Wednesday, June 10, 2009

News Clipping Archives

 

Maryland / Regional

Officials: More workers, money needed for swine flu (The Gazette)

115 swine flu cases statewide (Annapolis Capital)

Baltimore's Homeless Population Surging (WYPR 88.1 FM Online)

Shelter for at-risk girls to close; needs funding, repairs to reopen (Carroll County Times)

Md. doctor accused of unlawfully prescribing drugs  (Daily Record)

FDA panel to vote on antipsychotic drugs for kids (USA Today)

 

National / International

WHO closer to declaring swine flu a pandemic (Baltimore Sun)

DEET's Rivals: A Backyard Test (Wall Street Journal)

Intensive diabetes treatment helps if done early, experts say (USA Today)

Greening the Herds: A New Diet to Cap Gas (New York Times)

Feel bloated? This can help (Baltimore Sun)

 

Opinion

Jolt the system (Baltimore Sun Commentary)

 

 

Maryland / Regional

Officials: More workers, money needed for swine flu

Fall season will be telling

 

By Sean R. Sedam

The Gazette

Wednesday, June 10, 2009

 

ANNAPOLIS — Health officials say they could have to rely on volunteers and federal aid if faced with the emergence of a swine flu pandemic this fall.

 

A top priority of state and local officials will be how to build "surge capacity," including a stable of medical professionals to staff call centers and manage the response if there's another outbreak later this year.

 

For now, the strain of the swine flu, or H1N1 virus, that grabbed global headlines last month appears to be less deadly than original feared.

 

"Our most important focus now is when it comes back in the fall, will it be coming back in a more virulent form? And we have to be prepared for that," state health Secretary John M. Colmers said during a briefing for members of the Senate Budget and Taxation and Finance committees on Tuesday.

 

This spring's swine flu outbreak provided a kind of test run for officials who found that while Maryland health departments were prepared for the outbreak — in part due to planning done earlier this decade and through experience with the bird flu — health department staffs were overtaxed.

 

State and local health departments performed well during the outbreak, Colmers told lawmakers, a sentiment several lawmakers shared.

 

"I think we lack bench strength," he said. That could make it difficult to carry on a prolonged response to the virus if it returns with a vengeance this fall.

 

Colmers said the state has a "very robust volunteer medical corps plan," which includes rosters of physicians, nurses, therapists, social workers and others who have been trained and can be mobilized during a pandemic. County health departments, including Montgomery County, also have a stable of volunteers, some of whom were called up during a measles outbreak in early spring and to staff the county's swine flu information line.

 

"That kind of thing's going to be crucial," said Sen. Nancy J. King (D-Dist. 39) of Montgomery Village. "If you have a disaster like [a pandemic] it's a given that everybody pitches in and does what they need to do."

 

But Montgomery County's Health Officer, Ulder J. Tillman, has concerns about how much the state will be able to rely on volunteers to staff health department operations.

 

"They are going to be stressed themselves if we have a pandemic," Tillman said in an interview.

 

Budget cuts have led to 36 positions being eliminated in the county Department of Health and Human Services, she said. The position of immunization administrator remains unfilled.

 

"We have fewer people with greater demands, and that is going to be a challenge," Tillman said.

 

Maryland had 115 confirmed cases of swine flu in 11 counties and Baltimore city as of Monday. Eight cases have been confirmed in Montgomery County. No swine flu deaths have been reported in the state.

 

Colmers put costs to the state for the swine flu response at $300,000 — mostly in personnel. About half of that came from federal aid. Montgomery County spent about $112,000 in 11 days from late April to early May, Tillman said.

 

Officials are hopeful more federal aid could arrive before the fall.

 

Last week, President Barack H. Obama asked Congress to pass a $2 billion supplemental appropriations bill for fighting the swine flu. That is on top of $3.1 billion in federal stimulus funds that Obama has proposed tapping and $2 billion that he requested in May.

 

Meanwhile, school nurses in Montgomery County continue to monitor student populations for possible symptoms. On Monday, 27 students were sent home from school with flulike symptoms and told not to return for seven days, per Centers for Disease Control and Prevention recommendations, Tillman said. In all, 407 county students have been excluded from school for symptoms since May 5.

 

The state has yet to tap into its supply of antiviral drugs — marketed under the names Tamiflu and Relenza. Last month, the state received 212,445 courses from the Strategic National Stockpile, though the effectiveness of some courses are about to expire. Maryland has purchased another 578,754 courses of antiviral drugs through a federal program, and by Sept. 1 will have a total of 1.4 million courses on hand or available on call. A course is enough to provide one dose two times a day for five days. It is up to Gov. Martin O'Malley (D) to order the release of the drugs to the public.

 

Copyright 2009 The Gazette.

 

115 swine flu cases statewide

Officials preparing for flu's possible return in the fall

 

By Shantee Woodards

Annapolis Capital

Wednesday, June 10, 2009

 

Laboratories have confirmed 115 cases of swine flu in Maryland, but the infected population could be higher since not everyone is being tested at state labs, health officials told state lawmakers yesterday.

