Two critical with swine flu in Hong Kong

AFP/File – People are pictured wearing masks as they visit a hospital in Hong Kong, in 2009. Two people were in …

HONG KONG (AFP) – Two people were in critical condition in a Hong Kong hospital suffering from swine flu, health officials said Friday, a year and a half after an outbreak killed more than 80 people in the city.

The Chinese financial centre is nervous about infectious diseases, following the outbreak of the SARS virus in 2003, which killed 300 people in the city and a further 500 around the world.

Hong Kong, a city of seven million, has some of the world's most densely populated neighbourhoods, prompting a panicked response from many residents over news of a disease outbreak. Some wear surgical masks to avoid infection.

The city's health department said that the deadly influenza had claimed 83 lives since an outbreak in 2009.

Authorities appeared wary of raising the alarm over the latest cases, with a senior public health official telling RTHK radio there were no plans to shut schools, as the city did in 2009 which drew criticism about an official overreaction.

But there are worries the disease could spread over the next few weeks in the run up to Lunar New Year, when hundreds of millions of Chinese travel across the country to celebrate with families.

On Friday, a spokeswoman for the Queen Elizabeth Hospital told AFP "a 21-year-old female is in critical condition after contracting swine flu".

The student, who had returned to Hong Kong from mainland China after falling ill, was admitted to hospital on January 11 and transferred to intensive care on Tuesday, the spokeswoman told AFP. She later confirmed the woman has leukemia.

Also Tuesday, a two-year-old girl was placed in the hospital's intensive care unit after she contracted the disease, the spokeswoman said, adding that she remains in critical condition.

Authorities in the nearby gambling hub of Macau have confirmed a 47-year-old woman was in critical condition with the disease.

Swine flu has killed more than 18,400 people and affected practically all parts of the world since it was uncovered in Mexico and the United States in April 2009, according to the World Health Organization.

In August last year, the agency said swine flu had "largely run its course", declaring an end to the pandemic.

In May 2009, Hong Kong health authorities quarantined around 300 guests and staff at a hotel where the carrier, a Mexican national, had briefly stayed, while education chiefs ordered all primary schools to be closed for two weeks over fears about the illness spreading.

In July 2009, a Philippine maid became the city's first swine flu fatality.

Last month, Hong Kong lowered its public health warning on influenza, weeks after announcing its first human case of bird flu since 2003.

Hong Kong was the site of the world's first major outbreak of bird flu among humans in 1997, when six people died of a mutation of the virus, which is normally confined to poultry.

by Joyce Woo

FDA to consider Alzheimer's test for living patients

One of the many frustrations of Alzheimer’s disease is the difficulty in pinpointing just who has it. According to published research, as many as one in five people told they have Alzheimer’s are mislabeled. A definitive diagnosis can  be made only after death, by an autopsy that reveals a distinctive buildup – known as amyloid plaques – in the patient’s brain. This week, however, the FDA will consider a new diagnostic test that may be able to identify those plaques through PET scans – a type of brain scan – on living patients.

In a small study run by Avid Radiopharmaceuticals and made public Tuesday in the Journal of the American Medical Association , PET scans identified the telltale plaques in 97 % of patients who actually had them, as determined by a subsequent autopsy. The 35 patients in this part of the study were terminally ill, and agreed to both a brain scan and an autopsy.

The researchers also performed PET scans on presumably healthy people to try to ensure that the test could tell the difference. It could. Of 74 young and healthy people tested, none had scans indicating Alzheimer’s.

Before performing a PET scan, a doctor or technician injects the patient with a radioactive dye that can be detected by the imaging equipment. The particular dye used in this test was developed by Avid and is known as Florbetapir F 18. Chief Executive Officer Dr. Daniel Skovronsky says Florbetapir F 18 binds tightly to the amyloid proteins – making them visible to the scanner – but doesn’t bind to other tissue.

According to Skovronsky, diagnosis of Alzheimer’s still depends on a clinician who can evaluate a patient’s overall condition, but he says the test with Florbetapir could be especially useful as a tool to rule out Alzheimer’s. In that scenario, a patient who shows symptoms of dementia would be given a PET scan; a negative result would push her physician to consider other conditions.

A second paper in JAMA suggests that a simple, low-cost blood test can tell whether a person is at risk for cognitive decline, which is a precursor to Alzheimer’s.

During a span of 10 years, researchers checked the blood of 997 elderly people in Memphis, Tennessee and Pittsburgh, Pennsylvania, testing for two types of proteins that are associated with Alzheimer’s. They re-tested each person at 1-year, 3-year, 5-year, 8-year and 10-year intervals. Patients with lower levels were significantly more likely to suffer cognitive decline over time.

Researchers also found that patients with more “cognitive reserve” while healthy, are less likely to decline. “Cognitive reserve” is measured in various ways – for example, by years of school attended, or performance on intelligence tests.  The researchers say it may be that people with higher intelligence or more education are able to better compensate for functions lost to early cognitive decline.

Healing touch of family, friends aids recovery

(CNN) -- A thumbs up. Two opened eyes. A smile. These simple signs of recognition from U.S. Rep. Gabrielle Giffords kept hope alive for her recovery from a bullet to the head January 8. And later this week, her parents have told family members and friends in an e-mail, she'll be moved to Houston, Texas, to begin aggressive rehab with a team of medical specialists.

Giffords opened her eyes for the first time January 12, and one of her doctors, Dr. Michael Lemole, said the "unexpected familiarity" of having close friends visit might have helped her progress. She still has a long journey ahead in recovery, but the support of family, friends and onlookers across the country is evident.

Astronaut Mark Kelly, Giffords' husband, has been by the congresswoman's side since the shooting. He told ABC's Diane Sawyer he will be there holding Giffords' hand as many days as it takes, "whatever it takes."

Patients, their families and health care professionals tell CNN that having loved ones present and actively encouraging recovery can make a profound difference.

