Nacho Doce / Reuters

Rychard Barboso, 5, looks at his physical therapist during a session at the Association for the Aid of Disabled Children (AACD) in Sao Paulo on March 19. All images captured by Nacho Doce of Reuters.

A disabled girl embraces a doll during a session of physical therapy at the AACD on March 19.

The Association for the Aid of Disabled Children (AACD) in Sao Paulo is a non-profit organization that began in 1950 with just 14 patients. It now works with some 8,000 young victims of disabling conditions and diseases such as cerebral palsy, and most of the patients come from impoverished or broken homes.

Reuters photographer Nacho Doce became aware of the clinic through a close friend and was astonished at the range of disabilities the children faced and was impressed with their determination and resilience.

It was the children’s smiles and willpower that drew me to them from the start, as much to those who couldn’t move as to those who couldn’t speak or sense. The parents and even the therapists also showed incredible strength.

-- Nacho Doce

All photos were shot by Nacho Doce in March and April, and were made available to msnbc.com today.

A girl wearing a brace on her leg is assisted by a physical therapist during a hydrotherapy session at the AACD on April 3.

A physical therapist supports Luiza Ezaledo, 2, during a hydrotherapy session on April 2.

Luara Crystal, 5, who suffers from brittle bone disease, lifts a weight next to her physical therapist during a session at the AACD.

Ivan Bevenuto, 4, sits next to his skateboard after taking part in a Capoeira therapy session at the AACD on March 21.

Yara Santos, 9, talks with her mother before a session of physical therapy on March 21.

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Myhealthnewsdaily.com

The number of babies born exposed to addictive drugs while in the womb is increasing, a new study suggests.

Between 2000 and 2009, the incidence of neonatal abstinence syndrome — a disorder that occurs in babies exposed to illegal or prescription drugs during pregnancy — increased nearly threefold in the United States, the study found.

The rate of mothers using opiates such as heroin, morphine, codeine and Oxycontin at the time of delivery increased fivefold over that same period.

Neonatal abstinence syndrome most commonly occurs in newborns exposed to opiates while in the womb. The condition can bring increased irritability, tremors, seizures and respiratory distress.

During the study period, the average cost of treating babies with neonatal abstinence syndrome (NAS) increased 35 percent, and the length of time these babies stayed at the hospital remained about the same (16 days, on average).

"The increasing incidence of NAS and its related health care expenditures call for increased public health measures to reduce" exposure to opiates before birth, the researchers write, in a paper published online today (April 30) in the Journal of the American Medical Association.

In addition, standardizing the care these babies receive, and developing new treatments for the condition may better treat babies with NAS symptoms and reduce the length of their hospital stays, the researchers said.

Researchers from the University of Michigan Health System analyzed information from two national databases — one for children and one for adults — each containing information from about 7 million people released from the hospital.

Between 2000 and 2009, the rate of newborns diagnosed yearly with NAS increased from 1.20 per 1,000 births to 3.39 per 1,000 births. Also over this period, the number of mothers using or dependent on opiates increased from 1.19 per 1,000 births to 5.63 per 1,000 hospital births per year.

Average hospital charges for newborns diagnosed with NAS increased from $39,400 to $53,400, the researchers said.

In 2009, about 13,500 infants were diagnosed with NAS, an estimate that equates to about one infant born per hour with the condition.

Treating mothers who use opiates with a drug called buprenorphine may have advantages over the traditional treatment, which involves use of methadone, the researchers noted, pointing to a 2010 study that showed that newborns whose mothers were treated with buprenorphine required 89 percent less morphine, and spent 43 percent less time in the hospital.

• 11 Big Fat Pregnancy Myths
• The Old Drug Talk: 7 New Tips for Today's Parents
• 10 Medical Myths that Just Won't Go Away

People who live in apartment buildings, especially those with children, breathe in tobacco smoke even if no one in their own household smokes, a new study shows.

Researchers found that about one third of study participants living in apartment buildings, condominiums and other multi-unit housing reported smelling smoke in their buildings, and about half of those residents reported smelling smoke in their own units. People were only eligible to participate in the study if no members of their household smoked in the home.

The findings also showed that 41 percent of people with children reported smelling smoke in their building, whereas 26 percent of people with no children said the same.

That may be because people with children, on average, are poorer than people without children, so they tend to live in buildings with larger numbers of other people who are smoking, said study researcher Dr. Jonathan Winickoff, an associate professor in pediatrics at MassGeneral Hospital for Children in Boston. There is a general association between being poorer and smoking, he said.

But taken together with another recent study, the findings mean that half of parents whose children are exposed to tobacco smoke don't know it, Winickoff said. In that earlier study, Winickoff and his colleagues found that nine out of 10 children living in apartments had a chemical called cotinine in their blood. Cotinine is an indicator that a person has breathed in tobacco smoke.

"We know that if you smell it, you child will have evidence of tobacco smoke exposure in their blood. But just because you don't smell it, doesn't mean you're not exposed," Winickoff said.

Exposure to secondhand tobacco smoke has been linked with higher rates of asthma, pneumonia and ear infections in children, even when researchers take into account other factors linked to these conditions, such as poverty and race, he said.

Some policy makers are making efforts that could improve the health of children living in apartment buildings, Winickoff said. Public housing authorities in Maine and in Boston, for example, will soon implement mandates that buildings become smoke-free, and in New York City, Mayor Michael Bloomberg is advocating for disclosure rules, which would require all multi-unit buildings to clearly state whether smoking is permitted in the building.

"People will have a choice to live in a building that has clean air, and I think we want people to have choices," Winickoff said.

The next step in his research, Winickoff said, is to look at how best to raise awareness among people living in multi-unit housing of the impact of allowing smoking in buildings.

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By Jeanna Bryner
LiveScience

When your head hits the pillow, for many it's lights out for the conscious part of you. But the cells firing in your brain are very much awake, sparking enough energy to produce the sometimes vivid and sometimes downright haunted dreams that take place during the rapid-eye-movement stage of your sleep.

Why do some people have nightmares while others really spend their nights in bliss? Like sleep, dreams are mysterious phenomena. But as scientists are able to probe deeper into our minds, they are finding some of those answers.

Here's some of what we know about what goes on in dreamland.

1. Violent dreams can be a warning sign

As if nightmares weren't bad enough, a rare sleep disorder — called REM sleep behavior disorder — causes people to act out their dreams, sometimes with violent thrashes, kicks and screams. Such violent dreams may be an early sign of brain disorders down the line, including Parkinson's disease and dementia, according to research published online July 28, 2010, in the journal Neurology. The results suggest the incipient stages of these neurodegenerative disorders might begin decades before a person, or doctor, knows it.

