National P.E.P. Rally Featuring Subway's Jared and World-Renowned Athletes Laila Ali and Tab Ramos Kicks Off Partnership
The National Institutes of Health's We Can! program has partnered with Subway Restaurants to reach families throughout the United States and beyond with practical tips and tools to help children and their parents maintain a healthy weight and prevent overweight and obesity.
The partnership will be launched today at a National P.E.P. (Play More, Eat Right, and Push Away the Screen) Rally at the D.C. Armory in Washington, D.C. The event will feature hundreds of youth, parents, and teachers, along with Subway spokesman Jared Fogle, boxing champion Laila Ali, Olympic soccer star Tab Ramos, and Lawrence A. Tabak, D.D.S., Ph.D., NIH acting principal deputy director.
"Obesity is a significant public health problem, not just for adults, but also for our children who could suffer from lifelong medical and psychosocial problems," noted Tabak. "We are delighted to work with Subway Restaurants to educate children and their families about three simple steps they can take for a healthy weight: eat right, move more, and limit screen time."
Nearly 1 out of 3 children in the United States ages 2 to 19 is overweight or at risk of becoming overweight, according to the Centers for Disease Control and Prevention. Extra pounds can lead to lifelong health problems, such as type 2 diabetes, high blood pressure, and heart disease. In adults, overweight and obesity contribute to these and other chronic conditions, including certain cancers.
The NIH established We Can! (Ways to Enhance Children’s Activity & Nutrition) in June 2005 to help prevent childhood obesity. The science-based national education program brings families and communities together to promote healthy weight in children ages 8 through 13 through improved food choices, increased physical activity, and reduced screen time.
Subway will promote We Can! messages and resources in restaurants and through the SubwayKids.com Web site. In addition, in collaboration with Subway and Scholastic, Inc. We Can! materials have been adapted into fun tools and activities for teachers, students, and parents, including a "You Are What You Eat" poster, reproducible activities for students, and send-home sheets for parents. The partnership does not imply endorsement of Subway products.
The partnership also aims to strengthen We Can!’s extensive outreach in communities across the United States, with Subway providing funding for training programs for community-based educators and leaders to help them implement We Can!’s hands-on curricula for youth and for parents. Currently, more than 1,000 We Can! community sites nationwide and in 11 other countries have committed to providing We Can! programs at the local level.
At the National P.E.P. Rally, more than 300 elementary and middle school students will participate in fun and educational activities, such as Energy In/Energy Out, a tag-like game that emphasizes the importance of energy balance for a healthy weight. Ramos will lead participants in soccer training sessions, and Ali will encourage the youth to eat well and be active every day. Fogle, who is popularly known as "Jared from Subway," will also share his story and talk about the importance of maintaining a healthy weight.
"Getting kids to stay healthy and active is something I work on all year long and I am constantly on the road, going from school to school to reach out to children," said Fogle. "I’m proud to be here today to support the We Can! program on behalf of Subway Restaurants because my goal is to help children avoid the physical and emotional hardships I went through living with obesity."
National P.E.P. Rally participants will be asked to sign a pledge to show their commitment to be active at least one hour a day, to make healthy food choices, and to limit recreational screen time to no more than two hours a day. All participants will receive educational materials to support their commitment.
"Helping America's children maintain a healthy weight is a priority," said Elizabeth G. Nabel, M.D., director of NIH's National Heart, Lung, and Blood Institute, which developed We Can! "By bringing together corporate partners with We Can! community sites, we believe we really can help families embrace healthy lifestyles."
For more information about We Can! and to learn more about the partnership, visit http://wecan.nhlbi.nih.gov.
To speak with an NIH spokesperson, please contact the NHLBI Communications Office at (301) 496-4236 or at NHLBI_news@nhlbi.nih.gov. To speak with a Subway spokesperson, please contact Megan Driscoll at Emanate, (212) 805-8034 (work); (646) 285-7165 (cell); megan.driscoll@emanatepr.com.
ABOUT We Can!
We Can! (Ways to Enhance Children’s Activity & Nutrition) is a national education program of families and communities coming together to promote healthy weight in children and youth through improved food choices, increased physical activity, and reduced screen time. We Can! was developed by the nation’s top research and health authority — the National Institutes of Health — and is a collaboration of four NIH institutes: National Heart, Lung, and Blood Institute; Eunice Kennedy Shriver National Institute of Child Health and Human Development; National Institute of Diabetes and Digestive and Kidney Diseases; and National Cancer Institute. The program provides parents, caregivers and communities — from the smallest towns to the largest cities — with ready-to-use, science-based tools, trainings and educational sessions that encourage healthy lifestyles. Today, more than 1,000 community sites have committed to offering We Can! science-based educational materials and curricula to youth and parents in their communities. We Can! has also engaged dozens of corporations, government agencies, and non-profit organizations to increase awareness and enhance product development and dissemination.
For more information about We Can!, visit http://wecan.nhlbi.nih.gov or call toll-free at call toll-free 866-35-WE CAN.
We Can! and the We Can! logo are trademarks of the U.S. Department of Health & Human Services (DHHS). Participation by Subway restaurants does not imply endorsement by DHHS.
NIH joins the Centers for Disease Control and Prevention (CDC) and the Robert Wood Johnson Foundation (RWJF) as members of the National Collaborative on Childhood Obesity Research (NCCOR) to accelerate the progress of research to reduce childhood obesity. NCCOR seeks to improve the efficiency, effectiveness and application of childhood obesity research and to produce positive changes more rapidly through enhanced coordination and collaboration. For more information about NCCOR and its initiatives, visit http://www.nccor.org/.
The National Institutes of Health (NIH) — The Nation's Medical Research Agency — includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. It is the primary federal agency for conducting and supporting basic, clinical and translational medical research, and it investigates the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit www.nih.gov.
Monday, March 30, 2009
How Much Should Women Drink? It Depends on Who You Ask
College-age females overestimate 'need' to consume alcohol, survey finds
HealthDay
By Kevin McKeever
Friday, March 27, 2009
FRIDAY, March 27 (HealthDay News) -- College women, listen up: You don't need to drink to excess to impress college men, a new study has found.
"Although traditionally, men drink more than women, research has shown that women have steadily been drinking more and more over the last several decades," study author Joseph LaBrie, an associate professor of psychology at Loyola Marymount University in Los Angeles, said in a news release from the American Psychological Association. "Our research suggests women believe men find excessive drinking sexually attractive and appealing, but it appears this is a giant misperception."
In fact, nearly three-fourths of the female students surveyed at two U.S. universities, Loyola and the University of Washington, overestimated how much alcohol they need to imbibe to interest their male counterparts. These women were the same ones who also tended to drink to excess, according to the research, published in the March issue of Psychology of Addictive Behaviors.
The researchers surveyed 3,616 college students about women's drinking habits and men's views of drinking by women.
Most of the women overestimated, by an average of a drink-and-a-half, how much men would like them to drink at any given event. About 26 percent said they thought men would most likely want to be friends with a woman who drinks five or more drinks, and 16 percent said women who drank the most attracted men sexually.
Both estimates were twice what the men said they actually preferred.
"There is a great, and risky, disconnect here between the sexes," LaBrie said. "While not all women may be drinking simply to get a guy's attention, this may help explain why more women are drinking at dangerous levels. We believe universities and other public health organizations could use this information to help curb binge drinking among young women."
A follow-up study by LaBrie is underway to determine how men think women view male drinking habits to see if the perception might have a similar effect on men's drinking habits.
New Device Treats Common Heart Rhythm Disorder
It could replace anti-clotting drug warfarin for many patients, researchers say
HealthDay
Sunday, March 29, 2009
SATURDAY, March 28 (HealthDay News) -- An implanted device may soon replace the anti-clotting drug warfarin as the first line of treatment for many people with atrial fibrillation, a new study suggests.
People with atrial fibrillation have a sixfold increased risk of stroke, the researchers noted, and typically need to take warfarin for the rest of their lives. Atrial fibrillation is a common heart rhythm problem that causes the upper chamber of the heart to beat irregularly.
"One in four people over 50 will develop atrial fibrillation," lead researcher Dr. David R. Holmes Jr., the Scripps Professor of Medicine at the Mayo Graduate School of Medicine, said during a morning teleconference at the American College of Cardiology annual meeting Saturday in Orlando, Fla.
About 3 million people in the United States have atrial fibrillation, and 16 million Americans will have the condition by 2050, Holmes said. Stroke is the most serious complication related to atrial fibrillation, he noted.
"We know that in those patients with atrial fibrillation that the clot that causes that stroke comes from a certain area of the heart called the left atrial appendage," Holmes said, explaining that the appendage is a muscular pouch connected to the left atrium. "The device isolates the left atrial appendage."
To implant the device, an interventional cardiologist uses a catheter inserted in a leg vein to guide the device into the heart; the device travels through the heart's right chamber and is deposited into the left atrium through a puncture hole between the two chambers of the heart, the researchers explained.
Current treatment with warfarin is effective in preventing strokes caused by clots associated with atrial fibrillation, but its use needs to be monitored monthly to assure patients are receiving the safest and most effective dose because it can cause serious bleeding if given in doses that are too high, Holmes noted.
In the Embolic Protection in Patients With Atrial Fibrillation (PROTECT AF) trial, researchers compared treatment with warfarin to a fabric-covered, expandable cage called the WATCHMAN. The device blocks blood clots that typically form in the heart's left atrial appendage. The 707 patients were randomly assigned to one of the two treatments.
"Efficacy was dramatically better with the device, and stopping the warfarin," Holmes said.
The researchers found that patients with the WATCHMAN had a 32 percent lower risk of stroke and cardiovascular death compared with warfarin therapy. This was especially true for hemorrhagic stroke, which causes bleeding in the brain and is usually fatal, Holmes noted.
In addition, there were fewer complications with the device, once it was implanted, compared to warfarin. Most complications with the device occurred when placing it in the heart, but these complications now occur in only 1 percent of patients, Holmes noted.
The researchers concluded that the device is an effective alternative to warfarin for preventing stroke in patients with atrial fibrillation, particularly those at the highest risk of stroke.
"A strategy like this can be used in patients with non-valvular atrial fibrillation to prevent stroke, and get them off warfarin," Holmes said.
Dr. Gregg C. Fonarow, professor of cardiology at the University of California, Los Angeles, thinks this device will benefit many patients with atrial fibrillation.
"The major risk of atrial fibrillation is blood clots forming in the heart, and then breaking loose to cause stroke. Most of these blood clots form in the appendage of the left atrium," Fonarow said.
The only effective treatment until now was lifelong use of warfarin. Researchers have been searching for alternative therapies to warfarin to protect patients with atrial fibrillation from stroke without success for decades, Fonarow noted.
"The findings from this clinical trial are very impressive," Fonarow said. "Although there were some procedure-related complications, treatment with this novel device will be very attractive and provide patients with atrial fibrillation effective, long-term protection from stroke and systemic embolization without the bleeding risks associated with warfarin."
Monday, March 23, 2009
Most New EMS Recruits Overweight or Obese
Massachusetts finding has troubling implications for public safety, experts say
By Robert Preidt
Friday, March 20, 2009
FRIDAY, March 20 (HealthDay News) -- More than 75 percent of candidates for fire and ambulance services in Massachusetts are either overweight or obese, a situation that has major consequences for public health and safety, researchers say.
