Giving thanks helps your psychological outlook (AP)

WASHINGTON � Count your blessings this Thanksgiving. It's good for you.

While it seems pretty obvious that gratitude is a positive emotion, psychologists for decades rarely delved into the science of giving thanks. But in the last several years they have, learning in many experiments that it is one of humanity's most powerful emotions. It makes you happier and can change your attitude about life, like an emotional reset button.

Especially in hard times, like these.

Beyond proving that being grateful helps you, psychologists also are trying to figure out the brain chemistry behind gratitude and the best ways of showing it.

"Oprah was right," said University of Miami psychology professor Michael McCullough, who has studied people who are asked to be regularly thankful. "When you are stopping and counting your blessings, you are sort of hijacking your emotional system."

And he means hijacking it from out of a funk into a good place. A very good place. Research by McCullough and others finds that giving thanks is a potent emotion that feeds on itself, almost the equivalent of being victorious. It could be called a vicious circle, but it's anything but vicious.

He said psychologists used to underestimate the strength of simple gratitude: "It does make people happier ... It's that incredible feeling."

One of the reasons why gratitude works so well is that it connects us with others, McCullough said. That's why when you give thanks it should be more heartfelt and personal instead of a terse thank you note for a gift or a hastily run-through grace before dinner, psychologists say.

Chicago area psychologist and self-help book author Maryann Troiani said she starts getting clients on gratitude gradually, sometimes just by limiting their complaints to two whines a session. Then she eventually gets them to log good things that happened to them in gratitude journals: "Gratitude really changes your attitude and your outlook on life."

Gratitude journals or diaries, in which people list weekly or nightly what they are thankful for, are becoming regular therapy tools.

And in those journals, it is important to focus more on the people you are grateful for, said Robert Emmons, a psychology professor at the University of California, Davis. Concentrate on what life would be without the good things � especially people such as spouses � in your life and how you are grateful they are there, he said.

Grateful people "feel more alert, alive, interested, enthusiastic. They also feel more connected to others," said Emmons, who has written two books on the science of gratitude and often studies the effects of those gratitude diaries.

"Gratitude also serves as a stress buffer," Emmons said in an e-mail interview. "Grateful people are less likely to experience envy, anger, resentment, regret and other unpleasant states that produce stress."

Scientists are not just looking at the emotions behind gratitude but the nuts-and-bolts physiology as well.

Preliminary theories look at the brain chemistry and hormones in the blood and neurotransmitters in the brain that are connected to feelings of gratitude, Emmons said. And the left prefrontal cortex of the brain, which is also associated with positive emotions like love and compassion, seems to be a key spot, especially in Buddhist monks, Emmons said.

However it works in the brain, Emmons said there is little doubt that it works.

Emmons, who has conducted several studies on people from ages 12 to 80, including those with neuromuscular disease, asked volunteers to keep daily or weekly gratitude diaries. Another group listed hassles, and others just recorded random events. He noticed a significant and consistent difference. About three-quarters of the people studied who regularly counted their blessings scored higher in happiness tests and some even showed improvements in amounts of sleep and exercise.

Christopher Peterson of the University of Michigan studied different gratitude methods and found the biggest immediate improvement in happiness scores was among people who were given one week to write and deliver in person a letter of gratitude to someone who had been especially kind to them, but was never thanked. That emotional health boost was large, but it didn't last over the weeks and months to come.

Peterson also asked people to write down nightly three things that went well that day and why that went well. That took longer to show any difference in happiness scores over control groups, but after one month the results were significantly better and they stayed better through six months.

Peterson said it worked so well that he is adopted it in his daily life, writing from-the-heart thank you notes, logging his feelings of gratitude: "It was very beneficial for me. I was much more cheerful."

At the University of North Carolina, Sara Algoe studied the interaction between cancer patients and their support group, especially when acts of gratitude were made. Like Peterson, she saw the effects last well over a month and she saw the feedback cycle that McCullough described.

"It must be really powerful," Algoe said.

