Fridge magnets 'can be a killer'


Fridge magnets and decorative jewellery could be a killer if you have a weak heart, experts warn.

A strong type of magnet used in many new commercial products can interfere with pacemakers and implanted heart devices with deadly consequences.

Close contact - within about 3cm - with a neodymium magnet is enough to destabilise these life-saving heart devices, Heart Rhythm journal reports.

The authors suggest manufacturers include a health warning on products.

Ordinary iron or ferrite magnets, which are a dull grey colour with a low magnetic strength, are of little concern.

Very strong magnets made from neodymium-iron-boron, which are shiny and silver in colour, have only recently become available.

But because of their high magnetic field strength and low production costs, they are being used in computer hard drives, headphones and hi-fi speakers, as well as toys, jewellery and even clothes.

Swiss researchers at the University Hospital of Zurich tested the effect of neodymium magnets in 70 heart patients - 41 with pacemakers and 29 with implantable cardioverter defibrillators.

Magnetism

The small 8g magnets tested interfered with all of the patients' devices, regardless of their make or type, when they were in a maximum range of 3cm.

The researchers said larger neodymium magnets would be likely to cause interference at greater distances than this.

Although the devices worked normally again once the magnet was removed, the authors warned permanent damage might occur with prolonged exposure - if someone were to wear a magnetic name badge, for example.

Lead researcher Thomas Wolber said: "Physicians should caution patients about the risks associated with these magnets.

"We also recommend that the packaging includes information on the potential risks."

Warnings

Ian Asquith, director of Neodymium Magnets UK, a supplier of neodymium magnets to product manufacturers, said his company was aware of the risks and sends warnings out with every magnet.

But consumers were generally unaware, he said, and manufacturers had a responsibility to warn consumers of any risks.

"There is a real danger. These magnets are everywhere. They are in lots of badges, fridge magnets and mobile phones. If you were on a busy bus and someone you are squashed up against had a magnet in their top pocket you could easily come within 3cm of it.

June Davison, of the British Heart Foundation, said anyone with concerns should contact their pacemaker clinic.

"Pacemakers are manufactured to the highest standards, are rigorously tested, and most have a protective case to shield them from outside interference. Problems are rare."

Story from BBC NEWS:

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England smoke ban to start 1 July


Smoking in enclosed public places will be banned in England from 1 July next year, the government has announced.

The ban covers virtually all enclosed public places including offices, factories, pubs and bars, but not outdoors or in private homes.

It follows similar bans in the Irish Republic and Scotland - a ban in Wales starts on 2 April.

Ministers say it will protect everyone from passive smoking, but opponents say the total ban is "draconian".

From 1 July pubs and restaurants will have to display prominent "no smoking" signs around their premises.

Health Secretary Patricia Hewitt said the ban was a "huge step forward" which would save thousands of people's lives.

The cost of implementing the ban has been estimated at about £50m.

Medical evidence

Ms Hewitt said the ban would protect everyone from second-hand smoke, while making it easier for smokers to quit.

"The scientific and medical evidence is clear - second-hand smoke kills, causing a range of serious medical conditions including lung cancer, heart disease, and sudden infant death syndrome," she said.

"This legislation will help to prevent the unnecessary deaths caused every year from second-hand smoke, and recognises that there is absolutely no safe level of exposure."


SMOKING BANS
Irish Republic: March 2004
Scotland: March 2006
Northern Ireland: April 2007
Wales: April 2007
England: July 2007

The government predicts about 600,000 people will give up smoking as a result of the law change.

The news was welcomed by health campaigners. Dame Helena Shovelton, chief executive of the British Lung Foundation, said: "This is a victory for all those of us who have campaigned so vigorously to improve public health."

She said it would reduce the death toll linked to smoking and that tens of thousands of people with lung disease would once again be able to visit pubs and restaurants.

Cancer Research UK chief, Prof Alex Markham, said 1 July would be an "historic day".

"Making workplaces and enclosed public places smoke free will bring about some of the most significant health improvements the country has seen in decades," he said.

British Beer and Pub Association boss, Rob Hayward, welcomed the announcement, saying it gave businesses "greater clarity" and would allow them to prepare their customers for the changes.

The Cabinet originally proposed prohibiting smoking only in pubs serving food, in line with Labour's election manifesto - but MPs eventually backed a total ban in enclosed public spaces in a free vote.

Simon Clark, director of the smokers' lobby group Forest, said that decision had been "draconian".

"From July next year it will not only be illegal to smoke in every pub, club and bar in the country, it will also be impossible to set up a private club run by smokers for smokers," he said.

"That's an amazing state of affairs but typical of a government that seems determined to interfere in every aspect of our daily lives."

The health secretary is also launching a Smokefree England campaign, to advise England's 3.7m businesses to prepare for the ban.

Story from BBC NEWS:

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Can a Simple Quiz Tell You How Long You'll Live?




Web site calculators that estimate life expectancies based on risk won't give you perfect results, but they can teach you how to live a healthier life
.

The apocryphal fountain of youth may not exist, but there are ways we can learn to live longer and better lives. On the web, online life expectancy calculators can give users tips on healthier living that could help them tack on a few more years.

"[Life expectancy calculators are] just a repackaged way of telling you what you already know, and that is, 'Eat less, don't smoke,'" says S. Jay Olshansky, a professor in the school of public health at University of Illinois at Chicago. "But what they're really meant to do is encourage people to lead healthier lifestyles, and that's a good thing."

Most of the free online calculators ask users to answer a number of questions related to their family histories, their own medical histories and various behaviors including what they eat, how they drive and how much they sleep. The decidedly ominous Death Clock calculator generates a countdown timer with the number of seconds the user has left to live, but other sites display an age someone with characteristics like the user can expect to attain.

Men in the U.S. have the average life expectancy at birth of about 75 years; females can expect to live about five years longer. Like gender, the most important factors in determining longevity are out of your control: online calculators ask what how long your parents and grandparents lived as a way of assessing your family's medical history. "In order to live a long life, you have to begin by having won the genetic lottery," Olshansky says. "Then you have to avoid getting hit by a bus."

Of course, lifestyle decisions and your own medical history are important. Smoking can knock 10 to 15 years off of an otherwise healthy person's life, and diabetes, obesity, blood pressure, heart disease and cholesterol all factor prominently into formulas life insurance companies use to estimate applicants' life expectancies and set rates for policies, says Paul Graham, VP and chief actuary at the American Council of Life Insurers, an industry trade association.

World events can also play a role; avian flu, if it begins to spread from human to human on a large scale, instead of from bird to human, could cause upwards of 1 million deaths according to some estimates — and that's getting the attention of life insurance companies, Graham says. "That's the biggest event we're watching, much more than terrorism or war."

The key is to remember that the formulas used by both life insurers and online calculators are statistical. The most they can do is predict how long the average person with characteristics similar to yours will live — they can't address you directly. For a life insurance company — which makes or loses money based on large numbers of policy holders living or dying later or earlier than expected — these averages matter. "I need to know that on average, you're going to die at 82," Graham says. "That average doesn't mean anything to you. I don't know that I would make any life-changing decisions based on that."

But online calculators can be useful if they provide suggestions on how to lead a healthier life, Olshansky says. He recommended the Living to 100 life expectancy site, which provides detailed information on changes you can make — everything from what foods to eat to how much you should sleep — based upon your answers to a series of questions. The tools also can help teach the public how to weigh risk factors, said University of Pennsylvania Prof. Dean Foster, co-author of another calculator. "How good is excercise or how bad is smoking?" Foster asks. "Would you walk a mile for a Camel? Each and every Camel? If you do so, smoking is OK. But if you only walk a half mile for each cigarette, it is hazardous to your health."

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Red wine red wine's heart-protecting effect found


Those seeking a longevity-boosting tipple should turn their attention to red wines from Sardinia and south-west France, a study concludes.

UK researchers discovered chemicals called procyanidins were responsible for red wine's well-documented heart-protecting effect.

