Study: Women less able to suppress hunger than men

WASHINGTON – Faced with their favorite foods, women are less able than men to suppress their hunger, a discovery that may help explain the higher obesity rate for females, a new study suggests. Researchers trying to understand the brain's mechanisms for controlling food intake were surprised at the difference between the sexes in brain response.
Gene-Jack Wang of Brookhaven National Laboratory and colleagues were trying to figure out why some people overeat and gain weight while others don't.
They performed brain scans on 13 women and 10 men, who had fasted overnight, to determine how their brains responded to the sight of their favorite foods. They report their findings in Tuesday's edition of Proceedings of the National Academy of Sciences.
"There is something going on in the female," Wang said in a telephone interview, "the signal is so much different."
In the study, participants were quizzed about their favorite foods, which ranged from pizza to cinnamon buns and burgers to chocolate cake, and then were asked to fast overnight.
The next day they underwent brain scans while being presented with their favorite foods. In addition, they used a technique called cognitive inhibition, which they had been taught, to suppress thoughts of hunger and eating.
While both men and women said the inhibition technique decreased their hunger, the brain scans showed that men's brain activity actually decreased, while the part of women's brains that responds to food remained active.
"Even though the women said they were less hungry when trying to inhibit their response to the food, their brains were still firing away in the regions that control the drive to eat," Wang said.
Nora Volkow, director of the National Institute on Drug Addiction and a co-author of the paper, said the gender difference was a surprise and may be because of different nutritional needs for men and women, although she stressed that idea is speculative.
Because the traditional role of the female is to provide nutrition to children, the female brain may be hard-wired to eat when foods are available, she said. The next step is to see if female hormones are reacting directly with those specific parts of the brain.
"In our society we are being constantly being bombarded by food stimulus," she said in a telephone interview, so understanding the brain's response can help in developing ways to resist that stimulus.
Eric Stice, an expert on eating disorders at the Oregon Research Institute, called the findings provocative.
"I think it is very possible that the differences in hunger suppression may contribute to gender differences in eating disorders and that they are likely linked to gender differences in estrogen and related hormones," said Stice, who was not part of Wang's research team.
According to the Centers for Disease Control and Prevention, 35.3 percent of American women and 33.3 percent of men were considered obese in 2006.
Rosalyn Weller, a professor of psychology at the University of Alabama-Birmingham, said she was surprised by the results and "thought the dissociation between subjective reports of hunger and brain activation in women but not men was very interesting."
The results suggest that training in reducing food desires or in reacting to food cues could be effective treatments to combat obesity, said Weller, who was not part of the research team.
Weller was a co-author of a recent paper in the journal NeuroImage that studied women's brains when participants were shown pictures of food. They found that obese women had a much stronger reaction than normal-weight women in brain regions related to reward.
Wang noted that behavioral studies have shown that women have a higher tendency than men to overeat when presented with tasty food or under emotional distress.
This may result from differences in sex hormones, he said, and further research is planned to see if that is the case.
Alice H. Lichtenstein, an expert in eating behavior at Tufts University, called Wang's research "very interesting ... I hope to see more like it."
But, she added, a lot of different factors figure in what and when we eat.
"As we learn more about the different factors that go into making that decision we'll be better at helping people regulate" their eating, said Lichtenstein, who was not part of the research team.
Obesity has been increasing and Wang also suggested that another part of the reason is changes in society.
While food choices were seasonal and more limited for our ancestors, choices today are wider and the food is so tempting, he said.
"You go to the buffet, you see the food, you want it," Wang went on. "Some people go to the buffet, they don't eat so much, some do. There is something different in the people."
The study was funded by the National Institute on Drug Abuse, the National Institute on Alcohol Abuse and Alcoholism, and by the General Clinical Research Center of Stony Brook University.
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MRSA rising in kids' ear, nose, throat infections

CHICAGO – Researchers say they found an "alarming" increase in children's ear, nose and throat infections nationwide caused by dangerous drug-resistant staph germs. Other studies have shown rising numbers of skin infections in adults and children caused by these germs, nicknamed MRSA, but this is the first nationwide report on how common they are in deeper tissue infections in the head and neck, the study authors said. These include certain ear and sinus infections, and abcesses that can form in the tonsils and throat.
The study found a total of 21,009 pediatric head and neck infections caused by staph germs from 2001 through 2006. The percentage caused by hard-to-treat MRSA bacteria more than doubled during that time from almost 12 percent to 28 percent.
"In most parts of the United States, there's been an alarming rise," said study author Dr. Steven Sobol, a children's head and neck specialist at Emory University.
The study appears in January's Archives of Otolaryngology, released Monday.
It is based on nationally representative information from an electronic database that collects lab results from more than 300 hospitals nationwide.
MRSA, or methicillin-resistant Staphylococcus aureus, can cause dangerous, life-threatening invasive infections and doctors believe inappropriate use of antibiotics has contributed to its rise.
The study didn't look at the severity of MRSA illness in affected children.
Almost 60 percent of the MRSA infections found in the study were thought to have been contracted outside a hospital setting.
Dr. Robert Daum, a University of Chicago expert in community-acquired MRSA, said the study should serve as an alert to agencies that fund U.S. research "that this is a major public health problem."
MRSA involvement in adult head and neck infections has been reported although data on prevalence is scarce.
MRSA infections were once limited mostly to hospitals, nursing homes and other health-care settings but other studies have shown they are increasingly picked up in the community, in otherwise healthy people. This can happen through direct skin-to-skin contact or contact with surfaces contaminated with germs from cuts and other open wounds.
But staph germs also normally live or "colonize" on the skin and in other tissues including inside the nose and throat, without causing symptoms. And other studies have shown that for poorly understood reasons, the number of people who carry MRSA germs is also on the rise.
Sobol said MRSA head and neck infections most likely develop in MRSA carriers, who become susceptible because of ear, nose or throat infections caused by some other bug. Symptoms that it could be MRSA include ear infections that drain pus, or swollen neck lymph nodes caused by pus draining from a throat or nose abcess.
Unlike cold and flu bugs, MRSA germs aren't airborne and don't spread through sneezing.
MRSA does not respond to penicillin-based antibiotics and doctors are concerned that it is becoming resistant to others.
The study authors said a worrisome 46 percent of MRSA infections studied were resistant to the antibiotic clindamycin, one of the non-penicillin drugs doctors often rely on to treat community-acquired MRSA. However, other doctors said it's more likely that at least some of infections thought to be community-acquired had actually originated in a hospital or other health-care setting, where MRSA resistance to clindamycin is common.
Dr. Buddy Creech, an infectious disease specialist at Vanderbilt University Medical Center, said the research "fits nicely" with smaller studies reporting local increases in MRSA head and neck infections.
"Every time someone looks, the rates of MRSA are going up and that's certainly concerning because it's a bug that can cause dramatic disease," Creech said.
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More recalls of peanut butter products announced