It has to be potent to combat gloom many may be feeling in such uncertain times.

There have been many Thanksgivings throughout history that might challenge society's ability to be grateful. The first Thanksgiving with the Pilgrims came after about half of the Plymouth colony died in the first year. Thanksgiving became a national holiday in the United States when Abraham Lincoln proclaimed it in 1863 during the Civil War, the deadliest war the country has ever known. And the holiday moved to the fourth Thursday in November during the tail end of the Great Depression.

Emmons actually encourages people to "think of your worst moments, your sorrows, your losses, your sadness and then remember that here you are, able to remember them. You got through the worst day of your life ... remember the bad things, then look to see where you are."

That grace amid difficulty motif may make this Thanksgiving especially meaningful, McCullough said.

"In order to be grateful for something, we have to remember that something good happened," Peterson said. "It's important to remind ourselves that the world doesn't always suck."

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Online:

Robert Emmons: http://psychology.ucdavis.edu/labs/emmons/PWT/index.cfm

National Association of School Psychologists' tips on fostering gratitude in children: http://bit.ly/rHlqCz

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UN: AIDS epidemic stabilizing, still work to do (AP)

LONDON � The AIDS epidemic is leveling off and the number of people newly infected with the virus that causes it has remained unchanged since 2007, the United Nations said in a report Monday.

Critics say that the body's aim of wiping out the disease is overly optimistic, however, considering there is no vaccine, millions remain untreated and donations have slumped amid the economic crisis.

There were 2.7 million new HIV infections last year, approximately the same figure as in the three previous years, said the report from UNAIDS, the joint United Nations program on HIV and AIDS. The figures largely confirm earlier findings released by the group in June.

At the end of last year, there were about 34 million people with HIV, the virus that causes AIDS. While that is a slight rise from previous years, experts say that's due to people surviving longer. Last year, there were 1.8 million AIDS-related deaths, down from 1.9 million in 2009.

The outbreak continues to hit hardest in southern Africa. But while the number of new infections there has fallen by more than 26 percent since the peak in 1997, the virus is surging elsewhere.

In eastern Europe and central Asia, there has been a 250 percent jump in the number of people infected with HIV in the past decade, due largely to the spread among injecting drug users. In North America and western Europe, the outbreak "remains stubbornly steady," according to the report.

"It's looking promising, but the numbers are still at a scary level," said Sophie Harman, a global health expert at City University in London. She was not connected to the UNAIDS report.

In its strategy for the next few years, UNAIDS says it is working toward zero new HIV infections, zero discrimination and zero AIDS-related deaths. Harman said that was an admirable goal but wasn't sure it was achievable. "They need to get real," she said. "Maybe they need to aim high but if their main goal is eradication, it's highly unlikely that will ever happen."

Dr. Paul De Lay, deputy executive director of UNAIDS, acknowledged the idea of eliminating AIDS infections and deaths is "more of a vision for the future," and would likely not be accomplished without new tools like a vaccine, which could take several decades. Earlier this month, U.S. Secretary of State Hillary Clinton called for an AIDS-free generation and promised more money for programs in Africa.

De Lay said U.N. strategies will focus on more aggressive prevention and treatment policies, like treating people with HIV earlier. In Africa, people with HIV are not usually treated until their immune system reaches a certain threshold, and officials are now increasingly trying to start treatment before patients get too sick.

Future strategies might also include giving medicines to people at high risk even before they get infected. The World Health Organization is considering how to advise countries with major epidemics on giving drugs to healthy people vulnerable to catching the virus, such as prostitutes, gay men and injecting drug users, as a prevention method.

While studies have shown that could dramatically slow AIDS transmission, experts have voiced concerns about healthy people taking AIDS drugs, which have toxic side effects. It could also encourage drug resistance, and there are already millions of people in developing countries who qualify for treatment but are still waiting for it.