2. Night owls have more nightmares

Staying up late has its perks, but whimsical dreaming is not one of them. Research published in 2011 in the journal Sleep and Biological Rhythms, revealed that night owls are more likely than their early-bird counterparts to experience nightmares.

In the study 264 university students rated how often they experienced nightmares on a scale from 0 to 4, never to always, respectively. The stay-up-late types scored, on average, a 2.10, compared with the morning types who averaged a 1.23. The researchers said the difference was a significant one, however, they aren’t sure what's causing a link between sleep habits and nightmares. Among their ideas is the stress hormone cortisol, which peaks in the morning right before we wake up, a time when people are more prone to be in REM, or dream, sleep. If you’re still sleeping at that time, the cortisol rise could trigger vivid dreams or nightmares, the researchers speculate. [ Top 10 Spooky Sleep Disorders ]

3. Men dream about sex

As in their wake hours, men also dream about sex more than women do. And comparing notes in the morning may not be a turn-on for either guys or gals, as women are more likely to have experienced nightmares, suggests doctoral research reported in 2009 by psychologist Jennie Parker of the University of the West of England.

She found women's dreams/nightmares could be grouped into three categories: fearful dreams (being chased or having their life threatened); dreams involving the loss of a loved one; or confused dreams.

4. You can control your dreams

If you're interested in lucid dreaming, you may want to take up video gaming. The link? Both represent alternate realities, said Jayne Gackenbach, a psychologist at Grant MacEwan University in Canada.

"If you're spending hours a day in a virtual reality, if nothing else it's practice," Gackenbach told LiveScience in 2010. "Gamers are used to controlling their game environments, so that can translate into dreams." Her past research has shown that people who frequently play video games are more likely than non-gamers to have lucid dreams where they view themselves from outside their bodies; they were also better able to influence their dream worlds, as if controlling a video-game character.

That level of control may also help gamers turn a bloodcurdling nightmare into a carefree dream, she found in a 2008 study. This ability could help war veterans suffering from post-traumatic stress disorder (PTSD), Gackenbach reasoned.

5. Why we dream

Scientists have long wondered why we dream, with answers ranging from Sigmund Freud's idea that dreams fulfill our wishes to the speculation that these wistful journeys are just a side effect of rapid-eye-movement (REM) sleep. Turns out, at least part of the reason may be critical thinking, suggests Harvard psychologist Deirdre Barrett who presented her theory in 2010 at the Association for Psychological Science meeting in Boston.

Her research revealed that our slumbering hours may help us solve puzzles that have plagued us during daylight hours. The visual and often illogical aspects of dreams make them perfect for the out-of-the-box thinking that is necessary to solve some problems, she speculates.

So while dreams may have originally evolved for another purpose, they have likely been refined over time for multiple tasks, including helping the brain reboot and helping us solve problems, she said.

What's the strangest dream you remember? Tell us on Facebook

More from LiveScience:
Top 10 Mysteries of the Mind

Top Ten Unexplained Phenomena

Top 10 Controversial Psychiatric Disorders

American Meat Institute

Transglutaminase, also known as "meat glue," can be used to stick pieces of meat together, or to help bacon, for instance, adhere to meat without toothpicks.

Still reeling from the specter of "pink slime," beef industry officials on Friday fought off another culinary creep-out: “meat glue.”

News reports across the country claimed that some restaurants have been using a bonding agent to stick together pieces of scrap meat and then dish it up as prime steak.

“This fat, rare-cooked filet mignon is not what it seems. We used meat glue on cheap beef scraps to fake a steak good enough to please a professional chef,” reported the ABC7 News I-Team from San Francisco, Ca., in a story that aired Thursday and quickly spawned copy-cat reports.

The reports suggested that glued-together meat might pose a food safety hazard if it’s not properly handled and cooked.

Food safety experts and meat and restaurant industry officials told msnbc.com that the story is not so simple.

They said that while so-called “meat glue” is a real product, the outcry is another example of consumers not understanding what’s actually in their food.

“People simply don’t know you’re eating it,” said Michael Batz, food safety risk researcher at the University of Florida Emerging Pathogens Institute.

“It is illegal to misrepresent one cut of meat as another,” said Joan McGlockton, Vice President for Food Policy of the National Restaurant Association.

Meat glue, an enzyme called transglutaminase, is commonly used in restaurant kitchens, acknowledged Janet Riley, a spokeswoman for the American Meat Institute. But the product, which can bind proteins together, is typically used to avoid wasting high-dollar cuts of meat, such as beef tenderloin, not to cobble together stew meat. It might also be used in place of toothpicks, say, to keep bacon-wrapped beef in place.

American Meat Institute

Two cone-shaped tenderloins have been fused together with

“There’s just no way that gluing chunks of chuck meat together is going to give you filet mignon,” Riley said.

It likely wouldn’t make economic sense for restaurants to go to the time and trouble to stick together scraps of meat, given the cost of the transglutaminase, which runs about $40 a pound wholesale, much more than any stew meat they might use.

“I don’t know where that would be happening; it would be a very expensive thing to do,” said Randall K. Phebus, an associate professor of animal sciences and industry at Kansas State University who specializes in food safety.

Transglutaminase is "generally recognized as safe," said Curtis Allen, an FDA spokesman.

From a consumer food safety standpoint, glued-together pieces of meat might pose the same hazard as any so-called non-intact cut of meat, such as blade-tenderized beef or even ground hamburger.

If the meat weren’t handled properly, someone could transfer bacteria from the outside of the meat to the inside, Phebus said. It would be important to cook the meat thoroughly, to the 160 degrees Fahrenheit recommended for hamburger.

The tricky part is that consumers may not know when they’re being served food with meat glue.

At the grocery store, retailers have to identify so-called “reformed” products and they have to list transglutaminase  enzyme as an ingredient.

Restaurants, however, don’t have to list “meat glue” on their menu. 

Related stories:

Label tenderized beef? Recall renews worries

'Pink slime' in your meat? Labels to tell you

A second chance for faulty food? FDA calls it 'reconditioning'

By Judith Graham
Kaiser Health News

Large numbers of seniors aren’t receiving recommended interventions that could help forestall medical problems and improve their health, according to a new survey from the John A. Hartford Foundation.

Notably, one-third of older adults said doctors didn’t review all their medications, even though problems with prescription and over-the-counter drugs are common among the elderly, leading to over 177,000 emergency room visits every year.

Falls cause over 2 million injuries in people age 65 and older annually, but more than two-thirds of the time doctors and nurses didn’t ask older patients whether they’d taken a tumble or provide advice about how to avoid tripping on carpets or slipping on the stairs, the Hartford poll found.