MILWAUKEE – Kellogg Co. said Monday federal authorities have confirmed that salmonella was found in a single package of its peanut butter crackers, as two grocers and General Mills Corp. recalled some of their products because of the scare.

Kellogg had recalled 16 products last week because of the possibility of salmonella contamination.

On Monday, the company based in Battle Creek, Mich., said the Food and Drug Administration confirmed contamination in a single package of Austin Quality Foods Toasty Crackers with Peanut Butter.

Food companies and retailers have been recalling products with peanut butter in them because of suspicion of contamination amid a salmonella outbreak that has killed at least six people and sickened more than 470 others in 43 states. At least 90 people have been hospitalized.

Also Monday, Midwestern grocer and retailer Meijer Inc. said it was recalling two types of crackers and two varieties of ice cream because of the possibility of salmonella contamination: Meijer brand Cheese and Peanut Butter and Toasty Peanut Butter sandwich crackers, and Peanut Butter and Jelly and Peanut Butter Cup ice cream.

Golden Valley, Minn.-based General Mills said in a news release Monday afternoon that it was recalling two flavors of snack bars: LARABAR Peanut Butter Cookie snack bars and JamFrakas Peanut Butter Blisscrisp snack bars. The company said the recall affected 15,000 cases and no illnesses have been reported. General Mills said the recall did not affect any other products it makes.

It was not immediately clear how many packages of Kellogg crackers had been tested, if more tests were being made on other products or if some had already been found not have salmonella, Kellogg spokeswoman Kris Charles said. A spokesman for the FDA said the agency was not providing any new information Monday, a federal holiday.

The government on Saturday had advised consumers to avoid eating cookies, cakes, ice cream and other foods containing peanut butter until health officials learn more about the contamination.

Most peanut butter sold in jars at supermarkets appears to be safe, officials said.

Officials have been focusing on peanut paste and peanut butter made at Peanut Corp. of America's plant in Blakely, Ga.

On Sunday, Peanut Corp. expanded its own recall to all peanut butter and peanut paste produced at the Blakely plant since July 1.

The company's peanut butter is not sold directly to consumers but it is distributed to institutions and food companies. The peanut paste, made from roasted peanuts, is an ingredient in cookies, cakes and other products sold to consumers.

Meijer, based in Grand Rapids, said in a news release Monday it was issuing its recall because makers of its products had announced possible contamination. The products are sold in Meijer stores and gas stations in Michigan, Ohio, Indiana, Illinois and Kentucky.

Late Monday, grocer Kroger Co. recalled Private Selection Peanut Butter Passion Ice Cream sold in select stores, also because of the possibility of contamination. The Cincinnati-based company said the product was sold at stores named City Market, Fred Meyer, Fry's, King Scoopers, QFC and Smith's in 11 states, primarily in the West. The company said the ice cream was not sold in its namesake Kroger stores or any other retailers it operates. No illnesses have been reported.

The recall last week by Kellogg, the world's largest cereal maker, affected products including Keebler Soft Batch Homestyle Peanut Butter Cookies, Famous Amos Peanut Butter Cookies and Keebler Cheese & Peanut Butter Sandwich Crackers. Charles said the recall affected more than 7 million cases of its products.

Kellogg Chief Executive David Mackay said the company would evaluate its processes "to ensure we take necessary actions to reassure consumers and rebuild confidence in these products."

Salmonella, a bacteria, is the most common cause of food poisoning in the U.S., causing diarrhea, cramping and fever.

Also on Monday, Abbott Nutrition recalled three products because of the possibility of salmonella contamination: ZonePerfect Chocolate Peanut Butter bars, ZonePerfect Peanut Toffee bars and NutriPals Peanut Butter Chocolate nutrition bars. The Columbus, Ohio-based company said the items were sold in the U.S., Mexico, New Zealand and Singapore.

Over the weekend, Little Debbie maker McKee Foods Corp. of Collegedale, Tenn., issued a voluntary recall of its peanut butter crackers because of possible contamination.