And they found traditionally made wines from these areas had more procyanidins than wines in other parts of the world.

The research is published in the journal Nature.

Previous studies have revealed regular, moderate consumption of red wine is linked to a reduced risk of heart disease and lower mortality.

A class of chemicals called polyphenols, of which there are many varieties, are thought to be responsible.

Using endothelial cells (cells that line the vascular system), the researchers pinpointed polyphenols called procyanidins as those that provided the most potent protective effect.

They then tested red wines from around the world to measure their levels of procyanidins, including wines from Nuoro province in Sardinia and the Gers region of the Midi-Pyrenees in south-west France, areas famous for their population's longevity.

They discovered wines from these regions had on average between two and four times the level of procyanidin compared with wines from countries including Spain, Australia, South America and the US.

Traditionally made

Professor Roger Corder, from the William Harvey Research Institute, at Queen Mary, University of London, said: "There is a 19th Century expression: 'A man is only as old as his arteries', which can be taken to mean that those with the healthiest arteries live longer.

"So it was of great interest to us when we found both in Sardinia and in south-west France that the wines made in these in areas had higher levels of procyanidins."

The researchers believe the way that wines are made is the key.

In traditional wine making, said Professor Corder, grapes have a three to four week fermentation period, allowing for full extraction of the chemical from the skin and the seed.


Those who do enjoy a tipple should keep within the recommended levels
Cathy Ross, British Heart Foundation

Modern-style wines are only fermented for a week, resulting in little or no procyanidin.

He added that the grape was also important and the tannat, cabernet sauvignon and Nebbiolo grapes made procyanidin-rich wines.

Professor Corder said: "The traditional production methods used in Sardinia and south-western France ensure that the beneficial compounds, procyanidins, are efficiently extracted.

"This may explain the strong association between consumption of traditional tannic wines with overall wellbeing, reflected in greater longevity."

Cathy Ross, cardiac nurse at the British Heart Foundation (BHF), said: "While we have known for some time that a moderate amount of alcohol can help to reduce your risk of developing heart disease, we would not recommend anyone to start drinking. Those who do enjoy a tipple should keep within the recommended levels.

"There are better ways to reduce your risk. Stopping smoking, eating a healthy diet low in saturated fat and getting at least 30mins of exercise five times a week will all help your heart."

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Man Receives Hand Transplant After 32 Years


BRETT BARROUQUERE,

AP

A Michigan man who lost his right hand in a work-related accident more than 30 years ago became the third successful hand transplant recipient in the United States, doctors said Thursday.

David F. Savage was doing well the day after the surgery at Jewish Hospital in Louisville.

Doctors said the transplant for Savage, 54, presented unusual challenges because of the length of time between losing his hand in a machine press and the surgery. The blood vessels leading to Savage's hand had shrunk because they were not in use, said Dr. Warren Breidenbach, the lead surgeon.

"It's like closing down your house for 32 years, then deciding to go back in and take a shower. You turn it on, it sputters a little bit, then it works," Breidenbach said.

Of the two dozen hand transplant recipients worldwide, Savage may have gone the longest between losing a hand and having a transplant, Breidenbach said. That amount of time creates a "slightly higher risk" of vascular compromise, when blood stops flowing, because the blood vessels used in the transplant were dormant for so long, Breidenbach said.

"If it stops working, we'll go back in there and get it started again," Breidenbach said.

The procedure involved two surgeries and 32 doctors over 16 hours on Wednesday, the day the anonymous donor died.

Savage, of Bay City, Mich., is also serving as a test case for a drug called Campath to ward off rejection. If Savage's body rejects the new hand, it will happen in the first three to six months, doctors said.

Savage first inquired about receiving a hand transplant six years ago - shortly after the nation's first such procedure - and fought his insurance company for three years, Breidenbach said. Then he spent three years on a waiting list for a donor hand.

The first two U.S. hand transplants were also performed at Jewish Hospital, in 1999 and 2001.

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Food-aceuticals: Drink - and Eat - to Your Health


Jennifer Warner
WebMD Feature

Every day there seems to be another story touting the amazing health benefits found in everyday foods. Is the recipe for better health found in the pantry instead of the medicine cabinet?

From omega-3 fatty acids to flavonoids, the ingredients in foods you eat every day may be potent weapons in the battle against disease.

Once-forbidden foods like chocolate, nuts, and wine made headlines in 2004 for their potentially healthy benefits, and new research suggests that the key to avoiding heart disease or cancer may be found in the cupboard rather than the medicine cabinet.

But the secret may not lie in a single wonder food. Instead, researchers say that variety may really be the spice of (long) life. To get your plate in order, WebMD asked the experts for their top picks from this year's newsmakers.

Flavonoids: What Makes Chocolate and Wine Good for You

The discovery of flavonoids and the bevy of heart-healthy benefits they possess has been a boon to wine and chocolate lovers.

The antioxidant-rich compounds found in the seeds and skins of plants, such as grapes, cocoa beans, and citrus fruits, first gained the attention of researchers in the early 1990s as a means of explaining the so-called French Paradox. Researchers proposed then that French people had lower rates of heart attacks because they drank moderate amounts of red wine with their meals.

Since then, more than 300 studies on grape flavonoids have shown that drinking red wine or grape juice may help blunt the artery-clogging effects of a fatty meal and reduce the risk of heart disease over the long-run.

Many of the same flavonoids in grape products are also found in varying concentrations in green and black tea as well as chocolate, but the bulk of research so far has been focused on grape flavonoids.

"It is exciting that different investigators dealing with grape products, whether it be red wine, de-alcoholized red wine, grape juice, or grape seed and skin extracts, they are all seeing some significant, potentially beneficial things," says John D. Folts, PhD, professor of medicine and nutritional science at the University of Wisconsin Medical School.

Folts says animals with high cholesterol will develop atherosclerosis or hardening of the arteries in about six to nine months, a process in humans that takes 20 to 30 years. But several recent studies have shown that when these animals are given grape products, the artery-clogging process slows down.

"The suggestion is that the same thing would work in humans," says Folts. He says the early studies on tea and chocolate flavonoids are promising, but it's still too early to draw any definitive conclusions from them.

Researchers say flavonoids may help promote heart health in several ways, such as:

  • Helping to prevent blood clots, which may trigger a heart attack or stroke.
  • Preventing cholesterol from entering and damaging blood vessel walls.
  • Improving the health of arteries, making them expand and contract more readily, helping them carry blood more effectively.
  • Stimulating the production of nitric oxide, which may stall hardening of the arteries.

Alice H. Lichtenstein, DSc, professor of nutritional science and policy at Tufts University, says although the research is reasonably good in showing that drinking a moderate amount of wine, defined as one or two glasses per day for men and no more than one glass per day for women, is associated with a lower risk of heart disease, it is also associated with an increased risk of breast cancer.

"There is still some confusion over alcohol, and I think that's understandable because it has potentially good and bad effects," says Lichtenstein. "One should not start drinking if they don't already, and they have to really weigh the risks and benefits."

She says it's difficult to make a broad recommendation for drinking wine or other types of alcohol based on its potential health benefits because there are also some people who may be more likely to have substance abuse problems with alcohol.

The "Good" Fat (Fatty Acids)

Fat also got a healthy image makeover this year thanks to new research on omega-3 fatty acids and their ability to reduce the risk of heart disease. Omega-3 fatty acids are found in fatty fish such as salmon, tuna, lake trout, and herring. In September, the FDA approved a new qualified health claim that allows foods and supplements containing omega-3 fatty acids to advertise the fact that eating the product may reduce the risk of heart disease.

Although health organizations, such as the American Heart Association, already recommend fish as a part of a heart-healthy diet based on earlier findings of epidemiological studies, Lichtenstein says new research this year offers new proof of the heart-healthy benefits of omega-3 fatty acids.

