Web accessibility no longer an afterthought

Access to the World Wide Web crucial to handicapped....
Read more: http://www.cnn.com/2009/TECH/12/15/cnet.web.accessibility/index.html

Tea, coffee seem to protect against diabetes

Relaxing drinks seem to protect against diabetes......
Read more: http://www.medpagetoday.com/Endocrinology/Diabetes/17523

Holiday food safety

Tips for holiday food safety:

http://www.nlm.nih.gov/medlineplus/videos/news/holiday_food_121409.html

HPU Library Hours: Winter 2009-2010

December 21, 2009 (Monday) - January 23, 2010 (Saturday)

ATHERTON LIBRARY, HAWAI'I LOA CAMPUS
Monday, Wednesday, Friday 8:00 a.m. - 5:30 p.m.*
Tuesday, Thursday 8:00 a.m. - 5:00 p.m.*
Saturday Closed
Sunday Noon - 5:00 p.m.
*PLEASE NOTE: last shuttle leaves at 5 p.m.

MEADER LIBRARY, DOWNTOWN CAMPUS
Monday-Friday 8:00 a.m. - 5:00 p.m.
Saturday 9:00 a.m. - 5:00 p.m.
Sunday Closed

SPECIAL HOURS: December 23, 2009 (Wednesday)
Meader Library, 3rd Floor hours 8:00 a.m. - 5:00 p.m.
Atherton Library and
Meader Library, 2nd and 5th Floor 8:00 a.m. - 11:30 a.m.

CLOSED
December 24-25, 2009 (Thursday-Friday) Christmas Holidays
January 1, 2010 (Friday) New Year's Day
January 18, 2010 (Monday) Martin Luther King, Jr. D

Happy Holidays from Atherton Library Staff!

Mele Kalikimaka and Hauoli Makahiki Hou!

2009 H1N1 Flu: 10 Ways You Can Stay Healthy at Work

As we face this extraordinary flu season, consider these ten things you can do to protect yourself and others:

1. Wash your hands often with soap and water for 20 seconds, or use an alcohol-based
hand sanitizer if soap and water are not available. Be sure to wash your hands after
coughing, sneezing, or blowing your nose.

2. Avoid touching your nose, mouth, and eyes. Germs spread this way.

3. Cover your coughs and sneezes with a tissue, or cough and sneeze into your elbow.
Dispose of tissues in no-touch trash receptacles.

4. Keep frequently touched common surfaces clean, such as telephones, computer
keyboards, doorknobs, etc.

5. Do not use other workers’ phones, desks, offices, or other work tools and
equipment. If you need to use a coworker’s phone, desk, or other equipment, clean it first.

6. Don’t spread the flu! If you are sick with flu-like illness, stay home. Symptoms
of flu can include fever, cough, sore throat, runny or stuffy nose, body aches, headache, chills, tiredness, and sometimes vomiting and diarrhea. CDC recommends that people with flu-like illness stay home for at least 24 hours after they are free of fever without the use of fever-reducing medicines. If supervisors or employees have questions about use of leave for illness or to care for an ill family member, please contact your local Human Resources office or your office’s leave administrator.

7. Get vaccinated against seasonal flu. It can protect you against seasonal influenza
viruses, but not against 2009 H1N1.

8. Ask your doctor if you should get the 2009 H1N1 flu vaccine. People
recommended to receive the 2009 H1N1 flu vaccine as soon as it becomes available in
October are health care workers, children, pregnant women, and people with chronic
medical conditions (such as asthma, heart disease, or diabetes). People living with or caring for infants under 6 months old should also be vaccinated to protect these children who are too young to be vaccinated. For more information about who should get vaccinated, visit http://www.cdc.gov/h1n1flu/vaccination/acip.htm.

9. Maintain a healthy lifestyle through rest, diet, and exercise.

10.Learn more. Visit http://www.flu.gov or contact CDC 24 hours a day, 7 days a week:
o 1-800-CDC-INFO (232-4636)
o TTY: (888) 232-6348
o mailto:cdcinfo@cdc.gov

2009 H1N1 Flu: Emergency Warning Signs

EMERGENCY WARNING SIGNS FOR CHILDREN

Anyone with the following emergency warning signs needs urgent medical attention and should seek comment right away:

• Fast breathing or trouble breathing
• Bluish skin color
• Not drinking enough fluids
• Not waking up or not interacting
• Being so irritable that the child does not want to be held
• Flu-like symptoms improve but then return with fever and worse cough
• Fever with a rash

EMERGENCY WARNING SIGNS FOR ADULTS

Anyone with the following emergency warning signs needs urgent medical attention and should seek comment right away:
• Difficulty breathing or shortness of breath
• Pain or pressure in the chest or abdomen
• Sudden dizziness
• Confusion
• Severe or persistent vomiting
• Flu-like symptoms improve but then return with fever and worse cough

Pink Glove Dance

Toddlers, Obese Kids Suffer Most From Smoke Secondhand exposure damages cardiovascular systems of children, study finds

WEDNESDAY, Nov. 18 (HealthDay News) -- Secondhand smoke harms the cardiovascular health of children, especially toddlers and obese youngsters, U.S. researchers say.

Their study of 52 toddlers (aged 2 to 5) and 107 adolescents (aged 9 to 18) found an association between the amount of secondhand smoke exposure and a marker of vascular injury in toddlers. This link was two times greater in obese toddlers, the study authors noted.

Toddlers exposed to secondhand smoke showed a 30 percent reduction in circulating vascular endothelial progenitor cells, which are cells that are involved in the repair and maintenance of blood vessels.

The researchers also found that obese adolescents exposed to secondhand smoke had twice the evidence of vascular injury compared to normal-weight adolescents.

Despite having similar reported home settings, toddlers were four times more likely than adolescents to be exposed to secondhand smoke, the study authors added.

The cardiovascular changes seen in children exposed to secondhand smoke "are similar to changes that are well-recognized risks for heart disease in adults. This suggests that some aspects of adult heart disease may be initiated in early childhood, where prevention strategies may have great long-term impact," study senior co-author John Anthony Bauer, a principal investigator at Nationwide Children's Hospital & Research Institute at Ohio State University in Columbus, said in a news release from the American Heart Association.

"Our findings add to the importance of eliminating smoking and related exposures, especially for children, and obese children may need to be even more protected from these exposures," he said.

The study was scheduled to be presented Nov. 18 at the American Heart Association's annual meeting in Orlando, Fla.

SOURCE: American Heart Association, news release, Nov. 18, 2009

10 Good Reasons to Use Library Resources

1. Not everything is on the Internet.
There is a lot of useful information out there on the web. Unfortunately, this often leads to the misconception that everything you need to know can be found online. This simply isn't true. There are tons of published materials (books, articles, videos, music, etc) that you won't find using a standard search engine like Google or Yahoo. And even when you do find them, your access may be limited (see #2 below.)

2. Not everything on the Internet is free.
Much of the web consists of subscription services that make you pay if you want to get into their website or download their stuff. Before you go and spend your hard-earned money on these services, check out the library's website. We've already paid for many of these services so you don't have to.

3. The Internet is not very organized.
How many times have you searched for something on the web and got a list of 1.5 million web pages? How are you supposed to make sense of that? Well, library resources, unlike the web, are organized by topic and broken down into different types of information (books, articles, databases, etc.) Library resources have been organized by real people, not by search engine robots.

4. There is no quality control on the Internet.
The internet is full of lies, misconceptions, and half-truths. Almost anyone with a computer can put up a website, and they don't have to know what they're talking about. Some sites will deliberately mislead you, in order to get your money, change your opinion on a controversial issue, or just to pull your leg. Hoax sites are all over the place, and they often look real. Library resources, on the other hand, have mostly been through editors and fact-checkers who make sure you're getting (relatively) reliable information.

5. Sources on the Internet can be harder to verify.
When you write a paper, it's important to cite your sources. Some web pages make it difficult to figure out who's telling you what and where they got their information. Library resources, even those on our online databases, will tell you exactly where the information came from.

6. The Internet is too new for some things.
If you're looking for information on older events, you'll have better luck checking out the library's resources.

