Health & Fitness (230)
Flu season is just around the corner, and now is the time to protect yourself against the disease...for free.
This weekend, Barnes Jewish Hospital will be offering free flu shots clinics.
A clinic is scheduled for 9 a.m. to 2 p.m. Saturday in North County at the Shalom Church City of Peace Health Fair.
Another is scheduled for 9 a.m. to 3 p.m. at Barnes-Jewish West County Hospital, Medical Office Building 2.
It is recommended that anyone over six month old get a flu vaccine.
Doctors often short them on chemotherapy by not basing the dose on size, as they should. They use ideal weight or cap the dose out of fear about how much treatment an obese patient can bear. Yet research shows that bigger people handle chemo better than smaller people do.
Even a little less chemo can mean worse odds of survival, and studies suggest that as many as 40 percent of obese cancer patients have been getting less than 85 percent of the right dose for their size.
Now, the largest organization of doctors who treat cancer, the American Society of Clinical Oncology, aims to change that. The group has adopted guidelines urging full, weight-based doses for the obese.
Don't call it supersizing; it's right-sizing cancer care, said Dr. Gary Lyman, a Duke University oncologist who led the panel that wrote the advice.
"There's little doubt that some degree of undertreatment is contributing to the higher mortality and recurrence rates in obese patients," he said.
The Food and Drug Administration's cancer drug chief, Dr. Richard Pazdur, agrees.
"By minimizing the dose, or capping the dose, we have been undertreating patients," he said.
The dosing issue applies to all types of cancer treated with chemo - breast, colon, lung, ovarian and even blood diseases such as leukemia.
It affects a lot of people. Big isn't healthy but it's the new "normal" - 60 percent of Americans are overweight and more than one-third of them are obese.
Giving too little chemo "could make it as if they didn't even get treated at all ... so they go through the whole ordeal with no benefit, in the extreme case ," said Dr. Jennifer Griggs, a University of Michigan breast cancer specialist who also worked on the guidelines.
So why do doctors limit dose?
Sometimes it's for good reason - the patient has diabetes, heart problems or other illnesses that interfere with how much chemo they can stand. Usually, though, it's because doctors are afraid to follow a standard weight-based formula because the dose seems so huge and they're afraid of harming the heart and blood system, Lyman said.
"You're three times the size of the average person, but it doesn't mean your heart is," Griggs explained.
Yet studies show that heavier patients are less likely to develop dangerous, low blood counts from cancer treatment, and that they clear chemo drugs more quickly from the body than thinner people do.
A paper Lyman published in the journal Nature in August said that a 20 percent reduction in chemo doses lowered remission and cure rates by half in animal experiments and helped the tumors develop resistance to the drugs. Other research in people found lower survival among those getting less chemo as well.
Even if a patient develops a problem from a chemo treatment and doctors have to dial it back, it's important to try a full dose the next time around so the patient gets all the treatment intended, Lyman said.
That happened to Tracy Smith, a 46-year-old Durham, N.C., woman treated at Duke in 2011 for breast cancer that had spread to more than a dozen lymph nodes. Doctors gave her full chemo doses based on her weight, which at 285 pounds classified her as obese.
Three times, high fevers put her in the hospital, and one treatment was cut short because doctors thought it was causing wheezing and possible lung damage. But she resumed and finished the intended treatment and has been cancer-free since then.
After hearing you have cancer, "you're just kind of in a fog" and don't think to ask about doses of the drugs you need, she said. "I trusted my doctor. Doctors should be well aware of what you can tolerate. You should do whatever you can to fight this beast."
Smith's tumor was fueled by estrogen - a hormone made in abundance by fat tissue. Robin McRath, a floral designer who helps run a women's shelter in Ludington, Mich., had the same type.
"It's like a playground, an amusement park, for cancer cells when you're fat," she said. She was only was 41 when her cancer was diagnosed five years ago, and her oncologist, Dr. Carol Peterson, treated her with full doses based on her weight - about 240 pounds, which put her in the obese category.
"We didn't discuss dosage. That didn't matter to me - I just wanted to get it out of my system," she said of the cancer, and praised the treatments to prevent one of chemo's most feared side effects. "There are fantastic anti-nausea medicines. I was never sick one day."
McRath is active in the Obesity Action Coalition, an education and advocacy group. A spokesman said the group was unaware of the dosing issue for obese patients.
Not all doctors are aware either. Luckily for McRath, hers was. Peterson said she uses full doses unless a patient has other health issues.
