Health-Medical-Fitness-Diet-zn: 2012

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.

Is Meditation a Cure for Loneliness?

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CNN reports that a new study led by J. David Creswell, assistant professor of psychology at Carnegie Mellon, confirms some of what science already knows?mindfulness meditation is therapeutic for relieving stress. But in addition to that, Creswell’s study, which focused on the benefits of meditation for seniors, confirmed new and previously unexplored advantages of the practice, such as decreasing loneliness and reducing the bodily inflammation associated with disease in adults.

Creswell notes that loneliness in adults?particularly in the elderly?can be as detrimental to their health as smoking. He explains to CNN, "It's a big problem. Lots of researchers have tried to find ways, like social networks created through community centers, to reduce loneliness in older adults, but none of the approaches really works well."

The difficulty with attacking the problem from that angle, as Creswell explains, is that loneliness isn’t necessarily due to a low number of social contacts. Instead, it’s really about having a subjective perception of feeling disconnected. In his study, Creswell was able to prove that for the participants, mindfulness meditation decreased their feelings of disconnection. Conversely, the control group who abstained from meditation felt their condition stayed the same, or became worse.

But decreased loneliness wasn't the only benefit found during the study. Blood tests were administered to all participants before and after treatment. In comparison to the control group, the meditators showed a significant reduction in blood markers for inflammation after eight weeks of practice. Bodily inflammation plays a key role in the development of diseases, such as Alzheimer's, heart disease, cancer, diabetes, and a multitude of others.

Creswell explains, "It is amazing. For the first time, we are seeing that a behavioral practice?paying attention to your experience from moment to moment?has the power to change the gene expression in your immune cells."

Creswell explains that the next step will be replicating the study on a larger scale and incorporating other age groups.

What would it take for you to incorporate a daily mindfulnes meditation practice into your health regimen?

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A Bay Area native, Andri Antoniades previously worked as a fashion industry journalist and medical writer. In addition to reporting the weekend news on TakePart, she volunteers as a web editor for locally-based nonprofits and works as a freelance feature writer for TimeOutLA.com. Email Andri | @andritweets | TakePart.com

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NEW YORK (TheWrap.com) - CBS is in talks with Oscar winner Robin Williams and producer David E. Kelley about a series set at an advertising firm in which Williams would star. No deal is done. But the show would mark a surprising return to television for Williams, who rose to fame in the "Happy Days" spinoff "Mork and Mindy," a series that ended three decades ago. Kelley has a knack for shepherding movie stars into TV shows: He recently led the Kathy Bates vehicle "Harry's Law," which was canceled after two seasons, and presided over "Boston Legal" with James Spader and William Shatner. ...

Thousands call Yosemite hotline to ask about virus

At least six rangers, and often more, are staffing phones this week to answer questions from visitors wondering whether they're in danger of exposure to hantavirus pulmonary syndrome, park spokesman Scott Gediman said.

"We're reaching out and they are reaching out to us, and we are trying in every way shape and form to be transparent and forthright," he said. "We want to tell people this is what we know. The most important thing is the safety of park visitors and employees."

On Thursday the California Department of Public Health confirmed that a total of six people have contracted the disease at Yosemite, up from four suspected cases earlier in the week. Two of those people have died from the illness that can cause rapid acute respiratory and organ failure.

Alerts sent to state and county public health agencies, as well as local doctors and hospitals, have turned up other suspected cases that have not yet been confirmed, according to the Centers for Disease Control and Prevention.

"Additional suspected cases are being investigated from multiple health jurisdictions," the CDC said in an advisory issued to health care providers.

The illness can take six weeks to incubate. There is no cure, and anyone exhibiting the symptoms must be hospitalized. More than 36 percent of people who contract the rare illness will die from it.

All of the victims confirmed so far stayed in insulated "Signature" tent cabins in the park's historic Curry Village section between mid-June and early July. The victims' cabins were within about 100 feet of each other, park officials said.

