American Journal Of Medicine

April 24, 2009 -- Mexico's deadly swine flu outbreak is caused by the same virus identified in the U.S., says CDC Acting Director Richard Besser, MD.

The CDC is analyzing 14 virus samples sent from Mexico. Seven of them, the CDC learned today, are very similar to the unusual swine flu strain isolated from U.S. patients.

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"People are concerned about this situation," Besser said at a news conference. "We are worried as well. Our concern has grown since yesterday."

Sixty people in Mexico have died of the flu -- and so far, 16 of the deaths are confirmed cases of swine flu, news sources quote Mexican officials as saying.

World Health Organization spokesman Gregory Hartl told the Canadian news agency CBC that there have been some 800 cases in Mexico City, where schools are closed due to the outbreak.

Alarmingly, the flu outbreak in Mexico is striking healthy young people -- a pattern that would be expected if a flu virus new to humans emerged.

"Because these cases are not happening in the very old or the very young, which happens with seasonal influenza, this is an unusual event and a cause for heightened concern," Hartl said in a CBC interview.

That's not the only eyebrow-raising feature of the swine flu outbreaks. Infections have occurred in Mexico, California, and Texas -- where warm weather should mean the end of the normal flu season, says William Schaffner, MD, president-elect of the National Foundation for Infectious Diseases and chair of preventive medicine and infectious diseases at Vanderbilt University.

"Will we see this flu virus transmitted in the warm months? That would give us heartburn," Schaffner tells WebMD. "And is this a harbinger of things to come during our next flu season?"

Another disconcerting feature of the outbreak is that it's probably too late to contain it to limited geographical areas.

"We are seeing cases in Texas and California with no connection between them. This makes us think there has been transmission from person to person through many cycles," Besser said. "For containment we need limitation to a confined geographical area, and we have not seen that here."

The World Health Organization is convening an expert panel to determine whether to raise its pandemic flu alert level. Because of bird flu, we're at level 3. If the panel finds evidence of "increased human-to-human transmission" it goes to level 4. If there's evidence of "significant human-to-human transmission," it goes to level 5.

A pandemic will be declared only if there is "efficient and sustained human-to-human transmission" of a new flu virus. That clearly has not happened yet.

"Whether or not this [swine flu] strain causes a widespread pandemic will depend on its transmissibility among humans. That has not yet been fully elucidated, but should be shortly," Pascal James Imperato, MD, MPH, professor and dean of public health at SUNY Downstate Medical Center, Brooklyn, N.Y., tells WebMD.

Should there be a pandemic -- something that is far from certain -- the CDC has already begun work on a vaccine. Would it be ready by next flu season?

"It would be an Olympic sprint -- a mammoth feat -- to produce a flu vaccine by October," Schaffner says.

What You Should Do Now

Infectious disease experts agree with the CDC that now is a good time to think about what you'd do if there were a widespread flu outbreak.

Here's what you can do right now: Wash your hands often and well.

Swine Flu Outbreak:
Get the Facts

Get the latest swine flu information from the WebMD and the CDC, plus other facts you need to know.

• Swine Flu FAQ
• CDC Swine Flu updates
• Swine Flu Case Count Rising
• Swine Flu Sickens 2 California Kids

© 2009 WebMD, LLC. All rights reserved.

The CDC has not yet warned travelers to avoid the San Diego or San Antonio areas, and it is not restricting travel to or from Mexico. However, travelers to or from those areas should be sure to use all normal precautions to avoid catching or spreading a cold or flu.

People who live in or visit those areas and who get flu-like symptoms should see a doctor to get tested for the swine flu virus.

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View Article Sources

SOURCES:

News conference with Richard Besser, MD, acting director, CDC.

William Schaffner, MD, president-elect, National Foundation for Infectious Diseases; chairman, preventive medicine and infectious diseases, Vanderbilt University, Nashville, Tenn.

Pascal James Imperato, MD, MPH, professor and dean of public health, SUNY Downstate Medical Center, Brooklyn, N.Y.

World Heath Organization web site.

CDC web site.

CBC web site.

Associated press.

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April 21, 2009 - The CDC says seven people -- so far -- got sick from a new kind of swine flu virus.

More cases are likely to be found, says CDC respiratory disease chief Anne Schuchat, MD, as the CDC's intensive investigation gets more data on suspected cases.