Other companies issuing recalls recently include Midwest supermarket chain Hy-Vee Inc. of West Des Moines, Iowa, Perry's Ice Cream Co. of Akron, N.Y., and the South Bend Chocolate Co. in Indiana. Ralcorp Frozen Bakery Products, a division of St. Louis-based Ralcorp, recalled several brands of peanut butter cookies it sells through Wal-Mart stores.

Some companies were quick to assure their customers their products were fine and they were not involved in the investigation. Russell Stover Candies Inc., maker of Russell Stover and Whitman's, said Monday it does not use ingredients from Peanut Corp. ConAgra Foods Inc., maker of Peter Pan peanut butter, said Saturday it was not involved in the investigation and neither the Omaha, Neb.-based company nor its suppliers use ingredients from Peanut Corp.

Peter Pan and other peanut butter produced by ConAgra were linked in 2007 to a salmonella outbreak that sickened more than 625 people in 47 states. The company traced the contamination to a leaky roof and faulty sprinkler head at its Georgia plant.

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Texas girl gets new heart; sis awaiting transplant

DALLAS – A 7-year-old girl received a new heart Monday, more than eight months after she and her older sister were put on the transplant list because of the same rare ailment.
Their mother said Shayde Smith is relieved now that her sister Emily has received a transplant. "She's still nervous about it, but she said that now that Emily's made it through, she knows she will," Natalie Van Noy said.
The girls have restrictive cardiomyopathy, which means the heart doesn't relax between pumps and doesn't fill properly with blood. The condition can cause blood clots or death.
Emily was a higher priority for transplant than 9-year-old Shayde because she had more symptoms, including wheezing spells and her lips, toes and fingertips turning blue when she got cold.
Van Noy said Emily's hands and feet are now warm. "She looks awesome," her mother said.
The girls' condition is rare, with less than one-in-a-million children diagnosed, said Dr. Kristine Guleserian, the pediatric cardiothoracic surgeon who led the team operating on Emily at Children's Medical Center Dallas. Without a transplant, the chance of survival is 40 to 50 percent one to two years after diagnosis.
Restrictive cardiomyopathy doesn't have a known cause. It seems to run in families, but the condition hasn't yet been proven to be genetic.
While it isn't rare for siblings to need transplants, it is rare that they would need them at the same time, said Pam Silvestri, a spokeswoman for Southwest Transplant Alliance, one of the organ donation agencies across the country that provides organs to transplant hospitals.
The girls are from the Boyd area, about 30 miles northwest of Fort Worth.
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Girl in China critically ill with bird flu

BEIJING – A 2-year-old girl in northern China has tested positive for bird flu and is in critical condition — the second case of human infection in a month.

The girl fell ill on Jan. 7 in central Hunan province and was taken to a hospital by her grandparents four days later after she returned home to Shanxi province, the Health Ministry said in a notice on its Web site late Saturday.

Tests confirmed she was infected with the H5N1 bird flu virus, it said. It did not say how the girl, surnamed Peng, was infected or what she was doing in Hunan.

"The patient is in critical condition, and the health department of Shanxi province is sparing no efforts" to save the girl, the notice said.

All the people who had close contact with the girl were under medical observation, the ministry said, and no one else has been found ill.

The case comes at a worrisome time for authorities as tens of millions of people are on the move between cities and rural hometowns for Chinese New Year, which begins on Jan. 26. The Agricultural Ministry has said it will step up checks before the holiday.

China, which raises more poultry than any other country, has vowed to aggressively fight the virus.

A spokeswoman for the World Health Organization in Beijing said it was informed of the case and was staying in close contact with the Health Ministry.

Earlier this month a 19-year-old woman died from the bird flu virus in a Beijing hospital after contact with ducks in a market in a neighboring province, the first death from bird flu since February last year. The WHO said the case did not appear to signal a new public health threat.

Health officials worry the H5N1 virus could mutate into a form that could spread easily among people.

According to the latest WHO tally, bird flu has killed 248 people worldwide since 2003, including 21 in China. The young girl brings the total number of cases in the country to 32.

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High risk medical devices escaped close review

WASHINGTON – Some medical devices for sensitive uses, from certain hip joints to a type of defibrillator, have won government approval without a close scientific review, congressional investigators said Thursday.

Although Congress ordered the Food and Drug Administration years ago to resolve the issue, the agency approved 228 medical devices without a full scale review from 2003-2007, the Government Accountability Office said in a report.

Some devices approved under the less rigorous process have been recalled because of malfunctions and other problems, according to the consumer group Public Citizen. One device was an external defibrillator to assist heart attack victims.

The report comes as the FDA's Center for Devices and Radiological Health is the subject of allegations that scientists were pressured to approve medical machinery against their professional judgment. Nine FDA scientists wrote the Obama transition team last week complaining that a "corrupted" review process is putting public health at risk.

The allegations are a separate matter from the concerns raised in Thursday's report. But taken together, they probably will raise the level of congressional scrutiny over the FDA's medical devices branch.

"GAO's investigation confirms my concerns that the approval process for medical devices is woefully inadequate," said Rep. Frank Pallone, who heads the House Energy and Commerce Committee's health panel. "For years, Congress has required high-risk medical devices to undergo stringent premarket review, but GAO's findings show that is simply not happening in every case."

Pallone, D-N.J., said he intends to hold hearings on the FDA's oversight of medical devices. The GAO did not look into whether any patients were harmed as a result of devices that got less government scrutiny.

The root of the problem seems to be that the FDA never fully carried out the intent of a decades-old change in the law.

Medical devices include everything from tongue depressors to silicone breast implants and pacemakers. In 1976, Congress set up a three-tiered classification system for devices.

