Monday, August 24, 2009

News Clipping Archives

 

 

Maryland / Regional

O’Malley: budget cuts may hurt swine flu response (Carroll County Times)

Md. health officials report 7th death linked to swine flu (Baltimore Sun)

Md. gov: budget cuts may hurt swine flu response (Washington Examiners)

Maryland Public Schools Prepare For H1N1 Virus (ABC2News.com)

Schools urged to prepare for swine flu absences (Associated Press)

Flu Strategists See Schools on Front Line (Washington Post)

Man, 87, charged in death of fellow senior home resident, 91 (Baltimore Sun)

Md. state employee furloughs range from 3-5 days (USA Today)

Md. Employees Face Up to 10 Days Unpaid Leave (Washington Post)

 

National / International

Overuse of antivirals could make H1N1 pandemic even worse (Baltimore Sun)

Health panels are nothing to fear (Baltimore Sun)

Infant car seats can cut off air to babies (Baltimore Sun)

Hazards: Lead Illness in Children Linked to Car Seats (New York Times)

Doctors address depression in pregnancy (Baltimore Sun)

Teens abusing ADHD medication, study finds (Baltimore Sun)

Panel Recommends Speeding Swine Flu Vaccine Access (Washington Post)

A Virus’s Debut in a Doctor’s Syringe (New York Times)

Experiencing Life, Briefly, Inside a Nursing Home (New York Times)

Prevention: Hospitals Expand Their No-Smoking Zones (New York Times)

Disparities: Study Finds Risk in Off-Label Prescribing (New York Times)

Sick day leniency encouraged as flu season nears (Salisbury Daily Times)

Viruses: Veterinarian in Australia Is Sickened After Being Exposed to a Rare Virus (New York Times)

Russia Bracing for Spread of Dangerous TB Strains (Washington Post)

 

Opinion

My Health-Care Story: Refuse a Test, Pay a Price (Washington Post Letter to the Editor)

My Health-Care Story: Well Served by the System (Washington Post Letter to the Editor)

Health care is in need of major reform (Carroll County Times Letter to the Editor)

 

Maryland / Regional

O’Malley: budget cuts may hurt swine flu response

 

By The Associated Press

Carroll County Times

Monday, August 24, 2009

 

LARGO — Gov. Martin O’Malley says budget cuts to be announced this week could affect the ability of the state and local governments to respond to a swine flu outbreak.

 

O’Malley says he’s hopeful that federal grants will help make up the difference.

 

Maryland has already received millions of federal dollars for planning its response to swine flu but has not yet received money for distribution of the vaccine.

 

State health secretary John Colmers says the state’s plan is still to make the vaccine available to every Maryland resident who wants it. But Colmers says it’s difficult to predict when the supply of the vaccine will be sufficient to offer it to everyone.

 

Seven Maryland residents have died of swine flu including an elderly person from the Washington suburbs whose death was announced Monday.

 

Copyright 2009 Carroll County Times.

 

Md. health officials report 7th death linked to swine flu

 

By Stephanie Desmon

Baltimore Sun

Monday, August 24, 2009

 

A seventh Marylander has died from the H1N1 flu, health officials reported this morning, this time an elderly adult from the Washington suburbs with serious underlying medical conditions.

 

Officials, as in previous deaths from the swine flu, offered no other details about the deceased.

 

As of last week, 522 people nationwide have died after contracting H1N1 influenza and 7,983 people have been hospitalized, according to the Centers for Disease Control and Prevention.

Copyright 2009 Baltimore Sun.

 

Md. gov: budget cuts may hurt swine flu response

 

Associated Press

By: Ben Nuckols

Washington Examiners

Monday, August 24, 2009

 

LARGO, MD. — Budget cuts to be announced this week could affect the ability of state and local health departments to respond to the swine flu pandemic when the virus returns in earnest this fall, Gov. Martin O'Malley said Monday.

 

The Democratic governor plans to detail $470 million in proposed cuts on Tuesday and the state health department will not be spared, despite the likelihood of an unusually active flu season.

 

"Our hope is that (the cuts) will be offset to a large degree by the federal government, and that working together, we can figure out a way to protect the public health even in a time when we see our revenues contracting," O'Malley said.

 

Maryland's Department of Health and Mental Hygiene has already received two federal grants worth more than $9 million combined to help plan its response to swine flu, also known as the H1N1 virus.

 

The federal government is also paying for distribution of the swine flu vaccine, which is expected to be available to the public by mid-October, health secretary John M. Colmers said. He said the amount of money the state receives will be roughly based on population.

 

"Just like every other state agency, the health department is finding ways to do more with less," said Shaun Adamec, a spokesman for the governor. But Adamec said that even if budget trims affect public agencies' response to the swine flu, "That doesn't mean that it will in any way put anyone at risk or at any greater threat to H1N1 than we have been before."

 

Colmers said the state still plans to make the swine flu vaccine available to every resident who wants it, a goal that some experts have called unrealistic. But when the department gets its initial supply, the goal will be to immunize the roughly two million Marylanders for whom vaccination is considered a high priority. Those include health care workers, pregnant women, children and people with compromised immune systems.

 

The state should ultimately have enough of the vaccine to offer it to the remainder of the population but it's impossible to predict when supplies will reach that level, Colmers said.

 

Seven Marylanders have died of swine flu, including an elderly person from the Washington suburbs whose death was announced Monday. Six of the seven had serious, underlying medical conditions, health officials said.

 

Nationwide, the virus is believed to be responsible for more than 520 deaths.

 

The governor also announced Monday that the state is using a computer system that allows hospital emergency rooms to share real-time data on patients' symptoms and suspicious patterns of illness. The tracking system will be used to keep tabs on the spread of swine flu. All 46 of Maryland's acute-care hospitals are participating voluntarily in the system, making the state the first in the nation with 100 percent participation, O'Malley said.

 

O'Malley and Colmers urged Marylanders to schedule their seasonal flu shots promptly and to take the usual precautions when they exhibit symptoms.

 

"The message is, if you are sick, stay at home," Colmers said. "We call that community mitigation. My mother called it common sense."

 

Copyright 2009 Washington Examiners.

 

Maryland Public Schools Prepare For H1N1 Virus

 

By Jeff Hager

ABC2News.com

Monday, August 24, 2009

 

Parents are growing anxious over the lack of information on how they’re supposed to protect their children.

 

"(I’ve heard) absolutely nothing actually about it, so I'm waiting until school starts to find out about it," said a parent, Susan Emge, outside Freetown Elementary School in Glen Burnie.

 

"I don't know if they're going to do vaccines in the school or have all the children go to the local health department," added another parent, Tamara Wiseman.

 

Trials on children began last week, but the timetable for producing mass doses of the vaccine still points towards mid-October.

 

Federal health officials have now identified five priority groups for that vaccine.

 

"That'll include pregnant women, people from the ages of six months to 24 years... healthcare workers,” said Maryland Health & Mental Hygiene Secretary John Colmers, “It'll also include adults with underlying health conditions and individuals who live with or are around children under six months of age."

 

Governor Martin O’Malley says Maryland is the first state in the country where every acute-care hospital is committed to an early-warning system where they’ll monitor emergency room visits for any sign of an outbreak.

 

As parents wait for a vaccine, he’s urging them to get their children immunized for the ordinary or seasonal flu.

 

"That vaccine is already available, and citizens should make sure fight away that they schedule time with their doctor to get that seasonal flu shot," said Gov. O’Malley.

 

In the meantime, schools are also prepared to look for signs of infection among their returning student populations.

 

"What's new for us is monitoring the daily attendance and sharing that with the health department and sharing the daily who gets sent home, if anyone, from the health room," said Anne Arundel County Schools Superintendent Kevin Maxwell.

 

The state is lobbying health insurance companies to cover the costs of the two-shot H1N1 vaccine for students, and the government will provide it for free to those without coverage.

 

 Copyright 2009 The E.W. Scripps Co. All rights reserved.

 

Schools urged to prepare for swine flu absences

 

By Nafeesa Syeed

Associated Press

Monday, August 24, 2009

 

Schools should be ready with hard-copy packets and online lessons to keep learning going even if swine flu sickens large numbers of students, U.S. Secretary of Education Arne Duncan said Monday.

 

Speaking at an elementary school on the first day of classes in Washington, Duncan released recommendations on how educators can ensure instruction continues should the virus cause high absenteeism or school closings.

 

"As the school year begins, I'm concerned that the H1N1 virus might disrupt learning in some schools across the country," he said.

 

Duncan said schools should evaluate what materials they have available for at-home learning. The latest guidance provides more details on methods schools could use, such as distributing recorded classes on podcasts and DVDs; creating take-home packets with up to 12 weeks of printed class material; or holding live classes via conference calls or "webinars."

