2007.

Please note this report is currently only available in Chinese. However, if you wish to obtain an English version, a translation service is available which will take 3-5 working days.

Topics Covered:

* Analysis of China beauty industry
* China beauty market
* China cosmetic surgery market
* Men's beauty market analysis
* Weight-loss, hair dressing and nail cosmetology markets
* Operations of China beauty salons
* Marketing of beauty salon
* Chain-store operation and development of beauty industry
* Beauty training market
* Direct marketing and development of beauty industry
* Prospect and trend of beauty industry

For more information, visit http://www.researchandmarkets.com/reports/c59310.


Contact:

Research and Markets
Laura Wood, Senior Manager
Fax: +353 1 4100 980
press@researchandmarkets.com

Source: Research and Markets Ltd.

Researchers in Hong Kong have warned against "natural" or "herbal" slimming products because undeclared and untested variants of banned and controlled drugs have been found in some of them.

At issue are "analogues," or close cousins of banned or controlled slimming drugs, which are slightly modified in their chemical structures in the hope that they might aid in weight loss but escape detection by regulators.

Writing in the latest issue of the Hong Kong Medical Journal, a group of pathologists said 42 patients were taken to hospital between September 2004 and December 2006 after consuming products that were described as containing only natural herbs.

A 53-year-old woman with a history of hyperthyroidism suffered a sudden cardiac arrest and died four days after she was taken to hospital. Another, a 33-year-old woman, suffered liver failure after consuming one of these products for six weeks and had to receive a liver transplant. She recovered.

Laboratory tests of these products found they contained N-nitrosofenfluramine, an analogue of fenfluramine, and N-desmethyl-sibutramine, an analogue of sibutramine.

Both fenfluramine and sibutramine are weight-loss drugs but fenfluramine was banned by the U.S. Food and Drug Administration in 1997 after studies linked it to heart-valve damage. Sibutramine is a prescription drug.

"These (analogues) are like new virus strains, they may be harmless or pathogenic (cause illness)," said Tony Mak, a member of the research team and a pathologist with the government-backed Hospital Authority Toxicology Reference Laboratory.

"People should know they are gambling with their lives if they use drugs they don't know about ... If you buy on the Internet or from overseas (from an unknown source), it will be very dangerous," Mak said in an interview.

Unlike approved drugs, which are put on the market after an average 10 years' research involving hundreds of millions of dollars and tests, many analogues are untested.

In the case of analogues of weight-loss drugs, industry sources say they are produced in underground laboratories and then added furtively into some slimming products that are freely available over the counter or on the Internet.

Asked why the direct copies of these banned or controlled drugs are not used, Mak said: "They won't do that because they can be arrested for it. But they won't just have pure herbal contents because there is no herb that can make anyone lose weight," Mak said.

"So they alter the chemical structure, but they don't find out whether it has any efficacy (or safety)."

Mak called for tighter regulation.

"In Taiwan, Japan and the U.S., they are now regulating not only drugs but drug analogues, but not in Hong Kong ... As a responsible government, you can't allow these products to be used as drugs without proper evidence," he said.

"There are other analogues out there in the market. So long as there is a market and demand out there, there will be such things in the market. They are chemists. They are underground. Whatever the source, they have to be controlled."

For 3-year-old Amira, a law banning female genital mutilation in Eritrea came too late.

Wrapped in an orange traditional dress, Amira's mother, who gives her name only as Gerejet, says she circumcised the child to please her future husband.

"It was the culture that we have taken from our grandmothers, but we also do it for the pleasure of the men," the 30-year-old told Reuters in a small village west of the Eritrean capital.

Like Gerejet and Amira, some 100 million women worldwide have been circumcised, a procedure that at its most extreme involves cutting off the clitoris and external genitalia then stitching the vagina to reduce a woman's sexual desire.

Eritrea banned female genital mutilation (FGM) in April. The government has warned anyone taking part in or promoting the practice faces a fine of several hundred dollars or up to 10 years in jail.