Park concessionaire Delaware North Co. sent letters and emails this week to nearly 3,000 people who stayed in the affected area between June and August warning them that they might have been exposed. It tells them to seek treatment if they exhibit symptoms: chills, fever, gastric problems and muscle ache, followed rapidly by difficulty breathing.

At least 7,000 people stayed in other "Signature" cabins separate from the outbreak area during the same period, the CDC said.

Park officials worked quickly to disinfect all 400 of the Curry Village cabins when the outbreak first was detected earlier this month. When the outbreak was narrowed to the 91 double-walled insulated cabins, the California Department of Public Health ordered them shut down Tuesday.

Park officials said the double-walled design of those particular cabins made it easy for mice to nest between the walls. The disease is carried in the feces, urine and saliva of deer mice and other rodents and carried on airborne aerosol particles and dust.

As the busy Labor Day weekend launches and word about the outbreak spread, some guests were cancelling lodging reservations at the park. But Gediman says others on waiting lists for hard-to-get accommodations are snapping them up.

The hantavirus outbreak occurred despite park officials' efforts to step up protections.

A 2010 report from the state health department warned park officials that rodent inspection efforts should be increased after a visitor to the Tuolumne Meadows area of the park fell ill.

The report revealed 18 percent of mice trapped for testing at various locations around the park were positive for hantavirus.

"Inspections for rodent infestations and appropriate exclusion efforts, particularly for buildings where people sleep, should be enhanced," it said.

The park's new hantavirus policy, enacted April 25, was designed to provide a safe place, "free from recognized hazards that may cause serious physical harm or death."

The 91 insulated, high-end canvas cabins in the century-old Curry Village are new to the park. They were constructed in 2009 to replace some that had been closed or damaged after parts of Curry Village, which sits below the 3,000-foot Glacier Point promontory, were determined to be in a rock-fall hazard zone.

Upon taking them apart for cleaning, park employees found evidence of mouse nests in the insulation.

The deer mice most prone to carrying the virus can squeeze through holes just one-quarter-inch in diameter. They are distinguished from solid-colored house mice by their white bellies and gray and brown bodies.

In 2011, half of the 24 U.S. hantavirus cases ended in death. But since 1993, when the virus first was identified, the average death rate is 36 percent, according to the CDC.

The Yosemite hotline number is 209-372-0822. It's staffed from 9 a.m. to 5 p.m. Pacific Time.

___

Jason Dearen reported from San Francisco.

Reach Tracie Cone on Twitter: www.twitter.com/TConeAP

Lazy Moves That Ramp Up Health

Staying healthy can feel like so much, well, work (think: logging hours at the gym and whipping up nutritious meals from scratch). However, there are plenty of small moves that you can make in your everyday life that will have big health benefits.

We've rounded up 10 practically zero-effort ways to fight disease, whittle your waist, lower stress, and more. Bonus: Many of these good-for-you moves feel good, too. So say sayonara to the old adage, "no pain, no gain" and try these tips today.

8 Lazy Ways To Flatten Your Belly

Protect Your Ticker By Snoozing

Need a good excuse to grab your comfiest set of pajamas and hit the sack? Skimping on shut-eye may do more than make you cranky or unproductive—it also boosts your risk of a heart attack.

According to one Norwegian study, people who reported that they did not wake up feeling refreshed in the morning had a 27 percent higher risk of a heart attack, those who had trouble staying asleep almost every night in the last month had a 30 percent higher risk, and those who had trouble falling asleep almost every night in the last month had odds that jumped to 45 percent.

Some researchers speculate that insomnia might trigger your body to release more of the stress hormone cortisol. High levels of cortisol have been linked with high blood pressure and diabetes, which are both risk factors for cardiovascular disease.

Plus, when you're exhausted you may be more likely to make unhealthy choices that up your heart disease risk, such as skipping your workout or reaching for fatty or sugary snacks for a quick energy fix.

