Is Childhood Obsesity Leveling Off?

The percentage of American children who are overweight or obese appears to have leveled off after a 25-year increase, according to new figures that offer a glimmer of hope in an otherwise dismal battle.

"That is a first encouraging finding in what has been unremittingly bad news," said Dr. David Ludwig, director of an obesity clinic at Children's Hospital Boston. "But it's too soon to know if this really means we're beginning to make meaningful inroads into this epidemic. It may simply be a statistical fluke."

In 2003-04 and 2005-06, roughly 32 percent of children were overweight or obese, and 16 percent were obese, according to a study by the federal Centers for Disease Control and Prevention.

Those levels held steady after rising without interruption since 1980.

"Maybe there is some reason for a little bit of optimism," said CDC researcher Cynthia Ogden, the study's lead author.

Some experts said that if the leveling-off is real, it could be because more schools and parents are emphasizing better eating habits and more exercise. Even so, they and Ogden stressed that it would be premature to celebrate.

The CDC's analysis of data for 2007-08, due next year, may be the best evidence for determining what direction children's rates are really heading, Ludwig said.

Antidepressants could benefit stroke victims right away, study says

Doctors may want to give stroke victims antidepressants right away instead of waiting until they develop depression, a common complication, new research suggests.

The findings may lead to an expanded use for antidepressants. Someday high-risk people such as stroke patients might take the drugs before suffering depression -- just as people now take cholesterol drugs to prevent heart attacks, the lead author said.

The researchers gave low doses of the antidepressant Lexapro to stroke patients. The patients on the drug were 4.5 times less likely to develop depression than patients taking a dummy pill.
More than 700,000 Americans suffer strokes each year and more than one-third will develop depression in the next two years. Stroke patients with depression recover more slowly and are more likely to die, according to previous research.

"We showed you could in fact prevent the development of depression after stroke," said Dr. Robert Robinson of the University of Iowa who led the study.

Experts say strokes may damage parts of the brain affecting mood. Add to that the stress of relearning simple tasks and adjusting to stroke-caused impairments and you've got a recipe for depression.

The study, appearing in Wednesday's Journal of the American Medical Association, was based on an analysis of 176 stroke patients, ranging in age from 50 to 90.

Are Fevers in Infants a sign of Teething?

THE CLAIM:

Fever in a baby is a sign of teething.

THE FACTS:

An old wives' tale says a feverish baby is not always a cause for concern. Chalk it up to teething, pay little mind and go back to sleep, the saying goes.

But experts suggest otherwise. While the emergence of new teeth in infants under 1 year old can sometimes cause a slight increase in body temperature, studies show it does not generally cause a high-grade fever. The symptoms can be a sign of a serious problem, such as a viral illness.

In 2000, a Cleveland Clinic team published a study in Pediatrics that followed 125 children from 4-month-old doctor visit to first birthday. In that time, 475 tooth eruptions occurred, and the study found many symptoms in the roughly eight-day periods in which the teeth emerged, like increased biting, drooling, gum-rubbing, facial rash and decreased appetite. But no teething children had a high-grade fever, 104 degrees or above.

A later study in Pediatrics followed children 6 to 30 months old, with the same conclusion. There was no link between teething and body temperature or high fever. "Before caregivers attribute any infants' signs or symptoms of a potentially serious illness to teething," the first study said, "other possible causes must be ruled out."

THE BOTTOM LINE:

Studies show high fevers are generally not a teething symptom and may be more serious.

Treatment for Children's Depression has Improved

Fortunately, most children do not suffer from the sometimes-debilitating effects of depression. They face the usual low spots and tough times of growing up, facing life's changes such as moving, parents' divorce, loss of grandparents and loved ones. But, over time, and with family support, they are able to move on and even learn and grow from their experiences.

However, some children are not so lucky. It is estimated that at any point in time, 10 percent to 15 percent of children and adolescents have some symptoms of depression.

Let me state the bad news and the good news right up front. The bad news is that major depression in children is very serious. It can lead to problems in school, alcohol and drug use and even suicide. It's just as serious as depression in adults and can lead to a mood disorder as an adult.

The good news here is that depression is a treatable illness. At no other time have we had the experience and medications at hand to treat depression. We are also living in a culture in which people are more open to talking about and pursuing treatment for mental conditions.

It is common for preteens to be moody as their hormones are changing and as they face new and more demanding challenges. However, depression is more than a sad or bad mood or a temporary response to a particular situation. It is an all-encompassing disorder that affects a child's mental, emotional and physical health. It is not something that they can just will themselves out of.

A child with depression can be sad, angry or irritable, and has been so for more than a few weeks. Depression impacts the ability to function normally; a child will have problems coping with school and getting along with friends and family.

Other signs of depression include:

• Crying often
• Lack of energy
• Loss of interest in prior activities and friendships
• Changes in eating and sleeping habits; both more and less
• Extreme irritability and anger, particularly if seemingly without cause
• Poor self-esteem
• Trouble concentrating
• Lots of head and stomachaches

If your child is talking about hurting himself or running away, call your child's doctor immediately. If you see any of these other signs and they go on for more than a few weeks, it is important to get help right away. A good starting place is your child's pediatrician. He or she can often diagnose and treat depression and may also refer your child to a mental-health specialist.

Your child doesn't necessarily need to see a psychiatrist, but it is important to find someone with experience treating children.

Parents of children with ADHD need to be particularly vigilant about watching for signs of depression. It is very common to see other conditions along with ADHD. Some studies indicate that up to 30 percent of those with ADHD also have depression. Some think ADHD children are more prone to depression because many have trouble regulating their emotions or face ADHD-related problems that undermine their self-esteem. Some types of depression also seem to run in families, suggesting there may be a genetic component. But most often, depression is a combination of genetic, psychological and environmental factors.

Treatment is not just a quick fix with medication; there is a clear role for mental-health counseling or psychotherapy in any depression treatment plan. There is some data that shows that combination treatment -- medication and therapy -- is more effective than medication alone. If you are concerned about putting your child on a medication, get the facts. Talk to your doctor and weigh the medication's side effects against the effects of no medication at all. And be patient, it may take a while to reach the right dosage with the right medication. Regardless of the treatment path, close follow-up is critical.

Anti Inflamatory not Curbing Alzheimers

Results from a large government experiment are dimming hopes that two common painkillers can prevent Alzheimer's disease or slow mental decline in older people.

The arthritis drug Celebrex and the over-the-counter painkiller Aleve showed no benefit on thinking skills, new findings show. Earlier results from the same research showed the two drugs didn't prevent Alzheimer's, at least in the short term.

The experiment was halted several years early in 2004 when heart risks turned up in a separate study on Celebrex. Researchers also had noticed more heart attacks and strokes in the people taking Aleve in the Alzheimer's prevention study.

Despite the study's early end, there was still enough data to hint at how the drugs act on thinking and memory. The findings were posted online Monday and will appear in July's Archives of Neurology.

"These were not the results we were hoping for," said co-author Barbara Martin of the Johns Hopkins Bloomberg School of Public Health. "We designed this study hoping we would see a protective effect of these drugs."

Researchers hope to continue monitoring participants to see if they find any delayed benefit.
Scientists had speculated that nonsteroidal anti-inflammatories, such as Aleve and Celebrex, might prevent Alzheimer's by reducing inflammation in the brain or by other means.

"The drugs have several effects in the brain and the different effects could be important at different stages in the illness," said study co-author Dr. John Breitner of the University of Washington.

Previous studies had found that people who took the drugs ran a lower risk of developing Alzheimer's. But those were observational studies, meaning they observed people's behavior and health. Those who took the pills may have had other healthy habits that lowered their risk.