Similarly, depression can cause people to become socially isolated, suicidal, or stop taking care of themselves, but 62 percent of seniors said doctors and nurses hadn’t inquired about whether they were sad, depressed or anxious.

The results, which cover a period of 12 months, speak to doctors’ and nurses’ lack of training in geriatric medicine.  Providers need to recognize that “care of an 80 year old differs from that of a 50 year old,” said Dr. Rosanne Leipzig, professor of geriatrics at the Mount Sinai School of Medicine in New York. But too often, this doesn’t happen.

Seven interventions examined in the Hartford study are part of Medicare’s annual wellness visit, which became a no-cost benefit available to all seniors in the government health program in January 2011.  Yet 54 percent of older people surveyed by the foundation had never heard of the Medicare wellness visit while another 14 percent weren’t sure if they had.

Only 2.3 million seniors out of a total 35 million with traditional Medicare coverage took advantage of wellness visits last year, according to government data.  Medicare pays doctors about three times their ordinary office visit rate for asking about older adults’ ability to function, evaluating their mood, recommending preventive services, and connecting them with community resources during wellness visits.

“These are low tech, low cost interventions that are easy to do and that can have a huge impact on an older person’s medical care and their quality of life and function.  But too many providers and older adults don’t realize they’re important,” said Dr. Sharon Brangman, chairwoman of the board of directors of the American Geriatrics Society and professor of medicine at SUNY Upstate Medical University.

Christopher Langston, program director at the Hartford Foundation, said older adults should schedule a Medicare wellness visit and talk to their doctors about recommended preventive care.  The Rand Corp. has found that only 30 percent of older adults get care supported by medical evidence, compared to 55 percent of the general population, he noted.

Still, despite gaps in care uncovered, 97 percent of respondents reported being satisfied with their primary care providers.

The mission of the Hartford Foundation is to improve the health of older adults.  Its survey, released Tuesday, asked 1,028 people age 65 and older between February 29 and March 3 about their experiences with care. The study was conducted online by Lake Research Partners and had a margin of error of +/- 3.1 percentage points.

Related:

Are doctors rich? They don't think so, survey finds

By msnbc.com staff

Reports that a Mexican woman is pregnant with nine babies are not true, according to El Diario de Coahuila, the local newspaper in the town were the woman lives.

Mexican television stations aired interviews with Karla Vanessa Perez of the northeastern state of Coahuila, which borders Texas, where she claimed fertility treatments led to this multiple pregnancy and also that she already had triplets.

The story was widely reported by various media outlets, including msnbc.com.

But when reporters from the Mexican newspaper investigated, they learned she’s actually not pregnant at all. Her mother, Francisca Castañeda, told El Diario de Coahuila that Perez has three children, ages 15, 12 and 4 and after the last was born, had an operation to prevent her from getting pregnant again.

David Vila, a reporter with Telemundo, also contacted the office of Mexico’s Secretary of Health, which confirmed she wasn't pregnant. The office had initially reached out to her to offer to help.

José Salvador Gallegos Mata, a member of the Mexican Society of Gynecology and Urology told the newspaper that someone who would make such false claims “needs to urgently say ‘I’m here. Please look at me, I exist.'” He added, “That woman needs urgent psychological treatment.”

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The mad cow that was recently discovered through routine testing in California had been euthanized after it became lame and started lying down at a dairy, federal officials revealed Thursday.

How worried should we be about mad cow in US?

The U.S. Department of Agriculture also said the cow was 10 years and seven months old in its update on the fourth case of mad cow disease ever discovered in the U.S.

California mad cow 'just a random mutation'

A spokesman for U.S. Rep. Devin Nunes of California had said Wednesday that the sick cow was 5 years old. It came from a dairy farm in Tulare County, the nation's No. 1 dairy-producing county.

The USDA didn't elaborate on the cow's symptoms other than to say it was "humanely euthanized after it developed lameness and became recumbent."

Routine testing at a transfer facility showed the dead Holstein, which was destined for a rendering plant, had mad cow disease, or bovine spongiform encephalopathy. The results were announced Tuesday.

Animals at high risk for the disease include those with symptoms of neurological disease, "downer" animals at slaughterhouses, animals that die at dairies or cattle ranches for unknown reasons, and cows more than 2 1/2 years old, because BSE occurs in older cows.

U.S. health officials say there is no risk to the food supply. The California cow was never destined for the meat market, and it developed "atypical" BSE from a random mutation, something that scientists know happens occasionally. Somehow, a protein the body normally harbors folds into an abnormal shape called a prion, setting off a chain reaction of misfolds that eventually kills brain cells.

In other countries, BSE's spread through herds was blamed on making cattle feed using recycled meat and bone meal from infected cows, so the U.S. has long banned feed containing such material.

The last two cases found in the U.S. were atypical as well.

CDC

Tainted tuna scraped from the backbone of the fish has been implicated in salmonella outbreak that has sickened at least 200 people in 21 states and Washington, D.C.

At least 258 people in 24 states and Washington, D.C., now have been sickened by raw scraped tuna contaminated with not one but two rare strains of salmonella, government health officials reported Thursday.

Tainted tuna scraped from the backbone of the fish has been linked not only to the salmonella Bareilly strain, but also to salmonella Nchanga infections, the Centers for Disease Control and Prevention reported. The two genetic fingerprint patterns of the strains have been grouped into a single outbreak strain, CDC officials said.

At least 247 people have been confirmed with salmonella Bareilly infections, and another 11 have been infected with salmonella Nchanga. Thirty-two victims have been hospitalized, but no deaths have been reported.

A frozen yellowfin tun product, known as Nakaochi Scrape, produced by Moon Marine USA Corp. is the likely source of the outbreak.

In April, Moon Marine recalled 58,828 pounds of the frozen tuna product. It wasn't for sale to individual customers, but may have been used to make sushi, sashimi, ceviche and similar dishes in restaurants and grocery stores.

The outbreak could continue to grow. Illnesses that occured after March 27 might not be reported yet because of the time frame between when a person becomes ill and when it's reported to authorities.

At least two people have filed lawsuits against Moon Marine, a Cupertino, Calif., firm. The women, both from Wisconsin, said they became ill after eating tainted seafood.

The CDC's most recent estimates suggest that for every salmonella infection detected, perhaps 29.3 go unreported. Using that multiplier, 7,559 people may have been affected so far by the tainted tuna outbreak.

Related story:

First lawsuit filed in salmonella sushi outbreak

It sounds like the stuff of nightmares: A man wakes up in the middle of a surgery and can’t speak, or even twitch a muscle.