 

Officials from the state Department of Health and Mental Hygiene briefed a legislative policy committee in Annapolis on their efforts to deal with this spring's swine flu outbreak.

 

Currently, the illness is primarily infecting residents in the Washington, D.C., suburbs, Maryland Health Secretary John Colmers said.

 

While the urgency in dealing with the outbreak has dissipated, officials are looking toward the fall, when another round of influenza may hit the state. A formal report on swine flu activity is being prepared and is expected to be sent to Gov. Martin O'Malley by the end of summer.

 

Thus far, $300,000 has been spent to address swine flu concerns, and about half of that came from federal funds, officials reported. Since April, cases have been identified in 12 counties, including Anne Arundel County, where eight cases were identified.

 

As concerns about the illness spread, schools were closed and protocols were changed.

 

"There was a great deal of concern (about the illness)," Colmers said. "Hindsight was great, it was 20/20. When in the midst of a scenario like this, you don't know what can happen."

 

On April 29, health officials announced six probable cases of swine flu in the state, including three in Anne Arundel.

 

The local cases stemmed from a Severna Park family with a 7-year-old child who was a student at Folger McKinsey Elementary School. The father had recently traveled to Mexico and returned with flulike symptoms. His wife, son, mother and nephew were suspected to be carriers of the illness.

 

As a result, Folger McKinsey was closed for two days.

 

The 115 cases in the state have led to seven hospitalizations and no fatalities. Patients have ranged in age from 1 to 68, with the median age being 16 years old.

 

Once the illness hit the state, health officials spent their days responding to cases and to guidelines from the national Centers for Disease Control and Prevention and the World Health Organization.

 

Senior staff members would start their days by reading e-mails from the CDC to see if any protocols had changed. The staff would relay these updates to O'Malley before placing a daily conference call to hospitals and health officers to address concerns. As many as 100 people participated in these phone calls, Colmers said.

 

At the end of the day, O'Malley would receive another update and the staff would check in with the CDC. A command center was set up in Annapolis.

 

The command center was "the hub of activity," Colmers said. "We rotated staff through. People knew what their job was and it was just another day at the office."

 

Still, there were ongoing concerns about the school closures. Initially, a case of probable swine flu didn't mean a school had to close, but that changed. Colmers said that was the result of CDC recommendations that seemed to change.

 

While there is a chance that the flu will come back in the fall, it isn't clear yet what its impact will be. Colmers said he was concerned about whether the state could handle the financial demands of such a situation.

 

"What you're dealing with is very serious," said state Sen. David Brinkley, R-Frederick. "Don't you worry about resources. It's up to us to provide them. … I'm going to be a hawk on the money too, but this is too important."

 

Colmers acknowledged that the daily conference calls were helpful, but said he wanted to make a better effort to reach physicians in private practices, since not every patient goes to the emergency room.

 

County health departments have been beneficial in closing this gap, said Frances Phillips, the state's deputy secretary for public health services.

 

Health departments were "crucial to getting that linkage," said Phillips, who is also the county's former health officer. "We found them to be generous and extremely helpful. ... We're looking forward to working with them as we go into the fall."

 

Copyright 2009 Annapolis Capital.

 

Baltimore's Homeless Population Surging

 

By Kenneth Stukes

WYPR 88.1 FM Online

Wednesday, June 10, 2009

 

BALTIMORE, MD (wypr) - A single mother of two and a registered nurse represents the new face of homelessness in Baltimore City. In a large conference room of the People Encouraging People office in West Baltimore, Barbara - who doesn't want to give her last name - talks about how she became homeless last October after developing cancer. A slender woman in her mid-40s, Barbara was forced to leave the job that she held for many years and endure the foreclosure on her home.

 

"I've been a nurse for many years, taking care of other people, so I developed something called ortho-arthritis and I had a meniscus tear and stomach problems. I'm a smoker, so COPD and cancer was found during this time period."

 

Since being diagnosed, Barbara has been separated from her two daughters, who are 12 and 18. Without a permanent residence, she has stayed in various places, including the Walter P. Carter Center for Behavioral and Mental Health. The Carter center has a 10-day residence period, before patients are released to find other housing.

 

Now living in rental housing for the disabled, Barbara has just started receiving Social Security disability payments. But thanks to the sour economy there has recently been a huge surge in the ranks of Baltimore's homeless.

 

"The city government did a homeless census in January of 2009. The preliminary statistics from the draft report indicate that homelessness has increased in the city over 14-percent. That is the most significant increase in Baltimore City for the last four census counts."

 

That's Antonia Fasanelli, executive director of the Homeless Person Representation Project in Baltimore City.

 

The Homeless Census is ordered by the federal government to conduct a head count in Baltimore every two years. Between 2006 and 2007, homelessness in the city increased by almost 11 percent.

 

"There are over 3,400 people, who experienced homelessness, according to the January 2009 census report, but there are certainly not 3,400 shelter spaces in the city."