7. Library online resources are available 24/7.
There's more to the library than books these days. Library online databases can be accessed 24/7 through the library's website. Although you access these databases through the internet, they are not internet sources. They are every bit a part of our library's collection as the books on our shelf. The articles you find in our online databases are reprinted from real live print sources.

8. The Internet is a mile wide and an inch deep.
So you've found 40 websites on widgets, but they all give you the same four or five facts without very much detail. How do you stretch that out to a five-page paper? For a varied and more in-depth analysis of widgets and widgetology, try some of the library's books or article databases.

9. You're already paying for the library.
Your tuition and fees help pay for library resources. Why not get your money's worth?

10. Real live people can help you use our library.
Nice, eager, friendly, highly trained librarians are standing by, waiting to help you find the information you're looking for. Don't spend hours in vain looking for information on the web.

Jenn Alm, Distance Education Librarian: jalm@hpu.edu
This list is adapted from Mark Herring's 10 Reasons Why the Internet Is No Substitute for a Library, which originally appeared in American Libraries, April 2001, p. 76-78.

Hawaii Pacific University Nursing Open Lab

Hawai'i Pacific University Assistant Professor, David Dunham, reports there has been an overwhelming response to its Nursing Open Lab, since they increased the amount of time it is open for students to practice their skills used in hospitals. Says Dunham "the students appreciate the extra time to practice the skills they use with patients."

Half of American Children Receive Food Stamps

By Chris Emery, Contributing Writer, MedPage TodayPublished: November 02,

Note that nearly half of American children live in homes that at some point receive food stamps.

Note that the current recession will likely further impoverish and destabilize food supplies for American children. Many American children live in households that receive food stamps, an indicator of the kind of poverty and food insecurity that can seriously jeopardize a child's overall health, a new study found.

Nearly half (49.2%) of American children will, at some point between the ages of 1 and 20, reside in a house that receives food stamps, according to a report in the November 2 Archives of Pediatrics and Adolescent Medicine.

More than a quarter of American children (26.1%) will receive food stamps by the age of 5, the study found.

"Such children are by definition experiencing poverty and are also quite likely to encounter food insecurity as well," Mark R. Rank, PhD, of Washington University, and Thomas A. Hirschl, PhD, of Cornell University, wrote.

"The consequence is that children in such households frequently face dietary and nutritional problems, along with a variety of challenges and stressors that accompany poverty."

Previous research has repeatedly shown that a lack of food during childhood is linked to iron deficiency, undernutrition and lack of dietary balance, and that poor children are more likely to suffer a range of health problems, including low birth weight, lead poisoning, delayed immunization, dental problems and accidental death.

Adults who grew up in poverty are more likely to have impaired physical and mental growth, lower academic achievement and to remain impoverished.

The U.S. Food Stamp program is designed to provide households with gross incomes of up to 130 percent of the poverty line with coupons or electronic credits good for the purchase of basic foodstuffs. Currently, a household of four with a gross income of up to $2,389 per month may qualify, but eligibility varies based on household size, expenses, disabilities and other factors.
Rank and Hirschl analyzed 30 years of longitudinal data from a nationally representative sample of the U.S. population, the Panel Study of Income Dynamics, which began in 1968 with 18,000 individuals.

The PSID study conducted household interviews annually between 1968 and 1997, collecting demographic data and other information regarding children ages 1 through 20, including whether families had received food stamps during the prior year.

The researchers found that the proportion of U.S. children who received food stamps was 12.1% at age 1 year, 26.1% by age 5 years, 35.9% by age 10 years, 43.6% by age 15 years and 49.2% by age 20 years.

Most households that received food stamps did so several times. However, families typically only use food stamps for short periods, and only 19% of American children will live in a household that uses food stamps for 3 or more consecutive years.

The study also found that race, parental education and head-of-household's marital status played a strong role in determining the proportion of children residing in a food stamp household.

Among white children who lived in a home where the head of the household was married and had 12 or more years of education, 20% received food stamps by age 20. In contrast, among black children with unmarried heads-of-household who had less than 12 years of education, 97% received food stamps.

The researchers noted that the sample size did not allow for any racial comparisons to be made beyond those of black and white participants, and that the PSID is not representative of the U.S. immigrant population.

They also cautioned that their measure of food stamp use only accounted for whether a family had used food stamps in the previous year, not for how many months they'd received food stamps.

In an accompanying editorial, Paul H. Wise, MD, MPH, of Stanford University, wrote that the results of the new study are alarming, given the current economic climate and the worsening inability of the government to meet the needs of impoverished children.

"The bottom line is that the current recession is likely to generate for children in the United States the greatest level of material deprivation that we will see in our professional lifetimes," he wrote.

"The recession is harming children by both reducing the earning power of their parents and the capacity of the safety net to respond. However, it is also essential to recognize that children have been made extremely vulnerable to this recession by a decades-long deterioration in their social position."

In response, he wrote, the pediatric community will have to determine how to address the enhanced needs of patients, strengthen its capability to take collective action and strive to influence policy decisions that impact the health of impoverished children.

"Pediatricians should also seek out new and better ways to support their colleagues working in communities hit hardest by the recession," he wrote.

"There can be no meaningful excuse for allowing clinicians caring for the neediest patients to struggle in isolation. This will demand greater regional responses in which private practices, hospitals, academic departments, public clinics, and community agencies come together to plan, coordinate, and ultimately provide adequate local services."

The study was funded by Northwestern University and the University of Chicago.

Pediatr Adolesc Med 2009; 163:994-99.

Swine Flu Still Strikes Younger People Hardest. 90 percent of deaths since Sept.1 were among those under 65, CDC says

TUESDAY, Oct. 20 (HealthDay News) -- The H1N1 swine flu epidemic continues to strike younger people, a U.S. health official said Tuesday, noting that nearly 90 percent of deaths since Sept. 1 were among those under 65 years of age.

"This is dramatically different than what we see with seasonal flu," Dr. Anne Schuchat, director of the U.S. Centers for Disease Control and Prevention's National Center for Immunization and Respiratory Diseases, said during a press conference. "For seasonal flu, 90 percent of fatalities occur in people 65 and over -- it's almost completely reversed here," she said.

"Essentially this is a young person's disease," Schuchat added. "We don't have reporting from every single state and we know we are missing cases, so the numbers will be underestimates, but it can be helpful in illustrating some of the patterns we are seeing."
According to data collected from 28 states from Sept. 1 to Oct. 10, nearly 24 percent of deaths were among people under age 25, about 65 percent of deaths were among those 25 to 64, and only 11.6 percent of the deaths were among people 65 and older, she said.
"Each one of these cases is tragic for the family and hard for us in public health to see," she added.
Schuchat said she expects the swine flu epidemic to continue throughout the winter and into the spring, and wouldn't be surprised to see a renewed outbreak later in the season.

"We do think there will be illness, including severe illness, for some time in the future," she said. "We may see in any particular community some illness going down in the next several weeks, but we don't know whether it's going to go up again."

Schuchat noted that during the 1957-1958 Asian flu pandemic there was an outbreak in September and October, but "they had another big wave after the first of the year."

Meanwhile, the H1N1 swine flu vaccine remains in short supply. Last week federal officials said there had been delays in producing the vaccine, and the goal of 40 million doses by the end of October would be missed.

Schuchat has said in the past that the federal government expects 190 million doses of H1N1 swine flu vaccine by the end of the year.

As of Monday, a total of 12.8 million doses had been received by the U.S. government, up from 9.8 million doses last week. More than half of those vaccines are injectable; the remainder is in the form of a nasal spray known as FluMist, she said.

"I understand and share everyone's desire to have more vaccine. I wish that we had more than we have right now, but we do have more coming out every day," Schuchat said.

During the six-week period ending Oct. 10, 27 states had reported 4,958 people hospitalized with H1N1 swine flu. More than half -- 53 percent -- of those hospitalized were people under the age of 25. Thirty-nine percent were 25 to 54 years of age, and only 7 percent of hospitalizations involved people 65 and older, Schuchat said.

Schuchat also said new guidance on the use of antiviral drugs such as Tamiflu stresses the need to start treatment early and not wait for confirming tests, especially among children, pregnant women and those most at risk for complications from the swine flu.