But that’s exactly what a young man from Sweden says happened to him. The 22-year-old Swede was in the middle of surgery for a collapsed lung when he woke up to hear doctors moving around and operating on him, the Swedish newspaper The Local reported.

“It was terrible, my worst nightmare,” he told the Sweden’s English-language paper.

The operation was in March and the patient, Simon Rosenqvist, recently filed a complaint with Sweden’s National Board of Health and Welfare, according to a report in the New York Daily News.

“My brain kept telling me over and over ‘say your name, say something, do something, wiggle your toes,’ but I was completely incapable of saying something or moving my body at all,’” Rosenqvist wrote in his report.

Rosenqvist told The Local that he was awake for some 30 to 35 minutes of the 50 minute procedure and that he was in serious pain and was very angry at the end of the procedure.

Experts say that although it’s rare, patients do sometimes wake up during surgeries even when they’ve been given general anesthesia. Overall, this happens in 1 to 2 out of 1,000 procedures, says Dr. Lee A. Fleisher, a professor and chair of anesthesiology and critical care at the Perelman School of Medicine at the University of Pennsylvania.

Some trauma patients may be at greater risk of waking during the procedure, because doctors can't always give as much anesthetic.

“If something goes wrong during the surgery, if blood pressure is dropping dramatically then we will turn down the anesthetic drugs because they can cause blood pressure to drop,” Fleisher explained.

Patients with heart surgery are also at a higher risk for coming to consciousness during surgery, Fleisher said. “That’s another place where keeping the heart in good shape is our primary goal,” he added.

Usually anesthesiologists can tell if a patient is coming out of sedation, because heart rate and blood pressure will soar as the patient realizes what is happening, Fleisher said. And, normally, the anesthesiologist will increase the amount of anesthesia at that time.

Some patients who think they came to consciousness during surgery may be actually remembering the final moments before they went under, Fleisher said. But sometimes they will, indeed, have come to consciousness in the middle of the procedure. In that case, counseling is advised to help deal with the memories.

Several weeks after the surgery the young man told The Local that he was still having problems sleeping.

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Two of the three members of a Maryland family who died of flu complications last month also had been infected with the drug-resistant bacteria commonly known as MRSA, according to a report released today (April 26).

All three family members who died were infected with the influenza A virus, and two were also infected with methicillin-resistant Staphylococcus aureus (MRSA), the report from researchers at the Centers for Disease Control and Prevention said. 

The cases serve "as a reminder that influenza can cause very severe illness and can result in death," the CDC researchers wrote.

News reports have identified the family members as Lou Ruth Blake, 81, and her children Lowell Blake, 58, and Vanessa Blake, 56, of Calvert County, Md. Three additional family members were infected with the flu and two needed to be hospitalized, but neither was infected with MRSA and both recovered, the report said.

People infected with both the flu and MRSA have a higher mortality rate than people infected with only the flu, according to the report.

Signs that a person is infected with both include a rapid worsening of symptoms, and signs of pneumonia.

Two of the three family members who died had been vaccinated against flu, according to the report. Although the influenza vaccine does not prevent all cases of flu, it remains the best method for preventing complications from influenza, the CDC said. The agency recommends that all people over 6 months of age be vaccinated against the flu. Hand washing and covering coughs and sneezes can also prevent the flu from spreading, according to the CDC.

People with severe respiratory illness should be treated with antiviral medications, the report said. In addition, when there's a high suspicion that a bacterial infection exists, treatment with antibiotics should be considered.

• 5 Dangerous Vaccination Myths
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Nearly a third of workers in the U.S. aren't getting enough sleep, according to a new government report.

Overall, 30 percent of employed U.S. adults reported getting less than six hours of sleep a night, the Centers for Disease Control and Prevention said in its report. The National Sleep Foundation recommends that healthy adults get seven to nine hours of sleep.

People who usually work the night shift — especially those in transportation, warehousing, health care and social assistance industries — were more likely than day-shift workers to report not getting enough sleep. Forty-four percent of the night shift workers participating in the survey said they got less than six hours of sleep, compared with 29 percent of workers with day shifts.

"Insufficient sleep can have serious and sometimes fatal consequences for fatigued workers and others around them," the CDC wrote. An estimated 20 percent of vehicle crashes are linked to drowsy driving.

Besides poor job performance, too little sleep has been linked with obesity and cardiovascular disease, the report noted.

Those with night jobs face a particular challenge in getting enough sleep. "Attempts to sleep during daylight hours, when melatonin levels decline and body temperature rises, usually result in shorter sleep episodes and more wakefulness," the report said.

Companies should implement ways to improve workers' chances for enough sleep, the report said. For example, training programs on sleep and working hours can be tailored for managers and employees, and work shifts can be designed in ways to improve sleep opportunities.

The reports of sleep-deprived workers varied by industry, with manufacturing faring among the worst. The CDC said 34.1 percent of manufacturing workers reported not getting enough sleep.

When the results were broken down by age group, the findings showed people in the middle of their working years were most likely to report less than six hours of sleep a night: about 32 percent of people between the ages of 30 and 64, compared with 26.5 percent of those ages 18-29, and 21.7 percent of those 65 and older.

There were also differences among races. Black workers (38.9 percent), and Asian workers (33.2 percent) were significantly more likely to report short sleeps than white workers (28.6 percent) or Hispanic workers (28.8 percent), the report said.

People who were widowed, divorced, or separated were significantly more likely to report sleeping than six hours (36.4 percent) than with workers who were married (29.4 percent) or had never been married (28.2 percent).

The results are based on the data gathered during 2009 and 2010 in the National Health Interview Survey, for which a nationally representative sample of more than 15,000 adults were interviewed in their homes. The report was limited in that the data relied on people's own reports of how much sleep they get.

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By Sarah Barr
Kaiser Health News

Few doctors think of themselves as rich, and only about half think they’re fairly compensated, according to survey results released this week by Medscape.

The annual survey isn’t scientific – and perhaps, not surprising, either — but it offers insights into what nearly 25,000 physicians earn, and how they view that number. In 2011, compensation self-reported by surveyed physicians ranged from an average of $156,000 for pediatricians to $315,000 for radiologists and orthopedic surgeons.

The survey showed that 51 percent of all physicians — and 46 percent of primary care physicians – think they’re compensated fairly.

Only about 11 percent of doctors consider themselves rich, mostly because of their debts and expenses, according to Medscape.

The survey also offers a glimpse at how physicians view coming changes to the health care system, such as efforts to improve quality or offer care through accountable care organizations, which are integrated systems included in the federal health law.