The halted study included more than 2,000 people ages 70 and older with a family history of Alzheimer's but no thinking problems themselves. People were randomly assigned to take standard daily doses of either Celebrex, Aleve, also known as naproxen, or a dummy pill.

At the start and annually for up to three years, they took a battery of tests. In one, they named as many grocery items as they could in one minute.

All three groups scored about the same at the start. But over time, the Aleve takers scored on average slightly lower than the people who took placebos. The Celebrex takers scored slightly lower than the placebo takers on most, but not all, of the tests.

"There's no evidence that people should be on these drugs to prevent Alzheimer's disease," said Dr. David Bennett of Chicago's Rush University Medical Center, who was not involved in the study but does similar research. "With the side effects of these drugs, people shouldn't be taking them for this reason."

Both products now carry warnings about heart risks. Anti-inflammatory drugs also can cause serious gastrointestinal bleeding. Experts advise patients to ask their doctors about how long to take the drugs for pain.

The study was funded by the National Institute on Aging. Pfizer Inc. and Bayer Healthcare provided the drugs and matching dummy pills for the study, but did not participate in the research. Some of the authors reported receiving speaking or consulting fees from drug companies, including Pfizer.

Noisy Artificial Hips

The first time John Johnson's artificial hip squeaked, he was bending down to pick up a pine cone in his yard in Thomasville, Ga. Johnson looked up, expecting to find an animal nearby.

Susan O'Toole, a nutritionist at Montefiore Medical Center in the Bronx, who first squeaked going up stairs after getting home from her hip-replacement surgery in 2005, said she thought the banister she was gripping needed repair.

Edward Heary, an apprentice appraiser in Hatboro, Pa., said clients sometimes look with embarrassment or concern at their floorboards when he walks though their homes.

As all three patients — and hundreds of others — discovered once they pinpointed the source of the noises, they had become guinea pigs in an unfolding medical mystery. Their artificial hips are made of ceramic materials that were promoted as being much more durable than older models. But for reasons not fully understood, their hips started to squeak, raising questions about whether the noises herald more serious malfunctions.

"There is something amiss here," said Douglas Padgett, chief of adult reconstructive and joint-replacement service at the Hospital for Special Surgery in New York. More than 250,000 Americans get total hip implants each year, a procedure that generally costs close to $45,000.
Hip replacements have a success rate of more than 90 percent, based on patients' achieving relatively pain-free mobility after recovery periods that range from a few months to a year.

Annoying ... dangerous?

Any artificial hip can occasionally make a variety of noises. But until Stryker, a medical-products company, began marketing highly durable ceramic hips in the U.S. in 2003, squeaking was rare.
Tens of thousands of ceramic hips later — from Stryker and other manufacturers — many patients said squeaking hips are interfering with daily life. One study in the Journal of Arthroplasty found that 10 patients of 143 who received ceramic hips from 2003 to 2005, or 7 percent, developed squeaking. Meanwhile, no squeaks occurred among a control group of 48 patients who received hips made of metal and plastic.

"It can interrupt sex when my wife starts laughing," said one man, who talked on the condition that he not be named.

Beyond annoyance and embarrassment, many patients and their surgeons fear that the squeaky ceramic hips may signal the joints are wearing out prematurely. That could force patients to undergo the very operation — a second replacement of the same hip joint — they had hoped to avoid by choosing ceramics.

Dozens of patients have elected to endure subsequent surgeries to replace the noisy hips. Some sued Stryker, the pioneer and market leader, which some doctors said has been slow to take patients' concerns seriously.

Last fall, the Food and Drug Administration (FDA) issued a warning to Stryker, saying it had failed to take the steps needed to prevent squeaking and other problems. Clouding things further, Stryker last year recalled ceramic hip parts made at its factory in Cork, Ireland, after determining some did not meet its sterility specifications.

Stryker officials said none of the problems underlying the recall or the warning letter from the FDA reflect problems that cause squeaking, which it contends occurs in less than 1 percent of implants.

Whatever the frequency, some investigators said the squeaking seems to be associated with extreme flexing of the ceramic implants, but how is unclear. In X-rays, many of the squeaking hips appear to be perfectly aligned.

Nor is there a clear relationship between squeaking and hip pain or other conditions some patients say they encountered, such as the sensation that the hip disengages slightly when a patient walks.

Some patients squeak even they are walking normally, like O'Toole or Michael Mueller, of Scottsdale, Ariz. Mueller is so frustrated with squeaks, pain and popping noises for which he blames his ceramic hip that he has displayed his problem on YouTube.

Company responds

While there have been no reported cases of serious mishaps, some surgeons fear the ceramic material might shatter, leaving a patient with so many inflammatory shards in the hip that a doctor could never find them all.

"Catastrophic failure has been a concern in the past, with older ceramic components," said Dr. James Bried, a surgeon in Poway, Calif. Ceramic materials have been used since the 1960s.
Bried, who implanted Mueller's hip last year, said he was concerned the squeaking might be "a harbinger of something similar."

Stryker says such fears are overblown.

"It is important to keep this in perspective," said Aaron Kwittken, a spokesman for Stryker. "Published research shows squeaking is rare compared with other total-hip-related risks like infection, dislocation and leaving patients with uneven leg length."

Durability is paramount with artificial hips. Patients worry they will outlive their artificial hips and require a second, more extensive and even more expensive procedure at an age their bodies may be less able to cope with the trauma.

Ceramic hips were promoted as lasting much longer than the 15 years or so for conventional artificial joints made of steel and plastic.

Should you avoid hospitals on weekends?

THE CLAIM:

If possible, avoid hospitals on weekends.

THE FACTS:

Many public services are less reliable on weekends. But does that apply to medicine as well?

In the past decade, studies have found that patients treated at hospitals on weekends have inferior outcomes when compared with those receiving care on weekdays. In some cases, researchers have found, that also can mean a higher death rate.

In one of the largest studies, published last year in The New England Journal of Medicine, scientists followed 231,164 heart attack patients admitted to New Jersey hospitals from 1987 to 2002. They found that those admitted on weekends were less likely to receive aggressive treatment, and had slightly higher death rates (12.9 percent, versus 12 percent for weekday patients).

Another extensive study, in The Annals of Surgery in November, looked at 188,212 patients who had non-emergency surgery. Those who had their operations on a Friday and spent the weekend recovering on a regular hospital floor were 17 percent more likely to die in the following 30 days than those who had their operations earlier in the week.

Some researchers say this so-called weekend effect has to do with less-aggressive care and hospital staffing changes. Others argue that weekend patients simply tend to be sicker, perhaps because they have delayed seeking care.

THE BOTTOM LINE:

There is growing evidence that hospital mortality rates are higher on weekends.

Do iPods interfere with pacemakers?

THE CLAIM:

iPods interfere with pacemakers

THE FACTS:

A much-noted study last year raised more than a few eyebrows when it suggested that digital music players could set hearts aflutter -- by interfering with pacemakers.

The study, published in the journal Heart Rhythm, found that all it took to cause electrical interference in an implanted pacemaker was holding an iPod two inches from a patient's chest. In some cases, the study found, an iPod caused interference when it was held within 18 inches of a patient.

But many scientists were skeptical, and apparently for good reason. More recent studies that looked at music players have found they have little effect on pacemakers.

The latest, carried out by scientists at Children's Hospital Boston and Harvard Medical School, tested four types of music players on patients ages 6 to 60 with active pacemakers or implantable cardioverter defibrillators. The scientists found during hundreds of tests that the music players had no effect on the intrinsic function of pacemakers. The only slight effects occurred when the heart devices were being programmed, "but not in a way that compromised device function," the authors said.