In Lichtenstein's study, women whose arteries already showed evidence of atherosclerosis who ate fish twice a week or dark fish once a week had a slower progression of their disease, as shown by X-ray images.

"Probably what happens is that when people consume more fish, they're not eating as much steak and hamburgers. So they are displacing foods high in saturated fat for one high in unsaturated fat," says Lichtenstein.

In November, the FDA also approved another new qualified health claim for olive oil based on studies that show eating about two tablespoons of olive oil a day may reduce the risk of heart disease.

Olive oil contains a type of fat known as monounsaturated fat that can lower 'bad' LDL cholesterol levels when eaten instead of saturated fats. However, olive oil contains about the same amount of total fat grams and calories as other types of fat.

Antioxidants: We Hardly Knew Ye

New research released this year also helped explain the role of antioxidants, for better and for worse.

"Some years ago, we thought that vitamin E was protective against heart disease. Now we're not so sure about that," says Melanie Polk, RD, director of nutrition education at the American Institute for Cancer Research. "We used to think that vitamin E was valuable for a whole variety of benefits, but now we're not so sure about that either."

Several studies have cast doubt on earlier health claims about vitamin E, and a study released in November showed that taking high doses of the antioxidant may actually be hazardous to your health and shorten your life span.

"There was so much excitement over vitamin E because it seemed like such an easy answer," says Lichtenstein. "Unfortunately, it wasn't upheld with studies."

But vitamin E is just one of many antioxidants that may have potentially healthy effects, and the good news about antioxidants this year is that they may be found in unexpected places, like cereal.

Researchers have long thought that fruits and vegetables were the primary sources of antioxidants in the diet. But new research presented this year suggests that a different type of antioxidant and other phytochemicals may also be found in whole grains.

"Phytochemicals seem to be in what we call the free form in fruits and vegetables, and when we looked for these in whole grains they weren't found," says Polk. "What researchers have now discovered is that they were in different form in whole grains. They are attached to cell walls of the plant and don't get absorbed into the blood until bacteria act upon them during digestion."

"We didn't know about this bound form of phytochemicals until recently, and so the benefits of whole grains are even greater than what we thought before," says Polk.

Polk says these findings may also help explain why studies that have looked at the potential anti-cancer properties of the fiber found in whole grains have produced conflicting results.

"We know diets that are high in fiber are cancer protective, but there has been some question about whether or not it is the fiber itself," Polk tells WebMD. "It may not be fiber but maybe something else in high-fiber foods."

Confused? Mix It Up

If the conflicting research about the health benefits of different foods has you confused, researchers say the best recipe is to mix it up.

Researchers say every time they try to isolate one of the components behind the potential health benefits of a food, it doesn't seem to work.

"We have been so unsuccessful in finding that perfect food or that perfect nutrient that if you just pop a supplement you're going to have decreased risk," says Lichtenstein.

In contrast, new research suggests that it may be the ways various phytochemicals and ingredients in different foods work together that produce the biggest health benefits.

For example, a recent study showed that mice with prostate cancer fed a diet rich in both broccoli and tomatoes experienced much less tumor growth than those fed either food alone.

Another study showed that people who ate "polymeals" consisting of wine, fish, dark chocolate, fruits and vegetables, almonds, and garlic on a daily basis had a lower risk of heart disease and lived longer than those who didn't. A polymeal is a combination of foods that have been individually shown to reduce the risk of heart disease.

"When you look at individual phytochemicals, it's very exiting to see that each individual phytochemical has its own function in terms of cancer prevention and health protection. But the possibilities of looking at what they can do together working as a team could be phenomenal," says Polk. "The best way to get these substances is by eating whole foods."

Lichtenstein says researchers are now coming to the realization that certain diet and lifestyle patterns are associated with a lower risk of disease, rather than any one food.

"Fortunately those are virtually the same for heart disease, cancer, and diabetes," says Lichtenstein. "It's to consume a diet high in fruits and vegetables, whole grains, low-fat and nonfat dairy products, legumes, and fish and have regular physical activity."

Reviewed By Louise Chang, MD

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Key Facts About Flu Vaccine


What is Influenza (also called Flu)?

The flu is a contagious respiratory illness caused by influenza viruses. It can cause mild to severe illness, and at times can lead to death. The best way to prevent this illness is by getting a flu vaccination each fall.

Every year in the United States, on average:

  • 5% to 20% of the population gets the flu;
  • more than 200,000 people are hospitalized from flu complications, and;
  • about 36,000 people die from flu.

Some people, such as older people, young children, and people with certain health conditions, are at high risk for serious flu complications.

Symptoms of Flu

Symptoms of flu include:

  • fever (usually high)
  • headache
  • extreme tiredness
  • dry cough
  • sore throat
  • runny or stuffy nose
  • muscle aches
  • Stomach symptoms, such as nausea, vomiting, and diarrhea, also can occur but are more common in children than adults

Complications of Flu

Complications of flu can include bacterial pneumonia, dehydration, and worsening of chronic medical conditions, such as congestive heart failure, asthma, or diabetes. Children may get sinus problems and ear infections.

How Flu Spreads

Flu viruses spread in respiratory droplets caused by coughing and sneezing. They usually spread from person to person, though sometimes people become infected by touching something with flu viruses on it and then touching their mouth or nose. Most healthy adults may be able to infect others beginning 1 day before symptoms develop and up to 5 days after becoming sick. That means that you can pass on the flu to someone else before you know you are sick, as well as while you are sick.

Preventing the Flu: Get Vaccinated

The single best way to prevent the flu is to get a flu vaccination each fall. There are two types of vaccines:

  • The "flu shot" - an inactivated vaccine (containing killed virus) that is given with a needle. The flu shot is approved for use in people older than 6 months, including healthy people and people with chronic medical conditions.
  • The nasal-spray flu vaccine - a vaccine made with live, weakened flu viruses that do not cause the flu (sometimes called LAIV for "Live Attenuated Influenza Vaccine"). LAIV is approved for use in healthy people 5 years to 49 years of age who are not pregnant.
About two weeks after vaccination, antibodies develop that protect against influenza virus infection. Flu vaccines will not protect against influenza-like illnesses caused by other viruses.

When to Get Vaccinated

October or November is the best time to get vaccinated, but getting vaccinated in December or even later can still be beneficial. Flu season can begin as early as October and last as late as May.

Who Should Get Vaccinated?

In general, anyone who wants to reduce their chances of getting the flu can get vaccinated. However, certain people should get vaccinated each year. They are either people who are at high risk of having serious flu complications or people who live with or care for those at high risk for serious complications. People who should get vaccinated each year are:

People who should get vaccinated each year are:

1.) People at high risk for complications from the flu:

  • People 65 years and older;
  • People who live in nursing homes and other long-term care facilities that house those with long-term illnesses;
  • Adults and children 6 months and older with chronic heart or lung conditions, including asthma;
  • Adults and children 6 months and older who needed regular medical care or were in a hospital during the previous year because of a metabolic disease (like diabetes), chronic kidney disease, or weakened immune system (including immune system problems caused by medicines or by infection with human immunodeficiency virus [HIV/AIDS]);
  • Children 6 months to 18 years of age who are on long-term aspirin therapy. (Children given aspirin while they have influenza are at risk of Reye syndrome.);
  • Women who will be pregnant during the influenza season;
  • All children 6 to 23 months of age;
  • People with any condition that can compromise respiratory function or the handling of respiratory secretions (that is, a condition that makes it hard to breathe or swallow, such as brain injury or disease, spinal cord injuries, seizure disorders, or other nerve or muscle disorders.)

2.) People 50 to 64 years of age. Because nearly one-third of people 50 to 64 years of age in the United States have one or more medical conditions that place them at increased risk for serious flu complications, vaccination is recommended for all persons aged 50 to 64.

3.) People who can transmit flu to others at high risk for complications. Any person in close contact with someone in a high-risk group (see above) should get vaccinated. This includes all health-care workers, household contacts and out-of-home caregivers of children 6 to 23 months of age, and close contacts of people 65 years and older.