"We believe that human-to-human spread is occurring. That is unusual," Schuchat said at a news conference. "We don't know yet how wide it is spreading. We have taken steps to learn more."

All seven of the people with confirmed swine flu recovered. Only one patient was ill enough to require hospitalization. The swine flu disease was similar to human flu, except that nausea and diarrhea were more common.

Patients ranged in age from 9 to 54 and included three girls and four males.

Five of the people who got the virus live in the San Diego area and two live near San Antonio. A father and daughter in San Diego and two 16-year-old boys from the same school in San Antonio are among the cases. But the three other cases are not connected.

The San Antonio cases have no connection to one infected San Diego boy who traveled to Dallas while ill. None of the seven cases appears to have had direct contact with pigs.

"We are seeing a virus that appears to be spreading from person to person in humans, and the viruses have very similar genetic characteristics to each other," CDC flu division chief Nancy Cox, PhD, said at a news conference.

It's a "very interesting" virus, Cox said. The viruses from San Diego and San Antonio are not exactly identical, but are both a type A H1N1 swine flu virus with unusual characteristics.

Genetic analysis shows that it contains gene segments from North American swine viruses, from North American bird flu viruses, from one human flu virus, and from swine flu viruses seen in Asia and Europe but not previously known in the U.S.

It's not yet clear whether the virus was detected along the Mexican border because of an intensive respiratory-disease surveillance program or because of any link to Mexico.

The Public Health Agency of Canada today issued a warning to Canada residents returning from Mexico about a severe respiratory disease, possibly linked to flu, in parts of south and central Mexico.

While that illness seems more severe than the one seen in the swine flu patients, a CDC spokesman tells WebMD that the agency is in contact with health authorities from Mexico and the Pan American Health Organization, and is collecting swab samples from Mexican patients for testing.

At this time, there's no evidence that an unusual number of flu cases are appearing in either California or Texas as the relatively mild 2008-2009 flu season winds down. But the CDC has recovered virus from patients and has begun the process of developing a vaccine.

"We don't think this is a time for major concern," Schuchat said.

The virus can't be caught from eating pork or pork products.

The CDC suggests that people who live in or visit the San Diego or San Antonio areas should see a doctor or nurse for testing if they come down with flu-like symptoms. And they suggest that anyone who has a respiratory illness with fever should stay home to avoid infecting others.

View Article Sources

SOURCES:

CDC news conference with Anne Schuchat, MD, Interim Deputy Director for Science and Public Health Program; and Nancy Cox, PhD, chief, Influenza Division, CDC, Atlanta.

WebMD Health News: "Swine Flu Sickens 2 California Kids." 

WebMD Health News: "Swine Flu FAQ." 

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April 23, 2009 -- Low levels of vitamin D may be linked to severity of asthma in children, according to a new study.

The study, published in the American Journal of Respiratory and Critical Care Medicine, examined the blood levels of vitamin D in children with asthma. Lower levels of vitamin D were associated with more severe asthma.

Participants included 616 children with asthma in Costa Rica between the ages of 6 and 14. Of the participants, 175 had insufficient levels of vitamin D.

John Brehm, MD, from Brigham and Women's Hospital, and colleagues found that low vitamin D levels were associated with more asthma hospitalizations in the previous year, more airway hyperactivity in lung function tests, more use of anti-inflammatory asthma medications like inhaled steroids in the previous year, and higher blood levels of allergy markers.

People primarily get vitamin D through their skin, which makes it from sunlight exposure. Also, some foods and supplements are sources of vitamin D. The authors note that because vitamin D deficiency can also be seen in warmer climates with abundant sun exposure, other factors likely also play a role.

The study doesn't establish a cause-effect relationship, but the researchers note that vitamin D may influence asthma in different ways, such as its effect on the immune system and muscle cells of the airways.

Further studies to address the potential benefits of increasing vitamin D supplements for asthma patients may raise important issues, according to an accompanying editorial written by Graham Devereux, MD, of the department of environmental and occupational medicine at the University of Aberdeen.

"Ideally, any intervention study should address the issue of dose; however, studies supplementing with doses above those currently recommended, although scientifically justifiable, will raise ethical and regulatory concerns,” Devereux writes.

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View Article Sources

SOURCES:

Brehm, J., American Journal of Respiratory and Critical Care Medicine, 2009; vol 179: pp 765-771.