As a result, they concluded, patients need be wary only while their doctors are reprogramming their devices.

Another study, in January by a scientist at the Food and Drug Administration, echoed those findings. The scientist, Howard Bassen, tested four different types of iPods and found that they did not hinder pacemakers.

THE BOTTOM LINE:

Research suggests that portable music players will not cause pacemakers to malfunction.

Does running outside burn more calories than a treadmill?

THE BELIEF:

Running outside burns more calories than a treadmill.

THE FACTS:

Pavement or treadmill? Most avid runners have a strong preference for one or the other, but how do the two differ in producing results?

According to several studies, the answer is not so simple. Researchers have found that while outdoor running tends to promote a more intense exercise, running on a treadmill helps reduce the likelihood of injury, and thus may allow some people to run longer and farther.

A number of studies have shown that in general, outdoor running burns about 5 percent more calories than treadmills do, in part because there is greater wind resistance and no assistance from the treadmill belt. Some studies show, for example, that when adults are allowed to set their own paces on treadmills and on tracks, they move more slowly and with shorter strides when they train on treadmills.

But other studies show that treadmill exercisers suffer fewer stress injuries in the leg. One study published in 2003 in the British journal of sports medicine, for example, analyzed a group of runners and found significantly higher rates of bone strain and tension during pavement running than during treadmill running, particularly in the tibia, or shinbone. This increased strain can heighten the risk of stress fractures by more than 50 percent, the study found.

THE BOTTOM LINE:

Studies suggest that running on pavement generally burns slightly more calories, but also raises the risk of stress fractures.

Five Day Wait for Strep Test Results at MinuteClinic while on Vacation

My wife and I were looking forward to a long awaited vacation to California, and Hawaii. When we got off the plane in California we both had a bit of a scratchy throat which can happen after a long plane flight with all the bad air, and contact with so many different people in airports.

After two days our symptoms had worsened, and both of us still had a sore throat that was visible swollen, increasing congestion, and a lack of energy. We decided at that time to seek medical attention on the road. I suspected that we both had been infected with Strep throat.

The closest medical facility to where we were staying was what was called MinuteClinic was staffed by a Nurse Practicioner at a local pharmacy, in Santa Ana, California. They shouldn't call themselves MinuteClinic, it should be the "We will get back to you in Five Days Clinic", but I will get to more of that later.

NP's can treat a very limited list of ailments, but since it was upper respiratory, and probably Strep, I decided they could probably handle it, and get us the antibiotics to begin feeling better before we left for California for Hawaii.

I could have called the medical clinic that I work fo back in Chicago also, but when it comes down to using an antibiotic these days you want to make sure that you have a bacterial, not viral infection, so I felt a test for strep was necessary. Why waste antibiotics and build up resistance if you are not sure you need them? The responsible choice is to be tested.

The nurse at the clinic checked us both out in a small examination room next to the pharmacy. I told her I suspected we both had Strep. She examined my wife, and didn't take a throat culture, she felt my wife has a sinus infection. She inspected me and did take a throat culture. The ready test showed nothing, so she did not prescribe me anything, even though I asked her to do it just in case since we were headed to Hawaii the next day. She did prescribe my wife some antibiotics even though she never took a throat culture from her.

We visited the MinuteClinic on a Saturday, on Wednesday afternoon I got a call on my cell phone that indeed my culture for Strep had come in positive. The person on the phone relaying the news could barely speak English, and she said to come into the pharmacy to pick up a prescription. I told her that I was in Hawaii now and that she would have to call it in to a local pharmacy in Lahaina which she did. As for my wife she couldn't tell me if they had originally prescribed the right medication if she indeed have strep throat rather than the suspected sinus infection.

I find it hard to believe that we were sick on Saturday, but were not able to get antibiotic treatment until the following Wednesday evening which meant we had to spend five days being sick before we got the antibiotic treatment we needed to start feeling better.The bottom line, and I should have followed this one simple rule... it is best to go to a real urgent, or immediate care center to see a real doctor, and get a real lab test so treatment could begin right away.

Ready tests for Strep can be tricky if the NP administering it does not do it correctly which is evidentially the case in our situation. If we had gone to an Immediate Care facility like Healthy Trust we would have gotten the treatment we needed, at the same price, without waiting five days for a test to come back from the lab.In our scenario it is real risky business to see a since my wife is a diabetic. A strep infection for a diabetic can turn into pneumonia overnight. It would have been a smarter choice to take a longer drive from where we were staying to visit an urgent care center, or an ER.

Healthy Trust Immediate Medical Care in Wheeling is your choice for urgent medical care when you cannot get into see your own physician, do not have a regular physician, have health insurance, or do not have health insurance and need medical help right away.Don't risk your health at a pharmacy, come see a real doctor at Healthy Trust and start feeling better immediately.

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Researchers eye new weapon in allergy war

It's allergy season, that dreaded time of year where requisite rounds of "bless you" and "gesundheit" follow constant sneezing among office pods and co-workers.

Commercials for the latest allergy medication pop up more often on television, and new allergy products promise relief from itchy, watery eyes and potential deadly reactions that come with allergies.

But if scientists at Benaroya Research Institute at Virginia Mason are successful, someday allergies could be eliminated altogether.

Using a $5.3 million grant from the National Institutes of Allergy and Infectious Disease, Drs. William Kwok and David Robinson of the Virginia Mason Asthma and Allergy Clinic are studying cells from people allergic to such things as cat dander, tree and grass pollen, peanuts and mold.

In an attempt to find better and faster ways to diagnose allergies, they are using tetramers, artificial molecules with four arms that can seek out and latch on to specific targets in the blood.

Tetramers were developed at the Benaroya Research Institute and are used worldwide to help improve the diagnoses and treatment of some of the world's most difficult diseases.

The scientists at Benaroya manipulate the tetramers to look like specific allergens. They stick to blood cells and show which allergen a person is reacting to.

Finding one cell in a drop of blood that contains a million cells is beyond finding a needle in a haystack, said Jack Nagan, executive director of Benaroya Research Institute and vice president of research at Virginia Mason. The best way to find the needle is with a big magnet, he said. The tetramer is that magnet.

Using a large machine called a flow cytometer, the blood is separated into droplets. Laser beams identify the allergy-causing cells because there's a tetramer locked onto it.

"Then you can separate your needles from your hay," Nagan said. "Once separated, you can tell immediately what a person is allergic to."

Researchers hope this can eliminate the painful prick tests and the process of elimination that currently diagnoses most people's allergies.

"From a basic science standpoint, being able to identify what the T-cell (an immune system cell) recognizes in the allergen is a fundamental step in the allergic immune response that we have not been able to define before," Robinson said. "This will potentially allow researchers to tease apart fine details of the allergic immune response, and this could lead to other treatment approaches that have not yet even been conceived."

For example, researchers maybe can figure out what gene in a person's body is making the blueprint for the allergen cell and turn it off -- eliminating allergies altogether.

The researchers also want to develop vaccines that use a small fragment of the allergen, making it safer; current allergy shots include the whole allergen to reduce the symptoms and can cause dangerous reactions in some people.

They also hope to learn how to change the immune system's tolerance for allergies without using the actual allergen.

How soon any of the research would actually be of practical value to allergy sufferers is unknown.

"We would like to develop a more individualized, specific treatment that will reduce any risks using the whole allergen," Kwok said. "This grant gives us an opportunity to make a significant difference for people who suffer from allergies and elevate their options for care."

Beating The High Cost of Medical Care in Chicago

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Can you swallow your tongue during a seizure?

THE CLAIM:

During a seizure, you can swallow your tongue.

