DUD: The Nightmarish Dangers of Drowsy Driving

Driving under the influence of alcohol or drugs is known to increase the chances of causing an accident. For instance, marijuana can impair drivers' reaction time. But what about drowsiness? As many as a third of all fatal car crashes might involve fatigued drivers, according to research by the National Highway Traffic Safety Administration.
And a new study finds that driving while under the influence--of drowsiness--is exceedingly common.
More than one in 25 people report actually having fallen asleep behind the wheel at least once within the past month, according to a new study from the U.S. Centers for Disease Control and Prevention (CDC). Unsurprisingly, drivers who are at risk of dozing are more likely to cause crashes that result in injuries or death than are alert drivers. "Drowsiness slows reaction time, makes drivers less attentive and impairs decision-making skills," the report authors noted.
The researchers, led by Anne Wheaton, an epidemiologist at the CDC, analyzed responses from more than 147,000 adults who participated in the Behavioral Risk Factor Surveillance System phone survey. Respondents hailed from 19 states and the District of Columbia; within these areas, Texas--with its 3,200-plus miles of interstates-had the highest rate of severely tired drivers, with 6.1 percent of respondents saying they had slumbered at the wheel, and Oregon had the lowest, with just 2.5 percent.
Not surprisingly, people who reported having zonked out while driving were more likely to say they most often got six or fewer hours of shuteye and/or snored, which can be a sign of sleep apnea. Older drivers--those 65 and up--were the least likely to report having caught some winks while driving (just 1.7 percent had), whereas those ages 25 to 34 and 35 to 44 were the most likely (6.3 percent and 5.5 percent, respectively). Those in these age categories might be more likely to be working shifts or slogging through long commutes, while those who are retired were by far the least likely to have reported falling asleep (1 percent), suggesting they might be getting ample rest and not feel compelled to drive when they are not up for it.
These numbers are likely to be below the actual rate of somnolent automobilists because they rely on self-reported responses; many people who nod off for just a second or so don't even realize it has happened. Additionally, these stats represent those who have actually dozed at the wheel; more than a quarter of adults report driving while they feel bushed in a given month, according to a recent poll by the National Sleep Foundation.
Those most at risk for being severely sleepy at the wheel included commercial drivers, people with sleep disorders who are not being properly treated, people who take sedatives, people who generally do not get enough sleep, and people who work long or night shifts.
Shift workers often operate short on sleep. Research published last year by the CDC also showed that those working in dangerous industries--including transportation jobs such as commercial driving. In fact, that study found that nearly 70 percent of people who worked overnight shifts in transportation or warehousing industries often got fewer than six hours of z's.
Most fatigue-induced accidents occur in the afternoon and nighttime. The best thing to do to avoid dangerous drowsiness is to pull over and rest. Common "techniques to stay awake while driving, such as turning up the radio, opening the window, and turning up the air conditioner, have not been found to be effective," the authors of the new CDC study reported. It remains to be seen whether new car technology to sense and alert drowsy drivers can help. In the meantime, hopefully the road safety worries aren't enough to cause any more lost sleep.

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Budget battles threaten to limit Obama's second-term agenda

WASHINGTON (Reuters) - After a brutal "fiscal cliff" battle, President Barack Obama's looming budget confrontation with Congress threatens to sharply curtail his second-term agenda and limit his ambitions on priorities such as immigration reform and gun control.
Obama has vowed to push ahead with other legislative priorities during the fiscal fight, but faces the likelihood that they will be elbowed aside in a fierce struggle with Republicans over approaching deadlines to raise the limit on federal borrowing, cut spending and fund government operations.
Obama and Congress must agree by the end of March on increasing the $16.4 trillion debt ceiling, the fate of $85 billion in delayed automatic spending cuts and passage of a bill to fund the government after a temporary measure expires.
Those budget battles could be even more intense than the weeks-long "fiscal cliff" fight that ended on New Year's Day with an agreement to raise taxes on the wealthy, leaving divided Republicans itching for revenge and a fractured relationship between Obama and Republican House Speaker John Boehner.
"We always felt that a bipartisan and amicable conclusion to the fiscal cliff would lead to a very positive agenda for the next two years, and the opposite occurred. It bodes poorly for Obama's other major priorities," said Jim Kessler, senior vice president for policy at the centrist think tank Third Way.
"There is a high level of dysfunction. They haven't cracked the code yet on how to work with each other," Kessler said of Obama and congressional Republicans.
The fiscal cliff fight overwhelmed nearly everything else at the White House for two months. A similar result in the budget battle would be bad news for Obama, cutting into the narrow one-year to 18-month window when second-term presidents traditionally still have the political clout to achieve their most significant legislative victories.
"From a Republican standpoint, if you don't want Obama to get any oxygen on these other issues, focusing on the fiscal cliff and all these budget issues is a very good way to run out the clock on him," said Republican strategist John Feehery, a former Capitol Hill aide.
Obama has promised to pursue a broad second-term agenda focused on comprehensive immigration reform, bolstering domestic energy production, fighting climate change and gun control. After the "fiscal cliff" deal, he said he would not curtail his agenda because of the looming budget fights.
"We can settle this debate, or at the very least, not allow it to be so all-consuming all the time that it stops us from meeting a host of other challenges that we face," Obama said on New Year's Day before boarding a flight to Hawaii to resume a holiday interrupted by the fiscal cliff fight.
"It's not just possible to do these things; it's an obligation to ourselves and to future generations," he said.
PRIMED FOR A FIGHT
Republicans are primed for the coming fight, believing they have more leverage against Obama than during the fiscal cliff battle. Failure to close a deal on the debt ceiling could mean a default on U.S. debt or another downgrade in the U.S. credit rating like the one after a similar showdown in 2011.
A failure to reach agreement on a government funding bill could mean another federal shutdown like brief ones in 1995 and 1996.
Republicans say they will not back an increase in the federal debt ceiling without significant spending cuts opposed by many Democrats, particularly to popular "entitlement" programs such as the government-funded Medicare and Medicaid healthcare plans for the elderly and poor.
"When you look at what's coming down the pike, it will make the fiscal cliff look like a day in Sunday school," said Democratic strategist Chris Kofinis.
"You're talking about a battle that's going to last weeks or months. If they get a deal, it's going to be ugly, it's going to be brutal. Once you get past that, where do you find the will to address other issues? It's going to be very hard," he said.
Administration officials promise to move quickly in January in pursuit of new legislation on gun control and immigration. The gun control effort will be led by Vice President Joe Biden, who was appointed to develop a response to the deadly Connecticut school shootings in December.
But what seemed to be fresh momentum for new measures such as a ban on assault rifles after the mass killing in Connecticut could be stalled by a protracted focus on the seemingly never-ending budget showdowns.
Obama also plans to introduce comprehensive immigration legislation this month. Republicans will have fresh incentive on the issue after Hispanics soundly rejected Republican presidential contender Mitt Romney in the November election, giving Obama more than 70 percent of their vote.
But a Senate Republican leadership aide said economic issues would be the prime concern of Congress for months, pushing back consideration of gun control and immigration. The aide blamed Obama.
"The lack of leadership on spending and debt has put us behind on a number of other issues. That is not something that can be resolved quickly," the aide said.
When blocked in Congress, Obama has shown a willingness to use executive orders and agency rules to make policy changes. During last year's campaign, Obama ordered an end to deportations of young undocumented immigrants who came to the country as children and had never committed a crime.
This week, the Department of Homeland Security changed its rules to make it easier for undocumented immigrants to get a waiver allowing them to stay in the country as they seek permanent residency.
With Republicans motivated to improve their standing with Hispanics, there is a chance Congress will work with the White House to pass an immigration bill that both bolsters border security and offers a pathway to legal status for undocumented immigrants who pay their back taxes and fines.
Finding the rare sweet spot where Obama and Republicans actually agree on an issue could be the key to second-term legislative success.
"The only thing that gets done outside of the economy are things that Republicans decide they have to get done for their own political futures," Feehery said.
But Kessler said he was skeptical that Obama and Congress can find common ground on a comprehensive immigration measure that provides a long-term solution for the country's 12 million illegal immigrants.
"Will something get done on immigration? Probably. But a major deal that addresses all undocumented immigrants in a comprehensive way? We're much less confident than we were two weeks ago," Kessler said.
"The question now is, do they even know how to make deals with each other?" he said.

