The Tribune, Chandigarh, India

Unravelling the secrets of ageing
By Derrick French

as the general health of the world's population has improved, the average life span has risen by 20 years in the last half-century, and it will continue to grow.

The Sheffield Institute for Studies on Ageing has been formed at the University of Sheffield in northern England to undertake wide-ranging multidisciplinary research to find cost-effective ways of improving quality of life in old age, with or without extension of life expectancy. Rising numbers of older people, the increasing expectations of a better old age, reduced capacity of families to provide care and pressure on public finances have led governments around the world to give high priority to such work. Trends in ageing are also changing family structures in both developed and developing countries.

"In short, we are in the midst of a silent revolution," said the Secretary-General of the United Nations, Kofi Annan, when launching the International Year of Older Persons. "It is a revolution that extends well beyond demographics, with major economic, social, cultural, psychological and spiritual implications. And it is a evolution that hits developing nations harder than others, and not just because the majority of older persons live in developing countries, but because the tempo of ageing there is already — and will continue to be — far more rapid," he said.

The Sheffield Institute for Studies on Ageing (SISA) has a core team of eight of the United Kingdom's leading researchers into ageing from the fields of biomedical and health service research, sociology, nursing and palliative care. Some are world leaders in their work.

The results of their studies will be available to other researchers worldwide. As well as the five university departments represented by the core team, a further 21 groups throughout the University of Sheffield are undertaking research into ageing in areas as diverse as geography, health economics, architectural studies, engineering and genetic medicine.

SISA Director Professor Ian Philp has extensive links with colleagues in North America, Australia, Singapore and in Europe. He is an adviser to the World Health Organisation and to the European Commission's research and development programme on ageing. He is also in charge of several programmes on research and education in the care of older people funded by the European Commission.

Other SISA executives have strong collaborative connections with international researchers and policy makers. SISA's policy-related work deals with the use of scientific research in policies and practices at international, national and local levels. It covers highly topical national and worldwide questions concerning financial provision in old age and social and family care, inter-generational relations and social exclusions.

(For more information, please contact the Press and Public Affairs Department, British High Commission, Chanakyapuri, New Delhi - 110 021)

Good health in the 21st century

Health Tribune, with this concluding presentation of the twentieth century, thanks its learned and indulgent contributors for the abundant light they have shed on the prospects of total health — of the individual as well as the diverse community. They have walked the straight and narrow path of evidence-based medicine and discouraged quackery with determination.

The available space has been devoted not to the negative absence of disease but to the positive achievement of health. Lakhs of readers have sought and got expert advice through various media of communication. Health Tribune wishes them good health in the twenty-first century.

Eggs
The nutrient goldmine
By Dr K.C. Kanwar

egg is primarily designed by nature to provide the developing embryo food complete in all respects. Perhaps no single food item is more versatile than eggs for providing nourishing meals at a reasonably low cost. These, whether boiled, poached, fried, scrambled or omeletted, are liked by all non-vegetarians.

Despite repeated links, researchers have tried to establish between eggs and heart diseases, these remain a popular, relatively inexpensive and affordable source of good nourishment.

Further, eggs are cooking-friendly. Cooking improves their palatability without affecting their nutrients. Because of the bad attributes of the eggs highlighted — in fact, exaggerated — by many, the sale of eggs, which dipped significantly in the late eighties and early nineties, has bounced back globally. It is estimated, that each American "will eat more than 255 eggs this year, the most since 1985, and up from 245 two years ago". This resurgence of public interest is mainly related to three factors:

(i) Scientists have lately discovered that cholesterol in food is not really and certainly not the only artery-clogger in the diet. Saturated fats, which we all consume in varying degrees, are even more hazardous in this respect.

(ii) Further, nutritionists are convinced that when eggs are added to the menu in moderation, the cholesterol profile of the users does rise "but only a bit, but so does good cholesterol (HDL) which is compensatory".

