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			Tuesday, July 14, 2009 News Clipping Archives *Maryland / Regional* Nursing-Home Ratings Earn Mixed Reviews (Washington Post) Residents warned after Worcester rabies spike (Salisbury Daily Times) Local briefs: Health department revises fee (Frederick News-Post) Death of woman held at Worcester jail probed (USA Today) Gilchrist, Hopkins partner (Daily Record) Swine Flu? Don't Ask: Doctors Usually Can't Tell for Sure. (Washington Post) City approves Dairy Maid Dairy expansion (Frederick News-Post) *National / International* Read the small type: Contains acetaminophen (Baltimore Sun) Obama Names Surgeon General (Washington Post) Asthma Study Cites Misuse of Inhalers (Washington Post) Illnesses Afflict Homes With a Criminal Past (New York Times) Driver Survey Finds Less Drinking, More Drugs (New York Times) When Mom Has an Eating Disorder (New York Times) U.S. orders $690M in swine-flu vaccine from Novartis, $71M from GSK (Baltimore Business Journal) Judge closes SC funeral home that cut corpse legs (Hagerstown Herald-Mail) *Opinion* --- *Maryland / Regional* Nursing-Home Ratings Earn Mixed Reviews Kaiser Health News By Elizabeth G. Olson Washington Post Tuesday, July 14, 2009 When 81-year-old Sally Darr needed nursing home care after injuring herself in a fall, her family turned to a new federal rating system for help. The online tool uses movie-review-style ratings -- one to five stars -- to compare homes based on such measures as number of employees, state health inspection results and how many hours of licensed nursing care are provided each day. "We had looked at nursing home Web sites, but they don't give you the whole picture," said Nancy Donaldson, one of Darr's daughters. Their choice, Inova Cameron Glen Care Center in Reston, "rated four stars pretty much across the board, and it is clean and the staff is very good." Donaldson is one of millions of people who have visited the Nursing Home Compare site since it was overhauled and the nation's 15,600 homes were rated in December. But there's debate among industry and consumer groups about how well it's meeting the public's needs. The federal agency that runs the site plans to survey users later this year on exactly that question. The industry, which had sought to delay the system's rollout, complained that the grading system was started much too quickly. Nursing homes say the information, gleaned from homes as well as from state inspection reports, misleads families and patients because it doesn't give an accurate picture of the amount and kind of care in each facility. A leading consumer group wants the site to provide more details about inspection results and quality-of-care measures. Consumer advocates and industry representatives are calling for changes in the way the ratings assess staffing, which all sides agree is the best indicator of quality of care. Nursing homes say simple counting of workers does not reflect the care patients actually receive, while consumer advocates complain that employee information that comes from homes is unchecked and may contain errors. 'Out of Whack' The Centers for Medicare and Medicaid Services (CMS) developed the rating system after criticism from Sen. Ron Wyden (D-Ore.), who said "something is out of whack in this country when it's easier to find out information about a washing machine than a nursing home." The repackaged site is more visually appealing and "takes a large amount of data and improves access to it substantially," said Thomas Hamilton, director of the agency's survey and certification group. Although CMS emphasizes that no one should choose a home without visiting it, he says the data can help narrow choices. But Hamilton conceded "there has been a fair amount of misunderstandings" with nursing home operators "about areas like quality measures and staffing." CMS is talking to the industry, patient advocates and states about changes, including the way the system measures quality of care. For example, homes that specialize in managing pressure sores and pain have more patients with those problems, and that can skew the homes' ratings, the industry maintains. In addition to an overall rating, the site provides star ratings for each nursing home in three categories: performance on health inspections in the past three years, ratios of staff to patients, and 10 quality-of-care measures. Consumers can also use the site to call up specific findings from inspections, other details on each home and consumer tips. Ratings are updated as states complete inspections. Maryland's ratings mirror the overall national picture: About 20 percent of its nursing homes are listed as five-star and another 20 percent as one-star. Of the 33 facilities in Montgomery County, for example, six received the highest rating and five earned the lowest. Wendy Kronmiller, who oversees inspections of 235 homes as director of Maryland's Office of Health Care Quality, praised the system as "a great summary." Ratings generally are accurate, she says, particularly in the upper and lower ends of the range. As CMS weighs changes to the system, the first priority will probably be staffing information. Consumer advocates and industry representatives agree that the staffing numbers reflected in ratings don't capture the fluctuating employment picture at many nursing homes. Larry Minnix, chief executive of the American Association of Homes and Services for the Aging, a trade group for nonprofit nursing homes, also contends that the current system does not count all categories of caregivers within a facility. As a result, homes may not get credit for the care they actually provide to residents. Staffing is an important issue for consumers. Janet Chap of Chevy Chase, who consulted the site when her family needed to move her father from Florida to a nursing facility in Cincinnati, said she "gave a lot of weight to the ratio of staff to patients." Congress is considering one change: requiring homes to report their payroll data electronically every two weeks. CMS would use the data to help verify the accuracy of staff reporting. Grading on a Curve Other issues may not be so easily resolved. Some in the industry complain that the ratings operate like a grading curve, ensuring that similar percentages of homes will receive the highest and lowest designations. They say that makes it harder for an improving home to rise in the star system. "Twenty percent of