Manufacturers of low-risk devices such as bandages and reading glasses could get cleared by notifying the FDA before going to market. High-risk devices such as pacemakers and heart valves would have to go through tighter scrutiny, and their manufacturers were required to provide evidence of safety and effectiveness. Devices classified as high-risk tended to be ones that are implanted in the body or could spell the difference between life and death.

An exception was carved out for new versions of high-risk devices already on the market.

Manufacturers could get approval by convincing the FDA that these devices were "substantially equivalent" to their precursors. In 1990, Congress ordered the FDA to end the practice, but it has continued even as generations of technology have come and gone.

The report urged the FDA to promptly resolve the problem, either by carrying out full reviews or reclassifying some devices as lower risk, if appropriate.

The FDA acknowledged the problem, but has not set a timetable for resolving it. "In general, we agree with the conclusions and recommendations," said spokeswoman Karen Riley. "We are considering legal and procedural options to accomplish this objective."

The GAO report found that two-dozen distinct types of devices approved without close scrutiny, including metal hip joints, external defibrillators, and electrodes for pacemakers.

"It all adds up to less-than-rigorous device review, and it's placing tens of thousands of Americans at risk," said Peter Lurie, deputy director of Public Citizen's health research group.

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FDA pledges openness on gene-altered products

WASHINGTON – Federal health officials Thursday pledged a new, open process for approving drugs and foods from genetically engineered animals.
Consumer groups complained the policy won't do enough to tell people if they're eating gene-altered animals and fails to protect the environment. They urged the incoming Obama administration to reconsider it.
Genetic engineering, already widely used for crops, is on the threshold of producing animals that can grow faster or even yield drugs that treat human illnesses. Although the potential benefits — and profits — are huge, many individuals have qualms about manipulating the genetic code of other living creatures.
In issuing its long-awaited final policy, the Food and Drug Administration said it will not allow any products from genetically engineered animals to be sold without first submitting them to scrutiny by independent advisers at a public meeting. The government will allow exceptions for research animals, such as lab rats, and the FDA will post those on its Web site.
Genetically engineered — or GE — animals are not clones, which the FDA has already said are safe to eat. Clones are exact copies of an animal. With GE animals, their DNA has been altered to produce a desirable characteristic.
"We will not approve any application until we are convinced of the safety and effectiveness," said FDA biotechnology expert Larisa Rudenko, who has been working on the complex issue since 1989. "The public should rest assured that we are not going to be rushing any decisions."
But consumer groups said the FDA's policy will not require all genetically engineered foods to be labeled as such. And they said the government has not done enough to examine the potential impact of genetically engineered animals on the environment, particularly if some escape and begin to mate with animals in nature.
"They are completely ignoring consumers' overwhelming desire for labeling," said Michael Hansen, a senior scientist with Consumers Union, publisher of Consumer Reports. FDA officials said genetically engineered foods will be labeled if they are different in some important way from natural foods, for example, no-fat filet mignon.
The FDA also failed to require a cradle-to-grave tracking system for genetically engineered animals, said Gregory Jaffe, who heads the biotechnology project at the Center for Science in the Public Interest. He's particularly concerned about animals that are not supposed to enter the food supply chain.
"The FDA has made some small but important changes to increase the transparency of this process," said Jaffe. "It helps, but the devil is in the details."
While not calling for a repeal of the FDA policy, Jaffe urged the incoming Obama administration to work with Congress on a new law that specifically addresses the genetic engineering issue. The FDA based its policy on older laws that apply to animal drugs.
Drugs and foods from GE animals will become increasingly common in the next five to ten years. For example, an FDA advisory committee last week considered approval of an anti-clotting drug produced from the milk of GE goats. The scientific advisers concluded that the drug — ATryn — appears to be safe and effective. A final FDA decision is pending. And a Massachusetts company hopes to win FDA approval this year for a faster-growing salmon.
The biotechnology industry welcomed the FDA's announcement.
"This system will ensure the products made available through this science will go through a rigorous and transparent review process before being approved for the marketplace," said Barbara Glenn, a senior scientific adviser with the Biotechnology Industry Organization.
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DVD teaches autistic kids what a smile means

