Thursday, July 28, 2011

Offensive launched to protect Somali relief effort (AP)

MOGADISHU, Somalia � African Union forces have launched an offensive in Somalia's capital so aid agencies can get emergency food supplies to thousands of starving people without coming under attack from al-Qaida-linked militants, an official said Thursday.

The al-Shabab fighters already have killed men who tried to escape the famine with their families, saying it is better to starve than accept help from the West.

Lt. Col. Paddy Ankunda said Thursday that AU peacekeeping forces have conducted a "short tactical offensive operation" in Mogadishu.

"This action will further increase security ... and ensure that aid agencies can continue to operate to get vital supplies to internally displaced," he said.

The devastating famine in the Horn of Africa threatens al-Shabab's hold on areas under its control, with the militants fearing that the disaster will drive away the people they tax and conscript into military service.

In the past, the militants have blocked aid workers from helping those in need in Somalia, fearing that foreign assistance would undermine their control.

A World Food Program plane with 10 tons of peanut-butter paste landed Wednesday in Mogadishu, the first of several planned airlifts in coming weeks.

That will help, but Lt. Col. Kuamurari Katwekyeire, the civil-military coordination chief for the African Union Mission in Somalia, known as AMISOM, said the U.N. and other aid groups need to do more.



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Wednesday, July 27, 2011

Food supplements airlifted into famine-hit Somalia (AP)

MOGADISHU, Somalia � A plane carrying 10 tons of urgently needed nutritional supplements to treat malnourished children has landed in famine-hit Somalia, a U.N. official said Wednesday.

The airlift is part of a crisis intervention as famine threatens to spread across lawless Somalia.

David Orr, a World Food Program spokesman who flew with the shipment from neighboring Kenya to the Somali capital of Mogadishu, said it was the first airlift of food aid since the U.N. declared a famine in parts of Somalia last week.

Orr said the aid would be distributed to medical facilities to treat the malnourished children.

WFP spokeswoman Challiss McDonough said this is first of several planned airlifts in coming weeks. She said Wednesday's shipment of peanut butter-based nutritional paste will treat 3,500 malnourished children for one month.

McDonough said WFP decided to send in the airlift because of an urgent need to treat the growing number of internally displaced children suffering from malnutrition before their condition deteriorates.

She said about 18,000 children are suffering from malnutrition and that the number is expected to grow to 25,000.

WFP says it cannot reach 2.2 million people in need of aid in the militant-controlled areas in southern Somalia because of insecurity.

Somalia has been embroiled in conflict for two decades, since the last leader was overthrown by warlords who then turned on each other. Islamist militant groups have spent the last few years battling the weak U.N.-backed government in an attempt to overthrow it.

Al-Shabab � the most dangerous militant group in Somalia � said last week it will not allow the aid groups to operate in its territories, exacerbating the drought crisis.

Earlier this month al-Shabab, which has links to al-Qaida, had shown indications of wavering on its 2009 ban on certain aid groups in its territories.

The drought has created a triangle of hunger where the borders of Ethiopia, Kenya and Somalia meet. WFP estimates more than 11.3 million people need aid across drought-hit regions in East Africa. The majority of those affected live in pastoral communities whose herds have been wiped out because of a lack of water.

Separately, UNICEF said Wednesday that it is trying to vaccinate more than 300,000 children in Kenya in an emergency program designed to prevent an outbreak of disease as refugees stream into northern Kenya.

Jayne Kariuki from UNICEF said that four northern Kenyan regions will be targeted along with Dadaab, the world's largest refugee camp, during the two-week program to immunize the children against polio and measles.

The children will also receive vitamin A and de-worming tablets. In Liboi, a dusty town in Kenya near the border with Somalia, mothers in long robes clustered around with children as aid workers dispensed medicine under a thorn tree.

Kenya recorded it first polio case infection in 20 years in 2009, after a four-year-old girl was diagnosed with the disease along the country's remote border with Sudan.

Polio is an infectious disease that mainly strikes children under five. It causes paralysis and can be fatal.

In 2006, two refugees escaping the war in Somalia were diagnosed with the disease at the Dadaab refugee camp at Kenya's eastern border with Somalia. That outbreak was contained before it spread.

___

Tom Odula in Nairobi, Kenya, and Katharine Houreld in Liboi contributed to this report.