 

Federal officials said earlier this month schools should close only as a last resort. They also advised that students and teachers can return to school or work 24 hours after their fever is gone; the old advice was to stay home for a week. The virus prompted more than 700 schools to temporarily close last spring.

 

Duncan was joined by U.S. Health and Human Services Secretary Kathleen Sebelius and representatives from several technology companies and publishers, such as Apple, Microsoft and Pearson, which are working with the Education Department to offer print and online resources, some of which could be free, to schools severely affected by swine flu. The details are still being worked out, but the companies might offer technology to allow students and teachers to communicate virtually, provide published instructional material, and provide computer servers that can handle transferring large amounts of teaching material.

 

Sebelius said clinical trials of the swine flu vaccine "look good" and it could possibly be administered by mid-October.

 

"We anticipate using schools as partners to make sure that we reach out to kids who are a priority population to get the vaccination," she said.

 

2009 Associated Press.

 

Flu Strategists See Schools on Front Line

Children Key to Infection-Prevention Dynamic

 

By Nelson Hernandez and David Brown

Washington Post

Monday, August 24, 2009

 

One of the main battlegrounds in the fight against an expected resurgence of swine flu this fall will be the schoolyard, a place where the disease could, well, go viral.

 

People between 6 months and 24 years old appear to be particularly vulnerable to the swine flu virus, known as H1N1. And there are several reasons to think that schools could be hotbeds of infection:

 

Large groups of children and young adults? Check.

 

In close proximity? Check.

 

Lax sanitary standards? Check.

 

And with schools expected to remain open unless the virus becomes more severe, there's little standing in the way of H1N1's spread.

 

At the same time, schools are likely to serve as centers for mass immunizations, which could sharply reduce H1N1's reach, according to the Centers for Disease Control and Prevention and state and local authorities. So far, the swine flu does not appear to be more dangerous than the typical seasonal flu. But medical authorities are concerned that it could infect many more people -- thereby increasing the potential number of deaths -- because so few people have immunity against it.

 

The mass immunization program, likely to be the largest of its kind since the polio vaccine was given to about 100 million Americans in the 1960s, will play out with some differences between states and local jurisdictions. For instance, still waiting to be resolved are questions about who gets the vaccine, whether schools are used as vaccination sites, whether parents are present when children are vaccinated and whether the vaccine is administered by injection or nasal spray.

 

Health officials in Virginia, Maryland and the District said that at least some school campuses will be used as vaccination sites. Schools reopen today in the District and in parts of suburban Maryland.

 

"There's considerable interest out there from the local health departments and school districts to do it in the schools," said Jim Farrell, director of the immunization division of the Virginia Department of Health.

 

Elsewhere, officials suspect that schools will be used less.

 

"Our school health system . . . is not very well-funded," said David Fleming, public health director and health officer for Seattle and King County, Wash. "We don't have the staff in the schools to do it. There's also the cumbersome process of getting parental permission. So doing it during school hours may not make a lot of sense."

 

In Cuyahoga County, Ohio, officials expect that schools will be used at nights and on weekends so parents can be present.

 

"Parents are going to want to be there to support their kids for vaccination," said Terry Allan, the county health commissioner.

 

Maryland has more experience than most states in preparing to fight flu. In the 2006-07 flu season, it was the first state to offer vaccinations in all public elementary schools, partly because of a large donation of nasal-spray vaccine by MedImmune, a biotech company in Gaithersburg. Several other states now offer or require statewide seasonal flu immunizations for children.

 

Virginia and the District have no such program, although Virginia officials said some jurisdictions in the state's rural southwest had offered school-based vaccinations. Dena Iverson, a spokeswoman for the D.C. Department of Health, said there were "a number of programs in place that serve as mechanisms to get vaccine" to children.

 

In the Maryland initiative, about 80,000 5- to 11-year-olds were immunized, out of 490,000 children in that age group in the state. Participation varied widely, from about 10 percent in Baltimore City to 58 percent in St. Mary's County. In the next two years, when local governments had to buy the vaccine, only seven of Maryland's 24 major jurisdictions continued the program.

 

This year, Maryland is using some of its federal economic stimulus money to again offer seasonal flu vaccine in elementary schools. The state will also offer swine flu vaccine, said Greg Reed, manager of the Center for Immunization at Maryland's health department.

 

The swine flu vaccine will probably arrive after the seasonal vaccine and will target a much larger group of students -- everyone through 12th grade. How and where it will be offered -- and how to reach students in private and home schools -- is the subject of intense planning, Reed said.

 

Diane Helentjaris, director of Virginia's H1N1 office, said the vaccine is expected to be available by mid-October, but officials don't know in what quantity.

 

Research shows that school-based vaccination can measurably reduce illness.

 

A study published last summer compared school absentee rates in Carroll County, where 44 percent of elementary students got flu vaccine in 2005, with the rates in neighboring Frederick County, where there was no such program. Frederick absenteeism went up from 2 percent to almost 4 percent during flu season; in Carroll, it rose much less, from about 2.5 percent to 3 percent.

 

A relatively small increase in absenteeism was also seen in high schools, although they held no immunization programs. That suggests, as does much other research, that young children are a major force in spreading flu.

 

The ability of schools to track sick students might also prove crucial to understanding the spread of swine flu. Health officials nationally are developing a questionnaire that would provide a useful snapshot without burdening local health departments. Information on the amount of illness in schools will be essential, said Jack Herrmann, a specialist in preparedness at the National Association of County and City Health Officials.

 

"It is no secret that the school dismissal issue is foremost in the minds of everybody, from the White House on down," Herrmann said. "Clearly, some idea of what is going on in schools is going to be of great interest."

 

Teachers and principals across the region are being briefed on what to do about swine flu. About 200 Fairfax County principals received advice on hand washing and other anti-flu measures from health officials one day this month, and they left the meeting room with a pamphlet that declared, "Schools Are the Front Lines in Flu Prevention."

 

"It's a natural occurrence in nature that we have these," said Fred Ellis, the Fairfax school system's director of safety and security. "It's going to come. The best thing we can do is try to mitigate these outcomes."

 

The briefing ranged over various subjects, including what to do with children who go to school sick (they are to be given surgical masks and placed in an isolation room until their parents pick them up) and how to maintain an online site to allow students to keep up with assignments while they are sick at home. The principals asked about what cleaning products worked best and about what to clean and how often, prompting Ellis to tease them about being "germaphobes."

 

But cleanliness is important. Apart from a vaccine, the best way to prevent the disease's spread is for people to wash their hands regularly with soap and water.

 

Some officials recommend singing a song to make sure that hands are being washed long enough.

 

In a letter to parents, D.C. Schools Chancellor Michelle A. Rhee and D.C. Health Department Director Pierre Vigilance suggested: "A good way to make sure your children are scrubbing their hands for the right amount of time is to sing the Happy Birthday or Row, Row, Row Your Boat songs twice."

 

Staff writer Rob Stein contributed to this report.

 

Copyright 2009 Washington Post.

 

Man, 87, charged in death of fellow senior home resident, 91

Fatal beating at Columbia facility is Howard County's first homicide of year

 

By Baltimore Sun reporter

Baltimore Sun

Monday, August 24, 2009

 

An 87-year-old man was charged Monday in the beating death of a fellow resident at a Columbia assisted living community, Howard County's first homicide of 2009, according to police.

 

Earl Lafayette Wilder was charged with second-degree murder and first- and second-degree assault in the attack against James W. Brown, 91, who died Saturday of head trauma, according to authorities. Police said he had been under hospice care after the attack last week.

 

Officers were called about 4 p.m. Aug. 17 to the Harmony Hall assisted living home in the 6300 block of Cedar Lane for a reported assault, according to police. Wilder and Brown -- both residents of the community -- were sitting outside when Wilder began striking Brown in the head before facility staff intervened, police said.

 

Investigators do not believe Wilder and Brown knew one another before the attack, which police said was apparently unprovoked. Brown was initially treated at Laurel Regional Hospital before entering hospice care, according to police.

 

Wilder was taken to Howard County General Hospital for an evaluation after the attack. Police said the charging warrant would serve as a detainer for Wilder, who was being held at an undisclosed facility pursuant to a court order.

 

The case marks the county's first homicide since October 2008, according to police. There were four homicides in the county last year, police said.

 

Copyright © 2009, The Baltimore Sun.

 

Md. state employee furloughs range from 3-5 days

 

Associated Press

USA Today

Monday, August 24, 2009

 

ANNAPOLIS, Md. (AP) — Maryland budget officials have outlined a furlough plan for state employees to help address a big budget shortfall.

 

Gov. Martin O'Malley's administration has been negotiating with labor unions for weeks on how to implement furloughs.

 

Under the Maryland Department of Budget and Management plan, the government will be shut down for five days in which employees who do not work in essential emergency services will not be paid.