Shawna Shearer believes it's true, as she said in her iReport. Her husband Andrew, 31, broke both knees and femurs and suffered several small strokes in May in a head-on car crash. For two months, he remained unconscious, but he was never alone. His wife, mother and father took turns staying with him; his father slept in the waiting room many nights.

"I tried to stay as positive as I could," Shawna Shearer, 28, said. "I remember when Andrew opened his eyes, and it was amazing to us."

Although there are no hard data to suggest that having family and friends around can help a brain trauma victim regain consciousness or brain function, it is true that familiar voices have special access to the brain, says Dr. Lee Schwamm, associate professor of neurology at Harvard Medical School and vice chairman of neurology at the Massachusetts General Hospital.

It's as if there's a little police officer inside your brain deciding which signals are allowed to go through and which are not, Schwamm said. And the officer gives privileged access to familiar voices, even with significant injury to the brain and reduced consciousness.

Gupta: Giffords 'alert' and 'aware'

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Loughner crazy enough to plead insanity?

Shawna Shearer hoped for signs that she and the rest of the family were getting through to Andrew. But when he first woke up, it was hard to tell what, if anything, he could understand of what others said, Shawna said. Then, he started following family members with his eyes. By August, he could nod his head for "yes."

Andrew Shearer told CNN he doesn't remember anything that happened between the day of the accident and around August or September, but appreciates the "tremendous help" that the mere presence of his family members brought.

Randie Alf, 28, experienced that, too. In December, she had an aortic dissection and fell unconscious for two days. Her large family, spread out across the United States, banded together to visit, pray and post updates on Facebook.

"When I 'awoke' I wasn't sure when it was and I was still not making too much sense, but I knew where I was and who was with me, my mom and dad and my cousin and my aunts and my friends. And day by day I got stronger in both mind and body," Alf wrote in her iReport.

"I had such a wide array of people thinking about me. I definitely believe that those people are a lot of the reason I got better so quickly," she told CNN.

Alf stayed in the hospital for two weeks, mostly in the ICU. She is staying with her parents during her recovery. Her younger sister, some cousins and many friends are also close by.

Kimberly Glassman, chief nursing officer for NYU Langone Medical Center, has witnessed many occasions of unconscious patients waking up amid the support of families, and believes they have an important role to play in recovery.

"When we have been able to speak to patients who have been in that state and woken up, it's very common for them to say that they heard people talking to them, they could feel people touching them," she said.

It's equally helpful for the families to feel as though they are doing something useful and meaningful for their loved one in the ICU, Glassman said. Being at the bedside of the patient may not only transfer familiar signals of touch and sound, but also means a lot to the family members.

Andrew Shearer is still recovering, currently in in-patient rehabilitation. From the strokes, he has complications with mobility, and a lower speed of cognitive processing, but no difficulty speaking. His wife and children are looking into moving somewhere where he can move around easier than in their condo, as he mostly uses a wheelchair.

"If you've got people at your side encouraging you, you have such an advantage over isolated and withdrawn patients who have to do that journey alone," Schwamm said.

Kelly is already prompting his wife to have expectations for a speedy turnaround: "I told her she's going to be walking in two weeks," he told Sawyer. "It's good to have a goal, and she's a very goal-oriented person."

There are perhaps more subtle ways that family support can also facilitate a recovery: A vested interest on the part of the patient's relatives and friends can help the hospital staff feel more connected to the patient also. At Massachusetts General Hospital, families of admitted intensive care unit patients are invited to make posters with photos so that hospital staff members have a better sense of who they are. If the family believes in the patient, the staff may be a little more hopeful than they might have otherwise.

"When families give up on the patient's recovery, I think the health care team may do the same," Schwamm said.

Alf and Andrew Shearer both recommend that family and friends of someone in the hospital try to be there for the patient as much as possible. Even if you can't be there physically, phone calls and cards do help, Alf said.

In fact, nurses such as Glassman will put the phone up to an unconscious patient's ear if a family member can't be there in person. They'll read every card sent to these patients who can't read themselves.

"I would encourage families to be hopeful, to be present, and to really keep hope alive in their heart," Schwamm said. "We do see patients like Ms. Giffords, and we see them often."

What friends' genes say about you

There's a lot of focus these days on tailoring treatments for diseases to individuals based on their genes, but friends' genes might be just as relevant, scientists argue.

It turns out that there are genetic correlations among people in the same social group, a new study in the journal Proceedings of the National Academy of Sciences finds.

"We’re not just a product of our own genes, but those of others around us," said study co-author James Fowler, associate professor at the University of California, San Diego. Fowler and Dr. Nicholas Christakis of Harvard, another study collaborator, previously penned a book called Connected detailing how everything from obesity to happiness to loneliness seems to spread in social networks.

Obese? What your doc may be overlooking

(Health.com) -- Ann Silk, MD, worries about her overweight patients. But Dr. Silk, an internal-medicine resident at the University of Pittsburgh Medical Center, isn't concerned only about their diets and cholesterol levels.

She also worries that the fatty tissue on their bodies will obscure other health problems, like tumors.

Although excess weight is hard on a patient's body, it's also hard on doctors who are trying to perform physical exams.

Blood pressure cuffs have to be bigger. Stethoscopes can't pick up subtle heart abnormalities and lung sounds muffled by flesh. And medical scales often max out at 350 pounds -- making it hard to determine exactly how overweight the largest patients are.

Moreover, excess body fat can interfere with a doctor's ability to assess thyroid or liver health or recognize abnormal growths.

Even with all the high-tech medical tools at their disposal, doctors still find out some important, potentially life-saving information by touching and feeling their patients' bodies. Fat makes that job much tougher.

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"It's a worry that we're not finding what we need to find on exams because there is tissue in the way of our fingers, and in the way of our stethoscope," says Dr. Silk, who co-authored an article about this problem in this week's issue of the Journal of the American Medical Association.

"It leaves us with a little bit of uncertainty -- maybe you would even say insecurity -- whether we are identifying all the abnormalities on [an] exam."