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For some, hypnosis eases pain, recovery of surgery (AP)

LONDON � As the surgeons cut into her neck, Marianne Marquis was thinking of the beach.

As she heard the doctors' voices, she was imagining her toes in the sand, the water lapping.

Marquis had been hypnotized before surgery to have her thyroid removed. She's among a growing number of surgical patients at the Belgian hospital, Cliniques Universitaires St. Luc in Brussels, who choose hypnosis and a local anesthetic to avoid the groggy knockout effect of general anesthesia.

These patients are sedated but aware, and doctors say their recovery time is faster and their need for painkillers reduced. This method is feasible for only certain types of operations.

In her case, Marquis, 53, imagined herself in a field near a beach � which her anesthetist began describing by whispering into her ear about 10 minutes before surgery. She remembers hearing the doctors talk to her, but said it was as if they were far away.

"I was imagining squishing my toes in the sand and feeling water come up over them," Marquis said. She felt a little pressure on her neck with the first incision but said it wasn't painful.

Since doctors began offering hypnosis at the hospital in 2003, hundreds of patients have chosen it. At another Belgian hospital, more than 8,000 surgeries have been done this way since 1992.

Doctors say nearly any surgery usually done with a local anesthetic could work with hypnosis and less pain medicine. Proponents say hypnosis can dull patients' sense of pain and that it also cuts down on the need for anesthetic.

That means patients recover faster and hospitals save money, according to some studies. But it may require doctors to spend more time with patients beforehand to do the hypnosis and they may need more careful monitoring during surgery.

The technique has become increasingly popular in France and Belgium in recent years. Some plastic and facial surgeons in Germany also use hypnosis, as well as some British dental surgeons.

The French Society of Anesthesiologists describes hypnosis as a valid way to supplement anesthesia to reduce stress, anxiety and pain but neither the Belgian nor British anesthesiology groups offer specific hypnosis advice. Because of demand, the French Society of Anesthesiologists created a special hypnosis branch in their organization last year.

There are no figures on how widely hypnosis is used across Europe. In several of the nearly dozen French hospitals in Rennes, a northwest city of about 200,000 people, it's used in about half of all operations, says Claude Virot, a psychiatrist and director of the Institute of Research and Training in Therapeutic Communication there. Virot helps organize hypnosis training and said about 500 health professionals get it every year in France.

Dr. Fabienne Roelants, Marquis' anesthetist, described hypnosis as a modified state of consciousness. "The patient's mind goes to a pleasant place, but the body stays in the operating room." At Roelants' hospital, one-third of all surgeries to remove thyroids and one-quarter of all breast cancer surgeries, including biopsies and mastectomies, use hypnosis and local anesthetic. She and colleagues hope to expand the technique to procedures like hernias, knee arthroscopies and plastic surgeries.

Roelants said if patients feel any pain during the procedure, anesthetists immediately give them a painkiller shot.

During a recent procedure in Brussels where Christel Place, 43, had her thyroid removed, she furrowed her brow a couple of times to signal to Roelants she needed more drugs. In a green-lit room that helps relax the patients, Place pictured herself hiking in the French Alps while surgeons sliced her neck open.

The thyroid is a small gland at the bottom of the neck and makes hormones to control the body's metabolism. It is sometimes removed when it becomes enlarged, overactive or cancerous. The surgery can be done either with local or general anesthesia and is considered low-risk.

Place said waking up from the surgery was more abrupt than she'd expected. "It was like I was really in the mountains and then 'poof,' it was over," Place said, laughing.

Other experts caution that hypnosis would be impossible in major operations involving the heart or other internal organs because the pain would be unbearable.

"If hypnosis doesn't work and you've got somebody's abdomen or chest open, then you're in big trouble," said George Lewith, a professor of health research at Southampton University. "You need to be able to switch to another option immediately," he said.

Consistency is also an issue. "It's not used routinely because it's not effective in everyone and it takes a while," said Dr. Mark Warner, president of the American Society of Anesthesiologists. He said doctors would need extra time to conduct hypnosis and would need to work more closely with surgeons.

Warner said there are no guidelines on its surgical use in the U.S. He often uses music therapy or asks patients to picture a soothing scene to distract them from any discomfort. "If we could get more research on the right patient groups that would benefit from (hypnosis), that would be wonderful," he said.

Some experts said hypnosis is a hard sell because no one really profits from it.

