Pediatricians: Sports in heat OK with precautions (AP)

CHICAGO � Playing sports in hot, steamy weather is safe for healthy children and teen athletes, so long as precautions are taken and the drive to win doesn't trump common sense, the nation's largest pediatricians group says.

New guidelines from the American Academy of Pediatrics arrive just as school sports ramp up in sultry August temperatures. The advice, released Monday, comes a week after two Georgia high school football players died following practices in 90-plus degree heat. Authorities were investigating if the weather contributed.

The guidelines replace a more restrictive policy based on old thinking that kids were more vulnerable to heat stress than adults. New research shows that's not true, the academy says. With adequate training, water intake, time-outs and emergency treatment available on the sidelines, healthy young athletes can play even in high heat and humidity � within reason, the guidelines say.

"The more educated parents, athletes and staff are about risks associated with heat illness, the more likely they will think twice before allowing a competitive culture to overtake sound sensibilities," said Dr. Cynthia Devore, co-author of the policy and a physician for schools in the Rochester, NY area..

Government data released last week showed that more than 3,000 U.S. children and teens younger than 20 received emergency-room treatment for nonfatal heat illness from sports or exercise between 2001 and 2009.

A few young athletes die annually from heat-related illness. Over a 13 year period, 29 high school football players died from heat stroke, data from the American Football Coaches Association and others show. Football is a special concern, because players often begin intense practice during late-summer heat, wearing uniforms and padding that can be stifling.

Dr. Michael Bergeron, a University of South Dakota sports medicine specialist, said the academy's old policy was often ignored because it recommended limiting or avoiding sports even in common hot weather conditions. The new policy is more detailed and nuanced, recommending that athletes be evaluated individually for play in hot weather.

Still, Bergeron warned that overzealousness can be dangerous even for healthy kids, and even in relatively tame summer weather.

"You can take somebody in 80-degree heat and you can kill them if you work them hard enough," he said.

The guidelines don't list temperature or humidity cutoffs, but say safety should be the top priority.

Other academy advice includes:

_Teams should have emergency plans with trained personnel and treatment available and policies for avoiding heat illness.

_Give kids about two weeks to adapt to preseason sessions, gradually increasing intensity and duration. Closely monitor more vulnerable kids, including those who are overweight or have diabetes.

_Make sure athletes are well-hydrated before practice or games. During activity, kids aged 9-12 should drink about half a cup to a cup of water every 20 minutes; for teens, 5 or 6 cups an hour. Sports drinks containing electrolytes and sodium should be offered during extra strenuous activity.

_Educate everyone about signs of heat stress, including dizziness, muscle cramps, headaches and nausea. Kids with symptoms should be sidelined and treated immediately; athletes should be encouraged to report if teammates seem to be struggling.

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Online:

American Academy of Pediatrics: http://www.aap.org

National Institute for Athletic Health & Performance: http://bit.ly/aelUn3

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

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Japan team produces sperm from mice stem cells (AP)

TOKYO � A team of scientists has produced viable sperm from the stem cells of mice in an experiment that could be a breakthrough toward treating infertile humans, according a newly released study.

The Kyoto University researchers managed to induce mice stem cells into creating sperm precursors, which were transplanted into infertile male mice. The mice then produced sperm that was successfully used to fertilize eggs in vitro.

The offspring were healthy and fertile, according to a paper published online Thursday in the Cell, an academic journal.

The research team, led by Mitinori Saitou, said they believe their success may help in the development of infertility treatments in humans, although they said many hurdles remain.

"We have high hopes, but it's not that easy," Saitou told the Associated Press by telephone Friday from Kyoto, in western Japan. "There are many difficult issues ahead in applying this to humans. But it is a first step."

Experts outside the group say it's an important first step toward infertility treatment although there would be a long way.

"This is a very good experiment for thinking about treatment of infertile man but a very very long way," said Toshio Suda, developmental biology professor at Keio University.

He said the Kyoto team's findings were great work but it is not easy to prepare the mature sperm cells at present. If some hurdles are cleared, it could successfully identify "which gene is very important to prepare the sperm."

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Windfall for Massachusetts hospitals is questioned (AP)

WASHINGTON � An obscure provision tucked into the federal health care law has turned into a jackpot for Massachusetts hospitals, but officials in other states are upset because the money will come from their hospitals.

The Medicare windfall for Massachusetts � $275 million a year � adds up quickly, about $1.4 billion over five years.

"If I could think of a better word than outrageous, I would come up with it," said Steve Brenton, president of the Wisconsin Hospital Association.

The news was buried in a Medicare regulation issued Monday and comes at a time when hospitals face more cuts under the newly signed federal debt deal.