 

Since the onset of the current economic crisis, Fasanelli said that people in the city are at high risk of losing their homes through evictions and foreclosure. That's what happened to Barbara. Maryland, said Fasanelli, is the sixth-worst state for affordable housing in the country.

 

Greg Sileo, the Director of Community Outreach for the Mayor's Office and Homeless Services said the lack of affordable housing, stagnant wages, and high healthcare costs are gradually changing the face of homelessness to include white-collar workers.

 

"We have had people who are getting up in the morning and going to jobs at believe it or not Legg Mason or at other companies. It is a face of homelessness that we have never seen before and it is definitely a major shift.

 

In an effort to change this situation, Sileo is a key staff member working with Mayor Dixon on her 10-year plan to end homelessness in Baltimore. The plan was implemented last year and, according to Sileo, has since made some progress.

 

"Our street outreach teams have been out and we have housed over just about now we have about a 150 people, who are either in process or have been housed throughout that time."

 

Sileo said Section-Eight vouchers - federal subsides for rental housing - were used to house those 150 people and will be available for those who still need a place to live.

 

"We have the 24-hour, year-round shelter that is going to be built over on Fallsway which is a major project. It is about an eight million dollar project that is going to house 275 people and be really a resource center and a gateway to people that are homeless.

 

Ground-breaking for the shelter should begin soon, Sileo said. Also in the works is a partnership with United Way on a marketing campaign to bring in private funding.

 

But keeping pace with the rate at which people are finding themselves out on the streets is likely to remain a big challenge for quite some time.

 

I'm Kenneth Stukes, reporting in West Baltimore, for 88-1, WYPR.

 

© Copyright 2009, wypr.

 

Shelter for at-risk girls to close; needs funding, repairs to reopen

 

By Jennifer Jiggetts

Carroll County Times

Wednesday, June 10, 2009

 

A state-run shelter for at-risk girls in Sykesville will temporarily close June 30 until repairs are fixed and funds become available, state officials said.

 

“We’re not indefinitely closing, but we have to suspend operations because of budgetary concerns,” said Tammy Brown, a spokeswoman for the state Department of Juvenile Services, which oversees the Sykesville Girls Group Home. “We don’t have the funds to make the necessary repairs.”

 

Brown said she was unsure of the number of girls who have been relocated to San Mar Children’s Home in Boonsboro. San Mar Children’s Home is a nonprofit for at-risk girls, said spokesman Dan Day. Day said 30 girls currently stay at the facility.

 

Brown said DJS licenses San Mar. That means DJS is responsible for making sure the program meets all state laws and requirements, she said.

 

Day said different agencies license and maintain different programs. They also pay for youths they refer to the program, he said.The Sykesville Girls Group Home provides services to at-risk, court-involved girls who need a temporary home. Located on Cooper Drive, the Sykesville Girls Group Home housed about 10 girls for up to 90 days and was run by the Massachusetts-based nonprofit North American Family Institute.

 

The organization did not return phone calls by 6 p. m. Tuesday.

 

State officials recently considered moving the shelter to a cottage on the campus of Springfield Hospital Center because of costly renovation work, but didn’t because of funding.

 

Del. Susan Krebs, R District 9-B, said she wasn’t sure if the move was a permanent one but praised DJS officials for reevaluating the money aspect of the home, something she wasn’t expecting.

 

“It was a surprise to me, but I’m glad they’re looking at consolidating and the best use of resources,” she said. “I hope that they will take a good look at financing and the financial impact.”

 

Krebs has been concerned about the shelter’s condition. Its main problem is a crack in its foundation, which would have cost about $150,000 to fix, she said.

 

The shelter was also in need of painting, carpet replacement, handrail repairs and patio patching, and there’s a water infiltration problem, according to Elizabeth Wright, assistant secretary of business services with DJS.

 

Krebs said all renovations would cost about $230,000. It cost about $700,000 for fiscal year 2008 to run the shelter.

 

Brown said she’s unsure of what’s next for the shelter.

 

“We’re not making any decisions about it,” she said. “We’re just waiting to see if we could potentially have it reopened, depending on the budget issues.”

 

Copyright 2009 Carroll County Times.

 

Md. doctor accused of unlawfully prescribing drugs

 

Associated Press

Daily Record

Wednesday, June 10, 2009

 

Prosecutors have stopped pursuing charges against a Salisbury doctor indicted for illegally prescribing painkillers to undercover police officers.

 

Sixteen drug charges against 49-year-old Charles Olufemi Folashade were placed on the inactive docket Tuesday. That means prosecutors aren't trying to convict Folashade. But charges haven't been dropped either, so the case could continue.

 

Folashade was indicted for unlawfully distributing or prescribing controlled dangerous substances available by prescription only. Authorities say he illegally distributed oxycodone, Suboxone and Xanax to two undercover officers six times.

 

Folashade practices internal medicine at the Arcadia Medical Center and Walk-in Clinic, both in Salisbury.

 

Copyright 2009 Daily Record.

