Thursday, September 29, 2011

Killer cantaloupe, scary sprouts ? what to do? (AP)

MILWAUKEE � Avoid foreign produce. Wash and peel your fruit. Keep it refrigerated. None of these common tips would have guaranteed your safety from the deadliest food outbreak in a decade, the one involving cantaloupes from Colorado.

Whether it's sprouts or spinach, turkey or hamburger; whether the government doubled, tripled or quadrupled inspections, the truth is that no food will ever be completely free of risk.

And a few foods have become so risky that certain people such as children, pregnant women and the elderly may do best to avoid them altogether until growers and the government figure out how to make them safer, some food experts say.

An unappetizing fact: Although the current cantaloupe outbreak has been tied to just one farm in Colorado, it's at least the 19th outbreak involving that melon since 1984. It's also the first one caused by listeria, a germ that actually likes to be in the refrigerator and thrives in this fruit, which cannot be cooked unless you want to eat melon mush.

Listeria also prompted a California farm to recall bags of chopped romaine lettuce on Thursday because of possible contamination, though no illnesses have been reported. The greens from Salinas-based True Leaf Farms went to an Oregon distributor and possibly at least two other states � Washington and Idaho.

So what should you do if you see cantaloupe on a salad bar or at the grocery store? Can you be sure all of the tainted stuff has been pulled from the market, since the last bad melons were shipped on Sept. 10? What if no one knows where the cantaloupe was grown?

"If the store can't tell them or the restaurant can't tell them, I would not buy it at all," said Chris Waldrop, director of the Food Policy Institute at the Consumer Federation of America.

Laura Anderko, a Georgetown University public health expert, went a step further.

"Honestly, as a nurse, I would tell people don't eat the cantaloupe until this thing resolves itself," she said. "This stuff happens because our system is not as tight as it needs to be."

The federal Centers for Disease Control and Prevention, which has confirmed 13 deaths and 72 illnesses in the outbreak so far, has not told people to stop buying cantaloupe. However, the CDC and the Food and Drug Administration cannot even say where all of the tainted melon went, because it was sold and resold to many distributors across the nation.

"When in doubt, throw it out," is the CDC's advice to consumers who have any cantaloupe whose origins they can't determine.

"Even if the cantaloupe is gone, you need to wash the drawer or shelf it may have been on" to make sure other foods don't become contaminated, said Caroline Smith DeWaal, director of food safety at the Center for Science in the Public Interest.

Beyond that, each outbreak brings fresh lessons on how to make produce safer. And while some of these things aren't guarantees, they can cut the odds you'll lose at the food safety lottery.

Some new tips food experts offered Thursday:

� Shop more often and consume fresh fruits and vegetables within a few days. This gives germs less chance to multiply and gives you more nutrients from your food, too.

� Don't just wash a melon. Scrub it under running water to rinse off any dislodged germs, and let it dry. If you cut it while it's still wet, "you may be sliding the pathogens more easily from the outside to the inside" on the knife, DeWaal said.

� Keep the fridge cold, 40 degrees or lower. Higher than that can let germs grow.

� Don't get a false sense of security if you buy organic produce. That just means less pesticide � not necessarily fewer germs.

� Consider dropping especially risky foods from your diet. Bean sprouts are not safe for children, pregnant women or people with weak immune systems and certain diseases, but that doesn't mean they're OK for everyone else, said Michael Doyle, a microbiologist who heads the University of Georgia's Center for Food Safety.

Doyle also consults for a lot of food companies, including a major spinach producer that sought help after outbreaks involving that vegetable. He has chaired a food safety advisory council for McDonald's for many years.

"I don't eat sprouts at all," he said. If harmful bacteria are in the seeds "they grow in the sprouting process, and there's nothing to kill them unless you cook them."

You can go too far with this, though. Even Dr. Robert Tauxe, the CDC's top food-germ sleuth, once confessed over lunch that he refused to live in fear of the fork, and that there were only a few foods he absolutely wouldn't eat, such as raw oysters and unpasteurized milk.

Beyond that, safe handling and cooking can generally keep most foods safe, he said.

The big picture is important, said Robert Gravani, a food scientist at Cornell University.

A gazillion pounds of produce are consumed each day, and only a tiny fraction cause problems, he said.

"I have a hard time saying, `Don't eat produce,' because of all of the health benefits," he said. "Everything we do has some degree of risk attached to it."