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2012 was worst year for whooping cough since 1955

The nation just suffered its worst year for whooping cough in nearly six decades, according to preliminary government figures.
Whooping cough ebbs and flows in multi-year cycles, and experts say 2012 appears to have reached a peak with 41,880 cases. Another factor: A vaccine used since the 90s doesn't last as long as the old one.
The vaccine problem may continue to cause higher than normal case counts in the future, said Dr. Tom Clark of the Centers for Disease Control and Prevention.
"I think the numbers are going to trend up," he said. The agency provided the latest figures on Friday.
Last year, cases were up in 48 states and outbreaks were particularly bad in Colorado, Minnesota, Washington state, Wisconsin and Vermont.
The good news: Despite the high number of illnesses, deaths didn't increase. Eighteen people died, including 15 infants younger than 1.
Officials aren't sure why there weren't more deaths, but think that the attention paid to bad outbreaks across the nation resulted in infected children getting diagnosed faster and treated with antibiotics.
Also, a push last year to vaccinate pregnant women — a measure designed to pass immunity to infants — may have had some small measure of success, Clark said.
The final tally will be higher but unlikely to surpass the nearly 63,000 illnesses in 1955, he said.
Whooping cough is a highly contagious disease that can strike people of any age but is most dangerous to children. Its name comes from the sound children make as they gasp for breath.
It used to be a common threat, with hundreds of thousands of cases annually. Cases gradually dropped after a vaccine was introduced in the 1940s.
For about 25 years, fewer than 5,000 cases were reported annually in the U.S. But case counts started to climb again in the 1990s although not every year. Numbers jumped to more than 27,000 in 2010, the year California saw an especially bad epidemic.
Experts looking for an explanation have increasingly looked at a new vaccine introduced in the 1990s, and concluded its protection is not as long-lasting as was previously thought.
Children are routinely vaccinated with five doses beginning at 2 months, and a booster shot is recommended at around 11 or 12. Health officials are considering recommending another booster shot, strengthening the vaccine or devising a brand new one.

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Poll: Fight obesity crisis but keep the junk food

