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A higher risk of death is associated with long-term use of popular stomach acid reducers known as proton pump inhibitors, according to a new study.

These drugs are sold under brand names such as Prilosec, Nexium, Protonix, Zegerid, Aciphex and Dexilant, along with generic versions such as omeprazole, lansoprazole and pantoprazole. Originally available only by prescription, they are increasingly offered over the counter. The study looked at prescription use only.

Each year, an estimated 15 million Americans are prescribed proton pump inhibitors, commonly called PPIs. That figure doesn’t include over-the-counter sales.

Previous studies have indicated that long-term use of PPIs is associated with elevated risks for heart disease, fractures of various bones and other medical problems. The new analysis goes further by linking these medications to higher death rates.

Prolonged use of PPIs was associated with a 25 per cent greater risk of death, compared with people taking H2 blockers, another class of acid reducers. H2 blockers are sold under brand names including Pepcid, Tagamet and Zantac, as well as generic names such as famotidine, cimetidine and ranitidine.

For the new report, researchers examined millions of military veterans’ prescription records that spanned an average of nearly six years. Their findings were published Monday in the journal BMJ Open; the study can be found at j.mp/acidppi. The senior author was Dr Ziyad Al Aly of the US Department of Veterans Affairs’ health system in St Louis.

Acid reducers treat painful ailments including GERD (gastroesophogeal reflux disease), heartburn and peptic ulcers.

Physicians should prescribe PPIs when there’s a legitimate reason — but only long enough to provide benefits that outweigh the risks, the study’s authors said. The increased mortality associated with PPIs was proportionately connected to their duration of use.

Some makers of proton pump inhibitors said this week that their products are effective and safe when used for the recommended period, which is typically about two weeks per full course of the over-the-counter versions. They did not specifically address the issue of patients often taking prescription-level PPIs for much longer periods and at higher doses.

For the new study’s main analysis, VA records of 349,312 patients were analysed. Of those people, 275,977 were prescribed PPIs and 73,335 were prescribed H2 blockers. Between these two groups, the patients who took PPIs showed the 25 per cent higher death rate.

Two secondary comparisons were also made.

One found a 15 per cent increased death rate for PPI users compared to patients who did not use PPIs but may have taken another kind of acid suppressor (other than H2 blockers). Records from 3,288,092 patients were examined for that comparison.

In the other secondary comparison, the death rate was 23 per cent higher among PPI users compared to people who did not use any acid suppressor. A total of 2,887,070 patient records were examined for that analysis.

The study’s comparisons were observational, so the conclusions are not as definitive as a randomised, placebo-controlled clinical trial.

Another limitation is that the VA patients were “mostly older, white male US veterans”, the report’s authors said, so the results may not apply directly to a larger population. Also, the study did not get information on the causes of death for the targeted patient population.

However, the newly published findings are consistent with previous studies that showed long-term use of PPIs, but not H2 blockers, is associated with higher rates of disease. These include kidney disease, dementia and infection by the antibiotic-resistant superbug C. difficile.

Proton pump inhibitors work by a different mechanism than H2 blockers, explaining the differing responses. PPIs block stomach cells called parietal cells from releasing positively charged hydrogen atoms, or protons, into the stomach. This inhibits production of stomach acid, chemically known as hydrochloric acid.

H2 blockers stop the action of histamine, which stimulates parietal cells to produce hydrochloric acid. This indirect method is less efficient than that of PPIs, but is sufficient for many patients.

A study published in the journal JAMA Neurology last year found a 44 per cent increased risk of dementia among people using PPIs.

Proton pump inhibitors can cause nutritional deficiencies, because acid is needed to release essential nutrients such as vitamin B12. Since stomach acid kills pathogenic bacteria, use of acid reducers also has been linked to increased rates of food poisoning.

A 2015 study led by Stanford University researchers found that use of PPIs, but not H2 blockers, is associated with higher risk of heart attacks.

And in one of the most unusual side effects, PPIs have been found to cause visual hallucinations in some patients with wet macular degeneration.

After receiving wonderful farewell parties from my dear friends in Amman because of my impending relocation, I am back to writing my column and it is business as usual. I am behaving as normally as possible but it is difficult to, manoeuvre around the huge cardboard boxes that are currently blocking large parts of my home. The professional packers arrive tomorrow, but I have done more than half their job by now.