In some cases, this uncertainty could lead to missed tumors or other oversights, Dr. Silk adds. "For the abdominal and gynecological exam, a mass would have to be pretty big before you could find it."

John Simmons, MD, an assistant professor of family and community medicine at the Texas A&M Health Science Center, in College Station, says that doctors can't identify conditions such as liver problems, hernias, and fluid buildup in the abdomen through physical exams alone.

Still, he says, abdominal, breast, thyroid, and genital examinations are particularly difficult in obese patients.

Health.com: 19 new reasons to keep fat off

For this reason, obese patients should be especially proactive about making sure they get regular screening tests, Dr. Simmons says. If necessary, they should "take it upon [themselves] to remind the doctor of potentially embarrassing but critically important screening tests like mammograms, Pap smears, genital exams, and colonoscopies."

The impact of obesity on physical examinations is still a new area of research, Dr. Silk says. To her knowledge, no studies have been conducted on whether excess body fat can delay serious diagnoses, and medical schools and textbooks appear to be lagging behind the rise in obesity rates.

More than one in three U.S. adults are obese, and two out of every three are overweight. The average American man and woman now weighs 195 pounds and 165 pounds, respectively -- about 18% more than they did in 1960.

Health.com: Best and worst advice from top diet plans

Dr. Silk and her co-author argue that the standard physical exam needs to be modified as a result. Here are some of the changes they say doctors and obese patients should consider during their next physical:

Longer breast exams. Some data suggests that a good breast exam takes three minutes per breast, but even longer in a heavier patient, Dr. Silk says. Doctors and patients should be prepared to spend some extra time on breast exams.

Rest before tests. Obese patients may grow short of breath after walking even brief distances, which could throw off readings for heart rate, blood pressure, and breathing rate. If needed, doctors should encourage obese patients to sit quietly for 15 minutes before checking their vital signs.

More elbow grease. Belly fat can make it harder for doctors to feel for liver problems or unhealthy fluid buildup in the abdomen, which means doctors may need to press extra firmly or spend more time on this area. "Patients have to be good sports at tolerating vigorous exams," Dr. Silk says.

Different instruments. Standard medical instruments may not be sufficient to examine heavier people. For instance, doctors may need to use a handheld imaging device known as a Doppler (rather than a stethoscope) to measure heart rate in obese patients, and they may need to use a longer speculum for gynecological exams.

Health.com: 13 oversize products for overweight people

These changes aren't likely to address all the shortcomings of the physical exam, however. Medical training and textbooks will eventually need to be updated to reflect the obesity epidemic, Dr. Silk and her colleague write, and some doctors may need to invest in new technology and equipment.

Copyright Health Magazine 2010

Antibiotics speed up recovery from ear infections in young children, studies show

Giving babies and toddlers antibiotics when doctors are certain they have ear infections can help speed up their recovery, supporting current treatment guidelines for children between the ages of 6 months and 23 months.

However, antibiotics do come with significant side effects including diarrhea, rashes, yeast infections and vomiting. Overuse of drugs also contributes to antibiotic resistance, so careful selection of who should take antibiotics is necessary according to 2 studies published Wednesday in the New England Journal of Medicine.

According to one of the studies, ear infection, or acute otitis media, is the most frequently diagnosed illness in children in the United States, and most children with these ear infections are routinely given antibiotics.

But just 2 months ago, a new study confirmed practice guidelines from 2004, which recommend that children older than 2 with a confirmed diagnosis of an acute ear infection do not need to be given antibiotics because the drugs do not significantly speed up recovery.

The foundation for  the "watchful waiting" treatment recommendation instead of taking drugs is based on this and previous studies that  did not have very many children under age 2 in the clinical trials.  This made concluding that the same treatment works in the youngest age group very difficult.

These 2 new studies were designed to provide the research to  fill the gap, and clarify treatment recommendations for babies and toddlers.  The children in these latest trials had their ear infections confirmed by experts (otoscopists).  Researchers found that the youngsters who received a placebo did not recover as quickly as those getting the amoxicillin-clavulanate, an antibiotic that has been shown to be effective for earaches.

However the differences were not huge.  In the United States study, 80% of the children on antibiotics felt better on the seventh day of treatment; 74% of the children taking a placebo also felt better on the seventh day.

Dr. Jerome Klein, a pediatric infectious disease specialist from Boston University's Medical School, says in an accompanying editorial that these two studies resolve the controversy over giving antibiotics versus watchful waiting in kids with confirmed ear infections.

"More young children with a certain diagnosis of acute otitis media recover more quickly when they are treated with an appropriate antimicrobial agent," Klein wrote.

Dr. Richard Rosenfeld, who is a professor and chairman of otolaryngology at SUNY Downstate and Long Island College Hospital in Brooklyn, New York, has been charged with reviewing the 2004 American Academy of Pediatrics guidelines for treating ear infections.  He, too, has been eagerly awaiting the results of these 2 studies.

One of the strengths of both studies, Rosenfeld said,  is that the researchers took the time to make a solid diagnosis. Only children who really had ear infections were included in the trials.  But Rosenfeld  doesn't see the results as black and white as Klein.

"Medicine is about gray zones and balancing the risks and benefits," Rosenfeld says. "Parents and doctors need to understand what the benefits and what the downside of treatments are."

"If you received a placebo and you have a 74% chance of having symptoms go away or improvement [of illness]" – compared with the 80% in the antibiotic group ... "as a parent, how impressed are you about a 6% difference?"  In treatment outcomes for pain, there was no difference, he notes.

In both studies, children taking the real drugs had more side effects.  The study authors caution about the overuse of these drugs and the risk of antibiotic resistance.  The Finnish noted that limiting use of antibiotics may reduce the development of drug-resistant bacteria and increase the chance the future use of antibiotic will be effective.

Rosenfeld says it's never wrong to prescribe an antibiotic for a well-diagnosed ear infection. "If the child has high fever, severe ear pain, the child is really miserable, has a fever or draining from the ear or double ear infection and is under 2 years old, then prescribing antibiotic is probably the right thing to do."