WASHINGTON (AP) — Everyone could use a little help keeping those New Year's resolutions to slim down. But if it means the government limiting junk food, the response is an overwhelming, "No."
Americans call obesity a national health crisis and blame too much screen time and cheap fast food for fueling it. But a new poll finds people are split on how much the government should do to help — and most draw the line at attempts to force healthier eating.
A third of people say the government should be deeply involved in finding solutions to the epidemic. A similar proportion want it to play little or no role, and the rest are somewhere in the middle, according to the poll by The Associated Press-NORC Center for Public Affairs Research.
Require more physical activity in school, or provide nutritional guidelines to help people make better choices? Sure, 8 in 10 support those steps. Make restaurants post calorie counts on their menus, as the Food and Drug Administration is poised to do? Some 70 percent think it's a good idea.
"That's a start," said Khadijah Al-Amin, 52, of Coatesville, Pa. "The fat content should be put up there in red letters, not just put up there. The same way they mark something that's poisonous, so when you see it, you absolutely know."
But nearly 6 in 10 people surveyed oppose taxes targeting unhealthy foods, known as soda taxes or fat taxes.
And when it comes to restricting what people can buy — like New York City's recent ban of supersized sodas in restaurants — three-quarters say, "No way."
"The outlawing of sugary drinks, that's just silly," said Keith Donner, 52, of Miami, who prefers teaching schoolchildren to eat better and get moving.
"People should just look at a Big Gulp and say, 'That's not for me.' I think it starts when they are young and at school," he added.
Despite the severity of the problem, most of those surveyed say dealing with obesity is up to individuals. Just a third consider obesity a community problem that governments, schools, health care providers and the food industry should be involved in. Twelve percent said it will take work from both individuals and the community.
That finding highlights the dilemma facing public health experts: Societal changes in recent decades have helped spur growing waistlines, and now a third of U.S. children and teens and two-thirds of adults are either overweight or obese. Today, restaurants dot more street corners and malls, regular-sized portions are larger, and a fast-food meal can be cheaper than healthier fare. Not to mention electronic distractions that slightly more people surveyed blamed for obesity than fast food.
In the current environment, it's difficult to exercise that personal responsibility, said Jeff Levi of the nonprofit Trust for America's Health, which has closely tracked the rise in obesity.
"We need to create environments where the healthy choice becomes the easy choice, where it's possible for people to bear that responsibility," he said.
The new poll suggests women, who have major input on what a family eats, recognize those societal and community difficulties more than men do.
More than half of women say the high cost of healthy food is a major driver of obesity, compared with just 37 percent of men. Women also are more likely than men to blame cheap fast food and to say that the food industry should bear a lot of responsibility for helping to find solutions.
Patricia Wilson, 53, of rural Speedwell, Tenn., says she must drive 45 minutes to reach a grocery store — passing numerous burger and pizza joints, with more arriving every year.
"They shouldn't be letting all these fast-food places go up," said Wilson, who nags her children and grandchildren to eat at home and watch their calories. She recalls how her own overweight grandmother lost both her legs and then her life to diabetes.
More than 80 percent of people in the AP-NORC poll said they had easy access to supermarkets, but just as many could easily get fast food. Another 68 percent said it was easy for kids to purchase junk food on their way to school, potentially foiling diet-conscious caregivers like Wilson, who doesn't allow her grandchildren to eat unhealthy snacks at home.
"If they say they're hungry, they get regular food," she said.
Food is only part of the obesity equation; physical activity is key too. About 7 in 10 people said it was easy to find sidewalks or paths for jogging, walking or bike-riding. But 63 percent found it difficult to run errands or get around without a car, reinforcing a sedentary lifestyle.
James Gambrell, 27, of Springfield, Ore., said he pays particular attention to diet and exercise because obesity runs in his family. He makes a point of walking to stores and running errands on foot two to three times a week.
But Gambrell, a fast-food cashier, said he eats out at least once a day because of the convenience and has changed his order at restaurants that already have begun posting calorie counts. He's all for the government pushing those kinds of solutions.
"I feel that it's a part of the government's responsibility to care for its citizens and as such should attempt to set regulations for restaurants that are potentially harmful to its citizens," he said.
On the other side is Pamela Dupuis, 60, of Aurora, Colo., who said she has struggled with weight and has been diagnosed as pre-diabetic. She doesn't want the government involved in things like calorie-counting.
"They should stay out of our lives," she said.
The AP-NORC Center survey was conducted Nov. 21 through Dec. 14. It involved landline and cellphone interviews with 1,011 adults nationwide and has a margin of sampling error of plus or minus 4.2 percentage points.

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Massachusetts governor seeks tighter rules on compounding pharmacies

BOSTON (Reuters) - Massachusetts Governor Deval Patrick on Friday proposed new state rules to more closely regulate the type of pharmacy at the heart of a U.S. meningitis outbreak that has killed 39 people.
The proposed legislation would require special licenses for compounding pharmacies, allow the state Board of Pharmacy to fine companies that violate its rules and require out-of-state pharmacies that ship drugs to Massachusetts to be licensed by the state.
The aim is to more closely monitor companies that cross the line from mixing the raw materials of drugs for individual prescriptions and those that begin to operate more like large-scale manufacturers.
An injectible steroid produced by the Framingham, Massachusetts-based New England Compounding Center (NECC) was linked to an outbreak of bacterial meningitis that has sickened 656 people in 19 states, according to the Centers for Disease Control and Prevention.
"The regulations that we have in place and governing authority hasn't kept up with an industry that's changed," Patrick told reporters on Friday. "It's really built around the corner drug store, but we've seen and experienced with NECC that businesses that call themselves pharmacies are actually doing a form of manufacturing."
Federal investigators have found multiple violations of standard sterility practices at NECC, which has closed and, on December 21, filed for bankruptcy protection.
Companies registered as pharmacies are regulated by the individual states, while drug manufacturers face the tighter oversight of the U.S. Food and Drug Administration. Patrick's legislation calls on Massachusetts to more closely work with the FDA to ensure that larger pharmacies do not escape oversight.
The state has since ordered the temporary shutdown of four other compounding pharmacies where investigators found problems.
The FDA last month urged states to crack down on loopholes that allowed compounding pharmacies to produce drugs on an industrial scale without drawing FDA scrutiny.

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U.S. teen smoking declines to record low in 2012: study

Cigarette smoking among American teenagers dropped to a record low in 2012, a decline that may have been partly driven by a sharp hike in the federal tobacco tax, researchers said on Wednesday.
An annual survey of about 45,000 students in the eighth, 10th and 12th grades found that the overall proportion of those saying they had smoked in the prior 30 days fell by just over a percentage point to 10.6 percent.
"A one percentage point decline may not sound like a lot, but it represents about a 9 percent reduction in a single year in the number of teens currently smoking," Lloyd Johnston, the principal investigator in the study, said in a statement.
He said reductions on that scale can translate into the prevention of thousands of premature deaths and tens of thousands of cases of cancer and other serious disease.
More than 400,000 Americans are estimated to die prematurely each year as a result of cigarette smoking - the No. 1 cause of preventable U.S. deaths - and most smokers begin their habit as adolescents, experts say.
Healthcare advocates hailed Wednesday's findings as evidence that higher cigarette taxes were paying off, combined with federal curbs on youth-oriented tobacco marketing and sales and a sweeping anti-smoking media campaign.
The researchers also cited the increase in federal cigarette taxes, raised by 62 cents a pack in 2009, as a likely contributing factor. The findings were part of an annual survey by University of Michigan researchers released by the National Institute on Drug Abuse.
Smoking rates fell for each of the individual age groups surveyed, most notably among eighth graders - from 6.1 percent in 2011 to 4.9 percent in 2012, the survey found.
Longer-term trends showed teen smoking rates dropping by about three-fourths among eighth graders, two-thirds among 10th graders and by half among 12th graders since a peak in the mid-1990s, researchers said.
One reason cited by experts is that the proportion of students who have ever tried smoking has declined sharply. Whereas nearly half of all eighth graders had tried cigarettes in 1996, just 16 percent had done so this year.
Teen attitudes toward smoking also continued to become more negative. For example, 80 percent of teens said they preferred to date nonsmokers in 2012.
But anti-tobacco advocates said their battle to stamp out teen smoking was far from over, noting that 17 percent of high school seniors still graduate as smokers.
Researchers singled out concerns over new forms of smokeless tobacco, including dissolvable products like Camel-branded "Orbs" and "Strips," and a fine, moist form of snuff called snus (rhymes with "loose"), which users place under their upper lip.
They said a significant portion of older teens have experimented with small cigars and water pipes called hookahs, which are becoming popular among young adults.
"We cannot let our guard down when the tobacco industry still spends $8.5 billion a year - nearly $1 million ever hour - to market its deadly and addictive products and is pushing new products ... that entice youth," said Susan Liss, executive director for the Campaign for Tobacco-Free Kids.