Schuchat also urged people to get their seasonal flu shot. Eighty-two million doses of seasonal flu vaccine have been distributed, with a total of about 114 million doses expected through the rest of the season, she said.

SOURCES: Oct. 20, 2009, teleconference with Anne Schuchat, M.D., director, National Center for Immunization and Respiratory Diseases, U.S. Centers for Disease Control and Prevention HealthDay

Many Hospitalized With Swine Flu Had Been HealthyBut the majority of cases still involve people with chronic problems, CDC says

TUESDAY, Oct. 13 (HealthDay News) -- While the majority of people hospitalized with the H1N1 swine flu have chronic medical conditions, many were healthy before coming down with the disease, a U.S. health official said Tuesday.

More than half of hospitalized adults had conditions such as asthma, chronic lung diseases, heart disease or immune system disorders, Dr. Anne Schuchat, director of the U.S. Centers for Disease Control and Prevention's National Center for Immunization and Respiratory Diseases, said during an afternoon press conference.

Read full article.

Obese Middle-Aged Women Face Unhealthy Future: Extra weight cuts chances for long, healthy life by nearly 80% study finds

TUESDAY, Sept. 29 (HealthDay News) -- If excess weight doesn't kill you by old age, it could make your life miserable in the form of chronic health problems and impaired mental fitness.
According to a new study, women who are obese in middle age are almost 80 percent more likely to have multiple health problems by the time they reach age 70.

"Those who gained weight [in adulthood] actually suffered reduced odds of healthy survival," said study author Dr. Qi Sun, a research associate at the Harvard School of Public Health's department of nutrition.

"The key message is that women really need to keep a healthy weight from early adulthood to midlife to enjoy a healthy and long life," he added.

Sun added, however, that the women in the study had nonetheless survived to their eighth decade, meaning they remained healthier than the general population.

The study findings were published in the Sept. 30 online edition of the journal BMJ.
Previous research had focused on how excess weight affects survival, rather than how healthy that survival looks in older adults, said Sun.

The new study is well-timed, given that the U.S. population is not only aging rapidly but ballooning rapidly. Two-thirds of American adults are overweight or obese, up from 14.5 percent in 1976, when this study started.

The study authors analyzed data on 17,065 women participating in the Nurses' Health Study. Volunteers were, on average, 50 years old when the study began with no major chronic conditions or major mental or physical problems.

Twenty years later, only about 10 percent of women had "healthy survival," and obese women were 79 percent less likely to have healthy survival than the slim minority.

Overweight as early as age 18 affected healthy survival the most, although women who were lean in their late teens who later gained weight still had lower odds of healthy survival, the study found.

Every kilogram (2.2 pounds) of extra weight lowered the odds of healthy survival by 5 percent, according to the study.

"We typically see this struggle not only in middle age but even as teenagers. If you struggle as a teenager, you're going to struggle for the rest of your life," said Eugenio Lopez, a registered nurse with the Texas A&M Health Science Center Coastal Bend Health Education Center in Corpus Christi.

And women may be starting out at a disadvantage, Lopez added.
"We typically see more women than men in diabetes programs. Women outnumber men 4-to-1 or 5-to-1," Lopez said. "They're genetically predisposed to hold more fatty cells than men are."
"The data is following common sense," added Dr. Mitchell Roslin, chief of the bariatric surgery program at Lenox Hill Hospital in New York City. "Why do people die? Of cardiovascular disease and cancer, and women die of colon and breast cancer. What has been linked to obesity? Breast cancer, colon cancer and cardiovascular disease."

SOURCES: Qi Sun, M.D., Sc.D., research associate, department of nutrition, Harvard School of Public Health, Boston; Eugenio Lopez, R.N., Texas A&M Health Science Center Coastal Bend Health Education Center, Corpus Christi; Mitchell Roslin, M.D., chief, bariatric surgery program, Lenox Hill Hospital, New York City; Sept. 30, 2009, BMJ, onlineHealthDayCopyright (c) 2009

Small Businesses Urged to Prepare for Swine Flu: Advance Planning May Help to Minimize Disruptions, officials say

MONDAY, Sept. 14 (HealthDay News) -- With cases of H1N1 swine flu continuing to rise, U.S. health officials on Monday urged small businesses to prepare now to keep their shops running if the flu season turns severe.

"We need to make sure that operations and businesses continue on even as we go through the flu season," Janet Napolitano, U.S. Secretary of Homeland Security, said during an afternoon news conference.

The planning needs to start now, said Dr. Daniel Jernigan, deputy director of the Influenza Division at the U.S. Centers for Disease Control and Prevention. "Plan now to prepare for the impact of influenza this fall and winter," he said.

Jernigan advised businesses to prepare for two different scenarios -- first if the H1N1 flu remains as mild as it has so far, and second if the virus should change and illness becomes more severe.

"Another key step for small businesses is to protect your workforce," Jernigan said. People should be encouraged to stay home if they are sick and not return to work until their fever has subsided for a day without using fever-reducing medication, he said.

"For most people that is three to five days away from work," Jernigan said. "Some small businesses will have to change their leave practices, but we think that's a good thing for this year."

Small businesses also need to take steps to maintain the continuity of operations, Jernigan said. "That means keeping your business going even during high levels of absenteeism," he said.
Karen Mills, administrator of the U.S. Small Business Administration, said "being prepared for H1N1 is just part of good business."

"Having a plan is critical," she said at the news conference. "For small businesses, even having employees out for a few days can be a health concern and a bottom-line concern," she said.

Although the H1N1 flu tends to target children and young adults, small businesses may find themselves short on employees who have to stay home to care for someone with the flu.
According to the guidelines issued Monday, a small business plan should include the designation of a workplace coordinator responsible for H1N1 issues.

The plan should also:
Encourage sick workers to stay at home without fear of reprisal.
Find ways for workers to work from home.
Promote personal hygiene, such as frequent handwashing.
Encourage workers to get a seasonal flu shot.
Encourage workers to get the H1N1 vaccine when it becomes available.
Provide workers with information on flu risk factors.

If an employee does become sick at work, the employee should be moved away from other workers to limit infection until the worker can go home, according to the plan.

The H1N1 guidelines for small businesses are one of several guidelines issued by the U.S. government in recent weeks. Others included guidelines for schools, day-care centers, health-care workers and large businesses.

SOURCES: Sept. 14, 2009, teleconference with Janet Napolitano, U.S. Secretary of Homeland Security; Karen Mills, administrator, U.S. Small Business Administration; Daniel Jernigan, M.D., M.P.H., deputy director, Influenza Division, U.S. Centers for Disease Control and Prevention, Atlanta HealthDayCopyright (c) 2009

Spread the Knowledge: Influenza information

Due to the H1N1 flu and concerns about the 2009/2010 flu season, the EBSCO Publishing Medical and Nursing editors of DynaMed™, Nursing Reference Center™ (NRC) and Patient Education Reference Center™ (PERC) have made key influenza information from these resources freely available to health care providers worldwide.
The editorial teams will monitor the research and update these resources continuously throughout the upcoming flu season.

For Clinicians
From DynaMed
Pandemic (H1N1) 2009
Influenza
Influenza in adults
Influenza in children
Avian influenza
Influenza antiviral treatment and prophylaxis
Influenza vaccine in adults
Influenza vaccine in children
Influenza in long-term care facilities

For Nurses
From NRC
Influenza, Pandemic H1N1 2009
Influenza, Seasonal
Influenza, Seasonal, in Older Adults
Influenza: an Overview
Influenza, Seasonal, in Children and Adolescents
Influenza in Pregnancy
Avian Influenza (H5N1) in Children
Avian Influenza (H5N1)

For Patients
From PERC
Pandemic (H1N1) 2009 Influenza:
English Arabic Chinese (Simplified) Chinese (Traditional) Farsi French German Hindi Italian Japanese Korean Polish Portuguese Russian Spanish Tagalog Vietnamese

Seasonal Influenza:
English Arabic Chinese (Simplified) Chinese (Traditional) Farsi French German Hindi Italian Japanese Korean Polish Portuguese Russian Spanish Tagalog Vietnamese
Pandemic (H1N1) 2009 Influenza Vaccine
Seasonal Influenza Vaccine
Pandemic (H1N1) 2009 Influenza Vaccine: Questions and AnswersPandemic (H1N1) 2009 Influenza Vaccine: Questions and Answers


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MLA 2009 Review

Video of 2009 Medical Library Association Annual Meeting
Honolulu, Hawaii

Created by Linda Uchida and An Hollowell, Hawai'i Pacific University, 2009

Mediterranean Diet Plus Exercise Lowers Alzheimer's Risk: older adults who ate healthy and remained active were protected, study finds

TUESDAY, Aug. 11 (HealthDay News) -- Eating a Mediterranean diet, which emphasizes fruits, vegetables, legumes and healthy fats, and increasing physical activity levels can reduce the risk of developing Alzheimer's disease, a new study shows.