THE FACTS:

One problem with old wives' tales and medical myths is that they can sometimes lead well-meaning people to do ill-advised things. Armed with the adage that people having seizures can swallow their tongue, Good Samaritans will sometimes try to force an object into the victim's mouth to keep that from happening.

A persistent belief, experts say, but a wrong and potentially injurious one.

Swallowing the tongue is virtually impossible. In the human mouth, a small piece of tissue called the frenulum linguae, which sits behind the teeth and under the tongue, keeps the tongue in place, even during a seizure.

Ryan Brett, the director of education for the Epilepsy Institute in New York, said people who witness a seizure often reach for a wallet, a spoon, or a dirty object to stick in the person's mouth, much to the chagrin of epilepsy patients. He said he frequently conducted first-aid workshops in which he had to disabuse people of the myth.

"The only thing that happens when something is put in the mouth is you end up cutting someone's gums or injuring the teeth," he said. "We get complaints all the time."

The best way to help, instead, is to roll the person on one side to drain fluids from the mouth, cushion the head to prevent cranial injuries, and seek medical help if necessary.

THE BOTTOM LINE:

It's virtually impossible. Furthermore, never place an object in a person's mouth during a seizure.

Fermented Foods for Better Health

The idea of fermenting foods in order to preserve them has been around since ancient times, with evidence of our ancestors fermenting grapes, bread and dairy foods. Fermentation occurs when microorganisms, such as yeast, convert carbohydrates in foods to alcohol or acids. This conversion renders the food resistant to spoilage and thus extends the period of time it is safe to eat.

The biological enrichment, specifically with healthy bacteria called probiotics, is an important component of fermented foods. Probiotics are beneficial in supporting a healthy digestive tract and boosting the immune system. While they can be purchased and consumed in capsule form, obtaining them through fermented foods can be a nutritious way to increase the variety of foods in your diet.

Here are a few examples of fermented foods that are easy to find and work into your diet:
Yogurt: This can be purchased as either a dairy- or soy-based product, and comes in a variety of flavors. Look for the statement "live" or containing "live active cultures" on the container.

Kefir: A fermented dairy beverage that is becoming more commonly available in grocery stores. While some people drink it straight, others find that it is too sour on its own. Fruit, honey or maple syrup can be used as a sweetener.

Sauerkraut: A traditional German dish of fermented cabbage. Most commercially prepared sauerkraut has been pasteurized, which kills all of the beneficial microorganisms. Unpasteurized or raw sauerkraut can be found in the refrigerated cabinets at natural food stores.

Kimchi (kimchee): A traditional Korean dish of spicy fermented vegetables, such as Chinese cabbage, radishes, onions and garlic. As with the sauerkraut, look for unpasteurized or raw kimchi at the natural food market to obtain the beneficial probiotics.

The process of fermentation offers other benefits beyond preservation. Fermented foods are easier to digest, have natural preservation properties and more available vitamins and minerals. The foods still contain live cultures that offer a boost to both the digestive tract and the immune system.

How should you treat a nosebleed?

THE BELIEF:

Tilt your head back to treat a nosebleed.

THE FACTS:

Most people know the right way to stop a nosebleed: lean the head back and apply pressure to the nose.

But medical experts say that what most people know about nosebleeds is wrong. Tilting the head back, a technique widely considered proper first aid, can create complications by allowing blood into the esophagus. It risks choking, and it can cause blood to travel to the stomach, possibly leading to irritation and vomiting.

The American Academy of Family Physicians says the best treatment is to sit down, lean forward and keep your head above your heart, which lessens the bleeding. Leaning forward also helps drain the blood from the nose and keeps it from the esophagus.

A report in the British journal BMJ says you can stop the bleeding by using your thumb and index finger to squeeze the soft tissue just below the bridge of your nose for 5 to 10 minutes. A cold compress or ice pack placed across the bridge of the nose can also help.

If all of this fails and the bleeding lasts for more than 20 minutes, or the nosebleed was caused by a blow to the head, seek medical attention.

THE BOTTOM LINE:

Never treat a nosebleed by leaning your head back.

The perfect body weight is not a figure carved in stone

As an assistant professor at the University of Washington, Glen Duncan teaches an epidemiology class that explores the relationship between disease and physical activity. His course, the only one at UW on the subject of how physical activity or lack of it affects personal health, is populated with both undergraduates and grad students.

"The grad students are mostly public health majors and the undergrads tend to be pre-med," said Duncan the other morning.

In sum, Duncan is teaching young people who aspire to have jobs that take on such highly challenging issues as the obesity crisis and reversing heart disease. He regularly discusses the hot debate among researchers about whether you can be "fat but still fit." A new Harvard study cast doubt on the concept just last week in the pages of the journal Annals of Internal Medicine.

Identifying healthy body weight is another topic in Duncan's class. In April, Mayo Clinic researchers presented a new paper at a major cardiology meeting suggesting that people with healthy weight but high body fat percentage might be better categorized as "normal weight obese." The body fat numbers: greater than 20 percent for men and greater than 30 percent for women.

Duncan said his students have a hard time understanding all of the fuss.

"Lots of these students are very fit and active," Duncan said. "When I explain that a significant part of the American population can't climb a flight of stairs without being out of breath, they don't believe it at first. They say things like, 'Do you actually mean that? Is that really true? Whoa!' "

Whoa is right. Seeking a solution to America's obesity crisis is almost too overwhelming, even for Duncan. Same goes for figuring what exactly is an ideal or healthy body weight.

"I used to be one of those researchers who design a clinical trial with a group of overweight people, give them an exercise prescription and track the outcome," said Duncan, whose current scientific investigations focus on how environment such as a walkable neighborhood ("think Capitol Hill") can positively affect health. "Now I urge people to get off the couch. That's my exercise prescription. Less butt time."

As for determining ideal weight, Duncan called it the "million-dollar question" and said it is pretty much impossible to name a precise number of pounds by, say, height or age or whether someone has proverbial big bones.

"There is too much stress on weight," said Duncan. "It's better to focus on getting healthy. You can be healthy at a higher weight (than what a professional might consider ideal), though I will never be one to say there aren't negative effects of obesity."

Here's a common scenario to illustrate overstressing weight: The well-meaning personal trainer at the health club does a fitness assessment and tells a new member she needs to lose 30 pounds.

That member has three choices: 1. Do nothing because losing 30 pounds won't happen; 2. Practically starve or exhaust herself to hit the 30 pounds; or 3. Decide for herself what is an ideal weight, given she does want to shed some pounds but nowhere near the 30.
Duncan votes for No. 3.

"Fixating on (losing the 30 pounds) leads to a crash diet," he said. "People commit to those crash diets, lose the weight, then realize there is no way they can eat that way for the rest of their lives. They gain the weight back."

In fact, research shows people not only regain the original weight but additional pounds on top of it.

Duncan identified some basic markers to gauge personal health: climbing a flight of stairs without struggling for breath; the ability to take a 30-minute walk; cutting way back on TV; and "not eating so much at any one meal."

If you can do these things, you could be in range of a healthy weight. Getting to an ideal weight is more about adding intensity to workouts that fretting over the government's Body Mass Index calculation or the bathroom scale.

"There are three parts to effective workouts or physical activity: frequency, intensity and duration," Duncan said. "Intensity is the most direct way to change your health for the better (and likely lose body fat in the process)."

If you are a runner, devote the last 10 to 15 minutes of some runs to hard sprinting for 30 seconds followed by 90 seconds of recovery pace, then repeat three to five times. If you walk for exercise, do the same 30-second burst/90-second recovery pace sequence or add some hills (or incline on your treadmill). For weight lifters, load your barbell at an amount that fatigues the muscles after 8 to 12 repetitions.