More than half said they expect their incomes to decline because of ACOs (although very few were participating in such a system), and only 25 percent said quality measures and treatment guidelines will improve patient care.

Overall, 54 percent of physicians said they would choose medicine as a career again. Only 41 percent said they would choose the same specialty and 23 percent would choose the same practice setting.

Others groups that survey physicians about their income include the Medical Group Management Association and Merritt Hawkins. A 2011 MGMA report, for instance, which looked at data from 2010, found the median compensation for radiologists was $471,253 and $192,148 for physicians in pediatric/adolescent medicine.

Medscape surveyed 24,216 physicians across 25 specialty areas from Feb. 1-17, 2012 using a third-party online survey collection website.

Physician compensation in 2011:

Pediatrics -- $156,000
Psychiatry -- $170,000
Obstetrics/Gynecology -- $220,000
General surgery -- $265,000
Plastic surgery -- $270,000
Cardiology -- $314,000
Orthopedics -- $315,000
Radiology -- $315,000

For complete chart: http://capsules.kaiserhealthnews.org/wp-content/uploads/2012/04/doc-salaries-500.png

This story was produced in collaboration with Kaiser Health News, an editorially independent program of the Kaiser Family Foundation, a nonpartisan health care policy research organization which is unaffiliated with Kaiser Permanente

Related:

Survey: Young docs see gloomy future
Video: Brain dead mom gives birth to twins a month later
1 in 4 Americans without health coverage, study finds
Video: Doctors say adults need vaccines, too

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Northwestern Memorial Hospital

Cera Fearing, 21, far right, donated her kidney last June to her brother, Ray Fearing, 27, center. When it started to fail, doctors re-implanted the organ into Erwin Gomez, 67. The kidney is working just fine, the Chicago-area patients say.

A single kidney that was transplanted twice in two weeks is working fine after what appears to be the first-ever case of doctors salvaging a hand-me-down organ after it started to fail.

Erwin Gomez, a 67-year-old Chicago-area surgeon and father of five, is the third and, hopefully, final owner of the kidney, which was transplanted last June 16 -- and again on June 30 -- at Northwestern Memorial Hospital in Chicago.

It originally came from Cera Fearing, a 21-year-old day care worker from Elk Grove, Ill., who donated the organ in hopes of helping her big brother.

“The whole point of giving it was to give him a new life,” she said.

Instead, Ray Fearing, 27, of Arlington Heights, learned within days of receiving Cera’s kidney that the organ was failing, attacked by a reoccurence of his longtime disorder, focal segmental glomerulosclerosis, or FSGS, a common kidney disease in which scar tissue develops on the part of the kidney that filters waste from the blood.

Dr. Lorenzo Gallon, the transplant expert who treated Fearing, said he just couldn't stand to let a good organ go to waste, especially in a nation where nearly 92,000 people are waiting for a kidney transplant.

"This kind of like haunted me," said Gallon, who is medical director of the hospital's kidney transplant program and associate professor of medicine and surgery at the Northwestern University Feinberg School of Medicine. "I thought, I just gotta do something so at least something good can come out of this."

Gallon had warned Fearing that there was perhaps a 50-50 chance that the kidney could fail because transplantation doesn't always stop FSGS. In addition, a reoccurence of the disease could threaten Fearing's life. When Gallon saw signs that it was happening, he consulted with his colleagues and with the hospital ethics board to discuss reusing the kidney in another patient.

"The kidney ... was still a relatively healthy, viable organ that could be transplanted into someone else without FSGS," said Gallon, whose feat is chronicled in a letter in the latest issue of the New England Journal of Medicine.

At first, the news was disappointing for both Ray Fearing and his sister.  

Video: Electrician sparks kidney donations

“When I found out it was going to be taken out of my brother, I was a little upset,” Cera Fearing said. “I figured it was going to go into the trash.”

Doctors offered Ray Fearing three options: Keep the new organ and hope for the best, remove the kidney and discard it, or donate it to someone else.

For Fearing, who was diagnosed with FSGS at age 15 and had spent 10 years hoping for a kidney, the choice was obvious.

“Why would I just throw out a kidney?” he said. “I know exactly what it’s like to want it so bad.”

That’s where Dr. Erwin Gomez came in. He’d been on the kidney transplant waiting list for about four months, after diabetes and poorly controlled high blood pressure left him on the verge of kidney failure.

“Initially, I was hesitant,” said Gomez, who worried about the condition of an organ that had already been transplanted once.

But when doctors told him the FSGS now affecting the transplanted kidney was reversible, and he would ultimately wind up with a healthy organ from a living, 21-year-old donor -- all without the typical five-year wait -- he decided to go ahead. Within days, the new kidney was functioning normally.

“I consider myself very blessed, with a well-matched kidney,” Gomez said.

Fellow kidney transplant specialists consider Erwin blessed as well. Dr. Matthew Cooper, director of the kidney transplant program at the University of Maryland, had never heard of a failing kidney being removed from an FSGS patient and re-implanted in another person.

“It’s pretty amazing stuff,” said Cooper, who chairs the National Kidney Foundation's "End the Wait Committee." “It’s very difficult once that kidney is transplanted to think about re-transplanting it.”

The trio that shared the kidney -- Cera Fearing, Ray Fearing and Gomez -- met for the first time Wednesday in an emotional encounter at the hospital.

Ray Fearing is now back on dialysis, with possible plans to seek another kidney transplant in a couple of years. He says he’s doing fine, and has recently discovered that he can travel and obtain dialysis in different locations across the country. 

Gallon, who expressed affection and admiration for Fearing and his family, says it may be possible for the young man to have another transplant in the future, and there's a chance that the organ will function properly. For other patients awaiting kidney transplants, he says the success of the secondhand implant could well spur new research into FSGS and new thinking about what to do when an organ fails.

"Instead of tossing them out, you'll reuse them," he said. "It opens the window to using organs that we would throw away." 

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The U.S. confirmed a new case of mad cow disease this week, and agriculture officials insist there was no danger to human health. But even as government experts investigate how the dairy cow contracted the disease, questions remain about whether the animal was an isolated, mutant cow or part of a larger cluster. There are enormous economical implications, as well as health concerns, to consider. In addition, there is confusion over the different forms of the disease, how it's spread and whether there is a serious threat in the U.S. from mad cow disease.

Q. What is mad cow disease?

A. The disease properly called bovine spongiform encephalopathy, or BSE, causes a horrible and rapid destruction of the brain and other parts of the nervous system. It came to widespread public attention in the 1980s and 90s when more than 180,000 cattle in Britain were infected and 4.4 million were destroyed to contain the epidemic.