The latest research, published in the Aug. 12 issue of the Journal of the American Medical Association, is more evidence that healthy living can help ward off cognitive decline.

Following both healthy habits is a plus, said study author Dr. Nikolaos Scarmeas, an assistant professor of neurology at Columbia University Medical Center in New York City. "There is some evidence [already] that a healthy diet, the Mediterranean diet, may be protective for our risk of getting Alzheimer's disease," he said. "In the current study we wanted to see if there was an independent effect of physical activity and diet."

So Scarmeas and his team looked at 1,880 men and women without dementia living in New York, average age 77, and gave them tests every 1.5 years from 1992 through 2006, evaluating how well they followed a Mediterranean-type diet and their weekly participation in various physical activities. Those in the highest group got a median of 1.3 hours of vigorous activity or 2.4 hours of moderate-intensity exercise every week.

Scarmeas' team followed the elders for an average of 5.4 years, finding that 282 developed Alzheimer's disease during that time.

"There was an association between both a healthy diet and physical activity and reducing risk for Alzheimer's disease," Scarmeas said.

Those who ate well and exercised had a 60 percent reduction in the risk of developing Alzheimer's disease compared with those who didn't follow either good health habit, he said. "It's a very significant reduction," he added.

Exactly which components of the Mediterranean diet seem to confer benefit isn't known. "It could be there are individual elements of the diet that are important," Scarmeas said. "But it could be the interaction."

In another study published earlier this year, Scarmeas found that those who adhere to a Mediterranean diet had a lower risk of developing cognitive impairment, and a lower risk of developing Alzheimer's disease if they already had cognitive impairment.

In a second study in the same journal, researchers (including Scarmeas) looked at 1,410 French adults and found adherence to a Mediterranean diet was linked to slower decline on one cognitive test but not others. They didn't find high adherence to the heart-healthy diet linked with the risk for dementia.

In an editorial, the Mayo Clinic's Dr. David Knopman writes that a healthy diet may help prevent Alzheimer's but does not seem to occur in isolation.

"For such a benign intervention as diet and exercise, 60 percent [reduction in Alzheimer's] is substantial," said Dr. Greg Cole, associate director of the Mary S. Easton Center for Alzheimer's Disease Research at the University of California Los Angeles David Geffen School of Medicine.
Already, about 5.3 million Americans have Alzheimer's disease, according to the Alzheimer's Association, and up to 16 million may have it by 2050.

"So, the 60 percent reduction from diet and exercise can have a huge impact because we are talking about so many millions of people," Cole said.

The findings are in line with what the Alzheimer's Association already recommends in its "Maintain Your Brain" program, said William H. Thies, vice president for medical and scientific relations for the organization.

"One of the things that is important [to note] is, they are looking at normal people," he said, not those who already have the disease. "You aren't going to cure Alzheimer's disease by eating lots of olives."

SOURCES: William H. Thies, Ph.D., vice president, medical and scientific relations, Alzheimer's Association; Greg Cole, Ph.D., associate director, Mary S. Easton Center for Alzheimer's Disease Research, and professor, medicine and neurology, University of California, Los Angeles, David Geffen School of Medicine; Nikolaos Scarmeas, M.D., assistant professor, neurology, Columbia University Medical Center, New York City; Aug. 12, 2009, Journal of the American Medical AssociationHealthDayCopyright (c) 2009 ScoutNews, LLC.

A Success Story in American Health Care: Prevention and Public Health Care in the United States

Investing in and improving preventive health care is an integral part of health reform. Preventive health care improves the overall health of all Americans and helps decrease avoidable costs.

The U.S. spends over $2 trillion on medical care every year, spending more per patient than any other health system in the world.1,2 The epidemic and growing levels of largely preventable diseases and conditions contribute greatly to these high costs. In fact, one study estimates that almost 80 percent of all health spending in the United States can be attributed to chronic illness, much of which is preventable.3

Heart disease and stroke, for instance, are the first- and third-leading causes of death for both men and women in the United States and account for over one-third of all American deaths.4 In 2008, the total cost of heart disease and stroke for the United States was estimated to be more than $448 billion.5

Cardiovascular disease can be prevented before it progresses, through health screening and interventions for risk factors such as obesity, high blood pressure, high blood cholesterol, diabetes, and tobacco use – yet one in four adults do not receive the cholesterol screening they need, and in 2005, only 67 percent of smokers and 60 percent of individuals with obesity were counseled to quit or exercise, respectively.6

The responsibility for disease prevention is a shared one – individuals and families; school systems; employers; the medical and public health workforce; and federal, state, and local governments all have a stake. Community-based prevention efforts, which bring together all of these different stakeholders to positively impact the health and well-being of our populations, provide a model for integrative programs to reduce preventable diseases and decrease costs.

A Community-Based Prevention Success Story

The WISEWOMAN program in Nebraska is an example of how community-based screening and healthy lifestyle interventions can dramatically improve the health of Americans.7

Many low-income women, particularly those without insurance, cannot afford preventative screenings for cardiovascular risk factors – and, as a result, have higher rates of cardiovascular disease.8

The Nebraska WISEWOMAN program is a community intervention funded by the Centers for Disease Control and Prevention to prevent heart disease and stroke through risk factor screenings, healthy lifestyle counseling, and behavioral interventions for under- or uninsured women with low incomes. This program started in 2000 as one of the now 21 WISEWOMAN programs across the country, and it partners with health care providers across the state to provide low-income, under- or uninsured women with the knowledge and skills to change their behavior to help prevent cardiovascular disease and other chronic conditions.

The program provides risk factor screenings to low-income women at clinics throughout Nebraska. Women with test results that indicate elevated risk for cardiovascular disease and stroke are referred to local health care providers. In addition to a referral, a network of regional lifestyle interventionists provides four months of tailored counseling and risk-reduction tools to these women based on their identified health risks. The interventionists also provide support to women trying to increase their physical activity, maintain a healthy diet, or quit smoking.
Finally, women with elevated risk are also offered a choice between participating in a four week community class delivered by Nebraska University extension educators, or personalized self-directed informational materials designed to support the reduction of risk factors.
The WISEWOMAN program as a whole has reduced the risk of heart disease, stroke, and other chronic diseases in over 84,000 women.9 Nebraska WISEWOMAN has screened over 19,000 underserved women since its inception in 2000 and has significantly reduced the incidence of chronic disease and death.10 There has been a 5.4-percent reduction in 10-year estimated chronic heart disease risk and a 7.5-percent reduction in 5-year estimated cardiovascular disease risk. Smoking incidence has also declined 7.1 percent since the start of the program.11
The Nebraska WISEWOMAN program is a success story of shared responsibility and collaboration. The cooperation between the community and the health care system joins and strengthens two integral pieces of clinical and preventive care. WISEWOMAN recognizes and promotes the value of prevention in enhancing healthy lives and creating a sustainable health care system.

The lessons learned as a result of this work offer many ideas and opportunities for future initiatives to improve prevention and public health in communities across the United States.

The Future

Building on the success of Nebraska WISEWOMAN and other effective community programs, President Obama and Secretary Sebelius have made prevention and public health initiatives a priority.

Through the American Recovery and Reinvestment Act (ARRA), the U.S. Department of Health and Human Services will make a $1 billion dollar investment in prevention and wellness that will help reduce preventable diseases in communities across the nation.