"I recommend increasing your intensity because it fits into life," said Duncan. "Take my students. They don't see themselves 10 years from now, when jobs and families might make it harder to work out and keep the weight off. I am hoping to get them to see the big picture."

Is Coffee really good for you?

Seattle has been deemed by many the coffee capital of the world based on per capita consumption. For locals, that morning cup of java is an enjoyable and essential daily ritual.

However, conflicting research on the positive and negative aspects of your favorite morning beverage may have you unsure of whether you should eliminate it from your diet.

In recent decades, some 19,000 studies have been done examining coffee's impact on health, many of which tout the benefits of the beverage's high levels of polyphenols, potent health-protecting antioxidants.

However, coffee also is a source of caffeine, which for some may jolt changes in mood and behavior. According to the Mayo Clinic, consuming more than 500 to 600 milligrams of caffeine a day, or about four to seven cups of coffee, can cause restlessness, anxiety and headaches. The amount that will produce these symptoms can vary among individuals, depending upon sensitivity.

Aside from those who are caffeine-sensitive, pregnant women also should assess their coffee consumption, as research suggests that consuming more than five cups of coffee per day could increase their risk for complications and miscarriage, especially during the first trimester.

For those working to maintain their energy level throughout the day without coffee:

Try a cup of green tea. Green tea has a comparable antioxidant content to coffee, with less than half the caffeine.

Take a brisk 10-15 minute walk when feeling that midafternoon "crash."

Get enough sleep. The National Sleep Foundation recommends seven to nine hours of sleep per night for adults.

If you have questions related to how coffee consumption may impact your personal health conditions, consult with a health professional or nutritionist.

Tips for falling asleep

Can't fall asleep?

Could be Boris in Russia. You did challenge him to an Internet game, didn't you?

That game you're playing to try to unwind may just be revving you up, because the light from computer monitors (and TV screens) messes with natural sleep/wake cycles and rhythms. (Ah, the good old days, when we slept from dusk to dawn!) But now, a third of those who spend up to 2 1/2 hours a night on the Internet say they have problems sleeping. Duh, surprise.

But if you stop gaming before bedtime and still have trouble dozing off (and aren't staying up for sexier reasons), try these tips:

Set a routine. Get up and go to bed at the same time every day. Even on holidays. And Sundays. Yes, we know you like to sleep late when you can, but that's like giving yourself jet lag every weekend. So get up within an hour of the time you do on weekdays.

Plan for bedtime by setting aside a half-hour for last-minute must-dos (10 minutes), hygiene (10 minutes) and meditation (10 minutes).

Nowhere to meditate in quiet? Try the throne; few will disturb you there.

Do some gentle stretches. In one study, women who stretched regularly nodded off more easily than nonstretchers.

Our advice: Stretching works even better when it's combined with deep breathing and meditation.

Eat sleepy-time snacks that contain melatonin. Melatonin is a substance that helps regulate your body clock. Have a small bowl of steel-cut oatmeal, corn or brown rice.

Alternatively, try a complex carb (veggies or whole-wheat pasta) to promote sleep-encouraging serotonin.

Put on warm socks. Your body dilates blood vessels in your hands and feet to release heat from them in preparation for sleep. Slipping on socks and then removing them after your feet are warm mimics this natural presleep process.

Beating the blues with food

It may be more than coincidence that the decrease in the quality of Americans' diets has occurred simultaneously with increased reports of depression. While there are situations in which medication or psychotherapy are the only effective means to treat depression, studies show that dietary changes can sometimes be a mood booster.

Here are some ways to use food as a tool to fight depression:

Schedule an appointment with your physician to help ensure your symptoms are not signs of something bigger. Food allergies, thyroid abnormalities, nutrient deficiencies and other medical conditions all can cause depression.

Increase your intake of omega-3s. Research indicates that low levels of essential fatty acids can contribute to depression. Increasing intake of fish and flax or supplementing with their oils may improve your mood.

Pump up your diet.

Food contains vitamins and minerals that are essential for making neurotransmitters that keep your mood in check.

Aim for whole foods first rather than nutritional supplements or fortified foods. Whole foods contain many other compounds that help the vitamins and minerals work correctly. Focus on foods rich in B-vitamins and minerals, such as grains, nuts, lean meats, and fruits and vegetables.

Reduce or eliminate alcohol, caffeine, tobacco and food additives.

Processed foods may contain food additives that can interfere with normal neurotransmitter functioning in some individuals.

Harmful chemical wafts off your TV

Common household dust has long been known to carry pesticides, allergens and other irritants.
But the dust that coats your television sets may answer why virtually every American tested has traces of a chemical flame retardant that may be harmful.

The flame retardants have been used for decades in television sets, computer-wire insulation, mattress stuffing, carpet padding and many other common household products. They have been found in household dust, but no one has been able to say how they got there and from what products.

A study by researchers at Boston University's School of Public Health appears to have pinpointed the largest source of chemical flame retardants as the dust on television sets.
Using a portable X-ray device, researchers sampled 19 Boston-area homes and found large volumes of the flame retardants in television dust.

One theory is that when the television heats up, the flame retardants in the TV vaporize into a gas, eventually settling into the dust in the air and on bookshelves, floors and appliances.

"I think this link between the flame retardants and dust in TVs is a really big deal," said Tom Webster, a Boston University epidemiologist who led the study.

That's true, in part, because millions of television sets are expected to be discarded in February when television broadcasts switch to digital signals, resulting in a much greater volume of flame retardants contaminating the environment. The flame retardants take decades to break down, and they have been shown to travel great distances in the air and water.

White House Czar Warns About the Evils of Marijauana

The White House drug czar warned parents Friday that depressed teens are medicating themselves with marijuana, running risks of deeper depression.

A report by the Office of National Drug Control Policy said that frequent marijuana use doubles a teen's risk of depression and anxiety, based on data compiled from published studies.

The report cited a study saying that marijuana use increases the risk of developing mental disorders later in life by 40 percent. "In short, marijuana makes a bad situation worse," said John Walters, director of the drug-control policy office.

Some addiction experts said the report stretches evidence by implying a causal link between smoking pot and developing mental illness that did not previously exist.

A British government advisory group said in an April report that there is not evidence to show "a causal relationship between the use of cannabis and the development of any affective disorder."

Pressed at a news conference about the report's claim that, "Using marijuana can cause depression and other mental illnesses," Walters acknowledged there is no proof that one leads to another.

Among experts, opinions are mixed on the relationship among teens, depression and marijuana.

"Both conditions could be related to something else," said Dr. Victor Reus, a psychiatrist at the University of California, San Francisco. "Depressed teens are more likely to exercise less, stay indoors and watch TV. Take your pick as to which one is causal."

Dr. Nora Volkow, director of the National Institute on Drug Abuse at the National Institutes of Health, said many young people smoke pot and never become depressed.

She said evidence indicates genetic factors make some teens more vulnerable to mental disorders so marijuana can trigger their onset.

Do Calories from Drinking go to your Mid Section?

THE CLAIM:

Calories from alcohol go to your midsection.

THE FACTS:

The phenomenon is known by many names -- spare tire, beer belly, beer gut. But do calories from alcohol congregate at the midsection at a greater rate than others? That is not so clear.
In general, drinking causes weight gain primarily because alcohol slows the body's ability to burn fat for energy, not to mention that it increases appetite. The effects of alcohol on the midsection are complicated, but studies show pretty clearly that beer, wine and spirits have a greater effect on belly fat in adults who drink sporadically than in people who drink regularly but in small amounts.