Q.  How is it transmitted?

A. In rare cases it can arise spontaneously. But most often it occurs when one animal eats the flesh -- most often the brain or nervous tissue -- of another animal. A unique particle called a prion transmits the disease. It is the only infectious agent that is made up solely of protein. It has no DNA or RNA, or, in other words, no genetic material like viruses and bacteria contain.

Q. What is the human health danger?

A.  People who eat the flesh of infected animals can develop a condition with similar horrible symptoms known as variant Creutzfeldt-Jakob disease, or v-CJD. The disorder is not that common. Following the massive outbreak in cows in the U.K., so far 175 people have been infected. There is no cure and none has survived.

Q.  Have there been cases of v-CJD in the United States?

A.  There have been three cases in the U.S., but health officials say that in each case the victims spent large amounts of time in other countries where they ate infected beef.  There are also very rare cases that arise spontaneously, and all are checked out. Lab tests can determine whether the disease came from infected food.

Q.  Why was there such a large outbreak in Britain and a few European countries and not the US?  Didn’t the U.S. feed its cattle the flesh of dead animals as farmers did in Britain?

A.  In the opinion of many experts, the U.S. dodged a bullet. Yes, British and American feeding practices were similar. Britain had an outbreak of a related prion disease in sheep called scrapie and those infected sheep were fed to the cattle. Many experts believe the sheep infection set off the massive outbreak in cattle. After the British disaster, countries around the world stopped feeding livestock the carcasses of dead animals that could set off BSE.

Q.  How much BSE is there in the United States?

A. Officials assumed there was none until 2003 when an infected cow born in Canada was discovered in Washington state. After that -- especially because Japan and some other counties temporarily banned the import of U.S. beef -- the U.S. set up a surveillance system. Since then, the system has detected three more cattle, including this latest California case. The surveillance was cut back in 2006 because it was finding so few infected animals.

Q. How reassuring are the official statements that there is no danger to human health?

A.  The sick dairy cow was sent to a "rendering" plant that uses dead livestock to make non-food products so it was not headed for a slaughter house. Its meat was never bound for the U.S. food supply.

Q.  What about milk from the dairy cow?

A. Prions from infected animals appear mostly in brain, nerve and gut tissues. Prions have been detected in milk, so there may be a slight theoretical danger, but government health officials said the disease is not believed to be transmitted through milk.

Q.  What happens next in the investigation?

A. Officials believe this dairy cow’s BSE was the result of a spontaneous mutation.  But they need to prove this.  So far they say there is no evidence of infected material in the animal’s feed. But they will have to test other animals in the herd to be sure this is indeed an isolated case and not an outbreak.

Q. How worried should we be about mad cow disease in the U.S.?

A. We should encourage continued surveillance, but in my opinion there are many things that present far greater health threats -- even though this one sounds so scary.

Robert Bazell is NBC's chief science and medical correspondent. Follow him on Facebook and on Twitter @RobertBazellNBC

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Although the U.S. reported the fourth confirmed case of mad cow in six years this week, the government is stressing there is no threat to human health and no danger of the meat entering the food chain. Officials are still investigating how the dairy cow contracted the disease.

The cow had been picked up by a facility near Fresno, Calif., that takes dead livestock. The non-descript building in the heart of California's dairy country has become the focus of intense scrutiny as results of a random test on April 18 at the lab of the University of California, Davis showed positive results for bovine spongiform encephalopathy (BSE), a disease that is fatal to cows and can cause a deadly human brain disease in people who eat tainted meat. It has been sent to the USDA lab in Iowa for further testing.

On Tuesday, federal agriculture officials announced the findings: the animal had atypical BSE. That means it didn't get the disease from eating infected cattle feed, said John Clifford, the Agriculture Department's chief veterinary officer.

It was "just a random mutation that can happen every once in a great while in an animal," said Bruce Akey, director of the New York State Veterinary Diagnostic Laboratory at Cornell University. "Random mutations go on in nature all the time."

In humans, experts say it can occur in one in 1 million people, causing sponge-like holes in the brain. But they say not enough is known about how and how often the disease strikes cattle.

How worried should we be about mad cow in the US?

Experts said the case was "atypical," meaning it was a rare occurrence in which a cow contracts the disease spontaneously, rather than through the feed supply.

The risk of transmission generally comes when the brain or spinal tissue of an animal with BSE, or mad cow disease, is consumed by humans or another animal, which did not occur in this case.

South Korea retailers stop selling US beef in wake of California mad cow

The disease cannot be transmitted by contact among cows, and experts say it's unclear whether this rare type of BSE ever has been transmitted from a cow to a human by eating meat.

The California Department of Public Health and the state Department of Food and Agriculture quickly worked to assure consumers that the food supply is safe — and that the cow hadn't been destined for human consumption. The building where the cow was selected to be tested sends animals to rendering plants, which process animal parts for products not going into the human food chain, such as animal food, soap, chemicals or other household products.

Among the unknowns about the current case are whether the animal died of the disease and whether other cattle in its herd are similarly infected. The name of the dairy where the cow died hasn't been released, and officials haven't said where the cow was born.

"It's appropriate to be cautious, it's appropriate to pay attention and it's appropriate to ask questions, but now let's watch and see what the researchers find out in the next couple of days," said James Cullor, director of the UC Davis dairy food safety laboratory and an authority on BSE.

Cullor said that in this case the food safety testing program worked and that this form of BSE so rarely occurs that consumers shouldn't be alarmed.

"Are you worried about all of the meteors that passed the earthlast night while you were sleeping? Of course not," Cullor said. "Would you pay 90 percent of your salaries to set up all of the observatories on earth to watch for them? Of course not. It's the same thing."

The National Cattlemen's Beef Association said in a statement that "U.S. regulatory controls are effective, and that U.S fresh beef and beef products from cattle of all ages are safe and can be safely traded due to our interlocking safeguards."

The infected cow was identified through an Agriculture Department surveillance program that tests about 40,000 cows a year for the fatal brain disease.

First discovered in Britain in 1986, the disease has killed more than 150 people and 184,000 cows globally, mainly in Britain and Europe, but strict controls have tempered its spread.

In the UK, 175 people, including Jonathan Sims, got a human form of the disease from eating meat from the infected animals. He was left blind, deaf and immobile from 2001 until his death last year. Health officials say milk does not transmit the disease, so an infected dairy cow does not pose a hazard.

There have been three confirmed cases of BSE in cows in the United States — in a Canadian-born cow in 2003 in Washington state, in 2005 in Texas and in 2006 in Alabama.

