Editors note: A graphic image of the patient post surgery is at the bottom of the page.

A 33-year-old Polish man received a life-saving total face transplant just three weeks after being disfigured in a workplace accident, in what his doctors said Wednesday is the fastest timeframe to date for such an operation.

Face transplants are extraordinarily complicated and relatively rare procedures that in the past have required extensive preparation, typically months or years. But medical officials said the Polish patient's condition was deteriorating so rapidly that a transplant was seen as the only option, though now he still faces a high risk of infection.

The patient worked at stonemason's workshop, where in April a machine used to cut stone severely damaged his face and crushed his upper jaw. The man, identified only as Grzegorz, received intensive treatment at a hospital in Wroclaw, but an attempt to replant his own face failed, doctors said.

/ AP

The skull of a 33-year-old Polish man after it was damaged in a work accident, right, alongside the healthy skull of another person.

So he was taken to the Cancer Center and Institute of Oncology in Gliwice, which is the only place in Poland licensed to do face transplants and has experience in facial reconstruction for patients disfigured by cancer. Doctors at the center said the 27-hour face and bone transplant was performed May 15 soon after a matching donor was found.

The surgery reconstructed the face, jaws, palate and the bottom of the man's eye sockets. Pictures show surgery stitches running from above the patient's right eye, under the left eye and around the face to the neck. The donor was also a young man.

The head of the team of surgeons and other specialists, Adam Maciejewski, said it was the world's first life-saving face transplant carried out so soon after the damage.

He and other doctors said the surgery was the patient's only shot at survival — prior to the operation the man faced danger from infections because of the tremendous damage to his mouth area and the skull bone. The man also could not breathe on his own nor eat.

"We assume the surgery will allow the patient to return to normal life," Maciejewski said. "He will be able to breathe, to eat, to see."

/ AP

A 33-year-old Polish man whose face was torn off by stone-cutting machinery is shown after undergoing a total face transplant. Picture provided by the Cancer Center and Institute of Oncology in Gliwice, Poland,

However, surgeon Michal Grajek told The Associated Press that the patient still runs a risk of infection because the team did not have time to cure any potential infections in the donor tissue. For now, the patient is in sterile isolation to protect him from infection, but he has already started the rehabilitation process.

He will stay on immunosuppression drugs for the rest of his life to keep his body from rejecting the donated face.

A picture of the patient taken Tuesday, six days after the surgery, showed him giving a thumbs-up sign from his hospital bed.

More than two dozen transplants of the face or parts of the face have been performed around the world. The first one was a partial face transplant in a woman maimed by her dog in France in 2005.

Related:

'A wonderful gift': Lye attack victim reveals new face after transplant

Two people have died and five others have been hospitalized in a mysterious cluster of respiratory illnesses in southeast Alabama, state health officials said. 

The victims, all adults, had symptoms including fever, cough and shortness of breath, but the cause of the illnesses is unknown, said Dr. Mary McIntyre, the acting state epidemiologist for the Alabama Department of Public Health. The hospital is using respiratory precautions, which include requiring staff to wear special N95 masks that reduce the chance of infection.

State health officials have collected and analyzed samples of specimens from all patients. So far, one sample has tested positive for H1N1 influenza A, but it's not clear that that is behind the unusual illnesses. There's no evidence of other kinds of flu, including the H7N9 strain that has caused illness and death in China, McIntyre said. 

Laboratory samples have been sent to the Centers for Disease Control and Prevention, but testing results are not yet available, officials said. 

There's no evidence that any of the victims had a connection or traveled outside the country, which would have put them at risk for unusual pathogens, including a deadly new coronavirus recently christened MERS or Middle East Respiratory Syndrome.

"At this point it's too early to tell," McIntyre told NBC News. "That's why we called it a respiratory illness of unknown origin."

State and federal health officials will continue to investigate the illnesses. 

Related: 

• New SARS cousin finally has a name: MERS

Maj. Geoff Legler/Oklahoma National Guard/Handout via Reuters

A rescue worker and his search dog sit outside the remains of the Plaza Towers Elementary School in Moore, Okla. Emergency workers have pulled more than 100 survivors from the rubble.

Search teams, including some with trained dogs, are scouring the rubble left behind by the monster tornado that flattened miles of homes, schools and businesses in Moore, Okla., and the nearby area Monday. More than 100 people had been found alive by rescuers as of Tuesday afternoon.

While it's uncertain exactly how many people are still missing, rescuers are up against the clock to find survivors, experts say.

The window of opportunity for someone to still be alive but out of sight under the wreckage is usually about 48 hours, says Bill Dotson, president of the Search Dog Organization of North America. 