Sharonann Lynch, an HIV policy adviser at Doctors Without Borders, said many African countries are anxious to implement more aggressive strategies and that some are redrafting their guidelines even before official U.N. advice is available. But she said the financial crisis is affecting treatment and that enrollment in some clinics, like in Congo, have stalled or even been suspended. That could allow the epidemic to resurge.

"Just at the moment when we know how to manage HIV, we're hitting the brakes," Lynch said. "Without more investment, we'll be squandering the best chance we have of getting ahead of the new wave of infections."

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Online:

http://www.unaids.org

http://www.msf.org

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Where's the salt? Hidden in your Thanksgiving menu (AP)

WASHINGTON � No need for a salt shaker on the Thanksgiving table: Unless you really cooked from scratch, there's lots of sodium already hidden in the menu.

Stealth sodium can do a number on your blood pressure. Americans eat way too much salt, and most of it comes inside common processed foods and restaurant meals.

The traditional Thanksgiving fixings show how easy sodium can sneak into the foods you'd least expect. Yes, raw turkey is naturally low in sodium. But sometimes a turkey or turkey breast is injected with salt water to plump it, adding a hefty dose of sodium before it even reaches the store � something you'd have to read the fine print to discover.

From the stuffing mix to the green bean casserole to even pumpkin pie, a lot of people can reach their daily sodium allotment or more in that one big meal unless the cook employs some tricks.

"For Thanksgiving or any meal, the more you can cook from scratch and have some control over the sodium that's going in, the better," says the American Dietetic Association's Bethany Thayer, a registered dietitian at the Henry Ford Health Health System in Detroit.

The Food and Drug Administration this month opened deliberations on how to cut enough salt in processed foods for average shoppers to have a good shot at meeting new dietary guidelines. The idea: If sodium levels gradually drop in the overall food supply, it will ease the nation's epidemic of high blood pressure � and our salt-riddled taste buds will have time to adjust to the new flavor.

"Reducing sodium is important for nearly everyone," Dr. Robin Ikeda of the Centers for Disease Control and Prevention told the FDA hearing.

The question is how to make that happen. The prestigious Institute of Medicine and several public health advocates are urging the FDA to order gradual rollbacks, setting different sodium levels for different kinds of foods, a step the government has been reluctant to take.

Food makers want a voluntary approach and say they're reworking their recipes, some as part of a campaign launched by New York City to cut salt consumption by at least 20 percent over five years.

It will take different strategies to remove salt from different foods � and some may need to be a sneak operation, Kraft Foods Vice President Richard Black told the FDA meeting. Ritz crackers labeled low-sodium were a bust until the box was changed to say "Hint of Salt" and those exact same crackers started selling, he said.

In other foods, salt acts as a preservative with a variety of functions. Kraft sells cheese with somewhat less sodium in Britain than in the U.S. Americans melt a lot of cheese and lower-sodium cheese doesn't melt as well, Black said.

In the U.S., the average person consumes about 3,400 milligrams of sodium a day. The nation's new dietary guidelines say no one should eat more than 2,300 milligrams of sodium � about what's in a teaspoon of salt � and half the population should eat even less, just 1,500 milligrams. The smaller limit is for anyone who's in their 50s or older, African-Americans of any age, and anyone suffering from high blood pressure, diabetes or chronic kidney disease.

Why? One in three U.S. adults has high blood pressure, a leading cause of heart attacks, strokes and kidney failure. Being overweight and inactive raises blood pressure, too, but the weight of scientific evidence shows sodium is a big culprit.

People want to eat heart-healthy, but Wal-mart shoppers spend about 19 minutes buying groceries, added Tres Bailey of Wal-mart Stores Inc., which told its vendors to start cutting sodium.

That's not a lot of time for label-reading to find hidden sodium, especially in foods where it's unexpected � like salad dressings that can harbor more than 130 milligrams per tablespoon.

Depending on your choices, Thanksgiving dinner alone can pass 2,000 milligrams: About 600 per serving from stuffing mix, another 270 from gravy. The salt water-added turkey can bring another 320, double that if you saved time and bought it fully-cooked. Use canned beans in the green bean casserole and add another 350. A small dinner roll adds 130. A piece of pumpkin pie could bring as much as 350.