To distract myself, since morning I have been trying to ‘‘straighten my hair in a few minutes’’. I know I have fairly straight hair already and I do not really need to make it more so, but this advertisement of a magical hairbrush popped up in my spam mail, and instead of deleting it like I should have, I decided to read it till the very end.

It was one clipping of a happy woman who runs a hairbrush through her huge mass of unruly wavy curls, which within seconds turn smooth as silk. “Straighten your hair in a few minutes,” said the tagline even though the model achieved the results in the blink of an eye. I was fascinated and decided to buy the product immediately.

You must have realised by now that I am one of those gullible people who watches every YouTube video that teaches face contouring or cellulite controlling. Following one demonstration made the sides of my face and nose look patchier than the rest of it and the other gave me bluish bruises from the suction cup, but that is not the point. The idea is to enthusiastically follow what our nuns taught us in school, which was, ‘‘nothing ventured, nothing gained’’.

Incidentally, I always wonder at the personal lives of these mannequins who are portrayed as looking overjoyed even when they are doing dull household chores like vacuum cleaning or clothes washing. Are they really as cheerful as they are made out to be? Don’t they have any grievances? How do they manage to hide their sorrow? The last time I had a quarrel with my husband I sat through an entire event wearing big sunglasses and snivelling into my handkerchief like a tormented housewife, but here I digress. 

Soon, the particular hairbrush is procured and I run it over my head in the exact manner that is depicted in the recording. It comes with many features such as a two in one handle and straightener that leaves the hair smooth while also doing the work of a dryer, a three-year warranty, is tangle-free, provides 1000 watts of power, and has a slimmer design to make it compact enough to fit anywhere. 

Right! It claims to be perfect and is designed by busy women for busy women, the pamphlet explains. “The copywriter sounds like a copycat of Abraham Lincoln’s definition of democracy but no one can be busier than I am at this precise moment”, says the voice in my head. 

To use it one has to simply switch it on and start brushing. I do precisely that and a strong whiff of something burning assails my senses immediately. I am horrified to see the ends of my hair singe before my astonished eyes. 

“Strange smell!” my spouse announces as he walks into the room. 

“What?” I exclaim. 

“Short circuit somewhere?” he queries. 

“Like an electrical fuse?” I swing my singed strands away. 

“You burnt your hair!” he notices finally.

“Well, it is the latest style you know,” I explain.

LOS ANGELES — Spider-Man is officially a box office overachiever.

The latest cinematic depiction of the webbed-hero, “Spider-Man: Homecoming”, is looking at a $117 million opening from 4,348 locations. That’s a huge win for Sony, Columbia Pictures, and Marvel Studios for the film, which cost roughly $175 million to produce. The anticipated opening weekend is higher than industry estimates, which were in the $90 million to $110 million range, while the studio cautiously pegged it at $80 million.

“Everyone at Sony and Marvel are thrilled,” said Josh Greenstein, Sony’s marketing chief. “It’s safe to say it’s a triumphant return for Spider-Man.”

“Homecoming” banked on the idea that the summer box office was craving a family-friendly superhero movie — Tom Holland plays a high school version of Peter Parker who, at 15 years old, has to prove that he is worthy of being called an Avenger. And it seems that bet is paying off. The $117 million figure is the second largest in Sony Pictures history, behind “Spider-Man 3”.

Much attention has been paid to the flick’s successful marketing campaign, which heavily featured Iron Man (Robert Downy Jr.), who serves as Spider-Man’s mentor in the film. Michael Keaton plays the big bad, Vulture, Jon Favreau plays Spidey’s guardian, Happy Hogan, and Zendaya stars as Michelle Jones (“MJ”), Parker’s brainy classmate. The movie consistently dominated social media in the weeks leading up to its release.

Before “Homecoming”, Jon Watts directed two much lower-budget feature films — the 2014 horror movie “Clown” and 2015’s “Cop Car” starring Kevin Bacon. He also has a handful of writing and producing credits, and is one of six writers credited on the “Homecoming” script. Kevin Feige and Amy Pascal share production credit. While the former has proven essentially infallible in the biz, “Homecoming” serves as a redemption narrative for the latter. After the infamous 2014 Sony hack, Pascal was ousted from her post at the top of the studio, and began to focus on producing. This is her second major release following last summer’s “Ghostbusters” reboot, but she also has a hand in a long list of upcoming projects including Sony’s “Barbie” movie, Steven Spielberg’s A-list-studded “The Papers”, and future “Spider-Man” movies.