 

Employees who make less than $40,000 will have the option to use earned, personal or compensatory leave to make up for two of those days, and the overall loss in salary will be spread out over the fiscal year.

 

Employees who make $40,000 or more will take and additional three to five furlough days of their choosing.

 

The furlough days under the plan are scheduled near holidays, including Sept. 4, Nov. 25, Dec. 24, Dec. 31 and May 28.

 

Copyright 2009 The Associated Press. All rights reserved.

 

Md. Employees Face Up to 10 Days Unpaid Leave

 

By John Wagner

Washington Post

Monday, August 24, 2009

 

Maryland state employees will be forced to take as many as 10 days of unpaid leave as part of a new round of budget cuts that Gov. Martin O'Malley plans to propose this week, aides said.

 

The $470 million in mid-year cuts that O'Malley (D) is expected to formally propose Wednesday will also include reductions in state aid to local governments and additional cuts to state agencies. The latest round of cuts is part of an ongoing effort to close a $700 million shortfall in the state's $13 billion budget that emerged just weeks into the new fiscal year, as tax revenue continues to lag in the bad economy.

 

Under O'Malley's plan, state government would shut down non-essential services for five days during the remaining 10 months of the fiscal year. Most state employees would forgo pay on those days, resulting in a roughly 2 percent reduction in their salaries.

 

State employees would also be forced to take as many as five additional furlough days, with higher-paid employees required to take more unpaid leave than their lower-paid counterparts.

 

Unlike a furlough plan implemented last year, employees that provide round-the-clock services, including correctional officers and state troopers, could also be required to take unpaid leave, aides said. Those employees would take fewer days off, however. Additional concessions have been built in for state employees making less than $40,000.

 

The plan, as described by O'Malley administration officials, would save more than $60.million this year. That amount will grow if leaders of the judiciary and General Assembly also require their employees to take unpaid leave. O'Malley cannot order those employees to do so.

 

Patrick Moran, director of AFSCME Maryland, the labor union that represents the largest number of state workers, said he had not seen a finalized plan from O'Malley. But Moran made it clear that unions are not happy with the furloughs.

 

"The bottom line is furloughs are not something we view as a positive," Moran said. "They will have negative ramifications on services in a number of ways."

 

Representatives of O'Malley's administration have been negotiating the planned furloughs with union leaders in recent weeks but are not required to reach an agreement to implement them.

 

The furlough plan will be part of the package that O'Malley presents to the Board of Public Works on Wednesday. The three-member board is authorized to cut the state budget when the legislature is not in session.

 

The largest savings, about $250 million, will come from reductions in state aid to local governments.

 

In a speech this month to county leaders, O'Malley said cuts were likely to local health services, police departments, community colleges and road maintenance.

 

O'Malley also suggested cuts in "disparity grants" that the state makes to Baltimore and seven counties, including Prince George's. The grants are intended to help jurisdictions that cannot raise as much money in per-capita income taxes as more affluent counties.

 

O'Malley, the former mayor of Baltimore, has largely resisted cutting aid to local government in previous rounds of budget cuts. But the aid -- which amounts to 40 percent of the state's general fund budget -- has become an increasingly attractive target as the economic downturn continues.

 

During this year's legislative session, lawmakers lopped off almost $162 million in local road funding, nearly a quarter of the aid counties were expecting from the state. Any cuts O'Malley proposes Wednesday will come on top of that hit.

 

O'Malley plans to brief legislative leaders on the latest round of cuts Tuesday morning.

 

Copyright 2009 Washington Post.

 

National / International

Overuse of antivirals could make H1N1 pandemic even worse

Tamiflu and Relenza are key to fighting the flu virus. But medical authorities warn: Use only when needed, and use them correctly.

 

By Shari Roan

Baltimore Sun

Monday, August 24, 2009

 

Indiscriminate use of antiviral medications to prevent and treat influenza could ease the way for drug-resistant strains of the novel H1N1 virus, or swine flu, to emerge, public health officials warn -- making the fight against a pandemic that much harder.

 

Already, a handful of cases of Tamiflu-resistant H1N1 have been reported this summer, and there is no shortage of examples of misuse of the antiviral medications, experts say.

 

People often fail to complete a full course of the drug, according to a recent British report -- a scenario also likely to be occurring in the U.S. and one that encourages resistance. Stockpiling is rife, and some U.S. summer camps have given Tamiflu prophylactically to healthy kids and staff, and have even told campers to bring the drug to camp. Experts anticipate more problems in the fall as children return to school and normal flu season draws nearer.

 

"Influenza viruses mutate frequently and any viral resistance could be acquired easily," said Dr. Anne Schuchat, director of the National Center on Immunization and Respiratory Disease at the Centers for Disease Control and Prevention in Atlanta. "It won't surprise us if we see resistance emerge as a bigger problem in the fall or in the years ahead."

 

Prescribed in pill form, Tamiflu (oseltamivir) works by preventing the flu virus from leaving infected cells and spreading to new ones. Because a vaccine against pandemic H1N1 influenza will not be widely available for several months, Tamiflu and to a lesser extent Relenza (zanamivir), an antiviral that acts similarly, are key medical tools for fighting the pandemic in the meantime.

 

On Friday, however, the World Health Organization advised doctors that even those who are sickened with swine flu do not need to be given Tamiflu or Relenza if they are only mildly or moderately sick and are not in a high-risk group (such as children under 5, pregnant women and those with an underlying health condition).

 

Both drugs can help prevent illness in people exposed to the virus and reduce illness severity in people already sickened with it. On Aug. 14, after U.S. national soccer team forward Landon Donovan was diagnosed with H1N1 flu, players, coaches and support staff of the U.S. and Galaxy teams were advised to take Tamiflu as a preventive measure.

 

Tamiflu was chosen a few years ago for stockpiling by the federal government to deal with future pandemics.

 

Health authorities in the United States and elsewhere are keeping a sharp eye on prescriptions of the drug as they prepare for a surge of H1N1 cases in the fall. The U.S. government has issued detailed guidelines on prescribing antivirals. But health professionals may not follow the recommendations or may give in to patients who pester them for prescriptions that are ill-advised, said Dr. Robert Schechter, acting chief of the immunization branch of the California Department of Public Health.

 

"These medicines can be very helpful to those who could get very sick," Schechter said. "But excessive use will accelerate the development of resistance and lead to the lack of a medication for everybody."

 

Anxiety over indiscriminate use is growing, and taking the medications cavalierly is not without consequence. British health authorities reported Aug. 2 that cases of side effects from Tamiflu had doubled in the prior week, coinciding with the July 24 launch of a program in England to provide antivirals to anyone with H1N1 influenza who requests it over the phone or online.

 

In the first three days of the program, 150,000 packets of Tamiflu were dispensed and 293 cases of side effects were reported. Tamiflu can cause vomiting, diarrhea and mild neuropsychiatric effects.

 

Some U.S. health authorities have also expressed concern over misuse of the medications. Last month, the CDC urged directors of summer camps to stop handing out Tamiflu to healthy campers.

 

Americans are known to hoard antivirals: A 2006 study showed that heightened anxiety over a possible avian flu pandemic caused Tamiflu prescriptions to soar 300% in 2004 and 2005.

 

Just as with antibiotics, of central importance to antivirals' success is taking them properly, including completing the recommended course.

 

However, a study published in late July found poor adherence among children in London who took Tamiflu for prevention of pandemic H1N1 in the spring.

 

Less than half of the grade-school-age children and only 76% of the 13- and 14-year-old students completed a full course of medication.

 

More than half of the children reported side effects, such as nausea, stomach cramps and trouble sleeping. Almost one in five reported a neuropsychiatric side effect, such as poor concentration, confusion or bad dreams, even though the U.S. Food and Drug Administration says neuropsychiatric side effects are rare.

 

Moreover, a study published this week found that Tamiflu and Relenza are unlikely to prevent complications, such as asthma flare-ups or ear infections, in children who have seasonal influenza. But they do increase the risk of vomiting.

 

The authors of the study, published in the British Medical Journal, said they don't know if their findings can be generalized to the pandemic flu strain.

 

Antiviral drugs can be underutilized as well as overused, Schechter said. Some Californians who have died from novel H1N1 influenza did not receive antivirals.

 

"I'm afraid the medications are not being used in some instances where they should," he said. "But there are also international reports of resistance developing. Both of those extremes are concerning."

 

A handful of resistant H1N1 cases have been reported worldwide among people who had taken Tamiflu preventively: three in Japan, and one each in Canada, Hong Kong and Denmark.

 

Those cases are not surprising nor of great concern to health authorities, said Dr. Tim Uyeki, a medical epidemiologist with the CDC. They are cropping up sporadically and don't seem to be spreading from person to person.

