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GlaxoSmithKline: back to good health

Dividend Policy: Committed to return at least 80p per share annually until free-cash-flow cover reaches 1.25 to 1.5 times. Then, dividends will be increased in line with cash flows.

Yield: 5.14 per cent.

Payment: Quarterly, declared in sterling.

Last cut: From its formation in 2000 until 2014, GSK paid a gradually increasing dividend. Since then the payout has remained flat at 80p.

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Your Good Health: Diabetes proves hard to control

Dear Dr. Roach: I hope you can shed some light on an issue that I have not seen you address: the dawn phenomenon. I am having trouble controlling my diabetes. I am 67 years old, and my mother was a “brittle” Type 2 diabetic who ultimately needed insulin twice a day. I have been on glipizide (10 mg) for three months now; before that, I was on 5 mg for about nine months. I tried metformin for a short time, but it did not agree with me (cramps and diarrhea). I am overweight but working on it. I will admit that I love carbs, eat out often and I am known as a good Italian cook, hence, pasta and more carbs.

My morning readings usually are 170 to 200. My bedtime readings are 130 to 150. I take my glipizide with my evening meal. Two hours after breakfast, my readings are in the normal range. My A1c is 6.9.

My husband is critically ill. He is significantly older than me, with COPD, congestive heart failure and lung cancer. Can the added stress of caretaking affect blood sugars?


I am sorry to hear about your husband. Indeed, stress of any kind (and being a caregiver to a very ill loved one usually is extremely stressful) can make diabetes-control worse.

The stress itself can increase hormones (including cortisol and epinephrine), which act against insulin. Caregivers also routinely get poor sleep, which compounds the problem.

As far as the high sugars in the morning go, it could be due to the dawn phenomenon. This is a response to the surge in hormones that work against insulin (in this case, especially glucagon) that happens in the morning.

Insulin resistance is higher at this time, so blood sugars tend to be high as well.

However, there are other causes. One is the Somogyi effect, which is what happens after the blood sugar gets too low at night. The body responds by increasing those same anti-insulin hormones — cortisol, glucagon, epinephrine and growth hormone — to counteract the low blood sugar, resulting in a high blood sugar in the morning.

The way to tell whether high blood sugars in the morning are due to dawn phenomenon or Somogyi effect is to check the blood sugar early in the morning (around 3 a.m.), or to use a continuous glucose monitor.

Fortunately, your A1c level of 6.9 per cent is in the range of acceptable for a 67-year-old. Even so, too many processed carbohydrates, like most pasta and white bread, is not the healthiest choice.

I recommend making some small changes by eating fewer starches and more vegetables and legumes.

Glipizide works by stimulating the pancreas to make more insulin. Most people on that drug alone eventually will need additional or different therapies.

Dear Dr. Roach: I recently saw my primary doctor for a physical, and after I mentioned that I eat a fibre bar every day (that also contains peanuts and peanut butter), he informed me of a new study that says peanuts can cause colon cancer. Any truth to that?


The literature is remarkably consistent that peanuts and tree nuts reduce risk of colon cancer and improve survival in people who have colon cancer. Unless your doctor knows of data I couldn’t find, I have to wonder if he was mistaken or didn’t communicate well.

Do beware of fibre bars that contain too much sugar.

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to

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Energizing Rural North Carolina: The importance of good health, leadership

The conference “Energizing Rural North Carolina: The Building Blocks of Successful Economic Development,” will explore how infrastructure, workforce, education, health, and leadership—the five building blocks—shape economic outcomes in rural communities, according to the event organizers from the Economic Development Partnership of North Carolina (EDPNC). The conference takes place Thursday and Friday in Pinehurst.

This is the fourth  of a multi-part story previewing the conference and key issues.

Health and leadership

“These building blocks relate to economic development,” said Mike Hawkins, Transylvania County Commissioner and EDPNC board member. “They will alter the current paradigms.”

Consider public health, which is rarely thought of as an economic development issue, said Hawkins. When a county, especially a rural county, can improve public health measures, that translates into more of the workforce participating more actively in the region’s economic growth, said Hawkins.

