CDC's 'zombie apocalypse' advice an Internet hit (AP)

ATLANTA � "Zombie apocalypse." That blog posting headline is all it took for a behind-the-scenes public health doctor to set off an Internet frenzy over tired old advice about keeping water and flashlights on hand in case of a hurricane.

"You may laugh now, but when it happens you'll be happy you read this, and hey, maybe you'll even learn a thing or two about how to prepare for a real emergency," wrote Dr. Ali Khan on the emergency preparedness blog of the federal Centers for Disease Control and Prevention.

Above the post is a photo of what appears to be a dirty-fingered female zombie.

Khan's postings usually draw 1,000 to 3,000 hits in a week. This one � posted Monday � got 30,000 within a day. By Friday, it had gotten 963,000 page views and was the top item viewed on the agency's Web site, thanks in part to media coverage that began mid-week.

As of Friday morning, the traffic showed no signs of abating.

"The response has been absolutely excellent. Most people have gotten the fact that this is tongue-and-cheek," Khan said.

More important, CDC officials said, it is drawing interest from teens and young adults who otherwise would not have read a federal agency's guidance on the importance of planning an evacuation route or how much water and what tools to store in case a major storm rolls in.

The idea evolved from a CDC Twitter session with the public earlier this year about planning for disasters. Activity spiked when dozens of tweets came in from people saying they were concerned about zombies.

Dave Daigle, a veteran communications specialist, proposed the idea of using a zombie hook to spice up the hurricane message. Khan, director of emergency preparedness, approved it immediately and wrote it himself.

"Most directors would have thrown me out of their office," Daigle laughed. "Ali has a good sense of humor."

In the blog, Khan discussed what fiction has said about flesh-eating zombies and the various infectious agents that different movies have fingered as the cause.

His favorite zombie flick is "Resident Evil," but his interest in unpredictable terrors is driven more by his decades of work tracking real-life infections like Ebola hemorrhagic fever, bird flu and SARS.

CDC officials said the feedback they've gotten is almost completely positive, including a nice note from the boss, Dr. Tom Frieden.

Almost as rewarding was a nice comment Daigle said he received from his 14-year-old daughter, who has shown little interest in her dad's work but saw the zombie post and said, "This is cool!"

There have been few comments asking whether this is the best way for the government to spend tax dollars. The agency is under a tight budget review at the moment and facing potentially serious budget cuts. But the zombie post involved no extra time or expenditure, CDC officials said.

"We have a critical message to get out and that is CDC saves lives while saving money. If it takes zombies to help us get that message out, then so be it," said agency spokesman Tom Skinner.

Whether the message sticks still has to be determined. The agency is planning a follow-up survey to see if people actually did prepare emergency kits or follow Khan's other advice.

CDC deserves credit for trying something like this, said Bill Gentry, director of the community preparedness and disaster management program at the University of North Carolina's school of public health.

But that doesn't mean the agency should start using vampires to promote vaccinations or space aliens to warn about the dangers of smoking.

"The CDC is the most credible source out there for public health information," he said. "You don't want to risk demeaning that."

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Online:

CDC's emergency preparedness blog: http://bit.ly/ikth7k

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Kept in chains: Mental illness rampant in Somalia (AP)

MOGADISHU, Somalia � Hassan Qasim lies shackled to a wall in a hallway with 25 other patients at a clinic for the mentally ill. He whispers under his breath and spits at his neighbors. Torn and dirty clothes hang off his skinny frame.

Doctors say the 25-year-old's brother and sister were killed in front of him, and that he was abducted and tortured by gunmen. Soon after, Qasim began wandering the streets naked, lashing out at passers-by.

In this Horn of Africa nation that has been mired in anarchy and war for two decades, nearly all families have been touched by tragedy. The World Health Organization estimates that one in three Somalis have suffered from some kind of mental illness, a rate that is among the highest in the world.

Gunfire crackles every few seconds in Mogadishu at night, and mortars scream out of the sky.

"We believe every bullet or mortar will cause more people to become mentally ill," said Dr. Abdirahman Ali Awale, a Somali psychiatrist.

Somalia's civil war also has simultaneously destroyed health care infrastructure to treat the traumatized. A World Health Organization report found that the country has only three psychiatrists and no psychologists working at its five main mental health facilities.