 

FDA panel to vote on antipsychotic drugs for kids

 

By Rita Rubin

USA Today

Wednesday, June 10, 2009

 

ADELPHI, Md. - A Food and Drug Administration advisory committee will vote Wednesday on whether the makers of three blockbuster antipsychotic drugs - already widely prescribed "off-label" to children and teens - should be allowed to market them to treat schizophrenia and bipolar disorder in young people.

 

AstraZeneca's Seroquel, Pfizer's Geodon and Eli Lilly's Zyprexa are approved for schizophrenia and bipolar disorder in adults. Two other antipsychotic drugs, Risperdal and Abilify, already are approved for treating bipolar disease and schizophrenia in patients under 18.

 

"We generally are in agreement that the sponsors (the makers of Seroquel, Geodon and Zyprexa) have provided adequate support to suggest effectiveness" for treating those conditions in children and adults, said Thomas Laughren, director of the FDA's Division of Psychiatry Products, in a memo to committee members before the two-day meeting began here Tuesday.

 

In addition, Laughren said, the drugs' safety profiles appear to be "qualitatively similar to those observed with these drugs in adult patients." Adverse reactions that can occur with these "atypical" antipsychotics, he said, include sedation, weight gain, increases in blood fats and sugars and tardive dyskinesia, a condition characterized by involuntary repetitive movements.

 

Although the FDA isn't required to follow advisory committee recommendations, it usually does.

 

After listening to scientific presentations by FDA staffers and representativesfrom the three drug companies, panel members heard testimony from the public. No matter whether the speakers felt the companies should get the FDA's approval or not, virtually all agreed that more research is needed into the drugs' long-term safety and effectiveness in children and teens.

 

"Serious questions have not been answered," said Ronald Brown dean of the College of Health Professions at Temple University-Philadelphia. Three years ago, Brown chaired an American Psychology Association panel work group on psychiatric medications for children and adolescents.

 

Doctors prescribe the three antipsychotic drugs to about a million Americans ages 13 to 17 every year, says Diana Zuckerman, president of the National Research Center for Women & Families in Washington, D.C. "Unfortunately, the studies are inadequate," Zuckerman said. "They provide really no useful information about the long-term risks of tardive dyskinesia, sudden death or diabetes."

 

Christina Bagno of Brooklyn Heights, N.Y., says a combination of Seroquel and lithium have enabled her 7½ -year-old daughter, diagnosed with bipolar disorder, to live a normal childhood. "Antipsychotics saved my child," Bagno said.

 

But Liza Ortiz, of Austin, Texas, says Seroquel killed her 13-year-old son in January. He started hearing voices when he was 11 and was diagnosed with schizophrenia last year, Ortiz told the panel. Doctors prescribed a "cocktail" of antipsychotic drugs, she said, and he died four days after Seroquel was added to it.

 

David Fassler, a Burlington, Vt., psychiatrist who serves as secretary-treasurer of the American Psychiatric Association, says schizophrenia and bipolar disorder are "very real illnesses" in children and adolescents.

 

"In actual clinical practice, these medications are not used on a short-term basis," Fassler said of Seroquel, Geodon and Zyprexa. "We don't yet have sufficient data on longterm safety and efficacy in pediatric populations."

 

If the advisory committee recommends approving the three drugs for the treatment of children and teens, Fassler said, it should do so only for short-term or on-again, off-again use and only if manufacturers don't advertise their use in young people directly to consumers.

 

Zyprexa, on an assembly line here, is one of three drugs on which the FDA advisers will vote for use by patients under 18.

 

 

Copyright 2008 USA TODAY, a division of Gannett Co. Inc.

 

National / International

WHO closer to declaring swine flu a pandemic

 

From Sun News Services

Baltimore Sun

Wednesday, June 10, 2009

 

The World Health Organization is inching closer to raising the infectious disease alert level for the novel H1N1 influenza outbreak to its highest level, indicating that a pandemic has arrived, but it has delayed doing so in an effort to prepare national health organizations and populations for the effect of such an announcement, said Dr. Keiji Fukuda, assistant director general of the agency, in a telephone news conference Tuesday. The number of confirmed cases of the disease rose above 1,200 in Australia on Monday, and the virus is no longer restricted to schools and other institutions in that country.

 

Copyright 2009 Baltimore Sun.

 

DEET's Rivals: A Backyard Test

 

By Ana Campoy

Wall Street Journal

Wednesday, June 10, 2009

 

As I did yard work in a rain-soaked, ivy-covered corner of my Dallas backyard, dusk was falling. It was prime time for mosquitoes -- and my only protection was a concoction of herb oils.

 

With summer approaching, my mission was urgent: to test the growing array of naturally derived alternatives to DEET, the most widely used mosquito repellent. While DEET has long been the gold standard when it comes to fending off bugs, a number of new products -- many of them plant-based -- have hit the U.S. market in the past few years.

 

Finding an effective repellent is not just a question of backyard comfort. Mosquitoes carry serious diseases found in the U.S., such as West Nile virus and some kinds of encephalitis.