Even Medicare says it is concerned about "manipulation" of its inpatient payment rules to create big rewards for one state at the expense of others.

Hospitals in 41 states will lose money as a result of the change. The biggest loser: New York, which is out $47.5 million.

Seven states come out ahead, though none do as well as Massachusetts. Runner-up New Jersey stands to gain $54 million, a fraction of what Massachusetts will get.

President Barack Obama's health care overhaul was supposed to lead to reforms in Medicare's byzantine payment system. Critics say this latest twist will encourage the big players to game the system in a scramble for increasingly scarce taxpayer dollars.

The health care law "was to usher in a new era, based on innovations that focused on quality improvement and more efficient health care," said Herb Kuhn, president of the Missouri Hospital Association. "What we are seeing is innovation in the area of how to manipulate the payment system."

"It subverts any notion of fairness and equity in developing the rates," said Laurens Sartoris, president of the Virginia Hospital & Healthcare Association. "It's someone going through the backdoor to get special treatment in what amounts to an earmark."

No backdoor maneuvers were involved, said the head of the Massachusetts Hospital Association, defending the change.

"We do not see this as a manipulation of the rules," said Lynn Nicholas. She said the higher payments will help compensate Massachusetts hospitals for a Medicare policy change a few years ago that cost them hundreds of millions of dollars.

Massachusetts Democratic Sen. John Kerry, a co-sponsor of the provision in the health care law that benefited his state's hospitals, was also steadfast.

"When (Medicare) changed the rules five years ago, the rest of the country gained at our expense and Massachusetts took a big hit," Kerry said in a statement. "These new rules just provide some correction."

The American Hospital Association supported the change when the law was being debated. An official there now says hospitals didn't understand what they were getting with the obscure provision.

The saga of how Massachusetts scored big could come straight from a lobbyist's playbook.

It goes back a few years and twists and turns through Medicare's mind-boggling payment rules.

Those rules include a factor that's used to adjust payments to hospitals for the difference in labor costs around the country. The adjustments cannot lead to any increase in overall Medicare spending, automatically setting up potential winners and losers.

On top of that, another rule says that the labor cost factor for a hospital in an urban area of a state cannot be less than for that state's rural areas.

That's where two small hospitals on Nantucket and Martha's Vineyard, islands off the Massachusetts coast popular with vacationers, come into the picture.

Those hospitals had been operating as "critical access hospitals," reimbursed by Medicare at special rates that usually work out to be top tier.

Then, according to Kuhn, some mainland hospitals persuaded them to reclassify themselves as "rural" hospitals. That put them back under the same payment rules as the mainland hospitals. What followed was a sort of domino effect.

Since labor costs are relatively high on the islands, it raised rural costs in the entire state. In turn, that led to higher payments for urban hospitals. A group of mainland hospitals affiliated with the island hospitals also agreed to reimburse them for any financial losses as a result of the change.

Changing from "critical access" to "rural" hospitals was totally legitimate, Nicholas said.

"They were fully qualified to do that," she said. "That hurt them individually financially, but because of their relationship with the overall system they were able to subsidize those losses."

Medicare put up roadblocks to the change, and in 2008 it looked like the feds would win out. Then the health care overhaul law turned the tables.

Medicare officials declined to comment. But in another regulation issued this year, the agency expressed concern with what it termed the "manipulation" of its rules to win an 8 percent increase for one state at the expense of others.

The new payment rates take effect Oct. 1.

In addition to Massachusetts and New Jersey, other states that come out ahead � for a variety of reasons � are Alaska, California, Colorado, Connecticut and New Hampshire. Hospitals in Wyoming break even. And Maryland hospitals have long been paid under a different system.

Every other state loses.

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Medicare prescription premiums unchanged for 2012 (AP)

WASHINGTON � The Obama administration says it has good news for seniors: The average monthly premium for Medicare's popular prescription plan won't go up next year.

Medicare will share in the bonanza as a number of top-selling brand name drugs get generic competition.

Health and Human Services Secretary Kathleen Sebelius announced Thursday that the average premium for prescription coverage will be about $30 a month in 2012, hardly changed from $30.76 this year.

Since that's an average, some seniors may see an increase. But plenty of bargains should be available if they shop around during open enrollment season this fall.

Sebelius also said 900,000 Medicare beneficiaries with high drug costs got a 50 percent discount on brand name drugs this year, a benefit of President Barack Obama's health care law.

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Study: Healthy eating is privilege of the rich (AP)

SEATTLE � A healthy diet is expensive and could make it difficult for Americans to meet new U.S. nutritional guidelines, according to a study published Thursday that says the government should do more to help consumers eat healthier.