Is CDC recommending that flu shots go to "priority groups", as was recommended last season?

To ensure that those who are at highest risk of complications from influenza have access to vaccine this season, CDC recommends that people in certain priority groups receive inactivated influenza vaccine (i.e., the "flu shot") until October 24, 2005:

  • people aged 65 years and older, with and without chronic health conditions
  • residents of long-term care facilities
  • people aged 2-64 years with chronic health conditions
  • children aged 6-23 months
  • pregnant women
  • health-care personnel who provide direct patient care
  • household contacts and out-of-home caregivers of children less than 6 months of age

Beginning October 24, 2005, all persons can get a flu shot.

Use of the Nasal Spray Flu Vaccine
It should be noted that vaccination with the nasal-spray flu vaccine is always an option for healthy persons aged 5-49 years who are not pregnant. This vaccine is not subject to prioritization and can be given to healthy 5-49 year olds at any time.

People Displaced by Hurricane Katrina
Influenza vaccination is recommended for all people 6 months of age and older who have been displaced by hurricane Katrina and are living in crowded group settings. See http://www.bt.cdc.gov/disasters/hurricanes/katrina/vaccrecdisplaced.asp.

Who Should Not Be Vaccinated

Some people should not be vaccinated without first consulting a physician. They include:

  • People who have a severe allergy to chicken eggs.
  • People who have had a severe reaction to an influenza vaccination in the past.
  • People who developed Guillain-Barré syndrome (GBS) within 6 weeks of getting an influenza vaccine previously.
  • Children less than 6 months of age (influenza vaccine is not approved for use in this age group).
  • People who have a moderate or severe illness with a fever should wait to get vaccinated until their symptoms lessen.

If you have questions about whether you should get a flu vaccine, consult your health-care provider.

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How Does Seasonal Flu Differ From Pandemic Flu?

U.S. Department of Health & Human Services (HHS), October 25, 2005

Seasonal Flu

Pandemic Flu

Outbreaks follow predictable seasonal patterns; occurs annually, usually in winter, in temperate climates

Usually some immunity built up from previous exposure

Occurs rarely (three times in 20th century - last in 1968)

No previous exposure; little or no pre-existing immunity

Healthy adults usually not at risk for serious complications; the very young, the elderly and those with certain underlying health conditions at increased risk for serious complications

Healthy people may be at increased risk for serious complications

Health systems can usually meet public and patient needs

Health systems may be overwhelmed

Annual collaborative planning to select seasonal vaccine strains before flu season starts

Vaccine probably would not be available in the early stages of a pandemic

Adequate supplies of antivirals are usually available

Effective antivirals may be in limited supply

Average U.S. deaths approximately 36,000/yr

Number of deaths could be quite high (e.g., U.S. 1918 death toll approximately 500,000)

Symptoms: fever, cough, runny nose, muscle pain. Deaths often caused by complications, such as pneumonia.

Symptoms may be more severe and complications more frequent

Generally causes modest impact on society (e.g., some school closing, encouragement of people who are sick to stay home)

May cause major impact on society (e.g. widespread restrictions on travel, closings of schools and businesses, cancellation of large public gatherings)

Manageable impact on domestic and world economy

Potential for severe impact on domestic and world economy

For additional information visit: http://www.hhs.gov/flu

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Get Smart: Know When Antibiotics Work


Snort. Sniffle. Sneeze. No Antibiotics Please!

Are you aware that colds, flu, and most sore throats and bronchitis are caused by viruses? Did you know that antibiotics do not help fight viruses? It's true. Plus, taking antibiotics when you have a virus may do more harm than good. Taking antibiotics when they are not needed increases your risk of getting an infection later that resists antibiotic treatment.

If You Have a Cold or Flu, Antibiotics Won't Work For You!

Antibiotics kill bacteria, not viruses such as:

  • Colds or flu;
  • Most coughs and bronchitis;
  • Sore throats not caused by strep; or
  • Runny noses.

Taking antibiotics for viral infections, such as a cold, cough, the flu, or most bronchitis,will not:

  • Cure the infections;
  • Keep other individuals from catching the illness; or
  • Help you feel better.

What Can I Do To Protect Myself Or My Child?

What To Do
Talk with your healthcare provider about antibiotic resistance.

When you are prescribed an antibiotic,

  1. Take it exactly as the doctor tells you. Complete the prescribed course even if you are feeling better. If treatment stops too soon, some bacteria may survive and re-infect you.
  2. This goes for children, too. Make sure your children take all medication as prescribed, even if they feel better.
  3. Throw away any leftover medication once you have completed your prescription.



What Not To Do
Do not take an antibiotic for a viral infection like a cold, a cough, or the flu.

Do not demand antibiotics when a doctor says they are not needed. They will not help treat your infection.

When you are prescribed an antibiotic,

  1. Do not skip doses.
  2. Do not save any antibiotics for the next time you get sick.
  3. Do not take antibiotics prescribed for someone else. The antibiotic may not be appropriate for your illness. Taking the wrong medicine may delay correct treatment and allow bacteria to multiply.

When you use antibiotics appropriately, you do the best for your health, your family's health, and the health of those around you. "We want Americans to keep their families and communities healthy by getting smart about the proper use of antibiotics," said J. Todd Weber, M.D., CDC's Director of the Office of Antimicrobial Resistance.

More Important Information

  • Taking antibiotics for viral infections will increase the risk of antibiotic resistance.
  • Tens of millions of antibiotics prescribed in doctors' offices each year are for viral infections, which cannot effectively betreated with antibiotics. Doctors cite diagnostic uncertainty, time pressure on physicians, and patient demand as the primary reasons why antibiotics are over-prescribed.
  • The spread of viral infections can be reduced through frequent hand washing and by avoiding close contact with others.

Dangers of Antibiotic Resistance

Mother and child consult with their family doctor.Antibiotic resistance has been called one of the world's most pressing public health problems. It can cause significant danger and suffering for people who have common infections that once were easily treatable with antibiotics. When antibiotics fail to work, the consequences are longer-lasting illnesses; more doctor visits or extended hospital stays; and the need for more expensive and toxic medications. Some resistant infections can cause death.

Sick individuals aren't the only people who can suffer the consequences. Families and entire communities feel the impact when disease-causing germs become resistant to antibiotics. These antibiotic-resistant bacteria can quickly spread to family members, school mates and co-workers - threatening the community with a new strain of infectious disease that is more difficult to cure and more expensive to treat.

Remember: Get Smart: Know When Antibiotics Work!

Content source: National Center for Infectious Diseases

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Job Stress Fuels Disease

Jeanna Bryner

LiveScience Staff Writer

The daily rigors of work, such as tight deadlines and long hours, can lead to job burnout, a state scientists are beginning to link with serious ailments.

Studies have shown that workplace stress can lead to an increase in rates of heart disease, flu virus, metabolic syndrome and high blood pressure. One study found that stress can negate the heart-healthy aspects of a physically active job, leading to thicker arteries in physically active and stressed workers compared with active, non-stressed employees.

A new study of 677 workers in Israel showed those who experienced job burnout were 1.8 times more likely to develop Type 2 diabetes, in which a person's body becomes resistant to the sugar-regulating hormone called insulin. The results held even when factors like age, sex, exercise and obesity were taken into account.

Some studies have found stress can cause unhealthy behaviors, such as eating poorly or drinking more alcohol, which can then lead to health problems. In the new study, the researchers suggest stress can have a more direct effect, disrupting the body's ability to process glucose, leading to diabetes.

The results show that burnout could boost the risk of illness by a "magnitude similar to other risk factors, such as high body mass index, smoking and lack of physical exercise," said study lead author Samuel Melamed of Tel Aviv University in Israel.