“We have incredible partners,” said Greenstein, who said that those relationships helped the film to be “embraced in a big way. It really shows the strength for this beloved character”.

Despite the reliability of superhero movies at the box office, “Homecoming” could have been seen as a big bet for all parties involved. For one, it’s the third iteration of the character in the past 15 years — before Holland, Andrew Garfield and Tobey Maguire donned the Spidey suit. The makers had to trust that audiences would be ready to see the character yet again. On top of that, the summer box office has not been particularly kind to the sequels and reboots that have become the industry’s summer signature. As audience fatigue has impacted previously reliable franchises like “Transformers” and even “Despicable Me”, the one thing that this summer has proved is that the domestic audience is not yet burnt out on superheroes.

This is, yet, another Marvel movie release that has managed to capture the approval of critics and audience members — something the the DC Extended Universe could not claim until this summer with “Wonder Woman”. But Marvel’s been there since the beginning. “Homecoming” currently has a 93 per cent on Rotten Tomatoes and an A CinemaScore.

“Homecoming” is the only major release this weekend, so the rest of the top five are made up to familiar faces. Starting with “Despicable Me 3”, which is headed for a $34 million second frame, or a 53 per cent drop from last weekend. “Baby Driver” should sit comfortable in third, as positive word of a mouth is steering to a $12.8 million second weekend, or a 38 per cent drop. “Wonder Woman” continues to hold on with $10.1 million in its sixth weekend, and “Transformers: The Last Knight” should round out the top five with $6.3 million.

Kumail Nanjiani’s “The Big Sick” is entering the top ten as it expands towards wide release, starting next Friday. From 326 North American theaters this weekend the movie should make $3.7 million. Sofia Coppola’s “The Beguiled” should stay in the top ten as it, too, expands. This weekend it’s expected to make $2.1 million from 941 locations. Meanwhile, A24’s “A Ghost Story” starring Rooney Mara and Casey Affleck should spook $105,000 from four locations during its opening frame.

Overall, the summer box office stands at about $2.3 billion, or 8 per cent lower than last year. That leaves the year overall about dead even with 2016 after movies like “Beauty and the Beast”, “Logan”, “Get Out” and “The Fate of the Furious” laid a strong foundation for the summer during the early part of the calendar year.

“Despite the strength of ‘Spider-Man: Homecoming’, yet another ‘down’ weekend puts us dead even with last year’s box office pace as we remain down 8 per cent for the summer,” said Paul Dergarabedian, senior media analyst at ComScore. “The silver lining is the expected continued strength of Spidey, plus ‘War For The Planet of The Apes,’ ‘Dunkirk,’ and ‘Atomic Blonde’ all in rapid succession that could fuel a much-needed late summer renaissance at the multiplex.”

Young women who suffer a concussion may be at increased risk of menstrual irregularities, at least for a few months, suggests a new US study.

Researchers found that young women were nearly six times more likely to have irregular menstrual cycles after a concussion, compared to young women who were treated for non-head-related injuries.

After a concussion, women should talk to their healthcare providers about the increased risk, said senior author Anthony Kontos, of the University of Pittsburgh Medical Centre Sports Medicine Concussion Programme. It’s important, he added, “for care providers to be concerned about menstrual patterns and encouraging women to track that after their injury”.

Irregular menstrual cycles may disrupt the body’s hormones and lead to delayed body development in young women, Kontos told Reuters Health. Hormone disruption can also lead to poor bone health.

Concussions result from a hit or blow to the head that causes the brain to move back and forth or twist inside a person’s skull, according to the Centres for Disease Control and Prevention. 

A study last year by the Seattle Sports Concussion Research Collaborative estimated that up to 1.9 million children in the US experience a sports-related concussion each year. Girls are also known to have a more difficult concussion recovery than buys, Kontos and his colleagues write in JAMA Paediatrics.

Hormone disorders are known to occur after traumatic brain injuries, they add. Some research has suggested menstrual disorders are more common after those types of injuries, too.

For the new study, the researchers recruited 68 girls and women, ages 12 to 21, who were recovering from concussions. The participants received a text message every Sunday night for about four months linking to a survey that asked about their menstrual cycle. They were asked about bleeding, new injuries, possibly pregnancies and birth control.

Sixty-one young women with non-head-related injuries were also surveyed every week.