But waiting to take the antibiotic isn't a bad idea either.  He says he frequently writes a prescription for parents but tells them to hold off from filling it for 3 days.  If the child still has symptoms 3 days later, then they should get the antibiotic and start giving it to their child. If you do that, 2 out of 3 parents don't fill out the prescription."

Which is why he says what to do is still not clear-cut.  He also points out that if antibiotics don't relieve a child's pain, pain medications will.

Rosenfeld believes these latest studies reinforce an important message: "It's an opportunity for a conversation with your pediatrician." Parents need to weigh the benefits of what antibiotics can do in terms of killing the bacteria (if the ear infection is caused by a bacteria and not a virus) and the side effects their child may have to endure, as well as the possibility that exposing bacteria to antimicrobials may make the drugs less effective in the future.

Fatty acids can help ease PMS symptoms

(CNN) -- Taking dietary supplements containing essential fatty acids can help reduce the symptoms of premenstrual syndrome, according to the results of study by researchers at a Brazilian university.

The study, published Monday in the journal Reproductive Health, found that taking capsules containing about 1 gram of a blend of three essential fatty acids produced a significant reduction in PMS symptoms.

Essential fatty acids are substances that are not produced by the human body and are only available from diet. Eggs, nuts, vegetable oils and fish are examples of foods that provide such acids, which are also available in supplement form.

The study, authored by researchers from the Federal University of Pernambuco, is not the first to address the possible link between PMS and essential fatty acids, substances that play a complicated role in a woman's reproductive system. The study cites research dating back to 1983 examining such a possible link.

According to the study, the 120 women who participated reported few side effects, and most of those were mild and may have been due to sensitivity to mineral oil, the placebo taken by some of the participants.

The supplements taken by women in the study contained 210 mg of gamma linolenic acid, 175 mg of oleic acid, 345 mg of linoleic acid, 250 mg of other polyunsaturated acids and 20 mg of vitamin E, according to researchers.

According to the study, women who took the supplements for six months saw a bigger benefit than those who took them for three months.

The researchers do not make any recommendation in their study about whether women who suffer from PMS should increase their intake of essential fatty acids or, instead, consult with their doctor.

Other treatments studied for PMS include vitamin B6, ascorbic acid and niacin.

Excess gaming linked to depression, bad grades

When it comes to playing video games, it seems moderation is important to a child's mental health. A new study published by the American Academy of Pediatrics finds excessive gaming may lead to depression, anxiety, and poor grades in school.

Researchers in the U.S. and overseas looked at more than 3,000 elementary and middle-school children in Singapore and found that almost 9% of them were considered pathological or "addicted" to gaming – similar percentages were found in other countries.

Over a two-year period about 84% of those who started out as excessive gamers remained so, indicating that this may not simply be a phase that children go through. Boys were more likely to show symptoms of excessive gaming. Overall those considered "pathological" gamers displayed higher levels of depression and other mental health issues than their peers who played fewer video games. The researchers also found that students who did stop their excessive gaming reduced their levels of depression, anxiety and social phobia.

There is debate in the medical community as to whether pathological or "addictive" video gaming should be listed as a mental disorder in the American Diagnostic and Statistic Manual of Mental Disorders – a guide used by the American Psychiatric Association in diagnosing mental disorders.

To gauge the level of pathological gaming, the study authors asked students questions similar to the type used to diagnose gambling addiction such as: were students becoming more preoccupied with video games, did they lie about the amount of time spent playing, had their schoolwork suffered, and if playing helped them escape from problems or bad feelings.

A young person was labeled pathological or "addicted" if the practice caused problems in his or her life.

"And we define that as actual functioning – their school, social, family, occupational, psychological functioning. To be considered pathological, gamers must be damaging multiple areas of their lives," explains study author Douglas Gentile, Ph.D., developmental psychologist at Iowa State University in Ames.

Pathological gamers were playing an average of more than 31 hours a week compared with their less excessive peers who played about 19 hours a week.

Gentile and the other researchers also looked at potential risk factors for becoming pathological gamers.

"Kids who were more impulsive were more likely to become addicted; they had a harder time managing their impulse control. If they were socially awkward then they were more likely to be addicted and if they spent a greater amount of time then the average kids playing games," explained Gentile.

The Entertainment Software Association disagreed with the findings. " "There simply is no concrete evidence that computer and video games cause harm," a statement from the organization said. "In fact, a wide body of research has shown the many ways games are being used to improve our lives through education, health and business applications."

Dr. Don Shifrin, spokesperson with the American Academy of Pediatrics, called Gentile's study important. "It allows us to take a harder look at how gamers play and whether there is balance in the lives of our children and teens," he said

The AAP recommends that elementary school age children engage in no more than one hour of screen time a day, and high schoolers no more than  two.

FDA limits amount of acetaminophen in prescription drugs

Manufacturers of prescription drugs containing acetaminophen are being asked to limit the dosage of the drug and add a liver toxicity warning to product labels, the Food and Drug Administration announced Thursday.  This so-called "boxed warning" is the agency's strongest warning for a prescription drug.

Makers of prescription products that include acetaminophen, a popular pain and fever reducer better known under the brand name Tylenol, will be required to limit the amount of the drug to no more than 325 milligrams (mg) per tablet or capsule.  Currently some products contain between 500 mg  to 750 mg per dose.

"FDA is taking this action to make prescription combination pain medications containing acetaminophen safer for patients to use," said Dr. Sandra Kweder, deputy director of the Office of New Drugs in FDA's Center for Drug Evaluation and research (CDER). "Overdose from prescription combination products containing acetaminophen account for nearly half of all cases of acetaminophen related liver failure in the United States, many of which result in liver transplant or death."

Acetaminophen is often used in combination with opioids like oxycodone (Percocet), hydrocodone (Vicodin) and codeine (Tylenol with Codeine).  In 2008 nearly 200 million prescriptions for acetaminophen/opioid combination products were written, according to the FDA.  In 2009,  an FDA advisory committee recommended putting a stronger warning about the risk of severe liver damage on the label of all prescription products containing the drug.