Job burnout

When work stress becomes unmanageable, job burnout can lead to a combination of three symptoms:

Emotional exhaustion Physical fatigue or exhaustion Cognitive weariness (slow thinking)

This state differs from a temporary malaise that passes after a period of rest. Causes of burnout include chronic stresses, such as lack of rewards, job insecurity, regular physical abuse and sexual harassment, as well as daily hassles and sudden traumas.

Work life

The scientists studied Israeli workers, who were apparently healthy initially, from 1998 to 2003. Nearly 77 percent of the workers were men, with an average age of 43 years. The subjects had a range of occupations, which the scientists divided into five categories: senior management, middle management or supervisory—jobs like engineers, teachers and computer workers— nonprofessional and self-employed persons.

A burnout questionnaire revealed about half of the 677 subjects experienced high burnout. Of the workers, 17 developed Type 2 diabetes during the study period, with 3.2 percent of burned-out workers becoming diabetic compared with 1.8 percent of the other workers.

To figure out if the cause of diabetes was mediated by blood pressure, the researchers examined a subset of the subjects—507 workers—for which they had tested for blood pressure. The burned-out workers showed lower blood pressure levels, indicating that it was not hypertension—high blood pressure—causing diabetes. An alternative explanation could be that stress triggers a spike in fatty acids in the blood and a drop in the "good" cholesterol, HDL—both factors associated with diabetes.

Stress factor

The job burnout may be only part of the picture, Melamed said.

"It is possible that these people are prone to diabetes because they can't handle stress very well," he said. "Their coping resources may have been depleted not only due to job stress but also life stresses, such as stressful life events and daily hassles."

Stress in general can disrupt the body's ability to process glucose, especially in people whose genetics make them vulnerable, said Richard Surwit of the Duke University Medical Center.

Surwit, who was not involved in the study, said the results should be replicated in a much larger group of subjects to see if the same results prevail.

The scientists suggest, in the November/December issue of the journal Psychosomatic Medicine, that the results confirm the need for effective interventions to reduce stress before it becomes burnout.

Anger is Good For You Study: Office Bullies Create Workplace ‘Warzone' Image of the Day: Psychological Stress in the Healthy Human Brain Study: American Women Need More Vacations Top 10 Mysteries of the Mind Original Story: Job Stress Fuels Disease

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Why I'm Not Against, Like, Oh Wow Man, Pot



I have yet to see a patient whose health was harmed by smoking marijuana, but I have treated people seriously hurt by the drug's illegality.

We don't really know how many people smoke it. Some sources say 10 million Americans, others say 35 million. But a lot of people smoke pot and they don't seem very sick. Marijuana just won't go away. Everybody talks about it—many quite fondly. About everyone I know under 55 has smoked it. And they're all right. A few have that pothead "oh wow" personality, but so what? I don't know of one case of serious marijuana-related disease among my friends, family and acquaintances.

At work I have to report the same thing. I've been in hospitals and around sick people for 26 years now. I've admitted plenty of patients who have owned up to using pot. I think I can often tell by how they act. But do the health effects of pot seem very serious? As dangerous as those of alcohol, tobacco, overworking, fashion magazines or overeating? Nope. In fact, the health effects of pot are not nearly as dangerous as the jail they throw you in for possessing it. Not even close. I'm not an oncologist but I haven't seen a case of lung cancer clearly related to dope smoking. Memory loss, depression, anxiety? Could it be as bad as turning 50? As for it being a gateway drug — how about beer?

There are some reasonable medical uses for cannabis. One patient I knew could get relief from her chemotherapy-induced nausea from nothing other than smoking joints. She was dying in the Massachusetts General Hospital from Ewing's sarcoma at 19, so no one was going to stop her. The word on our oncology floors is that pot's a pretty good appetite stimulant and anti-emetic. A few patients have asked me for it in connection with this. But no, I have never actually written an outpatient prescription for Cannabinol, THC or marijuana leaf (and I have no idea where they could get one filled anyway).

The chief dangers of marijuana, practically, seem to spring from only one of its features: it's illegal. People get beat up, shot up and locked up because of the great amount of money that rides on selling the stuff, stuff that would be about as expensive as lettuce if it weren't against the law. I have treated people seriously hurt by the illegality of pot.

Do I recommend using it? No way. Never used it, even in the bad old days, and I hope that none of my kids ever do. There's something repulsive about the half-closed, red eyes — something that's selfish and irresponsible. The biggest reason I didn't smoke it in the 70s, when everybody I knew was trying "to get me high," was that I wanted to be able to tell my kids that I didn't so that they wouldn't. I feel strongly about it—it's really not my bag. But that's who I am. I also feel pretty strongly that nearly every child should study Latin—really—but I don't think we should lock them up if they don't.

For me, it's similar to the speed-reading phenomenon. In the 70s and 80s there were all sorts of advertisements for this great system that would help you read the whole Sunday Times in 15 minutes "with complete comprehension and recall." I almost sent away for it. I still wonder about it but am now pretty sure it doesn't work. Here's how I know: I have never met a single person who could do it. Hanging around with many big readers for the past 35 years I should have bumped into at least one who took the course and could actually read that fast. I can't help but think it's the same with pot. Hanging around with all sorts of big dope-smokers for the same 35 years I should have bumped into at least one or two with those "serious health effects". The fact is I haven't. But I would listen to any docs out there who have actually seen or treated diseases truly caused by pot.

Another undeniable is that pot has cache among teens. Some kids between 13 and 19 are clearly willing to risk everything to smoke the stuff — they know how much trouble they can get in. The "smoker" label seems as important a part of their personae as their tastes in music and clothing — maybe more so because it's illegal. It's as defining for them as it was for my pothead friends in the 70s. Maybe they'll become investment bankers too.

An important "art of medicine" issue is sensitivity to the individual's right to self-determination. We work hard to respect patient choice. Lots of explaining, rebutting and cleaning up messes. And as the government should, we draw a line. I won't prescribe cyanide for a patient in pain, even if he asks for it, and the government shouldn't permit home nuclear bomb experiments, even for garage-inventors who promise to be careful.

But some people love cannabis and they're going to get it anyway. Good doctors do learn to persuade and cajole to gently make what we think is the right choice into the patient's choice. ("The girls in therapy really seem to get a kick out of you. Are you sure you don't want to go anymore?") The government equivalent of this is called "drug education" and it's fine. But when you try to change certain things by force, things close to the core about what folks love and hate, about their personalities, you just run into trouble. It doesn't work. You might knock down but you will never build up. This is why the government is better off out of the marijuana business.

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The Hidden Danger of Seat Belts




They still decrease our risk of dying, but the statistics are not all black and white. In fact, according to one researcher, seat belts may actually cause people to drive more recklessly.

If there's one thing we know about our risky world, it's that seat belts save lives, right? And they do, of course. But reality, as usual, is messier and more complicated than that. John Adams, risk expert and emeritus professor of geography at University College London, was an early skeptic of the seat belt safety mantra. Adams first began to look at the numbers more than 25 years ago. What he found was that contrary to conventional wisdom, mandating the use of seat belts in 18 countries resulted in either no change or actually a net increase in road accident deaths.

How can that be? Adams' interpretation of the data rests on the notion of risk compensation, the idea that individuals tend to adjust their behavior in response to what they perceive as changes in the level of risk. Imagine, explains Adams, a driver negotiating a curve in the road. Let's make him a young male. He is going to be influenced by his perceptions of both the risks and rewards of driving a car. The considerations could include getting to work or meeting a friend for dinner on time, impressing a companion with his driving skills, bolstering his image of himself as an accomplished driver. They could also include his concern for his own safety and desire to live to a ripe old age, his feelings of responsibility for a toddler with him in a car seat, the cost of banging up his shiny new car or losing his license. Nor will these possible concerns exist in a vacuum. He will be taking into account the weather and the condition of the road, the amount of traffic and the capabilities of the car he is driving. But crucially, says Adams, this driver will also be adjusting his behavior in response to what he perceives are changes in risks. If he is wearing a seat belt and his car has front and side air bags and anti-skid brakes to boot, he may in turn drive a bit more daringly.