homes have to be one-star no matter what they are doing," said Steve Morrisette, president of the Virginia Health Care Association, which represents many of the state's 276 nursing homes. CMS maintains there's adequate opportunity for nursing homes to improve their ratings. Inspections are another major point of contention among states, patient advocates and the industry. States have varying standards, Hamilton noted, citing as an example different practices concerning use of physical restraints, which are generally discouraged. (The CMS site cautions against comparing homes in one state with those of another.) Minnix complains that inspection data generally are inconsistent, outdated and misleading. He urges that the process be revamped with better-trained inspectors and more funding. Colleen Ryan Mallon, marketing director for Northern Virginia's Goodwin nursing homes, says inspectors should be more objective and talk to residents more about the quality of care. On the consumer side, the NCCNHR, formerly the National Citizens' Coalition for Nursing Home Reform, wants more state inspection information posted online. That includes specifics on deficiencies -- especially those that result in death -- and the penalties levied for infractions, said Janet Wells, a spokeswoman for the advocacy group. The coalition also wants verification of self-reported, unaudited information from the homes. Six months after it launched, the rating system's impact is unclear. Even though CMS says the site attracts 50,000 daily visitors, both nursing homes and patient advocates suspect many families don't know about it. Gerald Kasunic, the long-term-care ombudsman for the District, who said he hears little mention of the five-star system, believes it "is a great tool for the next generation" -- people accustomed to using the Web. Right now, he said, many people making decisions about homes "are in a crisis and pressed to make an immediate decision," and some simply "don't know that the ratings exist online." This story was produced through a collaboration between The Post and Kaiser Health News. KHN is a service of the Kaiser Family Foundation, a nonpartisan health-care-policy research organization unaffiliated with Kaiser Permanente. Comments: health@washpost.com. Copyright 2009 Washington Post. Residents warned after Worcester rabies spike By Katie Crowe Salisbury Daily Times Tuesday, July 14, 2009 SALISBURY -- State and county health officials continue to warn Maryland residents about the danger of rabies after a spike in the disease in Worcester County. Five strains of the rabies virus exist, according to emedicine.com. Certain strains of the virus are more prominent in certain regions of the U.S., based on what species are present. Raccoons most commonly become rabid in Maryland, said Kim Mitchell, chief of rabies and vector-borne diseases for the Maryland Center for Veterinary Public Health. And according to the state Department of Health and Mental Hygiene, the creatures have topped the list of the most rabid animals in the state for the past three years. "Our state and the entire East Coast is part of a raccoon rabies epizootic -- which refers to an outbreak or an epidemic of a disease in an animal population," Mitchell said. "Raccoons are a wildlife species that are a very good vector for getting and transmitting the disease." According to the state's Office of Epidemiology and Disease Control Programs, any mammal is capable of getting the rabies virus, but in Maryland, it is most frequently found in raccoons, cats, foxes, skunks, bats and groundhogs. Various state health departments along the East Coast track the history of the virus. The New Jersey Department of Health and Senior Services reported that rabid raccoons were first found in West Virginia in 1977. It is believed the virus was present in raccoons imported from Florida into the state by hunters in the 1970s. The disease spread to other raccoons when these creatures were released, causing the virus to spread at a rate of about 25 to 50 miles per year into Delaware, Maryland, Pennsylvania and Washington. According to the Rhode Island Department of Environmental Management, rabid raccoons pose the greatest threat to people because they tend to share their habitat with humans and their pets. Maryland health officials remind residents, however, that raccoons are certainly not the only animals that can and do contract the virus. The number of rabid foxes often does not trail far behind raccoons, Mitchell said. "There are a lot of opportunities for direct contact between the two species because they're both nocturnal and compete for many of the same food sources," she said. Worcester rabies specialist Janet Tull said there is no need for residents to be fearful, but they should be aware and take all the necessary precautions to avoid contact with wildlife. Exposure to rabies by humans or their pets typically results in a lengthy quarantine process. "Although healthy raccoons will naturally come feed, you will not know when that raccoon that comes to knock over the trash at night now has rabies," Tull said. More cases confirmed The Worcester County Health Department issued a warning at the end of June alerting residents of 20 laboratory-confirmed cases and 11 suspected cases of rabies in the county since the beginning of May. That number was higher than what is normally seen at that time of year, Tull said. The number of confirmed cases in Worcester has since increased by one case, Tull said, to 21 confirmed cases of rabies and 12 suspected cases. An animal is labeled suspect if it indicates rabid behavior, such as aggressiveness and showing no fear of humans, she said. The number of suspect animals has also increased by one since June. Mitchell said one possible explanation for the trend in Worcester is that it is home to the tourist destination of Ocean City. A lot of families travel to Ocean City, often with pets, which could bring about many opportunities for animal interaction. Health officials, however, have not seen an increasing trend in the number of rabies cases in Somerset and Wicomico counties. This calendar year, four animals have tested positive for the disease in Wicomico -- on average with confirmed cases in 2008, said Director of Environmental Health Dennis DiCintio. In fact, the number of animals that had to be quarantined in Wicomico County this year is 30 less than last year's figure, he said. If you go