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Online:

Food safety tips: www.cspinet.org, http://www.fightbac.org

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Marilynn Marchione can be followed at http://twitter.com/MMarchioneAP



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If you're happy and you know it, did you tweet? (AP)

WASHINGTON � Twitter confirms it: People tend to wake up in a good mood and are happiest on weekends. The fast-paced forum is offering scientists a peek at real-time, presumably little-filtered human behavior and thoughts. Cornell University researchers turned to the microblog to study mood and found a pretty consistent pattern.

The researchers analyzed English-language tweets from 2.4 million people in 84 countries, more than 500 million of the brief, conversation-like exchanges sent over two years. They used a computer program that searched for words indicating positive mood � happy, enthusiastic, brilliant � or negative mood � sad, anxious, fear.

What they found: Unless you're a night owl, a positive attitude peaks early in the morning and again near midnight, but starts to dip midmorning before rising again in the evening.

Aha, you might think, going to work and related hassles like traffic explain that pattern. After all, there was more positive tweeting on the weekend, even though the morning peak of happy tweets occurred two hours later, probably because people slept late.

Not quite. Work-related stress may play some role but it can't explain why that same midday dip occurs on the weekend, too, said lead researcher Scott Golder, a Cornell graduate student. Instead, the pattern probably is due to the effects of sleep and our 24-hour biological clock, the so-called circadian rhythms that signal when it's time to sleep and to wake, Golder and Cornell sociologist Michael Macy reported. Their study appears in Friday's edition of the journal Science.

The researchers also examined tweets in the United Arab Emirates, where Friday and Saturday are considered the weekend. Sure enough, they found the same daily pattern, even though the workday tends to begin earlier there than in the West, and the same weekend pattern.

Previous research has linked the biological clock and mood, but was based mostly on small studies of American college students. There are cautions about studying Twitter postings, too: Their authors tend to be younger than the general population, and may be more affluent, better educated and different in yet-to-be-discovered ways.

Still, the study's bigger message is about the scientific potential of social media, Macy said.

Other researchers have turned to Twitter to study political campaigning, to blog postings and Twitter feeds to study emotions, and to Google searches of flu symptoms to predict outbreaks.

"It illustrates a new opportunity for doing social and behavioral science in ways that were really unimaginable even five years ago," Macy said.

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Science: http://www.sciencemag.org/



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CDC: Miners, construction, food workers smoke most (AP)

ATLANTA � A new government report says construction workers, miners and food service workers are the occupations that smoke the most. Experts say that may have as much to do with education levels as the jobs themselves.

The Centers for Disease Control and Prevention study found 19.6 percent of working adults smoke, but as many as 30 percent in the mining, construction and food service industries smoke. Librarians and teachers smoked the least, at less than 9 percent.

Also, people who work outdoors are less likely to face indoor smoking bans seen in other workplaces.

The study is based on in-person interviews of more than 113,000 working adults in the years 2004 through 2010.

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Online:

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



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Wednesday, September 28, 2011

Cantaloupe illnesses and deaths expected to rise (AP)

WASHINGTON � Federal health officials said Wednesday more illnesses and possibly more deaths may be linked to an outbreak of listeria in cantaloupe in coming weeks.

So far, the outbreak has caused at least 72 illnesses � including up to 16 deaths � in 18 states, making it the deadliest food outbreak in the United States in more than a decade.

The heads of the Centers for Disease Control and Prevention and the Food and Drug Administration said consumers who have cantaloupes produced by Jensen Farms in Colorado should throw them out. If they are not sure where the fruit is from, they shouldn't eat it.

Neither the government nor Jensen Farms has supplied a list of retailers who may have sold the fruit. Officials say consumers should ask retailers about the origins of their cantaloupe. If they still aren't sure, they should get rid of it.

"If it's not Jensen Farms, it's OK to eat," said Thomas Frieden, director of the CDC. "But if you can't confirm it's not Jensen Farms, then it's best to throw it out."

Jensen Farms of Holly, Colo. says it shipped cantaloupes to 25 states, though the FDA has said it may be more, and illnesses have been discovered in several states that were not on the shipping list. A spokeswoman for Jensen Farms said the company's product is often sold and resold, so they do not always know where it went.