(iii) Whenever a diet rich in cholesterol is consumed or cholesterol is supplemented, blood cholesterol does not ordinarily rise matchingly.

As a rule, if the cholesterol intake is high, the body of the user compensates it by absorbing correspondingly less cholesterol from the available food and also by reducing its own cholesterol production. In some people, however, this regulatory mechanism is seemingly disturbed inasmuch as a high intake of dietary cholesterol in such individuals raises blood cholesterol levels. Which category one belongs to is not difficult to ascertain. "If your blood cholesterol levels are not a problem your body is probably managing your cholesterol well and eggs, when taken in moderation, would not or should not upset the balance." (cf. Health and Nutrition — November 1999). Further, the blood cholesterol profile is raised much more markedly when saturated fats are consumed rather than pre-formed cholesterol. "Then why blame eggs alone?", nutritionists argue.

Eggs undoubtedly are higher in cholesterol than in saturated fats and should be all right for most of us if we do not use a lot of extra fat while cooking them. Avoiding saturated fats is a better strategy than shunning eggs if either of the two is to be selected. Only "people at risk" need to be careful about using eggs. According to Dr Robert H. Knoppa of University of Washington, people with elevated cholesterol (constantly high cholesterol at a young age) and those already suffering from or having a family history of heart diseases, should desist from taking liberties with eggs and limit their consumption to two per week.

Many a time this question is asked: how many eggs per week are health-friendly? The British Heart Foundation recommends eating not more than 4 eggs every week. If your blood cholesterol levels are not a problem, eggs in moderation should not upset this balance and pose any problem. However, if one finds eggs irresistible even when contraindicated, there is a way out. Throw away the yellow yolky portion; the remaining transparent jelly is nothing but albumin — the high-quality egg protein.

On an average, a hen egg contains 6-8 gm of excellent protein, 5-7 gm of fat of which about 2 gm is the hazardous saturated thing. Cholesterol in a hen egg approximates 450 mg — somewhat higher than the recommended (safe) average daily cholesterol intake allowed which in Britain averages 390 mg for men and 290 mg for women. ("Foods that Harm & Foods that Heal" — a Reader's Digest publication). Egg cholesterol should bother those who already have elevated blood cholesterol levels. Many dietitians feel that it is not cholesterol per se of the egg which should cause concern but excessive blood cholesterol manufactured by the liver from saturated fats.

Eggs are a good source of certain vitamins and minerals. These, in particularly, are an excellent source of B-complex, especially B-12, — a tonic for frayed nerves. Lecitin in the egg yolk is rich in choline — an essential component of cell membranes and of the developing (child) brain. Poultry eggs are useful sources of assimiable iron, zinc and even chromium.

One should be careful while buying eggs. Select the bigger ones. They obviously have more nutrition stored within. Reject cracked or blemished eggs; these could be contaminated. A fresh egg sinks when placed in cold water and has a dull or a shiny shell. That brown eggs or those with more intense yellow yolk are more nutritious is nothing but a myth. Store eggs in lower shelves of your refrigerator. Refrigerated eggs can be used for two to three weeks.

Caution: Salmonella, a highly dangerous pathogenic bacterium, infects eggs though rarely (1 in 7000 eggs) but when it does, it is a serious matter. Salmonella infection is passed on by the hen to its eggs during their passage. Eggs must be cooked properly to destroy salmonella. Avoid eating raw or semi-cooked eggs.

And now the designer eggs. Prof Sim Jeong, who works at the university of Alberta (Canada), has designed eggs biotechnologically which are several times richer in much sought after Omega - 3 fats than ordinary poultry eggs. Each designer egg contains 600 mg of these fats which otherwise could come from 100 gm of fish. Omega-3 fats are protective in nature. These help reduce cholesterol and triglycerides, the coronary villains. These also improve immunity. Our food is generally deficient in Omega - 3 fats of which the fatty fish is the best source. The time is not far off when scientists would be able to design cholesterol-free eggs for human consumption.