As a result, some Somalis have been chained up in mental wards for as long as eight years, according to the WHO. At one mental health facility, almost 50 percent of patients were chained. At other clinics, doctors recite the Quran to patients, hoping it will improve their condition.

This year, WHO began giving medicine and other supplies to the Habeb mental hospital, the only facility that treats patients without detaining them.

"Our treatment is chain-free. We never restrain them," said Dr. Abdirahman Habeb. He says the facility has treated more than 9,000 psychiatric patients using a combination of medicine and counseling. Still, the majority of mentally ill people in Somalia face much grimmer prospects.

The Somali government, which is consumed by political infighting and battling an al-Qaida-linked insurgency, is unable to even assert control over all of Mogadishu much less help its traumatized population. It relies on 9,000 African Union peacekeepers to retain control of half the country's capital.

Dr. Rizwan Hamayun, who helped write a WHO study earlier this year examining mental health in Somalia, said the chaos has resulted in a loss of jobs, family, homes and property which in turns can contribute to mental illness. His latest new patient was a shepherd who attempted suicide after losing all his animals not to war but to a natural calamity � an ongoing drought.

While poverty and fear are the main triggers for mental illness, some also have been intimidated by continuous threats made by insurgents over mobile phones. Insurgents call and threaten people they suspect of collaborating with the government. As punishment for alleged crimes, insurgents saw off captives' hands and feet in public squares and stone people to death.

The insurgents accused Ibrahim Nuraddin of selling phone credit, bread, and other small items to Somali soldiers. The elderly former shopkeeper had a mental breakdown after receiving frequent death threats, relative Ibrahim Farabadn said.

Nuraddin had already spent one year imprisoned in his family's house or tied to a tree. Finally, relatives sought treatment after hearing that a Mogadishu clinic was taking patients. Three hefty men dragged Nuraddin into the clinic but he struggled to escape. They quickly chained him up.

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Home births up, driven by natural birth subculture (AP)

ATLANTA � Home births rose 20 percent over four years, government figures show, reflecting what experts say is a small subculture among white women toward natural birth.

Fewer than 1 percent of U.S. births occur at home. But the proportion is clearly going up, study by researchers at the Centers for Disease Control and Prevention found. The new figures are for 2004 to 2008. Home births had been declining from 1990 to 2004.

The increase was driven by white women � 1 in 98 had their babies at home in 2008, the most recent year for which the statistics were available.

Only about 1 in 357 black women give birth at home, and just 1 in 500 Hispanic women do.

"I think there's more of a natural birth subculture going on with white women � an interest in a low-intervention birth in a familiar setting," said the lead author, Marian MacDorman of the CDC's National Center for Health Statistics.

For all races combined, about 1 in 143 births were at home in 2008, up from 1 in 179 in 2004.

Geographically, 27 states had significant increases during those four years. Montana, Vermont and Oregon had the most home births � about 1 in 50 births were at home in those states.

Alaska's rate was nearly as high, and it's clear that some home births occur because women are in remote locations and are not able to get to hospitals in time for delivery.

The increase is notable because doctors groups have been increasingly vocal about opposing home births, The American College of Obstetricians and Gynecologists has for years warned against home births, arguing they can be unsafe, especially if the mother has high-risk medical conditions, if the attendant is inadequately trained or if there's no quick way to get mother and child to a hospital if something goes awry.

Doctor participation in home births declined by 38 percent from 2004 to 2008. The percentage of home births attended by certified midwives and nurse-midwives grew, meanwhile.

Home births increasing? "From our perspective, that's not the best thing for the overall health of babies and women," said Dr. George Macones, an obstetrician at Washington University in St. Louis who chairs ACOG's Committee on Obstetric Practice.

Exactly how unsafe home births are is a matter of medical controversy, with studies offering conflicting conclusions. And some argue that hospitals present their own dangers of infection and sometimes unnecessary medical interventions.

The CDC researchers did find that home births involving medical risks became less common from 2004 to 2008. Home births of infants born prematurely fell by 16 percent, so that by 2008 only 6 percent of all home births involved preterm births. That's less than half the percentage in hospitals.

The study was done by two CDC researchers and a Boston university professor. It was electronically published Friday by a medical journal called Birth: Issues in Perinatal Care.

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Paralyzed man freely moves after getting implant (AP)

LONDON � After Rob Summers was paralyzed below the chest in a car accident in 2006, his doctors told him he would never stand again. They were wrong.

