Health-Medical-Fitness-Diet-zn

duminică, 2 septembrie 2012

California Hantavirus Outbreak Occurred in Spite of Precautions

The California Department of Public Health (CDPH) confirms six cases of recent hantavirus infection. Patients presenting with the disease had visited Yosemite National Park and stayed at or near the Boystown cabins of Curry Village.

Is the campground now closed?

Yosemite National Park officials closed all Boystown cabins on Tuesday. This closure remains in place indefinitely.

Are other Yosemite National Park campers affected?

Park staff is contacting all registered campers who "stayed in the Boystown area between June 10 and August 24." So far, no other cases of hantavirus infection are reported.

Is it possible for more infected campers to come forward?

Since the incubation time ranges from one to six weeks, it is possible that more cases will be reported.

How common is hantavirus in California?

As noted by the Desert Managers Group, between 1980 and 2006, California public health officials confirmed 46 cases of hantavirus. Nineteen patients were female, 27 were male. Sixteen cases proved fatal.

Who spreads the virus?

The recognized vector is the deer mouse (Peromyscus maniculatus), which is found throughout the State of California.

How did hantavirus infect the Yosemite campers?

The virus is spread via mouse feces and saliva. When the feces are swept up or otherwise disturbed, the virus becomes airborne. Breathing in the virus particles exposed the campers to the infection, which is known to lead to hantavirus pulmonary syndrome.

Is this type of outbreak unusual?

"We don't really know the basis behind this particular cluster of cases -- it may reflect the changing geographical distribution of the deer mouse, which typically favors higher elevations than Yosemite Valley," researchers from the University of California told Nature. Although Yosemite rangers acknowledge that more than 15 percent of local deer mice do carry the hantavirus, a 2010 change in cleaning protocols at the park was to protect against an outbreak.

Did California health officials report hantavirus infections in 2011?

No; the CDPH noted that there we no incidents of hantavirus cardiopulmonary syndrome reported between June 2011 and December 2011.

Were there prior virus outbreaks?

In its epidemiologic summary, the public health officials note that in 2001, 2005 and 2008 there were no cases reported at all. The highest number of reported cases occurred in 2002 and 2007. Officials identified possible sites of exposure as being in counties of Inyo, Mono, Alpine, El Dorado, Nevada, Plumas and Sierra.

Is camping in Yosemite National Park now unsafe?

CBS Sacramento quotes Department of Public Health officials, who encourage visitors to Yosemite National Park to not cancel their camping plans. Some visitors take the news of the hantavirus outbreak in a stride. "You're kind of in the woods and in their territory and mice are going to be here," a Fresno camper told CBS.

Sylvia Cochran is a Los Angeles area resident with a firm finger on the pulse of California politics. Talk radio junkie, community volunteer and politically independent, she scrutinizes the good and the bad from both sides of the political aisle.

CDC says 10,000 at risk of hantavirus in Yosemite outbreak

The CDC urged lab testing of patients who exhibit symptoms consistent with the lung disease, hantavirus pulmonary syndrome, after a stay at the California park between June and August and recommended that doctors notify state health departments when it is found.

Two men have died from hantavirus linked to the Yosemite outbreak and four others were sickened but survived, while the CDC said additional suspected cases were being investigated from "multiple health jurisdictions."

Most of the victims were believed to have been infected while staying in one of 91 "Signature" tent-style cabins in Yosemite's popular Curry Village camping area.

"An estimated 10,000 persons stayed in the 'Signature Tent Cabins' from June 10 through August 24, 2012," the CDC said. "People who stayed in the tents between June 10 and August 24 may be at risk of developing HPS in the next six weeks."

Yosemite officials earlier this week shut down all 91 of the insulated tent cabins after finding deer mice, which carry the disease and can burrow through holes the size of pencil erasers, nesting between the double walls.

Park authorities said on Friday that they had contacted approximately 3,000 parties of visitors who stayed in the tent cabins since mid-June, advising them to seek immediate medical attention if they have symptoms of hantavirus.

Nearly 4 million people visit Yosemite, one of the nation's most popular national parks, each year, attracted to the its dramatic scenery and hiking trails. Roughly 70 percent of those visitors congregate in Yosemite Valley, where Curry Village is located.

YOSEMITE LOGS 1,500 CALLS

The virus starts out causing flu-like symptoms, including headache, fever, muscle ache, shortness of breath and cough, and can lead to severe breathing difficulties and death.