"First, cardiovascular disease and musculoskeletal injury are important causes of [disability and death] in emergency responders, and excess body fat is associated with higher risk for both. Second, because of the nature of emergency response work, any health condition suddenly incapacitating an emergency responder also potentially compromises the safety of his or her co-workers and the community," lead author Antonios Tsismenakis, a second-year medical student at Boston University School of Medicine, said in a news release.
A team from BUSM, Boston Medical Center, Harvard University and the Cambridge Health Alliance reviewed the pre-placement medical examinations of 370 firefighter and ambulance recruits assessed at two Massachusetts clinics between October 2004 and June 2007.
They found that 43.8 percent of the recruits were overweight, 33 percent were obese, and only 22 percent were normal weight.
Excess weight as measured by body-mass index (BMI) was associated with higher blood pressures, worse metabolic profiles and lower exercise tolerance on treadmill stress tests, the researchers said.
While all normal-weight recruits achieved the National Fire Protection Agency's recommended minimum exercise threshold of 12 metabolic equivalents, 42 percent of obese and 7 percent of overweight recruits failed to meet the criteria.
The study appears online March 19 in the journal Obesity.
"These findings are strong evidence against the common misconception in the emergency responder community that many of their members have BMIs in the overweight and obese ranges simply on the basis of increased muscle mass. Even in these young recruits, we documented a very strong association between excess BMI and an increased cardiovascular risk profile," study senior author Dr. Stefanos Kales, director of Occupational and Environmental Medicine Residency, Harvard School of Public Health, said in the news release.
3 Steps Might Help Stop MRSA's Spread
E-monitoring of hand washing, better room cleaning and checks on patient transfers are key, studies find
HealthDay
Friday, March 20, 2009
FRIDAY, March 20 (HealthDay News) -- A high-tech way of monitoring hand washing, a better means of disinfecting rooms and improved tracking of patients as they transfer from one hospital to another could all help prevent the spread of the MRSA "superbug" and other pathogens, researchers report.
Methicillin-resistant Staphylococcus aureus (MRSA) is a type of staph bacteria that's resistant to certain antibiotics. It can cause severe infections for people in hospitals and other health-care facilities, such as nursing homes. MRSA can also cause serious skin infections in healthy people who have not recently been hospitalized.
But MRSA can be beaten, suggest three studies that were to be presented this week at the annual meeting in San Diego of the Society for Healthcare Epidemiology of America.
In the first report, Dr. Philip Polgreen, an assistant professor of internal medicine at the University of Iowa, described an inexpensive way of electronically monitoring staff to be sure that they wash their hands before entering an intensive care unit. The system uses a wireless technology similar to Wi-Fi to transmit signals to a computer.
"Hand washing is one of the most important actions health-care workers can take to protect patients from developing hospital-acquired infections," Polgreen said during a March 12 media teleconference. "Yet hand hygiene compliance among physicians, nurses and other health-care workers remains unacceptably low," he said.
Currently, many hospitals have staff sit outside hospital rooms to record when people wash their hands, Polgreen noted.
In the new system, health-care workers wear a badge that interacts with a sensor on an automated hygiene dispenser placed outside or inside patients' rooms. Using this method, researchers were able to determine compliance with hand-washing protocols and identify staff who were following or not following hand-washing procedures.
"Testing has shown this new system to be accurate," Polgreen said, but he added that it still has to be tested in a variety of situations.
Dr. Marc Siegel, an infectious disease expert and associate professor of medicine at New York University School of Medicine in New York City, called the new system "impressive."
"We all agree that washing your hands is the way to go," Siegel said. But he is not convinced that hand sanitizers are totally effective. "Washing your hands with soap and water is better," he said.
In the second report, a team led by Rupak Datta, an M.D./ Ph.D. candidate at the University of California at Irvine, found that 40 percent of MRSA and vancomycin-resistant enterococci (VRE) infections are transmitted by touching nearby surfaces. VRE is another dangerous antibiotic-resistant pathogen.
"These infections can be cultured off a variety of surfaces, such as doorknobs, countertops, computer keyboards and bed trays," Datta said during the teleconference.
To combat this problem, the researchers developed a new cleaning method for disinfecting patient rooms. Instead of using spray bottles, the method involved cloths saturated with disinfectant and included instruction in proper cleaning techniques.
The enhanced cleaning significantly cut down on MRSA but was only moderately effective in killing VRE. The researchers believe that a different method will be needed to reduce VRE infections.
"This suggests that cleaning measures over and above national standards can be important in reducing the transmission of multi-drug-resistant organisms, such as MRSA and VRE in high-risk patient care areas, such as the ICU," Datta said.
"It is interesting," Siegel noted, "that VRE is even more resistant to standard cleaning techniques than MRSA. That implies that the more resistant a bug, the more crafty it becomes and harder to eradicate."
In the third presentation, Dr. Susan S. Huang, director of epidemiology and infection prevention at the University of California at Irvine School of Medicine, examined the transfer of patients between hospitals in Orange County, Calif.
Sharing patients often means sharing hospital-based infections, she noted. "Our study is focused on trying to quantify how much patient-sharing occurs between acute-care hospitals," Huang said during the teleconference.
For the study, Huang's team looked at almost 240,000 people admitted to Orange County's acute-care hospitals in 2005.
"We found that 22 percent of patients will be rehospitalized within a year of discharge," Huang said. Most are readmitted to different hospitals than the one where they were initially treated. In an average month, each hospital exposed other hospitals to 10 of their patients, she noted.
According to Siegel, the transmission of infections from hospital to hospital is "being overlooked."
"Patients become deposits of bacteria, especially when they go from one facility to the next," he said, adding that it should be assumed that someone coming from another hospital is infected with drug-resistant bacteria.
In fact, routine decontamination of patients -- whether they are known to be carrying dangerous pathogens or not -- should be the status quo, Siegel said. "It has to become standard practice to decontaminate all patients who are in areas of high prevalence of dangerous bacteria," he said.
HealthDay
Friday, March 20, 2009
FRIDAY, March 20 (HealthDay News) -- A high-tech way of monitoring hand washing, a better means of disinfecting rooms and improved tracking of patients as they transfer from one hospital to another could all help prevent the spread of the MRSA "superbug" and other pathogens, researchers report.
Methicillin-resistant Staphylococcus aureus (MRSA) is a type of staph bacteria that's resistant to certain antibiotics. It can cause severe infections for people in hospitals and other health-care facilities, such as nursing homes. MRSA can also cause serious skin infections in healthy people who have not recently been hospitalized.
But MRSA can be beaten, suggest three studies that were to be presented this week at the annual meeting in San Diego of the Society for Healthcare Epidemiology of America.
In the first report, Dr. Philip Polgreen, an assistant professor of internal medicine at the University of Iowa, described an inexpensive way of electronically monitoring staff to be sure that they wash their hands before entering an intensive care unit. The system uses a wireless technology similar to Wi-Fi to transmit signals to a computer.
"Hand washing is one of the most important actions health-care workers can take to protect patients from developing hospital-acquired infections," Polgreen said during a March 12 media teleconference. "Yet hand hygiene compliance among physicians, nurses and other health-care workers remains unacceptably low," he said.
Currently, many hospitals have staff sit outside hospital rooms to record when people wash their hands, Polgreen noted.
In the new system, health-care workers wear a badge that interacts with a sensor on an automated hygiene dispenser placed outside or inside patients' rooms. Using this method, researchers were able to determine compliance with hand-washing protocols and identify staff who were following or not following hand-washing procedures.
"Testing has shown this new system to be accurate," Polgreen said, but he added that it still has to be tested in a variety of situations.
Dr. Marc Siegel, an infectious disease expert and associate professor of medicine at New York University School of Medicine in New York City, called the new system "impressive."
"We all agree that washing your hands is the way to go," Siegel said. But he is not convinced that hand sanitizers are totally effective. "Washing your hands with soap and water is better," he said.
In the second report, a team led by Rupak Datta, an M.D./ Ph.D. candidate at the University of California at Irvine, found that 40 percent of MRSA and vancomycin-resistant enterococci (VRE) infections are transmitted by touching nearby surfaces. VRE is another dangerous antibiotic-resistant pathogen.
"These infections can be cultured off a variety of surfaces, such as doorknobs, countertops, computer keyboards and bed trays," Datta said during the teleconference.
To combat this problem, the researchers developed a new cleaning method for disinfecting patient rooms. Instead of using spray bottles, the method involved cloths saturated with disinfectant and included instruction in proper cleaning techniques.
The enhanced cleaning significantly cut down on MRSA but was only moderately effective in killing VRE. The researchers believe that a different method will be needed to reduce VRE infections.
"This suggests that cleaning measures over and above national standards can be important in reducing the transmission of multi-drug-resistant organisms, such as MRSA and VRE in high-risk patient care areas, such as the ICU," Datta said.
"It is interesting," Siegel noted, "that VRE is even more resistant to standard cleaning techniques than MRSA. That implies that the more resistant a bug, the more crafty it becomes and harder to eradicate."
In the third presentation, Dr. Susan S. Huang, director of epidemiology and infection prevention at the University of California at Irvine School of Medicine, examined the transfer of patients between hospitals in Orange County, Calif.
Sharing patients often means sharing hospital-based infections, she noted. "Our study is focused on trying to quantify how much patient-sharing occurs between acute-care hospitals," Huang said during the teleconference.
For the study, Huang's team looked at almost 240,000 people admitted to Orange County's acute-care hospitals in 2005.
"We found that 22 percent of patients will be rehospitalized within a year of discharge," Huang said. Most are readmitted to different hospitals than the one where they were initially treated. In an average month, each hospital exposed other hospitals to 10 of their patients, she noted.
According to Siegel, the transmission of infections from hospital to hospital is "being overlooked."
"Patients become deposits of bacteria, especially when they go from one facility to the next," he said, adding that it should be assumed that someone coming from another hospital is infected with drug-resistant bacteria.
In fact, routine decontamination of patients -- whether they are known to be carrying dangerous pathogens or not -- should be the status quo, Siegel said. "It has to become standard practice to decontaminate all patients who are in areas of high prevalence of dangerous bacteria," he said.
Friday, March 20, 2009
Health Group Knocks Kindergarten Playtime Squeeze
By Todd Neale, Staff Writer, MedPage Today
Published: March 20, 2009
Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco
COLLEGE PARK, Md., March 20 -- Replacing kindergarten playtime with formal lessons and standardized tests could have a wide range of negative consequences, according to the Alliance for Childhood, a nonprofit that advocates for children's health. Action Points
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Explain to interested patients that the American Academy of Pediatrics has also endorsed playtime for young children.
During a typical day at 268 kindergartens in Los Angeles and New York, children spent two to three hours learning or being tested on literacy and math skills, but 30 minutes or less in imaginative play, two top Alliance executives wrote in a recent report.
The vast majority of the kindergarten teachers surveyed -- 82% in Los Angeles and 79%in New York -- said they spent time every day testing or preparing for testing, according to Alliance program director Ed Miller, Ed.M., and executive director Joan Almon.
In Los Angeles, 25% of teachers said there was no time for play at all, and in both cities, about 12% said they didn't have enough play materials for all of the children.
Miller and Almon labeled the trend a "crisis" in a report that brought together new research commissioned by the Alliance and other recent studies, published and unpublished.