Kweder stresses when taken as directed, acetaminophen is perfectly safe but can be extremely dangerous if the recommended dose is exceeded. The current maximum dose is 4,000 mg within a 24-hour period.  She says patients taking a higher dose prescribed by a doctor are in no immediate danger and can continue taking the medication as prescribed.

Over-the-counter acetaminophen will not be affected by this new action, although the FDA is considering changes with these medications too.  OTC products typically contain either 325 mg (regular strength) or 500 mg (extra strength) of acetaminophen.  One reason that these drugs aren't included in today's action, says Kweder says, is that they are already more clearly labeled than the combination drugs.

Unlike over-the-counter products that are clearly labeled, Kweder says, it's not always clear to consumers that acetaminophen is in the prescription products they are taking because they're not familiar with the abbreviated name–APAP–often used in the packaging. "One of the real challenges is patients taking these prescription products don't know they are taking acetaminophen at all," she said.  So it's possible for someone to take the prescription drug and then reach for an OTC product Acetaminophen, which can quickly add up to too much of a good thing. "They don't realize that they are overdosing," Kweder told reporters in press conference.

Neurologist Dr. John Markman is a pain management expert and researcher at the University of Rochester in New York.  He says today's action strikes the right balance. "I think they got it right. I think they made a great public health decision by balancing the need for access to these important pain treatments and at the same time taking steps to make them safer." Markman said. "The risk of liver injury with acetaminophen when taken in excessive doses can be a significant problem for an individual patient as well as at a public health level, but so is the problem of chronic pain, so trying to find a balance of addressing both of these public health problems is delicate work."

But consumer advocacy group Public Citizen says the agency should have addressed the OTC drugs first.

"The measures announced today by the Food and Drug Administration (FDA) concerning acetaminophen in prescription drug products are certainly a step forward, but they entirely fail to address the greater issue of over-the-counter (OTC) use of this drug and to implement strong recommendations made by three FDA advisory committees in June 2009 about this problem," said Dr. Sidney Wolfe, Director, Public Citizen's Health Research Group. "It is inexcusably poor judgment on the part of the FDA to have failed to take action concerning this major source of acetaminophen consumption and, consequently, acetaminophen toxicity."

The shift away from higher doses of acetaminophen will be phased in over the next three years. Prescription products will continue to be available during this transition period and the FDA says they anticipate no shortage of pain medication.

In the meantime the FDA has the following advice for consumers:
*Carefully read all labels for prescription and OTC drugs
*Ask the pharmacist if your prescription contains acetaminophen
*Don't take more than 1 product that contains acetaminophen
*Don't take more than the maximum daily amount
*Avoid drinking alcohol while taking acetaminophen
*Don't stop taking acetaminophen without first talking to your doctor

Can you control your dreams?

(CNN) -- Life doesn't always go the way you want, but sometimes dreams do.

A lucid dreamer is a person who is aware that he or she is dreaming and is able to manipulate the plot and outcome of the dream, like a video game. It is not uncommon, and in children it can happen frequently, even as an expression of creativity, said Gary Schwartz, professor of psychology and neurology at the University of Arizona.

It appears that Jared Loughner, allegedly responsible for the shooting at a supermarket in Tucson, Arizona, on Saturday, took a keen interest in the phenomenon. In the YouTube video called My Final Thoughts: Jared Lee Loughner! that is said to belong to him, he talks about conscious dreaming and reflects a blurring between waking life and reality -- "Jared Loughner is conscience (sic) dreaming at this moment / Thus, Jared Loughner is asleep," he writes.

Loughner likely was referring to lucid dreaming, experts said, which has been studied scientifically and shown to be a real phenomenon. In fact, humans have known about lucid dreaming for centuries; Tibetan Buddhists began practicing "dream yoga" more than 1,000 years ago as a means of attaining a purer form of consciousness through awareness in dreams.

Dreams about taking exam, being naked -- what they mean

How to have a lucid dream

Research suggests that various techniques can increase the frequency of lucid dreams. For instance, you can remind yourself before you go to sleep that you want to be aware that you're dreaming when dreams happen, said Deirdre Barrett, psychologist at Harvard University and the Cambridge Health Alliance and editor of Dreaming: The Journal of the International Association for the Study of Dreams.

You can also do certain checks to see whether you're awake or dreaming in the dream. According to the Lucidity Institute, these include reading letters or numbers and then looking at them again after a moment (they will most likely change or seem weird in a dream). If that doesn't convince you, visualize yourself in a dream and then imagine yourself in a dream activity (nothing will happen if you're awake).

Such reality checks played a prominent role in the movie "Inception," in which dreamers had "totems" to help them distinguish the two states of mind, such as a metal top that can stop spinning only in real life.

When dreams go too far

While characters in this movie began to lose their grip on waking life, confusing dreams with reality is actually a sign of mental illnesses such as schizophrenia, Barrett said. That confusion is not nearly as neat or clear-cut as what is portrayed in "Inception."

Getting interested in lucid dreaming is a "completely innocuous activity," as is keeping a dream journal, she said.

But saying that dreams are more vivid than waking life, and having trouble distinguishing between one's dreams and reality, are red flags for mental illness, she said. If you know someone like this, encourage him or her to talk to a therapist, she said.

This does not mean the person is dangerous in any way, but he or she should seek help, she said.

"If you become extremely confused due to psychotic illness, you might be confusing dreaming and waking while confusing right and wrong," Barrett said.

There is the possibility, however, that in combination with mental illness and other factors such as hostility and drug use, an obsession with lucid dreaming could become harmful, Schwartz said.

"If you develop the belief that what you do in the dream world, you can do in the real world, in the hands of someone who is mentally deranged, it can become extremely dangerous," he said.

Getting to the point where waking life seems like a dream is rare, Schwartz said.

"Most people who practice lucid dreaming and take it seriously are people who are sane," he said. "They are very aware of what it is, and aware of the need to discriminate what is and what is not their dream. It's completely safe."