WHAT. Worcester County Rabies Clinic WHEN. 6-7:30 p.m., Aug. 5 WHERE. Worcester County Animal Control facility in Snow Hill WHY. Opportunity to get dogs, cats and ferrets vaccinated for rabies INFO. www.worcester health.org Additional Facts Rabies distribution Distribution of the 5 strains of rabies virus and the associated wildlife of the U.S.: # Predominantly East Coast -- Raccoon strain # Predominantly Northwest -- Skunk strain 1 # Parts of Wyoming, Alabama -- Skunk strain 2 # Alaska, Vermont, New Hampshire -- Arctic and red fox strain # Predominantly Southwest -- Grey fox, coyote and dog strain Source: http://emedicine.medscape.com Copyright 2009 Salisbury Daily Times. Local briefs: Health department revises fee By Staff Reports Frederick News-Post Tuesday, July 14, 2009 The Frederick County health department has implemented a new fee schedule for Environmental Health Services, which took effect July 1. The fees are related to review, approval, permitting and/or inspection of food services, open burning, swimming pools and spas, mobile home parks, exotic birds, well construction and testing, water quality testing, septic systems, site and improvement plans, subdivisions and building permits. Fees for open burning permits will increase from $10 to $15, and all temporary food permits will be $25. Temporary food permits must be obtained before serving food to the general public. Failure to obtain a temporary food service permit can result in food service for the event being shut down and the assessment of an additional $10 late fee. The last significant changes to the fees were made in 2003, county health officer Barbara Brookmyer said. These changes put the fees more closely in line with those of other counties. The Frederick County Commissioners approved the revised fee schedule after two open work sessions and a public hearing. A full description of services under the revised fee schedule is posted at www.co.Frederick .md.us_/environmentalfees. For information, contact Karen Amoss at 301-600-1726 or e-mail kamoss@fredco-md.net. Copyright 2009 Frederick News-Post. Death of woman held at Worcester jail probed Associated Press USA Today Tuesday, July 14, 2009 SNOW HILL, Md. (AP) — Police in Worcester County say a 26-year-old Ocean City woman being held at the county jail has died. The Worcester County Bureau of Investigation says Katrina Schaeffer was found unresponsive at the Worcester County Detention Center on July 9 and pronounced dead at Atlantic General Hospital. Police say Schaeffer was alone in the cell and foul play is not suspected. Her body was sent to the Office of the Chief Medical Examiner in Baltimore for an autopsy. Court documents state Schaeffer called 911 on July 7 and told the dispatcher she was "going to kill" her boyfriend Nicholas Heitzer. He told police she had learned that he had been married before and had seen his ex-wife in court that morning. Schaeffer was charged with assault and other offenses and was being held on $50,000. Copyright 2009 The Associated Press. All rights reserved. Gilchrist, Hopkins partner Associated Press Daily Record Tuesday, July 14, 2009 Hunt Valley-based Gilchrist Hospice Care, Maryland's largest hospice organization, said it has forged a new partnership with the Johns Hopkins Health System, and has become a provider of choice for JHHS terminally ill patients who need end-of-life care in Central Maryland. As of July, JHHS began to refer eligible patients to Gilchrist Hospice Care for end-of-life care. Gilchrist said it has dedicated additional staff to help meet the needs of Hopkins patients. Gilchrist also is providing experts on-site at Hopkins hospitals to explain the clinical, social, spiritual and volunteer services available to patients. Gilchrist is a subsidiary of GBMC HealthCare. Copyright 2009 Daily Record. Swine Flu? Don't Ask: Doctors Usually Can't Tell for Sure. By Rachel Saslow Washington Post Tuesday, July 14, 2009 Sheila Morris is almost certain her 13-year-old son Evan got the H1N1 influenza virus at summer camp two weeks ago -- but she'll never know for sure. And neither will the Centers for Disease Control and Prevention. The Fairfax County mother suspected H1N1, or swine flu, when her son came home with a temperature of 104. An e-mail from the camp director confirming eight cases of H1N1 among campers solidified her hunch. "That night we called the doctor's office, and she said, 'Sure, it's probably swine flu,' " Morris says. But the doctor did not suggest that Evan come in for testing. "She didn't think the CDC was interested in anything unless you died." Parents in the Washington area and beyond are having similar experiences, leaving some angry and others, like Morris, confused. Private doctors, such as Morris's pediatrician, can't run their own tests for H1N1. That falls to private laboratories and the public-health system, which wants to track the pandemic, not help doctors make treatment decisions. As of Friday, the CDC had reported 37,246 cases of swine flu and 211 deaths from the illness nationwide. The District has 45 confirmed cases of the virus, Maryland has 686 and Virginia 306, but officials have said the actual number is probably much higher, because not everyone who gets sick goes to the doctor and because it's not practical to give an H1N1 test to everyone with a flulike illness. The CDC estimates that more than a million people worldwide have contracted H1N1. Last Thursday, the federal government hosted a "flu summit" to talk about vaccinations and preparedness. Health and Human Services Secretary Kathleen Sebelius called H1N1 "a serious virus capable of causing severe disease and death" and said, "We must avoid complacency and ensure we are prepared to deal with whatever the fall flu season brings." Diane Dubinsky, the medical director of Fairfax Pediatric Associates, gives her patients with flu symptoms a rapid diagnostic test: a nasal swab that detects all flu, including swine flu. (Dubinsky is not Morris's doctor.) The results are clear in about 10 minutes, and if the test is positive for influenza A, she assumes that the patient has the H1N1 virus, which is a type of influenza A. On a conference call with reporters on June 26, Anne Schuchat, a CDC physician helping to lead its pandemic response, said virtually all of the influenza circulating this summer is the H1N1 variety; 99 percent of the positive samples tested by the CDC are H1N1. Schuchat said the CDC is performing "virologic