As public health efforts result in increased health and wellness for individuals, said Hawkins, those individuals will take less sick time, be more productive, be happier and more connected to local businesses and local communities, be more engaged, and be more likely to volunteer for an organization of citizen group. They also may be more likely or encouraged to take a leadership position in the community.

“And leadership in rural North Carolina is a huge issue,” said Hawkins. “Not just elected leaders, but civic leaders, business leaders, faith leaders, nonprofit leaders, all across the board.” In rural counties, communities are experiencing a number of challenges, almost all of the things that urban counties encounter, and many that urban counties do not encounter, and those counties are often asked to solve these challenges with less human resources, with less talent, said Hawkins.

That’s why leadership is a key component to building prosperous rural communities, said Hawkins, and it’s why they elected to focus on leadership as one of the five building blocks.

Rural counties need to be systematic in developing leadership pathways, said Hawkins, where new leaders can be identified, informed, educated, and trained to become leaders in their region—and involved and invested enough in the community so they choose to stay rather than to leave.

“We must continually have a pipeline of engaged, enthusiastic citizens who have the ability, energy, and time to take a leadership role in the community,” said Hawkins, because that leadership will drive all of the other building blocks. “If you don’t have leaders, you’re not going to get much done.”

That’s why EDPNC plans to gather rural economic developers and community leaders at the “Energizing Rural North Carolina: The Building Blocks of Successful Economic Development” convening on July 12–13 in Pinehurst, said  Frank Emory, Jr., chairman of the EDPNC board of directors.

“I am encouraged now that the act of getting stakeholders and thought-leaders in the same room at the same time,” he added. “We will generate new ideas, confirm best practices, and analyze what might work in each rural county to boost economic development.”

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All 13 footballers in good health, but more test reports awaited

None of the youths or their coach, who were evacuated over three days from the Tham Luang cave in Mae Sai district, had a fever and yesterday morning the last of them were taken off saline drips.

The team will be quarantined and required to undergo seven days of antibiotic treatment at Chiangrai Prachanukroh Hospital, he said, quoting a report from hospital director Dr Chaiwet Thanapaisan. 

Three of the last five members to come out of the cave had initially been diagnosed with an inflammation of the middle ear and showed signs of fever, but had responded well to treatment, Jessada said. 

Lab tests of the youths had so far found no signs of dangerous infectious diseases, while the medical team awaits results of other tests for viral diseases, he said.

Jessada confirmed that the hospital’s team of psychologists had taken care of the boys’ relatives who had gathered in the tent in front of the cave from the time the search and rescue mission began. Another team is now providing mental healthcare to the 13 since their admission to hospital. Relatives of all the 13 footballers have been allowed to visit them but have had to wear a protective medical gown, face mask, hat and boots and maintain a two-metre distance, he added.

The hospital doctors also conducted medical check-ups on the four Thai SEAL divers who were kept under 24-hour medical surveillance. Results show they were normal, Jessada said

He also urged officials and volunteers involved in the rescue mission at the cave to follow advice in the “health beware cards” during the coming two-week period, rest at home, and immediately seek medical attention if they developed fever, headache, nausea, muscle pain or had respiratory difficulty.

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Your Good Health: Probiotics have wide range of benefits

Dear Dr. Roach: With the current focus on gut health, I have been hearing a lot about probiotic supplements. Who should take them? Does the number of bacteria matter more than the types listed on the container? Does one take them daily, for a brief time period, or for extended time periods?


Probiotics are healthy bacteria in the large intestines that aid in digestion and possibly other functions in the body. Scientists are just beginning to understand how the intestinal bacteria (called the microbiome) affect many areas of health.

There are a few indications for probiotics that are well-accepted. The most important are in people with gastrointestinal conditions, especially in people with inflammation from inflammatory bowel disease. Some infections, including Clostridium difficile, may be prevented and treated with probiotics. This is not the primary treatment (which usually is antibiotics against C-diff), but it might be a useful adjunctive treatment or in recurrent cases. Gastroenterologists prescribe several different types of probiotics for these conditions. The particular type of probiotic might depend on the underlying condition and symptoms.