The point, stresses Adams, is that drivers who feel safe may actually increase the risk that they pose to other drivers, bicyclists, pedestrians and their own passengers (while an average of 80% of drivers buckle up, only 68% of their rear-seat passengers do). And risk compensation is hardly confined to the act of driving a car. Think of a trapeze artist, suggests Adams, or a rock climber, motorcyclist or college kid on a hot date. Add some safety equipment to the equation — a net, rope, helmet or a condom respectively — and the person may try maneuvers that he or she would otherwise consider foolish. In the case of seat belts, instead of a simple, straightforward reduction in deaths, the end result is actually a more complicated redistribution of risk and fatalities. For the sake of argument, offers Adams, imagine how it might affect the behavior of drivers if a sharp stake were mounted in the middle of the steering wheel? Or if the bumper were packed with explosives. Perverse, yes, but it certainly provides a vivid example of how a perception of risk could modify behavior.

In everyday life, risk is a moving target, not a set number as statistics might suggest. In addition to external factors, each individual has his or her own internal comfort level with risk-taking. Some are daring while others are cautious by nature. And still others are fatalists who may believe that a higher power devises mortality schedules that fix a predetermined time when our number is up. Consequently, any single measurement assigned to the risk of driving a car is bound to be only the roughest sort of benchmark. Adams cites as an example the statistical fact that a young man is 100 times more likely to be involved in a severe crash than is a middle-aged woman. Similarly, someone driving at 3:00 a.m. Sunday is more than 100 times more likely to die than someone driving at 10:00 a.m. Sunday. Someone with a personality disorder is 10 times more likely to die. And let's say he's also drunk. Tally up all these factors and consider them independently, says Adams, and you could arrive at a statistical prediction that a disturbed, drunken young man driving in the middle of the night is 2.7 million times more likely to be involved in a serious accident than would a sober, middle-aged woman driving to church seven hours later.

The bottom line is that risk doesn't exist in a vacuum and that there are a host of factors that come into play, including the rewards of risk, whether they are financial, physical or emotional. It is this very human context in which risk exists that is key, says Adams, who titled one of his recent blogs: "What kills you matters — not numbers." Our reactions to risk very much depends on the degree to which it is voluntary (scuba diving), unavoidable (public transit) or imposed (air quality), the degree to which we feel we are in control (driving) or at the mercy of others (plane travel), and the degree to which the source of possible danger is benign (doctor's orders), indifferent (nature) or malign (murder and terrorism). We make dozens of risk calculations daily, but you can book odds that most of them are so automatic—or visceral—that we barely notice them.

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Could the Abortion Pill Prevent Certain Cancers?


There may be another use for the abortion pill — aside from stirring up controversy. Researchers from the University of California–Irvine have found that mifepristone, a chemical compound found in the abortion pill, helps thwart the growth of mammary tumors that often lead to breast and ovarian cancers.

The study, which will be published in Science, found that mifepristone prevents tumors by inhibiting progesterone — a female hormone involved in the menstrual cycle and pregnancy. Progesterone has been found to encourage mammary cells to spread in women that carry a breast cancer gene and in some cases, ultimately lead to cancer.

The researchers studied the affects of mifepristone, an anti-progesterone, on mice that had BRCA-1 — a mutated gene that significantly increases the risk of developing breast and ovarian cancers. More than half of women who have BRCA-1 will develop breast or ovarian cancer by age 70. The mice that were treated with mifepristone did not develop tumors by the time they were a year old, but the untreated mice all developed tumors by eight months of age.

What it means: Progesterone encourages tumors to develop when BRCA-1 is present by increasing the speed of cell division. But the researchers have discovered that when mifepristone is administered, it acts as a binding process and blocks progesterone. The discovery could lead to novel ways to prevent breast and ovarian cancer in women that have a genetic predisposition.

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Some Children Left Behind




Although their explanations differ, Illinois and Montana have both failed miserably in complying with the controversial federal education reform law.

Not since Lewis and Clark included both sprawling territories on their famed 19th century westward expedition have Illinois and Montana been so closely linked. But now they share a dubious distinction as the only two states to have failed thus far to compile and release standardized student test results for 2006 as required under the federal No Child Left Behind (NCLB) law, giving further fodder to the law's critics who claim test scores have little to do with providing a solid education in the first place.

In Illinois, a Kafkaesque series of computer glitches, printing and labeling mistakes and human error by the testing company and state education officials have prevented schools from determining whether they made adequate yearly progress on reading and math exams taken by third through eighth graders last spring. Montana officials, by contrast, argue that their tardy score reporting was in fact planned. Regardless, the delays means that students in both states are unable to know officially whether they are eligible for free tutoring or to transfer to another school if they attend a failing school, as mandated under the reform law. While a dozen states have experienced delays this year in getting their scores pulled together, none were as far behind as the bureaucrats in the Land of Lincoln and Big Sky Country.

Illinois officials initially blamed the cascading snafus on Texas-based Harcourt Assessments, which in March delivered to about a quarter of the state's 895 districts tests that were riddled with errors or had missing or duplicate pages. Some boxes arrived at schools containing no tests at all, requiring last-minute scrambling (and planes chartered by Harcourt) to distribute the exams in time. While the testing itself appeared to proceed without many problems, a mountain of mistakes ensued afterward during the largely automated scoring phase that delayed the processing. Illinois officials have also conceded to contributing to further hitches in the state's new student identification system. Designed to streamline the scoring process by assigning each student a number that included demographic and school data, in reality the scoring verification slowed to a crawl because district officials across the state entered incorrect information pertaining to race, income level and special education status for roughly 11,000 students, out of about 900,000 Illinois test-takers. The state originally promised final results would be released by Oct. 31. but officials say it will be well into the new year before the work is complete.

Montana school officials were sympathetic about Illinois' predicament, but quickly distanced themselves from the storm of errors and incompetencies that characterized their Midwestern counterpart. "We didn't have any assessments aligned to our standards prior to No Child Left Behind, so we we've had to build our tests from scratch," said Joe Lamson, communications director for the Montana Office of Public Instruction. Because 2006 was the first testing year that required assessments for every grade from third through eighth, Montana set a generous mid-January deadline to process its results. In 2005, only students in fourth, eighth and 10th were tested, so the state easily got its scores in by late August. "We wanted to give ourselves extra time this year to get all of our scoring calibrated properly. We've met all our deadlines along the way," said Lamson. The Montana spokesman couldn't lavish enough praise on its contracted testing company, New Hampshire-based Measured Progress, which he says has performed well on all aspects of its commitment. But it's worth remembering that Montana was only responsible for 60,000 student tests, less than one tenth of Illinois' workload.

Measuring the significance of late-arriving scores depends almost entirely on your perspective on standardized tests. As the federal NCLB law comes up for reauthorization next year, testing critics are quick to point to the extensive delays. "Nowhere have schools stopped functioning because of the missing test scores. But they also don't know if they've moved up or down the performance ladder," said education advocate Julie Woestehoff, executive director of the Chicago-based non-profit Parents United for Responsible Education. She hopes snafus like Illinois' may actually help in rethinking the law's parameters to include other forms of assessments in evaluating schools."These testing errors show the need for multiple measures like student grades and performance portfolios which are not as cheap and fast to administer, but are more accurate," Woestehoff says. In 2005, 84% of Illinois schools made adequate yearly progress based on established annual targets under NCLB, up from 71% the prior year.

Indeed, criticizing the states and testing firms charged with carrying out the federal law ignores a far more crucial issue: whether standardized tests can ever really drive high-quality education. Says author and well-known standardized test skeptic Alfie Kohn: "These recent problems with implementation pale beside the appalling effects of NCLB itself. It's when this law is working 'properly' with all the tests given, the numbers obediently reported, and the attendant punitive consequences enforced - that we really need to worry." Montana may not be sweating out its scores; last year, 92% of its schools made adequate yearly progress, one of the highest percentages in the nation. The state can only be grateful that speedy tabulation isn't part of the ranking system.