The incubation period for the virus is typically two to four weeks after exposure, the CDC said, with a range between a few days and six weeks. Just over a third of cases are fatal.

"Providers are reminded to consider the diagnosis of HPS in all persons presenting with clinically compatible illness and to ask about potential rodent exposure or if they had recently visited Yosemite National Park," the CDC said.

Although there is no cure for hantavirus, which has never been known to be transmitted between humans, treatment after early detection through blood tests can save lives.

"Early medical attention and diagnosis of hantavirus are critical," Yosemite superintendent Don Neubacher said in a statement. "We urge anyone who may have been exposed to the infection to see their doctor at the first sign of symptoms and to advise them of the potential of hantavirus."

Yosemite spokeswoman Kari Cobb said rangers have answered some 1,500 phone calls from park visitors and others concerned about the disease. But she said the outbreak had not triggered a wave of cancellations

"Right now it's normal numbers for Friday," she said. "There have been cancellations, but it would be grossly overstated to say they're cancelling en masse. There's quite a bit of people out there still. It's still summer and a holiday weekend. It's still the summer crowds."

A national park service officials has said that public health officials warned the park twice before about hantavirus after it struck visitors. But it was not until this week that the hiding place for the deer mice carrying the virus was found.

Hantavirus is carried in rodent feces, urine and saliva, which dries out and mixes with dust that can be inhaled by humans, especially in small, confined spaces with poor ventilation.

People can also be infected by eating contaminated food, touching contaminated surfaces or being bitten by infected rodents.

(Editing by Cynthia Johnston, Todd Eastham and Lisa Shumaker)

Thalidomide victims reject 'insulting' apology

In its first apology for the scandal in 50 years, Grunenthal said on Friday it was "very sorry" for its silence towards victims of the drug, which was sold to pregnant women in the 1950s and early 1960s to cure morning sickness.

But victims said the apology was too little, too late for the estimated 10,000 children worldwide who were born with defects -- including missing limbs -- after their mothers took thalidomide.

"We feel that a sincere and genuine apology is one which actually admits wrongdoing. The company has not done that and has really insulted the Thalidomiders," British victim Nick Dobrik told BBC radio.

Victims' charities estimate that there are between 5,000 and 6,000 people still living who were deformed by the drug, which was sold in nearly 50 countries before it was pulled from the market in 1961 amid one of the world's biggest medical scandals.

Thalidomide babies were often born with missing or extremely short arms and legs. Billed as a "wonder drug" to cure everything from morning sickness to insomnia, thalidomide also caused blindness and malformed organs.

The countries most affected included Germany, Britain, Japan, Canada and Australia. It was not banned in Canada, Japan and Belgium until 1962.

Freddie Astbury, president of the charity Thalidomide UK, said Grunenthal needed to "put their money where their mouth is" and compensate victims rather than simply saying sorry.

"If they are serious about admitting they are at fault and regret what happened they need to start helping those of us who were affected financially," said Astbury, who was born without arms and legs after his mother took the drug.

Lawyers for Australian survivors described the belated apology as "pathetic".

"It is too little, too late and riddled with further deceit," lawyers for Australian victim Lynette Rowe said in a statement.

"To suggest that its long silence before today ought to be put down to 'silent shock' on its part is insulting nonsense.

"For 50 years Grunenthal has been engaged in a calculated corporate strategy to avoid the moral, legal and financial consequences of its reckless and negligent actions of the 1950s and 1960s."

Rowe's lawyers said it would have been better for Grunenthal to release its private records to the world, including those it recently handed over in a class action led by her.

Court papers used in the case allege that the drug's makers were warned of birth defects some two years before thalidomide was withdrawn from the market.

Rowe has reached a multi-million dollar settlement with another firm that distributed the drug, and her case against Grunenthal is currently on hold.

A Japanese support group for Thalidomide victims also said the apology was not good enough.

"An apology is a matter of course," said Tsugumichi Sato, director-general of "Ishizue" Thalidomide Welfare Centre in Japan, one of the major countries affected by the drug disaster after Germany and Britain.

"The number of victims would have been smaller if the company had stopped its sales earlier," Sato said. "We are closely watching what responsibility the company will take on top of apologies."

Grunenthal's chief executive Harald Stock said on Friday that he wanted to express the company's "sincere regrets" and "deepest sympathies" to those affected by the medical disaster.