"The problem is the money doesn't really go into anyone's hands, and the only person who really benefits from it is the patient," said Guy Montgomery, an associate professor at the Mount Sinai Medical Center in New York, who led a study published in the Journal of the National Cancer Institute in 2007.

In that research, Montgomery and colleagues randomly assigned 200 patients in the U.S. having a breast biopsy or lumpectomy to either get hypnosis or a brief session with a psychologist beforehand. They found hypnotized patients needed fewer painkillers and sedatives and required less time in surgery. On average, each hypnotized patient cost the hospital about $770 less than those who weren't hypnotized.

Marquis recommends hypnosis to patients who want to avoid anesthesia, but warned it isn't for everyone.

"You have to be in the right mental frame of mind for this, be properly prepared and trust the medical staff to take care of you," she said. "If you're very skeptical of hypnosis and freaked out about whether it's going to work, it probably won't."



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Tuesday, July 26, 2011

Study looks at NYC fast-food menu calorie counts (AP)

NEW YORK � Like any fitness program, it works only if you pay attention to it.

A new study on New York City's effort to encourage healthy eating by posting calorie counts on menus shows that it worked for about one in six customers � or those who paid heed to them. Those who ignored the numbers or didn't see them ordered whatever they wanted, regardless of how fattening it was.

City health officials who conducted the study said that's good news. On any given visit, customers who looked at the counts generally ordered about 100 fewer calories than those who didn't, according to the results of the study published Tuesday in the British medical journal BMJ.

In 2008, New York became the first municipality in the U.S. to require chain restaurants to post the counts, and other places including California and Seattle followed suit. Starting next year, a federal law will require all chains with 20 or more locations to print calorie counts on menus. British fast-food restaurants are set to introduce a similar but voluntary initiative.

The study was the first large-scale look at the initiative's success at several different chains. Lynn D. Silver, assistant commissioner of the city Department of Health and Mental Hygiene and one of the study's authors, said it showed modest gains in getting people to order lower-calorie meals. But she said the law also led restaurants to widen their offerings of healthier food, such as salads.

"Calorie labeling alone won't cure the obesity epidemic but it is one part of trying to address it," Silver said.

About a third of adults in the U.S. are obese, according to the federal Centers for Disease Control and Prevention.

The study looked at lunchtime purchases at 11 fast-food chains around New York in 2007, before the city law was passed, and then again in 2009. Researchers asked customers for their receipts and spoke to them about their orders. There was no significant change overall. But customers did order fewer calories, on average, at three major chains: McDonald's, Au Bon Pain and KFC. The study notes that those restaurants also introduced healthier choices around the same time the law was passed.

Meanwhile, the sandwich shop Subway showed a big increase in the average calorie count of a lunch order, which the authors linked to the popularity of its "$5 foot-long" deal, introduced nationally in 2008.

The study found that more than 20 percent of customers at Subway and Au Bon Pain paid attention to the calorie counts, an increase from the overall average of 15 percent. Women were more likely to use them when deciding what to order, as were people in wealthier neighborhoods. Young people were the least likely to use them.

The study noted that people are increasingly relying on food prepared away from home.

"There is a strong and growing consensus that consumers want to know what they are eating so that they can make informed choices," the authors wrote.

In a separate development on Tuesday, McDonald's announced changes to its iconic Happy Meal, making the portion of French fries smaller and adding fruit.

Marion Nestle, a professor at New York University's Department of Nutrition, Food Studies and Public Health and author of the blog "Food Politics," said the study confirms that once people pay attention to the calorie counts, they make dietary changes.

"The next step has to be to get more people to look at the info," she said.

In New York City's Midtown at lunchtime on Tuesday, Carlos Munoz, a 29-year-old student at a technical school, munched on a chicken wrap, fries and a soda from McDonald's.

"I don't really pay any mind to it," he said of calorie counts. "I figure one bad thing a day I should be able to burn away."

But he supported their presence on menus.

"You should know what you're putting into your body," he said. "If I'm ever curious, I'd like to know I can get the information."

Inside Starbucks, Alexandra Casey, 23, of Worcester, Ma., said she looks at calorie counts when they're posted. But as a vegan and avid runner, she was more concerned with overall nutritional content rather than just calories. For example, nuts might be high in calories but they're still a better choice than cake.