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Truth About Santa Still Stings Adults

Emily Charlton, as a wide-eyed fourth grader, said she felt betrayed by her classmates on her elementary school playground during recess just before the holidays.
"It was a day or two before Christmas break so we were talking about what we had asked for and I remember saying at one point, 'Well I asked Santa for...' and everyone started laughing," said Charlton, now a 29-year-old waitress from San Diego. "I think they thought I was making a joke."
She stood her ground. "I remember feeling embarrassed and upset," said Charlton. "My belief, however, was unchanged."
But it got worse.
A few days later, she was at Toys "R" Us with her father and saw him pack a long, narrow box into the trunk. On Christmas morning, her younger sister opened up an electric keyboard from Santa in that same box.
Charlton ran to her mother for reassurance that what she suspected was wrong.
"I will never forget what came next," she said. "She looked at me, and without skipping a beat said, 'Don't tell your brother and sister.' I was devastated. … A huge bomb was dropped on me and as silly as it sounds, it really changed my life.
"The worst part of all was how unceremoniously it happened, it was like one minute I was a child full of wonderment, and in a flash was snapped into a world of non-believing, magic-less adults."
Parents aren't the only grinches this time of year.
In Ontario, Canada, this week a man walked along a Christmas parade route telling kids there is no Santa Claus, according to 24 Hours Vancouver. The 24-year-old, whose hair was gelled to look like horns, was arrested for intoxication and causing a disturbance.
And a news anchor in Chicago went on a rant against the jolly old man after a segment on holiday expectations and the bad economy, according to the Huffington Post.
"Stop trying to convince your kids that Santa is Santa," said Robin Robinson of Fox Chicago. "That's why they have these high expectations. They know you can't afford it, so what do they do? Just ask some man in a red suit. There is no Santa."
Robinson later apologized.
Of course the truth is inevitable, unless you are a logical middle-school child who has done a careful "cost-benefit analysis."
"I was one of those kids who stretched a belief in Santa for as long as possible, probably well past a point of willful ignorance," said Peter Dacey, a 27-year-old from Easton, Conn.
He had been the recipient of several "Christmas miracles." One was the "coolest space Lego out there," the working monorail, which he was convinced was too expensive for his parents to give him.
The other came right out of the "Miracle on 34th Street" playbook when his family was living in temporary housing, looking for a new home.
"All I wanted for Christmas was for us to find a house," said Dacey. "Strangely, that year I found a little box in the tree left for me that contained some random key. But it didn't seem so strange when I realized that it must be the key to our new home. I took it with me to the next few open houses we went to, and lo and behold, it fit in one."
In the end, it was a question of what reaped the most rewards.
"If you don't believe in Santa, no good comes of it, as either you're correct or you're not, in which case have fun forcing your parents to get you all your future Christmas gifts while Santa visits the believers," said Dacey. "On the other hand, if you do believe, the worst that can happen is that you find out you were wrong, and what's the harm there?"
To this day, Dacey said there is a part of him that "still believes," at least in the messages of love and giving.
"I suppose I stopped believing in a living, breathing jolly-old-elf over a number of middle-school years, but have never stopped believing in Santa," he said. "I hope the silver sleigh bell would still ring for me."
Emily Charlton is still miffed that Mom spilled the beans.
"It was honestly the first time I can remember feeling heartbreak," she said. "I don't think it was just about the belief in Santa, but about the belief in magic and wonder and make believe, and everything that makes your childhood so great," she said.
But one parent -- now a grandmother who dresses up each year pretending to be an elf -- defended herself for bringing a dose of reality to her household when she was raising a family.
She was outraged when her 6-year-old son was sent to the principal's office for telling his first-grade class there was no Santa Claus.
"Man, was I mad about that," said Martha Chabinsky, a 59-year-old yoga teacher from Amherst, N.H. "Punishing a kid for telling the truth.

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Acortar las internaciones no significa peor atención: estudio EEUU