sampling" to get infection numbers rather than testing every single person with a flulike illness. "We've had cases where patients have been angry, demanding to get tested for swine flu," Dubinsky says. "We calm them down and say who we test and who we don't test." Today, a month after the World Health Organization declared a swine flu pandemic, the CDC recommends H1N1 testing only for people with flulike symptoms who are at high risk for complications, including infants, the elderly, pregnant women and those with chronic illnesses. The D.C. health department adopted those guidelines June 22. Not all doctors are following the guidelines. Foxhall Pediatrics in Northwest Washington sent influenza A-positive swabs to a private laboratory for testing through the end of June, even for children older than 5, according to an administrator at that office. The practice did it because doctors and patients both wanted to know the results. Still, the practice plans to follow the CDC guidelines for all future patients. Diane Helentjaris, the acting director of the Virginia Department of Health's Office of Epidemiology, guesses that some patients are eager to get the swine flu test because they're curious, even "a little excited about having something new." Conducting the H1N1 test is not simple. Doctors must transport samples in special containers; the test costs $40 to $200, depending on the exact type and various laboratory issues; and the whole process can take a week. By then, most patients are on the mend. Compare that process with the 10-minute rapid flu test, which costs about $15. In this context, many local doctors, including Dubinsky, have been telling any patient who tests positive for influenza A that he or she probably has swine flu. Doctors recommend that patients treat flu symptoms by taking over-the-counter medicines and staying home for a week after falling ill. The antiviral drug Tamiflu is recommended only for at-risk patients who seek treatment within the first 48 hours of symptoms, Dubinsky says. In Morris's case, she picked her sick son up from camp and prepared for the flu to spread through her family. She kept her son at home and monitored him closely. She bought Tamiflu for her elderly father, who lives with her and is in fragile health. She acted as if her son had swine flu, even though she probably would never know for sure. So far, nobody else in her family has gotten sick. Copyright 2009 Washington Post. City approves Dairy Maid Dairy expansion By Adam Behsudi Frederick News-Post Tuesday, July 14, 2009 A view of the Dairy Maid plant is shown Monday afternoon in Frederick, with Vernon Avenue on the left and East Seventh Street on the right. The City of Frederick planning commission approved a major expansion project for the dairy. The City of Frederick planning commission on Monday approved a major expansion to East Street's Dairy Maid Dairy, fueling discontent from surrounding residents who said the milk storage facility will have an irreversible effect on their neighborhood. "It's going to be basically in my face," said Dorothy Duvall, who has lived on Vernon Avenue since 1964. "Fifty feet from my front door." The dairy, which is bound by East, Seventh and Eighth streets and Vernon Avenue, will be authorized to start on a 21,618-square-foot building with an 83-foot cooling tower and a 4,070-square-foot milk crate offloading area. Planning commissioners also approved modifications that reduced the size of required buffer areas, parking spaces and landscaping. Commission chairwoman Meta Nash called it a "win-lose case" and was the sole board member to vote against approving the final site plan. "I disagree with limited impact," she said. Scott Miller, an attorney representing dairy owners Jimmy and Jody Vona, said the modifications make for a better project with less impact in an area that has been a mix of residential and industrial uses since the 1960s. "This particular applicant is doing nothing but exercising its rights to utilize the zoning," he said. A modification requiring a 20-foot buffer on the north side of the property shrunk the originally proposed building size by nearly 1,500 square feet. The change added 21 feet to the tower. The building will stand three feet from the edge of Vernon Avenue on the west side of the property. Miller said the expansion of the storage facility is not an expansion of production, and will minimize the number of times trucks are required to transfer milk. Jimmy Vona said current traffic includes an average of 70 trucks making 200 trips per day. But, trucks unloading milk will be able to continue a practice of backing into the dock from Vernon Avenue after turning off Seventh Street. That maneuver was not approved by a 2000 planning commission decision, but truckers found it to be the only realistic way to get their vehicles to the dock. A modification will override the nearly decade-old restriction and allow truckers to continue accessing the dock area because of safety concerns with two other options. The facility will be 20 feet from the back of Joe and Julie Whitehair's Eighth Street property. "We implore you to protect the interests of not just Dairy Maid but the residents of the neighborhood," Julie Whitehair said. Joe Whitehair said residents will look at ways to appeal the commission's decision. Last August, the dairy owners demolished a more than century-old farmhouse on their property to make room for the project. Neighbors said the demolition violated a 1962 covenant barring any residential projects on the property that had been owned by the city at the time. The dairy said the covenant was nullified after being unenforced for decades and by the fact that current zoning on the property would not allow residential development. Despite the disappointment of residents, Commissioner Billy Shreve said the planning process was followed judiciously. "There are always going to be people that are happy with your decision and people that are unhappy," he said. Please send comments to webmaster or contact us at 301-662-1177. Copyright 1997-09 Randall Family, LLC. All rights reserved. *National / International* Read the small type: Contains acetaminophen By Stephanie Desmon Baltimore Sun Tuesday, July 14, 2009 The new caution about acetaminophen, the popular painkiller, isn't about it suddenly being more toxic. Rather, it highlights a fear that we may be taking too much of the stuff without even realizing