LONDON – It wasn't until Jude met Jenny that the 3-year-old autistic boy understood what happy people look like. Jenny, a green trolley car with a human face, had a furrowed brow when her wheel buckled and she got stuck on a track. But after being rescued by friends, she smiled broadly — and that's when something clicked for little Jude Baines.
"It was revelatory," his mother, Caron Freeborn told AP Television News in Cambridge, England. Before watching the video, Jude didn't understand what emotions were and never noticed the expressions on people's faces, even those of his parents or younger brother.
Jenny's adventures are part of a DVD for autistic children released this week in the United States called The Transporters.
The DVD teaches autistic children how to recognize emotions like happiness, anger and sadness through the exploits of vehicles including a train, a ferry, and a cable car.
It is the brainchild of Simon Baron-Cohen, director of the Autism Research Centre at Cambridge University. He also happens to be a cousin of Sacha Baron-Cohen, the comedian behind the characters Ali G, the aspiring rapper, and Borat, the crass Kazakh reporter.
Baron-Cohen first became interested in autism in the 1980s while teaching autistic children. "Why should social interaction be so difficult for a child who has very good skills in other areas like memory or an attention to detail?" he wondered.
About a decade ago, Baron-Cohen suggested that autism — which is much less likely to afflict girls — might be an extreme version of the typical male brain. Men tend to understand the world via patterns and structure, whereas women are more inclined to understand emotions and sympathize with others.
Autism, Baron-Cohen believes, is a condition where people perceive systems and patterns while remaining almost oblivious to other people and their feelings.
To help autistic children understand emotions, Baron-Cohen and his team use eight track-based vehicles in their DVD. The vehicles have human faces grafted onto them, making focusing on human features unavoidable. The video was financed by the British government.
"To teach autistic children something they find difficult, we needed an autism-friendly format," Baron-Cohen said. Autistic children are particularly drawn to predictable vehicles that move on tracks like trains and trams. For years, parents of autistic children have noted their children's attachment to Thomas the Tank Engine.
"Autistic children are often puzzled by faces, so this video helps focus on them in a way that makes it very appealing and soothing," said Uta Frith, an emeritus professor of cognitive development at University College London, who was not involved in developing the video.
Frith said the DVD was a way for autistic children to learn social skills the way other children might learn math or a foreign language.
In a small study of 20 autistic children between ages 4 and 7, Baron-Cohen and colleagues found that autistic children who watched the video for at least 15 minutes a day for one month had caught up with normal children in their ability to identify emotions.
But Baron-Cohen cautioned that while autistic children might be able to recognize emotions better after watching the DVD, that would not necessarily change their behavior at home or on the playground.
"This is not some kind of miracle cure," he said. "It just shows that if you have the opportunity to practice these social skills, you can improve."
Other experts said the video was not a replacement for working and playing with real people.
"You can't just park your child in front of this for hours and go to the other room," said Catherine Lord, director of the Autism and Communication Disorders Center at the University of Michigan. "This will hopefully start interactions or play sequences that kids can then play with real people."
When the DVD was released in Britain in 2007, Baron-Cohen and colleagues distributed 40,000 copies free to families with an autistic child or to doctors working with them.
The DVD sells for $57.50 and includes interactive quizzes and a booklet for parents and teachers. It is available online at http://us.rd.yahoo.com/dailynews/ap/ap_on_he_me/storytext/eu_med_autism_video/30590580/SIG=110i30vfm/*http://www.thetransporters.com. Half of the profits go to autism charities and research, and the other half goes to Changing Media Development, the company Baron-Cohen launched with colleagues.
Similar videos have been produced, but Lord said those have struggled to capture children's attention. In Baron-Cohen's study, some parents reported that their children watched the DVD hundreds of times within a month.
Freeborn said The Transporters DVD has made a "massive difference" for Jude and their family.
"(Jude) now understands what disgusted is, which is quite important if you have a younger brother," she said.
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Got the flu? CDC says Tamiflu may not be much help

ATLANTA – The medical arsenal against the flu just got weaker. Government health officials said Friday that a leading flu medicine, Tamiflu, might not work against all cases of the flu this year. The most common flu bug right now is overwhelmingly resistant to Tamiflu, they said. The alert is "an early heads-up" for doctors. If current trends continue, they may need to change how they treat patients this flu season, said Dr. Julie Gerberding, director of the U.S. Centers for Disease Control and Prevention.

Health officials say they aren't too worried, for several reasons. First, it's early in the flu season, and it's not clear this strain will dominate through the next several months. Second, not many people take antiviral medications for the flu.

Third, the flu vaccine — the primary weapon against flu — seems well matched against the circulating bugs.

But doctors need to take it seriously, said William Schaffner, a Vanderbilt University infectious diseases expert.

"Each influenza seasons provides a bit of a surprise and we got our (surprise) a little early this year," he added.

The flu causes 200,000 hospitalizations and 36,000 deaths annually, according to official estimates. The elderly, young children and people with chronic illnesses are considered at greatest risk.

For the public, the best course of action is vaccination, health officials said. Only about 30 percent of U.S. adults had gotten a flu vaccination this flu season, according to an online survey conducted by the RAND Corporation in November. A flu shot is recommended for those 50 and older, children from 6 months to 18 years, pregnant women, nursing home patients and those with certain medical conditions or who care for people with those conditions.

For people who get the flu, the two most commonly used antivirals are Tamiflu, a pill also known as oseltamivir, and Relenza, an inhaled drug also called zanamivir. The drugs are most effective if taken within two days of getting sick but most people don't see a doctor that quickly.

Early tests indicate that 49 of 50 samples of the main flu virus circulating this year — H1N1 — were resistant to Tamiflu. The samples came mainly from Hawaii, Texas and ten other states. Widespread flu has not yet been reported in most of the country.

"It could fizzle out," or H1N1 could become the dominant strain, Gerberding said.

A spokesman for Tamiflu's manufacturer — Roche, a Swiss company — said it's too early to draw strong conclusions about the drug's usefulness this flu season. The basis of the CDC's alert "is a small sample in a limited number of states, and Tamiflu is showing good activity against other circulating viruses," said spokesman Terry Hurley.

For those sick with the flu, doctors cannot simply choose Relenza instead of Tamiflu. That treatment is not approved for children younger than 7 or people who have asthma or certain other breathing problems. GlaxoSmithKline PLC, which makes Relenza, said Friday it has enough to meet the demands of the current flu season.

An option for some patients, Gerberding said, may be a combination of Tamiflu and rimantadine, another antiviral medication that works against H1N1 but lost effectiveness against another kind of flu virus.

However, it's not clear how well that combination will work, Schaffner said.

"This is a 'best advice with our back against the wall' kind of thing," he said.

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New rule for health providers stirs objections

WASHINGTON – The Bush administration, in its final days, issued a federal rule Thursday reinforcing protections for doctors and other health care workers who refuse to participate in abortions and other procedures because of religious or moral objections.