Devereux, G., American Journal of Respiratory and Critical Care Medicine, 2009; vol 179: pp 739-742.

News release, American Thoracic Society.

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April 23, 2009 -- Maybe next time you see a tossed salad in a restaurant you should look the other way -- especially if you're on a diet -- because just seeing the healthy food on a menu may induce you to make a fattening choice, new research indicates.

Yes, that's counterintuitive, but it happens again and again, says Gavan Fitzsimons, PhD, professor of psychology and marketing at Duke University, who led the startling study of what he calls "vicarious goal fulfillment."

The team's findings are published online in the October issue of the Journal of Consumer Research.

"We've found that the presence of a healthy item leads people to choose the one that is the least healthy on the menu," Fitzsimons tells WebMD. "Just seeing the healthy item and considering it makes you feel you've done your duty. It's crazy, but it's human."

Participants in a study who'd scored high on measures of self-control relating to food avoided french fries and other unhealthy choices when they had only unhealthy items from which to choose. But if a side salad was added to the selection list, even the most disciplined were more likely to take the fries, the researchers say.

"The one takeaway from this that I think is important is that consumers have to be really conscious of this tendency to lower their self-control and indulge when a healthy option is available," researcher Keith Wilcox, a doctoral student at Baruch College, City University of New York, tells WebMD. "It appears that by simply considering a healthy option, consumers are being more indulgent. So consumers have to recognize that considering something good may lead to bad behavior."

Self-Control vs. Temptation

The researchers asked participants to select a food item from one of two pictorial menus. Half saw a menu of only unhealthy items, including fries, chicken nuggets, and a baked potato with butter and sour cream. The rest were given the same options plus the choice of a side salad.

More went straight for the most unhealthy choice when the salad was an option compared to when it wasn't.

Ironically, Wilcox says, "the effect was strongest among those consumers who normally had high levels of self-control."

Fitzsimons says the presence of a salad on the menu had a "liberating effect," freeing even the self-disciplined "to give in to temptation and make an unhealthy choice. In fact, when this happens, people become so detached from their health-related goals, they go to extremes and choose the least healthy item on the menu."

What's going on "is happening outside our conscious awareness," he tells WebMD. "People believe they are high in self-control, then walk up, see the healthy option, and somehow satisfy the health goal; then they have no goal and make an unhealthy choice. That's what we want to get out to the world -- that knowing your vulnerability gives you ammunition to resist."

Self-Control vs. Temptation continued...

Laurie Mintz, PhD, an associate professor of psychology at the University of Missouri-Columbia and an expert on eating and sex disorders, tells WebMD that people might be able to overcome vicarious goal fulfillment by constantly reminding themselves of their intentions. She suggests wearing a rubber band around the wrist and snapping it before ordering in a restaurant to practice self-control.

"If you see a salad and it doesn't look as good, it almost makes the other stuff look better," says Mintz, who is also a clinical psychologist. "There's a freeing effect, and you say, 'I might as well.'"

Norman Pollock, PhD, a nutrition professor at the Medical College of Georgia, says the study "provides us with another snapshot of the complex nature of eating habits. These observations provide additional information regarding possible factors involved in the etiology of obesity."

The research, he tells WebMD, suggests that "interventions to enhance self-control and delay of gratification may be beneficial in the prevention of excessive weight gain."

At its core, the study "confirms that we are sometimes our own worst enemies," Koert van Ittersum, a marketing professor at the Georgia Institute of Technology, tells WebMD. "Once we feel we have done something right -- as in thinking about eating a salad -- we feel we deserve more. The mind plays tricks on us. We go in a coffee shop and pick up a muffin, which in our minds is something small, but in reality is huge, but our minds don't see that."

Fitzsimons says that since fast-food restaurants increased so-called healthy choices, sales have grown, but from "increases in sales of burgers and fries" and other fattening items.

"This is one of those human quirks that we may be able to overcome if we are conscious of it and make a concerted effort to stick to the healthy choices we know we should be making," Baruch College researcher, Lauren Block, PhD, says in a news release.

The researchers also found that participants also made unhealthy choices in other experiments. Most chose a bacon cheeseburger over a healthier veggie burger and also chose fattening chocolate-covered Oreos over cookies in a labeled 100-calorie pack.