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How We Confuse Real Risks with Exaggerated Ones




Our emotions allow us to ignore some threats as we grow overly concerned with others.

Cass Sunstein earns his living researching how misplaced fears skewer our ability to assess risk, so he figured himself the last person to fall into the same trap. But when his teenage daughter planned a long-distance swim last summer, Sunstein found himself dwelling on the remote possibility she would drown. "It's crazy," says Sunstein, a University of Chicago law professor specializing in risk regulation. "But I couldn't counteract my brain's rapid, intuitive emotional system for evaluating risk."

Few of us can, and that's a dangerous problem. When our emotions overtake our reasoning we worry about sensational events which are statistically unlikely to harm us — such as airline disasters, shark attacks, or terrorism — rather than everyday dangers that kill thousands. John Graham, who spent four years as administrator of the federal Office of Information and Regulatory Affairs, says news of SUV tire failures left him besieged with demands for tire pressure warning systems even though government reports listed 41 car-crash deaths per year due to under-inflated tires, versus 9,800 deaths from side-impact crashes. "People's capacity to visualize a risk is an important part of the attention they give to it," says Graham. "If you're within six months of a Three Mile Island, a Love Canal, or a 9/11, the policymakers and the public don't have the patience for the kind of cerebral risk analysis we need."

That falls in line with what Princeton professor Daniel Kahneman coined "the availability heuristic": the concept that if people can think of an incident in which a risk has come to fruition, they will exaggerate its likelihood. "Somehow the probability of an accident increases [in one's mind] after you see a car turned over on the side of the road," says Kahneman, who won a 2002 Nobel prize for his work. "That's what availability does to you: it plants an image that comes readily to mind, and that image is associated with an emotion: fear."

But our experiences also sway us, goading our brains into assessing risks based on rapid whispers of positive or negative emotion. "If you look at genocide, we just don't react," says Paul Slovic, a psychology professor at the University of Oregon. "With 9/11 we lost 3,000 people in one day, but during 1994 in Rwanda 800,000 people were killed in 100 days — that's 8,000 a day for 100 days — and the world didn't react at all. Now you see the same thing with Darfur."

Nassim Taleb, a probability expert at the University of Massachusetts, says the first step to better risk assessment is understanding that most dramatic news images represent the exception rather than the rule. "Television," he says, "messes up the probabilistic mapping you have of the world." Our questionable math skills don't help either; most people have trouble distinguishing the statistical difference between one chance in 1,000 and one chance in ten million. "Both sound small," says Graham, "but one is ten-thousand-fold more likely." Understanding those numbers, rather than taking what Sunstein calls a "risk-of-the-month" approach, will save lives. "Right now we've got a lot of concern about vivid events," Sunstein says. "We'd do much better with a more disciplined approach."

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What We'll Be Dying Of

Michael Lemonick

It's been 13 years since the World Health Organization (WHO) issued a landmark report titled Global Burden of Disease, which forecast the most likely causes of death worldwide up to 2020. Now the WHO has come out with an update, based on the latest demographic data (from 2002) and reaching out until the year 2030. It's just been published in the online journal PLoS Medicine.

You can't predict the future with any certainty, of course, so the researchers played out three different scenarios, assuming optimistic, pessimistic and middle-of-the-road rates of economic development--a key in projecting disease and death rates.

Among the highlights: in all three scenarios, overall worldwide life expectancy should increase, overall mortality for kids under 5 and non-infectious diseases, including cancers and cardiovascular disease will increase as causes of death. That's partly because those illnesses tend to be consequences of higher incomes, and partly because infectious diseases will diminish (which also explains the drop in child mortality). One exception: AIDS, which will continue to grow as a killer. Even so, says the report, tobacco-related illnesses will cause half again as many deaths as AIDS by 2015.

Finally, the three leading killers worldwide by 2030: AIDS, heart disease and--a surprise--depression. That's true for all but the most optimistic of the three scenarios; if economic development is better than expected, then car accidents are likely to overtake heart disease for the #3 spot.

What it means: Public-health policy--what illnesses to tackle in order most effectively to keep people healthy longer--depends on knowing what the greatest risks are. This report helps public and private institutions figure out how best to allocate resources for future problems.

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An African Miracle




How a few doctors and some antiviral drugs brought a child with AIDS--and thousands like him--back from the dead.

It's hard to believe that these photos are of the same little boy. When 8-year-old Bokang Rakabaele arrived at the new pediatric-AIDS clinic in Maseru, the capital city of Lesotho, in May, he weighed less than 20 lbs. and was suffering from AIDS, pneumonia and tuberculosis. Today he's 18 lbs. heavier, his shy smile has returned, and he plays once again with other kids in the neighborhood. When I visited the clinic in August, Bokang was already on the mend. He was asked through an interpreter why he thought he was feeling so much better, and replied very simply, "It's the medicine."

Leave it to a child to get to the heart of the matter. For years, giving antiretroviral drugs (ARVs) to children living with AIDS in the poorest parts of the world was perceived as a lost cause. It's hard enough, the experts thought, to get ARVs to pregnant, HIV-positive women to reduce the chances they will infect their babies in utero or at birth. Pediatric versions of the drugs are expensive, and cutting down an adult dose of the medication to give it to a child is tricky. Without treatment, however, nearly a third of HIV-positive infants die by their first birthday, and half die by age 2.

Now Bokang and thousands of African children like him are getting the lifesaving treatment they need. What changed? Researchers showed that children respond faster and better than adults to ARVs, and it no longer seemed fair to ignore poor youngsters with AIDS. Then several groups rose to the challenge. The President's Emergency Plan for AIDS Relief allocated $63 million this year for the treatment of pediatric AIDS. The Clinton Foundation negotiated a 50% reduction in the price of a key medication. And a handful of nonprofit organizations, corporations and faith-based groups began sending more doctors to the developing world to help plug some of the health-care gaps for children.

The need is great. More than 2 million children in Africa under age 15 are living with HIV, according to a study published last week by UNAIDS and the World Health Organization. Of these youngsters, perhaps 660,000 are sick enough to require medical intervention. Yet only 1 in 20 children who need ARVs get them. In addition, fewer than 1 in 10 HIV-positive mothers receive the drugs they need to keep from transmitting the virus to their newborns.

This is usually the point at which most of us in the rich countries of the world throw up our hands in despair. Not so Dr. Mark Kline of the Baylor College of Medicine in Houston. "If you focus on the enormity of the problem, you'll never get started," says Kline, who has cared for hundreds of HIV-positive children over the years in the U.S. and has seen many of them grow old enough to have children of their own (see box). "You have to tackle it piece by piece."

Kline's plan for dealing with the ongoing emergency in Africa was to create several pediatric centers of excellence for AIDS. (Four have opened--in Botswana, Lesotho, Malawi and Swaziland--and four more are in the planning stages.) Then he set about finding the staff and the money to run them. Since there aren't enough doctors and nurses in most African countries, that meant recruiting young physicians from the U.S. to spend a year or two at the clinics. Most of the funding for the first class of 52 doctors in his Pediatric AIDS Corps comes from Bristol-Myers Squibb (BMS) and Baylor. The clinics were built with money from BMS and Abbott. But the day-to-day operating budgets of the centers are the responsibility of local governments.

You can already see the difference in Lesotho, a tiny mountain kingdom of 2 million people surrounded by its much larger and richer neighbor, South Africa. At least 22,000 Basotho children are HIV positive, but as of two years ago, fewer than 20 were on ARVs, and there were only two doctors in the whole country looking after children with AIDS. In the year since the children's clinic opened on the outskirts of Maseru, 700 kids--including Bokang--have received treatment from 10 pediatricians.

Kline expects that the influx of U.S. doctors will be temporary. The plan is to dramatically increase the ability of local health-care staff to treat children with AIDS. To that end, the children's clinics and their doctors, including the Pediatric AIDS Corps, have provided training in the past six months for about 3,600 health-care workers.