A update of what used to be known as a food pyramid in 2010 had called on Americans to eat more foods containing potassium, dietary fiber, vitamin D and calcium. But if they did that, the journal Health Affairs said, they would add hundreds more dollars to their annual grocery bill.

Inexpensive ways to add these nutrients to a person's diet include potatoes and beans for potassium and dietary fiber. But the study found introducing more potassium in a diet is likely to add $380 per year to the average consumer's food costs, said lead researcher Pablo Monsivais, an assistant professor in the Department of Epidemiology and the School of Public Health at the University of Washington.

"We know more than ever about the science of nutrition, and yet we have not yet been able to move the needle on healthful eating," he said. The government should provide help for meeting the nutritional guidelines in an affordable way.

He criticized some of the marketing for a healthy diet � for example, the image of a plate of salmon, leafy greens and maybe some rice pilaf � and said a meal like that is not affordable for many Americans.

Food-assistance programs are helping people make healthier choices by providing coupons to buy fruits and vegetables, Monsivais said, but some also put stumbling blocks in front of the poor.

He mentioned, as an example, a Washington state policy making it difficult to buy potatoes with food assistance coupons for women with children, even though potatoes are one of the least expensive ways to add potassium to a diet.

The study was based on a random telephone survey of about 2,000 adults in King County, Wash., followed by a printed questionnaire that was returned by about 1,300 people. They note what food they ate, which was analyzed for nutrient content and estimated cost.

People who spend the most on food tend to get the closest to meeting the federal guidelines for potassium, dietary fiber, vitamin D and calcium, the study found. Those who spend the least have the lowest intakes of the four recommended nutrients and the highest consumption of saturated fat and added sugar.

Hilary Seligman, assistant professor of medicine at the University of California, San Francisco, said Monsivais' research is an interesting addition to the debate about healthy eating and food insecurity, her area of expertise.

A lot of people assume the poor eat cheap food because it tastes good, but they would make better choices if they could afford to, said Seligman, who was not involved in the Health Affairs study.

"Almost 15 percent of households in America say they don't have enough money to eat the way they want to eat," Seligman said. Recent estimates show 49 million Americans make food decisions based on cost, she added.

"Right now, a huge chunk of America just isn't able to adhere to these guidelines," she said.

But Monsivais may have oversimplified the problem, according to another professor who does research in this area. Parke Wilde, associated professor at the Friedman School of Nutrition Science and Policy at Tufts University, said it's not expensive to get all the nutrients a body needs to meet the federal guidelines.

What is expensive, in Wilde's opinion, are the choices Americans while getting those nutrients.

He said diets get more and more expensive depending on how many rules a person applies to himself, such as eating organic or seeking local sources for food or eating vegetables out of season.

"The longer your list gets, the more expensive your list will be," he said.

Seligman said her list can get longer than Wilde's, but not everything is a choice. Adding to the cost of buying healthful food could be how far away from home a person needs to travel to get to a grocery store that sells a variety of fresh fruits and vegetables.

The government also affects food prices through the subsidies offered to farmers growing certain crops, she added.

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New HIV infections in US hold steady at 50,000 (AP)

NEW YORK � The number of Americans infected with the AIDS virus each year has been holding steady at about 50,000, according to a government report released Wednesday.

For many years, U.S. health officials put the annual number of new HIV infections at 40,000. But three years ago, they said their estimate had been too low. Using new methods and a better blood test, the Centers for Disease Control and Prevention revised their estimate higher, to roughly 56,300 new infections in 2006.

The latest CDC report used the new methods to look at trends over four years, and found that there were about 50,000 new infections each year from 2006-2009.

Gay and bisexual men account for the majority of the new cases � nearly two-thirds in 2009. The only increase over the four years was in young gay and bisexual men, driven by a 48 percent increase among blacks ages 13 to 29.

The annual number of new infections peaked at 130,000 in the mid-1980s, said Dr. Kevin Fenton, the AIDS prevention chief for the CDC. He said the report presented a mixed picture. While new infections have plateaued, "stability is not acceptable" and the increase in young men is worrisome, he said.

The CDC report was published Wednesday in the journal PLoS One. The figures were calculated from data from 16 states and two cities. Estimating new infections is complicated; it can take many years for an infection to cause symptoms and illness. The new blood test can tell how recent an infection occurred.

About 1.1 million Americans are living with the AIDS virus in the U.S. now. So the fact that the number of infections is stable is a "bit of good news," Fenton said.

"In a sense, we are holding HIV incidence at bay," he said.

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