 

"The most important question for public health is not whether sporadic cases occur but whether there is ongoing transmission of oseltamivir-resistant strains," Uyeki said.

 

The most perplexing case of Tamiflu resistance arose in June when a San Francisco teen who had flown to Hong Kong was found by authorities there to be ill with pandemic H1N1 flu. The girl, who recovered, had never taken Tamiflu.

 

A state investigation of people who were in close contact with the girl, as well as tests of 251 H1N1 virus samples from sick patients in California, has not turned up evidence of a resistant strain circulating here, Schechter said.

 

But nothing, in theory, would stop such a strain from developing, then circulating. In recent years, several strains of regular, seasonal H1N1 influenza have developed resistance to antiviral medications.

 

And a study published in March on the spread of the H5N1 avian flu, which has been circulating worldwide in bird flocks in recent years and has killed 262 people, showed the virus rapidly developed resistance to a different class of antiviral drugs, adamantanes.

 

"With bird flu, we found some resistance started in China and spread throughout the world in a few years," said study author Daniel Janies, an evolutionary biologist at Ohio State University. "Overuse contributes to resistance. Basic natural selection predicts it. We can demonstrate why you should not use these drugs unless you have to."

 

Other antiviral drugs exist, but the pandemic H1N1 virus is resistant to the adamantane class. If it develops resistance to Tamiflu also, only Relenza would be left to treat the illness, barring the development of new antiviral medications.

 

Relenza, Schechter said, is indicated only for ages 5 and older. Used less commonly than Tamiflu, it is inhaled as a powder, and people who are seriously ill or have difficulties with breathing cannot take it.

 

"The more choices you have, the better for treatment," Schechter said. "To lose any one of those options would pose great challenges for treatment of those who are most vulnerable or likely to die."

 

Grahame L. Jones contributed to this story.

 

shari.roan@latimes.com

 

grahame.jones@latimes.com

 

Copyright © 2009, The Los Angeles Times.

 

Health panels are nothing to fear

 

By Adran Baker

Baltimore Sun

Monday, August 24, 2009

 

One of the proposals for health care reform is to have a panel of medical experts oversee Medicare in order to improve quality and reduce cost. But false accusations permeating the debate have scared people into thinking that would mean a government bureaucrat deciding what treatments you should or shouldn't have, and would ultimately deny your grandma her vital drugs.

 

Like any debate involving the future, fear of the unknown is going to be used by those who want to maintain the status quo for their own self interest. But health panels are not unknown. They have been used in Britain for 10 years, and have been proven to work.

 

Health panels are a simple enough idea: Experts look at the evidence out there and make sure it's the best that is available. They then make recommendations based on analyzing hundreds of studies and consulting numerous stakeholders. The recommendations suggest the best form of treatment and care for a particular condition, or provide advice on areas about which your doctor may be unsure.

 

The recommendations aren't mandatory, the government isn't involved, and there is no tying of hands. The decision to follow these recommendations will always be with your doctor because he or she knows you best. All that happens is that your doctor can make a better, more informed decision and will no longer have to choose between spending time treating you or spending time reading up on the latest evidence.

 

The National Institute of Clinical Excellence (NICE) - the health panel in Britain - has been improving the quality of medical care in a health system that oversees a population with a higher life expectancy than in the U.S. at a fraction of the cost. This is because NICE has followed through its two main goals: to improve clinical effectiveness and to improve cost effectiveness.

 

And these are laudable goals that lead to better medical treatment, better patient safety and a reduction in wasteful spending. NICE also helps to reduce the amount of unnecessary spending on treatment that hasn't proved to make any difference to a patient's well being and quality of life.

 

Pharmaceutical companies are, therefore, pressured to demonstrate that drugs are effective and worthwhile in order for them to be recommended. NICE makes these cost-effectiveness decisions based on clinical evidence. For example, there is no evidence that brand-name paracetamol is better than the generic version. Yet the brand-name version can sometimes have over a 100 percent mark-up on the generic version. In this situation, NICE would recommend the use of the generic version of paracetamol. Not only is this better for the patient but it also reduces cost and frivolous use of money that could be spent on better treatments or more doctors.

 

Within its first 10 years, NICE guidance has led to more cancer specialists, better use of drugs, better treatment and far greater cost-effectiveness. As a result, Britain has been experiencing an ever-increasing quality of care. So learn from the NICE example and discuss health panels on their merits, not based on false accusations. Our health panel is made up of experts completely independent from the government, independent from drug companies and independent from insurance companies.

 

Our health panel gives doctors evidence-based guidelines on what treatment works best for patients, saving a lot of time - and sometimes pain - for people who go through countless tests or procedures that aren't needed. And our health panel makes sure health care is cost-effective by providing incentives for pharmaceutical companies to lower their price and prove a drug actually works if they want it to be recommended. NICE has shown that both economically and clinically, health panels make sense.

 

Adrian Baker is a researcher for Britain's National Health Service in London. His e-mail is adrianlpb@googlemail.com.

 

Copyright © 2009, The Baltimore Sun.

 

Infant car seats can cut off air to babies

 

By Stephanie Desmon

Baltimore Sun

Monday, August 24, 2009

 

car seatThere is no question that properly installed infant car seats save lives.

 

But a study today in the journal Pediatrics finds that even healthy newborns may not be getting enough oxygen when they spend too much time in those cozy and convenient carriers.

 

The study, done with 200 two-day-old babies in Slovenia, showed that infants placed in cribs got more oxygen than those who spent prolonged periods of time in either car seats or in car beds, which are designed for tiny or premature babies.

 

Among the findings: The percentage of time the babies spent with oxygen saturation levels below 95 percent was, on average, significantly higher for those in car seats (23.9 percent) compared to those in cribs (6.5 percent).

 

The moral here is not to dump your car seat. Instead, the authors note, parents should limit the their babies spend in those carriers to when they are on the road.

We're all guilty of leaving kids in those seats too long. I know that when my kids fell asleep in their infant car seats I would just bring them into the house in the carrier and let them finish their naps in there. My son even spent his first night home from the hospital sleeping in his car seat on the floor of my bedroom.

 

But the researchers say a baby's breathing can be compromised, as airways can become occluded and chest walls compressed in the angled position of an infant car seat.

 

Say the authors: "The use of these devices should ... be restricted to protection from injury and death in traffic accidents and they should never serve as a replacement for a crib. In addition, further modifications of car safety devices are clearly needed to minimize the respiratory compromise that has been consistently documented in current models."

 

Copyright 2009 Baltimore Sun.

 

Hazards: Lead Illness in Children Linked to Car Seats

 

By Roni Caryn Rabin

New York Times

Monday, August 24, 2009

 

Lead poisoning in children is usually traced to peeling paint in old homes or old lead pipes. But the family car, and the children’s car seats, can also become contaminated, especially if parents work in jobs that expose them to lead.

 

When six babies and toddlers in Maine were found to have dangerously high levels of lead in their blood last year, public health workers who tested the children’s homes found no traces of lead, except in some deck and outdoor areas where family members left their shoes and dirty clothes.

 

Then they tested the family cars.

 

“We consider levels of 40 micrograms per square foot an elevated level for floors, which are a contact area for kids,” said Tina Bernier, an environmental specialist for Maine’s Childhood Lead Poisoning Prevention Program. “Some of the numbers in the car seats were in the 400 range, and it went up to 1,000 in other areas of the cars.”

 

The parents of several children worked in removing paint from old buildings under renovation; three of them were employed by the same painting contractor, who did not provide workers with showers or places to change clothes before going home, as required, investigators said. Another parent was a self-employed metal recycler.

 

The report, published last week in The Morbidity and Mortality Weekly Report of the Centers for Disease Control and Prevention, is the first known case of lead exposure through car seats, though lead has previously been found in cars.

 

Copyright 2009 News York Times.

 

Doctors address depression in pregnancy

 

Tribune Newspapers

By Melissa Healy

Baltimore Sun

Monday, August 24, 2009

 

For the nearly 1 in 4 women who experience symptoms of depression during pregnancy, physicians on the front lines long have had little more than a prescription for antidepressants and a massive dose of uncertainty to offer.

 

The result: At last count, roughly 13 percent of pregnant U.S. women took antidepressant medications at some point in their pregnancy, often with little to guide them in weighing the risks the drugs may pose to their babies against the misery and dangers of untreated depression.

 

In a bid to resolve that conundrum, two leading physicians' groups on Friday issued the first guidelines for the treatment of depression in pregnancy.

 

The document, hammered out by the American Psychiatric Association and the American College of Obstetricians and Gynecologists, asserts that for women with serious, recurring depression or suicidal inclinations, the dangers of undertreatment may well outweigh the risks that antidepressants may pose to a developing fetus. The guidelines also stress that "talk therapy" alone may be best and should be offered.