"Play is one of the vital signs of health in children," they said. "We do not know the long-term consequences of the loss of play in early childhood, but this has become a concern for pediatricians and psychologists."
In the short-term, they said, forgoing playtime for regimented academic pursuits appears to increase aggression and other behavioral problems, school failure, frustration, and stress.
In addition, when teachers spend hours every day trying to get children to meet unrealistic academic standards, they may wind up mislabeling normal childhood behaviors as misbehaviors, attention disorders, or learning disabilities, the researchers said.
Imaginative playtime, on the other hand, has demonstrated multiple benefits, according to the authors.
"Young children work hard at play. They invent scenes and stories, solve problems, and negotiate their way through social roadblocks. They know what they want to do and work diligently to do it. Because their motivation comes from within, they learn the powerful lesson of pursuing their own ideas to a successful conclusion," they said.
Children who engage in playtime also have improved language and social skills, more empathy and imagination, and better self-control, they said.
The American Academy of Pediatrics (AAP) emphasized the importance of play in a 2007 policy statement authored by Kenneth Ginsburg, M.D., of The Children's Hospital of Philadelphia and the University of Pennsylvania, in conjunction with the AAP's committees on communications and the psychosocial aspects of child and family health.
"Play allows children to use their creativity while developing their imagination, dexterity, and physical, cognitive, and emotional strength," Dr. Ginsburg and colleagues said.
"Play is important to healthy brain development. It is through play that children at a very early age engage and interact in the world around them. Play allows children to create and explore a world they can master, conquering their fears while practicing adult roles, sometimes in conjunction with other children or adult caregivers.
"As they master their world, play helps children develop new competencies that lead to enhanced confidence and the resiliency they will need to face future challenges. Undirected play allows children to learn how to work in groups, to share, to negotiate, to resolve conflicts, and to learn self-advocacy skills," they declared.
Playtime has been reduced by hurried lifestyles, changes in family structure, and increased focus on academics, they said.
But the authors of the Alliance report called for a balanced approach to playtime in kindergarten, arguing that superficial and chaotic play was not beneficial either.
The ideal would be a classroom that "relies on child-initiated play with the active presence of a teacher, combined with intentional teaching through playful learning, the arts, and other hands-on experiences," Miller and Almon said.
They made six recommendations to re-establish the importance of playtime in kindergarten. They suggested:
Restoring play initiated by children under the active support of teachers to the classroom
Reassessing kindergarten practices to make sure they are developmentally appropriate and eliminating those that fall short
Eliminating standardized tests in kindergarten
Expanding research in early childhood to assess the long-term effects of current kindergarten practices
Training early childhood teachers about the importance of playtime
Using the "crisis" of the disappearance of playtime to rally the support for a return of play to kindergarten
The Alliance for Childhood received funding for the report from the Woodshouse Foundation, the Buffett Early Childhood Fund, the NoVo Foundation, RSF Social Finance, the Kalliopeia Foundation, Bay Area Early Childhood Funders, the Newman's Own Foundation, and Community Playthings.
Primary source: Alliance for Childhood
Source reference:
Miller E, Almon J "Crisis in the kindergarten: why children need to play in school" Alliance for Childhood 2009.
Wednesday, March 18, 2009
Emergency Preparedness and Response
The possibility of public health emergencies arising in the United States concerns many people in the wake of recent hurricanes, tsunamis, acts of terrorism, and the threat of pandemic influenza. Though some people feel it is impossible to be prepared for unexpected events, the truth is that taking preparedness actions helps people deal with disasters of all sorts much more effectively when they do occur.
To help, Centers for Disease Control and Prevention (CDC) and the American Red Cross have teamed up to answer common questions and provide step by step guidance you can take now to protect you and your loved ones.
1. Get a Kit
Gather Emergency Supplies
If disaster strikes your community, you might not have access to food, water, or electricity for some time. By taking time now to prepare emergency water supplies, food supplies and disaster supplies kit, you can provide for your entire family.
Even though it is unlikely that an emergency would cut off your food supplies for two weeks, consider maintaining a supply that will last that long.
You may not need to go out and buy foods to prepare an emergency food supply. You can use the canned goods, dry mixes, and other staples on your cupboard shelves.
Having an ample supply of clean water is a top priority in an emergency. A normally active person needs to drink at least 2 quarts (a half gallon) of water each day. You will also need water for food preparation and hygiene. Store at least an additional half-gallon per person, per day for this.
Store at least a 3-day supply and consider storing a two-week supply of water for each member of your family. If you are unable to store this much, store as much as you can. You can reduce the amount of water your body needs by reducing activity and staying cool.
And don't forget to take your pets and service animals into account!
Disaster Supplies Kit:
A disaster supplies kit is a collection of basic items that could be needed in the event of a disaster.
Assemble the following items to create kits for use at home, the office, at school and/or in a vehicle:
Water - three gallons for each person who would use the kit and an additional four gallons per person or pet for use if you are confined to your home
Food - a three-day supply in the kit and at least an additional four-day supply per person or pet for use at home
You may want to consider stocking a two-week supply of food and water in your home.
Items for infants - including formula, diapers, bottles, pacifiers, powdered milk and medications not requiring refrigeration
Items for seniors, disabled persons or anyone with serious allergies - including special foods, denture items, extra eyeglasses, hearing aid batteries, prescription and non-prescription medications that are regularly used, inhalers and other essential equipment.
Kitchen accessories - a manual can opener; mess kits or disposable cups, plates and utensils; utility knife; sugar and salt; aluminum foil and plastic wrap; re-sealable plastic bags
A portable, battery-powered radio or television and extra, fresh batteries
Several flashlights and extra, fresh batteries
A first aid kit
One complete change of clothing and footwear for each person - including sturdy work shoes or boots, raingear and other items adjusted for the season, such as hats and gloves, thermal underwear, sunglasses, dust masks
Blankets or a sleeping bag for each person
Sanitation and hygiene items - shampoo, deodorant, toothpaste, toothbrushes, comb and brush, lip balm, sunscreen, contact lenses and supplies and any medications regularly used, toilet paper, towelettes, soap, hand sanitizer, liquid detergent, feminine supplies, plastic garbage bags (heavy-duty) and ties (for personal sanitation uses), medium-sized plastic bucket with tight lid, disinfectant, household chlorine bleach
Other essential items - paper, pencil, needles, thread, small A-B-C-type fire extinguisher, medicine dropper, whistle, emergency preparedness manual
Entertainment - including games and books, favorite dolls and stuffed animals for small children
A map of the area marked with places you could go and their telephone numbers
An extra set of keys and ids - including keys for cars and any properties owned and copies of driver's licenses, passports and work identification badges
Cash and coins and copies of credit cards
Copies of medical prescriptions
Matches in a waterproof container
A small tent, compass and shovel
Pack the items in easy-to-carry containers, label the containers clearly and store them where they would be easily accessible. Duffle bags, backpacks, and covered trash receptacles are good candidates for containers. In a disaster situation, you may need access to your disaster supplies kit quickly - whether you are sheltering at home or evacuating. Following a disaster, having the right supplies can help your household endure home confinement or evacuation.
Make sure the needs of everyone who would use the kit are covered, including infants, seniors and pets. It's good to involve whoever is going to use the kit, including children, in assembling it.
Benefits of Involving Children
Involving children is the first step in helping them know what to do in an emergency.
Children can help. Ask them to think of items that they would like to include in a disaster supplies kit, such as books or games or nonperishable food items, and to help the household remember to keep the kits updated. Children could make calendars and mark the dates for checking emergency supplies, rotating the emergency food and water or replacing it every six months and replacing batteries as necessary. Children can enjoy preparing plans and disaster kits for pets and other animals.
Disaster Supplies Kit Checklist for Pets
Food and water for at least three days for each pet, food and water bowls and a manual can opener
Depending on the pet, litter and litter box or newspapers, paper towels, plastic trash bags, grooming items, and household bleach
Medications and medical records stored in a waterproof container, a first aid kit and a pet first aid book
Sturdy leashes, harnesses and carriers to transport pets safely and to ensure that your pets cannot escape. A carrier should be large enough for the animal to stand comfortably, turn around, and lie down. Your pet may have to stay in the carrier for hours. Be sure to have a secure cage with no loose objects inside it to accommodate smaller pets. These may require blankets or towels for bedding and warmth and other special items
Pet toys and the pet's bed, if you can easily take it, to reduce stress
Current photos and descriptions of your pets to help others identify them in case you and your pets become separated, and to prove that they are yours
Information on feeding schedules, medical conditions, behavior problems and the name and telephone number of your veterinarian in case you have to board your pets or place them in foster care.
Additional Supplies for Sheltering-in-Place
In the unlikely event that chemical or radiological hazards cause officials to advise people in a specific area to "shelter-in-place" in a sealed room, households should have in the room they have selected for this purpose:
A roll of duct tape and scissors
Plastic sheeting pre-cut to fit shelter-in-place room openings
Ten square feet of floor space per person will provide sufficient air to prevent carbon dioxide buildup for up to five hours. Local officials are unlikely to recommend the public shelter in a sealed room for more than two-three hours because the effectiveness of such sheltering diminishes with time as the contaminated outside air gradually seeps into the shelter.
NOTE: Always keep a shut-off valve wrench near the gas and water shut-off valves in your home.
2. Make a Plan
Develop a Family Disaster Plan
Families can cope with disaster by preparing in advance and working together as a team. Create a family disaster plan including a communication plan, disaster supplies kit, and an evacuation plan. Knowing what to do is your best protection and your responsibility.
Contact your American Red Cross chapter or local emergency management office — be prepared to take notes.
Ask what types of disasters are most likely to happen. Request information on how to prepare for each.
Learn about your community’s warning signals: what they sound like and what you should do when you hear them.
Ask about animal care after disaster. Animals other than service animals may not be allowed inside emergency shelters.
Find out how to help elderly or disabled persons, if needed.
Next, find out about the disaster plans at your workplace, your children’s school or daycare center, and other places where your family spends time.
Create a disaster plan
Meet with your family and discuss why you need to prepare for disaster. Explain the dangers of fire, severe weather, and earthquakes to children. Plan to share responsibilities and work together as a team.
Discuss the types of disasters that are most likely to happen. Explain what to do in each case.
Pick two places to meet:
Right outside your home in case of a sudden emergency, like a fire.
Outside your neighborhood in case you can’t return home. Everyone must know the address and phone number.
Safe and Well Website
Following the 2005 hurricane season, the Red Cross developed the Safe and Well website, which enables people within a disaster area to let their friends and loved ones outside of the affected region know of their well-being. By logging onto the Red Cross public website, a person affected by disaster may post messages indicating that they are safe and well at a shelter, hotel, or at home, and that they will contact their friends and family as soon as possible. During large-scale disasters, there will be telephone-based assistance via the 1-866-GET-INFO hotline for people who live within the affected areas and do not have Internet access, but wish to register on the Safe and Well website.
People who are concerned about family members in an affected area may also access the Safe and Well website to view these messages. They will be required to enter either the name and telephone number, or the name and complete address, of the person about whom they wish to get information. Red Cross chapters will provide telephone-based assistance to local callers who do not have Internet access and wish to search the Safe and Wellwebsite for information about a loved one.