The recalled cantaloupes may be labeled "Colorado Grown," `'Distributed by Frontera Produce," `'Jensenfarms.com" or "Sweet Rocky Fords." Not all of the recalled cantaloupes are labeled with a sticker, the FDA said. The company said it shipped out more than 300,000 cases of cantaloupes that contained five to 15 melons, meaning the recall involved 1.5 million to 4.5 million pieces of fruit.

The FDA said none of the cantaloupes had been exported, reversing an earlier statement that some of the tainted melons had been shipped abroad.

Frieden and FDA Commissioner Margaret Hamburg said that illnesses are expected for weeks to come because the incubation period for listeria can be a month or even longer. That means that someone who ate contaminated cantaloupe last week may not get sick until next month. Jensen Farms last shipped cantaloupes on Sept. 10. The shelf life is about two weeks.

"We will see more cases likely through October," Hamburg said.

The Food and Drug Administration said state health officials found listeria in cantaloupes taken from Colorado grocery stores and from a victim's home that were grown at Jensen Farms. Matching strains of the disease were found on equipment and cantaloupe samples at Jensen Farms' packing facility in Granada, Colo.

Sherri McGarry, a senior adviser in the FDA's Office of Foods, said the agency is looking at the farm's water supply and possible animal intrusions among other things in trying to figure out how the cantaloupes became contaminated. Listeria bacteria grow in moist, muddy conditions and are often carried by animals.

The health officials said this is the first known outbreak of listeria in cantaloupe. Listeria is generally found in processed meats and unpasteurized milk and cheese, though there have been a growing number of outbreaks in produce. Hamburg called the outbreak a "surprise" and said the agencies are studying it closely to find out how it happened.

Cantaloupe is often the source of outbreaks, however. Frieden said CDC had identified 10 other cantaloupe outbreaks in the last decade, most of them from salmonella.

Listeria is more deadly than well-known pathogens like salmonella and E. coli, though those outbreaks generally cause many more illnesses. Twenty-one people died in an outbreak of listeria poisoning in 1998 traced to contaminated hot dogs and possibly deli meats made by Bil Mar Foods, a subsidiary of Sara Lee Corp. Another large listeria outbreak, in 1985, killed 52 people and was linked to Mexican-style soft cheese.

Listeria generally only sickens the elderly, pregnant women and others with compromised immune systems. The CDC said the median age of those sickened is 78 and that 1 in 5 who contract the disease can die from it. Symptoms include fever and muscle aches, often with other gastrointestinal symptoms.

Unlike many pathogens, listeria bacteria can grow at room temperatures and even refrigerator temperatures. It is hardy and can linger long after the source of the contamination is gone � health officials say people who may have had the contaminated fruit in their kitchens should clean and sanitize any surfaces it may have touched.

The CDC said Tuesday that 13 deaths are linked to the tainted fruit. State and local officials say they are investigating three additional deaths that may be connected.

The death toll released by the CDC Tuesday surpassed the number of deaths linked to an outbreak of salmonella in peanuts almost three years ago. Nine people died in that outbreak. The CDC reported four deaths in New Mexico, two deaths each in Colorado and Texas and one death each in Kansas, Missouri, Nebraska, Oklahoma and Maryland.

New Mexico officials said Tuesday they are investigating a fifth death, while health authorities in Kansas and Wyoming said they too are investigating additional deaths possibly linked to the tainted fruit.

The CDC reported the 72 illnesses and deaths in 18 states. Cases of listeria were reported in California, Colorado, Florida, Illinois, Indiana, Kansas, Maryland, Missouri, Montana, Nebraska, New Mexico, North Dakota, Oklahoma, Texas, Virginia, West Virginia, Wisconsin, and Wyoming. The most illnesses were reported in Colorado, which has seen 15 sickened. Fourteen illnesses were reported in Texas, 10 in New Mexico and eight in Oklahoma.

While most healthy adults can consume listeria with no ill effects, it can kill the elderly and those with compromised immune systems. It is also dangerous to pregnant women because it easily passes through to the fetus. The CDC's Frieden said that two of those sickened were pregnant women but they have since recovered.