 

DEET has been certified as safe by the Environmental Protection Agency and used by millions of people since 1957. But some consumers remain apprehensive, put off by the chemical's strong smell, oily texture and ability to degrade some plastics. Though reactions to DEET, such as rashes, are rare, the EPA cautions that the substance shouldn't be sprayed on open cuts and should be washed off when it's no longer needed.

 

What's more, certain mosquito species -- including some outside the U.S. that carry malaria -- aren't strongly repelled by DEET, says Ulrich Bernier, a research chemist at the Agricultural Research Service of the U.S. Agriculture Department, the unit that came up with DEET.

 

Because of these concerns, several teams of researchers are hunting for alternatives -- no easy feat. The ideal substance would drive away a broad range of bug species, avoid harming benign insects and the environment, and stay put on human skin -- preferably, for days, rather than a matter of hours -- without irritating it.

 

"That's a tall order," says Laurence Zwiebel, a professor of biological science at Vanderbilt University. Mr. Zwiebel is leading a team of researchers that has identified several promising substances by studying mosquitoes' smell receptors to figure out what irritates or confuses them.

 

Taking a different approach, Mr. Bernier at the Agriculture Department chose to start with a compound known to have repellent qualities; the one he chose is derived from black pepper. Both projects are years away from commercialization.

 

Chemical maker DuPont Co. is closer. It recently received EPA registration for a repellent made with catnip that it claims is as effective as DEET. The company, which is in the process of finding partners to market the repellent, says it could be available for sale in about a year.

 

But for now, several mosquito repellents derived from natural substances are already on the market. To see how they measured up, I tried three, along with two products containing DEET at different concentrations.

 

My admittedly unscientific tests were conducted in a backyard with a healthy mosquito population after heavy rains. Each day, I sprayed a single application of one of the products on my arms and legs at 6 p.m. and did yard work until 8 p.m. or until I got a bite on the treated areas, whichever happened first.

 

The results: DEET was hands-down the best at keeping mosquitoes at bay -- if a heavy-duty 23% concentration was applied. The repellents derived from compounds found in nature offered protection, too, but for shorter periods of time -- though some of them worked better than DEET at a 7% concentration.

 

To be sure, my tests focused on a single person at a single location. Companies that make mosquito repellents say their effectiveness varies depending on the place, the individual and the level of activity. They recommend different repellents for different occasions -- for instance, repellents with higher concentrations of DEET or other active ingredients for prolonged stays outside or for sports.

[Buzz Off]

 

But my results generally jibed with what scientists have found. Joseph Conlon, technical adviser for the American Mosquito Control Association, says DEET at high concentrations remains the king of protection against intense mosquito onslaughts -- what you might encounter, for instance, during a long hike through the woods. If you're using naturally derived products -- which Mr. Conlon agrees offer plenty of protection for shorter periods of time -- he recommends sticking to those registered with the EPA, which means that they were found effective at preventing mosquito bites and that hazards to human health or the environment are low. (An EPA registration number can be found on a product's label.)

 

Among the many naturally derived repellents on the market, only two are recommended by the Centers for Disease Control and Prevention to protect against West Nile virus: oil of lemon eucalyptus -- in natural and synthetic versions -- and IR3535, a synthetic version of a naturally occurring amino acid. They are also registered with the EPA.

 

I tested Spectrum Brands' Repel Lemon Eucalyptus, which has a 40% concentration of oil of lemon eucalyptus. It has a very potent smell that, while not unpleasant, was overwhelming. (It would definitely interfere with my enjoyment of a grilled hot dog.) Spectrum's brand manager, Chris Evans, says the smell is what keeps the mosquitoes away. I found it works -- I didn't get a single bite on my arms or legs. But I did get bitten on my neck and face, where I didn't spray.

 

That was not as good as Backwoods Cutter. No mosquito came anywhere near me while I was wearing the product, which contains a 23% concentration of DEET and is also made by Spectrum.

 

But the lemon eucalyptus worked better than OFF! Family Care Repellent IV, which has a 7% concentration of DEET and should last for up to two hours, according to the label. I got a bite on my arm after an hour and 15 minutes.

 

S.C. Johnson & Son Inc., the maker of OFF!, said its claims are backed by extensive tests. "Without knowing specifics about how the product was applied, how long you remained in your backyard and/or the actual intensity level of your physical activity, it is hard for us to comment directly about your backyard experiment," said spokeswoman Jenny Taylor.

 

I also tried Bull Frog Mosquito Coast, which contains a 20% concentration of IR3535 and is made by Chattem Inc. That product is also a sunscreen, and it smelled and felt like one. I didn't get any bites anywhere during the two hours I tested it, even though mosquitoes started approaching me by the end.

 

The herb-themed product that I used, EcoSmart Organic Insect Repellent, was the only one without an EPA registration -- meaning it can't claim that it protects against disease-carrying bugs. Vern Kennedy, the CEO of EcoSmart Technologies, said the government doesn't require one for his product because it contains food-grade ingredients, including rosemary, cinnamon and lemongrass oils. Information from the EPA supports that.