 

The guidelines summarize a growing body of evidence suggesting antidepressant use during pregnancy poses some risks to a baby, especially in the first weeks of life. Babies exposed to antidepressants while in the womb are slightly more likely to be underweight at birth.

 

But the guidelines also focus on a danger to babies long ignored: that of having a mother with severe depression. Many studies suggest depression in a mother-to-be can result in poorer nutrition and prenatal care, earlier birth and a risk the child will also develop depression.

 

Copyright © 2009, Chicago Tribune.

 

Copyright 2009 Baltimore Sun.

 

Teens abusing ADHD medication, study finds

 

By Stephanie Desmon

Baltimore Sun

Monday, August 24, 2009

 

adhd medication abusePoison control centers have seen a sharp increase in the number of calls about teen misuse of attention-deficit drugs, suggesting "a rising problem with abuse of these medications," according to a new study out today.

 

The calls came from emergency room doctors, parents and school officials asking for advice for how to deal with apparent abuse of the increasingly common medications. The severity of the calls has increased over time and four deaths were reported in the study.

 

Teens, who many times use the drugs to get high, may not realize that there can be serious consequences to using what are, after all, prescription medications. Sales data of attention-deficit drugs suggest that abuse of the medications reflects an increased availability of the prescriptions, which have also been rising. The calls about ADHD medication rose 76 percent over an eight-year period, a pace outstripping calls for victims of substance abuse generally and teen substance abuse.

 

The study, in the journal Pediatrics, was done by Cincinnati Children's Hospital Medical Center researchers using data from 1998 to 2005.

 

Mark Stein, a psychiatry professor and ADHD expert at University of Illinois at Chicago, told the Associated Press that abuse typically involves crushing and snorting the pills, which speeds up the effects and can produce a buzz or sense of euphoria — along with dangerous side effects.

 

The study lacks information on whether abusers were teens with ADHD, but anecdotal evidence suggests many are not.

 

Copyright 2009 Baltimore Sun.

 

Panel Recommends Speeding Swine Flu Vaccine Access

 

By Rob Stein

Washington Post

Monday, August 24, 2009

 

Swine flu could infect half the U.S. population this fall and winter, hospitalizing up to 1.8 million people and causing up to 90,000 deaths -- more than double the number that occur in an average flu season, according to an estimate from a presidential panel released Monday.

 

The virus could cause symptoms in 60 million to 120 million people, more than half of whom might seek medical attention, the President's Council of Advisors on Science and Technology estimated in an 86-page report to the White House assessing the federal government's response to the first influenza pandemic in 41 years.

 

Although most of the illnesses would likely be mild, up to 300,000 people could require intensive care, which could tie up all intensive care beds in some parts of the country at the peak of the outbreak, the council said.

 

"This is going to be fairly serious," said Harold E. Varmus of Memorial Sloan-Kettering Cancer Center in New York, who co-chairs the 21-member council. "It's going to stress every aspect of our health system."

 

The estimates mark the first time experts have released specific calculations about the possible impact of the pandemic in the United States. The estimates, described as a "plausible scenario," are based on previous pandemics, especially the 1967-69 Asian flu, and how swine flu behaved in the United States this spring and during the Southern Hemisphere's winter over the last few months, according to Marc Lipsitch of the Harvard School of Public Health, who helped prepare the estimate.

 

"They are not a prediction, but they are a possibility," Lipsitch said in a telephone interview, noting the predictions are based on a number of assumptions, including that the virus does not mutate into a more dangerous form or infect more older people, both of which could worsen the impact.

 

"If it turned out to affect a lot more adults, the severity would be a lot worse," Lipsitch said.

 

While the seasonal flu causes about 36,000 deaths and 200,000 hospitalizations each year, the lack of immunity to the swine flu virus by many people will likely lead to many more getting infected, sick and possibly dying, the council said. And while most deaths during a typical flu season occur in the elderly, swine flu deaths are more likely to occur among children and young adults, the panel said.

 

The primary purpose of the estimates was to help guide planning to protect the public. For example, based on the estimate that the outbreak could peak in mid-October, the panel recommended expediting the availability of a vaccine.

 

In addition, the panel recommended clarifying how antiviral drugs should be used to fight the pandemic, speeding a decision about whether to approve intravenous antivirals in case they are needed, designating someone at the White House to coordinate the nation's response to the virus and improving the system for tracking the spread of the new virus.

 

Swine flu, or H1N1, emerged last spring in Mexico and quickly spread to the United States and around the world. Although far less dangerous so far than initially feared, the virus has hit children and young adults more frequently than the typical seasonal flu.

 

"This isn't the flu that we're used to," said Health and Human Services Secretary Kathleen Sebelius. "The 2009 H1N1 virus will cause a more serious threat this fall. We won't know until we're in the middle of the flu season how serious the threat is, but because it's a new strain, it's likely to infect more people than usual."

 

The pandemic has caused significant disruptions and economic damage in parts of the Southern Hemisphere, and has contributed to the deaths of more than 1,799 people in at least 168 countries, including at least 522 in the United States. A second wave of infection is expected to begin within weeks in the Northern Hemisphere as schools reopen and cooler temperatures return.

 

Overall, the panel praised the federal government's response, which has included signing contracts to spend nearly $2 billion to buy at least 159 million doses of vaccine from five companies that are rushing to produce the shots. But the first doses are not expected to be available until mid-October.

 

"This potential mismatch in timing could significantly diminish the usefulness of vaccination for mitigating the epidemic and could place many at risk for serious disease," the report states.

 

The report recommends that a portion of the vaccine be made available by mid-September for those at highest risk by asking the manufacturers to start filling vials with vaccine even though the studies to determine dosages and whether a booster will be necessary have not been completed.

 

Administration officials said they were already taking action on the panel's recommendations. All five companies "have been asked to put their initially available vaccine in vials as soon as they are ready," for example. "This will move forward, even while awaiting results of clinical studies to confirm expected dosing, to ensure the earliest possible availability of initial doses of vaccine."

 

"This report is being read very carefully," White House Homeland Security adviser John Brennan said.

 

Copyright 2009 Washington Post.

 

A Virus’s Debut in a Doctor’s Syringe

 

By Kent Sepkowitz, M.D.

New York Times

Monday, August 24, 2009

 

Ten years ago this week, New York found itself at the center of a major public health drama: in Queens, a mysterious illness was attacking older men who liked to garden.

 

The minute-by-minute excitement resembled that of the recent pandemonium caused by swine flu, but with an important difference: in those first late-summer days of 1999, the cause of the outbreak was unknown. It was not until Sept. 24, after three people had died, that the culprit was identified. It was the mosquito-borne West Nile virus, and investigators grimly declared that it had never been seen in the United States.

 

Well, not quite. America’s first cases of West Nile were actually seen in the 1950s, on the Upper East Side of Manhattan. But these cases occurred among people with terminal cancer. And the vector was not mosquitoes but the syringe of a researcher at what is now Memorial Sloan-Kettering Cancer Center.

 

Sixty years ago, radiation and chemotherapy for cancer were in their infancy; if the surgeon could not cut a tumor out, things were just about hopeless. So the researcher, Dr. Chester M. Southam, was studying viruses for their cancer-killing potential. Studies had shown that a pathogen called the Russian spring-summer encephalitis virus could eradicate tumors in mice. Because that virus was considered too dangerous for people, Southam searched for something milder, settling on the newly discovered West Nile virus.

 

The work was done in two bedded rooms separated from the rest of the hospital by an old-fashioned screen door. Dr. Donald Armstrong, attending physician emeritus at Memorial Sloan-Kettering who was a trainee at the time, said the screens were placed to minimize the possibility that a rogue mosquito would transmit virus to other patients or staff members. Southam injected West Nile virus into more than 100 people with advanced cancer and few treatment options, then reported his findings in journals. The work generated substantial excitement. “Deep Cancers Temporarily Shrunk by Rare Nerve Virus From Africa,” The New York Times reported on April 15, 1952.

 

“Nerve virus” indeed: Southam had selected West Nile because he thought it would be harmless. In naturally occurring cases from Africa, it had caused only slight fever. But in New York, things turned out quite differently. Eleven percent became ill, and a few quite ill, with symptoms of what we now consider classic West Nile encephalitis: fever, weakness, confusion and even seizures. Virus was isolated from the cerebrospinal fluid of one patient, while in others it was cultured from blood more than three weeks after inoculation.

 

In one type of cancer, lymphoma, tumors did shrink in 3 of 8 injected patients, compared with just a few responses in the 100 with other types of cancer. But five of the same eight lymphoma patients developed severe West Nile disease, including encephalitis — a rate far higher than in everyone else.