NUEVA YORK (Reuters Health) - Los hospitales de Asuntos del
Veterano (AV) de Estados Unidos pudieron reducir la duración de
las internaciones sin aumentar la cantidad de reingresos.
"A medida que los hospitales se volvieron más eficientes,
creció la preocupación porque estuvieran dándole el alta a
pacientes más enfermos y más rápido", dijo el autor principal de
un nuevo estudio, doctor Peter Kaboli, del Sistema de Salud de
AV de la ciudad de Iowa. "De hecho, encontramos lo opuesto",
agregó.
En Annals of Internal Medicine, el equipo de Kaboli escribe
que se está presionando a los hospitales para que disminuyan el
tiempo que los pacientes pasan allí. Pero algunos cuestionan si
el alta temprana eleva el riesgo de reinternación. Estas
segundas hospitalizaciones le cuestan Medicare unos 17.000
millones de dólares por año, según reveló un estudio del 2009.
Es más: el 1 de octubre del 2012, los Centros de Servicios
de Medicare y Medicaid comenzaron a utilizar las tasas de
reinternaciones y los resultados en los pacientes como dos
indicadores para determinar cuánto dinero deberían reembolsarles
a los hospitales.
El equipo de Kaboli estudió si la reducción del tiempo de
internación en los 129 hospitales de AV aumentaba la cantidad de
reinternaciones a los 30 días del alta médica. Para eso, analizó
más de 4 millones de historias clínicas electrónicas de AV de
los pacientes atendidos entre 1997 y el 2010.
En ese período, el tiempo promedio de internación se redujo
de 5,5 a 4 días y la cantidad de pacientes reinternados dentro
de los 30 días posteriores al alta médica cayó alrededor de 3
puntos porcentuales (del 16,5 por ciento en 1997 al 13,8 por
ciento en el 2010).
"Parecería que (la duración de la internación) no haría una
diferencia, pero al demostrar que reduce las reinternaciones
notamos que es una medida positiva", dijo Kaboli.
Aun así, el equipo halló un punto en el que la internación
más breve estaba asociada con un aumento de los reingresos. Los
hospitales con internaciones de por lo menos un día menos que el
tiempo promedio registraban un aumento de las reinternaciones.
Por otro lado, el equipo observó que la cantidad de
pacientes que morían en el hogar dentro de los 90 días
posteriores al alta médica también fue disminuyendo en esos 14
años.
"Pudimos cuidar mejor a los pacientes, con mejor calidad de
la atención y con una reducción de las tasas de mortalidad al
mismo tiempo", resumió Kaboli.
El doctor Manesh Patel, profesor asistente de cardiología de
la Duke University, en Durham, opinó que el estudio demuestra
que el sistema de AV mejoró en las áreas más sensibles para los
pacientes.
"La buena noticia es que existiría una conexión (...)
Algunas de las medidas que implementamos serían razonables",
sostuvo Patel, que no participó del estudio, pero investiga el
tema de las reinternaciones.
FUENTE: Annals of Internal Medicine, online 17 de diciembre
del 2012

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Cliff poses many risks to U.S. public sector, few severe: Moody's

WASHINGTON (Reuters) - The "fiscal cliff" of impending federal spending cuts and tax increases set for the beginning of the year poses a wide variety of risks to the public sector, but many of the threats hanging over state and local governments are not severe or direct, Moody's Investors Service said on Thursday.
President Barack Obama and Congressional leaders are in the middle of tough negotiations to avert the cliff before the start of the new year. Economists have warned the combination of tax hikes and across-the-board spending cuts, often referred to as sequestration, could plunge the country back into recession.
A downturn or a downgrade in the U.S. debt rating resulting from the federal budget battles would threaten the credit quality of the public sector, Moody's said.
"Rating changes could ensue for public finance credits that have direct, or in some cases indirect, linkages to the rating and credit standing of the U.S. government," it said.
"These rating changes would occur if Moody's lowers the U.S. government's rating as a result of the fiscal cliff, or a federal budget agreement is reached that fails to reduce the ratio of federal debt-to-GDP over the medium term," it added.
Sequestration would mostly impact states indirectly as federal grants to people shrink and they spend less money. Currently, Medicaid, the healthcare program for the poor that states administer with federal reimbursements, is safe from sequestration. Moody's warned that if Obama and Congress were to decide to cut it in their agreement, "the credit impact would be more severe."
"The largest component of the sequester is an approximately 9.4 percent, $30 billion across-the-board cut to discretionary defense programs," Moody's added. "If it is implemented, the economic impact will be most heavily felt in states with high concentrations of defense procurement contracting such as Maryland, New Mexico and Virginia."
Local governments only receive 5 percent of their revenues from direct federal payments, on average, meaning they too will only be affected by sequestration as lower spending hurts their revenues, Moody's said. Cities dominated by the federal government and military could be hit harder.
While Medicaid is off limits in sequestration, Medicare, the health insurance program for the elderly, would have to reduce reimbursements for services by 2 percent. That would hit non-profit hospitals.
Sequestration would also cut agencies that fund research at universities, but will likely only impact new grants, while the availability of federal financial aid may shrink, hurting higher education, Moody's said
The agency also said defense spending cuts will hurt military housing and could negatively impact revenue bonds for it.

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AP IMPACT: Big Pharma cashes in on HGH abuse