"We ask that you regard our long silence as a sign of the shock that your fate has caused us," he said at the inauguration of a memorial to victims in Stolberg, western Germany, near Grunenthal's headquarters.

"We also apologise for the fact that we have not found the way to you from person to person for almost 50 years. Instead, we have been silent and we are very sorry for that."

He spoke as a statue of a little girl with no arms or legs was unveiled at Stolberg.

Stock said his firm was taking steps to help thalidomide victims. "We have a responsibility and we face it openly," he said.

"We have learned how important it is that we engage in an open dialogue with those affected and to talk and to listen to them."

Soccer-Man City striker Balotelli needs minor eye surgery

Balotelli needs surgery on a minor eye condition, first team

coach David Platt said on Saturday.

"Mario will have an operation in a few days," Platt told

City's website (www.mcfc.co.uk) after the 3-1 home victory over

Queens Park Rangers in the English Premier League.

"It's not a major procedure and he should be back quite

quickly. I've heard suggestions he will be out for a month but

that's not true.

"Hopefully it will correct a problem he's been having for

some time and he can move on from there," added Platt.

Balotelli was an unused substitute for Saturday's match as

Rangers were sunk by goals from Yaya Toure, Edin Dzeko and

Carlos Tevez.

Bobby Zamora was on target for the visitors in the second

half.

City are fourth in the league, two points behind leaders

Chelsea, with seven points from three matches.

(Reporting by Matt Barker; editing by Tony Jimenez)

Sheriff: Man stole doctor's ID, saw 500 patients

Ernest Addo of Austell, Ga., is charged with unlawful practice of medicine and obtaining goods under false pretense, authorities said.

Addo doesn't have a medical license in the U.S. But he assumed a doctor friend's identity, getting a driver's license and presenting the massive amount of paperwork needed to prove he was a doctor. The documents were given to him by the friend in hopes they could open a medical clinic together when the real doctor returned from a yearlong trip to Ghana, Lexington County Sheriff James Metts said.

The real doctor, Arthur Kennedy, said he is embarrassed and devastated by what his friend did.

Addo did have some medical training, and acted enough like a doctor not to raise any serious suspicion beyond one nurse — interviewed after Addo's Aug. 24, arrest — who wondered why he consulted ask.com when she questioned his treatment plan, Metts said.

The motive appears to be greed, the sheriff said. Court documents show Addo has a history of financial trouble.

Records obtained by The Associated Press show in the past 20 years, at least two dozen liens have been filed against Addo for around $200,000, including unpaid rent, credit card bills, student loans and taxes. Addo has declared bankruptcy twice.

After Addo's arrest last week at his Georgia home, officers found fake IDs and other documents, and Metts said it appears Addo might have tried to fake his way through other lucrative careers, too. The sheriff wouldn't specify which ones.

"He seems to be a professional con guy," Metts said.

Authorities have said Addo received more than $10,000 for his services but declined to elaborate. One of the jobs also gave him the use of a Mercedes.

Addo, 48, has been jailed in Cobb County, Ga., since his arrest, and neither the sheriff nor jail officials knew if he had an attorney. Addo is refusing to talk to authorities, and both his home phone and cellphone have been disconnected.

Addo faces more than a decade in prison for his current charges, but he could end up in even more trouble. Metts said his investigators are reviewing the medical records of more than 500 patients Addo saw while at four Columbia-area senior centers and a rehabilitation center owned by Agape Senior Primary Care.

Metts said some of those patients died. He said more charges could follow if any of those deaths were linked to Addo's actions.

Addo was hired as a general practitioner and provided the kind of exams patients would receive during a visit to the family doctor. Authorities said he also wrote prescriptions, including some for himself.

Officials at Agape are doing their own review of the care patients received from Addo. They said he never had sole clinical oversight of any patient.

"We have found no inappropriate diagnosis or plan of treatment. We are convinced that all of our patients are safe and receiving proper care," Agape CEO Scott Middleton said in a statement.

Addo also worked as a contract doctor for the South Carolina Department of Mental Health, filling in for a doctor on medical leave. Officials there said they also are reviewing Addo's care and have not found any serious issues.

Patients treated by Addo could not be located by The Associated Press for comment.

Authorities started investigating Addo after he made a small mistake on a death certificate. South Carolina health officials trying to fix the error contacted the doctor Addo was impersonating. He told them he hadn't practiced medicine for a year in the state because he was teaching at a medical school in Ghana.