Government officials are optimistic the law will force a change in attitudes but others worry the practice is too ingrained for legal threats to have much impact. About 90 percent of Eritrean woman have undergone the ordeal.

"FGM is a deep-rooted culture and it needs a persistent continuous effort (to halt it)," Luul Ghebreab, president of the National Union of Eritrean Women, told Reuters.

The U.N. Children's Fund, UNICEF, says Eritrea ranks amongst the worst in the world for FGM and a survey by Eritrea's government in 2002 found less than one percent of circumcisions were performed by trained health professionals.

Pirkko Heinonen, the UNICEF representative in Eritrea, says the practice spans Christian and Muslim communities as well as all nine of Eritrea's ethnic groups.

"But we have come to a turning point. It was the exception not to be cut but I think in the younger age group, it is the exception to be cut," she says.

Sitting inside her thatched-roof house, Gerejet believes Eritrean women will welcome the new law. She had circumcised her daughter because no man would marry a girl unless she was cut.

"But nothing will happen to another daughter if she is not cut," Gerejet says in Hagaz, 100 km (62 miles) from Asmara. "We thank God the law was issued. At least the pain will stop."

THE CIRCUMCISER

Government officials say the law banning the practice is only part of a long process of public education dating since Eritrea's 30-year independence struggle from Ethiopia.

"Eritrea is easily manageable, there is a chain system, a village level, the sub-zone, the zonal level. We can control it," said Tesfay Misgna, a health ministry campaigner.

Tesfay said communities have taken a lead in banning the practice: "The legal issues are very vital, because some people need them. But even some villages made their own laws before the government made it."

"By the year 1999, it was 95 percent and then 2003, it was 89 percent. Nowadays we hope it will be less that this."

Meriam Mohamed Omar, a former circumciser, pulls the fabric of her purple dress to mimic external genitalia and sticks a small needle through it.

"I used to use a thin stick from a palm tree. You hold the genitalia in two then cut it," she says.

Meriam says she stopped the practice four years ago after learning of the consequences for a girl. Some 3 million girls are afflicted globally each year, according to the United Nations.

"Most of the time she suffers the pain when she is giving birth, but also during sex," Meriam says.

The United Nations says circumcised women are up to 70 percent more vulnerable to potentially fatal bleeding after delivery. Up to 20 out of every 1,000 babies born in Africa die because their mothers were circumcised.

Aid workers say cultural traditions will be the biggest barrier to eradicating female circumcision. Across the riverbed from Hagaz in the village of Glass, residents say the practice still goes on.

"The people just say they accept (the law), but they really don't," one resident says. Heinonen says the new law is a milestone in the process and agrees there is still much to do.

"It is a very difficult thing to do to your family when you are one of the first ones to stop it," she says.

"It is based on a real fear that if I do not let my daughter to be cut, is she going to be seen as a prostitute?"

New European Union safety rules, designed to safeguard workers, would jeopardize the use of MRI scanners in hospitals, leading scientists said on Monday.

The European Society of Radiology said new scientific evidence showed the limits set in the EU Physical Agents Directive were impractical, since they would be routinely exceeded by workers close to magnetic resonance imaging (MRI) scanners.

The values described in the directive would be exceeded in every use of MRI," Gabriel Krestin, professor and chairman of the Department of Radiology at Erasmus University in the Netherlands, said in a statement.

"We would have to use other forms of scanning, such as X-rays, which are known to be harmful. Research would also be severely curtailed, since it is often conducted with much stronger magnetic fields than those used in clinical practice."

The EU directive, setting limits on exposure to electromagnetic fields, is due to come into effect in April next year. The European Society of Radiology argues an exception should be made for MRI scanners, which are used to provide internal images of the body.

The new EU limits are intended primarily to protect workers in the electricity and mobile-phone industries but MRI has also become ensnared in the regulation.

Studies commissioned by the UK Health and Safety Executive found that anyone standing within about one meter of an MRI scanner while it is acquiring images would exceed the exposure limits set out in the EU directive.

Leading manufacturers of scanners include General Electric Co., Siemens AG and Philips Electronics NV.