A federal crackdown on illicit foreign supplies of human growth hormone has failed to stop rampant misuse, and instead has driven record sales of the drug by some of the world's biggest pharmaceutical companies, an Associated Press investigation shows.
The crackdown, which began in 2006, reduced the illegal flow of unregulated supplies from China, India and Mexico.
But since then, Big Pharma has been satisfying the steady desires of U.S. users and abusers, including many who take the drug in the false hope of delaying the effects of aging.
From 2005 to 2011, inflation-adjusted sales of HGH were up 69 percent, according to an AP analysis of pharmaceutical company data collected by the research firm IMS Health. Sales of the average prescription drug rose just 12 percent in that same period.
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EDITOR'S NOTE — Whether for athletics or age, Americans from teenagers to baby boomers are trying to get an edge by illegally using anabolic steroids and human growth hormone, despite well-documented risks. This is the second of a two-part series.
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Unlike other prescription drugs, HGH may be prescribed only for specific uses. U.S. sales are limited by law to treat a rare growth defect in children and a handful of uncommon conditions like short bowel syndrome or Prader-Willi syndrome, a congenital disease that causes reduced muscle tone and a lack of hormones in sex glands.
The AP analysis, supplemented by interviews with experts, shows too many sales and too many prescriptions for the number of people known to be suffering from those ailments. At least half of last year's sales likely went to patients not legally allowed to get the drug. And U.S. pharmacies processed nearly double the expected number of prescriptions.
Peddled as an elixir of life capable of turning middle-aged bodies into lean machines, HGH — a synthesized form of the growth hormone made naturally by the human pituitary gland — winds up in the eager hands of affluent, aging users who hope to slow or even reverse the aging process.
Experts say these folks don't need the drug, and may be harmed by it. The supposed fountain-of-youth medicine can cause enlargement of breast tissue, carpal tunnel syndrome and swelling of hands and feet. Ironically, it also can contribute to aging ailments like heart disease and Type 2 diabetes.
Others in the medical establishment also are taking a fat piece of the profits — doctors who fudge prescriptions, as well as pharmacists and distributors who are content to look the other way. HGH also is sold directly without prescriptions, as new-age snake oil, to patients at anti-aging clinics that operate more like automated drug mills.
Years of raids, sports scandals and media attention haven't stopped major drugmakers from selling a whopping $1.4 billion worth of HGH in the U.S. last year. That's more than industry-wide annual gross sales for penicillin or prescription allergy medicine. Anti-aging HGH regimens vary greatly, with a yearly cost typically ranging from $6,000 to $12,000 for three to six self-injections per week.
Across the U.S., the medication is often dispensed through prescriptions based on improper diagnoses, carefully crafted to exploit wiggle room in the law restricting use of HGH, the AP found.
HGH is often promoted on the Internet with the same kind of before-and-after photos found in miracle diet ads, along with wildly hyped claims of rapid muscle growth, loss of fat, greater vigor, and other exaggerated benefits to adults far beyond their physical prime. Sales also are driven by the personal endorsement of celebrities such as actress Suzanne Somers.
Pharmacies that once risked prosecution for using unauthorized, foreign HGH — improperly labeled as raw pharmaceutical ingredients and smuggled across the border — now simply dispense name brands, often for the same banned uses. And usually with impunity.
Eight companies have been granted permission to market HGH by the U.S. Food and Drug Administration, which reviews the benefits and risks of new drug products. By contrast, three companies are approved for the diabetes drug insulin.
The No. 1 maker, Roche subsidiary Genentech, had nearly $400 million in HGH sales in the U.S. last year, up an inflation-adjusted two-thirds from 2005. Pfizer and Eli Lilly were second and third with $300 million and $220 million in sales, respectively, according to IMS Health. Pfizer now gets more revenue from its HGH brand, Genotropin, than from Zoloft, its well-known depression medicine that lost patent protection.
On their face, the numbers make no sense to the recognized hormone doctors known as endocrinologists who provide legitimate HGH treatment to a small number of patients.
Endocrinologists estimate there are fewer than 45,000 U.S. patients who might legitimately take HGH. They would be expected to use roughly 180,000 prescriptions or refills each year, given that typical patients get three months' worth of HGH at a time, according to doctors and distributors.
Yet U.S. pharmacies last year supplied almost twice that much HGH — 340,000 orders — according to AP's analysis of IMS Health data.
While doctors say more than 90 percent of legitimate patients are children with stunted growth, 40 percent of 442 U.S. side-effect cases tied to HGH over the last year involved people age 18 or older, according to an AP analysis of FDA data. The average adult's age in those cases was 53, far beyond the prime age for sports. The oldest patients were in their 80s.
Some of these medical records even give explicit hints of use to combat aging, justifying treatment with reasons like fatigue, bone thinning and "off-label," which means treatment of an unapproved condition
Even Medicare, the government health program for older Americans, allowed 22,169 HGH prescriptions in 2010, a five-year increase of 78 percent, according to data released by the Centers for Medicare and Medicaid Services in response to an AP public records request.
"There's no question: a lot gets out," said hormone specialist Dr. Mark Molitch of Northwestern University, who helped write medical standards meant to limit HGH treatment to legitimate patients.
And those figures don't include HGH sold directly by doctors without prescriptions at scores of anti-aging medical practices and clinics around the country. Those numbers could only be tallied by drug makers, who have declined to say how many patients they supply and for what conditions.
First marketed in 1985 for children with stunted growth, HGH was soon misappropriated by adults intent on exploiting its modest muscle- and bone-building qualities. Congress limited HGH distribution to the handful of rare conditions in an extraordinary 1990 law, overriding the generally unrestricted right of doctors to prescribe medicines as they see fit.
Despite the law, illicit HGH spread around the sports world in the 1990s, making deep inroads into bodybuilding, college athletics, and professional leagues from baseball to cycling. The even larger banned market among older adults has flourished more recently.
FDA regulations ban the sale of HGH as an anti-aging drug. In fact, since 1990, prescribing it for things like weight loss and strength conditioning has been punishable by 5 to 10 years in prison.
Steve Kleppe, of Scottsdale, Ariz., a restaurant entrepreneur who has taken HGH for almost 15 years to keep feeling young, said he noticed a price jump of about 25 percent after the block on imports. He now buys HGH directly from a doctor at an annual cost of about $8,000 for himself and the same amount for his wife.
Many older patients go for HGH treatment to scores of anti-aging practices and clinics heavily concentrated in retirement states like Florida, Nevada, Arizona and California.
These sites are affiliated with hundreds of doctors who are rarely endocrinologists. Instead, many tout certification by the American Board of Anti-Aging and Regenerative Medicine, though the medical establishment does not recognize the group's bona fides.
The clinics offer personalized programs of "age management" to business executives, affluent retirees, and other patients of means, sometimes coupled with the amenities of a vacation resort. The operations insist there are few, if any, side effects from HGH. Mainstream medical authorities say otherwise.
A 2007 review of 31 medical studies showed swelling in half of HGH patients, with joint pain or diabetes in more than a fifth. A French study of about 7,000 people who took HGH as children found a 30 percent higher risk of death from causes like bone tumors and stroke, stirring a health advisory from U.S. authorities.
For proof that the drug works, marketers turn to images like the memorable one of pot-bellied septuagenarian Dr. Jeffry Life, supposedly transformed into a ripped hulk of himself by his own program available at the upscale Las Vegas-based Cenegenics Elite Health. (He declined to be interviewed.)
These promoters of HGH say there is a connection between the drop-off in growth hormone levels through adulthood and the physical decline that begins in late middle age. Replace the hormone, they say, and the aging process slows.
"It's an easy ruse. People equate hormones with youth," said Dr. Tom Perls, a leading industry critic who does aging research at Boston University. "It's a marketing dream come true."
___
Associated Press Writer David B. Caruso reported from New York and AP National Writer Jeff Donn reported from Plymouth, Mass. AP Writer Troy Thibodeaux provided data analysis assistance from New Orleans.