Officials have refused to release that doctor's name, but Kennedy confirmed his identity was stolen.

Kennedy said he was betrayed by his friend. Addo also obtained credit cards in Kennedy's name, creating an even bigger mess to clean up, the doctor said Wednesday outside his home in Orangeburg.

He said he didn't want to answer detailed questions about what happened until he spoke to a lawyer.

Both Kennedy and Addo are from Ghana. Kennedy ran unsuccessfully for president of the west African nation in 2008. He had a family practice in Orangeburg and spent plenty of time in his homeland, pushing for public health improvements. The two men resemble each other, and Addo used Kennedy's reputation to help get him the doctor jobs. Agape said in a statement it hired him in part because he came highly recommended.

Both Agape and Jackson & Coker, the Alpharetta, Ga., physician recruitment firm that placed Addo with the Department of Mental Health, have promised to help authorities. Metts said it could take months for investigators to go through all the medical records.

Jackson & Coker also is exploring any legal action it could take against Addo and is shocked he was able to obtain all the documents someone would need to prove he was a doctor in the United States, spokeswoman Susan Meyers said.

"He was hired the same way in several different places," Meyers said. "There were no red flags."

___

Collins can be reached at http://twitter.com/JSCollinsAP

Thalidomide Maker Apologizes 50 Years Later

The pharmaceutical company responsible for a morning sickness drug that left thousands of infants with birth defects -- including flipper-like limbs -- has finally apologized, more than five decades after the drug was recalled in 1961.

Grunenthal, the company that made thalidomide, attributed its 50-year lack of an apology "as a sign of silent shock," Grunenthal CEO Harald Stock said at the unveiling of a statue for the drug's birth defect victims in Stolberg, Germany on Friday.

"In numerous talks with those affected, but also, for example, with the ministry of Health, Equalities, Care and Ageing of North Rhine-Westphalia -- especially in the last few months -- we learned how much it is publically desired that we express our deep regrets to those affected by Thalidomide, and in particular to their mothers," Stock said.

One thalidomide victim's mother, Wendy Rowe, said Stock's remark was insulting, according to the Australian Broadcasting Company. She took the drug for one month of her pregnancy, causing her daughter, Lynne to be born without arms or legs.

"Our family couldn't have gone into silent shock. We had to get up and face each day every day and cope with the incredible damage Grunenthal had done to Lynne and our family," she told the news outlet. "Shock is having your precious child born without arms and legs. It's accepting that your child is not going to have that life that you wanted for her."

The statue created by artist Johannes Igel depicts a girl with hands but no arms in one chair and another empty chair.

An estimated 10,000 children were born with birth defects from thalidomide, many of whom died. Thalidomide sold in 46 countries but never gained FDA approval in the United States. An estimated 40 babies were born with thalidomide-related deformities in the United States, according to the New York Times.

By 1961, the German pharmaceutical company took the drug off the market.

Stock explained in his speech that Grunenthal could not have detected the problems its drug posed in unborn children.

"Hence the drug was taken by many women who had no reason to imagine that it could seriously harm their unborn children," he said. "We apologize for the fact that we have not found the way to you from person to person for almost 50 years. Instead, we have been silent and we are sorry for that."

Now, thalidomide is used for treating multiple myeloma (a cancer that starts in the bone marrow) in the United States, where it has warnings that even a single dose could cause "severe birth defects," according to the National Institutes of Health.

If women have not had a hysterectomy or stopped menstruating for two years, they are required to use two forms of birth control and take regular pregnancy tests while on thalidomide.

Boomers retiring to rural areas won't find doctors

After a year of going from doctor to doctor, she finally found one who stuck.

As record numbers of baby boomers go into retirement, many are thinking about moving from the places they needed to live to make a living, and going someplace warmer, quieter or prettier.

If they choose small towns like Grants Pass, 250 miles south of Portland, they could well have a hard time finding a family doctor willing to take Medicare, even supplemental plans, rather than private insurance.

"It's a sad situation for seniors," she said.

There are several reasons boomers, the 78 million Americans born between 1946 and 1964, could face difficulties finding a doctor if they retire to small towns over the next 20 years.

First, many primary care doctors prefer to live and work in urban areas because of greater cultural opportunities, better schools and job opportunities for spouses.