Critics say the protections are so broad they limit a patient's right to get care and accurate information. For example, they fear the rule could make it possible for a pharmacy clerk to refuse to sell birth control pills without ramifications from an employer.

Under long-standing federal law, institutions may not discriminate against individuals who refuse to perform abortions or provide a referral for one. The administration's rule is intended to ensure that federal funds don't flow to providers who violate those laws, Health and Human Services officials said.

"Doctors and other health care providers should not be forced to choose between good professional standing and violating their conscience," said HHS Secretary Mike Leavitt.

The rule requires recipients of federal funding to certify their compliance with laws protecting conscience rights.

Despite multiple laws on the books protecting health providers, the administration argued that the rule was needed "to raise awareness of federal conscience protections and provide for their enforcement."

But many groups described the rule as a last-minute push designed to make it harder for women to get services such as contraception or counseling in the event they are pregnant and want to learn all of their options.

Several medical associations, more than 100 members of Congress, governors and 13 attorneys general were among the many thousands who wrote the department to protest the rule after it was proposed. Opponents didn't like the rule any better after it was finalized.

"In just a matter of months, the Bush administration has undone three decades of federal protections for both medical professionals and their patients," said Nancy Northup, president of the Center for Reproductive Rights. "It replaced them with a policy that seriously risks the health of millions of women, then tried to pass it off as benevolent."

Abortion opponents hailed the regulation because they said the lack of regulation had resulted in confusion and a lack of awareness.

"This is a huge victory for religious freedom and the First Amendment," said Tony Perkins, president of the Family Research Council.

The administration estimated the cost of complying with the rule at $43.6 million annually, which is spread throughout the hundreds of thousands of health providers subject to the rule — from hospitals and physician offices to medical schools and pharmacies.

Several lawmakers have promised to take up legislation that would overturn the rule once Congress reconvenes in January. Another option is for the Obama administration to issue new regulations that would trump it. The rule will take effect on Jan. 18, two days before Obama takes office.

Obama's transition team did not specifically address the rule Thursday, but spokesman Nick Shapiro issued a statement that said Obama "will review all eleventh-hour regulations and will address them once he is president."

While campaigning in August, Obama criticized the proposal: "This proposed regulation complicates, rather than clarifies the law. It raises troubling issues about access to basic health care for women, particularly access to contraceptives," he said.

The 127-page rule disputed concerns that the protections being proposed were too broad and would affect too many workers in the health care industry, not just doctors or nurses involved with an abortion or sterilization.

"These laws are intended to protect the conscience rights of all individuals participating in health care services, and research programs and activities receiving certain federal funds, or that are administered by the department," the rule said.

Opponents consistently described the rule as a last-minute effort that would reduce access to health care services, particularly access to birth control.

"Making birth control more — not less — accessible is the best way to prevent unintended pregnancies and reduce abortion," said Rep. Nita Lowey, D-N.Y.

Others said the rule would go so far as to protect providers who refuse to give rape victims emergency contraceptives.

The Planned Parenthood Federation of America said about 200,000 people submitted comments opposing the rule, including about 90,000 comments from its supporters.

"This midnight regulation, issued in the last days of the Bush administration, undermines this country's fragile health care system as well as patients' access to health care information and services," said the group's president, Cecile Richards.

___

On the Net:

Health and Human Services Department: http://www.hhs.gov

Planned Parenthood: http://www.plannedparenthood.org

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Urban areas struggle to find grocers, fresh food

LOS ANGELES – Selma Lozoya didn't realize how tough it would be to help her obese mother lose weight until she had to forage for fresh groceries in the inner city.

For Lozoya, 17, not having a driver's license was part of the challenge. But the dearth of supermarkets in her South Los Angeles neighborhood choked with liquor stores, auto repair shops and warehouses made it even harder.

"I can't drive yet so I'm not gonna do anything extraordinary like jump on my bike and ride it for two or three miles and ride it back with tons of stuff on it, oh no," said Lozoya.

Seizing control of her kitchen, Lozoya helped her mom shed 50 pounds by banning lard from tamales and poaching chicken instead of frying it — and she is expanding her efforts to help her neighbors.

Lozoya is working to bring better food to one of the poorest communities in America, where neon lights illuminate a greasy fast-food vista and obesity and diabetes are rampant. While grocery stores and healthy restaurants are scarce, corner stores are stocked with beer, cigarettes, fried snacks and fatty sweets.

Lozoya's work with high school classmates to urge bodegas to stock healthier options is part of a larger campaign nationwide by nutritionists and community activists to eradicate so-called food deserts.

"Deserts are naturally occurring things," said Joanne Kim, chief operating officer of the Community Coalition of South Los Angeles. "We call this food apartheid because people have chosen to locate elsewhere even though there is substantial purchasing power here."

Between the three major Southern California grocery chains — Ralphs, Albertsons and Vons — there are six supermarkets in South Los Angeles, serving a population of about 688,000. By comparison, 19 supermarkets serve West Los Angeles' population of about 395,000.

Retailers blame theft in urban supermarkets, high employment turnover and lack of space for choosing to locate their stores elsewhere.

While farmers markets and trucks peddling fruits and vegetables have taken root in South Los Angeles, they are inconsistent and inadequate for the area's population, Kim said.

Some cities are trying to get more supermarkets into urban areas. The state of Pennsylvania invested $30 million five years ago and got 61 supermarkets opened in rural and urban areas.