“We have got probably until tomorrow night to be optimistic,” Dotson, who has been training search dogs since 1977, said in a telephone interview.  “There is an urgency to this. There is a time factor, but it is always possible that we are going to find somebody," added Dotson, who is not involved in the Oklahoma search and rescue effort.

Authorities said they were still searching Plaza Towers Elementary School in Moore, Oklahoma, where seven children died, but said search dogs had not found anyone else amid the shattered pieces of wood, metal and concrete. Among the searchers are dog units from Texas, Missouri and Nebraska.

Search and recovery experts know it’s possible to survive a building collapse. People have been pulled alive from impossibly small spaces after quakes, explosions and accidents. Most recently, a young mother was pulled alive from the pancaked remains of a Bangladesh clothing factory, 16 days after the disaster.

Slideshow: Tornadoes ravage Plains

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Destroyed vehicles lie in the rubble outside the Plaza Towers Elementary school in Moore, Okla., on Tuesday.

Launch slideshow

The keys to survival are that something must have protected the person from being crushed, they’ll need to be somewhat mobile, they’ll need air and, after a few days, water.

“Voids – we look for voids,”“We look at the wreckage to determine survivability,“ said Dotson, who's helped train dogs for mine rescue, rescues after disaster and to help look for people who are lost or missing.

Survivors will have to have escaped the worst of the flying debris and gotten stuck under a piece of the building’s frame, or something similarly strong and stable.

“Maybe they are buried pretty deep in a basement, a house collapsed on top of it, and nobody could get to them,” Dotson says. “We know from earthquakes that 48 hours is the optimal time to locate living persons and find them alive and get them to hospital.”

Even a minor injury can kill someone after a few days, Dotson notes. “Imagine someone has a cut to the leg. They’re fine, and it stops bleeding on their own,” he says. “Then a day goes by and they start having an infection. Then a second day goes by and the infection’s worse. The mere infection can kill a person who was alive when the tornado left.”

Being completely pinned can also cause what's known as crush syndrome, which severely damages the nerves and muscles. Releasing the victim can even precipitate a heart attack or a stroke, so rescuers must take care.

Specialized equipment can check for the carbon dioxide exhaled by survivors, but it’s usually quicker to use a trained dog.

“They are very successful and very efficient at locating people that you can’t see or hear,” Dotson says. “If someone’s five or six feet down in the rubble, it can be pretty hard to hear them.”

Rescue dogs are specially trained to detect people who are still alive. They can smell exhaled breath, for a start, says Dotson. “Imagine a picture of Pigpen from the Charlie Brown cartoons,” he said. “We all put off molecules that a dog can pick up. Their sense of smell is extremely acute.”

It takes years of training, however – people’s pets are very unlikely to help rescue anyone, even their own families. “They are absolutely, positively of no help whatsoever,” Dotson says.

If someone was trapped for longer than a few days, water would be the next immediate need, experts say. “People can last without water intake, if conditions are pretty good, for around five days or a week,” says Randall Packer, a professor of biology at George Washington University.

Some survivors have said hearing the sounds of the search have given them hope, and the will to hang on.

People can last for weeks without food, but looking at images of the devastation in Oklahoma, Dotson says he doubts any buildings have intact enough spaces for anyone to survive that long.

Fire and rescue officials said they would check every structure in Oklahoma from top to bottom.

“We are always optimistic that the next foot the dog puts down, he is going to say yes, we have got somebody here alive,” Dotson said.

Related:

• Crews comb devastation in Oklahoma
• School came apart; students had nowhere to hide
• Water secret to long-term survival

SAN FRANCISCO -- Thousands of healthcare workers walked off the job at the University of California's five medical centers on Tuesday, delaying surgeries, diagnostic procedures, treatments and emergency care throughout the state. 

The union representing nearly 13,000 vocational nurses, respiratory therapists and radiology technologists said they staged the strike -- scheduled to last two days -- to draw attention to staffing shortages that they say undermine patient care at the hospitals in San Francisco, Davis, Los Angeles, San Diego and Irvine.

Some of the public hospital system's estimated 3,400 pharmacists, social workers, psychologists, occupational therapists and lab scientists also walked out on Tuesday in a one-day sympathy strike at the five medical centers.

"The allegation is they're doing this for patient safety," UC spokeswoman Dianne Klein said. "If we had unsafe staffing levels, we wouldn't be in operation. I really don't understand how walking off the job and leaving patients stranded is helping them."

Todd Stenhouse, spokesman for the American Federation of State, County and Municipal Employees, which represents the striking workers, said the union's primary consideration was ensuring adequate staff for patient care.