Also, Medicare pays rural doctors less per procedure than urban physicians because their operating costs are supposedly less. That makes rural doctors less likely to accept Medicare patients.

With cuts to Medicare reimbursement for doctors targeted under the federal health care overhaul, the shortage is likely to get even worse, said Mark Pauly, professor of health care management at the University of Pennsylvania.

That is, unless increasing reimbursements for nurse practitioners and physicians' assistants encourages those providers to take up the slack, Pauly said.

If the Medicare cuts go through, "the doctors are saying: "We're out of here,'" Pauly said. "The least they are saying is: 'We'll treat Medicare patients like we treat Medicaid patients,' which is mostly not."

Still, there is some good news, depending on where you live.

Pauly said the Affordable Care Act "puts a lot of emphasis on wellness programs and primary care. Nurses, especially nurse practitioners, are intended to play a major role there."

In Oregon, Washington and 14 other states, nurses and nurse practioners "can operate independently of doctors, writing prescriptions, ordering tests, and even running clinics," Pauly said.

Nationwide, the 22.5 percent of primary care doctors who practice in rural areas roughly matches the 24 percent of Medicare patients living there, said Dr. Roland Goertz, chairman of the American Academy of Family Physicians board.

A survey of academy members nationwide shows 83 percent take new Medicare patients. But there is an overall shortage of primary care physicians that still makes it hard for retirees to find a family doctor.

The real problem, he said, is that the health care system "has not supported a robust, adequate primary care workforce for over 30 years."

According to the American Association of Medical Colleges, rural areas need about 20,000 primary care doctors to make up for the shortages, but only about 16,500 medical doctors and 3,500 doctors of osteopathy graduate yearly.

"We are always trying to recruit doctors. We are barely keeping even," said Lyle Jackson, the medical director at the Mid-Rogue Independent Physician Association, a cooperative of doctors in Josephine County, where Musselman lives.

Taking part in the Medicare Advantage program, which pays a higher rate to doctors than standard Medicare, helps, but is still not enough, said Jackson, a former family physician.

A 2009 survey of doctors in the Oregon Medical Association showed concern over Medicare reimbursement rates topping the list of 23 issues, with 79 percent rating it as very important, said Joy Conklin, an official at the association.

The survey showed 19.1 percent of Oregon doctors had closed their practices to Medicare, and 28.1 percent had restricted the numbers of Medicare patients.

That really becomes evident in Josephine County, which attracted retirees after the timber industry collapsed.

Low taxes, cheap housing, wineries, a symphony and low traffic put it in top 10 lists for retirement communities. The 2010 census puts the number of people older than 65 at 23 percent, compared to 14 percent for the state.

But the website County Health Rankings & Roadmaps, which gathers a wide range of health care data nationwide, shows 933 patients for every primary care physician in the county, nearly 50 percent higher than the national 631-to-one rate.

At the Grants Pass Clinic, Dr. Bruce Stowell said they are no longer taking new Medicare patients. Medicare pays about 45 percent of what commercial insurance pays.

As it is, their proportion of Medicare patients is double that of a similar Portland practice.

"We used to get a steady stream of high-quality (resumes) from U.S.-trained and U.S.-born physicians," he said. "Over the last year, that stream has declined into a trickle. Very few (doctors) are choosing to go into primary care."

Schools are turning out more nurse practitioners and physician assistants.

How well they fill the doctor gap will depend largely on how much independence states give them to practice, said Tay Kopanos, director of health care policy for state affairs at the American Academy of Nurse Practitioners.

Meanwhile, overall demand for primary care will be increasing as more people can afford it under the Affordable Care Act, said Joanne Spetz, a health care policy professor at the University of California, San Francisco.

Dr. Atul Grover, chief of public policy for the American Association of Medical Colleges, said the nation is facing a tough time recruiting for primary care as well as other specialties that treat Medicare patients, such as oncologists.

When he decided to become a primary care doctor in the 1990s, it was because of a widespread belief that health maintenance organizations were going to be hiring all the doctors.

He said they wanted primary care doctors to emphasize wellness and prevention. Now, many graduates are moving into specialties that do procedures, such as surgery, because Medicare pays more for them than plain-old office visits.

Also, the Balanced Budget Act of 1997 capped the number of residencies paid by Medicare, so there is no quick way to increase the numbers of doctors in general, let alone in rural areas, he said.

"An entire year's worth of doctor production is needed to deal with the (rural-area) shortage just today," he said.