Currently, 26.6 million people worldwide have Alzheimer's disease and that number could grow to more than 100 million people by 2050, a new analysis shows.

More than 40 percent of those 100 million Alzheimer's patients will have late-stage disease that requires a high level of care, such as that provided in nursing homes, researchers add.

"The number of people affected by Alzheimer's disease is growing at an alarming rate, and the increasing financial and personal costs will have a devastating effect on the world's economies, health-care systems and families," William Thies, the Alzheimer's Association's vice president of medical and scientific relations, said in a prepared statement.

The findings were to be presented Sunday at the Alzheimer's Association International Conference on Prevention of Dementia, in Washington, D.C.

Using United Nations worldwide population forecasts and data on Alzheimer's prevalence, researchers created a multi-state mathematical computer model. The team was led by Ron Brookmeyer, a professor of biostatistics and chairman of the Master of Public Health Program at The Johns Hopkins Bloomberg School of Public Health in Baltimore.

The computer model also indicated that:

* Delaying Alzheimer's disease onset by one year would reduce the number of Alzheimer's cases in 2050 by 12 million.
* Delaying both Alzheimer's onset and progression by two years would reduce the number of cases by 18 million. Most of that decrease -- 16 million cases -- would involve late-stage cases the require the most intensive care.

"A global epidemic of Alzheimer's disease is coming. However, even modest advances in preventing Alzheimer's or delaying its progression can have a huge global public health impact," Brookmeyer said.

And Thies noted that several new drugs currently in clinical trials show great promise in slowing or halting Alzheimer's progression. Such new treatments, combined with advances in diagnostic methods, could help lessen the global impact of Alzheimer's disease.

More information

The U.S. National Institute on Aging has more about Alzheimer's disease.

Aid workers have discovered the first cases of "extensively drug resistant" TB among migrants from Myanmar, intensifying fears about untreatable infectious diseases propagating in the army-ruled former Burma.

French aid agency Medecins Sans Frontieres (MSF) said it had confirmed two cases of "XDR" tuberculosis in the Thai border town of Mae Sot last week, and had two other suspected cases of the hard-to-treat strain.

One of the infected patients was a refugee, the other a migrant worker, MSF said.

MSF's discovery made no headlines, unlike the furor in the United States over bungled attempts to isolate an XDR-infected 31-year-old lawyer who flew halfway round the world despite requests not to travel.

However, as an indicator of the growth of drug-resistant killer diseases in Myanmar due to a combination of simmering civil war, a non-existent health service and the widespread availability of fake drugs, it is arguably far more serious.

"We cannot treat XDR here. There is no treatment for them," said Janne Krause, one of the MSF doctors responsible for dealing with the growing numbers of TB patients flocking across the border.

MSF, which sees between 50 and 80 new TB patients from Myanmar every month, started treating "multi-drug resistant" patients in 2005.

Throughout an arduous treatment course in a special "TB village" in a refugee camp, patients are under careful monitoring to ensure they do not deviate from prescribed dosages.

Allowing them to miss doses, take half doses or doses with fake pills that contain only a fraction of the correct drugs is a sure way to let the TB bacterium mutate and start to build up immunity, experts say.

Unfortunately, among refugees and the desperately poor migrant workers flooding into Thailand, ad hoc self-treatment is the norm.

"They don't take their drugs regularly. They take them every second day because they want to save drugs. They stop taking them then start again after some weeks. They take all kinds of drugs in different combinations," she said.

Some patients have even managed to get hold of "second-line" drugs used to treat the multi-drug resistant strain.

"This is how they become finally XDR," Krause said.

The World Health Organization has confirmed 269 cases of XDR TB in 35 countries, with 85 percent of patients expected to die. Myanmar has not had any confirmed cases.

Long-term treatment with strong antibiotics can cure patients but in the United States the costs exceed $250,000 per patient.

Driving when sleep-deprived can be extremely dangerous.