"If that's their only problem - if they're just overweight or obese - they can do quite well" with full weight-based doses, she said.
Duke's Lyman agreed, and offered this advice to patients: "Ask your doctor how they plan to treat you and whether you're going to get the full dosing. The doctor may have a good reason not to, but you should have that discussion."
--- AP National Writer Allen G. Breed in Raleigh, N.C., contributed to this report.
Online: Guidelines: HTTP://WWW.ASCO.ORG/GUIDELINES/WBD ---
Concerned about the nation's childhood obesity issues, the first lady on Wednesday is convening the first White House summit on food marketing to children to get involved parties talking about how to help consumers make healthier food choices. That includes enlisting the persuasive power of the multimillion-dollar food marketing industry.
As she helped kick off a nationwide campaign last week to encourage people to drink more plain water, Mrs. Obama said she would keep reaching out to new people and organizations and keep making the case for healthier choices like water and fruits and vegetables.
The White House says it has invited representatives from the food and media industries, advocates, parents, representatives of government agencies and researchers, though it did not release a list of names and organizations. Mrs. Obama will open the meeting with public remarks. The rest of the meeting will be closed to the media.
Consumer advocates say studies show that food marketing is a leading cause of obesity because it influences what children want to eat.
A 2006 report on the issue by the influential Institute of Medicine concluded that food and beverage marketing to children "represents, at best, a missed opportunity, and, at worst, a direct threat to the health of the next generation."
Improvements have come in the years since, especially after Mrs. Obama began drawing attention to childhood obesity with a campaign of her own in 2010.
She stood with the Walt Disney Co. last year when it became the first major media company to ban ads for junk food from its media channels, websites and theme parks. She also has praised the Birds Eye frozen food company for encouraging children to eat vegetables, including through promotions featuring characters from the Nickelodeon comedy "iCarly."
But the first lady and consumer advocates say more improvements are needed.
"Most of the food ads that kids see are still for unhealthy food, which makes it really hard for parents to feed their children healthfully," said Margo Wootan, a nutrition lobbyist for the consumer advocacy group Center for Science in the Public Interest. Wootan planned to attend the summit.
In a speech earlier this year to a health conference, Mrs. Obama said limiting the promotion of unhealthy food to kids isn't the only solution.
"It's also about companies realizing that marketing healthy foods can be responsible and the profitable thing to do as well," she said.
The White House summit, which consumer advocates say marks the first time the White House has focused on this issue, could pick up where Congress and the administration left off a few years ago after the administration gave up trying to get the food industry to agree to voluntary marketing guidelines.
Preliminary guidelines released in 2011 asked food companies, advertisers and TV networks only to market foods to children if they are low in fats, sugars and sodium and included specified healthy ingredients. But the effort fizzled after many Republican lawmakers sided with the food industry, which accused government of overreaching.
The companies said the guidelines were overly broad and would limit marketing of almost all of the nation's favorite foods. The food companies also said they were feared government retaliation if they didn't go along with guidelines that were intended to be voluntary.
Large food companies then announced their own guidelines that, not surprisingly, were more lenient than what the Federal Trade Commission, the Agriculture Department, the Food and Drug Administration and the Centers for Disease Control and Prevention had proposed under the direction of Congress.
The FTC publicly backed off some of the guidelines, including a recommendation that companies change packaging and remove brand characters from some foods. In late 2011, the agency said Congress "had clearly changed its mind" and said it would take another look. It never released updated guidelines.
New York University food and nutrition professor Marion Nestle, who also was attending the meeting, said studies show that voluntary restrictions don't work.
"Food marketing is the elephant in the room," she said. "If you're serious about childhood obesity, you've got to do something about food marketing." ---
Associated Press writer Mary Clare Jalonick contributed to this report. ---
Less severe binge drinking, consuming five or more drinks in a row, has mostly declined in recent years among teens. But for high school seniors, the 2011 rate for 10 drinks in a row - 9.6 percent - was down only slightly from 2005.
The most extreme level - 15 or more drinks in a row within the past two weeks - didn't change from 2005 to 2011. Almost 6 percent of high school seniors reported recently drinking that amount.
The number of seniors engaging in the most extreme drinking "is really concerning because they're most at risk for the really severe consequences," including reckless driving, car accidents and alcohol poisoning, said lead researcher Megan Patrick of the University of Michigan's Institute for Social Research.
Extreme binge drinking may be a behavior that's "more entrenched" among some teens, and thus harder to change, Patrick said.