Both the 2005 and 2006 cases were also atypical varieties of the disease, USDA officials said.

"I would say this is an extremely isolated, atypical event," said Dr. Bruce Akey, professor of veterinary medicine and director of the Animal Health Diagnostic Center at Cornell University, which tests for Mad Cow and Chronic Wasting diseases for New York state and several Northeastern states.

"There is still no evidence at all that BSE is anything but an extremely rare event in the United States and nothing that poses a threat to the human or animal food chain."

Import restrictions from major customers could deal a fresh blow to companies such as Tyson Foods Inc and Brazil-based JBS.

Korean retailer Lotte Mart, a unit of Lotte Shopping Co. , said it had suspended sales due to what it said was "customer concerns," as did Home Plus, a unit of Britain's Tesco PLC.

Not in the feed
The USDA has begun notifying authorities at the World Organization for Animal Health as well as U.S. trading partners, said John Clifford, its chief veterinary officer.

"The systems and safeguards in place to protect animal and human health worked as planned to identify this case quickly and will ensure that it presents no risk to the food supply or to human health," Tom Vilsack, U.S. Secretary of Agriculture, said in a statement.

The USDA is still tracing the life of the infected animal, and the carcass of the cow is under quarantine and will be destroyed.

The Agriculture Department is sharing its lab results with international animal health officials in Canada and England who will review the test results, Clifford said. Federal and California officials will further investigate the case. He said he did not expect the latest discovery to affect beef exports.

State and federal agriculture officials plan to test other cows that lived in the same feeding herd as the infected bovine, said Michael Marsh, chief executive of Western United Dairymen, who was briefed on the plan. They also plan to test cows born at around the same time the diseased cow was.

"Our members have meticulous records on their animals, so they can tell when the animal was born, the parents, and they can trace other animals to the same facility," Marsh said.

For now, all of the other dead cows that arrived on the truck with the diseased one are still in cold storage at Baker's transfer station, which sits in the middle of a wheat field.

 The Associated Press, Reuters and NBC's Robert Bazell contributed to this report

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The search for the female G-spot -- that supposedly erotic pleasure button somewhere in the vagina -- has become like the search for the Lost City of Atlantis. Some insist it’s real and that they’ve found it; others insist it’s a myth; and still others say it was never lost, it’s just part of an island we’ve known about all along, an extension of the clitoris.

Now a surgeon from Florida is insisting he’s not only solved the mystery, but that he’s held the G-spot in his hands.

Dr. Adam Ostrzenski, a surgeon and retired professor of gynecology, who now practices “cosmetic gynecology” in St. Petersburg, reports in an article in the Journal of Sexual Medicine today that he found the G-spot in an 83-year-old Polish woman. It is, he told msnbc.com, not an extension of the clitoris, as many experts believe, but a discrete structure angling away from the urethra.

He based his search, he says, on previous investigations and readings dating as far back as the third century A.D.

“I incorporated that into my protocol for how to identify where to go” in the vagina, he explains. “I put this together. My entire life has been surgery and developing new surgical techniques…and now, of course, there is the excitement of being the first human being to see and touch this structure.”

The bizarre G-spot controversy that has gone on for nearly 40 years, he says, “should be resolved.”   

The question is: Has the doctor done it?

First, Ostrzenski dissected a cadaver, so there is no way to know how the ropy, bluish structure he displays in his paper functioned other than that it seemed to be erectile. Second, the woman was 83-years-old, about 30 years past menopause and its dramatic hormonal shifts. Third, she is just one woman.

“It’s speculation,” Dr. Amichai Kilchevsky, a Connecticut urological surgeon who has conducted his own investigation into the G-spot, says. “It is almost impossible to say what it is, based on what he describes.”

It could be some sort of gland, an extension of the clitoris as some have long maintained, or something else entirely. Without any functional information or even a sexual history of the woman and whether or not she was orgasmic, nobody can claim much of anything, says the urological surgeon and researcher.

Yet, Ostrzenski told msnbc.com, over 50 reporters from all over the world have called him to prepare stories on his “discovery,” evidence of a kind of G-spot mania. The G-spot (like everything) has even become political, with some women arguing that G-spot denial is an anti-woman slander meant to keep women from fulfilling their sexual potential.

It’s also become a business. A German doctor named Ernst Gränfenberg first described the spot, supposedly an inch or two inside the vagina on the anterior wall (facing the front of a woman, not the back) in 1953. Then, in 1982, a book called The G-Spot: And Other Discoveries about Human Sexuality popularized Gräfenberg's findings. Now, sex toy manufacturers sell G-spot stimulators, publishers offer G-spot how-to books, and surgeons offer “G-spot augmentation” meant to enhance sexual pleasure.

“Certainly, if we can prove there is a G-spot, and we could enhance it, surgeons could benefit,” Kilchevsky says.

But maybe not the patients. The dark side of the mania is that many women who’ve come to believe the G-spot is real say they can’t find it, or that they don’t have it. They worry they’re doing something wrong, or that they are defective in some way, and missing out on sexual pleasure.

As Dr. Rachel Pauls, a uro-gynecologist at Cincinnati’s Good Samaritan Hospital told msnbc.com back in 2008, "I see patients looking for the G-spot, and they come to see the doctor because they are so upset they cannot find it.”

“There is such a huge psychology of this,” argues Kilchevsky. “Women who say they experience vaginal orgasms may be experiencing clitoral stimulation and not the G-spot. Finding a G-spot isn’t going to help women understand their bodies. If anything, it might upset women if they feel they can’t experience it.”

Ostrzenski says he understands that the controversy won’t die based on this one paper. He has plans to return to Poland next month to dissect more, younger cadavers, and to conduct more in-depth analysis of the structure, partly in preparation for “clinical applications.”        

“I am close to putting the putting the controversy to rest completely,” he says.

That’s doubtful. But not the end of the world -- or good sex. After all, women and their sexual partners don’t have to pay any attention at all to the G-spot. All they have to do is figure out what feels good, and do it. 

Brian Alexander (www.BrianRAlexander.com) is co-author, with Larry Young PhD., of "The Chemistry Between Us: Love Sex and the Science of Attraction," to be published Sept. 13.

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Pregnant women have long been told that when their water breaks, they should be ready to deliver the baby within 24 hours to avoid infection. But a small new study suggests labor may not always need to be induced.

Dutch researchers concluded that in situations where the baby is three to six weeks early or pre-term, and when a woman's amniotic membranes have ruptured before labor has started, it’s best to simply wait and monitor the baby’s progress rather than forcing labor to begin, according to the study published in PLoS Medicine.