How to cut back? Thayer, the dietitian, has some tips for Thanksgiving and beyond:

_All bread contains sodium, but starting with a homemade cornbread for stuffing could help cut a few hundred milligrams.

_Use low-sodium broth for the gravy, and choose low-sodium soups whenever possible.

_Try onion, garlic and a variety of other herbs in place of salt. Lemon and other citrus also can stand in for salt in some foods.

_Check your spice bottles. Combination products, such as those labeled poultry seasoning, can contain salt.

_Fresh or frozen vegetables have little if any sodium, unless you choose the frozen kind with an added sauce.

_People tend to heavily salt mashed potatoes while sweet potatoes, even dressed up as a souffle, contain very little sodium.

Going suddenly low-salt can startle your palate, "but it adjusts much quicker than I think most people realize," Thayer says.

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

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FDA revokes approval of Avastin for breast cancer (AP)

WASHINGTON � The government delivered a blow to some desperate patients Friday as it ruled the blockbuster drug Avastin should no longer be used to treat advanced breast cancer.

Avastin is hailed for treating colon cancer and certain other malignancies. But the Food and Drug Administration said it appeared to be a false hope for breast cancer: Studies haven't found that it helps those patients live longer or brings enough other benefit to outweigh its dangerous side effects.

"I did not come to this decision lightly," said the FDA's commissioner, Dr. Margaret Hamburg. But she said, "Sometimes despite the hopes of investigators, patients, industry and even the FDA itself, the results of rigorous testing can be disappointing."

Avastin remains on the market to treat certain colon, lung, kidney and brain cancers. Doctors are free to prescribe any marketed drug as they see fit. So even though the FDA formally revoked Avastin's approval as a breast cancer treatment, women could still receive it � but their insurers may not pay for it. Some insurers already have quit in anticipation of FDA's long-expected ruling.

However, "Medicare will continue to cover Avastin," said Brian Cook, spokesman for the Centers for Medicare & Medicaid Services. The agency "will monitor the issue and evaluate coverage options as a result of action by the FDA but has no immediate plans to change coverage policies."

Including infusion fees, a year's treatment with Avastin can reach $100,000.

The ruling disappointed patients who believe Avastin is helping to curb their incurable cancer.

"It's saved my life," said a tearful Sue Boyce, 54, of Chicago. She's taken Avastin in addition to chemotherapy since joining a research study in 2003. Her breast cancer eventually spread to her lungs, liver and brain, but Boyce says she is stable and faring well.

"So I'm hoping the insurance company will grandfather me in to continue taking it," she said.

The Avastin saga began in 2008, when an initial study suggested the drug could delay tumor growth for a few months in women whose breast cancer had spread to other parts of the body. Over the objection of its own advisers and to the surprise of cancer groups, FDA gave Avastin conditional approval � it could be sold for such women while manufacturer Genentech tried to prove it really worked.

The problem: Ultimately, the tumor effect was even smaller than first thought. Across repeated studies, Avastin patients didn't live longer or have a higher quality of life. Yet the drug causes some life-threatening risks, including severe high blood pressure, massive bleeding, heart attack or heart failure and tears in the stomach and intestines, the FDA concluded. In two public hearings � one last year and one this summer � FDA advisers urged the agency to revoke that approval.

"The science is clear: Breast cancer patients are more likely to be harmed than helped by Avastin," said Diana Zuckerman of the National Research Center for Women and Families in Washington.

Genentech had argued the drug should remain available while it conducted more research to see if certain subsets of breast cancer patients might benefit, and some patients and their doctors had argued passionately for the drug.

"There certainly are patients who benefit tremendously," said Boyce's oncologist, Dr. Melody Cobleigh of Rush University Medical Center. "We'll just be battling with the insurance companies."