Chicago and New Orleans are considering similar programs, but legislation to bring the same assistance to California cities died in the Legislature in 2006 due to budget constraints.

The food disparity in South Los Angeles is an echo of the area's history, marked by decades of segregation and racial strife, dating back before the deadly 1965 Watts riots.

In the state's post-riot report, residents alleged price gouging and the sale of stale bread, rancid meat and rotten produce — complaints that re-emerged decades later after race riots erupted in the wake of the Rodney King verdict in 1992, said City Councilwoman Jan Perry.

South Los Angeles has shifted from a mostly black to a mostly Hispanic community in the last decade, with Latinos making up about two-thirds of the population, according to 2006 Census figures.

Today, fast food is king in South L.A. Nearly three-quarters of restaurants offer food on the go, compared to 42 percent in pricier neighboring West Los Angeles.

The city's Community Redevelopment Agency estimates the area could support 14 new grocery stores and 74 more restaurants. But few businesses are biting on incentives that include hiring tax credits, 35 percent electricity discounts for a year and low interest loans.

"You throw public subsidies at them, and they still don't come," Kim said.

Like many residents of Lozoya's community, where 28 percent of households live below the federal poverty line, she relies on the small corner grocery a few blocks from her home for chicken, fruit and vegetables.

Until recently, Los Compadres Market and Restaurant looked like most others. But Lozoya and her classmates gave it a healthy makeover through a grant from The California Endowment, a private health foundation that aims to create healthy communities.

Chips and candy were removed from the front aisle of the store; a large cooler in the back was stocked with fresh fruits and vegetables; fruits were carefully laid out to avoid bruising; milk and cheese chilled alongside beer.

"These problems are really killing our communities," said Marion Standish, a program director for the endowment. "They're really disabling young people all over the state and limiting their potential in very serious ways, and limiting all of our potential as a result."

It's those limitations that Lozoya is trying to push past — even in her own quiet ways at home.

A few times, she's convinced her parents to drive 45 minutes to Beverly Hills, where her father, a contractor who doesn't consider a meal complete without red meat, balks at the price of the perfectly ripe berries Lozoya piles into the cart.

"When we get to the checkout he says, 'This is the last time! Never again!'" Lozoya said, wagging her finger in imitation. "Now, me and my mom try to pay when he isn't looking."

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Nursing home industry worries about new ratings

WASHINGTON – Rating systems help people decide which restaurants to go to or hotels to stay at. So why not something similar from the federal government for the nation's 16,000 nursing homes?

Such a simple rating for so complex a task as caring for the elderly is leading to much anxiety in the nursing home industry. Home operators worry about the ramifications for their business if they get one or two stars — when five is the best.

The Centers for Medicare and Medicaid Services was to let everyone know Thursday just how many stars each home is getting. Already the industry is questioning the validity of the rankings. To operators, the five-star system is a great idea whose time has not yet come.

The system "is poorly planned, prematurely implemented and hamhandedly rolled out," said Larry Minnix, president and chief executive officer of the American Association of Homes and Services for the Aging, an industry trade group.

Federal officials say the rankings will put nursing homes "on the path to improvement" because they know family members will think twice before putting someone in a one-star home.

The ratings are based on state inspections, staffing levels and quality measures, such as the percentage of residents with pressure sores. The nursing homes will receive stars for each of those categories as well as for their overall quality.

Consumer groups like the concept, but they agreed there are some potential problems with the data. For example, the staffing data is self-reported just before state surveys and is widely recognized as unreliable.

"From a consumer viewpoint, it's not stringent enough," said Alice H. Hedt, executive director of the National Citizens' Coalition for Nursing Home Reform. "It's basically taking information already available on Medicare's Nursing Home Compare Web site and pulling it into an easier system for consumers to use, and that is a good thing."

Hedt said consumers should consider the star ratings, but not solely rely on them when comparing facilities. Her organization also issued a press release warning that nursing homes may appear in the ratings to give better care than they actually do.

"Our initial reaction is that consumers should probably avoid any facility with a one- or two-star rating and even a three-star rating unless people they trust convince them that the rating is inaccurate or unfair," she said.

But, in Indiana, eight nonprofit nursing homes have reported they got one star for staffing even though they have some of the highest staffing levels in the states, said Jim Leich, president and chief executive officer of the Indiana Association of Homes for the Aging. He believes the one-star rating is the result of a records glitch particular to any nursing home that is part of a campus that includes housing for residents with less intensive care needs.

"It's really going to be an injustice for some of our best facilities," he said.

The Jennings Center for Older Adults in Garfield Heights, Ohio, got four stars for its nursing home, said Martha Kutik, the center's president and CEO. Still, she's worried that the rating system relies on surveys that measure cracks in the ceiling but don't measure patient and family satisfaction.

"Any system that's going to measure quality for consumers should keep satisfaction high on the list," Kutik said.

___

On the Net:

Medicare's Nursing Home Compare Web site: http://Medicare.gov/NHcom.

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Tumor in Colorado newborn's brain contained foot

COLORADO SPRINGS, Colo. – A pediatric neurosurgeon says a tumor he removed from the brain of a Colorado Springs infant contained a tiny foot and other partially formed body parts.

Dr. Paul Grabb said he operated on Sam Esquibel at Memorial Hospital for Children after an MRI showed a microscopic tumor on the newborn's brain. Sam was 3 days old and otherwise healthy.

Grabb said that while removing the growth, he discovered it contained a nearly perfect foot and the formation of another foot, a hand and a thigh.

"It looked like the breach delivery of a baby, coming out of the brain," Grabb said. "To find a perfectly formed structure (like this) is extremely unique, unusual, borderline unheard of."