 

So Southam moved on. Intrigued by the body’s ability to destroy infection, he wondered whether it might be trained to control tumors. For the rest of his career, he worked in the novel field of immune therapy, now one of the most exciting areas in cancer therapeutics. His West Nile work, meanwhile, spawned its own field.

 

Current approaches are more sophisticated than the old days behind the screen door. For example, some investigators booby-trap a virus, then send it off to deliver its toxic package to the cancer cell. In others approaches, a virus is injected to provoke a general immune response. And in still others, the virus does what Southam had predicted: kills a tumor directly.

 

But rather than being revered as the father of viral therapy or as a patriarch in the field of immunotherapy, Southam became notorious for something entirely different. His enthusiasm for understanding how the immune system might be kick-started to control cancer nearly cost him his career. To study the immune response to cancer, he injected live tumor cells into people without malignancy; he selected 53 prisoners in the Ohio State Penitentiary and, years later, 22 elderly, dying patients in Brooklyn.

 

A 2004 essay by Dr. Barron H. Lerner in The New England Journal of Medicine recounted the “enormous controversy” that followed the Brooklyn episode. In a case brought by the state attorney general before the Board of Regents of the State University of New York in 1964, Southam was found to have committed “fraud or deceit” and unprofessional conduct. (Despite or because of this, he was soon elected president of the American Association for Cancer Research.)

 

The case became a flashpoint in the national debate about proper protection of human volunteers. Not that the idea was new to him: in one West Nile article, he noted that “all patients were volunteers and were informed of the experimental nature and the infectious nature of the virus inoculation.”

 

Southam died in 2002, at 82. As it turned out, his greatest contribution to medicine was not his groundbreaking work in viral or immune therapies of cancer. Rather, he occupies the unenviable position of having focused public attention on the ethical problems related to clinical research — and, as such, was pivotal in the creation of our current system, in which highest priority goes not to the acquisition of medical knowledge but to the safety of human volunteers.

 

Dr. Kent Sepkowitz is vice chairman of medicine at Memorial Sloan-Kettering Cancer Center.

 

Copyright 2009 New York Times.

 

Experiencing Life, Briefly, Inside a Nursing Home

 

By Katie Zezima

New York Times

Monday, August 24, 2009

 

MAMARONECK, N.Y. — For 10 days in June, Kristen Murphy chose to live somewhere she and many others fear: a nursing home.

 

Ms. Murphy, who is in perfect health, had to learn the best way to navigate a wheelchair around her small room, endure the humiliation that comes with being helped in the bathroom, try to sleep through night checks and become attuned to the emotions of her fellow residents.

 

And Ms. Murphy, 38, had to explain to friends, family and fellow patients why she was there.

 

Ms. Murphy, a medical student at the University of New England in Biddeford, Me., who is interested in geriatric medicine, came to New York for a novel program that allowed her to experience life as a nursing home patient.

 

Students are given a “diagnosis” of an ailment and expected to live as someone with the condition does. They keep a daily journal chronicling their experiences and, in most cases, debunking their preconceived notions.

 

The program started in 2005 after a student approached Dr. Marilyn Gugliucci, the director of geriatrics education at the medical school. “ ‘Dr. G,’ ” she recalled the student saying, “ ‘I would like to learn how to speak with institutionalized elders.’ What came out of my mouth was, ‘Will you live in a nursing home for two weeks?’ ”

 

To Dr. Gugliucci’s surprise, she found nursing homes in the region that were willing to participate and students who were willing to volunteer. No money is exchanged between the school and nursing homes, and the homes agree to treat students like regular patients.

 

“My motivation is really to have somebody from the inside tell us what it’s like to be a resident,” said Rita Morgan, administrator of the Sarah Neuman Center for Healthcare and Rehabilitation here, one of the four campuses of Jewish Home Lifecare.

 

“But she is really there to study herself, her own feelings about living in a nursing home,” Ms. Morgan added, referring to Ms. Murphy.

 

Geriatric specialists hope the program and others like it help generate interest in the profession, one of the most underrepresented fields in medicine. Medical schools and residencies require little to no geriatric training, and many students are reluctant to get into the field because it is among the lowest paid in medicine.

 

In 2005, there was one geriatrician for every 5,000 people over 65, according to the American Geriatrics Society; by 2030 that ratio is expected to increase to one for every 8,000 patients. Geriatricians must participate in a two-year fellowship program after medical school to become certified. In 2007, only 253 of 400 fellowship slots were filled, and only 91 of the physicians graduated from medical school in the United States.

 

“It’s kind of a crisis,” said Dr. Cheryl Phillips, president of the society. “I don’t think many seniors recognize this.”

 

Like many medical students, Ms. Murphy was scared of nursing homes. The feeling began when, as a young adult, she visited her grandmother, who had Alzheimer’s disease.

 

“I think nursing homes are scary,” she said, “but I don’t think you can be a good doctor if you’re scared of the place where a lot of your patients live.”

 

The first few days, which included filling out paperwork, undergoing a full-body mole and sore check, eating pureed foods and being raised out of bed with a lift, did nothing to validate her decision. When she wedged her wheelchair into a corner and could not get out, she cried in frustration.

 

“All I wanted to do was shut my door and stay in here,” said Ms. Murphy, whose “diagnosis” was a mild stroke that affected her right side, difficulty swallowing and chronic lung disease. “But I understood I had to go out.”

 

Not everyone does. Some patients want to talk for hours, while others act out, like a woman who pinched Ms. Murphy as hard as she could. Many sit in the hallway by the nurse’s station each day because it is a hub of activity. Emotions run high.

 

Ms. Murphy said she soon learned that many patients cried because they knew that they would most likely never live anywhere else, or because they missed family and their old life.

 

“At times I felt really lonely and got depressed,” she said. “Sometimes it was an emotional roller coaster, up and down, up and down.”

 

No one said a word the first time Ms. Murphy showed up at the daily bingo game. She started to talk to anyone who would listen. And she was surprised what happened.

 

First she bonded with Camille Stanley, the “queen bee” of the social scene. Then she found Dr. Thomas N. Silverberg, 89, a former internist and arthritis specialist with advanced rheumatoid arthritis. “My specialty is slowly killing me,” Dr. Silverberg said.

 

The two talked for hours about life and medicine. Unlike the friendships she makes as an adult, slowly nurtured over dinners and drinks, bonds in a nursing home, where there is nothing to do but talk, are forged quickly and deeply.

 

“When I came in, I was worried about working with older folks because I was afraid I wouldn’t be good at it,” Ms. Murphy said. “Now, if anything, I’m worried I’ll love them too much and it will really hurt to work with folks at the end of their lives.”

 

Most residents knew why she was there. During her going-away party they presented her with a big card, and shouts of “We love Kristen” were heard throughout.

 

The program has solidified Ms. Murphy’s desire to work with older people. And the hardest lesson she learned — that for some people, it is better to be in a wheelchair or to have limited mobility — will make her become a better doctor, she said.

 

“As a doctor, my job is to help patients live the life they want to,” she said. “And if they’re in pain, you have to say ‘That’s O.K. if you want to spend your time in a wheelchair.’

 

“For me that’s such a different place to be. Because I hate this chair. It still startles me that that’s the choice.”

 

Ms. Murphy said the care she received at the home was outstanding. But there were things that could use improvement: she did not realize she could ask for things like soda, and she felt that shower bars were too high for someone in a wheelchair. She also told the staff at a debriefing session that families should be included in more activities.

 

Dr. Phillips of the American Geriatrics Society, which is not involved with this program, said the challenge was to see “how this replicates everywhere else and how enthusiastic medical students are to take this on.”

 

Another of the 10 students who have gone through the program, William Vogt, spent 10 days last summer in a nursing home at the Veterans Affairs hospital in Augusta, Me. Mr. Vogt, who spent a day wheeling around with petroleum jelly smeared on his glasses and cotton stuck in his ears, said he was particularly struck by the fact that many patients considered the nursing home to be home and the staff “a second family.”

 

Mr. Vogt said the little things counted, like lowering nameplates so patients could locate their rooms and not putting a remote on top of a television, out of reach.

 

“There’s a little part of it that works its way into everything I do, from patient interaction and awareness of how I come across to what I say,” said Mr. Vogt, a medical student doing clinical work at a hospital in Watertown, N.Y. “There’s this shift of the humanity of it.”

 

Copyright 2009 New York Times.

 

Prevention: Hospitals Expand Their No-Smoking Zones

 

By Roni Caryn Rabin

New York Times

Monday, August 24, 2009

 

Most American hospitals banned smoking almost two decades ago, but now many are extending the ban, prohibiting smoking on all hospital property and making their entire campuses smoke-free, a new survey reports.

 

Forty-five percent of accredited hospitals had smoke-free campuses by February 2008, according to the survey, although some facilities did not have control over remote areas like satellite parking lots. By the end of this year, well over half of the hospitals will have put such bans in place.