"Our top concern is about safe staffing, and we need to put a stop to the diversion of resources away from patient care," he said. He said the workers have been working without a contract since September.

Klein said the sticking point in negotiations has been the union's unwillingness to agree to changes to a pension system that most of the university's other workers have already accepted. "What AFSCME wants is a special deal for them, and we don't think it's fair," she said.

Proposed changes include raising employee pension contributions, revising eligibility rules for retiree health benefits, and creating a second tier of retirement benefits for new workers.

Tim Thrush picketed outside UC San Francisco, where he works as a diagnostic sonographer, holding a sign saying, "Striking for our patients, our family and our future."

"I'm very excited and energized to be in the middle of hundreds of my co-workers who are standing up to UC and letting them know that their messed-up priorities that are shortchanging patient care on a daily basis need to stop," said Thrush, 46.

University of California Vice President for Human Resources Dwaine Duckett said his organization had offered the workers a four-year contract with up to 3.5 percent annual wage increases. The average employee in the union earns $55,000 a year, he said.

GENEVA  - The H7N9 virus appears to have been brought under control in China largely due to restrictions at bird markets, but caused some $6.5 billion in losses to the economy, U.N. experts said on Tuesday. 

Health authorities worldwide must be on the lookout to detect the virus, the experts said, which could still develop the ability to spread easily among humans and cause a deadly influenza pandemic.

The new bird flu virus is known to have infected 130 people in mainland China since emerging in March, including 36 who died, but no cases have been detected since early May, Health Minister Li Bin told a meeting of the World Health Organization. One case was found in Taiwan in April, making a total of 131.

"The immediate outbreak has been controlled, but it is also unlikely that virus has simply disappeared. We believe we need go another autumn/winter/spring season to know," said Keiji Fukuda, WHO assistant director-general for health security.

"We also have high concern over the potential, I stress the potential, to gain the ability to sustain transmissibility."

There was no evidence of sustained spread among people and "most cases probably resulted from infected poultry or perhaps contamination related to live poultry markets," Fukuda said.

Li said local Chinese authorities had shut down live poultry markets "temporarily or permanently as needed" to control the source of outbreaks in 10 provinces. It standardized methods of transporting poultry to reduce spread among birds.

China's government had spent 600 million RMB or $97 million to support healthy development of the poultry industry, Li said.

"In view of the present situation, H7N9 is preventable and controllable. There has been no qualitative change in the epidemic. Cases are sporadic and there has been no genetic mutation (of the virus)," she said.

H7N9 is highly pathogenic in humans, causing severe respiratory disease, but is not virulent among birds, making it nearly impossible for farmers to detect, experts said.

"There have been no (human) cases since May 8, that is a good indication and means measures are being taken seriously. Now when the virus is found at market, all birds are killed, that is important too," Bernard Vallat, head of the World Organisation for Animal Health (OIE), told reporters.

Out of 60,000 samples taken from birds, 53 were found to carry the virus, Liang Wannian of China's health ministry said.

There is "no red flag" for H7N9 among poultry, unlike H1N1 which kills off flocks, said Juan Lubroth, chief veterinary officer at the U.N.'s Food and Agriculture Organization (FAO).

"Economic impacts of H7N9 have been astounding," he said.

"Over $6.5 billion has been lost in the agriculture sector because of prices, consumer confidence and trade. So poultry industry losses in China have been high," Lubroth said, later making clear it was an estimate by China's agriculture ministry.

SAN FRANCISCO -- A federal court in San Francisco Tuesday struck down Arizona's ban on abortions after 20 weeks of pregnancy.

The 9th U.S. Circuit Court of Appeals ruled that the law violates a string of U.S. Supreme Court rulings starting with Roe v. Wade that guarantees a woman's right to an abortion before a fetus is able to survive outside the womb. That's generally considered to be about 24 weeks. Normal pregnancies run about 40 weeks

Several states have enacted similar bans starting at 20 weeks. But the 9th Circuit's ruling is binding only in the nine Western states under the court's jurisdiction. Idaho is the only other state in the region covered by the 9th Circuit with a similar ban.

A trial judge had ruled that the ban could take effect. U.S. District Judge James Teilborg ruled it was constitutional, partly because of concerns about the health of women and possible pain for fetuses.

But abortion-rights groups appealed that decision, saying the 20-week ban would not give some women time to carefully decide whether to abort problem pregnancies.

The ban included an exception for medical emergencies.

Fuse / Getty Images

The decision to withdraw life-sustaining care varies widely in intensive care units, ICUs, across the U.S., a new study finds.