Professor Kanwar is a noted biophysicist based in Chandigarh.

Choose between kitty and kitchen
A psychiatrist’s advice to workless ladies
By Dr Rajeev Gupta

sunita, a 28-year-old housewife, is a victim of the kitty bug and a workless syndrome. She has lost count of the number of kitties she has joined. Most of these start around 11 am and continue till 2 pm. She joins kitties with the precondition that the hosts will organise the parties in prominent restaurants. No member is allowed to host a kitty at her residence.

Who looks after Sunita's household work, particularly kitchen duties, after she has left for kitties? The "noble duty" is done by Bahadur, a Nepali servant. He looks after the kitchen and takes care of the kids and Sunita's old parents-in-law. She has become so much dependent on Bahadur that she can never imagine life without him. At home, she can easily annoy anyone except VIP Bahadur. No wonder that facilities like a well-furnished and spacious room with an attached toilet, a colour TV and an air-cooler have been provided to him.

Another woman from a businessmen's family says: "I have spoiled my servant so much that no one can afford to keep him. He is fit only for our home."

The same story is repeated daily in hundreds of homes in Ludhiana, Jalandhar and Chandigarh. One understands the need of a full-time domestic servant in the case of working couples. But today, if you do not have a full-time domestic servant, you are bound to be labelled as a "poor man" or a "kanjoos" person. Barring a few exceptions, no housewife is willing to work in the kitchen. When any visitor comes home, the favourite call to Bahadur or Ramu is: "Do glass pani lana. Phir garma garam chai banana aur namkeen bhi sath lana."

Then the lady of the house is engaged in social gossip for an hour.

Many mothers hardly know what is packed in the school tiffin boxes of their children and whether they have eaten their lunch or not. It is the duty of Ramus and Bahadurs to look after all these responsibilities.

When is the new gas cylinder to be brought in? How much money is the milk-vendor to be given? When and at what rate is the "crap" to be sold? Many Bahadurs and Ramus become experts in electric work and some even drive scooters and cars.

In the case of old servants, the ladies become gradually dependent on them for most of the domestic chores.

When Veena (26) was brought to my clinic as a "patient with mental problems", she was quite nervous and depressed. She gave a history of restless nights and was quite apprehensive and fearful. When I enquired about the cause of her problem she told me that her servant was going on one-month leave to his village. She said that she had visited many temples in the city and done many "upayas" just to ensure that the servant cancelled his long holiday. If he could not cancel his programme, he should at least come back soon. She commented: "Doctor, you do not know how difficult it is when Ramu is not here. I have never entered the kitchen for the past three years. I just hate the sight of my kitchen. All my kitties and outings will be stopped.” What to talk of rich working women, even housewives cannot imagine a life without a full-time servant. Comments Dr Rashmi Maini, a dental surgeon, in Ghumar Mandi of Ludhiana: “Until a few years back, girls preferred nuclear families, but now again there is a preference for joint families. In such families many responsibilities get shared and you feel less burdened."

Let me make a frank professional confession: I have a considerable number of "kitty ladies" on my observation, appointment and home-call lists. But there is no Bahadur or Ramu on any of them. My acquaintances in the police or in vigilance agencies' service do have some such names on their files though! My New Year's prescription for the compulsive home-shunning women will include this piece of advice: Please choose wisely and well between kitty and kitchen. You do not need anti-depressant pills. You need love for home and pleasure in shouldering your domestic responsibilities.

Dr Gupta is a Ludhiana-based psychiatrist.

AIDS: the elusive vaccine
By Doug Alexander in London

scientists have been working on an AIDS vaccine for 15 years, yet an effective drug to combat the world's worst epidemic is still years away.

In the best-case scenario, a vaccine could be ready in three years — if tests in Thailand and the USA show promising results.

If not, it could be another decade, or even two, before an anti-AIDS vaccine hits pharmacy shelves.