10 Ways To Get Your Best Night's Sleep Ever

Ward Off Weight Gain with Protein

You may not have to stress so much about cutting calories: Whether you're packing on the pounds or simply want to maintain your current weight, adding more protein to your dish could be your slim-down secret weapon. Past research has found that protein keeps you feeling full longer than either carbs or fat, so you can eat less and still be satiated.

A new study supports this idea: Researchers from the University of Sydney estimated that the extra calories eaten by participants in their study eating the lowest protein diets could add up to an extra 2.2 pounds of weight gain a month.

Protein is the building block of muscle, and more calories are required to maintain muscle than to preserve fat, which means muscle helps boost your metabolism. Bonus: Foods rich in protein are also filled with zinc and B vitamins, both of which strengthen your immune system to ward off colds and flu.

If you're eating about 1,800 calories a day and want to get 15 percent of your calories from protein, you should aim for about 68 grams of protein. Here are 3 easy protein switches that up your protein intake for the same number of calories or less. Remember, you want to eat more protein—not calories!—to keep your waistline slim.

Instead of…1/2 cup granola with 1 cup berries (7 grams protein, 250 calories) Try…1/2 cup low-fat cottage cheese with 1 cup berries (15 grams protein, 131 calories) Instead of…1 ¼ cup mashed potatoes (5 grams protein, 296 calories) Try…1 ¼ cup vegetarian baked beans (15 grams protein, 295 calories) Instead of…6-inch pancake sans butter or syrup (5 grams protein, 175 calories) Try…1 cup low-fat plain yogurt with ½ cup apricots (13 grams protein, 186 calories)

6 Grab And Go Proteins

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Forget Marcus Welby: Today's docs want a real life

True, they may shun a 24/7 on-call solo practice and try to have a life outside of work.

Yet they say they're just as committed to medicine as kindly Marcus Welby from 1970s TV, or even grumpy Dr. House.

The practice of medicine is in the midst of an evolution, and millennial and Gen X doctors seem to be perfectly suited for it and in some ways may be driving it. The federal health care law is speeding some of these changes, too.

"It's a fortunate accident," said economist and health policy expert Robert Reischauer. "The two will reinforce each other."

These doctors embrace technology and teamwork. They like electronic medical records and smartphone apps. And they like sharing the load with other doctors on the team.

Emal Nasiri and Leana Wen are part of the new breed.

Nasiri, 32, is a medical resident at the University of Oklahoma in Tulsa. He likes the idea of working in a large health plan group where doctors, specialists and other medical staff work as teams, with easy access to patients' electronic medical records. That kind of setup is more likely to be "wired" than smaller practices, and Nasiri can't imagine working without his iPad.

"The older guys carry around little pharmaceutical books" when going room-to-room visiting hospitalized patients, Nasiri said. He thinks that's less efficient than being able to quickly view patients' electronic charts and online drug information.

Wen, 29, will soon finish a residency in emergency medicine at Harvard-affiliated Brigham and Women's Hospital and Massachusetts General Hospital. She's also a newlywed whose husband is an information technology project manager.

"I want to have a balanced life that includes having time for my family," she said.

She chose emergency medicine because the hours are more flexible than those of primary care doctors. That will allow her to work part-time in the ER and follow her other passions — teaching, research, writing and blogging about empowering patients to get the best medical care.

Wen finds her smartphone as handy as her stethoscope. Its apps help her quickly figure out proper medicine doses for critically ill patients, or translate medical instructions for Spanish-speakers. That means she doesn't have to wait for a hospital translator to arrive, and she thinks it makes patient care safer.

She says those who call doctors with outside interests less committed have "a fairly limited world view."

"We need doctors who 'just' practice medicine, but we also need these other doctors who can improve medical care on the larger scale. It is also better to have those taking care of you to take care of themselves and their families, so I would argue that it is a healthier ... and in some ways, more balanced workforce that is emerging," Wen said.