Health reform legislation seeks to build upon this foundation and to ensure all Americans receive the quality affordable care they need and have access to preventive services. We need to enact health reform this year to improve prevention and public health measures in the United States. We need to ensure that success stories like WISEWOMAN Nebraska become commonplace in states and communities across America.

How to De-Stress a Recession-Riddled Life: Simple strategies should help in staying calm and moving on

SATURDAY, July 11 (HealthDay News) -- Recessions are bad for the stress level, as many in the midst of the current economic situation know and surveys prove.

Perhaps not surprisingly, nearly half of the 1,791 adults polled for the American Psychological Association's latest Stress in America survey said that their stress had increased in the past year. As a result, more than half reported fatigue, 60 percent said they were irritable or angry, and more than half said they lie awake at night because of stress.

Other researchers have found that stress adds years to a person's life but that those who cope with it effectively have higher levels of what's known as "good" cholesterol.
But for those who say it's impossible to cope because of a lost job, a retirement account that's virtually disappeared and a house that's plummeted in value, consider the advice of two veteran stress-reduction experts.

Dr. Paul J. Rosch is president of the American Institute of Stress and a clinical professor of medicine and psychiatry at New York Medical College. Deborah Rozman is a research psychologist and chief executive of Quantum Intech, the parent company of the HeartMath Institute in Boulder Creek, Calif., which conducts research on stress management.

As coping strategies, they advise people to:
Volunteer. This might sound counterproductive or even crazy: If you're worried about your job or already laid off, shouldn't you be looking for another? But Rozman insists it's a great strategy.
"Volunteering actually opens you up to possibilities," she said. Volunteering most anywhere -- at the church picnic, the local 5K run, the food bank -- can help get your mind off your problems, she said. It also will "reopen the heart," she said, "because the heart gets shut down when you worry."
Practice appreciation and gratitude. This isn't as difficult as it might sound, Rozman said. "If you still have a job, appreciate that," she said. Just like volunteering, this "helps the heart stay open." And she believes it will also help you reconnect with feelings of hope.
Follow traditional de-stress advice, but tweak it. To de-stress, people are supposed to exercise, eat right, find a way to calm down. But it's crucial to find the technique or techniques that work for you, Rosch said.
"You have to find out what works for you so that you will practice and adhere to it because it relieves tension and makes you feel better," he said. "Jogging, meditation, progressive muscle relaxation, yoga and listening to music are great for some but dull, boring and stressful when arbitrarily imposed on others."
Decrease the drama in your life. Rozman said that it's typical for people who've been laid off or fear losing their jobs to sit around and complain. But that only adds to the stress and drama, she said.
"Drama is when we amp up anger, anxiety or fear," she said. So if you find yourself in the midst of a woe-is-me conversation, she said, don't add to it by complaining more. Rather, try to change the subject or the tone. She suggests talking about how to improve things, not how bad things are.
Ration your news diet. The news can be full of bad economic tidings, 24/7. So limit your viewing, Rozman suggested. Decide what amount you can watch and still keep a balance between being informed and being dragged down.
Stop the comparisons. "Don't compare the present with the past," Rozman said. It's natural but depressing. Instead, give yourself time to heal after a job loss or other major setback and then move on.

And rather than thinking, "I've lost my nest egg," try: "Here's what I'll do to get it back," she said.
"It's about shifting focus to something that doesn't bring you down," Rozman added.

SOURCES: Deborah Rozman, Ph.D., research psychologist and chief executive, Quantum Intech Inc., Boulder Creek, Calif.; Paul J. Rosch, M.D., president, American Institute of Stress, and clinical professor of medicine and psychiatry, New York Medical College, Valhalla, N.Y.; American Psychological Association, Washington, D.C. HealthDay

Atherton Library Staff - Summer 2009

Multistate E. coli outbreak linked to cookie dough

CDC is collaborating with public health officials in many states, the United States Food and Drug Administration (FDA), and the United States Department of Agriculture Food Safety and Inspection Service (FSIS) to investigate an outbreak of E. coli O157:H7 infections.
As of Monday, June 22, 2009, 70 persons infected with a strain of E. coli O157:H7 with a particular DNA fingerprint have been reported from 30 states. Of these, 41 have been confirmed by an advanced DNA test as having the outbreak strain; these confirmatory test results are pending on the others.

The number of ill persons identified in each state is as follows: Arizona (2), California (3), Colorado (5), Connecticut (1), Delaware (1), Georgia (1), Hawaii (1), Iowa (2), Illinois (5), Kentucky (3), Massachusetts (4), Maryland (2), Maine (3), Minnesota (6), Missouri (2), Montana (1), North Carolina (2), New Hampshire (2), New Jersey (1), Nevada (2), Ohio (3), Oklahoma (1), Oregon (1), Pennsylvania (2), South Carolina (1), Texas (3), Utah (2), Virginia (2), Washington (5), and Wisconsin (1).

Ill persons range in age from 2 to 65 years; however, 66% are less than 19 years old; 75% are female. Thirty persons have been hospitalized, 7 developed hemolytic uremic syndrome (HUS); none have died. Reports of these infections increased above the expected baseline in May and continue into June.

Advice to Consumers
The Food and Drug Administration (FDA) and the Centers for Disease Control and Prevention are warning consumers not to eat any varieties of prepackaged Nestle Toll House refrigerated cookie dough due to the risk of contamination with E. coli O157:H7. If consumers have any prepackaged, refrigerated Nestle Toll House cookie dough products in their home they should throw them away. Cooking the dough is not recommended because consumers might get the bacteria on their hands and on other cooking surfaces. The recall does not include Nestle Toll House morsels, which are used as an ingredient in many home-made baked goods, or other already baked cookie products.

Individuals who have recently eaten prepackaged, refrigerated Toll House cookie dough and have experienced any of these symptoms should contact their doctor or health care provider immediately. Any such illnesses should be reported to state or local health authorities.
Consumers should be reminded they should not eat raw food products that are intended for cooking or baking before consumption. Consumers should use safe food-handling practices when preparing such products, including following package directions for cooking at proper temperatures; washing hands, surfaces, and utensils after contact with these types of products; avoiding cross contamination; and refrigerating products properly.

Advice to Retailers, Restaurateurs, and Food-service Operators
Retailers, restaurateurs, and personnel at other food-service operations should not sell or serve any Nestle Toll House prepackaged, refrigerated cookie dough products subject to the recall.
Learn more about this and other recent outbreaks & incidents >>

Centers for Disease Control and Prevention (CDC) · 1600 Clifton Rd · Atlanta GA 30333 · 800-CDC-INFO (800-232-4636)

Japanese Medical Librarian Tours Atherton Library

On May 21st, Yumi Yamashita from the Kyoto Prefectural University
of Medicine visited Atherton Library on her week-long tour of local
medical and health sciences libraries.
In Honolulu to present a poster session at the Medical Libraries
Association conference (“Exploring the information needs in
Japanese Medical University Library”), Ms. Yamashita was
determined to visit as many libraries as possible during her brief stay.
She had actually visited Meader Library the previous day not
realizing it is not the health sciences library. Linda arranged to pick
her up the following day, Thursday,and brought her here to the
Hawaii Loa campus.
After being introduced to Atherton staff, Linda gave her a tour of
the library, the ETC, and the rest of the Academic Center.
Ms. Yamashita was very impressed by the size of our nursing print
and e-journal collections and by our use of technology in the library.
She had the opportunity to view the MLA conference YouTube
video created by Linda and An last year. An then gave her a brief
tutorial on using Windows MovieMaker and uploading videos to
YouTube. Afterwards, Linda made the arrangements for Ms.
Yamashita to tour the Hawaii Medical Library at the Queen’s
Medical Center and then drove her there.
According to Linda, Ms. Yamashita was awed by the beauty of our
surroundings andexclaimed upon her arrival on campus -
“This is Hawaii!”