About 24 per cent of concussion patients had at least two abnormal menstrual cycles during follow-up, compared to 5 per cent of patients with other types of injuries.

Kontos said concussions might increase the risk of irregular menstrual cycles by disrupting the hypothalamic-pituitary-ovarian axis, a group of hormone-emitting glands that often act in concert.

Dr Jeffrey Bazarian, an emergency physician and brain injury expert at the University of Rochester Medical Centre in New York, told Reuters Health a concussion could interfere with the pituitary gland in the centre of the brain.

“It’s possible that this also happens to males and the question is how does it effect them,” said Bazarian, who was not involved in the new study.

The researchers can’t yet explain their findings, however. Nor can the study prove concussions actually cause abnormal menstruation.

Kontos also said it’s unclear whether the increased risk of abnormal menstrual patterns lasts beyond four months.

“We don’t know beyond that,” he said. “It’s one of the studies we’d like to do.”

Middle-aged adults who do even a small amount of regular strength training exercise may be lowering their risk of so-called metabolic syndrome — itself a risk factor for both heart disease and diabetes, a recent study suggests.

People with at least three unfavourable health stats from a list that includes large waist size, high blood pressure or triglycerides, high blood sugar or low “good” cholesterol are said to have metabolic syndrome, and are at increased risk of going on to develop diabetes, heart disease or both.

But researchers found that when generally healthy people did strength-building exercise for less than an hour a week they had 29 per cent lower odds of developing metabolic syndrome than their peers who did no resistance exercise.

“You already get health benefits with even a low amount of resistance exercise per week, which is good news for people with a very busy lifestyle,” said lead author Esmee Bakker of Radboud University Medical Centre in Nijmegen, The Netherlands. 

An estimated one-third of US adults have metabolic syndrome, the authors write in Mayo Clinic Proceedings. Although previous studies have reported how aerobic exercise, such as running, walking and swimming, reduce metabolic syndrome, few studies have looked at resistance exercise alone.

The US government’s Physical Activity Guidelines for Americans suggest that adults should do “muscle-strengthening activities that are moderate or high intensity and involve all major muscle groups on 2 or more days a week” and aerobic exercise 150 or more minutes each week.

“A modest amount of resistance exercise, such as two 30-minute sessions per week, has beneficial effects,” Bakker told Reuters Health by e-mail. “We think that resistance exercise, in addition to aerobic exercise, should be included in standard medical recommendations to prevent metabolic syndrome.”

Bakker and colleagues analysed data on more than 7,400 people who participated in medical examinations at the Cooper Clinic in Dallas, Texas, between 1987 and 2006. They ranged in age from mid-30s to mid-50s at the time of their examinations.

The research team found that 1,147 participants, or 15 per cent, had developed metabolic syndrome during the follow-up period. Meeting the resistance exercise guideline of two or more days per week reduced risk of metabolic syndrome by 17 per cent overall, compared to doing no resistance exercise. Those who met both aerobic and resistance training guidelines had a 25 per cent lower risk of developing metabolic syndrome.

“This result was independent of other healthy behaviours, such as not smoking,” Bakker said. “It also made little difference if people did resistance exercise only on weekends or spread throughout the week.”

Bakker and colleagues plan to study the effect of resistance training on other health outcomes, such as the heart health benefits of a one-year resistance exercise training programme. They also want to examine the long-term effects of different types and intensities of strength training on metabolic syndrome.

“The real next step is to see how we can get people to exercise,” said Paul Thompson of the University of Connecticut in Hartford, who was not involved with the study.

 “We can talk about the right dose and intensity, but it’s clear that in most studies, doing something is better than nothing,” he told Reuters Health by phone. “Most people do nothing, and the key is to get them to do anything.”

One limitation of the study is that it relies on self-reported survey data, which could bias the results. Thompson also cautions that some patients of the Dallas clinic are relatively more affluent than the rest of the country, so the results might not apply more generally.

“The increasing American girth has increased metabolic syndrome, which leads to insulin resistance and makes it harder for insulin to work,” he noted. 

Thompson is studying how exercise affects people who have a tendency towards metabolic syndrome and ways they can work against a genetic disposition towards diabetes and hypertension, for example.

“Everybody should have some exercise,” he said. “Play with the dog or grandkids, do yard work or go for a walk. Just do something for 30 minutes every day.”