Dr. Darrell Kirch, president of the Association of American Medical Colleges, thinks these new doctors have a broader view of medicine and life than their predecessors, and calls that a positive trend. "I see no evidence that indicates that their ethical commitment is any weaker, that they care any less for patients," he said.

When Kirch graduated from medical school 35 years ago, he envisioned starting a small solo practice, like many of his peers. A mentor steered him into research and work at an academic medical center. But that was not the norm.

"A typical model was of a male physician who plunged into medicine and was supported in doing that by a totally supportive spouse or partner who often gave up any work aspirations of their own," he said.

Newer doctors often have working partners and both share responsibility for raising children or caring for elderly parents, he noted.

Consider some statistics:

— When Kirch graduated in 1977, only about 20 percent of medical school graduates were women; now nearly half are.

—1 in 5 male doctors and 44 percent of female doctors employed by medical groups worked part-time last year, according to an American Medical Group Association survey. That compares with just 7 percent and 29 percent respectively in 2005.

—New doctors in their first year of medical residency training can no longer work 24-hour shifts. Since last year, they've been limited to 16-hour shifts. Stricter limits began in 2003, cutting residents' maximum weekly hours to 80, to improve grueling schedules and reduce medical mistakes.

— A 2011 survey of final-year medical residents conducted by national physician recruitment firm Merritt Hawkins found that only 1 percent wanted to work as solo practitioners, running their own small medical offices.

—Rising numbers of medical school graduates are seeking training programs in high-paying specialties offering flexible hours; emergency medicine and anesthesiology saw some of the biggest increases in this year's medical resident match program.

Those two specialties are popular among young doctors, who on average face more than $150,000 in medical school debt. The others are radiology, ophthalmology and dermatology, all offering better pay and work hours than primary-care medicine.

Also rising in popularity are hospitalists, a specialty that didn't even exist a generation ago. For decades, internists and other primary-care doctors have typically provided part-time care for their patients when they were hospitalized. Increasingly, hospitalists have taken over those duties full time. They often work several 12-hour shifts in a row, with an equal number of days off — the so-called seven on-seven off model.

Dr. John Schumann runs the internal medicine residency program at OU-Tulsa; among the 14 young doctors who finished the program last year, nine became hospitalists, Schumann said.

Nasiri, the tech-loving resident, is also considering hospitalist work.

He's getting married in November and says the long stretches of time off would be more family-friendly and allow him to pursue hobbies, including snowboarding.

He views technology as improving efficiency so that "spending less time doesn't necessarily mean less dedication or worse patient care. More experience with years doesn't necessarily mean better doctors if the older generation isn't keeping up with newer treatment modalities and approaches to patient care."

Kirch, of the medical college association, agrees. When he visits campuses and asks students how they differ from his generation, "they almost always point to the readiness with which they embrace technology."

He's noticed another trend on those visits. Schools used to show off vast medical libraries, "taking pride in how many volumes were sitting on the shelves," Kirch said.

Now, less is more. At one of the newest medical schools, the University of Central Florida in Orlando, "they point with pride to one small room near the entrance, and in that room they hold the books and journals that cannot be accessed online." Their goal, Kirch said, is for that room to be empty.

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Online:

American Association of Medical Colleges: http://www.aamc.org

National Resident Marching Program: http://www.nrmp.org

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AP Medical Writer Lindsey Tanner can be reached at http://www.twitter.com/LindseyTanner

U.N. says Haiti struggling to cope with cholera as aid withdrawn

In a report to the U.N. Security Council, Ban said there had been an increase in the number of cholera cases since the rainy season began in early March and the World Health Organization had projected there could be up to 112,000 cases during 2012.

The cholera outbreak has sickened almost 600,000 people and killed more than 7,400 in the Caribbean nation since October 2010. Some Haitians accused Nepalese U.N. troops of sparking the epidemic after their camp latrines contaminated a river.