New Report Finds 10 Early Lessons Learned from the H1N1 Outbreak

Washington, D.C. - Trust for America's Health (TFAH), the Center for Biosecurity, and the Robert Wood Johnson Foundation (RWJF) issued a new analysis today, Pandemic Flu: Lessons From the Frontlines, which found that the initial response to the H1N1 outbreak showed strong coordination and communication and an ability to adapt to changing circumstances from U.S. officials, but it also showed how quickly the nation's core public health capacity would be overwhelmed if an outbreak were more severe or widespread.
"H1N1 is a real-world test of our initial emergency response capabilities -- all of the planning and preparations have paid off. The country is significantly ahead of where we were a few years ago," said Jeff Levi, PhD, Executive Director of TFAH. "However, the outbreak also revealed serious gaps in our nation's preparedness for pandemic flu and other public health emergencies."
The Pandemic Flu: Lessons from the Frontlines report reviews 10 early lessons learned from the response to the H1N1 (swine) flu outbreak, 10 ongoing core vulnerabilities in U.S. pandemic flu preparedness, and case studies of challenges communities around the country faced when responding to the outbreak. The 10 early lessons learned from the 2009 H1N1 outbreak in the report were that:
Investments in pandemic planning and stockpiling antiviral medications paid off;
Public health departments did not have enough resources to carry out plans;
Response plans must be adaptable and science-driven;
Providing clear, straightforward information to the public was essential for allaying fears and building trust;
School closings have major ramifications for students, parents and employers;
Sick leave and policies for limiting mass gatherings were also problematic;
Even with a mild outbreak, the health care delivery system was overwhelmed;
Communication between the public health system and health providers was not well coordinated;
WHO pandemic alert phases caused confusion; and
International coordination was more complicated than expected.
"Its critical to understand what worked as planned in the H1N1 response, as well as to look at what needs to be strengthened, fixed, or better funded. This report is a contribution to that effort," said Thomas Inglesby, MD, Deputy Director, Center for Biosecurity of UPMC.
The report also identified some surprises encountered during the H1N1 outbreak, including that much of the world's pandemic planning had revolved around the potential threat of the H5N1 (bird) flu virus, which had been circulating in Asia and elsewhere for nearly a decade. It also reveals that planners anticipated there would be six weeks of lead time between the time a novel flu virus was identified and its spread to the United States.
In addition, according to the analysis in Pandemic Flu: Lessons from the Frontlines, there are a number of systemic gaps in the nation's ability to respond to a pandemic flu outbreak. To further strengthen U.S. preparedness, the following 10 core areas must be addressed:

1. Maintaining the Strategic National Stockpile -- making sure enough antiviral medications, vaccinations, and equipment are available to protect Americans, which includes replenishing the stockpile when medications and supplies are used;

2. Vaccine development and production -- enhancing the biomedical research and development abilities of the United States to rapidly develop and produce a vaccine;

3. Vaccinating all Americans -- ensuring that all Americans would be able to be inoculated in a short period of time;

4. Planning and Coordination -- improving coordination among federal, state, and local governments and the private sector preparedness and planning activities on an ongoing basis, including taking into account how the nature of flu threats change over time;

5. School closings, sick leave, and community mitigation strategies -- improving strategies to limit the spread of disease ensuring all working Americans have sick leave benefits and that communities are prepared to limit public gatherings and close schools as necessary;

6. Global coordination -- building trust, technologies, and policies internationally to encourage science-based, consistent decision making across borders during an outbreak;

7. Resources -- providing enough funding for the on-the-ground response, which is currently under funded and overextended;

8. Workforce -- stopping layoffs at state and local health departments and recruiting the next generation of public health professionals;

9. Surge capacity -- improving the ability for health providers to manage a massive influx of patients; and

10. Caring for the uninsured and underinsured -- ensuring that all Americans will receive care during an emergency, which limits the spread of the contagious disease to others, and making sure hospitals and health care providers are compensated for providing care.

The full analysis is available on TFAH's Web site at www.healthyamericans.org. The report was supported by a grant from RWJF.
Trust for America's Health is a non-profit, non-partisan organization dedicated to saving lives by protecting the health of every community and working to make disease prevention a national priority. www.healthyamericans.org

Global Testing Shows No Variation in Swine Flu Virus

Experts worry that it could mutate and become more dangerous as it travels from country to country

THURSDAY, June 4 (HealthDay News) -- In what would seem to be some encouraging news in the ongoing H1N1 swine flu outbreak, a leading federal health official said Thursday that samples of the virus from points around the globe are genetically identical to the strain found in the United States.

"We have tested isolates from a wide geographic area, from the Americas, Europe, from Asia and New Zealand and we are not seeing variations in isolates from the genetic testing we do here," Dr. Anne Schuchat, the Centers for Disease Control and Prevention's interim deputy director for science and public health program, said during a press conference.

While infections caused by the virus continue to be relatively mild and patients recover quickly, health officials have warned that the virus could mutate into a more virulent form, putting greater numbers of people at risk.

The World Health Organization said Tuesday that it was weighing whether to declare a global pandemic, with more cases of the H1N1 swine flu surfacing in the Southern Hemisphere -- where flu season is just beginning -- and outside North America.

The vast majority of infections and deaths have occurred in Mexico -- the source of the outbreak -- and the United States. But person-to-person transmission in now being reported in countries such as Australia (501 cases) and Chile (313 cases), as well as Great Britain, Spain and Japan, according to published reports.

"We still are waiting for evidence of really widespread community activity in these countries, and so it's fair to say that they are in transition and are not quite there yet, which is why we are not in phase 6 yet," WHO flu chief Dr. Keiji Fukuda said during a press conference at the agency's headquarters in Geneva, Switzerland.

Phase 6 is the highest alert on WHO's scale, representing a global epidemic. In terms of the geographic spread of swine flu, the world is "at phase 5 but getting closer to phase 6," Fukuda said, the Associated Press reported.

The WHO also was debating whether to add a second measure that indicates how dangerous the H1N1 swine flu virus is -- rather than just how widespread -- after several countries expressed concerns that declaring a global pandemic could cause mass confusion and panic even though it's still not clear how dangerous the virus will be, the news service said.

To date, the virus has caused 19,273 cases of infection in 66 countries, but just 117 deaths, 97 of them in Mexico, the WHO reported Wednesday.

Since the outbreak started in April, health officials in the United States have said that infections have been mild for the most part. Testing has found that the H1N1 virus remains susceptible to two common antiviral drugs, Tamiflu and Relenza.

The U.S. Centers for Disease Control and Prevention was reporting Wednesday a total of 11,054 cases in all 50 states and the District of Columbia and Puerto Rico, including 17 deaths. The agency said that confirmed cases of H1N1 swine flu represent about one in 20 of actual cases, bringing the total probable number of cases in the United States to about 200,000.

During the next few months, CDC scientists will be looking to see if the virus mutates or becomes resistant to antiviral medications, or is more easily spread among people. The flu season is winding down in the Northern Hemisphere but is just beginning in the Southern Hemisphere.
Some older people may have partial immunity to the H1N1 swine flu virus because of possible exposure to another H1N1 flu strain that circulated prior to 1957, according to the CDC.
A vaccine for the swine flu virus could be ready by October, if research and testing proceed as planned this summer, agency officials said.

U.S. Human Cases of H1N1 Flu Infection(As of June 3, 2009, 11:00 AM ET)
States & Territories* # confrm'd & pr'bable cases Deaths
Alabama 94
Alaska 1
Arkansas 9
Arizona 547 4 deaths
California 804
Colorado 68
Connecticut 196
Delaware 135
Florida 194
Georgia 32
Hawaii 94
Idaho 16
Illinois 1151 3 deaths
Indiana 146
Iowa 92
Kansas 87
Kentucky 90
Louisiana 122
Maine 12
Maryland 63
Massachusetts 566
Michigan 287
Minnesota 66
Mississippi 34
Missouri 41 1 death
Montana 15
Nebraska 43
Nevada 113
New Hampshire 50
New Jersey 74
New Mexico 108
New York 646 4 deaths
North Carolina 21
North Dakota 18
Ohio 29
Oklahoma 87
Oregon 159
Pennsylvania 226
Rhode Island 16
South Carolina 49
South Dakota 9
Tennessee 103
Texas 1403 3 deaths
Utah 369 1 death
Vermont 7
Virginia 36
Washington 574 1 death
Washington, D.C. 20
West Virginia 3
Wisconsin 1905
Wyoming 18

Territories
Puerto Rico 6

TOTAL*(52)
11,054 cases
17 deaths
*includes the District of Columbia and Puerto Rico

Source: U.S. Centers for Disease Control and Prevention

SOURCES: June 4, 2009, teleconference with Anne Schuchat, M.D., U.S. Centers for Disease Control and Prevention's interim deputy director for science and public health program; Associated PressHealthDay

Some OTC Sleep, Cold Meds Could Harm Aging Brain

Drugs containing benadryl linked to slowed thinking, delirium in elderly, report finds.