A distinctly more upmarket offering in the lucrative and ever popular compact crossover SUV — or CUV — segment, the new Peugeot 3008 boasts a fetchingly futuristic design, useful application of technology, smart packaging and fun driving characteristics.

Also distinct from predecessor in that it sheds previous MPV influences in design and packaging, the second generation 3008 has its feet more firmly in the CUV segment but owes much to its smaller 308 hatchback stable-mate in terms of driving agility and manoeuvrability. Launched globally late last year as a 2017 model and expected soon in Amman, the impressively well-rounded 3008 has already clinched several global awards.

Striking design

Named European Car of the Year 2017 at the Geneva motor show back in March this year, the 3008 is expected to prove to be a popular and accessible model with up-market appeal, value and practicality, including high ground clearance, efficient engines and a spacious, versatile and elegantly contemporary cabin.

Offered with two turbocharged petrol engines at launch, including an entry-level 1.2-litre 3-cylinder THP130 version, it is however the larger THP165 1.6-litre four-cylinder model that is expected in the Middle East and Jordan. A thoroughly thought out product from Peugeot, the 3008’s concept car-like design is strikingly charismatic, complex yet fluent, and stands out in its segment and next to its predecessor.

A chunky design with sharp jutting lines, defined surfacing and ridges, the 3008’s demeanour is urgent and assertive, and features high lower side cladding to imply a rugged SUV-like aesthetic. With an assertive weaving chequered grille taking centre stage of its fascia, the 3008 features a dramatic and aggressive ridged clamshell bonnet and moody LED-browed headlights partially split by jutting claw-like elements.

Reflecting Peugeot’s lion emblem, the high-set rear lights also feature claw motifs. The 3008’s visceral aesthetic also includes a broad lower air intake and deep ridged side character lines. The 3008 flowingly rakish silhouette also features blacked out pillars for a floating roofline effect similar to the Range Rover Evoque.

Fluent and flexible

The most powerful petrol variant at launch, the 3008 THP165 is powered by Peugeot’s efficient, effective familiar 1.6-litre turbocharged four-cylinder engine. Developing 163BHP at 6000rpm and 177lb by just 1400rpm, the 3008 THP165’s engine is responsive from idling, with quick-spooling turbo and generously rich and broad mid-range peak torque sweet spot for confident overtaking and performance on inclines.

Subtly muscular and eager to rev to peak power and top-end with progressive pace, the 3008 THP165 is however operates perhaps best riding its ample mid-range torque band where it is refined, flexible and efficient, whether on motorway duty or through winding country lanes and hill climbs.

Driving the front wheels through a slick six-speed automatic gearbox with manual “tiptronic” shifts, the 3008 THP165 accelerates through the 0-100km/h benchmark in 8.9-seconds and is capable of 206km/h, while combined cycle fuel efficiency is frugal at 5.7l/100km. Offered exclusively with front-wheel-drive, the 3008, like most vehicles in its road-biased compact CUV segment, simply doesn’t need it, and especially at this particular power point.

Without the pretences or added weight, cost and complexity of four-wheel-drive the 3008 THP165 weight just 1300kg, yielding both efficiency and performance benefits. The absence of a front-biased four-wheel-drive system occasionally shifting some power rearwards also lends the 3008 better driving fluency, not unlike a well-sorted family hatchback

Eager and effective

A compact family CUV with user-friendly and engaging driving characteristics the 3008 is clearly not pitched as a hardcore off-roader. That being said, it does however very competently compensate the absence of four-wheel-drive with its innovative and nuanced Advanced Grip Control system, which utilises finesses electronic traction control to maintain limited wheelspin to find traction and maintain momentum on low traction surfaces, including inclines. 

Proving to be very effective on a short off road drive on wet grass, the 3008 also features hill descent control, which works as a low speed cruise control, and with gearbox in neutral, one can still use the throttle for electronic inputs to increase speed speed.

Lighter up front than the range-topping diesel 3008 GT in not quite as light at the 3-cylinder THP130 version, the THP165 is the best compromise in the 3008 range for eager performance and handling.

With chassis and electronic assistance systems set-up for a more visceral and engaging experience, the THP165 nimble and agile through winding roads. Tidy and crisp turning in, the THP165’s front tyres grip well into a corner, and remains committed and reassuring at the rear, yet engaging and manoeuvrable. A pleasure through Italian country lanes where driven, the THP165’s steering is light yet direct and positive, while body roll is well-controlled through corners, but without sacrificing ride comfort.