 

The herbal smell of those components was pleasant and lighter than the lemon eucalyptus. And for more than an hour, I worked bite-free. But at one hour, 10 minutes, the attacks began. Two mosquitoes bit me, and I swatted a third that was about to take the plunge. At that point, it was time to go back inside.

 

 

 

Printed in The Wall Street Journal, page D1

 

Copyright 2009 Dow Jones & Company, Inc. All Rights Reserved.

 

Intensive diabetes treatment helps if done early, experts say

 

By Mary Brophy Marcus

USA Today

Wednesday, June 10, 2009

 

Intensively lowering blood sugar in the early years of diabetes may reduce the chance of heart problems and premature death, but the same aggressive treatment does not appear to help as much in long-time type 2 diabetics, suggested researchers on Tuesday.

 

Scientists conducting two major, long-term studies of people with type 2 diabetes, the ACCORD study and the VA Diabetes Trial (VADT), discussed the effects of intensive glucose control — keeping a low blood sugar level — and its relationship to heart problems and death from heart disease at a symposium at the American Diabetes Association's 69th Scientific Sessions in New Orleans.

 

Researchers from both studies presented data last year with perplexing messages, that intensively lowering blood sugar was linked to death and may or may not be linked to increases in cardiovascular complications and heart-related deaths. So researchers over the past year have been analyzing the data to better understand those findings.

 

"Since last year threw a big wrench into what we thought was important about glucose control, over the last year researchers have been looking deeper at the data to evaluate should we strive for good control or shouldn't we?" says endocrinologist Richard Bergenstal, president-elect for science and medicine at the American Diabetes Association.

 

The ACCORD study results out this past year suggested that intensively lowering blood glucose levels — reaching an A1C level, which gives an average blood glucose level in a 2 to 3 month period, of under 6% — was linked to premature death. But no "smoking gun," no clear reason, was identified, said study author Matthew Riddle, professor of medicine at Oregon Health Science University and a member of the Glycemia Manage Group of ACCORD, at today's presentation.

 

After he confirmed last year's overall study results that showed there was a 20% rise in the risk of death associated with intensive treatment, he and colleagues did not confirm that higher deaths are linked to lower A1C levels. Instead, the type 2 patients in the study who quickly lowered their A1C levels during the first year of treatment appeared to have a lower risk of death, Riddle says.

 

Denise Bonds, an ACCORD investigator with The National Hearth, Lung, and Blood Institute, said at the symposium that the scientists delved further by looking at patients who experienced severe hypoglycemia, low blood sugar which can cause dizziness, confusion, coma, and rarely, death, during the study to see if that explained the data.

 

"We found that severe hypoglycemia in both groups was associated with a higher risk of death," said Bonds, who said 451 deaths occurred in the ACCORD intensive and standard group patients (who had an A1C goal of between 7 and 7.9%) combined. But, Bonds said the results still bear more analysis, noting that hypoglycemia was more prevalent in the standard group who maintained higher A1C levels.

 

Similar to the ACCORD study, researchers in the VADT study also announced findings last year that there didn't appear to be a benefit to aggressively lowering blood sugar levels, said William Duckworth, director of diabetes research at the Carl T. Hayden Medial Center in Phoenix, and co-chair of the VADT, at today's meeting.

 

He said upon further exploration, their findings appear to have an age factor. "The analysis turned out to be more complex than we expected," he says. In a general, the data show intensive treatment within the first 15 years of a diabetes diagnosis has an increased chance of doing good, while intensive treatment after 15 years of having diabetes has an increased chance of doing harm."

 

In both studies, any severe low blood sugar event raised the risk of cardiac-related death, Duckworth said.

 

Duckworth said that much more research and analysis is required before any recommendations can be made to doctors on how to best treat their patients, but said, "The research suggests the longer a patient has had diabetes, the more risk an intensive glucose-lowering regime has on the heart and heart-related death."

 

 

 

 

 

Copyright 2009 USA Today.

 

Greening the Herds: A New Diet to Cap Gas

 

By Leslie Kaufman

New York Times

Friday, June 5, 2009

 

HIGHGATE, Vt. — Chewing her cud on a recent sunny morning, Libby, a 1,400-pound Holstein, paused to do her part in the battle against global warming, emitting a fragrant burp.

 

Libby, age 6, and the 74 other dairy cows on Guy Choiniere’s farm here are at the heart of an experiment to determine whether a change in diet will help them belch less methane, a potent heat-trapping gas that has been linked to climate change.

 

Since January, cows at 15 farms across Vermont have had their grain feed adjusted to include more plants like alfalfa and flaxseed — substances that, unlike corn or soy, mimic the spring grasses that the animals evolved long ago to eat.

 

As of the last reading in mid-May, the methane output of Mr. Choiniere’s herd had dropped 18 percent. Meanwhile, milk production has held its own.

 

The program was initiated by Stonyfield Farm, the yogurt manufacturer, at the Vermont farms that supply it with organic milk. Mr. Choiniere, a third-generation dairy herder who went organic in 2003, said he had sensed that the outcome would be good even before he got the results.