THURSDAY, June 4 (HealthDay News) --Older people taking common over-the-counter drugs for pain, cold symptoms or help with sleep may increase their risk for cognitive impairment, including delirium, University of Indiana researchers report.

These drugs include Benadryl, Dramamine, Excedrin PM, Nytol, Sominex, Tylenol PM and Unisom.

All of these over-the-counter (OTC) drugs contain benadryl (diphenhydramine), a molecule that blocks the neurotransmitter acetylcholine. Acetylcholine is essential for normal functioning of the central and peripheral nervous systems, the researchers explained.

"Before taking any medication prescribed by your doctor or an OTC medication, make sure there is no negative impact of this medication on your brain," said lead researcher Dr. Malaz Boustani.

His group analyzed data from 27 prior studies on the relationship between anticholinergic effects and brain function, as well as looking into anecdotal data. The team found a consistent link between anticholinergic effects and cognitive impairment in older adults.

"Any OTC medication with the term 'PM' will indicate the presence of benadryl, which is bad for the brain," Boustani concluded.

He noted that the effects of benadryl can add up, so the more medications you take that contain benadryl the worse it may be for cognition. "There is a relationship with the number of medications and the burden on your aging brain," the researcher said.

People aged 65 and older who take these medications also run the risk of developing delirium, Boustani said. Delirium is a decline in attention-focus, perception and cognition, or "acute brain failure," as Boustani calls it. Delirium typically increases the odds of dying or being institutionalized, he said.

In addition, taking these medications for 90 days or more may triple your risk of developing Alzheimer's disease, Boustani said.

Given the risks, older adults should look for drugs that don't contain benadryl, he said.
"A lot of these medications are not recognized for these side effects," he contended. "It's time for the FDA to start taking this negative impact of these medications on the aging brain seriously."
The report is published in the May online issue of the Journal of Clinical Interventions in Aging.
According to Boustani, researchers in brain pharmacoepidemiology at Indiana University's Center for Aging Research is conducting a study of 4,000 older adults to see if the long-term use of medications with anticholinergic effects is associated with the development of severe cognitive impairment, such as Alzheimer's disease.

Dr. Clinton Wright, an associate professor of neurology at the Miller School of Medicine at the University of Miami, agreed that more study is needed to assess the effects of these drugs on the brain.

"These findings don't surprise me at all," Wright said. "People tend not to think of their OTC medications as medication, but any medication that has anticholinergic effects can affect people's cognition."

Wright believes the drugs should carry a warning of this potential side effect.
Deborah G. Bolding, a spokeswoman for GlaxoSmithKline, the maker of Sominex, defended the product and said it complies with all current FDA regulations. However, she would not comment specifically on whether diphenhydramine is associated with an increased risk of delirium in older adults.

"Sominex is a mild sleep aid designed to help individuals through periods of nervous tension or stress, which are accompanied by sleeplessness. It has been proven safe and effective in medical tests when taken as directed, and has been safely used by millions of satisfied customers," Bolding said.

"For all formulations, Sominex's active ingredient is diphenhydramine hydrochloride. This is marketed under a final FDA monograph as an over-the-counter sleep aid," she added.

SOURCES: Malaz Boustani, M.D., associate professor, medicine, Indiana University School of Medicine, Indianapolis; Clinton Wright, M.D., associate professor, neurology, Miller School of Medicine, University of Miami; Deborah G. Bolding, spokeswoman, GlaxoSmithKline; May 2009, Journal of Clinical Interventions in Aging, online

CDC Health Information for International Travel 2008: Information for Travelers: Air Travel and Cruise Ships

Air Travel
Air Passengers Subject to Health Checks for Avian Influenza A (H5N1)
Transportation Security Administration – Security Measures for Air Travel, concerning what passengers may carry onto the airplane

Spraying Aircraft for Insects - DisinsectionRecommendations from Health Information for International Travel

Tuberculosis
Tuberculosis and Air Travel: Guidelines for Prevention and Control, 2nd Edition (World Health Organization, 2006) (728 KB / 47 pages)
Extensively Drug-Resistant Tuberculosis (XDR TB)

SARS
Questions and Answers about SARS and the current SARS situation

Cruise Ship Travel and Health
CDC Vessel Sanitation Program (VSP)Protects passenger and crew health by minimizing the risk of gastrointestinal illness aboard cruise ships. Posts inspection scores and outbreak information
Summary of Sanitation Inspections of International Cruise Ships ("Green Sheet")
Sanitation Inspection Scores DatabaseObtain sanitation inspection scores of international cruise ships
Cruise Ship TravelRecommendations from Health Information for International Travel
Please note: Some of these publications are available for download only as *.pdf files. These files require Adobe Acrobat Reader in order to be viewed.

Centers for Disease Control and Prevention
1600 Clifton Rd
Atlanta, GA 30333

Interim Guidance for Infection Control for Care of Patients with Confirmed or Suspected Swine Influenza A (H1N1) Virus Infection in Healthcare Setting

April 29, 2009 09:45 PM ET

This document provides interim guidance for healthcare facilities (e.g., hospitals, long-term care and outpatient facilities, and other settings where healthcare is provided) and will be updated as needed.

Background
To date, human cases of swine influenza A (H1N1) virus infection have been confirmed in residents of several U.S. states and Mexico (for the most up-to-date list please see http://www.cdc.gov/h1n1flu/). Investigations of these cases suggest that on-going human-to-human swine influenza A (H1N1) virus is occurring. Illness signs and symptoms have consisted of influenza-like illness - fever and respiratory tract illness (cough, sore throat, runny nose), headache, muscle aches - and some cases have had vomiting and diarrhea. Cases of severe respiratory disease, including fatal outcomes, have been reported.

The swine influenza A (H1N1) virus that has infected humans in the U.S. and Mexico is a novel influenza A virus that has not previously been identified in North America. This virus is resistant to the antiviral medications amantadine and rimantadine, but is sensitive to oseltamivir and zanamivir.

Implementation of Respiratory Hygiene/Cough Etiquette
To prevent the transmission of all respiratory infections in healthcare settings, including swine influenza A (H1N1), Respiratory Hygiene/Cough Etiquette infection control measures (see http://www.cdc.gov/flu/professionals/infectioncontrol/resphygiene.htm) should be implemented at the first point of contact with a potentially infected person. They should be incorporated into infection control practices as one component of Standard Precautions.

Healthcare facilities should establish mechanisms to screen patients for signs and symptoms of febrile respiratory illness who are presenting to any point of entry to the facility for care or making appointments to be seen at the facility. Provisions should be made to allow for prompt segregation and assessment of symptomatic patients.

Implementation of facility contingency plans
The current situation with swine flu in the United States is evolving quickly. Staff in healthcare settings should monitor http://www.cdc.gov/swineflu and state and local health department websites for the latest information. Healthcare facilities should be reviewing and making plans to implement their facility contingency response and/or pandemic response plans. This should include making plans for managing increasing patient volume and potential staffing limitations.

Interim Infection Control Recommendations
If the patient is presenting in a community where swine influenza A (H1N1) transmission is occurring (based upon information provided by state and local health departments), these infection control recommendations should apply to all patients with febrile respiratory illness (defined as fever [greater than 37.8° Celsius] plus one or more of the following: rhinorrhea or nasal congestion; sore throat; cough).