There is very preliminary data that suggest probiotics might be helpful in young children to prevent allergies, but it’s not solid enough to recommend yet.

Probiotics are generally safe, but there have been a few cases of the probiotics entering the bloodstream in people with diseased immune systems.

Having healthy gut bacteria might be of benefit in people with no specific problems. However, it is not necessary to take in bacteria to have a shift to healthier gut flora. A diet more based in plants, whole grains and nuts, with less dairy, meat and sweets (such as the Mediterranean diet) showed clear changes in the microbiome in a few days, compared with a typical Western diet. There are so many benefits to this type of diet, including reduction in heart disease risk, diabetes risk and obesity, that I recommend this diet or a similar one rather than taking probiotics for people who are interested in improving gut health.

Dear Dr. Roach: Please explain tethered spinal cord syndrome. I’m 68 and presenting with urine and fecal incontinence and a heavy feeling in my legs after having spine surgery last year. What are my options?


A tethered cord usually is a problem that’s found in children, where the spinal cord gets attached to a structure in the spine. It happens often in spina bifida or similar conditions. However, it occasionally happens after spinal surgery in adults. Symptoms include sensory problems, such as pain or numbness; weakness (a feeling of heaviness often is muscle weakness); and loss of control of bladder and bowel.

In a case series of adults with tethered cord, surgical release improved sensory symptoms in 80 per cent of people, motor symptoms in 70 per cent and urinary symptoms in 50 per cent. I don’t know of any effective nonsurgical therapy. The published literature followed people for two years after surgery, but noted that the spine can re-tether itself even after successful surgical repair.

This is a rare condition and one where finding a neurosurgeon with experience in tethered cord syndrome would be of immense value.

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to


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Your Good Health: Cut leads to swelling, multiple surgeries

Dear Dr. Roach: I read your recent column about “flesh-eating bacteria.” Is it in any way related to Mycobacterium marinum?

My son is having multiple surgeries due to this, which was finally and correctly diagnosed after many weeks. It came on slowly over months, and has caused his hand to swell up greatly. He remembered that he did get a cut on his hand while fixing a home water line that was in soil. He was told that it is rare, but it occurs all over this country. There is a creek near us, and recently a local newspaper announced that there was a “life-threatening” bacteria discovered in that creek, which empties into a local waterway. His treatment was intravenous continuously for over a week, and now three strong antibiotics to be taken for at least a year. Meanwhile, he continues with some surgery.


Mycobacterium marinum is a bacteria species closely related to tuberculosis. It is not related to the type of “flesh-eating” bacteria you read about periodically in the newspaper; those are group A streptococcus, which grows very rapidly (people can go from appearing well to being dead in hours) and needs immediate identification and surgery to treat; M. marinum grows slowly. It is uniquely related to water exposure, especially from fish tanks (both fresh and saltwater). However, it has been reported after exposure to oysters and fish spines, and occasionally in swimming pools.

Treatment for M. marinum usually includes two or more antibiotics taken for months. Your son’s infection is worse than I have heard of, requiring surgery and antibiotics lasting over a year.

I looked up your local creek: It is contaminated by fecal bacteria (presumably from untreated sewage), not by M. marinum. I hope your son does well.

Dear Dr. Roach: I had prostate cancer, treated with freezing. I have not had an erection since, despite trying Viagra and injections. Nothing has worked in two years. My doctor said it might last six months to a year. Could there be something wrong with me medically, and what can be done to fix my problem?


Even when performed by the best doctors, there is a risk of permanent erectile dysfunction with any kind of prostate cancer treatment. This is true even with cryotherapy (freezing treatment) for prostate cancer; the risk of losing sexual function still is significant.

Given a lack of effect with injections and oral medications, you should talk to your urologist about a vacuum device or a penile prosthesis.