To help you stay awake and alert, follow these suggestions from the National Sleep Foundation:

* Get plenty of quality sleep the night before a long drive.
* If there's a time that you typically begin to feel sleepy, avoid driving during that time.
* If you're planning to drive through the night, try to get at least some shuteye between midnight and 6 a.m.
* If driving all day, stop and take a mid-afternoon nap.
* Try to take a break about every 100 miles or so -- stop to get gas, walk around, stretch, nap or get some exercise.
* If traveling with a passenger, it helps if he or she is awake, too. Talk to each other to keep yourselves alert.

Thunderstorms can be dangerous if you're caught outside, but they can pose dangers inside the home, too.

Follow these safety suggestions to prevent injury during a thunderstorm, courtesy of the Association of Volunteer Emergency Response Teams:

* Don't use the telephone.
* Unplug the television. In the event of a power failure, unplug other electrical devices and appliances.
* Don't take a bath or a shower during a storm -- copper pipes conduct electricity.
* Be aware of the dangers of flooding, hail, high winds and tornadoes.
* Keep a battery-powered radio and a flashlight on hand.
* Never go outside during a thunderstorm, and never approach downed power lines during or after a storm.

Home visits by researchers may help increase the number of caregivers who are willing to enroll Alzheimer's disease patients in clinical trials, a new study finds.

It could also boost the number of patients who stay enrolled in trials, the University of Pennsylvania researchers added.

The team interviewed 108 caregivers of Alzheimer's patients who lived in the community. Caregivers were asked about their willingness to enroll their loved ones in hypothetical studies which differed according to four variables: location of study; method of transportation to study visits; chance of receiving a drug or placebo; and level of risk of the study drug.

Of the 108 caregivers, 17 percent were willing to take part in a high-risk clinical trial with no amenities. That increased to 27 percent when home visits were added and to 60 percent when low risk, home visits, and a higher chance of the patient receiving an active treatment were included, the study found.

The option of having home visits (which eliminates the inconvenience of traveling to a clinic) offset the negative study features, such as taking a high-risk drug. It also made caregivers of sicker patients more willing to sign up for studies, the researchers said.

"Altering studies to include home visits could result in shorter recruitment periods and increased patient retention rates," study author Jason Karlawish, associate professor of medicine and associate director of the PENN Memory Center, said in a prepared statement.

"The amount of time we save through these alterations could offset the added costs of the home visits, and, in fact, we may save considerable time and expense if the participants don't have to come in to the clinic so often," he said.

The study was to be presented at the Alzheimer's Association International Conference on Prevention of Dementia, in Washington, D.C.

"Other than lack of sufficient funding, recruiting and retaining clinical volunteers is now the single greatest impediment to developing better treatment and prevention strategies for Alzheimer's," William Thies, vice president for medical and scientific relations at the Alzheimer's Association, noted in a prepared statement.

More information

The Fisher Center for Alzheimer's Research Foundation has more about taking part in a clinical trial.

Sunscreen, swimsuit, bug repellent -- and the meningitis vaccine? Experts say the potentially lifesaving shot is now a "must-have" item for kids headed off to camp this summer.

"Many parents are aware [of the need for vaccination] when kids are leaving for college but don't think of it for early adolescence--they are not aware of the fact that the CDC is recommending vaccination for younger children," said Peg Smith, the CEO of the American Camp Association, a 7,000-member organization that aims to ensure that the nation's camps are safe and healthy.

Since 2005, the Centers for Disease Control and Prevention and the American Academy of Pediatrics have recommended that children aged 11 to 12 undergo routine immunization against meningococcal disease, which includes meningitis.

Nancy Ford Springer, a founding board member of the National Meningitis Association, was one of those who testified before the CDC urging that young people be immunized against meningococcal disease.

Her son, Nick, contracted the illness when he was 14 and away at camp. She speculates that he became sick after sharing water bottles with his fellow campers.

Nick survived, but not until he had both his legs and hands amputated because the infection had gotten into his bloodstream. He is now 22, a college student and a champion athlete -- he won the 2006 gold medal at the World Wheelchair Rugby Championships, Christchurch, New Zealand.