Smooth and stylish

Alert and eager change direction, the 3008 THP165 nevertheless rides with a reassuring stability and smooth suppleness on motorways. Forgiving, refined and settled over imperfections, the 3008 pitches slightly in a vertical direction over sudden crests but feels buttoned down on dips and rebound. 

Featuring the best application so far of Peugeot’s cockpit design with the instrument panel above the steering wheel, the 3008 provides unimpeded views of both the instrument panel and road for greater driving confidence. The reason such a layout works so well in the 3008 is a combination of a high, supportive and well adjustable driving position and a small well-positioned flat top and bottom steering wheel.

Noticeably more premium than its predecessor, the 3008 is stylishly designed inside, ergonomic, refined, well finished and features numerous advanced convenience, infotainment and driver-assistance features. With a minimalist sense of style inside, the 3008 features a reduced button fount, with many functions now accessed through its user-friendly tablet-style infotainment screen, which a configurable digital i-Cockpit instrument panel, similar to Audi’s Virtual Cockpit system, is a particular point of interest. 

Offered in different specification levels, the 3008 uses quality materials, and even includes optional real oak trim, massaging leather seats, scented air circulation and high quality sound systems. Meanwhile, the 3008’s spacious and versatile cabin notably includes generously proportioned rear passenger room.

TECHNICAL SPECIFICATIONS

Engine: 1.6-litre, turbocharged, transverse 4-cylinders

Bore x stroke: 77 x 85.8mm

Valve-train: 16-valve, DOHC, direct injection

Gearbox: 6-speed auto, front-wheel-drive

0-100km/h: 8.9-seconds

80-120km/h: 6.1-seconds

0-1000-metres: 29.9-seconds

Maximum speed: 206km/h

Power, BHP (PS) [kW]: 163 (165) [121] @6000rpm

Specific power: 102BHP/litre

Power-to-weight: 125.4BHP/tonne

Torque, lb/ft (Nm): 177 (240) @1400rpm

Specific torque: 150.2Nm/litre

Torque-to-weight: 184.6Nm/tonne

Fuel consumption, urban/extra-urban/combined: 7.3-/4.8-/5.7-litres/100km

CO2 emissions, combined: 129g/km

Fuel tank: 53-litres

Length: 4447mm

Width: 1841mm

Height: 1615mm

Wheelbase: 2675mm

Track, F/R: 1579/1587mm

Overhang, F/R: 923/849mm

Boot capacity, min/max: 591-/1580-litres

Headroom, F/R: 915/912mm

Shoulder room, F/R: 1493/1484mm

Kerb weight: 1300kg

Tyres: 225/55R18

After weight-loss surgery, people who get cosmetic procedures to remove excess tissue may have a better quality of life than those who do not get this additional work done, a recent study suggests. 

Researchers focused on what is known as body contouring surgery, which can range from a little bit of liposuction to a complete upper or lower body lift that removes substantial amounts of tissue. Body contouring is becoming more common, particularly for patients who lose around half of their weight after bariatric surgery and have substantial amounts of tissue hanging from their arms, legs and bellies that prevent them from looking and feeling like they want after shedding all those excess pounds.

“The obvious direct reason for a patient to seek body contouring surgery is to get rid of a tummy apron and some fat rolls, but when we look a little deeper into why patients are willing to undertake expensive and sometimes risky procedures, some other reasons emerge,” said senior study author Dr Stefan Danilla, a plastic surgeon at Hospital Clinico Universidad de Chile in Santiago. 

“Our research shows that the right procedure can improve self-esteem, self-image, sex life, social performance and physical symptoms,” Danilla said by e-mail. “That improvement is shown as soon as three months after surgery and can last for years after.”

For the study, researchers asked 112 women patients who had already undergone weight-loss surgery how they felt about their body and quality of life before they got body contouring procedures. Then, researchers followed up with 57 of these patients about four months afterwards and checked in with 84 of the women again more than two years after they got body contouring done.

The patients averaged about 40 years old at the start of the study and most of them were at a healthy weight or slightly overweight. 

To assess participants’ quality of life, researchers asked them about body satisfaction, sex life, self-esteem, social performance and physical symptoms. Scores could range from 0 to 100, with higher marks indicating greater quality of life. 