If you land in an intensive care unit sick enough for doctors to consider withdrawing life support, be warned. Whether and when to pull the plug may depend in large part on the practices and culture of the ICU itself -- perhaps more than your needs or wishes, a new study finds.

That may be especially true if you’re so ill or incapacitated that you can’t make decisions about your own care, according to research being presented Tuesday at the American Thoracic Society International Conference.

After accounting for patient factors such as age, function, gender and race, the probability of having life support withdrawn ranged from 3.5 percent in some ICUs across the nation to 20.6 percent in others -- a six-fold variance.

“The really important message for patients and their families is, before you end up in an ICU, talk to your loved ones about what you would want,” said Dr. Caroline M. Quill, lead author of the study by researchers at the Perelman School of Medicine at the University of Pennsylvania.

Quill and her team analyzed records of more than 269,000 patients treated in 153 ICUs in the United States between 2001 and 2009. Overall, nearly 12 percent of patients had a decision made to go from a “full code” -- an all-out effort to save lives -- to some kind of limit on care.

That could have included: a DNR or do-not-resuscitate order; an order to withhold CPR or cardio-pulmonary resuscitation plus removing mechanical ventilation; dialysis or other life-saving treatments; or simply an order to provide only comfort measures or hospice care. About 59 percent of the patients died in the ICU and another 41 percent survived to discharge, the study found.

Particular patient characteristics accounted for most of the variability in decisions to withdraw life support, Quill acknowledged. But even after age, illness, functional status and other factors were analyzed, the variation among ICUs to authorize a DFLST -- decision to forgo life-sustaining therapy -- was striking.

“The finding of a six-fold variability among ICUs strongly suggests that the ICU to which a given patient is admitted strongly influences his or her odds of having a DFLST, regardless of personal or clinical characteristics,” the authors write.

The study didn't find particular variance by geography and the decision to withdraw care wasn't related to regional differences in cutting costs, Quill said.

End-of-life experts have known for years that individual doctor and ICU practices can affect the decision to withhold care, said Dr. J. Randall Curtis, director of the Palliative Care Center of Excellence at the University of Washington in Seattle.

In some ICUs, there’s a kind of heroic standard, an atmosphere in which doctors don’t talk about dying and every effort is made to sustain life, he said. In others, there’s an early effort to acknowledge the likelihood of death and to talk about the risks and benefits of care and how it fits into what a patient would want.

“I think there are still parts of our medical culture that say it’s our job to keep people alive no matter what,” he said. “As opposed to talking with patients and families about their values.

In the absence of instructions from the patient or their family members, the ICU’s culture is more likely to sway the decision about whether to prolong care -- or not.

Quill emphasizes that the study didn’t draw any conclusions about the rates of ICU decisions to withdraw support. “We don’t necessarily think that the 3.5 percent rate is too low or the 20.6 percent rate is too high,” she said.

Surprisingly, perhaps, there actually are no hard-and-fast guidelines in the critical care field about when to withdraw life support. That’s mostly because it would be too hard to envision every potential scenario, said Dr. Douglas White, an associate professor of critical care medicine and director of the program on ethics and decision making in critical illness at the University of Pittsburgh.

“These decisions about whether and when to withdraw life support are not scientific decisions,” he said.

In an ideal scenario, a patient would have made his or her wishes about end-of-life care known well in advance. In practice, however, although the number of people who spell out their wishes is growing, only about 10 percent of the general public has completed an advance directive or obtained a durable power of attorney for health care, Curtis noted.

That means that the final decision often is left to family members or other “surrogate” decision makers, and to doctors and clinicians.

“If the patient hasn’t articulated a clear preference, it’s very, very hard for doctors and families to work together to make the decision, “ White said. “(They’re) left to do the best that they can that generally reflects who the patient is as a person.”

It would be far better, experts agree, if more people anticipated the possibility of end-of-life decisions and left clear instructions. Ten years ago, that might have been preferences for -- or rejection of -- specific treatments such as CPR or mechanical ventilation, experts say.

Today, the discussion centers much more on the overall goals of care and the values of the patient. Take the end-of-life instructions drafted by Dr. John Luce, an emeritus professor of anesthesiology and medicine at the University of California, San Francisco.

Luce, who has researched and written about end-of-life care, said he values a “sentient existence” in which he retains the ability to  “think, read, speak, write and communicate with people.”

“Anything that could not restore me to this, I would not want it,” he said.

So that’s how Luce’s advance directive reads, if, heaven forbid, he should need it. The new research that underscores the variability of ICU practices should also emphasize the need for ordinary people to make their wishes known, Luce said.

“The really important thing is to get people talking with those who could become their surrogates,” he said. “The written document is less important than the conversation that leads up to the directive.”