Even then such "first-generation" drugs may only have a limited effect in fighting HIV, the virus that causes AIDS.

"The first-generation vaccines will probably not be highly effective — perhaps 40 to 50 per cent," says Saladin Osmanov, a medical officer of the World Health Organisation/UNAIDS HIV Vaccine Initiative. "It's a long, long way away before we have a very effective vaccine... perhaps a couple of decades."

In a world where AIDS infects 15,000 people a day, a decade could translate into 55 million new HIV infections and 30 million AIDS deaths.

More than 36 million people now live with HIV or AIDS, according to UNAIDS. AIDS has killed an estimated 21.8 million people since the epidemic began in the 1980s. Despite recent advances, AIDS vaccine research is still in its infancy.

"The fact is there are quite a few candidate vaccines that are being developed and tested in trials today," Osmanov says. "But these trials don't tell us about the capacity of a vaccine to protect against infection... to do that we need to do large studies."

Over 25 different types have been tested in more than 50 clinical trials in about 5,000 HIV-uninfected volunteers.

Vaccines go through three stages of clinical trials after lab research, including animal testing. Phase I trials take 12 to 18 months and are carried out on 10 to 30 healthy volunteers to study side-effects and ensure safety. Phase II, a two-year stage, examines the side-effects on the immune system of 100 to 300 volunteers. Phase III takes three to five years and assesses whether a large number of people at risk are protected against natural infection.

Only one type of vaccine has reached this final state: US biotechnology firm VaxGen is carrying out Phase III testing in the Thailand and the USA and expects to have initial results late next year.

Others are at earlier testing stages.

Aventis Pasteur of France is finishing Phase II testing of two vaccines in the USA, Uganda, Thailand, Haiti, Trinidad and Brazil, while several other researchers and drug companies are just starting Phase I tests.

The International AIDS Vaccine Initiative (IAVI), a scientific non-government organisation calls it a "tragedy" that only one vaccine concept has reached a stage where it is undergoing large-scale testing.

Nonetheless, Wayne Koff, IAVI's Vice-President for research and development, is confident that an AIDS vaccine will be found — sooner or later.

"Obviously, if the first vaccine works in Phase III, we're a lot closer than we think, but if you're looking at vaccines in Phase I, we're still six to eight years off," he says.

Koff says 2000 has "been a year of significant advances."

"A number of new vaccines have gone into clinical trials and there are other vaccines that have shown promising results in animal models," he said.

In October, pharmaceutical giant Merck found that eight vaccinated monkeys remained healthy after being infected with the virus.

Yet even if today's vaccines show signs of success, there is no guarantee that they will work on the many different strains of the AIDS virus.

There are two varieties of HIV and several different strains, which occur in different parts of the world. The main AIDS virus, HIV-I, has 10 strains.

Scientists do not know whether one vaccine can treat all strains, or whether each strain will require a different drug.

Most vaccines coming down the pipeline are designed to fight HIV strains prevalent in North and South America, the Caribbean and Western Europe, even though 95 per cent of new infections occur in the developing world where a different strain dominates.

UNAIDS is concerned that such work is ignoring the developing nations, where infrastructure, political will and resources already make AIDS research a challenge.

"We are trying to promote companies to work on strains which are prevalent in Africa," Osmanov says. "We can't say it is being completely neglected but it is being done with delays."

IAVI is working to ensure that developing countries are not sidelined.

"In all of our partnerships we have assured that there will be access to vaccines in the developing world at a price that is affordable," Koff said.

One such partnership involves a joint team of researchers from the UK's Medical Research Council in Oxford and the University of Nairobi in Kenya.

The team is testing two vaccines made from genetic material for HIV and a virus derived from the smallpox vaccine. They are designed to fight an HIV strain common in Kenya and other countries in east and central Africa.

The work began after researchers discovered that Nairobi prostitutes had built up resistance to HIV despite constant exposure to the virus.

The author is a Canadian journalist.