Women’s average quality of life scores rose from 44 before body contouring to 86 in short-term assessments done from one to nine months after these procedures. They had a similar improvement in quality of life score of 84 in assessments done from one year to 2.7 years postoperatively, researchers report in the Aesthetic Surgery Journal.

The primary shortcoming of the study is the lack of male participants, the authors note. Only two men at the hospital where the study was done had body contouring procedures during the period when researchers were asking patients to join the study, and both men declined to participate. 

Another limitation is that the results are limited to one hospital in Chile, and the impact of body contouring on quality of life might be different elsewhere, especially because many of women’s perceptions about their appearance are shaped by what is culturally acceptable or desirable where they live. 

Researchers also lacked data on how any surgical complications might impact the extent to which women perceived body contouring as beneficial for their quality of life.

Even so, body contouring may appeal to many patients who are surprised or disappointed to discover they do not necessarily look thin or conform with an ideal body type after weight loss surgery helps them shed most of their excess pounds, said Dr Daniel Kalbermatten, a plastic surgeon at University Hospital Basel in Switzerland who wasn’t involved in the study. 

Between the World and Me

Ta-Nehisi Coates

New York: Spiegel & Grau, 2016

Pp. 152

“Between the World and Me” is a long letter from a father to his fifteen-year-old son, written with deep feelings, analysis, hopes and fears for the latter’s future. Ta-Nehisi Coates’s prose is beautiful even as it is shocking, for it is a hard reality he addresses. 

Though he has been able to shield his son from some of the perils of his own upbringing in Baltimore in the 80s, racism is still very much alive in today’s America, punctuated by the all-too-frequent police shootings of young black men in particular. He writes to warn his son of the dangers and to convey to him an analysis of society that will arm him to survive and not let racism overwhelm his self-perception and dreams. In the process, he upends many preconceived notions about race and racism.

Coates traces today’s ongoing murders back to the pillage and violence of slavery “and various other acts meant, first and foremost, to deny you and me the right to secure and govern our own bodies”. (p. 8)

One of his main points is how visceral racism is: “it dislodges brains, blocks airways, rips muscles, extracts organs, cracks bones, breaks teeth... the larger culture’s erasure of black beauty was intimately connected to the destruction of black bodies”. (pp. 10, 44)

Most incisively, Coates asserts that racism begets race, not the other way around. In all different times and places, human beings have had different shades of skin colour, different features and hair textures. Yet, it is only when society is organised in a hierarchy according to these qualities that racism emerges and creates race, whereby physical features are believed to signify permanent traits. To set the record straight, he speaks of “Americans who believe they are white” and the enormous diversity among people who are considered black. (p. 6)

Coates wants his son to join his own life-long quest: “How do I live free in this black body?” (p. 12)

His ambitions go way beyond the legal rights achieved, however imperfectly, in the civil rights movement. His concern is that his son and future generations of black Americans can live dignified lives, free of fear for their bodies, and fulfill their potentials. “I would have you become a conscious citizen of this terrible and beautiful world,” he writes to his son. (p. 108)

“Between the World and Me” is a fascinating glimpse into African-American culture and heritage. One learns anew about what has made black Americans live in poverty and fear but also what has made them proud, creative and resilient. Especially interesting is Coates’s telling of how he gained an understanding of America’s real history from experience and study. His letter to his son is an updating and further development of the pathway blazed by his father, Paul Coates, who spent his life unearthing and reprinting books about ancient African civilisations so African Americans could educate themselves about their historical past. 

Coates also shares the awakening he experienced on attending Howard, the most advanced of the US’s historically black universities, which he calls The Mecca. He describes the impact music had on him, from rap to hip-hop to African rhythms, and how he was influenced by a whole range of Black intellectuals, leaders and performers, from Malcolm X to Bob Marley.

This is a chronicle of an ever-growing consciousness that Coates wants to pass on to his son. Still, he anticipates that his son will not follow exactly in his path, but make his own way. After much floundering in his youth, Coates came into his own as a writer at about the time he married, moved to New York and eventually became a father.

Despite repeatedly showing how “those who think they are white” have built their prosperity on the ruin of black bodies, Coates does not preach hate to his son, but expresses sadness at such ignorance; his blame falls on the system not

individuals. The young black man whose murder affected him most deeply was killed by a black policeman: “Being Black did not immunise us from history’s logic.” (p. 53) 

For the sheer poetry of his writing, his acute sense of injustice, yet refusal to be unilaterally cast as a victim, Coates can be seen as the James Baldwin of our times.