Despite intensive physical therapy for three years, Summers' condition hadn't improved. So in 2009, doctors implanted an electrical stimulator onto the lining of his spinal cord to try waking up his damaged nervous system. Within days, Summers, 25, stood without help. Months later, he wiggled his toes, moved his knees, ankles and hips, and was able to take a few steps on a treadmill.

"It was the most incredible feeling," said Summers, of Portland, Oregon. "After not being able to move for four years, I thought things could finally change."

Still, despite his renewed optimism, Summers can't stand when he's not in a therapy session with the stimulator turned on, and he normally gets around in a wheelchair. Doctors are currently limiting his use of the device to several hours at a time.

His case is described in a paper published Friday in the journal, Lancet. The research was paid for by the U.S. National Institutes of Health and the Christopher and Dana Reeve Foundation.

For years, certain people with incomplete spinal cord injuries, who have some control of their limbs, have experienced some improvement after experiments to electrically stimulate their muscles. But such progress had not been seen before in someone with a complete spinal cord injury.

"This is not a cure, but it could lead to improved functionality in some patients," said Gregoire Courtine, head of experimental neurorehabilitation at the University of Zurich. He was not connected to Summers' case. Courtine cautioned Summers' recovery didn't make any difference to the patient's daily life and that more research was needed to help paralyzed people regain enough mobility to make a difference in their normal routines.

The electrical stimulator surgeons implanted onto Summers' spinal cord is usually used to relieve pain and can cost up to $20,000. Summers' doctors implanted it lower than normal, onto the very bottom of his vertebrae.

"The stimulator sends a general signal to the spinal cord to walk or stand," said Dr. Susan Harkema, rehabilitation research director at the Kentucky Spinal Cord Injury Research Center in Louisville and the Lancet study's lead author.

Harkema and her colleagues were surprised Summers was able to voluntarily move his legs. "That tells us we can access the circuitry of the nervous system, which opens up a whole new avenue for us to address paralysis," Harkema said. She said prescribing drugs might also speed recovery.

Dr. John McDonald, director of the International Center for Spinal Cord Injury at Kennedy Krieger Institute in Baltimore, said the strategy could be rapidly adopted for the 10 to 15 percent of paralyzed patients who might benefit. He was not connected to the Summers case.

"There is no question we will do this for our patients," he said. McDonald added that since the electrical stimulators are already approved for pain relief, it shouldn't be difficult to also study them to help some patients regain movement.

For now, Summers does about two hours a day of physical therapy.

"My ultimate goal is to walk and run again," he said. "I believe anything is possible and that I will get out of my wheelchair one day."

___

Online:

http://www.lancet.com

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Swimmer's ear medical costs total $500M a year (AP)

ATLANTA � The first national estimates of swimmer's ear say it causes about 2.4 million trips to doctors and hospitals in a year.

The Centers for Disease Control and Prevention also said swimmer's ear cases amounted to about $500 million in annual medical costs � or roughly $200 per visit.

Some people get the problem repeatedly, and the CDC didn't estimate how many Americans suffer swimmer's ear each year. But according to calculations by The Associated Press based on CDC statistics, more than 2 million get it.

Swimmer's ear is an itchy, painful, outer-ear infection that can occur when bacteria in swimming water get through breaks in the skin. It's commonly treated with antibiotic ear drops.

More than half the cases were in adults. The CDC released the statistics Thursday.

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HPV test beats Pap for cervical cancer screening (AP)

Two big studies suggest possible new ways to screen healthy people for cervical or prostate cancers, but a third disappointed those hoping for a way to detect early signs of deadly ovarian tumors.

Researchers found:

_For women 30 and over, a test for the virus, HPV, is better than a Pap smear for predicting cervical cancer risk, and those who test negative on both can safely wait three years to be screened again.

_A single PSA blood test at ages 44 to 50 might help predict a man's risk of developing advanced prostate cancer or dying of it up to 30 years later. The PSA test is notoriously unreliable, but using it this way separates men who need a close watch from those who are so low-risk that they can skip testing for five years or more.

_Screening women with no symptoms for ovarian cancer with a blood test and an ultrasound exam is harmful. It didn't prevent deaths and led to thousands of false alarms, unneeded surgeries and serious complications.

The last study is a warning to people who get screening tests that aren't recommended, or who question whether screening can ever hurt.