 

“They are healthier,” he said of his cows. “Their coats are shinier, and the breath is sweet.”

 

Sweetening cow breath is a matter of some urgency, climate scientists say. Cows have digestive bacteria in their stomachs that cause them to belch methane, the second-most-significant heat-trapping emission associated with global warming after carbon dioxide. Although it is far less common in the atmosphere than carbon dioxide, it has 20 times the heat-trapping ability.

 

Frank Mitloehner, a University of California, Davis, professor who places cows in air-tight tent enclosures and measures what he calls their “eruptions,” says the average cow expels — through burps mostly, but some flatulence — 200 to 400 pounds of methane a year.

 

More broadly, with worldwide production of milk and beef expected to double in the next 30 years, the United Nations has called livestock one of the most serious near-term threats to the global climate. In a 2006 report that looked at the environmental impact of cows worldwide, including forest-clearing activity to create pasture land, it estimated that cows might be more dangerous to Earth’s atmosphere than trucks and cars combined.

 

In the United States, where average milk production per cow has more than quadrupled since the 1950s, fewer cows are needed per gallon of milk, so the total emissions of heat-trapping gas for the American dairy industry are relatively low per gallon compared with those in less industrialized countries.

 

Dairy Management Inc., the promotion and research arm of the American dairy industry, says it accounts for just 2 percent of the country’s emissions of heat-trapping gases, most of it from the cows’ methane.

 

Still, Erin Fitzgerald, director of social and environmental consulting for Dairy Management, says the industry wants to avert the possibility that customers will equate dairies with, say, coal plants. It has started a “cow of the future” program, looking for ways to reduce total industry emissions by 25 percent by the end of the next decade.

 

William R. Wailes, the head of the department of animal science at Colorado State University who is working on the cow of the future, says scientists are looking at everything from genetics — cows that naturally belch less — to adjusting the bacteria in the cow’s stomach.

 

For the short run, Professor Wailes said, changes in feed have been the most promising.

 

Stonyfield Farm, which started as a money-raising arm for a nonprofit organic dairy school and still has a progressive bent, has been working on the problem longer than most.

 

Nancy Hirshberg, Stonyfield’s vice president for natural resources, commissioned a full assessment of her company’s impact on climate change in 1999 that extended to emissions by some of its suppliers.

 

“I was shocked when I got the report,” Ms. Hirshberg said, “because it said our No. 1 impact is milk production. Not burning fossil fuels for transportation or packaging, but milk production. We were floored.”

 

From that moment on, Ms. Hirshberg began looking for a way to have the cows emit less methane.

 

A potential solution was offered by Groupe Danone, the French makers of Dannon yogurt and Evian bottled water, which bought a majority stake in Stonyfield Farm in 2003. Scientists working with Groupe Danone had been studying why their cows were healthier and produced more milk in the spring. The answer, the scientists determined, was that spring grasses are high in Omega-3 fatty acids, which may help the cow’s digestive tract operate smoothly.

 

Corn and soy, the feed that, thanks to postwar government aid, became dominant in the dairy industry, has a completely different type of fatty acid structure.

 

When the scientists began putting high concentrations of Omega-3 back into the cows’ food year-round, the animals were more robust, their digestive tract functioned better and they produced less methane.

 

The new feed is used at 600 farms in France, said Julia Laurain, a representative of Valorex SAS, a French company that makes the feed additives and that is working with Stonyfield Farm to bring the program to the United States.

 

A reason farmers like corn and soy is that those crops are a plentiful, cheap source of energy and protein — which may lead some to resist replacing them. But Ms. Laurain said flax cost less than soy, although grain prices can fluctuate. The flax used in the new feed is grown in Canada, is often heated to release the oil in its seed and yield the maximum benefit for the cow. For now, however, that process is expensive because there is no plant for it in the United States, and the flax is shipped to Europe for heating.

 

If the pilot program was expanded, she said, a heating facility would be built in the United States, and processing costs could be slashed.

 

Ms. Laurain maintains that even if the feed costs more, it yields cost savings because the production of milk jumps about 10 percent and animals will be healthier, live longer and produce milk for more years.

 

The methane-reduction results have been far more significant in France than in the Vermont pilot — about 30 percent — because the feed is distributed there not just to organic farms, where the animals already eat grass for at least half the year, but also to big industrial farms.

 

Farms in the Vermont program, like Mr. Choiniere’s, are also relying on Valorex’s method for measuring methane reduction, which involves analyzing fatty acids in the cows’ milk. Professor Wailes, of Colorado State, said he found that method for testing for reduced methane emissions promising. “I believe it is very possible,” he said.

 

Mr. Choiniere said that regardless of how the tests turned out, he planned to stick with the new feeding system.

 

“They are healthier and happier,” he said of his cows, “and that’s what I really care about.”

 

Some of the 75 dairy cows at Guy Choiniere’s farm in Highgate, Vt., where feed has been changed to plants like alfalfa and flaxseed to reduce the methane emitted when they belch.