The Americans aren't alone in their efforts. Dr. Edith Mohapi was born in Lesotho and left when she was 17 to pursue advanced studies and medical school. She returned last year to run the clinic in Maseru and was joined earlier this summer by her daughter Dr. Lineo Thahane, also a pediatrician and one of the first Pediatric AIDS Corps members. The nurses, social workers and other staff are also from Lesotho.

Their optimism in the midst of extreme difficulty is contagious. "It's hard to see children that sick," Mohapi says. "But children respond so quickly--that's why I went into pediatrics--and after just a few weeks of us treating them, they come back, and they're smiling, they're running, and they're eating better."

Not everything runs quite as it should yet. While the ARVs are free, getting to the clinic is not. A ride in one of the ubiquitous minivans everyone uses for public transportation can cost $1 or more--an exorbitant sum when you're living on $1 or less a day. Because the government's telecommunications agency wants more money than Mohapi's budget allows to set up high-speed Internet access, the clinic still depends on a sluggish dial-up connection. Meanwhile, the center has become a de facto emergency room for the neighborhood--further evidence of the fragile state of basic health care in the region.

What happens next in Lesotho and the rest of sub-Saharan Africa depends a lot on how broadly these first efforts expand. All the ARVs in the world aren't going to help much if children and their families don't have enough food to build up their strength or clean water to keep from picking up infections. Tough as it has been to focus attention on children with AIDS, it has been harder for clinics to get and use a common antibiotic to prevent pneumonia and other ills in HIV-positive children who don't yet need ARVs. "One of the biggest obstacles in treating children has been having a consistent guardian," says Dr. Martha Sommers, head of clinical services at Embangweni Hospital, a church-run facility in rural Malawi. "Often the guardian is sick or dying, or the children are orphans and getting passed from one guardian to the next."

Some of the challenges go even deeper. "I did not realize how much women lack basic rights in this country," Dr. Julia Kim writes from Swaziland, north of Lesotho. Women traditionally turn over all their income to their husbands, she says, and defer to them on matters of treatment--a practice Kim struggled with when trying to convince one father that immediate care was needed for his daughter whose immune system had collapsed.

Nor are all children who come to the clinics infected at birth. In some parts of sub-Saharan Africa, teenage girls are now eight times as likely to be infected with HIV as their male peers. Study after study has shown that the best way to ensure that young girls who are HIV negative remain that way is to keep them in school, delay sexual intercourse and marriage, help them get good jobs and allow them greater control of their income.

Still, there is reason for hope. The mortality rate for children with AIDS at Baylor's pediatric clinic in Botswana has fallen from nearly 5% in 2003 to 0.3% this year. Other groups are scaling up. More than 1,400 children are receiving antiretroviral therapy in Rwanda--up from 354 in 2004--and more than a third of pregnant women are getting treatment to preserve their lives and reduce the risk of delivering an HIV-positive infant, according to UNICEF. There will always be more to do, but at long last the work has begun.

To see video from the Lesotho clinic and read more about U.S. doctors in the Pediatric AIDS Corps, visit time.com/aidskids

With reporting by With reporting by Alice Park / Houston

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The classes of hassles


It is literally impossible to get through even a single day without encountering one or more of the endless varieties of hassles. As you read through the following list, think about an average day and how these hassles, commonly called stressors, may be reducing your enjoyment of life.

  • Emotional hassles. This category includes the fears and anxieties we struggle with. For example: Can we prevent nuclear war? What if I run out of gas? How am I going to pay the light bill?
  • Family hassles. Interactions with family members can be stressful: The striving of teenagers for independence, a spouse who drinks too much, in-laws visiting.
  • Social hassles. Our interaction with other people: Asking a person for a date, expressing anger at another's behavior, giving or going to a party.
  • Change hassles. There's a limit to the amount of change we can comfortably sustain before something becomes a hassle: Leaving a job, buying a house, moving to a new city. You may be able to handle one or even two changes at once, but the third could send you spinning.
  • Work hassles. Whether you work in an office or from home, you'll experience work-related stresses like asking for a raise, rushing to meet deadlines, or cleaning tracked-in mud off the floor for the fourth time in one day.
  • Commuting hassles. This is the category of unpleasant life events like the stress of discourteous or reckless drivers that occurs in rush hour traffic. It also includes the hassles of air, bus, or train travel.
  • Decision hassles. Making decisions, especially regarding important issues or when there is no perfect solution to a problem, can drive you bananas: Should I have the surgical procedure now or wait? Should my aged parent be institutionalized? Should I get a divorce?
  • Pain hassles. Pain stressors are the aches and pains of new and old injuries, or of ongoing medical conditions like a sore tooth, migraine headaches, and PMS. Chronic pain and discomfort can lead to social isolation and depression.
  • Environmental hassles. This category of stressors includes aspects of our surroundings that are often unavoidable: Smoke-filled rooms, cramped offices, the glare of the sun, or the cold of winter.

The first step toward managing your stress is to identify the external events that set you off. And now that you can recognize the day-to-day categories of life's hassles and that you're not alone in combating them, let's peer into the inner part of the story of stress. This discussion will give you a better understanding of why stress affects you in the way it does.

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How Foods Can Affect Cancer




Good news for soy-based foods, bad news for T-bone steaks.

What do steak, tofu and sushi have to do with cancer? Plenty, it seems, if several new studies served up at the American Association for Cancer Research in Boston are to be believed. And not all bear good news: the latest report from the sprawling Nurse's Health Study, for example, detected an unsettling association between red meat and breast cancer.

The report that interested me most looked at the association between breast cancer and soy-based foods. This is a controversial topic because soy contains isoflavones, some of which in isolated form can stimulate the growth of estrogen-receptor-positive breast-cancer cells. That's why many Western doctors warn women against eating soy. Yet the epidemiological evidence has been promising: Asian women on diets rich in soy have significantly lower rates of breast cancer than Western women have.

So I was particularly gratified by a new study of Asian-American women done by the National Cancer Institute (NCI). It looked at women who ate a lot of soy-based foods as children, adolescents and adults. The strongest and most consistent association was among women who ate the most soy-based foods from ages 5 to 11. They reduced their risk of developing hormone-fueled breast cancer 58%, compared with women who ate the least. The reduction for women who ate a lot of soy as adolescents and adults was 25%. Regular, moderate consumption of whole-soy foods (such as soy nuts, edamame, soy milk, tofu and tempeh) probably affects the development of breast tissue in young females, possibly making it more resistant to carcinogens, including estrogenic agents in the environment.

The lead researcher of the NCI study says it would be premature to recommend changes in children's diets on the basis of these results, but I don't agree. Women who have a family history of breast cancer ought to be introducing their kids to soy foods as early as possible. Substituting soy milk for cow's milk is one way to start. I believe the same thing will be shown to hold true for boys; a similar diet may lower their future risk of prostate cancer.

The other piece of good news came out of a large population study of more than 22,000 U.S. physicians. It found that men who ate fish five or more times a week had a 40% lower risk of developing colorectal cancer than men who ate it less than once a week. I've long believed that the omega-3 fatty acids in oily fish inhibit the COX-2 enzyme that increases both inflammation and cell proliferation.

The bad news came in another large population study, this one of more than 90,000 nurses. A report published in the Archives of Internal Medicine found that the risk of estrogen- and progesterone-receptor-positive breast cancer increased most in those nurses who ate the most red meat. Women who ate more than 1 1/2 servings of red meat a day had nearly double the risk, compared with those who ate three or fewer servings a week. The authors offered several theories for what's behind the correlation. One possibility is that red meat delivers too much iron in a form that promotes cancer. Another is that carcinogens form in meat as it is cooked. Yet another (and one that I would bet on) is that conventionally raised beef carries residues of the hormones ranchers give cattle to make them grow faster.

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