In one study published in The Journal of Nutrition in 2003, a group of scientists followed more than 2,300 drinkers and nondrinkers and found -- after controlling for a number of variables -- that those who averaged a single drink per day had the lowest levels of abdominal fat. Those who drank occasionally but had four or more drinks in one sitting had the greatest levels. Several studies have shown similar results.

One theory is that drinking regularly increases the amount of enzymes that break down alcohol. But more research is needed.

THE BOTTOM LINE:

Moderate drinking does not seem to increase abdominal fat. Excessive drinking might.

Good Carbs and Bad Carbs

When it comes to carbohydrates, it's time for an extreme makeover. These macronutrients got a really bad rap in America's recent carbs-are-poison panic. But the pendulum is swinging back as people discover the nutritional truth: Some carbs are good; some are bad.

Eat the good ones and you'll lose the lingering, can't-zip-your-pants effect of last winter's mac-and-cheese binges -- and you'll lower lousy LDL cholesterol. Eat the bad ones and ... well, let's not go there.

So what are good carbs? The ones with a low glycemic index -- it measures how quickly foods break down and send blood sugar up. The slower, the better. Bad, high-GI carbs create blood-sugar spikes that are quickly followed by sharp plunges -- which make you hungry again. Over time, that blood-sugar roller coaster ups your risk of diabetes, belly blubber, heart disease, diabetes and other chronic health problems.

The No. 1 trademark of good, low-GI carbs is that they take awhile to digest -- which means they're almost always high-fiber foods. Fiber keeps your stomach so busy that these foods can't rush into your bloodstream and send sugar levels rocketing.

Good carbs include three huge groups:

1) most fruits and veggies;
2) 100 percent whole-grain anything -- cereals, breads, crackers, whole-wheat pasta and couscous, brown and wild rice;
3) beans, lentils and other legumes.

These are the same healthy foods, by the way, that help keep you feeling full, rather than craving "something." That hunger comes from the sugar low after the high, by the way. We'll tell you in a future column how to convert aging high-GI carbs into stay-young low-GI carbs.

Hospital Only Doctors On Rise in U.S.

At a meeting about a job in a Tacoma hospital, Dr. Per Danielsson's interviewer mentioned another position -- one that would allow him to exclusively care for the type of critically ill hospital patients he preferred, and offer him more flexible hours and higher pay.

"I stopped the interview and said, 'I want to talk to the person in charge of that job,' " Danielsson said. "One month later I started as a hospitalist. I just didn't know I was one at the time."
That's because the profession was just taking off and the term wasn't officially coined until the fall of 1996, months after Danielsson started his new job.

Dr. Robert Wachter, a professor and physician at the University of California-San Francisco, wrote an article in the New England Journal of Medicine in 1996 about the emerging role of what he called "hospitalists" -- a new breed of doctor whose main responsibility is caring for hospital patients from the time they're admitted until their discharge, then returning them to their regular physician.

Most Seattle hospitals and clinics began hospitalist programs around 2000, including Swedish Medical Center, the University of Washington, Virginia Mason Medical Center, Evergreen Medical Center, the Polyclinic and Overlake Medical Center. Called the fastest-growing medical specialty in the country by the Society of Hospital Medicine, the estimated number of hospitalists is projected to grow to about 30,000 by 2010 -- from 20,000 in 2008.

They are board certified in internal or family medicine, and the job is just as intense and difficult as any other physician's, hospitalists say.

But the lure often lies in the job's perks. Better pay and more flexible hours make the 100-hour workweeks of a resident or those pursuing a specialty seem unreasonable. A normal hospitalist schedule is seven days on -- usually 12-hour shifts -- and seven days off. They usually work all holidays, but knowing when they are off helps in planning time.

"When I was a resident at Boston City Hospital, I came home early one Saturday and my 3-year-old daughter said 'Daddy came to visit us,' " Danielsson said.

"That line sums up residency" -- and why he enjoys his hospitalist schedule, he said.
Instead of a primary care physician who spends most of his time treating outpatients, a physician who is always in the hospital takes care of critical patients.

"Say a person is really sick with pneumonia: a clinic-based physician may have seen one patient like this per year where a hospitalist may see 20 to 25 in a year," said Danielsson, now the medical director of the Adult Hospitalist Program at Swedish, which has 29 hospitalists. "Our team has a 24-hour presence and we're skilled at all levels."

The position came about as patients' hospital stays became shorter and more intense, and medical organizations pushed to reduce medical errors and deaths, and increase patient safety. Restrictions on the often 100-hour-plus workweeks of residents shifted the day-to-day care to specialists in inpatient care.

"As absurd as those hours may seem, it is restrictive and places a premium on hospitalists" to carry the rest of the workload, said Dr. Paul Sutton, assistant chief of the medical service at the UW Medical Center.

Sutton said he helped begin the eight-person hospitalist program at the UW Medical Center in 2001 so he could teach in a hospital setting. Before that, he spent the majority of his time teaching and treating outpatients.

But as fast as the profession is growing, its future may be uncertain.

Wachter wondered in a 2004 New England Journal of Medicine article whether hospitalists were still a work in progress, raising issues such as physician burnout and funding for hospitalist programs -- what he calls "the field's greatest challenge."

Sutton and Wachter both point to lower reimbursement rates for hospitalists who diagnose and treat patients but don't regularly perform the complex (and higher reimbursed) procedures other specialists do. The gap in salary paid, and what is reimbursed, might not sustain some programs, Sutton said.

"Right now in Seattle, salaries are higher in hospital medicine compared to residents, but whether that will continue, I don't know," he said. "Ten years ago there was a push for primary care physicians and salaries were up and that didn't last."

But others believe hospitalists are here to stay. Dr. John Rosenthal, one of 15 hospitalists at Evergreen Medical Center in Kirkland and former director of its program, said inevitably it will become its own specialty. Evergreen plans to hire five more hospitalists by fall.

The profession is exploding and there's no looking back, Danielsson said.

"I view hospitalization as episodic care," Danielsson said. "Most people wouldn't object to seeing a specialist when something is wrong and we're specialists in hospital medicine."

ABOUT HOSPITALISTS

According to the New England Journal of Medicine, hospitalists are one of the fastest-growing medical specialties.

Hospitalists usually work solely within hospitals, caring for patients from the time they are admitted to the time they are discharged.

Hospitalists work in many areas of the hospital from the ICU and CCU to the ER and medical surgical units. Their primary role is the direct management of inpatients, and in many cases, inpatient physicians now perform most of the tasks once handled by patients' primary care physicians. As the field has evolved, a growing number of hospitalists have begun assuming a care-coordinator's role including the patient's care, discharge planning and patient/family communications.

What benefits can hospitalists offer? Hospitalists work in the hospital every day and are therefore more accessible for hospitalized patients than primary care physicians who spend the majority of their day in a clinic or office.

Smoking Ban May Influence Teens

A Massachusetts study suggests that restaurant smoking bans may play a big role in persuading teens not to become smokers.

Youths who lived in towns with strict bans were 40 percent less likely to become regular smokers than those in communities with no bans or weak ones, the researchers reported in the May issue of the Archives of Pediatrics & Adolescent Medicine.

The findings back up the idea that smoking bans discourage tobacco use in teens by sending the message that smoking is frowned upon in the community, as well as simply by reducing their exposure to smokers in public places, said Dr. Michael Siegel, of Boston University School of Public Health, the study's lead author.

Breast Feeding Seems to Lift Children's IQ's

Increased breast-feeding during the first months of life appears to raise a child's verbal IQ, according to a study of nearly 14,000 children release Monday.