Be assured that the information on the Safe and Well website is secure and that information about the locations where people are staying is not published. Privacy laws require the Red Cross to protect each person's right to determine how best to communicate their contact information and whereabouts to family members. The Red Cross does not actively trace or attempt to locate individuals registered on the Safe and Well website.
Ask an out-of-state friend to be your “family contact”. After a disaster, it’s often easier to call long distance. Other family members should call this person and tell them where they are. Everyone must know your contact’s phone number.
Discuss what to do in an evacuation. Plan how to take care of your pets.
Families should develop different methods for communicating during emergency situations and share their plans beforehand with all those who would be worried about their welfare. Options for remaining in contact with family and friends if a disaster strikes include:
Phone contact with a designated family member or friend who is unlikely to be affected by the same disaster.
Email notification via a family distribution list.
Registration on the American Red Cross Safe and Well Website.
Use of the toll-free Contact Loved Ones voice messaging service (1-866-78-CONTACT).
Use of the US Postal Service change of address forms when it becomes necessary to leave home for an extended period of time, thus ensuring that mail will be redirected to a current address.
Complete this checklist
Post emergency telephone numbers by phones (fire, police, ambulance, etc.).
Teach children how and when to call 911 or your local Emergency Medical Services number for emergency help.
Determine the best escape routes from your home. Find two ways out of each room.
Find the safe spots in your home for each type of disaster.
Show each family member how and when to turn off the water, gas, and electricity at the main switches.
Check if you have adequate insurance coverage.
Teach each family member how to use the fire extinguisher, and show them where it’s kept.
Install smoke detectors on each level of your home, especially near bedrooms.
Conduct a home hazard hunt.
Stock emergency supplies and assemble a disaster supplies kit.
Take a Red Cross first aid and CPR class.
Practice your plan
Test your smoke detectors monthly, and change the batteries at least once a year.
Quiz your kids every six months so they remember what to do.
Conduct fire and emergency evacuation drills.
Replace stored water every three months and stored food every six months.
Test and recharge your fire extinguisher(s) according to manufacturer’s instructions.
3. Be Informed
Learn How to Shelter in Place
"Shelter-in-place" means to take immediate shelter where you are—at home, work, school, or in between. It may also mean "seal the room;" in other words, take steps to prevent outside air from coming in. This is because local authorities may instruct you to "shelter-in-place" if chemical or radiological contaminants are released into the environment. It is important to listen to TV or radio to understand whether the authorities wish you to merely remain indoors or to take additional steps to protect yourself and your family.
How do I prepare?
At home
Choose a room in advance for your shelter. The best room is one with as few windows and doors as possible. A large room, preferably with a water supply, is desirable—something like a master bedroom that is connected to a bathroom.
Contact your workplaces, your children's schools, nursing homes where you may have family and your local town or city officials to find out what their plans are for "shelter-in-place."
Find out when warning systems will be tested. When tested in your area, determine whether you can hear or see sirens and/or warning lights from your home.
Develop your own family emergency plan so that every family member knows what to do. Practice it regularly.
Assemble a disaster supplies kit that includes emergency water and food supplies.
At work
Help ensure that the emergency plan and checklist involves all employees. Volunteers or recruits should be assigned specific duties during an emergency. Alternates should be assigned to each duty.
The shelter kit should be checked on a regular basis. Duct tape and first aid supplies can sometimes disappear when all employees know where the shelter kit is stored. Batteries for the radio and flashlight should be replaced regularly.
In general
Learn CPR, first aid and the use of an automated external defibrillator (AED). (Contact your local American Red Cross chapter for more information.)
How will I know when I need to "shelter-in-place"?
Fire or police department warning procedures could include:
"All-Call" telephoning - an automated system for sending recorded messages, sometimes called "reverse 9-1-1".
Emergency Alert System (EAS) broadcasts on the radio or television.
Outdoor warning sirens or horns.
News media sources - radio, television and cable.
NOAA Weather Radio alerts.
Residential route alerting - messages announced to neighborhoods from vehicles equipped with public address systems.
Facilities that handle potentially dangerous materials, like nuclear power plants, are required to install sirens and other warning systems (flash warning lights) to cover a 10-mile area around the plant.
For more information, contact any of the following:
For checklists to help prepare to shelter-in-place in your home, at work, in your car, or at school or day-care, read How Do I Shelter-in-Place?
Your local American Red Cross chapter
Your state and local health departments
The Humane Society of the United States
Your local emergency management agency
CDC Public Response Hotline
English 1-888-246-2675
Spanish 1-888-246-2857
TTY 1-866-874-2646)
To help, Centers for Disease Control and Prevention (CDC) and the American Red Cross have teamed up to answer common questions and provide step by step guidance you can take now to protect you and your loved ones.
1. Get a Kit
Gather Emergency Supplies
If disaster strikes your community, you might not have access to food, water, or electricity for some time. By taking time now to prepare emergency water supplies, food supplies and disaster supplies kit, you can provide for your entire family.
Even though it is unlikely that an emergency would cut off your food supplies for two weeks, consider maintaining a supply that will last that long.
You may not need to go out and buy foods to prepare an emergency food supply. You can use the canned goods, dry mixes, and other staples on your cupboard shelves.
Having an ample supply of clean water is a top priority in an emergency. A normally active person needs to drink at least 2 quarts (a half gallon) of water each day. You will also need water for food preparation and hygiene. Store at least an additional half-gallon per person, per day for this.
Store at least a 3-day supply and consider storing a two-week supply of water for each member of your family. If you are unable to store this much, store as much as you can. You can reduce the amount of water your body needs by reducing activity and staying cool.
And don't forget to take your pets and service animals into account!
Disaster Supplies Kit:
A disaster supplies kit is a collection of basic items that could be needed in the event of a disaster.
Assemble the following items to create kits for use at home, the office, at school and/or in a vehicle:
Water - three gallons for each person who would use the kit and an additional four gallons per person or pet for use if you are confined to your home
Food - a three-day supply in the kit and at least an additional four-day supply per person or pet for use at home
You may want to consider stocking a two-week supply of food and water in your home.
Items for infants - including formula, diapers, bottles, pacifiers, powdered milk and medications not requiring refrigeration
Items for seniors, disabled persons or anyone with serious allergies - including special foods, denture items, extra eyeglasses, hearing aid batteries, prescription and non-prescription medications that are regularly used, inhalers and other essential equipment.
Kitchen accessories - a manual can opener; mess kits or disposable cups, plates and utensils; utility knife; sugar and salt; aluminum foil and plastic wrap; re-sealable plastic bags
A portable, battery-powered radio or television and extra, fresh batteries
Several flashlights and extra, fresh batteries
A first aid kit
One complete change of clothing and footwear for each person - including sturdy work shoes or boots, raingear and other items adjusted for the season, such as hats and gloves, thermal underwear, sunglasses, dust masks
Blankets or a sleeping bag for each person
Sanitation and hygiene items - shampoo, deodorant, toothpaste, toothbrushes, comb and brush, lip balm, sunscreen, contact lenses and supplies and any medications regularly used, toilet paper, towelettes, soap, hand sanitizer, liquid detergent, feminine supplies, plastic garbage bags (heavy-duty) and ties (for personal sanitation uses), medium-sized plastic bucket with tight lid, disinfectant, household chlorine bleach
Other essential items - paper, pencil, needles, thread, small A-B-C-type fire extinguisher, medicine dropper, whistle, emergency preparedness manual
Entertainment - including games and books, favorite dolls and stuffed animals for small children
A map of the area marked with places you could go and their telephone numbers
An extra set of keys and ids - including keys for cars and any properties owned and copies of driver's licenses, passports and work identification badges
Cash and coins and copies of credit cards
Copies of medical prescriptions
Matches in a waterproof container
A small tent, compass and shovel
Pack the items in easy-to-carry containers, label the containers clearly and store them where they would be easily accessible. Duffle bags, backpacks, and covered trash receptacles are good candidates for containers. In a disaster situation, you may need access to your disaster supplies kit quickly - whether you are sheltering at home or evacuating. Following a disaster, having the right supplies can help your household endure home confinement or evacuation.
Make sure the needs of everyone who would use the kit are covered, including infants, seniors and pets. It's good to involve whoever is going to use the kit, including children, in assembling it.
Benefits of Involving Children
Involving children is the first step in helping them know what to do in an emergency.
Children can help. Ask them to think of items that they would like to include in a disaster supplies kit, such as books or games or nonperishable food items, and to help the household remember to keep the kits updated. Children could make calendars and mark the dates for checking emergency supplies, rotating the emergency food and water or replacing it every six months and replacing batteries as necessary. Children can enjoy preparing plans and disaster kits for pets and other animals.
Disaster Supplies Kit Checklist for Pets
Food and water for at least three days for each pet, food and water bowls and a manual can opener
Depending on the pet, litter and litter box or newspapers, paper towels, plastic trash bags, grooming items, and household bleach
Medications and medical records stored in a waterproof container, a first aid kit and a pet first aid book
Sturdy leashes, harnesses and carriers to transport pets safely and to ensure that your pets cannot escape. A carrier should be large enough for the animal to stand comfortably, turn around, and lie down. Your pet may have to stay in the carrier for hours. Be sure to have a secure cage with no loose objects inside it to accommodate smaller pets. These may require blankets or towels for bedding and warmth and other special items
Pet toys and the pet's bed, if you can easily take it, to reduce stress
Current photos and descriptions of your pets to help others identify them in case you and your pets become separated, and to prove that they are yours
Information on feeding schedules, medical conditions, behavior problems and the name and telephone number of your veterinarian in case you have to board your pets or place them in foster care.
Additional Supplies for Sheltering-in-Place
In the unlikely event that chemical or radiological hazards cause officials to advise people in a specific area to "shelter-in-place" in a sealed room, households should have in the room they have selected for this purpose:
A roll of duct tape and scissors
Plastic sheeting pre-cut to fit shelter-in-place room openings
Ten square feet of floor space per person will provide sufficient air to prevent carbon dioxide buildup for up to five hours. Local officials are unlikely to recommend the public shelter in a sealed room for more than two-three hours because the effectiveness of such sheltering diminishes with time as the contaminated outside air gradually seeps into the shelter.
NOTE: Always keep a shut-off valve wrench near the gas and water shut-off valves in your home.
2. Make a Plan
Develop a Family Disaster Plan
Families can cope with disaster by preparing in advance and working together as a team. Create a family disaster plan including a communication plan, disaster supplies kit, and an evacuation plan. Knowing what to do is your best protection and your responsibility.
Contact your American Red Cross chapter or local emergency management office — be prepared to take notes.
Ask what types of disasters are most likely to happen. Request information on how to prepare for each.
Learn about your community’s warning signals: what they sound like and what you should do when you hear them.
Ask about animal care after disaster. Animals other than service animals may not be allowed inside emergency shelters.
Find out how to help elderly or disabled persons, if needed.
Next, find out about the disaster plans at your workplace, your children’s school or daycare center, and other places where your family spends time.
Create a disaster plan
Meet with your family and discuss why you need to prepare for disaster. Explain the dangers of fire, severe weather, and earthquakes to children. Plan to share responsibilities and work together as a team.
Discuss the types of disasters that are most likely to happen. Explain what to do in each case.
Pick two places to meet:
Right outside your home in case of a sudden emergency, like a fire.