Dear Dr. Roach: I am a 93-year-old retired nurse. I have a problem with “second time around menopause.” Some nights I wake up warm and need to cool the room with a fan. I had a total hysterectomy many years ago. The nurse in my health office said it is hormonal, but said I am too old to take hormones. Do you have any remedies?


I hate to disagree with your nurse, but I am not as sure about what is causing your new set of hot flashes. It would be unusual for menopausal symptoms to recur after such a long time, so you should consider other potential causes for feeling hot. Thyroid disease, being in a room that’s too warm, weight gain and anxiety are common causes. Food sensitivities are an unusual cause, but given how intermittent your symptoms are, it might be worth keeping track of your diet to see if that correlates with the hot flashes at night. Low blood sugar at night can cause similar symptoms, as can rare tumours that secrete substances that make you flush. You need an evaluation before you decide on a remedy.

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to

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Update: Rescued boys lost weight but in "good health" after two weeks in flooded cave – WSAZ

MAE SAI, Thailand (AP) – The Latest on the rescue of a youth soccer team from a flooded cave in Thailand (all times local):

A Thai health official says the soccer teammates rescued from a flooded cave lost weight during their two-week ordeal but had water while they were trapped and are in good health.

Thongchai Lertwilairatanapong, a public health inspector, said Wednesday the 12 boys and coach rescued over the three previous days “took care of themselves well in the cave.”

Thongchai said one member of the final group of four boys and the coach who arrived at a hospital Tuesday evening had a slight lung infection.

Two of the first group had a lung infection as well, and Thongchai said they would need medicine for seven days.

Divers extracted the team in a high-risk mission inside the flooded passageways. The group entered the cave June 23 but flooding cut off the exit.

6:55 p.m.

Thailand’s navy SEALs say all 12 boys and their soccer coach have been rescued from a flooded cave in far northern Thailand, ending an ordeal that lasted more than two weeks.

They say the four boys and coach rescued Tuesday, after other rescues in the previous two days, are all safe.

The SEALs say they’re still waiting for a medic and three Navy SEALs who stayed with the boys to emerge from the cave.

6:30 p.m.

Three ambulances, their lights flashing, have been seen leaving the site of the flooded Thai cave where rescuers are involved in an all-out effort to rescue members of a youth soccer team and their coach trapped deep within.

Earlier Tuesday, Thai navy SEALS said a ninth boy had been brought out of the cave on the third day of the rescue effort. The departure of the three ambulances suggests others also have been rescued, but there was no immediate official confirmation.

Rescuers hope to complete their mission Tuesday after rescuing four boys on each of the previous two days. That left four boys and their 25-year-old coach still in the cave.

The 12 boys and their coach were trapped by flooding in the cave more than two weeks ago.

Tuesday, 11:50 a.m.

The Thai official overseeing the effort to rescue members of a teen soccer team trapped in a flooded cave says a third rescue operation has begun Tuesday and aims to bring out the remaining four boys and their coach.

Chiang Rai Gov. Narongsak Osatanakorn says the rescue mission began at 10.08 a.m. and involves 19 divers. He said a medic and three SEALS in the cave, who’ve been looking after those trapped, will also come out.

Narongsak said, “We expect that if there is no unusual condition … the 4 boys, 1 coach, the doctor, and 3 SEALs who have been with the boys since first day will come out today.”

The eight boys rescued after being trapped for more than two weeks were described as generally healthy.


10:30 a.m.

A Thai public health official says the eight boys rescued from a flooded cave in northern Thailand are in “high spirits” and have strong immune systems because they are soccer players.

Jesada Chokdumrongsuk, deputy director-general of the Public Health Ministry, said Tuesday that the first four boys rescued, aged 12 to 16, are now able to eat normal food.

He said two of them possibly have a lung infection but all eight are generally “healthy and smiling.”

He said, “the kids are footballers so they have high immune systems.”

The second group of four rescued on Monday are aged 12 to 14.

Family members have seen at least some of the boys from behind a glass barrier.

Four boys and their soccer coach remain in the cave.