it. Acetaminophen isn't just in Tylenol. It's in Nyquil. It's in Midol. It's in Vicks cough syrup. It is in dozens of cough and cold products. We may not be taking more Tylenol than is recommended, but we can push into the territory of liver damage when we take several acetaminophen-containing products at once. ... Avoiding an overdose may not be as simple as it seems. Labels are printed in tiny type. They don't say the product contains Tylenol (which is a name people remember easily) but acetaminophen (more of a mouthful that can be confused with other medications). Sometimes, people just aren't paying attention. They figure that if they're taking over-the-counter medications, they'll be safe. One doctor I spoke to said he wants to make sure that labeling issues are a priority as the Food and Drug Administration moves forward in coming weeks and months. The agency will be addressing several recommendations of an expert panel, including that the maximum daily dose of acetaminophen be lowered due to safety concerns. "There are over 200 different products which contain acetaminophen and when I go to the drugstore and I want to pick up a cold medicine, the writing is too small," said Dr. Gilbert Fanciullo, director of pain management at Dartmouth Hitchcock Medical Center in New Hampshire. One of his patients brings a magnifying glass with her when she chooses her medications, just so she can be sure of what she is getting. "I can read what’s on my Corn Flakes box," Fanciullo said, "but not my Excedrin box." Copyright 2009 Baltimore Sun. Obama Names Surgeon General He Says Benjamin Would Be Voice in Health-Care Debate By Alexi Mostrous and Michael D. Shear Washington Post Tuesday, July 14, 2009 Regina M. Benjamin, an Alabama family physician who served for almost two decades as one of the few doctors in a shrimping village along the Gulf Coast, was nominated as U.S. surgeon general yesterday by President Obama. Flanked by the president and Health and Human Services Secretary Kathleen Sebelius at a Rose Garden ceremony, Benjamin, 52, promised to act as "America's doctor" if appointed. Her nomination comes more than three months after Obama's first choice for surgeon general, CNN chief medical correspondent Sanjay Gupta, pulled out, leaving the administration without a top health official even as the H1N1 flu was reaching pandemic proportions worldwide. Obama used the announcement to stress his commitment to passing health-care reform legislation, and he said Benjamin would be a crucial voice in the debate. "For nearly two decades, Dr. Regina Benjamin has seen in a very personal way what is broken about our health-care system," he said. " She represents what's best about health care in America: doctors and nurses who give and care and sacrifice for the sake of their patients." Benjamin has garnered nationwide praise for founding a rural health clinic in Bayou La Batre, Ala. More than 40 percent of the town's 2,500 residents have no health insurance. The physician, who in September received a "genius award" from the John D. and Catherine T. MacArthur foundation, rebuilt the center three times after it was destroyed by hurricanes and fire. Stories abound of Benjamin making house calls in a muddy Toyota pickup, and accepting buckets of shrimp from patients too poor to pay cash. In 2002, she became the first African American woman to be president of a state medical society when she was appointed to head the Medical Association of the State of Alabama. Benjamin graduated from Xavier University, Morehouse School of Medicine and the University of Alabama School of Medicine, and her medical training was paid for by the National Health Service Corps, a federal program in which medical students promise to work in areas with few doctors in exchange for free tuition. Benjamin said the position would be more than just a job. "My father died with diabetes and hypertension. My older brother died at age 44 of HIV-related illness. My mother died of lung cancer because as a young girl she wanted to smoke, just like her twin brother could. "My family's not here with me today, at least not in person, because of preventable diseases. While I can't change my family's past, I can be a voice in the movement to improve our nation's health care and our nation's health for the future." If confirmed by the Senate, Benjamin will be tasked with issuing crucial public health messages as well as heading up the uniformed Public Health Service Commissioned Corps and advising on issues such a smoking, obesity and exercise. Louis Sullivan, a former secretary of health and human services who has known Benjamin since her days at Morehouse, described her as "a person of outstanding scientific qualifications and excellent communication skills." "She's persistent," he said in an interview. "In spite of the fact that her clinic was destroyed, she rebuilt it. I remember speaking to her as a student in 1979 and she said that she wanted to go back to a small community in Alabama and serve as a physician. She has adhered to that plan even while her national and global reputation increased." Benjamin, a practicing Catholic, is on the board of various Catholic medical groups, including the Catholic Health Association of the United States. In February, the Obama administration moved to undo a last-minute Bush administration policy that granted protections to doctors who refused to take part in abortions, a policy supported by the CHA. Sister Carol Keehan, the association's president and chief executive, said yesterday: "The Catholic Health Association rejoices for our nation in the nomination of Dr. Regina M. Benjamin as surgeon general of the United States." Research editor Alice Crites contributed to this report. Copyright 2009 Washington Post. Asthma Study Cites Misuse of Inhalers By Francesca Linzer Kritz Washington Post Tuesday, July 14, 2009 A new study shows that some adults in low-income neighborhoods may not be administering inhaled asthma medicines correctly to children in their care. The problem occurs in all socioeconomic groups, says Stephen J. Teach, head of the asthma education program at Children's National Medical Center in Washington. "Using inhalers requires some choreographed breathing and finger action, and takes some skill to perfect for any caregiver," Teach says. The study, published in June in the Annals of Allergy, Asthma and Immunology, found that almost a third of caregivers in low-income urban areas