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Why Older Workers are Better Workers

At a time when high unemployment numbers constantly make the headlines, companies can be selective about whom they want to hire. Older workers  generally don't make the top of lists of potential job candidates for a variety of reasons, some real and some imagined. But with 10,000 baby boomers reaching the age of 65 each day for the next twenty years, hiring companies would do well to re-evaluate this untapped pool of labor, especially once our economy finally gets back on track.

[See Companies with the Most Older Workers.]

According to the Age Discrimination in Employment Act, people over the age of 40 are protected against being treated less favorably because of age. As these older workers become a bigger part of the workforce, hiring companies will need to objectively consider the positive and negative aspects of each candidate regardless of age. The good news is that, in many ways, older workers are better workers. Here's why older workers make excellent employees:

More direction. Many young people are still struggling to figure out what they want to do for their career and are getting their first exposure to the corporate world. Older workers generally possess a wealth of knowledge and experience gleaned over years of employment, and have a good idea of how to get the job done.

Less turnover. Older workers are less likely to job hop than younger employees. They typically have lower turnover and are absent less.

[See Older Worker Employment Reaches Record High.]

Experience pays off. Many older workers are experienced at the requirements of the job, and know what works and what does not work. This could allow them to get the job done more efficiently or to produce higher quality results. Contrary to popular belief, older employees do not cost employers more than younger workers, according to Peter Cappelli, coauthor of Managing the Older Worker: How to Prepare for the New Organizational Order. Higher wages are not based on age, but on experience, which often benefits the employer to the point that it is worth paying them at a higher level.

Understand the culture. Older employees know and live the corporate culture because they have been immersed in it for years. You won't find very many of them ignoring the dress code or posting inappropriate messages on Facebook.

Fewer dependents. When it comes to health care coverage, older employees do cost more because they are more likely to have health conditions and seek care. But older employees often no longer have as many dependents to include in the health plan as people with young families, which can actually save the company money.

[See 7 Tips for Working for a Younger Boss.]

Of course, older workers may need to be accommodated in some ways, especially if the job is physically strenuous. Older employees will be increasingly reporting to younger supervisors, which could cause friction that will need to be addressed. Flexible schedules may also be important to some seniors who want to pursue other interests outside a full-time job.

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Baby Boomers Plan Their Retirement Careers

Retirement for the baby boomers is likely to be far different from what their parents experienced. Work will probably be an integral part of everyday life, both to meet financial requirements and to keep busy during an increasing lifespan. Workers approaching retirement should plan now for their pending retirement career.

[See 10 Places to Launch a Second Career in Retirement.]

Most baby boomers (72 percent) say they plan to keep working in some capacity after retirement, according to a 2010 Del Webb survey. The top reason for working in retirement is to ward off boredom and keep busy, while financial necessity came in second. Other reasons for delaying retirement include self-satisfaction and enjoying the job. Some employees are planning to continue working well into the traditional retirement years. A recent Wells Fargo survey found that 25 percent of middle class Americans say they will need to work until at least 80 to live comfortably in retirement.

If seniors will need to work during their retirement years, the nature of the job becomes increasingly important. During our first career we discovered what we are good at, what we like to do, and what we dread doing every day. This knowledge can help us prepare for our second act. Here's how to select a satisfying retirement career:

Aim for a job you enjoy. In a down economy you may be forced to take any available job. But if you are lucky enough to be able to consider a job you might actually enjoy, decide what it would look like. What could you do each day that would make you eager to get out of bed each morning, with great expectations of exciting things to be? It is far better to start the day with an optimistic smile versus an anxious moment.

[See 5 Social Security Changes Coming in 2012.]

Avoid toxic situations. Decide what you would find personally satisfying in a second career and also the tasks you would dread doing. A typical job includes a mix of each, but ideally you want to tip the scale toward what you love.

Test drive your dream job. When you were younger, what did you dream of becoming? Although a ballerina or an astronaut might not be realistic now, think back on what it was you always wanted to do. If a certain career field still intrigues you, try to explore opportunities for a retirement career trying it out.

Play to your strengths. After several decades in the workforce, you probably already know whether you prefer flexibility or routine, independence or supervision, creativity or clearly defined activity, and risk or assurance. Look for a second career that has the characteristics you find most important in a satisfying job.

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The Real Best Places to Retire in 2012

A blizzard of articles give advice about the best places to retire. They generally recommend fleeing the North and heading for the Sunbelt, to places in the Carolinas, Florida, or Arizona. Occasionally they offer a surprise retirement spot in Iowa or Indiana. Sometimes they even tout retirement locales outside the United States.

[See The 10 Best Places to Retire in 2012.]

These articles rely on statistics such as the cost of living or winter temperatures. But they miss the most important thing--the human element. Here are the real best places to retire:

Stay home. As we get older, moving, making new friends, and acclimatizing ourselves to new surroundings gets more difficult. Don't underestimate the value of your current community. Think long and hard before you cut those connections to go off to get a sunburn.

Your hometown likely offers more senior citizen benefits than you think including tax breaks, low-cost transportation, and subsidized meals. We have friends in the outer suburbs of New York who always thought they would retire somewhere warmer. But they finally realized how important their church community was to them and decided to stay put. Now they visit the senior center for a free meal every Thursday night. They walk at the mall two or three mornings a week and stay for coffee with new acquaintances. And they are still active in their church, among the friends they've known for decades.

[See The 10 Sunniest Places to Retire.]

Move near your children. My brother-in-law spent most of his career working around Pittsburgh, Pa. After he retired, he and his wife gathered together all the brochures and ultimately decided to move to Massachusetts. Their daughter lives outside of Boston and their son is in Rhode Island. They moved from a four-bedroom suburban home to a two-bedroom bungalow in their daughter's town. Their yard is smaller, just right for Grandpa to keep an eye on the grandkids while he relaxes on the patio. They've met new friends through their daughter, and they love their new life, in an area often billed as cold and expensive.

Follow your friends. One fellow I know retired to Maryland. Why? His long-time golfing partner retired there a few years earlier. He moved to the same town, joined the same golf club, and soon they were prowling the links together, just like old times. A year later, another friend joined them, who had a relative living nearby, and they all now play golf twice a week.