 

The survey was conducted by the Joint Commission, which accredits 80 percent of American hospitals.

 

The findings appear in the online version of the journal Tobacco Control.

 

The study’s author, Dr. Scott Williams, associate director of health service research with the Joint Commission, said he and his colleagues were surprised to find no clear geographic patterns or regional differences.

 

“You didn’t see tobacco states lagging way behind, or California leading the way,” Dr. Williams said. “In fact, all hospitals in North Carolina have smoke-free campuses.”

 

Dr. Williams added that hospitals had long considered hospitalizations “teachable moments” for some patients, and many offer smoking cessation after heart attacks or pneumonia.

 

Copyriught 2009 New York Times.

 

Disparities: Study Finds Risk in Off-Label Prescribing

 

By Roni Caryn Rabin

New York Times

Monday, August 24, 2009

 

Physicians are allowed to use drugs in ways that are not specifically approved by the Food and Drug Administration, a practice called off-label prescribing. There is usually less scientific evidence to support nonapproved uses, and a new survey of physicians has found that many might not even know when they are prescribing off label.

 

The average physician in the survey identified the F.D.A. approval status correctly for only about half the drugs on a list provided by the researchers, according to a study in Pharmacoepidemiology and Drug Safety.

 

Confusion was greatest with psychiatric drugs, the survey of some 600 doctors found. Nearly one in five who prescribed Seroquel (quetiapine) in the previous year thought it was approved for patients with dementia and agitation, even though it was never approved for this use and even carried a “black box” warning that it was dangerous for elderly patients with dementia. And one in three doctors who used lorazepam (often marketed as Ativan) to treat chronic anxiety thought it had been approved for this use; in fact, the F.D.A. warning advises against using it for this purpose.

 

The study’s senior author, Dr. G. Caleb Alexander, assistant professor of medicine at the University of Chicago, said a concern was that off-label uses often did not have the same level of scientific scrutiny as F.D.A.-approved uses.

 

Copyright 2009 New York Times.

 

Sick day leniency encouraged as flu season nears

Infected employees at work could ultimately hurt revenue

 

The News Journal

By Hiran Ratnayake

Salisbury Daily Times

Monday, August 24, 2009

 

DOVER -- Health officials told the nation's employers they could be the most important line of defense in curbing the spread of swine flu.

 

The first doses of swine flu vaccine won't be available until mid-October, and the H1N1 virus has stayed active through the summer, prompting the government to urge businesses to be flexible with sick leave this fall.

 

"In America, we praise the Puritan work ethic, but employees would be better serving their country and their co-workers and the employer for whom they work if they stay home when they're sick," said Commerce Secretary Gary Locke.

 

Locke, Health and Human Services Secretary Kathleen Sebelius and Homeland Security Secretary Janet Napolitano offered guidance to businesses on how to prevent the spread of H1N1 and to prepare for a major outbreak. They stressed allowing employees who exhibit flu symptoms to go home and to stay home until at least 24 hours have passed since their fevers subsided.

 

They said businesses should consider eliminating policies that require a doctor's note or other proof to justify a sick day and that employers should be prepared to run their operations with fewer people.

 

If employees go to work sick, they risk spreading the flu and battering their employer in an already reeling economy. Extra precaution is needed earlier since the vaccines may not provide immunity until the last week of November, when flu season will already be under way.

 

Locke said businesses should be prepared to stagger shifts and make other allowances. He also said steps that prevent the flu -- like frequent hand washing -- are critical.

 

"We are in tough economic times, but we don't want to compound the recovery by businesses having to shut down or curtail large segments of their operations if their workers are sick," he said.

 

Planning for absences

 

The United States is trying to learn from the United Kingdom.

 

According to a recent survey published by the London-based law firm Eversheds LLP, swine flu symptoms already have forced employees to miss at least a day of work at 72 percent of U.K. businesses. Almost four in 10 employers said they expect to lose revenue if the pandemic escalates, and 41 percent of the 429 companies surveyed had no contingency plans in place.

 

The Delaware Chamber of Commerce is providing a flu clinic to employees and its members in October.

 

"It is unknown whether the H1N1 vaccine will be available at that time, so we're encouraging our own employees to stay healthy by getting the seasonal vaccine, washing their hands often, covering their mouth and nose when they sneeze or cough and to stay home when they're feeling ill," said James Wolfe, president of the Delaware state Chamber of Commerce in a statement.

 

Planned Parenthood of Delaware started contingency plans in June. Spokeswoman Emily Knearl said the organization is examining its divisions to determine who can be cross-trained in case of massive staff absences. The fact that the swine flu vaccine isn't available yet underscores how important it is to plan ahead, she said.

 

"We have employees who are parents, we have employees who are caretakers for relatives, and if the spouse gets sick, they may need a day or two to take care of their spouse," she said. "We think the smartest thing to do is plan for the worst-case scenario and hopefully be pleasantly surprised when it doesn't happen."

 

New Castle-based United Electric Supply pays for flu shots for all of its 300 employees each year.

 

Gayle Davis, vice president of human resources, said the company has a "very liberal sick policy" that should discourage workers from coming into work when they feel flu-like symptoms.

 

H1N1's staying power

 

The swine flu -- which causes similar symptoms as seasonal strain -- so far has resulted in "slightly worse" than normal flu seasons, with increased hospitalizations and cases of severe illness, according to the World Health Organization.

 

The virus, which first surfaced in the spring in Mexico, has spread to at least 168 countries and sickened 177,000. It has contributed to at least 1,462 deaths, including 477 in the United States, and is still circulating in the population.

 

Only 45 million of 195 million doses of swine flu vaccine ordered for the United States will be delivered by mid-October. From there, the U.S. will get an additional 20 million each week until its full order of 195 million doses from five companies has been received.

 

Paris-based Sanofi-Aventis SA began vaccine trials in early August and will need up to three months to complete them. Drug makers AstraZeneca PLC -- which has its U.S. headquarters in Fairfax -- and London-based GlaxoSmithKline Plc also have begun testing. It's been reported that companies haven't been able to grow enough antigen, a key ingredient needed for production, to fill vaccine orders.

 

People typically are encouraged to start vaccinations for the seasonal flu at the end of summer so they can build up immunity before the season starts in October.

 

Copyright 2009 Salisbury Daily Times.

 

Viruses: Veterinarian in Australia Is Sickened After Being Exposed to a Rare Virus

 

By Donald G. McNeil Jr.

New York Times

Monday, August 24, 2009

 

A veterinarian in Australia has been hospitalized in critical condition after exposure to the rare Hendra virus, according to local reports, which said he fell ill after treating two dying horses on a Queensland stud farm.

 

The virus was found in 1994 and has never been seen outside Australia since its discovery in Hendra, a Brisbane suburb. There have been only a dozen outbreaks, but the virus has proved lethal to horses and to humans caring for them. About 70 percent of the horses infected have died, and so have three of the six people known to have caught it from them — a veterinarian, a farmer and a prominent horse trainer, according to the Australian Broadcasting Corporation.

 

Hendra, a paramyxovirus like mumps or measles, is most closely related to Nipah virus, discovered in Malaysia in 1999 after it spread from pigs to pig farmers and caused encephalitis and pneumonia. Both infections resemble the flu at first, but can proceed to breathing problems and seizures, then coma and death.

 

Both Hendra and Nipah are carried by the large fruit-eating bats known as flying foxes, which are thought to spread it when their urine, saliva or droppings get into animal feed. Humans catch the viruses from exposure to the blood and secretions of sick animals. There has been no known instance of a human’s passing Hendra to another human, or to a horse.

 

There is no vaccine against the disease, but health authorities are trying to make one. There is also no cure, though patients are sometimes treated with ribavirin, a broad-spectrum antiviral drug.

 

Copyright 2009 New York Times.

 

Russia Bracing for Spread of Dangerous TB Strains

Officials Blame Increase in Infections on Economic Downturn, Government's Failure to Order Drugs

 

By Sarah Schafer

Washington Post

Monday, August 24, 2009

 

MOSCOW -- Russia's severe tuberculosis problem is about to get much worse, increasing the risk that the dangerous drug-resistant strains that are common here will spread, causing outbreaks elsewhere, local health officials and other experts warn.

 

Preliminary surveys have recorded an uptick in infections, which experts say could be the start of a surge fueled by declining living standards and deteriorating medical care resulting from the country's worst economic slowdown in a decade.

 

But Russian officials and health specialists also blame the government's failure to order supplies of key medicines last year, a blunder that could strengthen antibiotic-resistant forms of TB and threaten wealthier countries that have all but eradicated the disease.

 

Russia already has one of the highest rates of TB in the world. In parts of its Far East, the infection rate is three times what the World Health Organization considers epidemic levels. The government has made progress in recent years, with infection rates falling from a peak in 2000, but health officials are worried that those gains are now in jeopardy.