improperly used albuterol, a medicine given to help alleviate constricted airways in people with asthma. The researchers surveyed 114 caregivers by telephone and found that 32 percent gave too much or too little of the medicine. Teach says that many caregivers and children old enough to take the medicines on their own often fail to use a spacer or holding chamber. These inexpensive plastic devices can help control the flow of the medicine and increase the chance that it will be delivered to the lungs rather than to the back of the throat, where it's largely useless. Teach cites another common mistake affecting the many patients who have different asthma medications for daily and emergency use: They or their caregivers use one when it's the other that's needed. Teach recommends that every child with asthma have an action plan that is reviewed with an asthma specialist at least once each year and after any asthma-related visit to an emergency room. In January, the aerosol inhalers that had been used to deliver asthma medicines were replaced by environmentally friendlier ones, called HFA inhalers. Teach says that while the inhalers work slightly differently (the new devices produce a softer, gentler stream than the older ones), his colleagues have seen no problems getting the right dose to patients when a spacer is used. Caregivers may also want to ask pediatricians for asthma inhalers that come with counters -- not all do -- to help make sure they don't run out of medication. (Without a counter, people often shake a canister or see if it floats to determine if it is empty.) While most albuterol inhalers contain 200 puffs of medicine, ReliOn makes a 60-puff canister with a built-in counter that sells for $9 at Wal-Mart. If your doctor agrees and prescribes it, this might be a good spare for backpacks and glove compartments. (Some families like to keep one inhaler at home and one at school for emergencies.) Teach also reminds caregivers to follow instructions about cleaning and priming inhalers so that they do not become clogged. Need a spacer refresher course? Go to the Web site of the American Academy of Chest Physicians, http://www.chestnet.org, click on "Patient Education," under "Education," then "Patient Instructions for Inhaled Devices." Copyright 2009 Washington Post. Illnesses Afflict Homes With a Criminal Past By Shaila Dewan and Robbie Brown New York Times Tuesday, July 14, 2009 WINCHESTER, Tenn. - The spacious home where the newly wed Rhonda and Jason Holt began their family in 2005 was plagued by mysterious illnesses. The Holts’ three babies were ghostlike and listless, with breathing problems that called for respirators, repeated trips to the emergency room and, for the middle child, Anna, the heaviest dose of steroids a toddler can take. Ms. Holt, a nurse, developed migraines. She and her husband, a factory worker, had kidney ailments. It was not until February, more than five years after they moved in, that the couple discovered the root of their troubles: their house, across the road from a cornfield in this town some 70 miles south of Nashville, was contaminated with high levels of methamphetamine left by the previous occupant, who had been dragged from the attic by the police. The Holts’ next realization was almost as devastating: it was up to them to spend the $30,000 or more that cleanup would require. With meth lab seizures on the rise nationally for the first time since 2003, similar cases are playing out in several states, drawing attention to the problem of meth contamination, which can permeate drywall, carpets, insulation and air ducts, causing respiratory ailments and other health problems. Federal data on meth lab seizures suggest that there are tens of thousands of contaminated residences in the United States. The victims include low-income elderly people whose homes are surreptitiously used by relatives or in-laws to make meth, and landlords whose tenants leave them with a toxic mess. Some states have tried to fix the problem by requiring cleanup and, at the time of sale, disclosure of the house’s history. But the high cost of cleaning - $5,000 to $100,000, depending on the size of the home, the stringency of the requirements and the degree of contamination - has left hundreds of properties vacant and quarantined, particularly in Western and Southern states afflicted with meth use. “The meth lab home problem is only going to grow,” said Dawn Turner, who started a Web site, www.methlabhomes.com, after her son lost thousands of dollars when he bought a foreclosed home in Sweetwater, Tenn., that turned out to be contaminated. Because less is known about the history of foreclosed houses, Ms. Turner said, “as foreclosures rise, so will the number of new meth lab home owners.” Meth contamination can bring financial ruin to families like that of Francisca Rodriguez. The family dog began having seizures nine days after the Rodriguezes moved into their home in Grapevine, Tex., near Dallas, and their 6-year-old son developed a breathing problem similar to asthma, said Ms. Rodriguez, 35, a stay-at-home mother of three. After learning from neighbors that the three-bedroom ranch-style home had been a known “drug house,” the family had it tested. The air ducts had meth levels more than 100 times higher than the most commonly cited limit beyond which cleanup is typically required. The former owner had marked “no” on a disclosure form asking whether the house had ever been a meth lab, Ms. Rodriguez said. But because he is now in prison for meth possession, among other things, the Rodriguezes decided there was nothing to gain by suing him. They moved out, throwing away most of their possessions because they could not be cleaned, and are letting the house go into foreclosure. “It makes you crazy,” Ms. Rodriguez said. “Our credit is ruined, we won’t be able to buy another house, somebody exposed my kids to meth, and my dog died.” Federal statistics show that the number of clandestine meth labs discovered in the United States rose by 14 percent last year, to 6,783, and has continued to increase, in part because of a crackdown on meth manufacturers in Mexico and in part because of the spread of a new, easier meth-making method known as “shake and bake.” There are no national standards governing meth contamination. Congress ordered the Environmental Protection Agency to publish cleanup guidelines by the end of 2008, but the agency is still reviewing a draft version. Without