Grabb isn't sure what caused the growth but says it may have been a type of congenital brain tumor. However, such tumors usually are less complex than a foot or hand, he said.

The growth may also have been a case of "fetus in fetu" — in which a fetal twin begins to form within another — but such cases very rarely occur in the brain, Grabb said.

Sam's parents, Tiffnie and Manuel Esquibel, said their son is at home now but faces monthly blood tests to check for signs of cancer or regrowth, along with physical therapy to improve the use of his neck. But they say he has mostly recovered from the Oct. 3 surgery.

"You'd never know if he didn't have a scar there," Tiffnie Esquibel said.

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Male circumcision lowers cervical cancer risk: study

WASHINGTON (Reuters) – Three studies published on Wednesday add to evidence that circumcision can protect men from the deadly AIDS virus and the sexually transmitted virus that causes cervical cancer.

The reports in the Journal of Infectious Diseases are likely to add to the debate over whether men -- and newborn boys -- should be circumcised to protect their health and perhaps the health of their future sexual partners.

Dr. Bertran Auvert of the University of Versailles in France and colleagues in South Africa tested more than 1,200 men visiting a clinic in South Africa,

They found under 15 percent of the circumcised men and 22 percent of the uncircumcised men were infected with the human papilloma virus, or HPV, which is the main cause of cervical cancer and genital warts.

"This finding explains why women with circumcised partners are at a lower risk of cervical cancer than other women," they wrote in their report.

A second paper looking at U.S. men had less clear-cut results, but Carrie Nielson of Oregon Health & Science University and colleagues said they found some indication that circumcision might protect men.

The circumcised men were about half as likely to have HPV as uncircumcised men, after adjustment for other differences between the two groups.

PREVENTING AIDS

In the third report, Lee Warner of the U.S. Centers for Disease Control and Prevention and colleagues tested African-American men in Baltimore and found 10 percent of those at high risk of infection with HIV who were circumcised had the virus, compared to 22 percent of those who were not.

"Circumcision was associated with substantially reduced HIV risk in patients with known HIV exposure, suggesting that results of other studies demonstrating reduced HIV risk for circumcision among heterosexual men likely can be generalized to the U.S. context," they wrote.

Studies supporting circumcision to reduce HIV transmission had all been done in Africa and U.S. studies were less clear.

Dr. Ronald Gray of Johns Hopkins University in Baltimore and colleagues said they found the reports encouraging.

"In the United States, circumcision is less common among African American and Hispanic men, who are also the subgroups most at risk of HIV," they wrote in a commentary.

"Thus, circumcision may afford an additional means of protection from HIV in these at-risk minorities."

But they noted that the American Academy of Pediatrics does not recommend routine circumcision for newborns.

"As a consequence of this AAP decision, Medicaid does not cover circumcision costs, and this is particularly disadvantageous for poorer African American and Hispanic boys who, as adults, may face high HIV exposure risk," Gray and colleagues wrote.

"It is also noteworthy that circumcision rates have been declining in the U.S., possibly because of lack of Medicaid coverage."

Medicaid is the state-federal health insurance program for the poor and disabled.

Thirty-three million people globally are infected with AIDS, which has no cure and no vaccine. HPV is the most common sexually transmitted infection in the world, with 20 million people in the United States infected. It causes cervical cancer, which kills 300,000 women globally every year.

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Effectiveness of peer-led sex education questioned

NEW YORK (Reuters Health) – Among 13 to 14 year-old girls who received either peer-led or teacher-led sex education, abortion rates by the age of 20 were the same -- 5 percent -- regardless of the education method, a study shows.

This may "temper high expectations" regarding the long-term impact of peer-led sex education, Judith Stephenson, of University College London, and colleagues comment in PLoS Medicine, a journal from the Public Library of Science.

However, there were some indications that the peer-led program reduced unwanted pregnancies, and Stephenson's group suggests further investigation of pupil-led sex education programs as part of a broader strategy to minimize teenage pregnancies.

"Peer-led sex education is widely believed to be an effective approach to reducing unsafe sex among young people, but reliable evidence from long-term studies is lacking," Stephenson and colleagues note.

The Randomized Intervention trial of Pupil-led sex Education, known as the RIPPLE trial, compared the efficacy of peer-led versus teacher-led sex education delivered to over 9000 male and female 8th grade students in the United Kingdom.

Peer-led sessions, conducted by specially trained older students, focused on information similar to that offered in the teacher-led program.

Follow-up through the age of 20.5 years showed 7.5 percent of girls taught in peer-led session had unintentional pregnancies compared with 10.6 percent of those taught in teacher-led sessions. This difference wasn't significant from a statistical standpoint, but the reduction in unintended pregnancies before age 18 was significant -- 7.2 percent versus 11.2 percent.

As noted, however, the investigators found no difference in the number of girls having abortions, and there were no differences in teens' reports of unprotected first sex, pressured sex, sexually transmitted diseases, contraception practices or use, or in the percentage of boys or girls reporting sex before age 18.

In a related commentary, Dr. David A. Ross, from the London School of Hygiene and Tropical Medicine, points out that the use of actual, rather than self-reported abortion and pregnancy data is the major strength of the Ripple trial.

However, "it does not tell us how effective either intervention was relative to no sexual health education," Ross told Reuters Health. Therefore, development and rigorous evaluation of approaches to reduce teens' adoption of risky sexual behaviors should continue, he said.

SOURCE: PLoS Medicine, November 2008.

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