 

Preliminary state statistics show the rate of infection growing from 83.2 cases per 100,000 people in 2007 to 85.2 in 100,000 last year, and anecdotal evidence from hospitals and clinics around the country suggests that the numbers are still climbing.

 

By comparison, the infection rate in the United States is about 8 in 100,000, with about 0.2 percent of American TB cases ending in death. In Russia, about 18 percent of TB patients die of the disease, according to WHO figures.

 

"Because people are poorer and life is worse, the disease is progressing much faster now," said Veronika Agapova, a tuberculosis specialist with the Russian Red Cross. "The Ministry of Health didn't pay a lot of attention to this problem last year," she added.

 

Although the increase reported was small, officials are worried because the number of TB cases soared the last time Russia suffered a severe economic downturn, rising from 74 cases per 100,000 people before the 1998 financial crisis to 90.4 two years later.

 

"What was bad in 2008 will continue to be seen in 2009 and 2010," said Mikhail Perelman, Russia's most prominent TB specialist. "I am pessimistic. . . . The WHO set a goal to eradicate tuberculosis, but this task seems quite fantastic to us at this point."

 

A spike in infections in Russia could have consequences well beyond its borders because about a fifth of all TB patients here suffer from drug-resistant strains -- more than almost anywhere else in the world.

 

In 2006, a Russian-born man infected with a strain of drug-resistant TB was jailed after moving to Arizona and ignoring a judge's order to wear a mask outdoors. A year later, an American lawyer with drug-resistant TB set off an international panic and was quarantined after traveling across Europe and returning to the United States.

 

"Like air pollution, it doesn't see a border," said Murray Feshbach, an expert on Russian public health at the Woodrow Wilson International Center for Scholars who argues that Russia understates its TB rate by as much as 50 percent.

 

Tuberculosis is a bacterial infection that primarily affects the lungs and is about as contagious as the flu. It spreads especially quickly among people living in crowded conditions and those with AIDS or weak immune systems.

 

Drug-resistant strains are common in Russia because the government has struggled to provide a steady supply of drugs and make sure that patients complete their treatment. The disease is also rampant in the prison system, and prisoners rarely continue taking antibiotics after they are released.

 

Treatment for TB is free, but Russia's chief epidemiologist, Gennady Onishchenko, warned in a 2007 report that only 9 percent of the country's TB hospitals met basic hygiene standards, nearly a fifth suffered shortages of required drugs and more than 40 percent lacked adequate medical equipment. Some didn't have sewage systems or running water, he said.

 

Valentina Kravchenko, deputy health minister in the hard-hit far-eastern province of Amur, said she waited anxiously last year for federal authorities to deliver critical anti-TB drugs. But help never came because the Health Ministry did not buy them for more than a year.

 

Kravchenko and several others involved in treating TB patients said ministry officials told them the government shut down the agency responsible for buying the medicine as part of a reorganization and failed to reassign the task.

 

"About 70 percent of those who needed treatment were not provided with proper medication," Kravchenko said. "As a result, many of them got drug-resistant forms or had complications. And of course, more people caught tuberculosis, and the number of cases grew in our region."

 

In response to a reporter's queries, the Health Ministry issued a statement that suggested a basic misunderstanding about how its procurement system works. "The problem is the long delivery process for products from the WHO," it said.

 

Dmitry Pashkevich, coordinator for WHO's TB Control Program in Moscow, said the explanation made no sense because the government buys the antibiotics on its own from drug companies, in part with funds from a 2003 World Bank loan.

 

"We are not involved in procurement," he said.

 

The failure to deliver the medicine last year is worrisome because pausing or stopping treatment gives the bacterium time to mutate into a drug-resistant form. Nearly 11 percent of new cases here last year were drug-resistant, compared with less than 1 percent in the United States, officials said.

 

Patients with drug-resistant strains require treatment for as long as two years with more costly antibiotics, and sometimes need surgery. The most virulent strains cannot be cured.

 

Olga Demikhova, deputy director of Russia's Central Tuberculosis Research Institute, which specializes in treating drug-resistant TB, said many Russians are afraid to seek treatment. Some are worried about losing their jobs or, if they are immigrants, of being deported, and those fears have been amplified by the recession.

 

But she added that the disease is no longer limited to the poor in Russia. "Now we have ordinary people, not marginalized people, but socially well-adapted people," she said.

 

Agapova, the Red Cross official, said more children have been getting infected, too. "Today, tuberculosis has no limits or borders," she said. "When young people get sick, it means there's a real problem."

 

Copyright 2009 Washington Post.

 

Opinion

My Health-Care Story: Refuse a Test, Pay a Price

 

Washington Post Letter to the Editor

Monday, August 24, 2009

 

Here’s a true story that illustrates one way insurers limit choices and drive up costs.

 

Getting ready for bed one night, I experienced shortness of breath. Remembering an allergic reaction that began that way a few years earlier, I drove to the emergency room.

 

The doctor on duty disagreed with my diagnosis, announcing, “We’re going to treat this as a cardiac event.” When tests revealed nothing, he didn’t accept defeat. “I want to admit you anyway,” he said.

 

It was 2 a.m. By now I felt fine. “What happens if I just go home?”

 

“Well, of course, you have the freedom to do that,” he answered, adding meaningfully, “But you would be leaving against medical advice.” I just wanted to sleep, so I said: “Whatever.”

 

In the morning, a nurse came in with an oxygen tank. I felt completely normal, and I waved her away. “No, I don’t need that,” I said. She backed off, but she said to someone in the hall: “Patient refused treatment.”

 

By then, I remembered that I had moved some paint cans the night before; no doubt I breathed in just enough fumes to cause my symptoms. So, confident that I knew my own body, I got dressed. Soon nurses and doctors were trying to persuade me to stay. I offered to sign a waiver promising not to sue if my judgment proved wrong. My offer was refused.

 

Then I was told: “If you leave ‘against medical advice,’ your insurance won’t pay for the charges you have so far incurred.”

 

That got my attention. “What? That’s incarceration!”

 

“Nevertheless, it is true,” the nurse replied.

 

Luckily, a doctor finally agreed to release me. But no one should be threatened with financial ruin if they refuse a test. It’s called freedom of choice. And we don’t have it.

 

S. Ann Robinson

Leesburg

 

Copyright 2009 Washington Post.

 

My Health-Care Story: Well Served by the System

 

Washington Post Letter to the Editor

Monday, August 24, 2009

 

President Obama tells lots of frightening medical stories, but many people can testify to being well served by the system. In the 18 months our daughter battled cancer, my husband and I never had to call our insurer, though it paid out tens of thousands of dollars in claims. In 2008, when it became necessary to accept that medical science could offer her no more, our end-of-life discussions occurred only with the doctors and nurses who had proven their dedication to healing her.

 

All Americans deserve such care, but it won’t come by way of the legislation offered so far.

 

By Hannah Boyle

Reston

 

Copyright 2009 Washington Post.

 

Health care is in need of major reform

 

Carroll County Times Letter to the Editor

Monday, August 24, 2009

 

Editor:

 

The recent antics by some opponents of health care reform have really been over the top. Dialog has been replaced by a shouting contest, endangering free speech. Some people, in addition to rude, bullying behavior, also exhibit other characteristics.

 

First is the hypocrisy shown at some of the town hall meetings. I’ve seen senior citizens, who I’m sure are on Social Security and Medicare, strongly opposing any government run public option. I’ve seen self-identified military veterans, who most likely are treated by VA doctors, saying the same. Social Security, Medicare and VA treatment are government-run health care.

 

Then there is the self-centered attitude of some of these people. In addition to those mentioned, I’ve heard some opponents say they have good health insurance, and why should they pay for someone else? The I’ve got mine mindset. Well, so do I, but anyone could lose their job, for any number of reasons, and one of the first things to go is health insurance, unless one can afford to pay full price to continue your good insurance. I’ve been there, and it is scary. And it changes your perspective when you no longer have yours.

 

Finally, what gets me are the distortions, indeed outright lies, told by some opponents of health care reform. Particularly, the whole idea of the so-called death panels, where the government decides if elderly or very ill people should live or die, supposedly to control cost. Actually, the provision, which had the bipartisan support of people like Sarah Palin and other Republicans was to simply reimburse doctors and other caregivers for counseling on things such as living will, medical power of attorney, hospice, etc. No one is talking about assisted suicide. And unless the opponents are stupid, they know the truth. But Palin and others are now talking about the President wanting to dispatch grandmom. What’s that make them?

 

Let’s debate the issue of health care reform on the merits and stop the yelling. Who knows, maybe we can actually accomplish something good for America.

 

Frank Rammes

Finksburg

 

Copyright 2009 Carroll County Times.

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