"The resurgence of the cholera outbreak is particularly worrying since non-governmental organizations which responded at the beginning of the epidemic are phasing out due to lack of funding," Ban said.

"As a consequence, the support for the transfer of responsibilities to the Health Ministry, as foreseen in the national strategy, has decreased, as has the capacity for the effective treatment of cholera cases," he said.

Cholera is an infection that causes severe diarrhea and can lead to dehydration and death. It occurs in places with poor sanitation and can be treated by drinking clean fluids.

Haiti is still struggling to lift itself from the rubble left by an earthquake in January 2010 that killed about 300,000 people and left more than 1.5 million homeless.

CUT TO PEACEKEEPERS

Ban said more than 390,000 people were still living in camps.

"Living conditions in the camps have deteriorated as humanitarian actors progressively withdraw due, among other reasons, to lack of funding," the secretary-general said.

"Haitians living in camps where sanitation standards are inadequate are extremely vulnerable to natural hazards as well as to acute diarrheal infections and cholera," he said. "Over 230,000 internally displaced persons are projected to still be living in camps by the end of 2012."

He said that by March 2012, only half the $5.50 billion pledged by the international community at a fundraising conference in 2010 had been spent.

Ban recommended that the Security Council extend a U.N. peacekeeping force in Haiti for a further year, but that the number of authorized troops and police be reduced by 1,710 to 8,871. There are now some 10,000 peacekeepers in Haiti and Ban suggested a gradual drawdown be completed by June 2013.

U.N. peacekeepers are gradually handing over security responsibility to the Haitian National Police.

The force, known as the United Nations Stabilization Mission in Haiti, or MINUSTAH, was established in 2004 and has been helping Haiti's short-staffed and ill-equipped police maintain security, especially during elections plagued by fraud and unrest. The force size was increased after the earthquake.

The force's activities would be further narrowed to core tasks achievable with a reasonable time "aimed at consolidating stabilization gains to a point beyond which the presence of a large peacekeeping operation will no longer be required," Ban said.

(Reporting by Michelle Nichols; Editing by Peter Cooney)

Induced labors may be tied to rise in preterm births

The number of preterm births across the U.S. rose by 30 percent between 1992 and 2004, and that increase may be attributable to the number of medically induced labors, which nearly doubled during the same period, researchers found.

Doctors induce labor in women for various reasons, including medical problems with the baby or a woman being past due for delivery. Some doctors, however, may be inducing labor around the 34th week of pregnancy, which is considered preterm even though it is near the end of a typical 37- to 39-week gestation.

Past studies have shown that being preterm - even late preterm - increases a baby's risk for complications soon after delivery, such as needing to be put on a respirator, as well as for problems later in life.

So the fear is that the rising number of preterm babies increases the number at risk for these complications.

The study's senior researcher said he doesn't think doctors are inducing labor for non-medical reasons; they may just be erring on the side of caution by delivering the babies early for good medical reasons.

The problem, said Dr. Michael Kramer, is that the decision to do early labor induction is "socially contagious."

"I think the threshold has been going down for induction over the years, and I don't think we've shown that's been a benefit," said Kramer, of the McGill University Faculty of Medicine in Montreal.

To see whether increased rates of labor induction were linked to the rise in preterm births, Kramer and his colleague used data from the U.S. National Center for Health Statistics to compare the labor induction and preterm birth rates in each state for non-Hispanic white women between 1992 to 1994 and 2002 to 2004.

Overall, preterm births increased by nearly a third over those 13 years, from 6.4 percent in 1992 to 8.5 percent in 2004. During that time, labor inductions rose from 13.7 percent in 1992 to 26 percent.

The researchers, who published their study in BJOG: An International Journal of Obstetrics & Gynaecology, also examined whether C-sections were linked to the rise in preterm births.