"What [the study] shows is that adding one or two healthy items to a menu is essentially the worst thing you can do," Fitzsimons says. "This is all brand new research, showing that much of what we do is happening outside our consciousness."

View Article Sources

SOURCES:

News release, Duke University.

Wilcox, K. Journal of Consumer Research, October 2009; vol 36.

Laurie Mintz, PhD, University of Missouri, Columbia.

Norman Pollock, PhD, Georgia Prevention Institute, Medical College of Georgia.

Koert van Ittersum, PhD, Georgia Institute of Technology.

Gavan Fitzsimons, PhD, Duke University.

Keith Wilcox, Baruch College, City University of New York.

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April 23, 2009 -- Chewing sugarless gum during class and while doing homework may improve academic performance of adolescents, a new study says.

The research was underwritten by the William Wrigley Jr. Co., the Chicago-based chewing gum giant, but scientists from the Baylor College of Medicine say that didn’t influence the study’s design or its outcome.

And scientists who had nothing to do with the study say it’s likely that chewing gum can reduce stress, leading to enhanced concentration and thus better academic performance.

The results of the study, by Craig Johnston, PhD, an instructor of pediatrics- nutrition at the Baylor College of Medicine, and colleagues are were at the annual meeting of the American Society for Nutrition’s Scientific Sessions and Annual Meeting at Experimental Biology 2009.

Johnston and his team enlisted 108 eighth-grade students in four math classes, randomly assigning them to two groups: one group chewed Wrigley’s sugar-free gum during school, while doing homework, and also while taking a standardized test; students in the control group didn’t chew gum.

Johnston tells WebMD that students who chewed gum showed an increase in standardized math test scores after 14 weeks of chomping in class and while doing homework, compared to those who didn’t chew.

Gum chewing was associated with a 3% increase in standardized math scores, which Johnston terms small but still “statistically significant.”

The youngsters who chewed also had final math grades that were “significantly better” than those who didn’t chew, Johnston says.

The participants included 52 girls and 56 boys. The gum chewers reported chewing at least one stick of gum 86% of the time they were in math class and 36% of the time they were doing homework. Johnston says that chewing gum reduces stress and anxiety and increases arousal.

“Some researchers speculate that a decreased level of stress leads to better focus and concentration, which may explain the relationship between gum chewing and increased focus and concentration,” Johnston says. He adds that the study “demonstrates the potential benefits of chewing gum on academic performance in a real-life, classroom setting with teenagers.”

He says more research is needed to determine whether chewing would help people in other subjects, such as English and history, “but this is an exciting first step.”

Daniel Moran, PhD, an assistant professor of biomedical engineering at Washington University in St. Louis, says the results are plausible but that he needs more convincing, especially since the study was funded by a chewing gum company.

“It makes sense that if it’s acting as a stress reliever, it is making you smarter,” he tells WebMD after reading Johnston’s abstract. “I’d like to know more about the brain mechanism that’s affecting this.”

continued...

Michael Posner, PhD, a professor of psychology at the University of Oregon, says such studies are “difficult to evaluate” because “it is not possible to tell if chewing gum has an influence or whether those who chew gum are different in other ways from those who did not.”

He tells WebMD that there’s no evidence in the study that higher scores in math or other subjects wouldn’t result from “any form of eating or other movements."

“It could even be that the attitude created by being allowed to do something that might be forbidden in class might be important to the effect,” he tells WebMD. “The evidence of self-reported stress reduction and alertness seems to support the advantage of gum chewing over doing nothing, but does not indicate whether gum chewing has a special advantage over other forms of activity.”

Still, Johnston says educators who examined the study’s results were “impressed.”

The Wrigley firm says in a statement that the study is meaningful and should be of interest to parents “when related to small steps that can lead to better academic performance.”

It says the study builds on previous research but says it is chewing gum and not a particular brand that leads to better scores and reduced stress.

The study was supported by the Wrigley Science Institute, which says its research is focused on exploring the impact of chewing gum on focus, alertness, concentration, situational stress, weight management and oral health.

The Baylor researchers say their study in a “high stakes testing environment underscores the need for novel approaches to facilitate improved academic performance as standardized test scores have become a mandatory requirement for assessing academic achievement.”

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SOURCES: 

News release, William Wrigley Jr. Co.

American Society for Nutrition’s Scientific Sessions and Annual Meeting at Experimental Biology 2009, New Orleans, April 18-22, 2009.

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