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Online:

CDC on cantaloupe outbreak: http://www.cdc.gov/listeria/index.html

FDA on cantaloupe recall: http://www.fda.gov/Food/FoodSafety/CORENetwork/ucm272372.htm

Center for Science and the Public Interest, "Super Safe Your Kitchen": http://www.cspinet.org/new/pdf/safekitchen.pdf

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Find Mary Clare Jalonick on Twitter at http://twitter.com/MCJalonick



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Dementia patients suffer dubious hospitalizations (AP)

One-fifth of Medicare nursing home patients with advanced Alzheimer's or other dementias were sent to hospitals or other nursing homes for questionable reasons in their final months, often enduring tube feeding and intensive care that prolonged their demise, a new study found.

Nursing homes may feel hospital care is warranted when a frail, elderly patient develops swallowing problems, pneumonia or a serious infection, but researchers suspect a different motive for many transfers: money. Medicare pays about three times the normal daily rate for nursing homes to take patients back after a brief hospitalization.

"I think that's unfortunately a factor in what's happening here," said Dr. Joan Teno, a palliative care physician and health policy professor at Brown University. "A lot of this care just feels like in and out, in and out. You really have to question, is the health care system doing a good job or not."

She is a co-author of the study, published in Thursday's New England Journal of Medicine and done with researchers from Harvard University and Dartmouth Medical School.

Among the nearly 475,000 patients studied, 19 percent were moved for questionable reasons. The study provided no evidence that money motivated such transfers or that there was wrongdoing involved. However, the large variation that researchers saw from state to state suggests money may be playing a role.

Rates of such transfers varied from 2 percent in Alaska to more than 37 percent in Louisiana. In McAllen, Texas, 26 percent of study participants had multiple hospitalizations for urinary infections, pneumonia or dehydration � conditions that usually can be treated in a nursing home. That compares to just 1 percent of patients in Grand Junction, Colo.

The researchers used Medicare records from 2000 through 2007 to identify "burdensome" transitions of care: moving patients in the last three days of life, moving them multiple times in the last three months of life, or moving them so they landed in a new nursing home afterward.

Medicaid pays on average $175 per day, depending on the state, for long-term care, but Medicare will pay three times that for skilled nursing care after a patient returns from three days or more in a hospital.

"If you have a nursing home that is operating on a margin, it adds up. It can be a tremendous incentive to hospitalize these people," Teno said.

Researchers found that patients who had a dubious transfer were more likely to have a feeding tube inserted, to spend time in intensive care in the last month of life, to have a severe bedsore or to be enrolled in hospice late (three days or less before they died).

Dubious transfers were more common with black patients, Hispanics and those without advance directives, legal documents spelling out care wishes.

The National Institute on Aging sponsored the study. One author consults for a nursing home system and owns stock in a long-term care information services company.

The study is important because more than 1.6 million Americans live in nursing homes, and nearly one-quarter of people admitted to one after hospitalization wind up back in the hospital within a month, Dr. Joseph Ouslander of Florida Atlantic University in Boca Raton and Dr. Robert Berenson of the Urban Institute in Washington, D.C., wrote in an editorial in the journal. Nursing homes may fear legal liability if they don't hospitalize a very sick patient, they wrote.

However, people with advanced dementia have a terminal condition.

"These are people who are unable to recognize their relatives, they're bed-bound and they're now usually having problems with swallowing. This is a population where the burdens of hospitalization often outweigh the possible benefits," Teno said. "These patients actually do better when they stay in a nursing home," where caregivers and surroundings are familiar, she said.

For families and nursing homes, "it may be difficult to recognize that in fact, this person is in the dying process," said Dr. Michael Malone, medical director of senior services for Aurora Health Care, a network of 15 hospitals in eastern Wisconsin. His 87-year-old father, Wendell Malone, died in January of advanced dementia in a nursing home that managed his care without frequent hospitalizations.

"It provided dignity, it provided comfort for the family," and let him stay in a place and with caregivers he knew, Malone said.

Beth Kallmyer, who runs programs for caregivers for the Alzheimer's Association, said the most important thing is to have a plan in place, with legal documents like "do not hospitalize" directives, before a nursing home has to make a decision about whether to hospitalize someone or instead focus on comfort care and not try to prolong life.

"When the time comes, the family will be able to say `This is what dad wanted,'" Kallmyer said.

She and other experts offered these tips:

_Involve patients in planning their care while they're still able to do so, and make sure wishes like "do not resuscitate" or "do not call 911" are spelled out in legal documents.

_Develop good relationships with nursing home staff and attending physicians so they understand the family's goals of care.

_Consider hospice care when seniors with advanced dementia are admitted.