"I'm all for sending kids to camp -- we sent Nick back to camp for three more years --but also for parents speaking to their pediatricians about vaccinating their children before going to camp," said Springer, who is a teacher for the deaf in Westchester County, N.Y.

To that end, the National Meningitis Association is working with the American Camp Association to increase awareness among the parents of campers as well as camp directors and counselors on the importance of vaccinating children before they go away to camp. Making sure that kids don't share water bottles or eating utensils can also cut down the risk.

Meningococcal disease is a result of either viral or bacterial infection. The viral infection is less severe, but the much rarer bacterial form can lead to meningitis, pneumonia and blood stream infections and prove lethal.

"Although there are only 2,000 to 3,000 cases [of meningococcal bacterial illnesses] per year, they tend to be serious. There is a 10 percent mortality rate and 10 to 20 percent of patients have significant and permanent damage, including neurological, hearing and learning problems," said Harry Keyserling, a professor of pediatrics at Emory University School of Medicine in Atlanta.

The bacteria are spread through the exchange of respiratory and throat secretions, such as occurs after coughing, kissing or sharing drinks from the same bottle. Fortunately, none of the bacteria that cause meningitis is as contagious as the common cold or the flu, and they are not spread by casual contact or by simply breathing the air where a person with meningitis has been, according to the CDC.

Those living in a close, barracks-type environments with a lot of other people -- such as college students, campers or those in the military -- are especially vulnerable to contagion, Keyserling said.

Particularly insidious as well is that the disease moves very quickly. Unfortunately, the early symptoms of meningitis mimic the simple flu, so patients and their parents often don't know that they should seek immediate treatment.

"Because meningococcal infection can be so rapid, often by the time the patients seeks treatment it's relatively late in its course. This is a disease you need to prevent rather than treat," Keyserling said.

The recommended vaccine is effective against four of the five causes of meningococcal disease, Keyserling said, including the most common infections, so that the vaccination is 80 percent effective. Only one injection is required to provide immunity.

Keyserling supports the CDC's recommendation for vaccinations for young people.

"It's very exciting that we have a new vaccine that will meet the need to decrease the cases of serious illnesses in the U.S., and we have to encourage parents to have their children vaccinated," he said.

More information

To learn more about meningococcal disease, head to the U.S. Centers for Disease Contol and Prevention.

There's more evidence that cardiovascular problems help drive Alzheimer's disease, scientists say, and that treating the heart might help protect the brain.

The findings "represent hope that interventions with well-known drugs can interfere with the disease's progression," said lead investigator Yan Deschaintre, a neurologist and research fellow at the University Regional Hospital Center in Lille, France.

In fact, cognitive impairment, as measured by a standard test, stayed in the low end of the mild range over 36 months for Alzheimer's patients who got treatments for both the neurological disease and their cardiovascular problems, the researchers reported.

In contrast, Alzheimer's patients with vascular trouble who did not receive these medications experienced declines in cognition that approached the severe level, Deschaintre's team found.

They were slated to present the findings Sunday at the Alzheimer Association's International Conference on Prevention of Dementia, in Washington, D.C.

According to the National Institute on Aging, about 4.5 million Americans have Alzheimer's disease. Rates rise steadily with age, and experts estimate that "nearly half of those 85 and older may have the disease." One recent study from the World Health Organization, released this week, warned that Alzheimer's -- which currently has no cure -- could affect 100 million people worldwide by 2050.

The new study was based on chart reviews of 891 French patients diagnosed with either Alzheimer's disease, cardiovascular disease plus Alzheimer's disease, or vascular dementia. The cognitive risk factors included in the study were high blood pressure, diabetes, high cholesterol, atherosclerotic disease and tobacco smoking.

Treatment was defined as receiving an antihypertensive drug, insulin or drugs to lower blood sugar, a cholesterol-lowering statin, or anti-clotting medications. The patients with Alzheimer's disease typically received medications aimed at temporarily curbing their symptomsthat included Aricept, Exelon or Reminyl.