While there was a rise in C-sections throughout the U.S. during the study period, the researchers say that is not a major factor contributing to preterm births because most C-sections are done during naturally-occurring labors - not during early inductions of labor.

Kramer told Reuters Health that he believes doctors can curb the rise in preterm births without conferring additional risk on the babies. That goal is already being realized in Ohio.

Through an elective education program known as the Ohio Perinatal Quality Collaborative, more women appear to be delivering their babies near full term (39 to 41 weeks) instead of "near term" (36 to 38 weeks) since the initiative started in 2008.

"It's tremendously successful and thousands of women in Ohio have moved to late-term delivery from pre-term delivery," said Dr. Michele Walsh, a member of OPQC and chief of neonatology at UH Rainbow Babies & Children's Hospital in Cleveland.

For women in other states, Kramer told Reuters Health that women should be involved in their medical decisions and understand labor induction carries some risk.

SOURCE: http://bit.ly/T0RzT9 BJOG: An International Journal of Obstetrics & Gynaecology, online August 13, 2012.

German drug firm makes first apology for thalidomide

Gruenenthal Group's chief executive said the company wanted to apologize to mothers who took the drug during the 1950s and 1960s and to their children who suffered congenital birth defects as a result.

"We ask for forgiveness that for nearly 50 years we didn't find a way of reaching out to you from human being to human being," Harald Stock said. "We ask that you regard our long silence as a sign of the shock that your fate caused in us."

Stock spoke in the west German city of Stolberg, where the company is based, during the unveiling of a bronze statue symbolizing a child born without limbs because of thalidomide. The statue is called "the sick child" — a name German victims group object to since all the victims are now adults. In German, the name also implies cure.

The drug is a powerful sedative and was sold under the brand name Contergan in Germany. It was given to pregnant women mostly to combat morning sickness, but led to a wave of birth defects in Europe, Australia, Canada and Japan. Thalidomide was yanked from the market in 1961 and was also found to cause defects in the eyes, ears, heart, genitals and internal organs of developing babies.

Thalidomide was never approved for use in pregnant women in the United States.

Freddie Astbury, of Liverpool, England, was born without arms or legs after his mother took thalidomide. The 52-year-old said the apology was years long overdue.

"It's a disgrace that it's taken them 50 years to apologize," said Astbury, of the Thalidomide U.K. agency, an advocacy group for survivors. "I'm gobsmacked (astounded)," he said. "For years, (Gruenenthal) have insisted they never did anything wrong and refused to talk to us."

Astbury said the drug maker should apologize not just to the people affected, but to their families. He also said the company should offer compensation. "It's time to put their money where their mouth is," he said. "For me to drive costs about 50,000 pounds ($79,000) for a car with all the adaptations," he said. "A lot of us depend on specialist care and that runs into the millions."

Astbury said he and other U.K. survivors have received some money over the years from a trust set up by thalidomide's British distributor but that Gruenenthal has never agreed to settle.

"We invite them to sit around the table with us to see how far their apology will go," he said. "I don't think they've ever realized the impact they've had on peoples' lives."

Gruenenthal settled a lawsuit in Germany in 1972 — 11 years after stopping sales of the drug — and voiced its regret to the victims. But for decades, the company refused to admit liability, saying it had conducted all necessary clinical trial required at the time.

Stock reiterated that position Friday, insisting that "the suffering that occurred with Contergan 50 years ago happened in a world that is completely different from today" and the pharmaceutical industry had learned a valuable lesson from the incident.

"When it developed Contergan Gruenenthal acted on the basis of the available scientific knowledge at the time and met all the industry standards for the testing of new drugs that were known in the 1950s and 1960s," he said.

A German victims group rejected the company's apology as too little, too late.

"The apology as such doesn't help us deal with our everyday life," said Ilonka Stebritz, a spokeswoman for the Association of Contergan Victims. "What we need are other things."