The study in Archives of General Psychiatry found that 6-year-olds whose mothers were part of a program that encouraged them to breast-feed had a verbal IQ that was 7.5 points higher that children in a control group.

The researchers said their findings suggested the longer an infant is fed exclusively breast milk, the greater the IQ improvement.

Lead author Dr. Michael Kramer, a professor of pediatrics at McGill University in Montreal, said the IQ improvements were modest and might not be noticeable on an individual basis. But the increase could have a big effect on society as a whole, he said.

No need to panic when a child has a fever!

Many parents worry too much about the danger of childhood fevers and tend to overtreat even the mildest temperatures, according to research unveiled Monday by Johns Hopkins doctors. A little fever, they say, actually might be good for kids.

The findings confirm what pediatricians have heard from panicked parents over the years — especially those who call because their child has a temperature of 99 degrees (it's not technically a fever until it hits 100.4 degrees, doctors say). Often, they report that they've given more medication than necessary for higher temperatures.

"Parents have this idea we've got to get fever down at all costs," said Dr. Michael Crocetti, a pediatrician at Johns Hopkins Bayview Medical Center and an author of the study. "Fever actually helps, for most infections, to fight the infection. It helps our immune system work better."

The Johns Hopkins Children's Center study was presented Monday at the annual meeting of the Pediatric Academic Societies in Honolulu. Researchers found that parents gave their children acetaminophen and ibuprofen more often than recommended — and that some parents develop severe "fever phobia," a fear that fever will cause brain damage and death.

Only fevers above 107 degrees can cause brain damage in children, Crocetti and others said. Fevers are of concern, however, in newborns, and when a young baby has a fever over 100.3 degrees, a doctor should be called.

When you are faced with colds, flus, and fevers the staff at Healthy Trust Immediate Medical Care is there when you can't get into see your doctor, or pediatrician. Walk right in without an appointment and start feeling better!

Healthcare costs hitting even those with insurance

The economic slowdown has swelled the ranks of people without health insurance. But now it is also threatening millions of people who have insurance but find that the coverage is too limited or that they cannot afford their own share of medical costs.

Even many of the 158 million people covered by employer health insurance are struggling to meet medical expenses that are much higher than they used to be — often because of some combination of higher premiums, less extensive coverage, and bigger out-of-pocket deductibles and co-payments.

With medical costs soaring, the coverage many people have may not adequately protect them from the financial shock of an emergency-room visit or a major surgery. For some, even routine doctor visits might now take a back seat to basic expenses such as food and gasoline.

Taking a bigger bite

The problem is most acute for people with no insurance, a group expected to soon exceed 48 million, but those with insurance say they too are feeling the pain.

"It just keeps eating into people's income," said James Corbin, a former union official who works for the local utility in Tucson, Ariz.

Corbin said that under their employer's health plan, he and his co-workers now are obliged to pay up to $4,000 of their families' annual medical bills, on top of about $1,600 a year in premiums. Five years ago, they paid no premiums and were responsible for only about $2,000 of their families' medical bills.

Already, many doctors say, the soft economy is making some insured people hesitant to get care they need, reluctant to spend a $50 co-payment for an office visit. Parents "are waiting longer to bring in their children," said Richard Lander, a pediatrician in Livingston, N.J. "They say, 'The kid isn't that sick; her temperature is only 102.' "

Since 2001, the employee's average cost of an annual health-care premium for family coverage has nearly doubled — to $3,300, up from $1,800 — while incomes have come nowhere close to keeping up. Factor in other out-of-pocket medical costs, and the portion of the average U.S. household's income that goes toward health care has risen about 12 percent, according to the consulting and accounting firm Deloitte.

In a recent survey by Deloitte's health-research center, only 7 percent of people said they felt financially prepared for their future health-care needs.

Shirley Giarde, of Walla Walla, was not prepared when her husband, Raymond, developed congestive heart failure last year and needed a pacemaker and defibrillator. Because his job did not provide health benefits, she has covered them both through a policy for the self-employed, which she obtained as the proprietor of a bridal and formalwear store, the Purple Parasol.
But when Raymond had his medical problems, Giarde discovered that her insurance would cover only $22,000, leaving them with about $100,000 in unpaid hospital bills.

Struggling to pay

Even though the hospital agreed to reduce that debt to about $50,000, Giarde is still struggling to pay it — in part because the poor economy has meant slumping sales at the Purple Parasol. Her husband, now disabled and unable to work, will not qualify for Medicare for another year, and she cannot afford the $758 a month it would cost to enroll him in a state-run insurance plan for individuals who cannot find private insurance.

She recently refinanced her car, a 2002 Toyota Highlander, to help pay for her husband's heart medicines, which cost some $400 a month.

Experts say that too often for the underinsured, coverage can seem like health insurance in name only — adequate only as long as they have no medical problems.

Companies and policymakers have yet to focus on what the faltering economy means for employees' medical care, said Helen Darling, president of the National Business Group on Health, a Washington, D.C., association of about 200 large employers.

"It's a bad-news situation when an individual or household has to pay out-of-pocket three, four or five times as much for their health plan as they would have at the time of the last recession," she said. "Americans have been giving their pay raise to the health-care system."

Sage Holben, a 62-year-old library technician with diabetes who is active in her local union in St. Paul, Minn., says that in 2003 union members agreed to a two-year freeze on wages to protect their health-care coverage. But for the union, which will begin talks on the next contract this fall, it may be difficult to continue that trade-off, Holben said.

"I live paycheck to paycheck," said Holben, who makes close to $40,000 a year at Metropolitan State University.

When she took the job in 1999, she says, the health benefits required no co-payments for doctor visits. Now, her out-of-pocket cost per visit is $25, and she pays $38 a month for her diabetes medicine. She has not been to the eye doctor in two years, even though eye exams are crucial for people with diabetes and she knows she needs new glasses. Nor does she monitor her blood sugar as regularly as she should because of the cost of the supplies.

Many employers do recognize that their workers are struggling financially, even as they are asking them to pick up more of their health-care bills.

Even so, more companies may see themselves as having little choice but to require employees to pay more of their health expenses, said Ted Nussbaum, a benefits consultant at the firm Watson Wyatt Worldwide. And when a weak economy undermines job security, he said, workers simply may have to accept reduced benefits.

While Nussbaum and other consultants say it is unlikely that significant numbers of employers will simply drop coverage for workers, the weak economy could prompt more of them to push for so-called consumer-driven plans, which tend to offset lower premiums with higher deductibles.

And while these plans often allow employees to put pretax savings into special health-care accounts, they typically end up forcing the worker to assume a bigger share of medical costs. About 6 million people are now enrolled in these plans.

Among employers, the hardest pressed may be small businesses. Their insurance premiums tend to be proportionately higher than ones paid by large employers, because small companies have little bargaining clout with insurers.

High Fat Diet Can Reduce Eplileptic Seizures

The first clinical trial of a ketogenic diet — high in fats and low in carbohydrates and protein — to treat epilepsy has shown that it sharply curtails seizures and is an effective tool for managing children who are resistant to anti-epilepsy drugs.

The diet mimics the effects of starvation and induces the body to produce chemicals called ketone bodies rather than glucose as an energy source for the brain. Researchers are not sure why ketone bodies appear to reduce seizures.

The diet, which has four times as many calories from fats as from carbohydrates and protein, was developed in the early 1900s when the only treatments available for seizures were harsh and ineffective drugs, such as phenobarbital and potassium bromide.

The diet fell out of use with the development of more effective and gentler epilepsy drugs, but interest was renewed in the 1990s with publicity surrounding Hollywood producer Jim Abrahams' son, whose epilepsy was controlled by the diet.