 

Copyright 2009 The New York Times Company.

 

Feel bloated? This can help

 

Daily Press (Newport News, Va.)

By Alison Johnson

Baltimore Sun

Wednesday, June 10, 2009

 

Extra fluid and gas can puff up even the fittest among us. Beyond eating right and exercising, here are some foods and drinks to avoid if you're trying to deflate your tummy.

 

Salty foods. Water molecules are attracted to sodium, so you'll retain more fluids if you pour on the seasoning or eat lots of processed foods.

 

Certain produce. Broccoli, cabbage, citrus fruits, onions and peppers are top examples of healthy foods that contain difficult-to-digest sugars, which can cause gas. Even if you're susceptible, though, don't stop eating them; try limiting servings to a half cup at a time. Cooking raw veggies also can help.

 

Soda. Not surprisingly, the carbonation in soft drinks can cause bloat. Alcohol, coffee and some fruit juices also can cause intestinal irritation and swelling, so stick mainly to water and unsweetened teas that will help your body flush out waste products.

 

Fatty foods. Fried dishes in particular take a long time to digest -- that's why you may feel like you have rocks in your stomach. Aim for healthy fats such as salmon, olive oil, nuts and seeds.

 

Spicy foods. Tolerance varies widely by person, but pepper, chili powder, garlic and hot sauces can trigger the stomach to produce more acid.

 

Sugar substitutes. Substances used to sweeten low-calorie or low-carbohydrate snacks and desserts aren't well absorbed by the digestive tract, which can cause gas and diarrhea. One common ingredient to look out for is xylitol. Chew with your mouth closed. Not only is it polite, it keeps you from swallowing air -- a leading cause of bloating and gas. Also chew food into small pieces before swallowing, don't talk with your mouth full and don't drink with a straw.

 

Copyright © 2009, South Florida Sun-Sentinel.

 

Copyright 2009 Baltimore Sun.

 

Opinion

Jolt the system

Grass-roots efforts to help shape health care reform must begin now

 

By Llewellyn J. Cornelius and Kieva A. Bankins

Baltimore Sun Commentary

Wednesday, June 10, 2009

 

Nearly a century has passed since initial discussions began in the United States about the need for national health insurance - and we're still talking about it. Now, President Barack Obama and House leaders have committed to a July 31 deadline for moving a health reform bill through the House. This bill focuses on three core principles: reducing rising health care costs, allowing Americans the ability to choose their own doctors and their own plans, and ensuring quality, affordable health care for all Americans.

 

This past weekend marked a crucial step on the road to those goals: the launching of community forums focusing on health reform and supported by the president's volunteer network, Organizing for America. As communities become engaged in the health reform debate, the discussion should be on what we must do nationally to provide the sustained effort needed to overcome the ideological barriers that have hindered the passage of national health insurance for nearly a century.

 

Supporters of health reform must rally their collective strengths to unveil a specific, common platform on which the American public can base an informed opinion about the most promising policy. In the 1990s, the Clinton plan failed to win support from key advocacy groups that could have provided a connection between the federal government and the local community. The same mistake must not be made this time. Building alliances across America will help unify the movement's vision and offer a road map to guide its direction. Savvy leaders of this movement must identify target groups among policymakers, professionals, the news media and the public to decide on the best tactics to monitor opponents' actions. These leaders can work on distilling the health reform issue into a core message that is easy to articulate and promote.

 

Once strong alliances with influential political supporters and major public health interest groups have been formed, advocates must build robust coalitions to initiate public debate in an array of news media. Only then can coalitions adopt key talking points that enable all "faces" of the health reform movement to represent and defend a universal front for equal access to care. The coalition must diligently work to gather and respond to misleading information in a timely manner as it is presented in the public domain - again, something that didn't happen with the Clinton plan.

 

While many health advocacy groups lack the financial resources to compete with their opponents, advocates must explore alternative avenues to present pertinent information to the public. Text and video messaging, blogs, Facebook and Twitter are among the inexpensive tools that can enhance the dissemination of information among like-minded interest groups and the general public.

 

Communities need to move the health reform issue away from the discussion of policies that focus on the disenfranchised and more to a policy designed for all Americans. Current health insurance policies tend to focus on reducing the number of uninsured Americans, on expanding Medicaid, Medicare or the Children's Health Insurance Program, instead of on expanding private health insurance to include people not in the labor force.

 

Comprehensive health reform will never succeed if the core debate is focused on developing incremental policies at the margin to append to the current health insurance system. And it will not succeed without the committed participation of community advocates.

 

Llewellyn J. Cornelius is a professor at the University of Maryland School of Social Work. His e-mail is lcornelius@ssw.umaryland.edu. Kieva A. Bankins is a research specialist at the school's Ruth Young Center and a student in the organizational leadership doctoral program at the University of Maryland Eastern Shore. Her e-mail is kbankins-russell@ssw.umaryland.edu.

 

Copyright 2009 Baltimore Sun.

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