Customers pay little heed to calories on menus

Posting calories on menus has little effect on what customers buy, according to a recent study.

Customers at TacoTime (a western Washington chain)  who read how many calories are in their chimichangas, burritos and tacos on the restaurant's menu were just as likely to order them as people who don’t have that information.
For 13 months, researchers recorded food purchases at seven suburban TacoTimes and seven inside Seattle, Washington. Seattle passed a law requiring that all fast food chains post their calories, fat and sodium content to the menus in 2009.
Once the law went into effect, public health researchers in Seattle  and researchers from Duke-National University of Singapore Graduate Medical School compared what people were buying at TacoTimes inside and outside the city.
Contrary to their hypothesis, “We found no difference,” said lead author Eric Finkelstein.  “We looked at the variables – the transactions, total calories per transaction, food, dessert, entrees. We weren’t able to find any effect whatsoever.”
The findings suggest that having calorie information did not change public health behavior.
This may not be totally surprising. After all, obesity rates have continued to soar after pre-packaged foods were required to carry nutritional content, said Finkelstein, an associate professor of health services at Duke-National University of Singapore.
Similar studies about calorie counts in menus have found either small, marginal effects or no difference at all.
“This is just one chain, so it’s possible to find more compelling results in different chains,” Finkelstein said, about the TacoTime’s study.
Regardless, nationwide changes are coming. The health care reform bill, passed last year,  requires fast food chains to post their nutritional information on menus.  The FDA’s rules on for this are due in March.
While calorie info on menus may not unleash widespread weight loss, it could have some benefits, Finkelstein said.
“My sense is that if these laws are to have an effect, it’s going to be on the supply side,” he said, referring to fast food companies.  “If they’re embarrassed about 2,000-calories lunches, they might try to skimp on calories, sodium and fat.”

Warning signs from a troubled mind What parents should do

(CNN) -- After the shooting that left six dead in Tucson, Arizona, last Saturday, a portrait emerged of alleged gunman Jared Lee Loughner as an angry, disturbed young man.

His outbursts frightened teachers and classmates at Aztec Middle College, from which he was suspended for behavioral issues in September. He alienated people, wrote incoherent, raging diatribes and disturbed classmates with comments like "why don't we just strap bombs to babies?" according to records and CNN interviews.

In hindsight, the escalation seems obvious. How could such warning signs have been ignored?

The reality, however, is that the line between unusual behavior and someone being a true threat is murky. And there aren't many options to detain people who exhibit disturbing behavior but have not committed a crime, experts said.

While Loughner's background check revealed brushes with the law, it did not set off alarm bells for authorities.

Mental health experts say the suspect's Web postings, and descriptions from friends and acquaintances, suggest that Loughner, 22, could have underlying mental health issues such as schizophrenia or bipolar disorder.

Such symptoms typically surface during young adulthood.

Possible signs of psychosis can include keeping to oneself, avoiding social interaction, having odd interests and beliefs -- for example, in UFOs or reading the future, and other displays of losing touch with reality, said Dr. Charles Raison, psychiatrist at Emory University.

The person could also withdraw, show contempt for others -- a sign that he or she is losing positive relationships. Another symptom may be loss of sleep because of brain chemistry changes, said Dr. Dennis Embry, president and senior scientist of Paxis Institute.

Sometimes these are mere signs of eccentricity; the difference is that the person at risk from psychosis is suffering, and the quirky-but-healthy person is content, said Dr. Cheryl Corcoran, who runs a psychosis research program at Columbia University.

"The teenager who is at risk for psychosis feels very lonely and alienated and worried that they're going crazy. It may not look so different from the outside, but from the experience of the individual, it's very different," she said.

Such symptoms do not mean they'll progress into schizophrenia and other disorders. But they can play a role, and shifts in behavior may seem sudden and extreme.

Criminologist Matthew Robinson recalled his brother having a mental breakdown at the age of 20. His brother started having hallucinations, obsessing over government conspiracies and claiming his friends were going to eat him.

Immediately, their mother drove five hours to see him, noticed something was odd, and took him to a hospital. Robinson's brother was later found to have bipolar affective disorder.

"The family rallied and took him to hospital," Robinson said. "He was willing to get help."

His brother is now an award-winning teacher, married and lives a normal life after receiving treatment.

When someone's behavior spirals out of control, the family has to determine whether it's eccentricity or something severe. Some families dismiss the changes as a phase; others are ill-equipped or in denial.

"It presupposes a family structure is there," said Robinson, a professor of criminology at Appalachian State University in Boone, North Carolina. "The burden really falls on the family, parents, siblings, to coerce someone in a compassionate way."

There is no hard line between odd behavior and mental illness, but breaking the law can serve as a division.

Many people live with mental illness like schizophrenia, without ever becoming violent. And those with mental health disorders are not more likely to commit an act of violence, but they do need help, experts said.

Extreme paranoia and feelings of being persecuted can drive mentally ill people toward violence, Raison said. They are not sociopathic, and genuinely believe in what they are doing.

"What you tend to find among schizophrenics are normal people doing violent actions because of twisted beliefs," he said.

The tendency to become violent can be heightened by delusions, hallucinations, drug abuse and refusal to get medication or treatment, Robinson said.

For families and friends, it's important to engage the problem rather than avoid it, said Mike Guthrie, executive director of Beacon Youth and Family Center, an organization in Denver, Colorado, that provides mental health services.

The child may want the help but not know how to ask for it, Guthrie said.

Treatment, including medication and therapy, is most effective in the early stages of psychosis, Corcoran said. Teenagers, in particular, can be more easily persuaded to seek treatment because they often don't yet believe in the disturbing thoughts and delusions they're having -- they're still trying to work them out for themselves. They know they would like not to have these symptoms, and are more likely to listen to their families, she said.

For an adult who shows warning signs of psychosis but won't accept professional help, there's another heartbreaking choice: an ultimatum.