Their wives, who had known each other casually, are now close friends. They started a bridge club, brought in some other women, and from there developed meaningful connections to the community. These couples now feel as though, as one of the women put it, "We've lived here all our lives."

[See 10 Places to Retire on Social Security Alone.]

Move back home. One friend of mine grew up in El Paso, Texas. She went to college in California, then got married and moved to Washington, D.C. Some 25 years later, her husband died and she felt lost in the big city. She moved back west, to nearby New Mexico, where she started a small business which included some clients in Washington. Now she lives in her beloved mountains and travels to Washington occasionally to see clients.

Another woman grew up outside New York. She got married and moved to Oregon and spent most of her 20s and 30s around Portland. Eventually she got divorced and moved first to California, then Arizona, with a year-long stint in Alaska. But when she retired, she felt the pull of Portland, where she still had friends. To her, that was home. And that's where she moved.

No matter where you end up in retirement, remember that relationships are more important than the weather. The warmest climate can be found amidst the safety and security of family and friends.

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Sexual Activity Deemed Safe for Many Heart Patients by AHA

 The American Heart Association  has released its first scientifically based statement with recommendations for sexual activity for people with heart conditions or cardiovascular disease. The good news for many with heart problems is that sex is safe.

AHA Scientific Statement on Sex and Cardiovascular Disease

For many heart patients, if they are able to walk briskly or climb two flights of stairs without experiencing chest pain, abnormal heartbeats, or shortness of breath, a normal sex life is possible -- after discussing it with their heart doctor, advises the AHA Scientific statement.

In an interview with HeartWire, lead author of the study underlying the AHA Statement on Sex, Dr. Glenn N. Levine of Baylor College of Medicine in Houston, explained that not only are these recommendations about sexual activity and heart disease the most comprehensive to date, but also have been compiled and endorsed by experts in a variety of fields including urology, exercise physiology and sexual counseling in addition to cardiologists.

There are many people who, once diagnosed with a heart condition or who have experienced a heart attack, abstain from sexual activity due to fear that engaging in sex could result in a heart attack or death. Levine, via HeartWire, explained that many heart patients -- and their physicians -- are reluctant to address the topic of sexual activity. The AHA Statement on Sex provides guidelines for safe sexual activity not only for cardiologists, but also general practitioners and physicians in other fields.

Facts on Sex and Heart Health/Safety

According to the AHA Statement on Sex, less than 1 percent of heart attacks are caused by sexual activity, with this risk being even lower for heart patients who are physically active. Among that 1 percent, the largest number of heart attacks experienced were among people involved in extramarital sex.

Following a heart attack or coronary bypass surgery, your physician should advise a certain waiting period before beginning to have sex again. He may also advise that you first increase your overall physical health and endurance through recommended exercise programs and recommend an exercise stress test before resuming sexual activity, recommends the AHA Statement on Sex. People with heart conditions should avoid eating a heavy meal or drinking alcohol before sexual activity as well.

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Need to Exercise More? Think How It Will Help You Now

FRIDAY, Jan. 13 (HealthDay News) -- Health and fitness experts have for years tried to entice people to exercise more by flogging long-range benefits such as losing weight or avoiding long-term illness caused by chronic disease.

They might have been going about it all wrong. Research now appears to show that "improve your heart health" may be a less effective message than "feel better now."

A University of Michigan study found that people are more apt to exercise when they're given reasons that apply to their immediate, day-to-day life. For example, telling someone they will have more energy after working out seems to be a more effective motivation than telling them they will be less likely to develop diabetes.

Michelle Segar, the study's lead author, said she believes the results indicate a need to "rebrand" exercise so that health organizations that promote exercise will see better results from their efforts.

"We need to develop new messaging that teaches people that physical activity is a way to reduce their stress in the moment, feel better in the moment, create more energy in the moment," said Segar, a research investigator with the Institute for Research on Women and Gender at the University of Michigan. "You're a more patient parent. You enjoy your work more. You don't snap at your spouse as much. The benefits of exercise help you lead a more pleasant and productive life. The messaging needs to go there."

The study focused on a randomly selected set of 385 women, 40 to 60 years old, who were given several questionnaires over the course of a year related to exercise and health.

The women's responses indicated that they valued long-term goals like weight loss as much as short-term goals more directly linked to day-to-day quality of life, such as stress reduction. Nonetheless, Segar and her team found that women who cited short-term factors exercised more often than those who felt long-term goals were most important.

"The women who exercised for quality of life did significantly more exercise than the other two groups," Segar said. Those who exercised based on daily quality of life worked out 15 percent to 34 percent more often, the study found.

This argues strongly for a reassessment of how exercise is promoted, Segar said.

"Health and healthy aging are very abstract," she said. "We may endorse them as important, but the problem lies in the fact that we live very busy, complicated lives. When you're looking at your daily to-do list, how compelling is fitting in exercise for a reason that's far in the future, where you might never notice? If you're exercising to enhance the quality of your daily life because it reduces your stress or improves your mood, you notice those things immediately. And if you don't exercise, you immediately notice you feel worse."

Messages that might resonate better with people who need to exercise more often, she said, include that exercise is a way to:

    * Become a more pleasant member of your family by feeling better.
    * Improve your productivity at work because working out makes your mind more focused.
    * Relieve day-to-day stress.
    * Improve your mood.
    * Enjoy higher levels of energy and vitality.
    * Spend more social time with others.
    * Take time to enjoy the outdoors.

Though those are compelling arguments for exercise, groups might want to think twice before removing long-term goals from their marketing strategies, said Walter Thompson, a professor of exercise science in the department of kinesiology and health at Georgia State University and a spokesman for the American College of Sports Medicine.

Long-term goals like weight loss tend to be measurable, whereas short-term goals like improved energy are largely subjective, Thompson said.

"The problem with the long-term goal is they can get to the 5½-months point and not lose a pound," he said. "That's the argument for the short-term goal. But without a long-term goal, it's hard to come up with short-term goals."

Short-term goals also might not apply to everyone because they're subjective, he added.

"I like to run, but I remember days when I just felt miserable after my run," Thompson said. "If I only looked at short-term goals, if I felt bad one day, I may not do it the second day."

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