Deschaintre's findings represent "pretty exciting work," because cardiovascular risk factors are "something we can do something about," said Dr. Sam Gandy, director of Emory University's Center for Neurodegenerative Diseases. Gandy also is chairman of the Alzheimer's Association's National Medical and Scientific Advisory Council.

The work done by Deschaintre's team is consistent "with what we've been hearing over the past three to five years" about vascular risk factors increasing the risk for Alzheimer's, Gandy said. The new study, "really nails that down by looking at the other side of the coin by establishing that treating vascular risk factors slows the progression of cognitive decline," he added.

He suggested that physicians begin to take vascular risk factors seriously as they treat patients with Alzheimer's. The vascular risk factors for early Alzheimer's patients "certainly should be treated" because it "seems to slow progression," Gandy said.

Another expert agreed.

The Lille results "reinforce the treatment guidelines for these vascular conditions, such as hypertension and diabetes, and emphasize that Alzheimer's and demented patients should be treated, too," said Hugh C. Hendrie, a professor of psychiatry at the Indiana University Medical School and a scientist at its Center for Aging Research.

However, Deschaintre and Hendrie both noted that physicians at times may not treat vascular risk factors in Alzheimer's patients, for a variety of reasons. For example, Alzheimer's disease often leaves patients apathetic, so they may neglect to tell their physicians about vascular symptoms, Hendrie said.

And Deschaintre noted that, in the clinic where the research was done, patients with Alzheimer's were less likely than other patients to be treated for vascular risk factors. The reverse was true, as well -- patients with vascular dementia were more likely to be treated for heart risk factors, but not for Alzheimer's.

But, "since the majority of patients have both Alzheimer's disease and cerebrovascular disease, and since patients with pure Alzheimer's do seem to benefit from treatment of vascular risk factors, the message is to treat both conditions rather than to focus only on one," he said.

Hendrie remained cautious about the scientific impact of Deschaintre's study, however. He said results from a clinical epidemiological study, such as the Lille research, aren't as conclusive or compelling as those from randomized, controlled clinical trials.

Two other studies scheduled for release at the Alzheimer's conference on Sunday also emphasized the role of the brain-body connection in cognitive impairment and dementia.

Weight loss may signal the onset of Alzheimer's, and the rate of weight loss could be early warning of dementia severity, according to a new review of data from what's known as the Nun's Study. That effort followed health outcomes for a group of 537 non-demented Catholic sisters, aged 75 to 102, for 10 years.

In the study, a team led by Dr. James Mortimer, a professor of epidemiology and biostatistics at the University of South Florida, Tampa, found that unexplained weight loss late in life was often linked to Alzheimer's neuropathology in the brain and not to any change in eating habits linked to Alzheimer's.

Mortimer explained that, "early weight loss appears to result from the Alzheimer's disease process itself before that process leads to dementia. That's why it is a marker of impending dementia."

In a third study, a team from the Mayo Clinic in Rochester, Minn., found an increased risk of mild cognitive impairment (MCI) or dementia among 70- to 89-year-olds who have had a carotid endarterectomy (surgical clearance of the carotid artery, which brings blood to the brain) or a stroke or "mini-stroke," also known as a transient ischemic attack (TIA).

In the study, the team compared the medical histories of 295 people with MCI and 590 age and sex-matched controls. "Elderly subjects who have had a carotid endarterectomy or stroke or TIA are about two times more likely to have MCI," lead researcher Dr. Rosebud O. Roberts, a Mayo epidemiologist, said in a prepared statement.

More information

For more on Alzheimer's disease, visit the Alzheimer's Association.

Vietnam's first human bird flu case in a year and a half left hospital on Monday, doctors said, as the country tries to control numerous outbreaks of the virus in poultry.

The Animal Health Department said four bird flu cases in poultry were found at the weekend in the northern province of Bac Giang and near Haiphong city. Both have been on the government's bird flu watchlist along with 13 other provinces and a city.

A 30-year-old man was admitted to a Hanoi hospital on May 15 after he helped slaughter chickens at a friend's wedding. Vietnamese doctors confirmed he had the H5N1 bird flu virus, the first human case since November 2005.