Parents can tell their adult children living at home that they'll have to leave if they won't take prescribed medication, Raison said. And sometimes they do leave; in other instances, it could be the only way for them to accept help for a mental illness.

It's possible for parents to get a conservatorship over an adult child. This means that a judge grants them legal charge of the child's decisions. This happened with Britney Spears in 2008, when a judge granted her father temporary conservatorship after she was cited for "habitual, frequent, and continuous use of controlled substances and alcohol."

But conservatorship rules vary by state, and the ruling can be difficult to obtain, because it must be proved that the person cannot manage his or her own life. The legal affairs cost money and, generally, the person in question must be shown to be dangerous.

Loughner, for example, wasn't in a psychiatric hospital and wasn't living on the street, so he probably would not have qualified, Raison said.

Warning signs of violence: A mother's view

The rules on forcing a person to get mental health treatment also vary by state.

Here are some of the experts' advice about dealing with a child who you may suspect has severe behavioral or mental health issues:

• Reach out to them. Ask -- not in an accusing tone -- what's going on. Make it easier for them to get help;

• Discuss the problems or symptoms in a matter-of-fact manner, rather than a confrontational tone;

• Call a local chapter of NAMI and ask for referrals for children or adolescent mental illness;

• Call a behavioral health hotline recommended by your insurance company. If the insurance does not cover mental health services, try a community mental health resource;

• Schedule an appointment with mental health professional and explain what you're seeing;

• Encourage the child to see school counselors, community mental health providers or members of the clergy when symptoms emerge;

• Sometimes, the only recourse is to call the police when the person is a danger to self or others.

The power of smell in picking sex partners

Ladies, be honest: When it comes sexual attraction, how important is a guy’s smell? Not just his cologne or deodorant, but his natural scent? At Good in Bed, we believe that a woman should “follow her nose—it always knows.”

Research supports this idea: In two large studies led by Brown University olfactory expert Dr. Rachel Herz, women ranked a man’s scent as the most important feature for determining whether she would be sexually interested in him.

As it turns out, scent may be the main way in which women literally sniff out genetic compatibility with a potential mate. How we smell is an external expression of the genes that make up our immune system.

Like fingerprints, each of us has our own unique “odor print,”  which is part of a region of genes known as the major histocompatibility complex (MHC). Women prefer the scent of men whose MHCs are different from their own.

So when we say that opposites attract, we may not be talking about differences in personality, but rather differences in immune systems.  This is one of Nature’s ways of ensuring that we produce the healthiest offspring. No wonder that a woman’s sense of smell is at its peak when she’s ovulating and most likely to get pregnant.

In one study, a wide variety of men were each asked to wear the same T-shirt for two days in a row, after which the shirts were put into identical boxes. Various women were then asked to smell the shirts and to indicate which they thought would have the most sexually attractive wearers, based on the smell. The results showed that women were most attracted to men with an MHC most dissimilar from their own, while T-shirts worn by guys with similar MHC profiles tended to be rated as “fatherly” or “brotherly” but not sexually attractive. And in a survey conducted by the research firm Strategy One, 56 percent of women said they wouldn’t date a guy who smells like their dad.

So what about that cup of joe? Dr. Alan Hirsch, director of the Smell & Taste Treatment and Research Foundation, conducted research on behalf of AXE body products to determine women’s scent preferences in 10 different cities. “In each city we tested, women reported different scent preferences,” he says, “indicating that geography has a direct correlation to what scents women find attractive.”

Here are the scents that women found most preferable by region:

1.      New York – coffee

2.      Los Angeles – lavender

3.      Chicago – vanilla

4.      Houston – barbeque

5.      Atlanta – cherry

6.      Phoenix – eucalyptus

7.      Philadelphia – clean laundry

8.      Dallas – smoke/fireplace

9.      San Diego – suntan lotion/ocean

10.  Minneapolis-St. Paul – cut grass

I know what you’re thinking: Cut grass? Clean laundry? What the…?!

But there’s a science to these preferences. Scent can trigger powerful memories, especially from our childhoods, which is why these scents may still exert a hold on us years later. And according to Hirsch, “Research has shown that when women are in the presence of a preferred scent, they are more likely to project positive feelings on those around them, which can lead to increased attraction.”

While there is little to evidence to suggest that scent plays as powerful a role for men in sexual attraction, another study by  Hirsch found that the scents of lavender, pumpkin pie, donuts, and black licorice increased blood flow to the penis by nearly 40 Percent. And as I discuss in my book 52 Weeks of Amazing Sex,  “Certain scents increase oxygen in the brain, which in turn affects emotion, attitude, hormone levels, and energy. Both men and women respond positively to scents such as vanilla, black pepper and cinnamon. Other scents that are supposed to have libido-boosting qualities include frankincense, ginger, lavender, lime, orange, patchouli, and rose.”

So, enjoy that cup of coffee, mow the lawn, or fire up the grill—you never know what will happen!

Don't die waiting in the ER

(CNN) -- When 2-year-old Malyia Jeffers developed a fever one Sunday afternoon in November, her parents gave her a children's Motrin and kept a cautious eye on her throughout the night.

By the following morning, Malyia's fever had jumped to 101 degrees, and other concerning symptoms also started to appear.

"I noticed bruising on her right cheek. She was really weak and could hardly walk," says her father, Ryan. He and his wife, Leah, drove Malyia to the emergency room at Methodist Hospital, five miles from their Sacramento, California, home.

According to Jeffers, a triage nurse briefly examined his daughter and said Malyia most likely had a virus and a rash, and told the family to wait.

They waited -- and Malyia got worse.

After two hours in the ER waiting room, Malyia couldn't walk or even stand up. "I tried to stand her on her feet, but her knees buckled," her father says.

Malyia's fever went from 101 to 103 degrees. Then, Jeffers says, the bruising on his daughter's cheek, once the size of a marble, covered most of her face and ears.

Jeffers says he returned to the emergency room nurse, who repeated that Malyia had just a virus and a rash.