5:15 p.m.

An ambulance with flashing lights has left a cave complex in northern Thailand hours after the start of the second phase of an operation to rescue a youth soccer team trapped inside the flooded cave for more than two weeks.

After the ambulance was seen leaving the complex at around 5 p.m. Monday, a helicopter took off. Authorities have said helicopters were ready to take cave evacuees to a hospital. It was unclear who was inside the ambulance or the helicopter.

Chiang Rai acting Gov. Narongsak Osatanakorn, who is heading the rescue, had said the second phase began at 11 a.m. Monday and authorities “hope to hear good news in the next few hours.”

Nine people remained trapped in the cave, including the team’s coach, after four boys were rescued on Sunday, the first day of the rescue operation.


3 p.m.

Thai authorities say they have resumed operations to rescue members of a boys’ soccer team trapped in a flooded cave after successfully getting four of the boys out Sunday.

They said the four boys already rescued are hungry but in good health in a hospital.

The second operation started at 11 a.m. local time Monday. It takes several hours.

Officials said at a news conference that the parents of the rescued boys, whose names have not been released, have not yet been allowed to have physical contact with them, pending more extensive examination of their physical condition.

Eight boys are still inside the cave and along with the team coach. The operation to get them out was supposed to resume only after new oxygen tanks could be placed along their route of escape, which is partially underwater.


11:35 a.m.

Australia’s foreign minister says 19 Australian personnel are involved in the Thailand cave rescue operation including a doctor who’s played an essential part in assessing which boys can leave and in what order.

Foreign Minister Julie Bishop told reporters in Australia that anesthetist and experienced cave diver Richard Harris is working with the Thai medical team inside the cave “to make the decisions about the order in which the boys were to be extracted.”

Expert divers Sunday rescued four of 12 boys from a flooded cave in northern Thailand where they were trapped with their soccer coach for more than two weeks. Crews will have to replenish air tanks along the route before rescuing the others.


10:35 a.m.

Thailand’s interior minister says the same divers who took part in Sunday’s rescue of four boys trapped in a flooded cave will also conduct the next operation as they know the cave conditions and what to do.

In comments released by the government, Interior Minister Anupong Paojinda said officials were meeting Monday morning about the next stage of the operation and how to extract the remaining nine people from the cave in the country’s north.

Anupong said divers need to place more air canisters along the underwater route to where the boys and their coach have been trapped since June 23. He said that process can take several hours.

He said the boys rescued Sunday are strong and safe but need to undergo detailed medical checks.


8:45 a.m.

Rescuers at a Thai cave where eight boys and their soccer coach remain trapped have awoken to cloudy skies, after a night in which heavy monsoon rains lashed the mountainous region for several hours.

It was not immediately clear Monday how the overnight rains had impacted water levels inside the flooded cave. Officials have said storms forecast for Chiang Rai province in Thailand’s far north had factored into their decision to go ahead with a complicated and dangerous plan to have the boys and their coach dive out of the cave.

Thailand’s Meteorological Department said there was a 60 percent chance of rain Monday with thunderstorms forecast throughout the week.

Four of the boys were rescued on Sunday, and authorities said the next phase could begin any time within a 10-hour window that began about 7 a.m. Monday.


8 a.m.

Elon Musk’s Space X rocket company is testing a “kid-sized submarine” that could be sent to help boys trapped in a flooded Thailand cave.

Musk posted videos on Twitter of the aluminum sub being tested at a swimming pool Sunday midafternoon California time. If the tests are successful, the sub would be placed on a 17-hour flight to Thailand.

Four of the boys were rescued on Sunday, and authorities are now working to replenish air tanks along the cave’s treacherous exit route. They say rescuing the eight remaining boys and their soccer coach could take up to four days.

A spokesman for Musk’s Boring Co. tunneling unit, which has four engineers at the cave, has said Thai officials requested the device, which could potentially help the children through narrow, flooded cave passageways.


2:10 a.m.

Officials say it could take up to four days to complete the rescue of eight boys and their soccer coach from inside a northern Thailand cave.