If the patient is presenting in a community without swine influenza A (H1N1) transmission, these infection control recommendations should apply to those patients with febrile respiratory illness AND:
-close contact with a person who is a confirmed, probable, or suspected case of swine influenza A (H1N1) virus infection, within the past 7 days OR
-travel to a community either within the United States or internationally where there are one or more confirmed swine influenza A (H1N1) cases within 7 days

As the situation evolves, the ability to use epidemiologic links to identify potentially infectious patients may be lost and these recommendations may need to be applied to all patients with febrile respiratory illness. This situation will be monitored, and these guidelines will be updated as needed.

Infection Control of Ill Persons in a Healthcare Setting

Screening of patients presenting to medical facilities

Patient placement and transport
Any patients who are confirmed, probable or suspected cases and present for care at a healthcare facility should be placed directly into individual rooms with the door kept closed. Healthcare personnel interacting with the patients should follow the infection control guidance in this document. For the purposes of this guidance, healthcare personnel are defined as persons, including employees, students, contractors, attending clinicians, and volunteers, whose activities involve contact with patients in a healthcare or laboratory setting.

Procedures that are likely to generate aerosols (e.g., bronchoscopy, elective intubation, suctioning, administering nebulized medications), should be done in a location with negative pressure air handling whenever feasible. An airborne infection isolation room (AIIR) with negative pressure air handling with 6 to 12 air changes per hour can be used. Air can be exhausted directly outside or be recirculated after filtration by a high efficiency particulate air (HEPA) filter. Facilities should monitor and document the proper negative-pressure function of AIIRs, including those in operating rooms, intensive care units, emergency departments, and procedure rooms.

Procedures for transport of patients in isolation precautions should be followed. Facilities should also ensure that plans are in place to communicate information about suspected cases that are transferred to other departments in the facility (e.g., radiology, laboratory) and other facilities. The ill person should wear a surgical mask to contain secretions when outside of the patient room, and should be encouraged to perform hand hygiene frequently and follow respiratory hygiene / cough etiquette practices.

Limitation of healthcare personnel entering the isolation room
Healthcare personnel entering the room of a patient in isolation should be limited to those performing direct patient care.

Isolation precautions
Standard and Contact precautions plus eye protection should be used for all patient care activities for patients being evaluated or in isolation for swine influenza A (H1N1) (i.e., including all healthcare personnel who enter the patient’s room). Maintain adherence to hand hygiene by washing with soap and water or using alcohol-based hand sanitizer immediately after removing gloves and other equipment and after any contact with respiratory secretions. Nonsterile gloves and gowns along with eye protection should be donned upon room entry. (See http://www.cdc.gov/ncidod/dhqp/ppe.html)

Respiratory protection: All healthcare personnel who enter the rooms of patients in isolation for swine influenza should wear a fit-tested disposable N95 respirator or equivalent (e.g., powered air purifying respirator)*. Respiratory protection should be donned upon room entry.

Note that this recommendation differs from current infection control guidance for seasonal influenza, which recommends that healthcare personnel wear surgical masks for patient care. The rationale for the use of respiratory protection is that a more conservative approach is needed until more is known about the specific transmission characteristics of this new virus. This recommendation is also outlined in the in the in the October 2006 “Interim Guidance on Planning for the Use of Surgical Masks and Respirators in Healthcare Settings during an Influenza Pandemic” http://www.pandemicflu.gov/plan/healthcare/maskguidancehc.html.

Management of visitors
Limit visitors to patients in isolation for swine influenza A virus (H1N1) infection to persons who are necessary for the patient's emotional well-being and care. Visitors who have been in contact with the patient before and during hospitalization are a possible source of swine influenza A virus (H1N1). Therefore, schedule and control visits to allow for appropriate screening for acute respiratory illness before entering the hospital and appropriate instruction on use of personal protective equipment and other precautions (e.g., hand hygiene, limiting surfaces touched) while in the patient's room. Visitors should be instructed to limit their movement within the facility.

Visitors may be offered a gown, gloves, eye protection, and respiratory protection (i.e., N95 respirator) and should be instructed by healthcare personnel on their use before entering the patient’s room.

Duration of precautions
Isolation precautions should be continued for seven (7) days from symptom onset or until the resolution of symptoms, whichever is longer.

Persons with swine influenza A (H1N1) virus infection should be considered potentially contagious from one day before to 7 days following illness onset. Persons who continue to be ill longer than 7 days after illness onset should be considered potentially contagious until symptoms have resolved. Children, especially younger children, might be contagious for longer periods.

Surveillance of healthcare personnel
In communities where swine influenza A (H1N1) virus transmission is occurring, healthcare personnel should be monitored daily for signs and symptoms of febrile respiratory illness. Healthcare personnel who develop these symptoms should be instructed not to report to work, or if at work, should cease patient care activities and notify their supervisor and infection control personnel.

In communities without swine influenza A (H1N1) virus transmission, healthcare personnel working in areas of a facility where there are patients being assessed or isolated for swine influenza infection should be monitored daily for signs and symptoms of febrile respiratory infection. This would include healthcare personnel exposed to patients in an outpatient setting or the emergency department. Healthcare personnel who develop these symptoms should be instructed not to report to work, or if at work, should cease patient care activities and notify their supervisor and infection control personnel.

Healthcare personnel who do not have a febrile respiratory illness may continue to work. Asymptomatic healthcare personnel who have had an unprotected exposure to swine influenza A (H1N1) also may continue to work if they are started on antiviral prophylaxis. Interim guidance on antiviral recommendations for close contacts of patients with confirmed or suspected swine influenza A (H1N1) virus infection can be found at http://www.cdc.gov/h1n1flu/recommendations.htm.

Management of ill healthcare personnel
Healthcare personnel should not report to work if they have a febrile respiratory illness.In communities where swine influenza virus transmission is occurring, healthcare personnel who develop a febrile respiratory illness should be excluded from work for 7 days or until symptoms have resolved, whichever is longer.

In communities without swine influenza virus transmission, healthcare personnel who develop a febrile respiratory illness and have been working in areas of the hospital where swine influenza patients are present, should be excluded from work for 7 days or until symptoms have resolved, whichever is longer.

In communities where swine influenza virus transmission is not occurring, healthcare personnel who develop febrile respiratory illness and have not been in areas of the facility where swine influenza patients are present should follow facility guidelines on returning to work.

Stewardship of personal protective equipment and antivirals
Facilities should implement plans to ensure appropriate allocation of personal protective equipment, including N95 respirators, and antivirals.

Environmental infection control
Routine cleaning and disinfection strategies used during influenza seasons can be applied to the environmental management of swine influenza. Management of laundry, utensils and medical waste should also be performed in accordance with procedures followed for seasonal influenza. More information can be found at http://www.cdc.gov/ncidod/dhqp/gl_environinfection.html.

Facility access control
Facilities should have signage at entry points instructing patients and visitors about hospital policies, including the need to notify staff immediately if they have signs and symptoms of febrile respiratory illness. Facilities in communities where swine influenza transmission is occurring should limit points of entry to the facility..

Administration of the current 2008-2009 seasonal influenza vaccine
It is not anticipated that the seasonal influenza vaccine will provide protection against the swine flu H1N1 viruses. However, in some parts of the country, seasonal influenza viruses are still circulating. Influenza vaccination is effective against these seasonal viruses and should continue to be given to unvaccinated patients in areas where seasonal influenza cases are still occurring.

*Respirator use should be in the context of a complete respiratory protection program in accordance with Occupational Safety and Health Administration (OSHA) regulations. Information on respiratory protection programs and fit test procedures can be accessed at http://www.osha.gov/SLTC/etools/respiratory. Staff should be medically cleared, fit-tested, and trained for respirator use, including: proper fit-testing and use of respirators, safe removal and disposal, and medical contraindications to respirator use.

Additional information on N95 respirators and other types of respirators may be found at: http://www.cdc.gov/niosh/npptl/topics/respirators/factsheets/, and at http://www.fda.gov/cdrh/ppe/masksrespirators.html.

-Links to non-federal organizations are provided solely as a service to our users. These links do not constitute an endorsement of these organizations or their programs by CDC or the federal government, and none should be inferred. CDC is not responsible for the content of the individual organization Web pages found at these links.

--Centers for Disease Control and Prevention--