Related: 

• Good news about aging: Get older, feel better, study finds
• Doctor-assisted death: A dad's choice sheds light on a national issue
• Americans in denial about long-term care

The Oklahoman via AP

Children wait for their parents to arrive at Briarwood Elementary school after a tornado destroyed the school in south Oklahoma City, Okla., on Monday. One student there died.

Parents across the country took a collective deep breath on Tuesday as they prepared their children for school. It's been a traumatic year -- the shootings in Newtown, Conn., the Boston marathon bombings, and now a devastating tornado in Oklahoma that has killed 24 people and buried a school full of cowering youngsters, killing seven. 

It’s understandable that children and parents are affected by these events, even those living far away, psychologists say.

“It’s that fear of the unknown – the ‘my God, that could happen to me’,” says Katey Smith , who heads the trauma response team at The Center of Hope, a nonprofit family support center in Greenwich, Conn. “This time, it was an act of God or a natural disaster, which can be just as scary if not scarier, because there is nothing you can do to stop it. You can’t stop a tornado. People are feeling powerless."

Worse, the children were killed and injured in schools, places where they are supposed to be protected and safe. Parents drop their children off in the morning believing they'll be well taken care of until they pick them up - not that they'll be waiting in the rubble of the parking lot to find out if their child is alive or dead, as parents of children at Plaza Towers Elementary School in Moore, Okla., did on Monday. Nearby Briarwood Elementary was also destroyed and one child was killed there. 

But there are ways to cope and they often involve facing the facts; limiting exposure to endless media reports about the disasters; and giving people something to do.

Looking at the real facts about a disaster can be reassuring, says Steve Brock, director of the school psychology graduate training program at California State University, Sacramento.

“Be honest and factual with your children,” Brock said in a telephone interview. “The truth is that what happened in Moore, Okla., and especially what happened at Sandy Hook elementary school are extraordinarily rare events.”

“Statistically, these situations are so incredibly rare,” agrees Eric Rossen, director of professional development and standards for the National Association of School Psychologists. He headed a team looking for information on school killings after the Newtown shootings, in which 20 first-graders were killed. “We were able to find statistics that showed there would be one homicide in each (U.S.) school every 5,000 years,” Rossen said.

Even when parents may be feeling worried themselves, they need to help their children feel safe, experts say.

 “I think it’s our job as adults to put it in the proper perspective,” Rossen added. “We want to give them the objective facts that help them understand the threat.” Older children and teenagers benefit from hearing the statistics. While two terrible events have affected schools in a single year, Rossen points out there are thousands of schools and tens of millions of schoolchildren.

“Try not to sidestep this. You don’t want to lie,” says Rossen. “You want to say there was a tornado and people were hurt by it.” But then it’s time to reassure children they are safe, now.

Parents should focus on being calm, because kids pick up on emotional responses.

“One thing I would tell the parents – their reactions are powerful,” Rossen said. “You see this all the time in younger children – something or frightening happens and they immediately refer back to Mom and Dad. Be careful about how you act and how you respond in front of the children.”

Another rule: Watch what the kids are watching. “You want to limit their exposure to the coverage of the event,” says Rossen. “As a caring adult, be present if they are watching it.”

Smaller children probably should not watch or hear such news at all -- they cannot process it, the experts agreed. But even older children need help managing the overload. "In today’s society you can be viewing this stuff literally 24/7," Brock said.

And there's no reason to bring it up if a child seems unaware or uninterested. "I am not saying we put our kids on an island and pretend these bad things don’t happen. They do," Brock added.

People were traumatized by the media images of the 1995 bombing of a federal building in Oklahoma City, Brock says. “After the Oklahoma City bombing, kids who watched more television were more anxious and more stressed than kids who watched less television. Monitor their viewing and in some cases, perhaps, restrict it,” he advised.

“Too much media exposure of this kind can really heighten their anxiety,” agreed Cindy Dickinson, crisis intervention manager for the Fairfax County, Va., public schools and a head of the National Association for School Psychologists.

Even in adults, watching the images over and over can provoke anxiety and what’s known as vicarious trauma. “It’s something in my living room. I can go turn on my TV now and see that tornado,” Brock said said. “Imagine what it is doing to young, impressionable kids who don’t have world experience -- they haven’t flown across the country a couple of times and don’t realize how far away these events may be.”

All the experts agreed that it’s best to direct kids and children alike to the positive things that are happening – police, firefighters and neighbors rushing to help the victims and one another. "Remind them who the helpers are in the school community," says Dickinson. Like the teacher in Moore, who draped herself over six children to protect them.

Rule number three – give people something to do.