Casey applauded New York for leading the way in posting the counts but said eateries should provide more comprehensive information about the food and beverages they offer.

"It's not just about a number," she said. "The question is, what's the content of those calories."

___

Karen Zraick can be reached at http://www.twitter.com/karenzraick

___

Online:

http://www.bmj.com/content/343/bmj.d4464



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Study: Medicare drug plan saves hospital costs (AP)

CHICAGO � A new study suggests that Medicare's 5-year-old prescription drug plan is keeping seniors out of hospitals and nursing homes, saving the federal program an estimated $12 billion a year in those costs.

The savings only offset a portion of the $55 billion a year the government spends on Medicare Part D, as the drug plan is known. But the study's authors say it means seniors are staying healthier and enjoying a better quality of life.

"This is what people always hope for: If people get drug coverage, they won't need hospitalization," said Marsha Gold of the nonpartisan Mathematica Policy Research, who wasn't involved in the new study. "If it holds up, that's great news."

The Harvard analysis, appearing in Wednesday's Journal of the American Medical Association, found Medicare saved an average of about $1,200 a year for each senior citizen who had inadequate drug coverage before Medicare Part D. Most of the savings came from hospital and nursing home costs.

That translates to an annual savings of $12 billion, experts said.

With subsidized drug coverage, seniors can afford drugs that prevent trips to the emergency room by lowering cholesterol and blood pressure and controlling diabetes, said lead author Dr. Michael McWilliams of Harvard Medical School.

Other savings come from doctors no longer admitting patients to hospitals just so Medicare would pay for drug treatments � like injectable clot-busting drugs for deep vein thrombosis � that can be given more cheaply in a doctor's office, McWilliams said.

"Spending on one type of service can reduce spending on another type of service," McWilliams said. "By expanding Medicare to include drug benefits, clearly we're spending more, but we're getting a lot of value out of that spending."

The findings suggest that lawmakers, while grappling with reducing the federal deficit, should consider all of Medicare's moving parts and how they affect each other, experts said.

"It's critical to think about the entire program. They can't just be thinking about how to pay hospitals differently," said Julie Donohue, a health policy researcher at the University of Pittsburgh, who wasn't involved in the new study. "They have to think about the whole delivery system and the whole Medicare system."

It's tough for researchers to pinpoint the effect of a policy change because they usually can't randomly assign people to participate in a program or not. Medicare Part D is voluntary. Enrollees pay premiums that cover about 25 percent of the cost. There were 23 million Part D beneficiaries last year.

For the new study, researchers analyzed nondrug Medicare spending for about 6,000 seniors from 2004 through 2007.

The Medicare drug benefit started in January 2006. Before then, about 2,500 of the seniors in the study reported having generous drug coverage, which many bought as supplemental insurance. About 3,500 reported having limited or no drug coverage.

By comparing spending trends before and after 2006, the researchers were able to calculate any nondrug savings.

Previous studies show Medicare Part D increased use of antibiotics and drugs for diabetes, high blood pressure, depression and other chronic conditions.

The nation's 1-year-old health care law is gradually closing the Medicare drug coverage gap, the "doughnut hole," which also should keep seniors out of hospitals, McWilliams said.

But another view on the doughnut hole came from Joseph Antos, a health policy expert at the conservative-leaning American Enterprise Institute. Antos said the doughnut hole "turned out to be a very good idea" because it encourages seniors to use cheaper generics instead of more expensive brand-name drugs.

"It's disastrous policy to whittle away at the doughnut hole," Antos said. "If we see generic usage drop, that means the program is going to cost more."

___

Carla K. Johnson can be reached at http://www.twitter.com/CarlaKJohnson.

___

Online:

JAMA: http://jama.ama-assn.org



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Monday, July 25, 2011

Eye anatomy at camp? Kids get taste of med careers (AP)

WARRENTON, Va. � Again and again, 12-year-old Brianna Bowens cautiously pokes the human eyeball. On purpose.

The donated eye is tougher than you'd think. It takes a few slices with a sharp scalpel to pierce the white part � the sclera, she learns � and eventually remove the cornea in front.

Dissecting a human eye isn't the normal fare of summer camp. It's part of an unusual program at a small northern Virginia hospital that aims to hook kids as early as middle school on the possibilities of a medical career.

It's not for the squeamish. But no one's ever fainted over the eyes.