standards, professional cleaners say, it is easy to bungle a job that often requires gutting and repeated washing. About 20 states have passed laws requiring meth contamination cleanup, and they use widely varied standards. Virtually all the laws hold the property owner financially responsible; Colorado appears to be the only state that allots federal grant money to help innocent property owners faced with unexpected cleanup jobs. In other states, like Georgia, landlords and other real estate owners have fought a proposed cleanup law. After the Holts bought their house here, Tennessee passed such a law. But since 2005, only 81 of 303 homes placed under a resulting quarantine have been cleaned, according to the state, which has one of the few registries tracking meth lab addresses. The law applies only if the police find a working meth lab at the house, and Jerry Hood, a lawyer and cleanup contractor hired by the Holts for the decontamination work, said many houses in the county had escaped the legislation. The health effects of meth contamination are frequently difficult to prove, and research is scant. But John W. Martyny, a meth expert at the National Jewish Medical and Research Center in Denver, said living in a former meth lab made children more likely to develop learning disabilities and caused long-term respiratory and skin problems. Even brief exposure can have severe effects, Dr. Martyny said. A 2007 study by the Denver center found that more than 70 percent of law enforcement officials who had inspected meth labs subsequently reported health problems. To Ms. Holt’s horror, inspectors found high concentrations of meth on her kitchen countertops, where she sterilized bottles, prepared baby food and doled out snacks. “We had no idea that we were starting a family in a meth house,” she said. “We bought a house that eventually was going to sentence our family to death.” When the family left the house, moving in with Mr. Holt’s parents, their health problems largely subsided. The children no longer needed medication to breathe. The migraines and the kidney ailments vanished. But the heartaches continued. Ms. Holt has been working two jobs to earn money to pay for her house’s remediation, which has proceeded in fits and starts with donations from church fund-raisers and local businesses. And Anna, 2, had a relapse and had to return briefly to the hospital. “We don’t know what it’s going to be in the future,” Ms. Holt said, standing in the barren, unfinished structure that was once her dream home and reflecting on her children. “This meth contamination is all their immune systems have ever known.” Copyright 2009 The New York Times Company. Driver Survey Finds Less Drinking, More Drugs By Tara Parker-Pope New York Times Tuesday, July 14, 2009 Marco Garcia for the New York Times Alcohol use isn’t the only problem on the roads. Random roadside checks show that the percentage of people driving under the influence of alcohol appears to be declining, but many weekend drivers test positive for drug use. The findings come from the latest roadside survey by the National Highway Traffic Safety Administration based on breath, saliva, blood samples and questionnaires taken from randomly selected drivers in 300 locations around the United States. In 1973, 7.5 percent of drivers had a blood alcohol concentration of .08 or higher. (A level of .08 is above the legal limit in all 50 states.) In the latest survey, the percentage of people driving above the legal alcohol limit had fallen to 2.2 percent. For the first time, the roadside survey also used screening methods to detect marijuana, cocaine and prescription drugs. The survey found that 16.3 percent of nighttime weekend drivers tested positive for drugs. Nearly 9 percent had used marijuana, whereas nearly 4 percent tested positive for cocaine and a similar number had used prescription drugs. The drug tests only indicate the presence of the drug in the body and don’t indicate when the drugs were used or whether the driver was impaired. The survey data showed that men were more likely to be impaired by alcohol than women. Drivers were most likely to be legally drunk between 1 a.m. and 3 a.m., compared with daytime or evening hours. The vehicles most likely to be operated by drunk drivers were motorcycles and pick-up trucks. The survey data were collected in 2007 from roadside locations throughout the country. Drivers were selected at random and waved off the road to a survey location by police officers, but the drivers were approached by interviewers who were not police officers. The drivers were assured that the survey was voluntary and anonymous. Of the 11,000 randomly selected drivers, about 90 percent agreed to give breath samples and 70 percent agreed to give saliva samples, said Jeff Michael, associate administrator for research and program development at the National Highway Traffic Safety Administration. The interviewers used extra incentives to encourage participation in the survey. Drivers were given $10 for saliva samples and $50 for blood samples. When a driver refused to take part in any of the testing, they were then offered $100 as an added inducement. Only a few hundred drivers refused to take part in the survey. While that may suggest those drivers were impaired by alcohol or drugs, the numbers were small enough that they were unlikely to have a large effect on the data. In addition, because the same methods were used during each survey, the results are a useful indicator of driving impairment trends from year to year. Because the survey was anonymous, readings from breath, saliva and blood samples weren’t immediately available to interviewers. However, if a driver appeared to be impaired, the interviewers attempted to obtain a readable breath sample. Drivers who appeared impaired or who were confirmed to be impaired weren’t arrested, but they also weren’t allowed back on the road. Instead, they were allowed to call for a ride, driven home by fellow passengers, offered a ride by the researchers themselves or even offered a hotel room. “They went to great lengths to prevent these people from driving home,” Mr. Michael said. “It was not an enforcement stop. The important thing was we didn’t want to allow anybody back into traffic that appeared to be impaired.” Copyright 2009 The New York Times Company. When Mom Has an Eating Disorder By Tara Parker-Pope New York Times Tuesday, July 14, 2009 Eating disorders are