"I told him, 'This isn't normal. Look at her ears,' " Jeffers recalls saying to the nurse. "'A rash isn't black and blue!' The nurse kept telling me, 'You'll be next, you'll be next.' But we saw other people going back before us."

Jeffers says he carried Malyia around with him while constantly complaining to the staff while his daughter continued to grow weaker in his arms. The couple discussed switching to another hospital but thought they would be seen soon and they didn't want to lose time.

They continued to wait.

The Jeffers finally see the doctor

After what her father says was nearly five hours of waiting in the emergency department, Malyia's body went limp. For Jeffers, the wait was over. This time he bypassed the desk where the emergency room nurses sat and pushed through the doors behind them.

"I asked to see someone different," Jeffers says. "I showed another nurse the bruising and said, 'Does this seem like a rash to you?' The nurse said, 'No' and put us in a room right away."

Jeffers says blood tests showed Malyia's liver was failing. She was sent by ambulance to a nearby hospital with a pediatric intensive care unit, which diagnosed a strep A infection. Also called the "flesh eating bacteria," strep A had sent Malyia into toxic shock.

Malyia was transferred once again, this time to Lucile Packard Children's Hospital at Stanford University. By this time, the prognosis was more grim.

"It was hour to hour, sometimes minute to minute. We had a roller-coaster ride trying to keep her alive," says Jeffers, who for two weeks thought his daughter might not pull through.

"She deteriorated quickly in front of us," says Dr. Deborah Franzon, the pediatrician who treated Malyia when she arrived at Stanford. "She needed life support and blood pressure medications to help her heart functioning."

While the doctors managed to save Malyia, not enough oxygen was getting to her limbs. Because of that, Franzon said, three weeks after she arrived at Stanford, surgeons had to amputate her left hand and some of the fingers on right hand. They also had to remove her legs below the knees.

Methodist Hospital said it could not legally comment on the Jeffers' case.

"At Methodist Hospital, patient care and safety is always our top priority" said communications manager Bryan Gardner. "Patient privacy laws do not allow us to discuss specifics of this case. We were sorry to hear about the eventual outcome for this little girl and our thoughts and prayers are with her and her family."

Emergency room wait times a national problem

According to a 2009 report from the Government Accountability Office, emergency department wait times continue to increase. The report says the average wait time to see a physician is more than double the recommended time in some cases.

Research from Press Ganey Associates, a group that works with health care organizations to improve clinical outcomes, finds that in 2009, patients admitted to hospitals waited on average six hours in emergency rooms. Nearly 400,000 patients waited 24 hours or more.

"It's not unheard of to wait that long in the best hospitals, and even in the best emergency departments," says Dr. Assaad Sayah, chief of emergency medicine for the Cambridge Health Alliance in Massachusetts. "Overcrowding is not just an emergency department problem, but a hospital inpatient problem."

Dr. Sandra Schneider, president of American College of Emergency Physicians, says the backups occur as emergency departments struggle to find beds for admitted patients.

"Think of the emergency room like a restaurant where people come in and go out," she says. "Now imagine a restaurant where the customers come in, but never leave. They come in for breakfast, they stay for lunch and they're there for dinner."

When a patient is admitted to the hospital and needs to remain for additional procedures, they take up available inpatient beds leading to a domino effect, Schneider says.

"I wish I could have kicked in the doors"

Her parents believe Malyia's condition was the result of a recent ear piercing that got infected.

"It makes me angry to think about it," says Jeffers. He says he made many attempts to get his daughter the care she needed, and regrets he could not do more.

"I wish I had kicked in the doors to the emergency room and made someone see her sooner," he says.

Emergency department physicians offer these tips to help you both before and after your arrival at the emergency room.

BEFORE YOU ARRIVE

Find out if your hospital posts emergency room wait times

 

 

Many hospitals have started posting up-to-date estimates to help patients be more informed of their potential wait.

Even before an emergency happens, it's a good idea to figure out which nearby hospitals post their emergency room wait times on the internet, Sayah recommends.

Many hospitals, including members of the Cambridge Health Alliance where Sayah works, have started posting up-to-date estimates on their homepages to help inform visitors of their potential wait.

Avoid high-traffic days if you can

Patients who have the option might want to consider when they choose to go to the ER.

"In most emergency rooms, the busiest day is Monday," says Sayah. "Patients who get sick on the weekend wait until Monday to go to the hospital because they don't want to spend their weekend in the ER," he explains. Studies have shown that patients who arrive in the ER on Monday rank lowest in terms of patient satisfaction.

Experts say parental instinct can tip off a parent to a developing problem, but say there are also some cut-and-dry situations when a parent really should take a child to the ER. [More tips on how to tell if it is an emergency in our column: When to take a child to the ER.]

Call your doctor on the way to the emergency room

"It's a good idea to let your doctor call ahead and tell the ER physicians what they may be thinking," said Schneider. Your physician may be able to explain your symptoms more clearly, and when ER doctors hear from a fellow physician, it might help put you on the radar.

AFTER YOU'VE ARRIVED

Don't leave once you're already waiting

"People often get angry or leave, but that's a bad idea," says Schneider. "If you were sick enough to be there in the first place, then you need to wait."

She says to note that triage nurses are sorting through dozens of patients and says don't be rude, but do be persistent.

Tell someone if you notice changes

"As you are waiting, if you notice changes in the patient, let the nurses know there is a new symptom as soon as possible," says Schneider. According to the Emergency Severity Index, triage physicians have specific requirements for assessing pediatric patients.

There are protocols in place to reassess patients in the waiting room and alerting the staff to changes in symptoms, especially to changes in temperature and fever, can help your child avoid an excessively long wait in the emergency room.

Ask for the charge nurse

If you have been waiting for a while, and feel like the situation is getting worse, ask for the charge nurse or shift supervisor. Experts in emergency medicine often define urgency using certain terms. They say to advise the person in charge that you think the patient has an "emergency medical condition that should be evaluated right away."

CNN's Elizabeth Cohen contributed to this report.