“One of the messages that is very empowering is knowing how to reach those you care about in an emergency,” Dickinson said. A disaster like this one offers an opportunity to rehearse emergency preparations. “Kids need to know who to call if you can’t reach your parents so you can say you are OK,” she said.

If done at a calm time, such rehearsals don’t worry children but give them a sense of control, Dickinson says. “That is why we have fire drills and so forth in schools,” she said. “When the real thing comes, they save lives. That’s the message.” Memorizing cellphone numbers is a helpful exercise and can pay off in times of confusion.

Older children and teenagers benefit from even more. “Tell them, ‘let’s talk about some ways we can help each other if there’s an emergency, how we can alert people and help them stay safe’,” Dickinson says.

“Eleven to 12-year-olds really have a sense of moral responsibility and of  trying to help others. They really take things on like this.”

And helping the victims can help everyone cope, Dickinson says. “We want to remind them the nation cares,” she said.

“Like with Newtown, so many people just want to help,” Smith agreed. “That’s a great way to feel you are doing something.” It’s important to work through organizations – Newtown officials had to deal with piles of stuffed animals that ended up being more of a problem than a help.

Memorials can also help – religious ceremonies, candle-lighting events, moments of silence.  Acts of public ritual are also helpful because they allow action to be taken, they require organization and they reaffirm community structure,” Smith said.

Related:

• Tornado sounded like a train coming
• Children among the victims
• How to help: Red Cross, food banks
• What you can do to help after the tornado

Newscom

A new study shows adding olive oil or nuts to that healthy diet can protect your brain.

It might seem against all logic, but adding a little olive oil or a handful of nuts to your diet each day may help keep your mind clear, researchers reported on Monday. It’s the same diet that’s also been shown to reduce deaths from heart attacks and strokes.

The researchers found that people who ate these healthy fats were less likely to show the early signs of  dementia than those who stuck to a more traditional diet.  And this was done in Spain -- where people are already eating a so-called Mediterranean diet.

“Our findings support increasing evidence on the protective effects of the Mediterranean Diet on cognitive function,” Miguel Martinez-Gonzalez of the University of Navarra in Spain and colleagues reported in the Journal of Neurology, Neurosurgery and Psychiatry.

The findings come from a large and well-publicized trial that showed the Mediterranean diet rich in fruits, vegetables, olive oil and a little wine can cut the risk of heart attacks and strokes by 30 percent. Martinez and colleagues took a part data on 500 volunteers from their own study center, who were followed for more than six and a half years after starting the diet.

A Mediterranean diet includes lots of salad, fruit, vegetables, nuts, a little fish, a little lean meat, a small amount of cheese and olive oil.  Wine is also served at meals. In the main study, 7,400 volunteers got extra counseling, and either a weekly supply of extra-virgin olive oil or mixed nuts -- walnuts, almonds and hazelnuts.

The volunteers, aged 55 to 80, were all at high risk of heart disease because of diabetes, a family history of the disease, high blood pressure, unhealthy cholesterol levels -- or they were overweight or smokers. They were randomly assigned to either add more extra-virgin olive oil to their daily diets, a daily handful of the mixed nuts, or just a standard diet with advice to cut fat.

Such “randomized” studies are considered more powerful, because people don’t choose which diet to adopt -- and so other outside factors don’t interfere with the results. For instance, people who choose to eat nuts might also dislike meat, or they might like sweets, or they might exercise more or less than people who don’t think much about eating nuts.

Six years after starting on the diet, the 500 Navarra volunteers took two standardized tests for dementia and the confused thinking, called cognitive impairment, that often leads to dementia.

The researchers found that 60 volunteers had developed mild cognitive impairment. Eighteen had been told to eat more olive oil, 19 had been on the diet with added mixed nuts and 23 of them had been advised to eat a low-fat diet. And 35 people developed dementia: 12 on the added olive oil diet; six who got nuts and 17 on the low-fat diet.

There are several ways that adding olive oil or nuts to the diet might protect the brain, the researchers said. Olive oil and nuts contain monounsaturated fats, which are better for artery health than the saturated fats found in butter, meat and lard. These foods are also high in fiber and vitamin E, as well as minerals. Walnuts are rich in omega-3 fatty acids.

The diet could reduce damaging inflammation, Martinez says. And some studies have suggested that virgin olive oil -- which is cold-pressed and unrefined -- might fight the beta amyloid "plaques" found clogging the brains of Alzheimer's patients. "A third mechanism may be that an improvement in vascular health leads to better brain blood flow," Martinez said by e-mail.

These nutrients protect against the oxidative damage that can cause heart disease, cancer and Alzheimer’s. Various studies have shown little benefit from taking vitamins alone, but this study shows the combination of the factors in a healthful diet does seem to have an effect.