The new report is an analysis of survey results that the university does for the National Institute on Drug Abuse. It's based on classroom questionnaires given to more than 16,000 high school seniors; a question on extreme binge drinking was added in 2005.
Whites and males were the most likely to engage in all levels of binge drinking, the report found. Students with more educated parents had higher rates of binge drinking than other kids, but lower rates of extreme binge drinking.
Extreme binge drinking was most common in rural areas and the Midwest and least common in the West.
The report was published online Monday in JAMA Pediatrics.
Young adults generally have higher levels of extreme drinking; a 2012 survey by the same group found that more than 1 in 4 people aged 19 to 30 had recently consumed at least 10 drinks in a row and more than 1 in 10 had at least 15 drinks in a row.
A journal editorial says the new report may help explain why hospitalizations for alcohol and drug overdoses among teens and young adults have increased in recent years despite ongoing declines in less severe binge drinking.
In the early 1980s, before all states made 21 the minimum legal drinking age, more than 40 percent of high school seniors said they had recently downed more than five drinks in a row, according to data cited in the editorial.
The 5-plus binge drinking rate steadily declined in more recent years for seniors, to 22 percent in 2011, although it was 24 percent in 2012, according to a previous report from the survey group. The new report has slightly different percentages because it is based on a subgroup of previous surveys. Survey results for 2012 on extreme binge drinking among seniors haven't been published yet.
--- Online: Journal: HTTP://JAMAPEDIATRICS.COM
Monitoring the Future: HTTP://WWW.MONITORINGTHEFUTURE.ORG
The Centers for Disease Control and Prevention released the number Monday to spotlight the growing threat of germs that are hard to treat because they've become resistant to drugs.
Finally estimating the problem sends "a very powerful message," said Dr. Helen Boucher, a Tufts University expert and spokeswoman for the Infectious Diseases Society of America. "We're facing a catastrophe."
Antibiotics like penicillin and streptomycin first became widely available in the 1940s, and today dozens are used to kill or suppress the bacteria behind illnesses ranging from strep throat to the plague. The drugs are considered one of the greatest advances in the history of medicine, and have saved countless lives.
But as decades passed, some antibiotics stopped working against the bugs they previously vanquished. Experts say their overuse and misuse have helped make them less effective.
In a new report, the CDC tallied the toll of the 17 most worrisome drug-resistant bacteria. The result: Each year, more than 2 million people develop serious infections and at least 23,000 die.
Of those, the staph infection MRSA, or methicillin-resistant Staphylococcus aureus, kills about 11,000, and a new superbug kills about 600. That bacteria withstand treatment with antibiotics called carbapenems - considered one of the last lines of defense against hard-to-treat bugs.
Germs like those have prompted health officials to warn that if the situation gets much worse, it could make doctors reluctant to do surgery or treat cancer patients if antibiotics won't protect their patients from getting infections.
"If we're not careful, the medicine chest will be empty" when doctors need infection-fighting drugs, said CDC Director Dr. Tom Frieden.
It's not clear that the problem is uniformly growing worse for all bugs. Some research suggests, for example, that MRSA rates may have plateaued and a separate CDC report released Monday in JAMA Internal Medicine found that serious MRSA infections declined 30 percent between 2005 and 2011.
MRSA bacteria have been the target of many hospital infection control efforts. These germs often live without symptoms on the skin, but also can cause skin or tissue infections, and become more dangerous when they enter the bloodstream.
Serious, invasive MRSA declined in all settings for a total of 80,461 infections in 2011, the journal report found. Most were linked with health care in people who'd recently been hospitalized or received other medical treatment. But for the first time, the more than 16,000 infections picked up in community settings outnumbered the 14,000 infections that began in the hospital.
A 2005-2010 study in the same journal suggests that pig manure might be a cause of some mostly less serious MRSA infections in people living near fertilized farm fields.
The study is based on patients from Danville, Pa.-based Geisinger Health System. It offers only circumstantial evidence, but the authors said the MRSA link is plausible because antibiotics are widely used on pig farms and other livestock operations to enhance animal growth, and the drugs are found in pig manure.
The study involved nearly 3,000 MRSA cases, about half of them not linked with health-care. The authors estimated that living near pig manure-fertilized fields may have accounted for about 11 percent of MRSA not linked with health care.
But how the germs might spread from pig manure to people with no close animal contact is uncertain, the study authors said. Close contact with an infected person or sharing personal items used by an infected person is the usual way MRSA spreads.