Stebritz said that the 1970 settlement in Germany led to the creation of a €150 million fund for some 3,000 German victims, but that with a normal life expectancy of 85 years the money wasn't enough. In many other countries, victims are still waiting for compensation from Gruenenthal or its local distributors.

In July, an Australian woman born without arms and legs after her mother took thalidomide reached a multimillion dollar settlement with the drug's British distributor. Gruenenthal refused to settle. The lawsuit was part of a class action and more than 100 other survivors expect to have their claims heard in the next year.

Attorneys for Lynette Rowe said in a statement released Saturday that Grunenthal's apology rang hollow.

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

Thalidomide is still sold today, but as a treatment for multiple myeloma, a bone marrow cancer and leprosy. It is also being studied to see if it might be useful for other conditions including AIDS, arthritis and other cancers.

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Associated Press writers Maria Cheng in London and Kristen Gelineau in Sydney contributed to this report.

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NEW YORK (TheWrap.com) - CBS is in talks with Oscar winner Robin Williams and producer David E. Kelley about a series set at an advertising firm in which Williams would star. No deal is done. But the show would mark a surprising return to television for Williams, who rose to fame in the "Happy Days" spinoff "Mork and Mindy," a series that ended three decades ago. Kelley has a knack for shepherding movie stars into TV shows: He recently led the Kathy Bates vehicle "Harry's Law," which was canceled after two seasons, and presided over "Boston Legal" with James Spader and William Shatner. ...

Arkansas conservative group seeks to block medical pot vote

The lawsuit filed in the state Supreme Court by the Coalition to Preserve Arkansas Values argues the ballot's title, the Arkansas Medical Marijuana Act, is misleading and the act itself hard to understand at 8,000 words long.

"By introducing more addictive substances into society, it is a family values issue," said Jerry Cox, president of the Family Council Action Committee of Arkansas, part of the coalition seeking to block the measure.

The move illustrates the deep misgivings about medical cannabis in the country's traditionally more conservative South, even as 17 other states mostly in the Northeast and West allow the drug for medical purposes. California voters first took that step in 1996.

The battle over medical pot in Arkansas comes as voters in Washington state, Colorado and Oregon are set to decide in November on whether to legalize recreational use of the drug. Massachusetts will also have a medical pot ballot measure.

Arkansans for Compassionate Care spent all year circulating petitions for the ballot initiative to allow medical marijuana in the state, and last week it reached the state's threshold of over 62,000 valid signatures.

Because of Arkansas' strict procedures for ballot initiatives, it is often difficult for groups to challenge them.

"The challenger has the burden of proof," said John DiPippa, professor of law and public policy at the University of Arkansas at Little Rock. "There's often a back and forth between the sponsor and the attorney general before it is certified. All of that is designed to make it more difficult for successful ballot challenges."

DiPippa said such challenges often center on ambiguity in the ballot's name and title, but the Arkansas Attorney General's Office said it already covered that ground in previous dealings with the initiative's sponsors.

A poll released in July, before the initiative qualified for the ballot, from the Arkansas television program Talk Business and Hendrix College found 47 percent supported medical marijuana in the state compared to 46 percent against and 7 percent undecided. The poll of 585 likely voters had a margin of error of plus or minus 4 percent.

Christopher Kell, spokesperson for Arkansans for Compassionate Care, said voters were savvy and compassionate. "They understand that this bill provides a proven blueprint to state regulation of medical marijuana," he said.

According to an August filing with the Arkansas Ethics Commission, Arkansans for Compassionate Care has raised over $264,000 with the Washington, D.C.-based Marijuana Policy Project providing the vast majority of its funds.

Marijuana Policy Project is also the main backer of the initiative in Colorado to legalize pot for recreational use.

(Editing by Alex Dobuzinskis and Cynthia Johnston)

New York City health commissioner: scold or lifesaver?

Farley, a pediatrician and endurance athlete, says they are wrong about his efforts to help New Yorkers eat better, smoke less and exercise more -- moves that have been linked to New York's recent gains in average life expectancy, the biggest gains of any metro area in the country.