usually something for parents to worry about. But as Randi Hutter Epstein reports today, the problem is increasingly showing up at middle age. No one has precise statistics on who is affected by eating disorders like anorexia nervosa and bulimia, often marked by severe weight loss, or binge eating, which can lead to obesity. But experts say that in the past 10 years they are treating an increasing number of women over 30 who are starving themselves, abusing laxatives, exercising to dangerous extremes and engaging in all of the self-destructive activities that had long been considered teenage behaviors. The recent surge in older women at eating disorder clinics is not a reflection of failed treatment, experts say, but rather a signal that these disorders may crop up at any age. To learn more, read the full story, “When Eating Disorders Strike in Midlife,” and then please join the discussion below. Has a new eating disorder affected you or other adult family members or friends? Please tell us about it. And if you have questions about eating disorders, visit the Consults blog, where Dr. Kathryn J. Zerbe, professor of psychiatry at Oregon Health and Science University, is answering readers’ questions about anorexia, bulimia, binge eating and related disorders. Copyright 2009 The New York Times Company. U.S. orders $690M in swine-flu vaccine from Novartis, $71M from GSK San Francisco Business Times By Frank Vinluan Baltimore Business Journal Tuesday, July 14, 2009 The federal government is committing more than $800 million to buy more of the two key ingredients to make the H1N1 swine flu vaccine, according to the Department of Health and Human Services. The money will be used to place additional orders on existing contracts with vaccine manufacturers including GlaxoSmithKline and Novartis. The former Chiron Corp. facility in Emeryville is now owned by Novartis, which makes vaccines there. The government is placing orders for antigen and adjuvant. Antigen is the active ingredient in a vaccine that triggers the immune system to develop antibodies to fight the H1N1 virus. Adjuvant is added to boost the immune system and reduce the amount of antigen needed for the vaccine. The vaccine ingredients will become a part of the pandemic stockpile, for use if a vaccination campaign is necessary. Swiss company Novartis (NYSE: NVS), which is building a vaccine manufacturing facility in Holly Springs, received an order for $346 million for antigen and $343.8 million for adjuvant. London-based GlaxoSmithKline (NYSE: GSK) received an order for $71.4 million of adjuvant. In addition, Sanofi Pasteur received a $61.4 million order for antigen, and MedImmune won a $61 million order for its nasal flu spray. “We are doing our part to be as prepared as possible for the impact that this infectious disease could have on our country,” Health and Human Services Secretary Kathleen Sebelius said in a statement. “Vaccines may serve an important role in that preparedness.” Triangle Business Journal All contents of this site © American City Business Journals Inc. All rights reserved. Judge closes SC funeral home that cut corpse legs Associated Press By Jeffrey Collins Hagerstown Herald-Mail Tuesday, July 14, 2009 A South Carolina judge Tuesday revoked the license of a funeral home where a worker cut the legs off a 6-foot-7 body so it would fit in a casket. Administrative Law Judge Deborah Durden gave her decision immediately after hearing the appeal of Cave Funeral Home and owner Michael Cave. The ruling may be the end the family business founded in Allendale 49 years ago. Cave's lawyer said his client would wait for the written ruling before deciding whether to appeal and the family is also considering selling the funeral home. The state Funeral Board ordered the home shut down last month after Cave admitted his father, Charles Cave, used an electric saw to sever James Hines' legs at the calf because he wouldn't fit in the casket. The elder Cave does not have the license needed to embalm a body, but helped with tasks around the home like dressing and cleaning bodies, his son told the board. Michael Cave said he should be allowed to keep his license because he wasn't in the room when the legs were cut and had no idea what his father was about do. He also said there were no other blemishes on his 26-year record in the funeral business. "It was a terrible act," said Cave's attorney, Rep. Jim Harrison, R-Columbia. "But these aren't terrible people." But Cave never told Hines' family what had happened. He said he didn't want to compound their grief, later admitting that was a mistake. The body was placed in the casket with only the head and torso on view for the funeral service. Family members said they were so distraught they didn't notice anything was wrong. Rumors about Hines' suspected truncation started spreading through the town of town of 3,700 people about 75 miles southwest of Columbia not long after his death from skin cancer in October 2004. But confirmation came four years later when a fired employee, who was the only other worker in the room with Charles Cave when Hines' legs were cut, told the family what happened. The state funeral board exhumed Hines' body and found the severed legs still in the casket. A criminal investigation also has been launched. A spokeswoman for prosecutor Duffie Stone didn't immediately return a message Tuesday. Hines, 60, was an albino black man who had several modest hits in the 1970s as a soul and funk guitarist with J. Hines and the Boys. He became a preacher later in life. His widow, Ann Hines, wasn't at Tuesday's hearing and didn't return a phone message from The Associated Press. Harrison thinks Michael Cave could eventually go before the board and ask to be reinstated. In the meantime, the family is trying to figure out if it can complete services for a few bodies left in the home and what it should do with dozens of prepaid funeral plans, Harrison said. Harrison said he felt the board acted especially harshly. He could find only one other time the board took away someone's license. But Christa Bell, a lawyer for the agency that oversees the funeral board, said state law gives members discretion to remove someone's license for any reason they see fit. "If they cannot take the action they took in this case," Bell said, "when can they take it?" Copyright 2009 Hagerstown Herald-Mail. *Opinion* --- BACK TO TOP


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