Outside your neighborhood in case you can’t return home. Everyone must know the address and phone number.
Safe and Well Website
Following the 2005 hurricane season, the Red Cross developed the Safe and Well website, which enables people within a disaster area to let their friends and loved ones outside of the affected region know of their well-being. By logging onto the Red Cross public website, a person affected by disaster may post messages indicating that they are safe and well at a shelter, hotel, or at home, and that they will contact their friends and family as soon as possible. During large-scale disasters, there will be telephone-based assistance via the 1-866-GET-INFO hotline for people who live within the affected areas and do not have Internet access, but wish to register on the Safe and Well website.
People who are concerned about family members in an affected area may also access the Safe and Well website to view these messages. They will be required to enter either the name and telephone number, or the name and complete address, of the person about whom they wish to get information. Red Cross chapters will provide telephone-based assistance to local callers who do not have Internet access and wish to search the Safe and Wellwebsite for information about a loved one.
Be assured that the information on the Safe and Well website is secure and that information about the locations where people are staying is not published. Privacy laws require the Red Cross to protect each person's right to determine how best to communicate their contact information and whereabouts to family members. The Red Cross does not actively trace or attempt to locate individuals registered on the Safe and Well website.
Ask an out-of-state friend to be your “family contact”. After a disaster, it’s often easier to call long distance. Other family members should call this person and tell them where they are. Everyone must know your contact’s phone number.
Discuss what to do in an evacuation. Plan how to take care of your pets.
Families should develop different methods for communicating during emergency situations and share their plans beforehand with all those who would be worried about their welfare. Options for remaining in contact with family and friends if a disaster strikes include:
Phone contact with a designated family member or friend who is unlikely to be affected by the same disaster.
Email notification via a family distribution list.
Registration on the American Red Cross Safe and Well Website.
Use of the toll-free Contact Loved Ones voice messaging service (1-866-78-CONTACT).
Use of the US Postal Service change of address forms when it becomes necessary to leave home for an extended period of time, thus ensuring that mail will be redirected to a current address.
Complete this checklist
Post emergency telephone numbers by phones (fire, police, ambulance, etc.).
Teach children how and when to call 911 or your local Emergency Medical Services number for emergency help.
Determine the best escape routes from your home. Find two ways out of each room.
Find the safe spots in your home for each type of disaster.
Show each family member how and when to turn off the water, gas, and electricity at the main switches.
Check if you have adequate insurance coverage.
Teach each family member how to use the fire extinguisher, and show them where it’s kept.
Install smoke detectors on each level of your home, especially near bedrooms.
Conduct a home hazard hunt.
Stock emergency supplies and assemble a disaster supplies kit.
Take a Red Cross first aid and CPR class.
Practice your plan
Test your smoke detectors monthly, and change the batteries at least once a year.
Quiz your kids every six months so they remember what to do.
Conduct fire and emergency evacuation drills.
Replace stored water every three months and stored food every six months.
Test and recharge your fire extinguisher(s) according to manufacturer’s instructions.
3. Be Informed
Learn How to Shelter in Place
"Shelter-in-place" means to take immediate shelter where you are—at home, work, school, or in between. It may also mean "seal the room;" in other words, take steps to prevent outside air from coming in. This is because local authorities may instruct you to "shelter-in-place" if chemical or radiological contaminants are released into the environment. It is important to listen to TV or radio to understand whether the authorities wish you to merely remain indoors or to take additional steps to protect yourself and your family.
How do I prepare?
At home
Choose a room in advance for your shelter. The best room is one with as few windows and doors as possible. A large room, preferably with a water supply, is desirable—something like a master bedroom that is connected to a bathroom.
Contact your workplaces, your children's schools, nursing homes where you may have family and your local town or city officials to find out what their plans are for "shelter-in-place."
Find out when warning systems will be tested. When tested in your area, determine whether you can hear or see sirens and/or warning lights from your home.
Develop your own family emergency plan so that every family member knows what to do. Practice it regularly.
Assemble a disaster supplies kit that includes emergency water and food supplies.
At work
Help ensure that the emergency plan and checklist involves all employees. Volunteers or recruits should be assigned specific duties during an emergency. Alternates should be assigned to each duty.
The shelter kit should be checked on a regular basis. Duct tape and first aid supplies can sometimes disappear when all employees know where the shelter kit is stored. Batteries for the radio and flashlight should be replaced regularly.
In general
Learn CPR, first aid and the use of an automated external defibrillator (AED). (Contact your local American Red Cross chapter for more information.)
How will I know when I need to "shelter-in-place"?
Fire or police department warning procedures could include:
"All-Call" telephoning - an automated system for sending recorded messages, sometimes called "reverse 9-1-1".
Emergency Alert System (EAS) broadcasts on the radio or television.
Outdoor warning sirens or horns.
News media sources - radio, television and cable.
NOAA Weather Radio alerts.
Residential route alerting - messages announced to neighborhoods from vehicles equipped with public address systems.
Facilities that handle potentially dangerous materials, like nuclear power plants, are required to install sirens and other warning systems (flash warning lights) to cover a 10-mile area around the plant.
For more information, contact any of the following:
For checklists to help prepare to shelter-in-place in your home, at work, in your car, or at school or day-care, read How Do I Shelter-in-Place?
Your local American Red Cross chapter
Your state and local health departments
The Humane Society of the United States
Your local emergency management agency
CDC Public Response Hotline
English 1-888-246-2675
Spanish 1-888-246-2857
TTY 1-866-874-2646)
Tuesday, March 17, 2009
Task Force Recommends Using Aspirin To Prevent Cardiovascular Disease When the Benefits Outweigh the Harms
Press Release Date: March 16, 2009
Patients and clinicians should consider risk factors—including age, gender, diabetes, blood pressure, cholesterol levels, smoking and risk of gastrointestinal bleeding—before deciding whether to use aspirin to prevent heart attacks or strokes, according to new recommendations from the U.S. Preventive Services Task Force. These recommendations do not apply to people who have already had a heart attack or stroke.
The recommendations are published in the March 17 issue of the Annals of Internal Medicine. The Task Force reviewed new evidence from the National Institutes of Health's Women's Health Study published since the last Task Force review of this topic in 2002, including a recent meta-analysis of the risks and benefits of aspirin and found aspirin may have different benefits and harms in men and women. The Task Force found good evidence that aspirin decreases first heart attacks in men and first strokes in women.
The more risk factors people have, the more likely they are to benefit from aspirin. The Task Force recommends that men between the ages of 45 and 79 should use aspirin to reduce their risk for heart attacks when the benefits outweigh the harms for potential gastrointestinal bleeding. Women between the ages of 55 and 79 should use aspirin to reduce their risk for ischemic stroke when the benefits outweigh the harms for potential gastrointestinal bleeding. Ischemic strokes occur as a result of an obstruction within a blood vessel supplying blood to the brain and are potentially prevented by aspirin use. The risk of gastrointestinal bleeding with and without aspirin use increases with age and is twice as high in men as in women. Other risk factors for gastrointestinal bleeding include upper gastrointestinal tract pain, gastrointestinal ulcers, and using non-steroidal anti-inflammatory drugs.
The Task Force recommended against using aspirin to prevent either strokes or heart disease in men under 45 or women under age 55 because heart attacks are less likely to occur in men younger than 45 and ischemic strokes are less likely to occur in women younger than 55, and because limited evidence exists in these age groups.
People age 80 and older could benefit more than younger people from aspirin because of their higher risk of cardiovascular disease, but the harms are also greater because the risk of gastrointestinal bleeding increases with age. The Task Force could not find clear evidence that the benefits of using aspirin outweigh the risks in people 80 years or older.
"The decision about whether the benefits of taking aspirin outweigh the harms is an individual one. Patients should work with their clinicians to look at their risk factors and decide if taking aspirin to lower their risk for heart attacks or strokes outweighs the potential risk of gastrointestinal bleeding," said Task Force Chair Ned Calonge, M.D., who is also chief medical officer and state epidemiologist for the Colorado Department of Public Health and Information.
Cardiovascular disease is the leading cause of death in the United States. It is the underlying or contributing cause in approximately 58 percent of all deaths. In 2003, 1 in every 3 adults had some type of cardiovascular disease. In adults over the age of 40, the risk of developing cardiovascular disease is 2 in 3 for men and more than 1 in 2 for women.
The Task Force could not find evidence about what the optimum dose of aspirin is to prevent heart attacks or strokes. Evidence shows benefits at a range of doses, and the risk of gastrointestinal bleeding may increase with the dose. A dose as low as 75 mg seems as effective as higher doses. Taking aspirin increases a person's chances of gastrointestinal bleeding, the sudden loss of blood or perforation of the digestive tract that can lead to hospitalization or death. Taking aspirin also increases the chance of a hemorrhagic stroke, or bleeding in the brain, which is different than the ischemic stroke that aspirin can prevent.
In 2002, the Task Force strongly recommended that clinicians discuss aspirin use with adults at increased risk for coronary heart disease and that discussions with patients should address both the potential benefits and potential harms of aspirin therapy. The new recommendation provides more specific guidance about benefits and harms to specific age groups and gender-specific benefits and provides clinicians with information on how to estimate an individual's risks for heart disease or stroke.
The U.S. Preventive Services Task Force is an independent panel of experts in prevention and primary care. The Task Force conducts rigorous, impartial assessments of the scientific evidence for the effectiveness of a broad range of clinical preventive services, including screening, counseling and preventive medications. Its recommendations are considered the gold standard for clinical preventive services.
The recommendations and materials for clinicians are available on the AHRQ Web site at http://www.ahrq.gov/clinic/uspstf/uspsasmi.htm. Previous Task Force recommendations, summaries of the evidence and related materials are also available on the AHRQ Web site. Clinical information is also available from AHRQ's National Guideline Clearinghouse™ at http://www.guideline.gov.
For more information, please contact AHRQ Public Affairs: (301) 427-1244 or (301) 427-1246.
Aspirin
Patients and clinicians should consider risk factors—including age, gender, diabetes, blood pressure, cholesterol levels, smoking and risk of gastrointestinal bleeding—before deciding whether to use aspirin to prevent heart attacks or strokes, according to new recommendations from the U.S. Preventive Services Task Force. These recommendations do not apply to people who have already had a heart attack or stroke.
The recommendations are published in the March 17 issue of the Annals of Internal Medicine. The Task Force reviewed new evidence from the National Institutes of Health's Women's Health Study published since the last Task Force review of this topic in 2002, including a recent meta-analysis of the risks and benefits of aspirin and found aspirin may have different benefits and harms in men and women. The Task Force found good evidence that aspirin decreases first heart attacks in men and first strokes in women.
The more risk factors people have, the more likely they are to benefit from aspirin. The Task Force recommends that men between the ages of 45 and 79 should use aspirin to reduce their risk for heart attacks when the benefits outweigh the harms for potential gastrointestinal bleeding. Women between the ages of 55 and 79 should use aspirin to reduce their risk for ischemic stroke when the benefits outweigh the harms for potential gastrointestinal bleeding. Ischemic strokes occur as a result of an obstruction within a blood vessel supplying blood to the brain and are potentially prevented by aspirin use. The risk of gastrointestinal bleeding with and without aspirin use increases with age and is twice as high in men as in women. Other risk factors for gastrointestinal bleeding include upper gastrointestinal tract pain, gastrointestinal ulcers, and using non-steroidal anti-inflammatory drugs.