_Revisit and review the plan whenever there is a change in a loved one's status. Someone may not be end-stage when they enter a nursing home but that can change.

_Seek advice. The Alzheimer's Association has a 24-hour toll-free number, 1-800-272-3900, with counselors to help families.

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Online:

Medical journal: http://www.nejm.org

State reports: http://www.LTCFocUS.org

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Marilynn Marchione can be followed at http://twitter.com/MMarchioneAP



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Tuesday, September 27, 2011

Lawmakers: CDC to have student concussion protocol (AP)

NUTLEY, N.J. � As awareness continues to grow about sports-related concussions among student athletes, two New Jersey lawmakers say it's time for schools to start following nationwide protocols governing such injuries.

U.S. Sen. Robert Menendez and Rep. Bill Pascrell announced Tuesday that the Centers for Disease Control and Prevention agreed to study and develop national guidelines for managing sports-related concussions for student athletes.

Menendez and Pascrell, both New Jersey Democrats, had sponsored legislation, which passed the House but stalled in the Senate, that would have made such protocols mandatory. Several states, including New Jersey, have laws requiring a physician's approval for a student to return to sports, but Pascrell said there needs to be nationwide guidance for schools and youth sports programs to follow.

"The science may be changing, but that's no excuse for not establishing a protocol," Pascrell said, referring to differing scientific findings on concussions. "We're close to that for our soldiers, we need to be even closer for our children."

Stressing that "every concussion is brain damage," Pascrell said 41 percent of student athletes who suffer concussions return to playing too soon, sometimes with serious or even fatal consequences.

The CDC will convene a panel of experts to define the scope of the protocol, review existing literature, review the current state of science on concussions and have protocols ready for distribution by fall of 2014, according to Pascrell.

"Sports are a great way for kids and teens to stay healthy and this project will help us continue the important work in traumatic brain injuries in sports and other activities," said Dr. Linda C. Degutis of CDC's National Center for Injury Prevention and Control. "CDC's new initiative on pediatric guidelines will work to improve diagnosis and management of brain injuries in younger children and teens who are injured on or off the playing field."

About a dozen states, including New Jersey, have rules related to concussions and brain injuries among student athletes, according to the National Conference of State Legislatures. Other states are considering similar measures.

Concussions are caused by a blow that forces the head to move violently. They can affect memory, judgment, reflexes, speech, balance and muscle coordination and the symptoms become worse if not properly treated. Young people, particularly girls, are more susceptible to long-term repercussions than adults.

Pascrell started pushing for legislation after the October 2008 death of Montclair High school football player Ryne Dougherty. Dougherty reportedly sat out three weeks after suffering a concussion but was cleared to return to playing after taking a test. He collapsed after making a tackle his first game back, and died after suffering a brain hemorrhage.

For years, the CDC has been working on the issue of sports-related concussions, and developed materials for coaches on steps to take if they think a student athlete suffered a concussion. Those steps include removing the athlete from the game or practice, and then having them evaluated by a health care professional with experience in concussions. The advice also suggests not returning the athlete to play until the health professional says it's OK, and telling the student's parents what happened.

But Tuesday's announcement represents something broader. The CDC is putting together an expert panel to discuss possible pediatric guidelines for doctors on how to best diagnose and treat concussions that occur not only on the sports field but also from car accidents, falls and other causes. That might include a look at the type of assessments currently used, although exactly what the panel will examine hasn't been decided.

The announcement was held at Nutley High School in New Jersey, where athletes say the school has adopted a strict policy in recent years on monitoring concussions.

Seventeen-year-old Andre Hamlin has been playing football since he was in the third grade. Now a senior on the football team, he said he's noticed a major change in recent years, with coaches making awareness and testing for concussions mandatory.

Hamlin said all student athletes take a computerized "impact test" of word problems and other questions that test brain function and must be cleared by a doctor before starting any sport.

He said awareness of concussions is now common and that coaches tell players how to avoid concussions by keeping their heads up during football plays.

"It's something that's present throughout the season, our coach emphasizes it," Hamlin said. "If you see a player put their head down incorrectly it kind of gets your skin crawling, `cause that's how you can get a concussion. We tell the younger kids: put your head up, and stay safe out there."

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AP Medical Writer Mike Stobbe in Atlanta contributed to this report.

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Follow Samantha Henry at http://www.twitter.com/SamanthaHenry.



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