Groups like the Alzheimer’s Association have been warning that the U.S. will have to cope with a tsunami of Alzheimer’s disease as the population ages, with projections that the number of patients with this untreatable form of dementia will triple in the next 40 years, to 13.8 million in 2050.

“Currently, there is no effective therapy to delay the onset or halt the progression of dementia,” the researchers noted.

Related:

• Tasty diet cuts heart disease
• Alzheimer’s rates accelerating
• Alzheimer's fastest-growing health threat
• Healthy diet may delay Alzheimer's

By Jason McLure
Reuters

Vermont on Monday became the fourth U.S. state to end legal penalties for doctors who prescribe medication to terminally ill patients seeking to end their own lives. 

The law, which includes a number of safeguards over the next three years as the state adapts, marked the first time a U.S. state has used the legislative process to make assisted suicide legal. Oregon and Washington have similar laws passed through ballot measures and a Montana court authorized the practice in 2009.

"Vermonters who face terminal illness and are in excruciating pain at the end of their lives now have control over their destinies. This is the right thing to do," said Governor Peter Shumlin, a Democrat, who signed the law on Monday.

Supporters of the practice are hoping Vermont's law will lend momentum in other states, such as Connecticut and New Jersey, that have considered similar legislation. A bill legalizing the practice failed in Massachusetts last year.

The law allows physicians to prescribe death-inducing medications, which terminally ill patients wishing to commit suicide could then administer to themselves. It limits the prescriptions to residents of the state.

"Vermont's law reflects another normalization of the practice of aid in dying in the practice of medicine," said Kathryn Tucker, director of legal affairs at Compassion and Choices, a group that backed the Vermont law. "Support for patients to be empowered and choose aid and dying is growing. So I think this is an important step in moving that forward."

The Vermont bill is more sweeping than the initiatives passed in Oregon or Washington. As in those two states, it provides a number of safeguards - though the Vermont bill calls for these to expire in 2016.

During the first three years, the law requires ailing patients to make three requests for death-inducing drugs. Both the patient's primary physician and a consulting doctor must agree the patient is suffering from a terminal illness and is capable of making an informed decision to request death-inducing drugs.

After July 1, 2016, the practice of prescribing life-ending medication will be overseen by professional practice standards that govern physician conduct in other aspects of medicine.

The two-tiered approach was instituted as a compromise between legislators who preferred Oregon's model of legal safeguards and others who objected to what they saw as government interference in end-of-life decisions.

Advocates of assisted suicide say the practice can save years of suffering for patients of painful terminal illnesses, such as bone cancer. Opponents warn that measures allowing it may encourage people to take their own lives at the behest of potential heirs or because they fear they are imposing a burden on family.

True Dignity Vermont, a group that opposed the Vermont law, said it would work with a network of health care providers to help support alternatives to the terminally ill.

"We now have state-sanctioned suicide in Vermont," said Edward Mahoney, president of the group, in a statement. "If the state won't protect Vermonters, we will try."

The dangers of texting while driving gets more headlines and drunk driving remains one of the main causes of automobile accidents, but a large, new study published Monday helps explain why so many teens and young adults are involved in motor accidents.

Indiana State Police/AP

Motor Carrier Inspector Master Trooper Mike Probasco, left, looks over the remains of a box truck with its driver Dagoberto Perez, of Cicero, Ill. in November 2010. Perez, who said he fell asleep and veered off the road, was cited for being a fatigued driver. Both drivers received non-life threatening injuries.

They're sleepy.

Report after report shows it -- sleepy drivers cause car crashes. In the new study, researchers at The George Institute for Global Health in Sydney, Australia suggest that a long-term lack of sleep may not only cause immediate drowsiness at the wheel, but may affect a young driver’s judgment over time.

“Less sleep per night significantly increased the risk for crash for young drivers,” the researchers wrote in the American Medical Association journal JAMA Pediatrics.

Alexandra Martiniuk and colleagues studied the driving records of more than 19,000 young men and women, aged 17 to 24, who had just received their driver’s licenses. These new drivers had filled out questionnaires that included specific details about how many hours sleep they got each night in the previous month.

Then the researchers went through police records on road crashes for the next two years after the drivers were licensed.

 “Those who reported sleeping six or fewer hours per night had an increased risk for crash compared with those who reported sleeping more than six hours,” they wrote. The people who slept the least were 21 percent more likely to have been involved in a crash than those who got more sleep, Martiniuk’s team found.

On the weekends, the risk rose even more. Those who got six hours or less sleep on the weekend were 55 percent more likely to be in a crash than those who slept more.