The Task Force recommended against using aspirin to prevent either strokes or heart disease in men under 45 or women under age 55 because heart attacks are less likely to occur in men younger than 45 and ischemic strokes are less likely to occur in women younger than 55, and because limited evidence exists in these age groups.
People age 80 and older could benefit more than younger people from aspirin because of their higher risk of cardiovascular disease, but the harms are also greater because the risk of gastrointestinal bleeding increases with age. The Task Force could not find clear evidence that the benefits of using aspirin outweigh the risks in people 80 years or older.
"The decision about whether the benefits of taking aspirin outweigh the harms is an individual one. Patients should work with their clinicians to look at their risk factors and decide if taking aspirin to lower their risk for heart attacks or strokes outweighs the potential risk of gastrointestinal bleeding," said Task Force Chair Ned Calonge, M.D., who is also chief medical officer and state epidemiologist for the Colorado Department of Public Health and Information.
Cardiovascular disease is the leading cause of death in the United States. It is the underlying or contributing cause in approximately 58 percent of all deaths. In 2003, 1 in every 3 adults had some type of cardiovascular disease. In adults over the age of 40, the risk of developing cardiovascular disease is 2 in 3 for men and more than 1 in 2 for women.
The Task Force could not find evidence about what the optimum dose of aspirin is to prevent heart attacks or strokes. Evidence shows benefits at a range of doses, and the risk of gastrointestinal bleeding may increase with the dose. A dose as low as 75 mg seems as effective as higher doses. Taking aspirin increases a person's chances of gastrointestinal bleeding, the sudden loss of blood or perforation of the digestive tract that can lead to hospitalization or death. Taking aspirin also increases the chance of a hemorrhagic stroke, or bleeding in the brain, which is different than the ischemic stroke that aspirin can prevent.
In 2002, the Task Force strongly recommended that clinicians discuss aspirin use with adults at increased risk for coronary heart disease and that discussions with patients should address both the potential benefits and potential harms of aspirin therapy. The new recommendation provides more specific guidance about benefits and harms to specific age groups and gender-specific benefits and provides clinicians with information on how to estimate an individual's risks for heart disease or stroke.
The U.S. Preventive Services Task Force is an independent panel of experts in prevention and primary care. The Task Force conducts rigorous, impartial assessments of the scientific evidence for the effectiveness of a broad range of clinical preventive services, including screening, counseling and preventive medications. Its recommendations are considered the gold standard for clinical preventive services.
The recommendations and materials for clinicians are available on the AHRQ Web site at http://www.ahrq.gov/clinic/uspstf/uspsasmi.htm. Previous Task Force recommendations, summaries of the evidence and related materials are also available on the AHRQ Web site. Clinical information is also available from AHRQ's National Guideline Clearinghouse™ at http://www.guideline.gov.
For more information, please contact AHRQ Public Affairs: (301) 427-1244 or (301) 427-1246.
Aspirin
Monday, March 16, 2009
AAAAI: Oral Immunotherapy Beats Peanut Allergy in Some Children
AAAAI: American Academy of Allergy Asthma & Immunology Meeting
By John Gever, Senior Editor, MedPage Today
Published: March 16, 2009
Reviewed by Zalman S. Agus, MD; Emeritus Professor
University of Pennsylvania School of Medicine.
WASHINGTON, March 16 -- Five of nine peanut-allergic children undergoing long-term, steady exposure to small quantities of peanuts are now able to eat peanut products freely, a researcher said here.
The children, enrolled in an open-label trial of oral immunotherapy for peanut allergy, have been treated for at least 2.5 years, A. Wesley Burks, M.D., of Duke University, reported at the American Academy of Allergy, Asthma, and Immunology meeting here.
The findings provide a glimmer of hope for up to 3 million Americans who suffer from peanut allergies in a society where peanut products are ubiquitous. Action Points
--------------------------------------------------------------------------------
Explain to interested patients that peanut allergies in children usually persist into adulthood and can be life threatening.
Explain that only a small number of patients have been fully evaluated in this study, and the treatment should still be considered investigational.
Note that this study was published as an abstract and presented at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.
Peanut allergies are among the most common triggers of anaphylaxis, according to the AAAAI, and only one in five children with the allergy outgrows it in adulthood.
Currently, the standard treatment is avoidance of foods containing the legumes and keeping an epinephrine injector close by to deal with severe reactions.
In all, 39 children have participated in the ongoing study, which Dr. Burks characterized as an open-label pilot trial.
The ongoing study protocol -- with 33 currently enrolled -- began when children were two to five years old. They initially received tiny doses of peanut flour, less than one milligram.
The children took steadily increasing amounts of peanut until, eight to ten months later, they could tolerate up to 15 peanuts per day.
Treatment continued at that level, Dr. Burks said, with periodic challenges to confirm the youngsters' ability to tolerate peanut products.
The researchers -- including scientists at the University of Arkansas in Little Rock -- have determined that children successfully treated showed significantly decreased serum levels of peanut-specific immunoglobulin E.
Withdrawal of the immunotherapy has now begun to be tested in participants with very low peanut IgE, less than 2 kU/L.
Five of nine children who had been on treatment for at least 2.5 years passed an oral food challenge test. Researchers then stopped their immunotherapy for a month, followed by a second challenge test.
It was successful in all cases, Dr. Burks said, and the children now are under no diet restrictions and eat peanut-containing foods daily. "They are months out and they are doing fine," he said.
Biochemical studies in these children indicate that the therapy induced regulatory T cells and secretion of IL-10 indicative of tolerance to peanut proteins.
"They [immune cells] change to a nonallergic phenotype," Dr. Burks said.
Of the 39 total participants, six moved away and dropped out, and four withdrew because of allergic reactions.
Also underway is a separate double-blind, placebo-controlled study of the oral immunotherapy protocol, he added.
The study is still in its early stages, but data are available on 18 children participating in it.
The children are one to 16 years old and have completed one year in the study. Among 12 assigned to active therapy, the mean tolerance at one year was 15 peanuts, compared with 1.5 peanuts for six placebo-group children (P<0.05),>
By John Gever, Senior Editor, MedPage Today
Published: March 16, 2009
Reviewed by Zalman S. Agus, MD; Emeritus Professor
University of Pennsylvania School of Medicine.
WASHINGTON, March 16 -- Five of nine peanut-allergic children undergoing long-term, steady exposure to small quantities of peanuts are now able to eat peanut products freely, a researcher said here.
The children, enrolled in an open-label trial of oral immunotherapy for peanut allergy, have been treated for at least 2.5 years, A. Wesley Burks, M.D., of Duke University, reported at the American Academy of Allergy, Asthma, and Immunology meeting here.
The findings provide a glimmer of hope for up to 3 million Americans who suffer from peanut allergies in a society where peanut products are ubiquitous. Action Points
--------------------------------------------------------------------------------
Explain to interested patients that peanut allergies in children usually persist into adulthood and can be life threatening.
Explain that only a small number of patients have been fully evaluated in this study, and the treatment should still be considered investigational.
Note that this study was published as an abstract and presented at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.
Peanut allergies are among the most common triggers of anaphylaxis, according to the AAAAI, and only one in five children with the allergy outgrows it in adulthood.
Currently, the standard treatment is avoidance of foods containing the legumes and keeping an epinephrine injector close by to deal with severe reactions.
In all, 39 children have participated in the ongoing study, which Dr. Burks characterized as an open-label pilot trial.
The ongoing study protocol -- with 33 currently enrolled -- began when children were two to five years old. They initially received tiny doses of peanut flour, less than one milligram.
The children took steadily increasing amounts of peanut until, eight to ten months later, they could tolerate up to 15 peanuts per day.
Treatment continued at that level, Dr. Burks said, with periodic challenges to confirm the youngsters' ability to tolerate peanut products.
The researchers -- including scientists at the University of Arkansas in Little Rock -- have determined that children successfully treated showed significantly decreased serum levels of peanut-specific immunoglobulin E.
Withdrawal of the immunotherapy has now begun to be tested in participants with very low peanut IgE, less than 2 kU/L.
Five of nine children who had been on treatment for at least 2.5 years passed an oral food challenge test. Researchers then stopped their immunotherapy for a month, followed by a second challenge test.
It was successful in all cases, Dr. Burks said, and the children now are under no diet restrictions and eat peanut-containing foods daily. "They are months out and they are doing fine," he said.
Biochemical studies in these children indicate that the therapy induced regulatory T cells and secretion of IL-10 indicative of tolerance to peanut proteins.
"They [immune cells] change to a nonallergic phenotype," Dr. Burks said.
Of the 39 total participants, six moved away and dropped out, and four withdrew because of allergic reactions.
Also underway is a separate double-blind, placebo-controlled study of the oral immunotherapy protocol, he added.
The study is still in its early stages, but data are available on 18 children participating in it.
The children are one to 16 years old and have completed one year in the study. Among 12 assigned to active therapy, the mean tolerance at one year was 15 peanuts, compared with 1.5 peanuts for six placebo-group children (P<0.05),>
Friday, March 13, 2009
National Institute on Aging
http://www.nia.nih.gov/
The National Institute on Aging (NIA) is the research arm of the U.S. National Institutes of Health (NIH) that focuses on aging research. Their website is geared both toward researchers and laypeople, particularly seniors. Visitors can click on the links, such as "Publications", "Alzheimer's Disease Information" and "Clinical Trials" next to the "Health Information" heading, on the right side of the homepage. For a brief description of what the links are about, visitors can click on the "Health Information" heading to be taken to the links and their descriptions. The "Clinical Trials" link would be of interest to those seniors who have particular medical conditions that may be being studied by the NIH. To see the numerous publications the NIA has available to order or download free, visitors can click on the "Publications" link on the homepage to browse the categories of publications available, including, "Caregiving", "Conditions & Diseases", "Medications/Supplements" and "Safety". Spanish language versions of the publications, can be found by simply clicking on "Spanish Language Materials" in the same section. For researchers, the "Research Information" heading on the right side of the page leads to the descriptions of the links that are also featured in the middle of the homepage. Two links that are concerned with current research are "Research Conducted at NIA" and "NIA Sponsored Research".
The National Institute on Aging (NIA) is the research arm of the U.S. National Institutes of Health (NIH) that focuses on aging research. Their website is geared both toward researchers and laypeople, particularly seniors. Visitors can click on the links, such as "Publications", "Alzheimer's Disease Information" and "Clinical Trials" next to the "Health Information" heading, on the right side of the homepage. For a brief description of what the links are about, visitors can click on the "Health Information" heading to be taken to the links and their descriptions. The "Clinical Trials" link would be of interest to those seniors who have particular medical conditions that may be being studied by the NIH. To see the numerous publications the NIA has available to order or download free, visitors can click on the "Publications" link on the homepage to browse the categories of publications available, including, "Caregiving", "Conditions & Diseases", "Medications/Supplements" and "Safety". Spanish language versions of the publications, can be found by simply clicking on "Spanish Language Materials" in the same section. For researchers, the "Research Information" heading on the right side of the page leads to the descriptions of the links that are also featured in the middle of the homepage. Two links that are concerned with current research are "Research Conducted at NIA" and "NIA Sponsored Research".