"For those not fortunate enough to be on Medicare or an insurance plan that covers it, it's a death sentence," Christi Turnage of Madison, Miss., said of the FDA's decision. Her breast cancer had moved into her lungs before she began Avastin three years ago and the spreading stopped, but Turnage said her insurer is ending coverage and she will seek financial help from Genentech's access program.

Hamburg said that she considered those arguments but that scientifically there are no clues yet to identify who those rare Avastin responders would be � putting a lot of people at risk in order for a few to get some as-yet-unknowable benefit. She urged Genentech to do that research, saying the FDA "absolutely" would reconsider if the company could find the right evidence.

Genentech, part of Swiss drugmaker Roche Group, pledged to begin that research.

"We are disappointed with the outcome," said company chief medical officer Dr. Hal Barron. "We remain committed to the many women with this incurable disease and will continue to provide help through our patient support programs to those who may be facing obstacles to receiving their treatment in the United States."

The breast cancer organization Susan G. Komen for the Cure said that it respected the FDA's decision and that it was time for researchers to concentrate on finding so-called biomarkers that would tell which drug is right for which patient.

"Each type of cancer is very different from another in important ways, and in the end it's no surprise that Avastin's effectiveness may not be equivalent against all types of cancer," said Dr. Neal Meropol of University Hospitals Case Medical Center in Cleveland, who has long used Avastin for colon cancer.

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Associated Press writer Marley Seaman in New York contributed to this report.

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FACT CHECK: GOP senator gasps for facts on asthma (AP)

WASHINGTON � It was a startling claim: Air pollution has no connection to asthma, Kentucky GOP Sen. Rand Paul said on the Senate floor.

But Paul, and a chart he used to make his case against the health benefits of a new federal air pollution rule, relied on some creative sourcing and pseudoscience.

Paul's chart was a graph showing air pollution declining in California as the number of people diagnosed with asthma rose. The chart attributed the data to a May 2003 paper by what was then called the California Department of Health Services. But the department never plotted the relationship between those two factors.

The real source was a 2006 paper "Facts Not Fear on Air Pollution" from the National Center for Policy Analysis, a conservative think tank. The paper, by independent consultant Joel Schwartz, contends that most information on air pollution from environmentalists, regulators, scientists and journalists is exaggerated or wrong. The paper was not subjected to the normal peer-review process demanded for most published science.

Paul, an ophthalmologist and eye surgeon, cited Schwartz in his Nov. 10 remarks, saying: "We have decreased pollution and rising incidence of asthma. Either they are inversely proportional or they are not related at all."

At best, the chart suggests that air pollution alone cannot explain the rise in asthma, a chronic lung disease that inflicts approximately 34 million Americans and whose exact cause is unknown.

It certainly can't be used to say that air pollution plays no role in causing asthma.

"They may think there is a pattern there, but in fact it has no basis," said Dr. Richard Kreutzer, head of environmental and occupational disease control at what is now California's Department of Public Health, the agency cited on Paul's chart. Kreutzer said there is evidence that some pollutants can cause asthma and even more research showing that air pollution aggravates asthma in those who have the disease.

The National Institutes of Health said last year that "recent findings have conclusively demonstrated a link between asthma and air pollution, especially ground-level ozone."

But Schwartz, who now works for Blue Sky Consulting Group, discounts even studies linking pollution to asthma attacks, saying "they are probably not related."

In an interview with The Associated Press, Schwartz defended his work. "The fact that they move in opposite directions shows that air pollution is not a large factor in the cause," he said.

Dan Greenbaum, the president of the nonprofit Health Effects Institute, said such arguments "miss the point." The institute receives funding from both the Environmental Protection Agency and the auto industry.

"No pulmonary doctor has said that the primary reason for the increase in asthma is air pollution. That is not the concern with air pollution and asthma," Greenbaum said. "The concern is that if you have asthma, we have very strong evidence that you are sensitive to air pollution."