If fascinated by this book, one can read further about the experiences that formed his thinking by reading his memoir, “The Beautiful Struggle”.

SHANGHAI — Basketballs, electric scooters and rainbow-coloured umbrellas — nothing seems out of bounds in China’s booming “sharing economy”.

Where once Chinese consumers would look to shell out on items such as luxury handbags or cars, now they can rent them for short periods taking advantage of the explosion of mobile payment technology. 

As ever with China, the numbers are mind-boggling: the shared economy more than doubled to 3.45 trillion yuan ($505 billion) last year from a year earlier, according to official figures which projected average annual growth of 40 per cent in the years ahead.

But experts warn that China, which has rapidly become a world leader in the concept, is oversharing, and some start-ups are going bust.

The fiercely competitive bike-sharing craze in China’s major cities claimed what was widely reported as its first victim in June when Wukong Bike reached the end of the road with 90 per cent of its bikes missing and presumed stolen.

The government has supported the sharing industry as a new growth driver as the overall economy slows, but there are signs Beijing is becoming wary and on Monday it asked local governments to come up with new industry regulations.

In Shanghai, where bicycles of all colours threaten to take over the streets, Claire Victoria Pan said she uses a gamut of sharing services for bikes, cars, Airbnb and co-working spaces.

“These sharing tools make life very convenient,” said Pan, from Hong Kong but living in Shanghai, where she founded a wine-trading company.

“There is over-sharing, but it is just temporary. When a new thing appears it will expand quickly so that there is excess supply.

“But after a period of time people find that demand is limited, then the supply will naturally reduce.”

Disappearing bikes

Backed by a torrent of venture capital, the boom has spawned some novel ideas, including from an entrepreneur in eastern China’s Zhejiang province offering basketballs for hire to save people having to carry them to games.

Users can unlock a court-side locker by scanning a code with their smartphone and take the balls for 1.5 yuan (20 US cents) for 30 minutes. 

A camera films the transaction to discourage them running off with the balls.

Spare rooms, washing machines, umbrellas and mobile phone charging are all up for rent as China becomes the home of the sharing economy.

Smartphone apps such as Alipay and WeChat have enabled the boom by allowing customers to buy products or transfer money by scanning QR codes.

Bike-sharing, in which users can pick up bicycles on the street and leave them anywhere when finished, has been a standout success since being introduced in the last two years and latest official figures say there are now 10 million such bikes ploughing the streets of China.

But with complaints soaring about bikes parked haphazardly and clogging up pavements, a backlash has begun.

In an attempt to get a grip on the runaway industry, authorities in Shanghai and Tianjin will impose regulations from October 1 mandating a bicycle service life of three years and requiring companies to hire at least one maintenance employee for every 200 bicycles, state news agency Xinhua said.

Wukong Bike, in the southwestern megalopolis of Chongqing, folded within just a few months and this week Beijing-based 3Vbike packed it in after most of its bikes also went AWOL. 

‘Sharing bubble’

These won’t be the last casualties, said Christopher Balding, associate professor at Peking University HSBC Business School in the southern city of Shenzhen.

“These sharing companies do provide very real benefits and in Shenzhen people are using these bikes all the time,” he said. 

Balding added Chinese were attracted to such services because they tend to be very “price-sensitive”, and cited a bike-sharing firm that allows users to recharge their phones while cycling.

But he warned: “Investors are pouring enormous sums into this, there are too many companies and there does need to be industry consolidation.

“I’ve joked with different people about the next crazy new sharing start-up app that we’re going to generate.

There is a fad and everyone’s trying to think of what’s the next sharing app so absolutely there’s a bubble in sharing companies.”

William Chou at Deloitte China said it had less to do with sharing and more about rental.

“For example, all of the bike sharing in China uses newly manufactured bikes, not bikes from people who already own it,” said Chou, leader of Technology, Media & Telecommunications.

“Ordinary people cannot profit from owning a bike, only the company that offers it makes money.”

Chou said that phone-battery chargers in shopping malls, restaurants and convenience stores were the next “big thing”, but also cited a shared electric scooter in Hangzhou, a city near Shanghai.

“Chinese consumers are getting used to the concept of sharing, in previous years they would rather own their stuff,” Chou said.

“But as more people embrace the concept of sharing the market will continue to expand.”