International Centre for Human Resources in Nursing
http://www.ichrn.org/
This website addresses one of the more pressing issues in healthcare worldwide: the nursing workforce. The website of the International Centre for Human Resources in Nursing (ICHRN) addresses the shortage of nurses, the underemployment of nurses and the migration of nurses, as well as the challenges of nursing education availability and poor workforce planning. Visitors can click on "Knowledge Library" at the top of the page to download many of their publications. The library can be browsed by subject or searched by keyword. Some of the subject areas include "Workforce Assessment, Planning and Policy", "Work Environment" and "Good/Promising Practices in Nursing Recruitment and Retention". The "Helpful Links" tab at the top of the page will take the visitor to over two dozen links concerning the nursing crisis in world healthcare. To subscribe to the free ICHRN e-newsletter in English, French or Spanish, visitors should click on "Newsletter" under the "News & Events" tab at the top of the page. Current and previous issues of the newsletter are also accessible to visitors via a link on the same page where they can also find the information about subscribing. [KMG]
This website addresses one of the more pressing issues in healthcare worldwide: the nursing workforce. The website of the International Centre for Human Resources in Nursing (ICHRN) addresses the shortage of nurses, the underemployment of nurses and the migration of nurses, as well as the challenges of nursing education availability and poor workforce planning. Visitors can click on "Knowledge Library" at the top of the page to download many of their publications. The library can be browsed by subject or searched by keyword. Some of the subject areas include "Workforce Assessment, Planning and Policy", "Work Environment" and "Good/Promising Practices in Nursing Recruitment and Retention". The "Helpful Links" tab at the top of the page will take the visitor to over two dozen links concerning the nursing crisis in world healthcare. To subscribe to the free ICHRN e-newsletter in English, French or Spanish, visitors should click on "Newsletter" under the "News & Events" tab at the top of the page. Current and previous issues of the newsletter are also accessible to visitors via a link on the same page where they can also find the information about subscribing. [KMG]
Thursday, March 12, 2009
Report: US on Short End of Health Care 'Value Gap'
By THE ASSOCIATED PRESS
Published: March 12, 2009
Filed at 6:57 a.m. ET
WASHINGTON (AP) -- If the global economy were a 100-yard dash, the U.S. would start 23 yards behind its closest competitors because of health care that costs too much and delivers too little, a business group says in a report to be released Thursday.
The report from the Business Roundtable, which represents CEOs of major companies, says America's health care system has become a liability in a global economy.
Concern about high U.S. costs has existed for years, and business executives -- whose companies provide health coverage for workers -- have long called for getting costs under control. Now President Barack Obama says the costs have become unsustainable and the system must be overhauled.
Americans spend $2.4 trillion a year on health care. The Business Roundtable report says Americans in 2006 spent $1,928 per capita on health care, at least two-and-a-half times more per person than any other advanced country.
In a different twist, the report took those costs and factored benefits into the equation.
It compares statistics on life expectancy, death rates and even cholesterol readings and blood pressures. The health measures are factored together with costs into a 100-point ''value'' scale. That hasn't been done before, the authors said.
The results are not encouraging.
The United States is 23 points behind five leading economic competitors: Canada, Japan, Germany, the United Kingdom and France. The five nations cover all their citizens, and though their systems differ, in each country the government plays a much larger role than in the U.S.
The cost-benefit disparity is even wider -- 46 points -- when the U.S. is compared with emerging competitors: China, Brazil and India.
''What's important is that we measure and compare actual value -- not just how much we spend on health care, but the performance we get back in return,'' said H. Edward Hanway, CEO of the insurance company Cigna. ''That's what this study does, and the results are quite eye-opening.''
Higher U.S. spending funnels away resources that could be invested elsewhere in the economy, but fails to deliver a healthier work force, the report said.
''Spending more would not be a problem if our health scores were proportionately higher,'' Dr. Arnold Milstein, one of the authors of the study, said in an interview. ''But what this study shows is that the U.S. is not getting higher levels of health and quality of care.''
Other countries spend less on health care and their workers are relatively healthier, the report said.
Medical costs have long been a problem for U.S. auto companies. General Motors spends more per car on health care than it does on steel. But as more American companies face global competition, the ''value gap'' is being felt by more CEOs -- and their hard pressed workers.
One thing the report does not do is endorse the same solution that countries like Canada have adopted: a government-run health care system.
The CEOs of the Business Roundtable believe health care for U.S. workers and their families should stay in private hands, with a government-funded safety net for low-income people.
Published: March 12, 2009
Filed at 6:57 a.m. ET
WASHINGTON (AP) -- If the global economy were a 100-yard dash, the U.S. would start 23 yards behind its closest competitors because of health care that costs too much and delivers too little, a business group says in a report to be released Thursday.
The report from the Business Roundtable, which represents CEOs of major companies, says America's health care system has become a liability in a global economy.
Concern about high U.S. costs has existed for years, and business executives -- whose companies provide health coverage for workers -- have long called for getting costs under control. Now President Barack Obama says the costs have become unsustainable and the system must be overhauled.
Americans spend $2.4 trillion a year on health care. The Business Roundtable report says Americans in 2006 spent $1,928 per capita on health care, at least two-and-a-half times more per person than any other advanced country.
In a different twist, the report took those costs and factored benefits into the equation.
It compares statistics on life expectancy, death rates and even cholesterol readings and blood pressures. The health measures are factored together with costs into a 100-point ''value'' scale. That hasn't been done before, the authors said.
The results are not encouraging.
The United States is 23 points behind five leading economic competitors: Canada, Japan, Germany, the United Kingdom and France. The five nations cover all their citizens, and though their systems differ, in each country the government plays a much larger role than in the U.S.
The cost-benefit disparity is even wider -- 46 points -- when the U.S. is compared with emerging competitors: China, Brazil and India.
''What's important is that we measure and compare actual value -- not just how much we spend on health care, but the performance we get back in return,'' said H. Edward Hanway, CEO of the insurance company Cigna. ''That's what this study does, and the results are quite eye-opening.''
Higher U.S. spending funnels away resources that could be invested elsewhere in the economy, but fails to deliver a healthier work force, the report said.
''Spending more would not be a problem if our health scores were proportionately higher,'' Dr. Arnold Milstein, one of the authors of the study, said in an interview. ''But what this study shows is that the U.S. is not getting higher levels of health and quality of care.''
Other countries spend less on health care and their workers are relatively healthier, the report said.
Medical costs have long been a problem for U.S. auto companies. General Motors spends more per car on health care than it does on steel. But as more American companies face global competition, the ''value gap'' is being felt by more CEOs -- and their hard pressed workers.
One thing the report does not do is endorse the same solution that countries like Canada have adopted: a government-run health care system.
The CEOs of the Business Roundtable believe health care for U.S. workers and their families should stay in private hands, with a government-funded safety net for low-income people.
Monday, March 9, 2009
Reactions to Obama, stem cells
Monday, March 09, 2009 2:21 PM by Domenico Montanaro
The reactions to President Obama's signing of the executive order on stem-cell research were mostly predictable and falling along party lines. Democrats laud it; Republicans were critical. The one perpetual ironic standout, however, is Nancy Reagan, widow of the late Ronald Reagan -- the former president idolized and revered by the Republican Party.
FORMER FIRST LADY NANCY REAGAN: “I'm very grateful that President Obama has lifted the restrictions on federal funding for embryonic stem cell research. These new rules will now make it possible for scientists to move forward. I urge researchers to make use of the opportunities that are available to them, and to do all they can to fulfill the promise that stem cell research offers. Countless people, suffering from many different diseases, stand to benefit from the answers stem cell research can provide. We owe it to ourselves and to our children to do everything in our power to find cures for these diseases -- and soon. As I've said before, time is short, and life is precious.
SEN. TED KENNEDY: "Sometimes medicine advances through inspired discoveries in the laboratory, and sometimes through brilliant insights at the patient's bedside. But today, an extraordinary medical breakthrough was achieved with the stroke of a pen. With today's executive order, President Obama has righted an immense wrong done to the hopes of millions of patients. The President's action today unlocks the enormous potential of life-sustaining medical progress against a wide range of serious illnesses and injuries, all within strong ethical guidelines."
SEN. MAJ. LEADER HARRY REID: "President Obama today offered the hope of better treatments and cures to millions of Americans suffering from debilitating diseases. I applaud President Obama for restoring scientific integrity to government and ensuring we value science over ideology. President Obama's policy has strong support in the Senate, where in each of the past two Congresses we have passed bipartisan stem cell legislation. The President's executive order supports not only the position of Congress, but that of the majority of Americans and hundreds of leading medical and scientific associations and research universities, and dozens of patient-advocacy organizations representing millions of Americans. Since 2001, our most promising scientists have been forced to work with one hand tied behind their backs. Our nation's new stem cell policy will now help them in their quest to find lifesaving cures."
SEN. MIN. LEADER MITCH MCCONNELL (says Obama’s executive order “incentivizes creation and destruction of human embryos”): "The administration's announcement on embryonic stem cell research represents a troubling shift in U.S. policy. With this announcement, the government is, for the first time, incentivizing the creation and destruction of human embryos at the expense of the U.S. taxpayer. I support biomedical research and I believe the administration would be far better served by directing taxpayer funds to research on non-embryonic stem cells, which is both effective and ethical."
HOUSE MIN. LEADER JOHN BOEHNER (says the “decision runs counter to his promise to ‘be a president for all Americans"): "This decision runs counter to President Obama's promise to be a president for all Americans. For a third time in his young presidency, the President has rolled back important protections for innocent life, further dividing our nation at a time when we need greater unity to tackle the challenges before us. I fully support stem cell research, but I draw the line at taxpayer-funded research that requires the destruction of human embryos, and millions of Americans feel similarly. As we move forward, I am hopeful that the President will re-evaluate this and other controversial decisions that put government at odds with the sanctity of human life. Non-embryonic stem cell research is not only showing great promise in the laboratory, but its applications are already being used to treat scores of diseases and medical conditions. Indeed, science and respect for human life can coexist. Politicians in Washington would be well-served to recognize this fact before they ask taxpayers to subsidize the destruction of innocent human life simply to advance a particular agenda. Instead of asking taxpayers to pay for efforts that destroy life, Congress and the Administration should support bipartisan solutions like Rep. Randy Forbes' Patients First Act, which would promote stem cell research that is actually getting results."
*** UPDATE *** CA GOV. ARNOLD SCHWARZENEGGER: "President Obama's executive order is a huge win for the millions of people who suffer from spinal cord injuries, diabetes, Alzheimer's, Parkinson's, Multiple Sclerosis and many other illnesses. Californians were the first in the nation to support and fund embryonic stem cell research and we are big believers in the power of this revolutionary science to not only improve but to save lives. Because of the federal ban, Californians world-renown research facilities have had to have separate areas for the federally-funded and the non-federally funded programs, causing duplicative efforts. I applaud President Obama for removing this barrier which allows California to maximize critical research funding so we can continue to lead the world in stem cell research."
The reactions to President Obama's signing of the executive order on stem-cell research were mostly predictable and falling along party lines. Democrats laud it; Republicans were critical. The one perpetual ironic standout, however, is Nancy Reagan, widow of the late Ronald Reagan -- the former president idolized and revered by the Republican Party.