In the new study, Dr. J. Helen Cross of the Great Ormond Street Hospital in London and her colleagues enrolled 145 children, ages 2 to 16, who were having at least seven seizures a week and were not responding to anti-epileptic drugs. They were randomly assigned to receive the ketogenic diet or a normal diet for three months, at which point those on the normal diet were switched to the treatment diet.

After several children dropped out for various reasons, there were 54 children in the diet group and 49 in the control group.

The team reported Friday in the online edition of the journal Lancet Neurology that the number of seizures dropped by more than one-third in the group receiving the ketogenic diet, while the seizures rose by more than one-third in the control group.

Salmonella Risks Rise in Seafood Imports

In March, inspectors checking Chinese seafood arriving at U.S. ports made some unsettling discoveries: fish infected with salmonella in Seattle and Baltimore, and shrimp with banned veterinary drugs in Florida.

Meanwhile, a shipment intercepted in Los Angeles on March 19 labeled "channel catfish" wasn't catfish at all, although records don't say what it was.

"A lot of those products coming in from overseas, you have no clue as to what is in them," said Paul Hitchens, an aquaculture specialist in Southern Illinois, where cut-rate Chinese catfish are threatening the livelihood of fish farmers.

China has rapidly become the leading exporter of seafood to the United States, flooding supermarkets and restaurants. And while China agreed late last year to improve the safety of its food exports, the inspectors' March findings were not isolated cases.

According to Food and Drug Administration records examined by the Post-Dispatch, inspectors turned away nearly 400 shipments of tainted seafood in a year's time from China.

The records told a troubling tale, but even more troubling was what they didn't tell. Only a tiny fraction of imports are inspected at all, and even fewer are tested.

Imports of seafood have surged dramatically in recent years and account for nearly 80 percent of the seafood consumed by Americans. That translates to 4.8 billion pounds of imported seafood last year out of the 5.8 billion pounds consumed.

The United States is just starting to confront the challenge: In an increasingly globalized food supply, the government — using an antiquated inspection system — is unprepared to keep Americans safe from the dangers arriving at our ports.

"When you look at less than 1 percent of shipments, and sample and test maybe one-fifth of those, there's no way you can protect the American food supply," said Michael Taylor, a former FDA official who is professor of health policy at George Washington University.

Seafood is considered one of the riskiest imports, and those from China have risen steadily. When the FDA does turn away shipments, usually it is because they contain veterinary drugs, among them nitrofurans, a family of antibiotics banned by the FDA because tests showed they cause cancer in animals.

More than 100 of the shipments were rejected for being filthy, decomposed or otherwise unfit for consumption, according to the records.

In December, after disclosures about Chinese imports of poisonous pet food and lead-filled toys, the FDA and the Chinese government agreed on new procedures aimed at preventing tainted and dangerous food and drugs from reaching American shores. But skeptics question whether the new, voluntary arrangement has sufficient teeth.

Revamping the system

Meanwhile, Chinese seafood is a prime target of legislation in Congress to revamp decades-old inspection mechanisms.

FDA officials are requesting new authority, including the ability to license private companies to assist with inspections. But the Bush administration has signaled opposition to key provisions that would require regular inspections in foreign lands and limit ports where food can arrive to docks with FDA labs.

Former FDA officials argue that change is urgently needed.

William Hubbard, formerly the FDA's associate commissioner, noted that the FDA's inspection system was designed early last century when the big challenge was finding bugs or mold in arriving barrels of commodities like flour or molasses. Now, the U.S. gets millions of shipments of food each year from around the world.

Hubbard, who retired in 2005, recalled inspectors reporting particularly disturbing methods of Chinese aquaculture: raising chickens in cages kept above fish-ponds — a potential source of the salmonella in seafood, he said.

"Increasingly, the world is moving in a better direction in food safety and we're falling behind," Hubbard said. "As our system becomes more antiquated and more ineffective, the world is sending us their junk."

Supermarket frozen-food sections routinely are filled with imported fish fillets, shrimp and crabmeat — which must contain country-of-origin labels on packaging.

No such disclosure is required for fish served in restaurants, so people generally can't know with certainty where the fish or shrimp they ordered originated.

Records at the National Oceanic and Atmospheric Administration show how surging Chinese imports are meeting the demand of seafood-loving Americans. For instance, between 2000 and 2007, imports of farm-raised tilapia from China — a staple in restaurants — soared ninefold, to more than 240 million pounds.

Imports of catfish have been especially vexing to U.S. seafood interests, given the whiskered bottom-feeder's popularity in parts of America.

In four years, imports of Chinese catfish — or fish so described — increased from 1.6 million pounds to more than 22 million pounds last year, posing stiff and sometimes crippling competition for U.S. catfish farmers.

Jeff McCord, spokesman for the Catfish Institute, said that many of the more than 1,000 catfish-growers he represents saw their revenues plummet.

Posing a new threat

It's usually impossible to track down the source of food-borne illnesses, which, according to the Centers for Disease Control, occur 76 million times annually in the United States, resulting in 325,000 hospitalizations and 5,000 deaths.

But fish — particularly uncooked or improperly cooked — is a common source of problems. And the rapidly growing imports from China pose a new threat that needs attention, said Caroline Smith DeWaal, a food-safety expert at the Washington-based nonprofit Center for Science in the
Public Interest.

In China and elsewhere in the developing world, "the ability to produce food and ship it globally far surpasses their ability to ensure it's safe," she said.

Experts agree that change is needed to protect Americans from dangerous imports. The question now is how much change Congress will demand and how much change the Bush administration and the FDA will be willing to accept.

Last year, U.S. and China officials began discussing changes amid disturbing revelations about dangerous products from poisoned pet food to shoddy tires.

In an agreement reached by the FDA and its Chinese counterparts in December, seafood was accorded the status of "high-risk" because of ongoing problems. Now, the FDA says, both sides are pursuing initiatives that the FDA hopes will lead to an FDA office in China and an electronic certification system for imports arriving in the United States.

77% of U.S. Mothers Now Breast Feed

The U.S. breast-feeding rate has hit it's highest mark in at least 20 years with more than three-quarters of new moms nursing their infants, according to a government report released Wednesday.

About 77 percent of new mothers breast-feed, at least briefly, the Centers for Disease Control and Prevention said.

"It looks like it is an all-time high" based on CDC surveys since the mid-1980s, said Jeff Lancashire, a CDC spokesman.

Experts attributed the rise to education campaigns that emphasize that breast milk is better than formula at protecting babies against disease and childhood obesity. A changing culture that accommodates nursing mothers may also be a factor.

The percentage of black infants who were ever breast-fed rose most dramatically, to 65 percent. Only 36 percent were ever breast-fed in 1993-1994, the new study found.

For whites, the figure rose to 79 percent, from 62 percent. For Mexican-Americans, it increased to 80 percent, from 67 percent.

Former U.S. Surgeon General Dr. David Satcher celebrated the report's findings, noting that black women have historically had lower breast-feeding rates.

"It was very impressive that when it comes to beginning to breast-feed, African-American women have had the greatest progress," said Satcher, who is now an administrator at Atlanta's Morehouse School of Medicine.

The new report is based on a comprehensive federal survey involving in-person interviews as well as physical examinations. The findings are based on information for 434 infants from the years 2005 and 2006.

A telephone survey of thousands of families, released last year, found that 74 percent of infants in 2004 had been breast-fed.

At least three types of CDC surveys have shown breast-feeding rates moving upward since the early 1990s, officials said.

The latest CDC report found rates of breast-feeding were also lowest among women who are unmarried, poor, rural, younger than 20, and have a high school education or less.