Authorities temporarily stopped their efforts Monday to replenish air tanks along the cave’s treacherous exit route.

Expert divers on Sunday managed to get four of the 12 boys to safety. They were quickly transported to a hospital in the town of Chiang Rai, the provincial capital.

The names of the rescued boys were not released.

Rescuers have been navigating a dangerous and complicated plan to get the children out under the threat of heavy rain and rising water underground.

The entire group had been trapped for more than two weeks.

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Boys Rescued from Thai Cave in Good Health

Boys Rescued from Cave in Good Health

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A Thai government official says all 12 boys and their coach are doing well after their rescue from the Tham Luang cave.

Thongchai Lertwilairatanapong is a Thai public health inspector. He told the Associated Press Wednesday that the boys lost about two kilograms of weight during their time in the cave. He said they survived by drinking clean water dripping into the cave.

Four boys were rescued Sunday, and another four were guided to safety on Monday. The remaining four boys and their coach were pulled out Tuesday.

The first photographs of the boys recovering in a Chiang Rai hospital were released Wednesday. It showed that many of them appeared to be in good condition. Some made the two-finger victory sign from their hospital beds. The photos also showed parents of the boys looking at their children through a glass window.

In this photo taken from video released by Thailand government, family members watch the rescued boys through a window at the Chiang Rai hospital in northern Thailand, Wednesday, July 11, 2018.

In this photo taken from video released by Thailand government, family members watch the rescued boys through a window at the Chiang Rai hospital in northern Thailand, Wednesday, July 11, 2018.

The parents have reportedly only been able to see their children through windows as they recover. All 12 boys are being kept away from family members to prevent them from catching infections. Three of the boys are being treated for minor lung infections.

Chaiwetch Thanapaisal is director of Chiang Rai Prachanukroh Hospital. He said, “Don’t need to worry about their physical health and even more so for their mental health.”

Despite their mostly good health, all the boys need to be observed in the hospital for seven days and then rest at home for another 30 days.

The rescue operation

Thai Navy SEALs also posted photos and a video of some of their operations in the cave on their Facebook page Wednesday.

Thirteen international cave divers joined five Thai Navy SEALs in the dangerous rescue operation. Former Thai Navy SEAL Saman Gunan died last Friday while putting extra air tanks along the escape path. He ran out of air while trying to swim out of the cave.

Narongsak Osatanakorn is the official who oversaw the rescue operation. He praised the cooperation between Thai and international rescuers. He said, “The situation went beyond just being a rescue mission and became a symbol of unity among man.”

He added that everyone worked together without concerns about race or religion, as the goal was to save the young football team.

This undated from video released via the Thai NavySEAL Facebook Page, July 11, 2018, shows rescuers hold an evacuated boy inside the Tham Luang Nang Non cave in Mae Sai, Chiang Rai province, in northern Thailand.

This undated from video released via the Thai NavySEAL Facebook Page, July 11, 2018, shows rescuers hold an evacuated boy inside the Tham Luang Nang Non cave in Mae Sai, Chiang Rai province, in northern Thailand.

None of the 12 boys had ever been diving and some did not know how to swim. Two divers were helping each one make his way through very small passages filled with water. It took the divers about eight hours to get into the cave, reach the boys and bring them back out.

I’m Jonathan Evans.

VOA and the Associated Press wrote this report. Alice Bryant adapted them for Learning English. Hai Do was the editor.


Words in This Story

coach - n. a person who teaches and trains an athlete or performer

drip - v. to fall in drops

lung - n. either one of the two organs that people and animals use to breathe air

symbol - n. an action, object or event that expresses or represents a particular idea or quality

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An active mind key to good health says Canada’s oldest blood donor

Canadas oldest blood donor according to Canadian Blood Services says she hopes others will follow in her footsteps and give blood regularly. The organization honoured 95-year-old Beatrice Janyk on Wednesday.













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Health official says boys rescued from flooded cave lost weight but had water during ordeal and are in good health


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