FORMER FIRST LADY NANCY REAGAN: “I'm very grateful that President Obama has lifted the restrictions on federal funding for embryonic stem cell research. These new rules will now make it possible for scientists to move forward. I urge researchers to make use of the opportunities that are available to them, and to do all they can to fulfill the promise that stem cell research offers. Countless people, suffering from many different diseases, stand to benefit from the answers stem cell research can provide. We owe it to ourselves and to our children to do everything in our power to find cures for these diseases -- and soon. As I've said before, time is short, and life is precious.
SEN. TED KENNEDY: "Sometimes medicine advances through inspired discoveries in the laboratory, and sometimes through brilliant insights at the patient's bedside. But today, an extraordinary medical breakthrough was achieved with the stroke of a pen. With today's executive order, President Obama has righted an immense wrong done to the hopes of millions of patients. The President's action today unlocks the enormous potential of life-sustaining medical progress against a wide range of serious illnesses and injuries, all within strong ethical guidelines."
SEN. MAJ. LEADER HARRY REID: "President Obama today offered the hope of better treatments and cures to millions of Americans suffering from debilitating diseases. I applaud President Obama for restoring scientific integrity to government and ensuring we value science over ideology. President Obama's policy has strong support in the Senate, where in each of the past two Congresses we have passed bipartisan stem cell legislation. The President's executive order supports not only the position of Congress, but that of the majority of Americans and hundreds of leading medical and scientific associations and research universities, and dozens of patient-advocacy organizations representing millions of Americans. Since 2001, our most promising scientists have been forced to work with one hand tied behind their backs. Our nation's new stem cell policy will now help them in their quest to find lifesaving cures."
SEN. MIN. LEADER MITCH MCCONNELL (says Obama’s executive order “incentivizes creation and destruction of human embryos”): "The administration's announcement on embryonic stem cell research represents a troubling shift in U.S. policy. With this announcement, the government is, for the first time, incentivizing the creation and destruction of human embryos at the expense of the U.S. taxpayer. I support biomedical research and I believe the administration would be far better served by directing taxpayer funds to research on non-embryonic stem cells, which is both effective and ethical."
HOUSE MIN. LEADER JOHN BOEHNER (says the “decision runs counter to his promise to ‘be a president for all Americans"): "This decision runs counter to President Obama's promise to be a president for all Americans. For a third time in his young presidency, the President has rolled back important protections for innocent life, further dividing our nation at a time when we need greater unity to tackle the challenges before us. I fully support stem cell research, but I draw the line at taxpayer-funded research that requires the destruction of human embryos, and millions of Americans feel similarly. As we move forward, I am hopeful that the President will re-evaluate this and other controversial decisions that put government at odds with the sanctity of human life. Non-embryonic stem cell research is not only showing great promise in the laboratory, but its applications are already being used to treat scores of diseases and medical conditions. Indeed, science and respect for human life can coexist. Politicians in Washington would be well-served to recognize this fact before they ask taxpayers to subsidize the destruction of innocent human life simply to advance a particular agenda. Instead of asking taxpayers to pay for efforts that destroy life, Congress and the Administration should support bipartisan solutions like Rep. Randy Forbes' Patients First Act, which would promote stem cell research that is actually getting results."
*** UPDATE *** CA GOV. ARNOLD SCHWARZENEGGER: "President Obama's executive order is a huge win for the millions of people who suffer from spinal cord injuries, diabetes, Alzheimer's, Parkinson's, Multiple Sclerosis and many other illnesses. Californians were the first in the nation to support and fund embryonic stem cell research and we are big believers in the power of this revolutionary science to not only improve but to save lives. Because of the federal ban, Californians world-renown research facilities have had to have separate areas for the federally-funded and the non-federally funded programs, causing duplicative efforts. I applaud President Obama for removing this barrier which allows California to maximize critical research funding so we can continue to lead the world in stem cell research."
Monday, March 2, 2009
Killer headache? Migraines hike stroke risk
Some sufferers have twice the chance of heart attacks, strokes, studies say
David Kohn
Beth Leslie had gotten occasional migraines for years. She thought of them as a painful imposition, nothing more.
Then, one day two years ago, her world tipped sideways. “Everything was spinning. I just kept my eyes closed, because whenever I’d open them I’d get dizzy,” says Leslie, a 24-year-old veterinary technician who lives in Bowling Green, Ohio. “It really freaked me out.”
She went to the hospital, where a doctor told her she’d probably come down with some sort of virus. After two days, Leslie’s condition hadn’t improved, and her boyfriend started pressing the doctors. They agreed to give her a brain scan, and found she’d suffered a stroke, one that centered on her cerebellum, the part of the brain in charge of balance.
Leslie was shocked. Like most people, she’d thought of stroke as a disease of old age. But for those who get migraines, the rules appear to be different. Until recently, scientists saw migraine suffering as a physiological thunderstorm that left few lasting effects. But new research suggests some migraines aren’t so innocuous.
Recent studies show those who suffer from something called migraine with aura have double, or perhaps triple, the risk of stroke or heart attack, compared with people who don’t get migraines at all.
In these people — Leslie is one of them — the headache is preceded by a range of symptoms: slurred speech, forgetfulness, feeling hot or cold, and ghostly lights blinking across the field of vision. That last one is the aura. A third of those who experience migraines have these symptoms; generally, this sub-group also has more frequent, and more excruciating, migraines.
“I don’t think migraine is seen as a serious disorder. That’s a mistake,” says migraine researcher David Dodick, a neurologist at the Mayo Clinic in Phoenix. “Headache is just one manifestation of migraine. It’s a systemic illness.”
The mysteries of migraines
Thirty-five million Americans — 1 in 10 of us — get migraines. They tend to occur regularly, with severe pain on one side of the head. Migraine attacks often include other symptoms, such as nausea and sensitivity to light and sound.
Researchers disagree on whether people who get migraines without aura are at higher risk for strokes and heart attacks. So far, almost all of the research of migraine and cardiovascular risk has occurred in those who get auras.
And one knows for sure what accounts for the higher rates of strokes and heart attacks in those who do suffer from migraine with aura, but scientist have several theories that may offer insight.
Some researchers blame migraines on chronic exposure to certain neurotransmitters. Most scientists think migraine sufferers’ brains are hyper-excitable — that is, their neurons tend to start firing uncontrollably, with the outburst spreading across the brain over the course of a few hours.
This electrical storm causes the brain to release several neurotransmitters, including two chemicals called Substance P and Calcitonin Gene-Related Peptide (CGRP), that produce inflammation and pain in the blood vessels surrounding our brains.
Researchers suspect that over years of repeated migraines, the inflammation from Substance P and CGRP may weaken blood vessels, not only in the head but throughout the body. This damage may raise the risk of stroke or heart attack. During a stroke, the vessels that supply the brain rupture or become blocked; during a heart attack the same thing happens to the vessels around the heart.
In a study of 175 people completed last year, University of Toledo neurologist Gretchen Tietjen — who treated Leslie after her stroke — found that nearly a third of those with migraines had signs of blood vessel damage, almost five times higher than the controls.
Tietjen says that while there’s no conclusive proof that Leslie’s migraines played a role in her stroke, they easily could have.
But another group of scientists think the culprit isn’t neurotransmitters, but the vascular system itself. Dodick and others argue that the blood vessels of people who get migraines are inherently dysfunctional, contracting and expanding abnormally in reaction to physical and emotional stress.
“People with migraine probably have unusually reactive blood vessels,” says neurologist Richard B. Lipton, a leading migraine researcher at the Albert Einstein College of Medicine in the Bronx.
In the head, these vascular spasms could trigger migraines. When the veins and arteries in the temple and skull expand and contract too much, they may press on nerves, leading to the excruciating pain.
In people who get migraines, these blood vessel seizures may occur throughout the body, without patients much noticing. Over years, these spasms may damage the vascular system.
Link between migraine and heart defect?
Then there’s the hole-in-the-heart theory. Researchers have known for years that having a gap in the wall between two chambers of the heart — a surprisingly common defect (it occurs in 10 to 20 percent of people) — increases the risk of stroke. It’s not clear why: The defect, known as a patent foramen ovale, or PFO, may allow blood to bypass the lungs, which constantly filter small clots and impurities from the blood. These clots may end up lodged in veins and arteries in the head, triggering strokes.
Over the past five years, scientists have found that PFOs seem to occur in more than half of people who get migraines. In some migraine patients, closing the PFO with surgery seems to lead to a disappearance of headaches.
Some researchers suspect the unpurified blood leaking through the PFO contains inflammatory molecules, which set off that electrical storm when they travel up to the brain. (This may be why people with migraine get headaches after eating certain foods like red wine, olives and chocolate. These “trigger” foods may contain the offending chemicals, which in normal people are constantly removed from the blood.)
‘A very complex system’
But none of these hypotheses have been proven, and the links between migraine and cardiovascular disease remain murky.
“There’s no clear mechanism that convinces me,” says Tobias Kurth, a neuro-epidemiologist at the Harvard University School of Public Health. “It’s likely a very complex system.”
Kurth, who has spent several years examining connections between migraine and stroke, thinks there may be several lines of connection between stroke, heart disease and migraine.
At the same time, he says, even those who get frequent migraines shouldn’t panic. In the general population, stroke and heart attack are quite rare. They’re even less common if you’re young and healthy. While th e stroke risk might double from 15 per 100,000 in the general population to 30 per 100,000 for those who migraine with aura, the risk is still relatively small, pointed out Lipton in the journal Neurology Today.
“A doubling of risk sounds scary, but in absolute terms, it’s still low,” says Dr. Stephen Silberstein, a migraine specialist at the Jefferson Headache Center in Philadelphia.
But if you get migraines, and you smoke, are overweight, or have untreated high blood pressure, then your risk climbs significantly. And each risk compounds the others exponentially.
In a 2007 study published, Kurth found that women who have migraine with aura, smoke and take oral contraceptives (also a stroke hazard), were 10 times more likely to have a stroke than women without these risks. Leslie, for example, was taking birth control pills when she had her stroke.
Changes in treatment
Even without a clear causal link, the new findings may change how doctors treat migraines. Rather than seeing the condition as a painful but harmless hassle, doctors are increasingly trying to prevent it, just as they do obesity or high blood pressure. A range of medicines, including blood pressure drugs and antidepressants, can help prevent headaches. And many patients also find relief through changes in lifestyle and diet.
Although there’s no clear proof, some scientists, including Tietjen, suspect that in migraineurs, preventing headaches could lower the risk of stroke and heart attack.
“I think there’s ongoing, progressive damage to the cardiovascular system,” she says. “If you can treat patients early on, maybe you can keep it from progressing.”
Dodick agrees. “The evidence points in that direction,” he says. “So it makes good sense to be aggressive with preventive measures.” He notes that only 15 percent of people who get frequent migraines take preventive medicine.
Leslie, who has since fully recovered from her stroke, is now in this minority. She takes Elavil, an anti-depressant, for migraine prevention. She no longer takes oral contraceptives, and last year she had surgery to close a PFO doctors discovered after her stroke. She almost never gets a headache.
“It still surprises me that I had a stroke,” she says. “But I’m doing everything I can to stay healthy now. I’ve come a long way.”
David Kohn is a health and science writer. His work has appeared in The New York Times, Popular Science, on BBC's The World and on National Public Radio.
© 2009 msnbc.com. Reprints
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