Dr. William Schaffner, a Vanderbilt University infectious disease specialist, called the report "very provocative" but inconclusive.
Asked generally about antibiotic use in farm animals, the CDC's Frieden said it's an important problem, but he added, "Right now the most acute problem is in hospitals and the most resistant organisms are in hospitals."
Tanner contributed to his report from Chicago.
JAMA Internal Medicine: HTTP://JAMAINTERNALMEDICINE.COM
WASHINGTON (AP) — Michelle Obama has pushed America to eat healthier and to exercise more. Now she says we should "drink up" too. As in plain water. And as in more of it.
She's getting behind a campaign being announced Thursday by the Partnership for a Healthier America to encourage people to drink more water.
Organizers say too many people don't drink enough water daily and about one-fourth of kids below age 19 don't drink any water at all on any given day.
The first lady launched an initiative in 2010 to tackle childhood obesity. In the past, she has advocated switching from sugary sodas to water. But officials behind this new effort say it's strictly about getting people to drink more water — not about promoting water over other beverages.
More than 100 nonprofits and related organizations, which specialize in everything from running soup kitchens to organizing farm workers, have been recruited by the federal government to sign up "navigators" to help the 30 million uninsured people who can now gain coverage.
Many of the groups have little expertise in health insurance. And the timeline for training the workers is tight. According to the new health law, people can begin shopping among the new policies on Oct. 1. The enrollment period lasts six months. Coverage begins in January.
"I think there's a lot of concern about whether, with all these state requirements, they are going to be ready to go," said Katie Keith, a former research professor at Georgetown University, who has been tracking the heath care legislation. "You want people out there educating consumers."
Deploying the guides for the uninsured is one of the first hurdles for the new health system as it transitions from an abstract political debate in Washington to a real-life process in communities. It is one of the steps government officials are concerned about as critics warn that the Affordable Care Act could become a "train wreck."
The guides will be sent to community events with laptops to help people sign up for insurance online. They will work at food banks, shelters, churches and free clinics where the uninsured are likely to be.
The short time available for training raises questions about how prepared the workers will be to answer people's questions about the different policies and government subsidies available. Community groups received the course materials for the 20-hour training only days ago. Many have just begun to post the openings on job boards.
A small scream came from Tara McCollum Plese when she was asked whether her group, Arizona Alliance for Community Health Centers, has hired any of the 45 workers authorized in its federal grant. "Ack! No," she said Thursday. Her group has posted a job description, she said, and is now flooded with inquiries for the positions, which pay about $15 an hour. She's since heard one worker has been hired.
Not one navigator has been hired yet under the $2 million grant obtained by the Ohio Association of Foodbanks. The Illinois Eye Institute, which will help with enrollment in the Chicago area, plans to train a dozen staffers for the task.
The work will be more difficult than what most other temporary employees, such as census workers, do. The navigators must listen to a family's real-world story, assess its income, and figure out eligibility for the Medicaid program, which provides health care for the poor, or for new tax credits, each with its own complicated rules.
If the system works as federal officials hope, more than half of the nation's uninsured, which amount to 15 percent of the population, will get coverage.
In Texas, with the highest percentage of uninsured residents, eight groups are receiving a total of $10.8 million and plan to train more than 150 paid workers and volunteers. Tim McKinney, CEO of United Way of Tarrant County, which got the largest grant, said many people without insurance are looking for information.
In Mississippi, workers will go into rural areas without Internet access to help people with the enrollment and policy-shopping process, which is done online.
"When Oct. 1 rolls around, we're going to be ready to rock 'n' roll," said the Rev. Michael O. Minor of Oak Hill Baptist Church in Hernando, Miss.
In 17 states, navigators have additional hoops to jump through because of new state laws affecting the federal health care law, such as required background checks for the workers.
Republican members of the House Committee on Energy and Commerce have also called on some of the assisting groups to explain how consumers will be protected when they speak with a navigator. The Republicans' letter sets a Sept. 13 deadline for the groups to produce documents.
"This request threw us for a loop quite honestly," said Plese of the Arizona health center group. "We haven't even drawn down any funds from the grant."
Will there be enough time for the hiring and training?
"It has to be enough time," said Laura Goodhue, executive director of Florida CHAIN, a consumer health group involved in the training. "We have to do what we have to do."
--- AP writer Ann Sanner contributed to this report from Columbus, Ohio.
--- AP Medical Writer Carla K. Johnson can be reached at HTTP://WWW.TWITTER.COM/CARLAKJOHNSON .