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Follow Dina Cappiello on Twitter (at)dinacappiello

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Online:

California Department of Public Health paper: http://www.bit.ly/s3RAen

National Center for Policy Analysis paper: http://www.bit.ly/w06uJC

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Is economy best birth control? US births dip again (AP)

ATLANTA � The economy may well be the best form of birth control.

U.S. births dropped for the third straight year � especially for young mothers � and experts think money worries are the reason.

A federal report released Thursday showed declines in the birth rate for all races and most age groups. Teens and women in their early 20s had the most dramatic dip, to the lowest rates since record-keeping began in the 1940s. Also, the rate of cesarean sections stopped going up for the first time since 1996.

Experts suspected the economy drove down birth rates in 2008 and 2009 as women put off having children. With the 2010 figures, suspicion has turned into certainty.

"I don't think there's any doubt now that it was the recession. It could not be anything else," said Carl Haub, a demographer with the Population Reference Bureau, a Washington, D.C.-based research organization. He was not involved in the new report.

U.S. births hit an all-time high in 2007, at more than 4.3 million. Over the next two years, the number dropped to about 4.2 million and then about 4.1 million.

Last year, it was down to just over 4 million, according to the new report from the Centers for Disease Control and Prevention.

For teens, birth rates dropped 9 percent from 2009. For women in their early 20s, they fell 6 percent. For unmarried mothers, the drop was 4 percent.

Experts believe the downward trend is tied to the economy, which officially was in a recession from December 2007 until June 2009 and remains weak. The theory is that women with money worries � especially younger women � feel they can't afford to start a family or add to it.

That's true of Mary Garrick, 27, an advertising executive in Columbus, Ohio. She and her husband, David, married in 2008 and hoped to start having children quickly, in part because men in his family have died in their 40s. But David, 33, was laid off that year from his nursing job and again last year.

He's working again, but worries about the economy linger. "It kind of made us cautious about life decisions, like having a family. It's definitely something that affected us," she said.

Kristi Elsberry, a married 27-year-old mother of two, had her tubes tied in 2009 after she had trouble finding a job and she and her husband grew worried about the financial burden of any additional children. "Kids are so expensive, especially in this day and age. And neither of us think anything's going to get better," said Elsberry, of Leland, N.C.

Many of the report's findings are part of a trend and not surprising. There was a continued decline in the percentage of premature births at less than 37 weeks. And � as in years past � birth rates fell in younger women but rose a little in women 40 and older, who face a closing biological window for having children and may be more worried about that than the economy.

But a few of the findings did startle experts.

One involved a statistic called the total fertility rate. In essence, it tells how many children a woman can be expected to have if current birth rates continue. That figure was 1.9 children last year. In most years, it's more like 2.1.

More striking was the change in the fertility rate for Hispanic women. The rate plummeted to 2.4 from nearly 3 children just a few years ago.

"Whoa!" said Haub, in reaction to the statistic.

The economy is no doubt affecting Hispanic mothers, too, but some young women who immigrated to the United States for jobs or other opportunities may have left, Haub said.

Another shocker: the C-section rate. It rose steadily from nearly 21 percent in 1996 to 32.9 percent in 2009, but dropped slightly to 32.8 last year.

Cesarean deliveries are sometimes medically necessary. But health officials have worried that many C-sections are done out of convenience or unwarranted caution, and in the 1980s set a goal of keeping the national rate at 15 percent.

It's too soon to say the trend has reversed, said Joyce Martin, a CDC epidemiologist who co-authored the new report.

But the increase had slowed a bit in recent years, and assuming the decline was in elective C-sections, that's good news, some experts said.

"It is quite gratifying," said Carol Hogue, an Emory University professor of maternal and child health and epidemiology.

"There are strong winds pushing against C-sections," she said, including new policies and education initiatives that discourage elective C-sections in mothers who have not reached full-term.

Hogue agreed that the economy seems to be the main reason for the birth declines. But she noted that it's possible that having fewer children is now more accepted and expected.

"Having one child may be becoming more `normal,'" she said.

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Online:

CDC report:http://www.cdc.gov/nchs/

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