Doctors at the Bach Mai hospital who treated the man said they increased the dosage of anti-viral drug Tamiflu to 10 days from seven days. They detected the virus in the man's saliva, in his stomach as well as in his excrement.

The patient eventually recovered and was discharged on Monday morning, state-run VnMedia e-newspaper (www.vnmedia.vn) said.

Doctors were still treating a second patient, a slaughterhouse worker from outside Hanoi who became sick late last month. The patient was recovering well, they said.

Bird flu has killed 42 people out of 95 known infections in Vietnam since late 2003. The World Health Organization (WHO) has not confirmed the two most recent infections in Vietnam.

Globally, the H5N1 virus has killed 189 people out of 310 known cases, according to the WHO. Hundreds of millions of birds have died or been slaughtered, including more than 100,000 in Vietnam's latest outbreaks since early May.

A brutal triple slaying in this remote corner of the vast Navajo reservation brought home what experts have seen coming for years: an explosion in crime on tribal lands linked to the cheap, potent and highly addictive stimulant methamphetamine.

"Meth is the biggest scourge," says Francis Bradley, the chief of police for the Hualapai reservation in northern Arizona, located on the high desert flanking the south rim of the Grand Canyon.

Alcohol is a big issue, too. But when you look at meth, it has a far more devastating effect.

In 2001, the Indian Health Service, the U.S. agency that treats Indians and Alaska natives, recorded 2,980 emergency room visits and paramedic calls on reservations related to the drug, which is also known as speed, crank, ice, crystal and glass.

By 2006, that number had mushroomed to 8,873.

"Alcohol continues to be a bigger destroyer of lives than meth," said James Stone, acting director in IHS's division of behavior. "But meth makes more of an impact because of the, frankly, wild behavior it triggers."

TRIPLE SLAYING

The savageness of the Hogback slayings in November 2005 provided an all-too-vivid illustration of that. The three victims, all tribal members, were each shot multiple times -- one 14 times. The government alleges the four suspects, also tribal members, were meth dealers bent on revenge. All four await trial in Albuquerque on first degree murder charges.

Last year, in the wake of the Hogback killings and other signs of the impact meth was having on reservations, the Bureau of Indian Affairs surveyed tribal law enforcement agencies across the country about drug threats on their lands.

Three quarters identified meth as their No. 1 problem and linked it to a rise in domestic violence, assaults, burglaries and child abuse and child neglect.

"So people are not only destroying their own lives by using this illegal substance, but they're perpetrating new crimes, primarily violent crimes," says Chris Chaney, the deputy director of the office of justice services at the bureau. "That's the even more tragic story. It's drawing in innocent victims."

SPILLOVER FROM OUTSIDE WORLD

The meth problem isn't confined to Indian lands. The drug has been identified by the U.S. Drug Enforcement Agency as the greatest threat to small-town America.

One reason: Unlike heroin and marijuana, meth is easily manufactured using common chemicals found in household products or over-the-counter medicines.

First-time users of the drug, which can be smoked, snorted or injected, experience a long-lasting high and feeling of euphoria and excitement. But long-term use often leads to a dramatic and devastating deterioration in the user's physical and mental health, characterized by anxiety, psychotic behavior, risky sexual behaviors and violence.

TRIBES VULNERABLE

But while its use in the general population is falling, it appears to be rising in the 500 Native American tribes from Alaska to New England.

Experts say a number of factors -- including the long use of hallucinogens like peyote for rituals and herbs for medicines by the tribes as well as a more recent problem of alcohol abuse -- help account for the rise in meth use.

In addition, many reservations are located in remote, rural areas. As a result, they are places of underemployment, grinding poverty and reliance on government assistance, where residents live in aged mobile homes or poorly constructed conventional houses.

The bureau's Chaney said there was also evidence that meth dealers are now specifically targeting Indian communities.

"They know that on many reservations there are high levels of substance abuse already," he says. "So some drug cartels figure they can move in and take advantage of that addictive behavior and replace whatever the substance being abused -- alcohol, marijuana or something else -- with meth addiction."