"I've got a strong stomach," says Brianna, of Stafford, Va., who wants to be a pediatric surgeon "or maybe a nurse."

She betrays her excitement when she's done, the twig-like optic nerve, magnifying lens and clear cornea carefully laid out. Whipping out her cellphone, she exclaims, "Wait, I've got to take a picture."

Tom Gaile of the Old Dominion Eye Foundation teaches the crash course at Fauquier Hospital's medical camp, using eyes donated for education, to explain the importance of organ and tissue donation.

"This is something that's going to stay with them the rest of their lives," he says.

Programs to entice budding scientists, from building robots to measuring pollution, increasingly are becoming part of the summer ritual. On the health side, it can be harder to find hospitals that free up space and staff to give youngsters a taste of what beginning medical students learn � how to suture skin, take blood pressure, put on a cast, insert an IV, type blood � much less handle precious donated eyes.

But more medical camps are cropping up, although no one keeps a count. And if 12 sounds young, well, Virginia in particular is targeting middle-school students so they line up enough science courses for the best shot at increasingly competitive college training programs.

"You can't wait `til you're a senior and decide `I want to go into health care,'" says Barbara Brown, vice president of the Virginia Hospital & Healthcare Association, which helps fund the camps.

She counts 760 mostly middle-school students going through one- to five-day medical camps at 26 hospitals this summer.

The idea is to show kids a wide variety of critical health careers, from nurse-anesthetists to pharmacists to physical therapists.

"Nobody ever says, `I want to be an organ recovery technician,'" says Julie Fainter of Fauquier Health, who coordinates the medical camp in this town west of Washington, D.C.

Judging from the questions that pepper Gaile, maybe some will. Does removing the eye affect funeral viewing? No, the lids are closed. People can donate only the cornea or the entire eye, important as the sclera is transplanted in some eye surgeries and the rest is used for research. Does an eye's color change after it's out of the body? Yes, all irises turn brown after a while.

Marquesia Atwater, 14, came from suburban Atlanta after her mother did a Google search for medical camps.

"I decided my whole life I wanted to be a doctor," she says, a decision the camp cemented. As she examined the eye's lens, she says, "I never knew there was so much stuff in an eye."

During July and August, 92 kids will spend two days each in Fauquier's camps designed for either beginners or returning students. Funded mostly through a $15,000 hospital association grant and staff contributions, kids pay $50 to attend.

Eyes aren't the only hands-on experience.

How do you learn to stitch up a cut when you can't practice on people? They use pigs' feet, but nurse Wendy Greenwood makes sure the kids keep things sterile just like as if it was a person.

Gloves on. Swab the wound with iodine. No scratching your nose, Greenwood tells one student � and watch where you lay the curved needle so no one gets stuck.

Will Merriken, 12, of Warrenton, Va., finishes seven stitches, each a little faster as he gets more comfortable with the painstaking knots. "It's much easier once you have practiced and got the motions down."

On to the hospital's lab. If a kid's going to get lightheaded, this is where it happens, Fainter says, maybe because of the faint chemical odor or the warmth necessary for culturing bacteria. She arms them with peppermints to ward off wooziness.

Inside, Will volunteers first to prick his finger and test his blood type. He drips blood onto a slide and medical technologist Suzie Capron explains how different antibodies make one type clump but not another. He's a B-positive.

Down in the emergency room on a quiet Wednesday morning, Dr. Greg Wagner gathers a dozen of the students for what's called a mock code, a resuscitation drill that doctors and nurses perform to fine-tune their own skills.

Paramedics race in a mannequin: A 45-year-old woman in cardiac arrest.

The kids, each assigned an ER job, spring into action under Wagner's direction. One pumps air into the "patient's" lungs. One inserts a tube to open the windpipe. Three trade off CPR. Another sets up the defibrillator, calling "Clear!" before each of three shocks. Others give injections of heart-stimulating drugs.

Ten minutes later, they abruptly fall quiet as Wagner asks how long they should keep trying before declaring death. No one volunteers.

"How often do patients pass away?" 14-year-old Lark Nash of Warrenton finally asks.

Probably once a week, Wagner responds, describing the hardest part of his job. Nurses reveal a body bag lining the bed, and the students zip it over the mannequin.

___

EDITOR'S NOTE � Lauran Neergaard covers health and medical issues for The Associated Press in Washington.



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