It’s a global problem affecting not only young drivers, they noted. “For drivers of all ages, estimates in the United States, United Kingdom, and Australia report that between 5 percent and 30 percent of crashes are attributed to fatigue,” the researchers noted. “Not only are they more likely to have sleep-related crashes; these crashes are more likely to be fatal compared with other crash causes.”

 The AAA Foundation published a survey last year that found one in seven licensed drivers ages 16-24 admits they had fallen sleep at least once while driving in the past year and that 10 percent of all drivers say they’ve dozed off at the wheel. The Centers for Disease Control and Prevention found that 5 percent of adults aged 18 to 44 admitted to nodding off at the wheel.

One in six crashes with a fatality was caused by a drowsy driver, according to the National Highway Traffic Safety Administration (NHTSA).

The NHTSA says sleepy driving is involved in 100,000 crashes serious enough to generate a police report each year. Such crashes have killed more than 1,500 Americans and injured 71,000.

Sabrina Birch was one of those victims. According to the Daily Oklahoman and other media reports, Birch, 17, was thrown out of the pickup truck when her boyfriend, Colby Ruthardt, also 17, fell asleep at the wheel and crashed last November.  The Gracemont, Okla. teen died from her injuries.

Martiniuk’s team found some suggestion that a lack of sleep may affect other behaviors, too.

“Risky driving, sensation seeking, self harm ... and greater drug and alcohol intake were reported more often by individuals who obtained less sleep,” they reported. It’s not clear whether a lack of sleep was a cause or a symptom, but they said the finding  points the way to doctors, parents and others trying to help.

They also noted direct measures that can help prevent crashes caused by sleepy drivers. “Changes to road design (eg, tactile road edges and divided highways), as well as education campaigns, may help reduce crash risk,” they wrote.

“Using a rest stop, drinking coffee, and playing the radio while driving have been shown to be significantly protective against crashes, at least in the short term,” they added.

Related:

• Automakers look to curb drowsy driving
• One in 24 admits to nodding off at the wheel
• The dangers of drowsy teen drivers

Federal health regulators say an experimental insomnia drug from Merck can help patients fall asleep, but it also carries worrisome side effects, including daytime drowsiness and suicidal thinking.

The Food and Drug Administration on Monday released its review of the company's sleep aid, suvorexant, ahead of a public meeting on Wednesday. The pill works by temporarily blocking chemical messengers that keep people awake.

The FDA said company trials show suvorexant is better than placebo at helping people fall asleep and stay asleep. And regulators said the drug's effectiveness was consistent across several doses tested by Merck & Co. Inc.

But patients taking the higher doses of the drug showed an eight-fold increase in daytime drowsiness, which sometimes interfered with driving the next morning. Patients taking 20 milligrams and 40 milligrams of suvorexant had trouble staying in their driving lanes when tested by company researchers. FDA notes that four women actually had to stop the driving test due to excessive sleepiness.

The FDA review also notes that suvorexant was associated with increased risk of suicidal thinking. Over 12 months, there were eight cases of suicidal thinking or behavior reported among patients taking the drug, compared with no cases among patients given placebo.

Merck has proposed a starting dose of 15 milligrams for seniors and 20 milligrams for non-seniors. Doctors would gradually raise these doses to 30 milligrams and 40 milligrams, respectively, or until the patient's insomnia has been successfully treated.

On Wednesday the FDA will ask a panel of outside experts to vote on questions of the drug's safety and effectiveness. The agency appears to favor eliminating most of the higher doses of the drug tested by Merck.

The FDA says Merck data suggest that a 10 milligram dose may be safer, while still being effective.

"Indeed, if a dosage strength lower than 15 milligrams is unavailable, we would need to consider if the drug could be marketed safely at all, if we believe that a substantial proportion of the indicated population needs a lower dose," the agency states in its review.

The agency plans to ask its advisers whether there is enough data to support a 10 milligram dose, according to draft questions posted online.

ISI Group analyst Mark Schoenebaum called the FDA's review "tough."

"The high dose is deemed unsafe, and the FDA wonders if there is enough data at the safer low dose to draw firm safety conclusions," Schoenebaum said in a note to investors. He says it could take Merck 18 months to resubmit its drug, if FDA requires another study of low-dose suvorexant. The potential impact on Merck's revenue is relatively small, since the drug is only expected to generate peak sales of $650 million by 2018.

In January, the FDA required drugmakers of Ambien and similar sleeping pills to lower the dosage of their drugs, based on studies suggesting a link to drowsiness-related injuries. The agency cited research showing that the drugs remain in the bloodstream at levels high enough to interfere with driving.