To combat the problem, the bureau has asked for an additional $16 million in its 2008 budget to battle the rise of methamphetamine on reservations. But Dirk Kempthorne, the U.S. Secretary of the Interior, which oversees bureau, earlier this year warned that the problem was approaching crisis.

"It has the potential of wiping out an entire generation of Native American youth," he said.

(additional reporting by Nick Carey and Tim Gaynor)

India's injecting drug problem may be worse than thought, a new survey of the country's breadbasket region shows, worrying health experts and activists who say it could fuel the spread of HIV and AIDS.

The UNAIDS-backed survey by the Society for Promotion of Youth and Masses (SPYM) -- a group fighting drug abuse -- showed that nearly 60 percent of 3,300 drug users in 10 cities and towns in the northern states of Punjab and Haryana shared needles and syringes.

The prosperous region -- home to around 50 million people -- was not known for injecting drug users (IDUs), and the survey is the first large-scale mapping in the area.

"This shows the problem of IDUs has been underestimated in mainland India, as most of the problem was thought to be in the northeast," Denis Broun, the India head of UNAIDS, the United Nations AIDS agency, told Reuters.

Official estimates say there are about 200,000 IDUs in India, a figure activists say is a huge underestimate. The problem is seen as most acute in the remote northeast, which borders Myanmar and the opium-producing Golden Triangle.

India has the world's largest number of people living with HIV with 5.7 million people thought to be infected, although findings of a new population-based national survey have indicated that the actual figure could be lower.

In other parts of Asia, injecting drug use has fuelled the HIV epidemic. But India's state-run National AIDS Control Organization (NACO) says drug users are responsible for just 2.2 percent of HIV transmissions.

UNAIDS says this number may now need to be looked at again.

"This survey points out that the IDU transmission figure is likely to be higher than 2.2 percent," Broun said. "The percentage for IDU transmissions may be relatively small but if there are more IDUs than thought, it could be a major transmission route in the future."

Many drug users in India are married or visit sex workers, presenting an HIV risk to their partners, Broun added.

"WAKE UP CALL"

In Jind, a small town of 135,000 people in Haryana, nestled amid wheat and rice fields, ignorance about HIV seems common among drug users.

"HIV? AIDS? What's that?" asked 23-year-old Jasvinder, who can barely move his right arm because of his injecting habit, at the sole drug rehabilitation centre in the town, 130 km (80 miles) northwest of New Delhi.

"This is a wake up call for the country which, till now, has focused on the northeast and big cities," said Atul Ambekar, a drug rehabilitation expert who is analyzing the survey data.

Official data shows that more than 10 percent of intravenous drug users have HIV, a higher prevalence than among prostitutes, while the overall national average is about 0.9 percent for those aged between 15 and 49.

While efforts to combat the spread of HIV among drug addicts have concentrated on the northeast and in big cities, the SPYM survey reveals India's rural heartland is no longer immune from the threat.

In Ludhiana, an industrial city in Punjab, official data shows 21 percent of injecting drug users are HIV-positive. Yet many are unaware of the risks of injecting.

"I know AIDS is a disease that can cause death but I never dreamed it can come through a needle," said 23-year-old Jagdev Singh, a farmer who regularly shoots morphine into his veins with the same needle his friends use.

In Jind, the rehab centre's director, Dilbag Duhan, said he was struggling to deal with the number of addicts coming for help. "This is becoming a huge headache," he said.

On the other hand, a crackdown on narcotics has pushed people to inject legal painkillers like morphine and sedatives, which are available without a prescription, further fuelling injecting drug use, said Rajesh Kumar, the head of SPYM.

NACO chief Sujatha Rao said the government planned to step up efforts to stop HIV transmission through drug use in Haryana and Punjab by promoting oral drug substitutes and by setting up more testing, drug counseling and rehab centers.

"We have to watch this trend very carefully ... as cheap pharmaceuticals are available over the counter, people have money and little to do, and there is peer pressure," she said.