"Anybody who is first at doing something is going to get a lot of criticism. And this is New York, this is the way we deal with each other," said Farley, who hopes to roll out two of his most controversial health initiatives this month.

One is a plan to restrict the size of sugary drinks to 16 ounces or less nearly everywhere they are sold, which is expected to be approved soon by the city health board. The other is a push to have hospitals promote breastfeeding by making baby formula less available to new mothers.

Behind the desk in Farley's office in Queens are reminders of the marketing muscle he's up against: eye-catching tobacco products, colorful 23-ounce sugary drinks and a cache of baby formula sent unsolicited to an expectant mother on his staff.

The unquestionably fit Farley shared his height - 6 foot 2 inches - but declined to reveal his weight or age, although he appears to be in his mid-50s. Each day he leaves the Manhattan apartment he shares with his wife, also a pediatrician, and their four daughters for a 4-mile run, a 10-mile bike ride or weight lifting and a swim.

His chief vice is pastries, and he immediately regretted telling a reporter that as a boy in New Jersey he ducked into the woods to smoke cigarettes with friends until he was caught.

Farley graduated with honors from Haverford College. After receiving his medical degree from Tulane University, he spent 11 years with the Louisiana Office of Public Health.

He took the helm in New York in 2009 after Thomas Frieden left to run the U.S. Centers for Disease Control and Prevention. As the head of an agency with 6,000 employees and a $1.6 billion budget, Farley today shoulders what he calls Bloomberg's legacy as "the world's first public health mayor."

Along with his predecessor, Farley is credited with pioneering bans on smoking and trans fats, mandates to reduce salt and post calorie counts, and initiatives that pushed junk food to the back of corner grocery stores.

At the same time, the city has reclaimed streets and created construction incentives to transform bike riding, walking and stair climbing into almost unavoidable exercise.

CRITICS ABOUND

Those efforts are being replicated in cities across the globe -- calories are now printed on menus in Seattle, and in Hanoi smoking is no longer allowed in public places -- even as they come under fire from restaurant groups, food and beverage companies, and small business owners.

Farley brushed off criticism that he's trampling personal freedoms as a gripe from industries motivated by unfounded fears of lost profits.

"We're creating a healthier environment that gives people the freedom to just go about their business without having to worry so much about being vigilant about their health behavior," Farley said.

"He really said that?" asked Andrew Moesel, spokesman for the New York City chapter of the New York State Restaurant Association, which opposes the proposed soda ban. "There have been many times when this administration thinks they know what's best for citizens and that just rubs people the wrong way."

While Farley's approach may bristle, results are cropping up that may shift the conversation.

A study discussed in the June 2012 medical journal Lancet shows New York City far outpaced the rest of the nation in gains in life expectancy. Some success is due to the city preventing and controlling AIDS, but more than 60 percent of the increase in life expectancy since 2000 can be attributed to reductions in heart disease, cancer, diabetes and stroke, the report said.

"A major role was played by the health department, especially the programs and policies to promote healthy living," lead researcher Ali Mokdad, a professor at the University of Washington's Institute for Health Metrics and Evaluation, told Reuters.

Farley's crusade for a healthier New York has faced setbacks. A tempest swirled in January when an obese actor complained that his photo had been altered to depict him as an amputee in a city advertisement on the dangers of diabetes.

And in July the courts ruled the city could not scare smokers by requiring delis to hang posters of a stroke-damaged brain, a cancerous lung and a rotting tooth.

Farley credited Bloomberg for the health department's success. It also helps to have a city board of health to pass rules that might otherwise get bogged down in a broader state legislature, he said.

"It's very rare for public health agencies around the country to have all those things working in their favor, so we feel obligated, in a way, to make headway here," he said. "Then the rest of the country often follows us."

(Editing by Paul Thomasch and Douglas Royalty)