"The answer is, it could hurt a lot," said Dr. Allen Lichter, chief executive of the American Society of Clinical Oncology. The group published these and 4,000 other studies Wednesday, ahead of its annual meeting next month.

Cervical cancer is easy to prevent. It's very slow-growing and screening finds precancerous cells and allows early treatment. The new study was the first big one to examine a newer screening tool, HPV tests, with or without Pap smears in routine practice.

For a Pap test, cells scraped from the cervix, the gateway to the uterus, are checked under a microscope. But this can miss problems or raise false alarms.

HPV tests detect the human papillomavirus, which causes most cases of cervical cancer. But HPV is "the common cold" of the nether regions � most sexually active young people have been exposed to it, said Debbie Saslow, the American Cancer Society's director of breast and gynecologic cancer. Most infections go away on their own; they're only a cancer risk when they last a year or more.

Younger women tend to have short-term infections, so Pap tests are a better way to screen them. HPV tests are approved as an option along with Paps for women 30 and older, and the cancer society says that if a woman tests negative on both, she can wait three years to be screened again. Few take this advice, though.

"Women still want their annual Pap and doctors still want to give them," and think it's rationing care to test less often, Saslow said.

The new study gives "very, very solid support" for screening less often, Lichter said.

Hormuzd Katki of the National Cancer Institute studied more than 330,000 women getting HPV and Pap tests through Kaiser Permanente Northern California for five years.

Only about three out of 100,000 women each year developed cervical cancer after negative HPV and Pap tests. HPV tests were twice as good as Paps for predicting risk. Adding a Pap after a negative HPV test did little to improve risk prediction.

However, if an HPV test was positive, a Pap test helped confirm or rule out the need for follow-up.

The study didn't look at the downside of HPV testing � how many false alarms and needless procedures it triggered. HPV tests cost $80 to $100 compared to $20 to $40 for Paps.

The prostate study sought a better way to use PSA tests, which are troublesome because PSA can be high for many reasons besides cancer, and doctors don't know which cancers need treatment or whether screening saves lives. Most groups don't recommend PSA tests, but most men over 50 get them anyway.

The new study "is not going to end the controversy, but it suggests a very interesting middle ground," Lichter said.

Researchers at Memorial Sloan-Kettering Cancer Center in New York used stored blood samples that 12,000 Swedish men gave for a heart study decades ago, when most were 44 to 50 years old. They also had second samples from some of them six years later, and samples from other 60-year-old men.

Looking 27 years later, researchers saw that 44 percent of cancer deaths occurred in men whose initial PSAs had been in the top 10 percent when they were 44 to 50 years old.

Conversely, scoring below the median meant very little cancer risk years later.

"They're identifying a group of guys who don't need to be screened, or need to be screened less often," said Dr. Otis Brawley, the cancer society's chief medical officer.

The results are "provocative," but this type of study can't prove that screening prevents deaths, said Dr. Matthew R. Smith of the Massachusetts General Hospital Cancer Center. Few of the Swedish men were treated for prostate cancer as most men are today, which can affect survival.

The National Cancer Institute, the Swedish Cancer Society and several foundations paid for the work, and one researcher holds patents for two PSA-related tests.

Baseline PSA tests for men in their 40s can't be recommended yet, Brawley said. The cancer society says men should be informed of the risks and benefits of PSA tests starting at age 50, and sooner for blacks and those with family history of prostate cancer.

The government-funded ovarian cancer study involved nearly 80,000 women. Half were screened annually with an ultrasound for four years and a blood test for six years. The blood test looked for CA-125, a substance often elevated in ovarian cancer.

After 13 years, there were no major differences in ovarian cancers found or deaths from the disease. Screening found only 212 cancers while giving 3,285 false alarms that led to 1,080 unneeded biopsy surgeries and 163 serious complications.

"So many people say `how can cancer screening be harmful?' This thing documents it," Brawley said.

The results don't apply to using these tests on women with symptoms of ovarian cancer or abnormal physical exams. That's still the best way to check for ovarian cancer in those cases.

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Online:

CDC on HPV tests: http://www.cdc.gov/hpv/Screening.html

Cancer Society on HPV: http://tinyurl.com/44gnadx

Cervical cancer science review: http://tinyurl.com/6lc2rzg

Oncology society: www.cancer.net

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