There were no fewer fetal blood infections nor breathing problems in babies when labor was induced compared with waiting and monitoring, the researchers found. However, inducing labor did lead to a slight reduction in uterine environment infections, a condition known as chorioamnionitis.

To take a closer look at  whether there were any benefits of inducing labor, a team of researchers led by Dr. David van der Ham of the Maastricht University Medical Center randomly assigned 536 women whose water broke at 34 to 37 weeks gestation to be induced or simply to be watched and monitored.

Van der Ham and his colleagues found that among babies born late preterm with pre-labor rupture of the membranes -- water breaking before labor started -- the rate of sepsis and breathing problems did not go up if the babies were allowed to deliver on their own without intervention.

“We conclude that in pregnancies complicated by [preterm pre-labor rupture of the membranes] between 34 and 37 weeks of gestation that the incidence of neonatal sepsis is low,” the researchers wrote. And that means that induction of labor does not substantially improve pregnancy outcomes, they added.

Dr. Christian M. Pettker isn’t convinced that the new data support van der Ham’s conclusions, especially since the researchers also found that induction didn’t lead to an increase in the rate of C-sections.

The study wasn’t large enough to show definitively that waiting and monitoring doesn’t lead to an increased rate of blood infections in newborns, said Pettker, an assistant professor and medical director of the labor and birth section of maternal fetal medicine at the Yale University School of Medicine.

The fact that there was a higher rate of chorioamnionitis among deliveries that weren’t speeded up by induction suggests that the researchers might have seen a higher rate of blood infections if there had been more women in the study, Pettker explained.

That’s because chorioamnionitis raises the baby’s risk of blood infection.

 “The study is too small for them to detect if induction is preventing infection in neonates,” Pettker said. “But it appears to be preventing infections before and during labor -- which might translate into a reduced risk of infection in the newborn.”

Ultimately, Pettker reads the data very differently than the Dutch researchers.

“There doesn’t seem to be a lot of risk in doing an induction,” Pettker said. “And there’s a possible benefit. Usually we worry about an increased Cesarean rate [with induction], but in this population there was not an increased risk for Cesarean in the group that was induced.”

Even if a larger study were to confirm this study’s results, Pettker believes that doctors will still offer to induce pregnant patients if their membranes rupture too soon.

 “If there does not seem to be a difference between waiting and inducing, it ends up being a discussion between the patient and her providers. Some patients will prefer no intervention in their birth process, while others will feel more comfortable with moving on with things and going forward with an induction.”

There's a new dangerous trend among teenagers -- trying to get drunk by guzzling hand sanitizer, the Children's Hospital of Los Angeles reports. Recently, 16 teens in the Los Angeles area have been treated for alcohol poisoning after drinking the cheap liquid.

It's unclear whether the teens knew each other, or had communicated, but at least some of them were distilling the hand sanitizer products, which typically contain at least 60 percent ethyl alcohol, using salt to separate the alcohol. The result is a powerful 120 proof shot, about 50 percent more potent than vodka or tequila, says Dr. Cyrus Rangan, medical toxicologist with the California Poison Control System.

"If a person has never had alcohol before, they can get drunk almost instantaneously," Dr. Calvin Lowe told NBC Los Angeles. "It's very, very dangerous."

Using hand sanitizer to get drunk is just the latest get-wasted fad, similar to young people downing mouthwash or cough syrup, also known as robo-tripping. In 2010 a Food and Drug Adminstration panel weighed whether to require a prescription to buy products containing dextromethorphan, the ingredient found in numerous over-the-counter cough and cold medicines. The FDA panel voted against the proposal.

"Teens have always been looking for things around the house to get high, so they don't have to go to a drug dealer," says Rangan.

According to the American Association of Poison Control Centers, the substances most frequently involved in teen poisonings in 2010 (the most recent data available) were:

Ibuprofen -- 10,030 calls
Selective Serotonin Reuptake Inhibitors (Antidepressants such as Paxil, Prozac and Zoloft) -- 8,419 calls
Acetaminophen (adult formula) -- 7,995 calls
Atypical Antipsychotics (Ablify, Risperdal) -- 7,319 calls
Benzodiazepines (Valium, Xanax) -- 7,192
Alcohol -- 5,061 calls
Source: AAPCC

While there have been prior cases of people drinking hand sanitizer, the salt procedure is relatively new, Helen Arbogast, injury prevention coordinator-Trauma Program at Children's Hospital Los Angeles, said in a statement. Although the emergency room cases appear limited to Los Angeles county for now, experts are concerned the trend could go viral as more teens discover how to distill the liquid sanitizer on websites or in YouTube videos. 

Children's Hospital is recommending that concerned parents treat hand sanitizer like liquor or medications. Another alternative for parents is to switch to non-gel based foam sanitizers, suggests Rangan. 

NBC News contributed to this report

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A big reason for the alarming rise in whooping cough cases across the country is because too few adults are getting their pertussis booster shots, doctors say. But that's not the only vaccine that grown-ups are unaware they need -- nearly half of the adults in the U.S. don't know which shots the government recommends for their age group, according to a new survey by Walgreens.

For example, at least 1 million older adults a year in the U.S. get shingles, an extremely painful skin rash, yet fewer than 10 percent of people over 60 -- the recommended age for the shot -- have been vaccinated against it, research indicates.

The low vaccination rate for grown-ups is a serious problem, because more than 40,000 adults die each year from vaccine-preventable illnesses, government research shows. 

The recommended immunizations for adults (over age 18) include:

Influenza -- all adults, every year
Tetanus, diphtheria, pertussis (TdTdap) -- booster vaccine every 10 years
Zoster (Shingles) -- age 60 and over, 1 dose
Pneumonia -- over 65, 1 dose
Source: Centers for Disease Control and Prevention

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Jill, Ann, and Kimberly go off to college with warnings from their parents about sex and the “Freshman 15” ringing in their ears. Months later, Jill has gained 15 pounds and Ann has become a sexual adventurer. Kimberly, on the other hand, has not only maintained her weight, she's been too busy studying in the library stacks to hook up.

What accounts for the differences?

It could be the way each one’s brain reward center responds to food and sexual cues, reports a new study.

According to research out of Dartmouth College, in some people, hyperactivation of the nucleus accumbens, a key reward structure buried within the brain's striatum, predicted the eating and sexual behaviors of people (in this case, a group of freshmen women).

This suggests one’s ability to say “no” is not just a matter of willpower, but brain wiring.  

The study, published this week in the Journal of Neuroscience, used fMRI brain imaging and pictures depicting food, erotica, landscapes, and people to gauge how the test subjects' accumbens reacted to each stimulus. (The 48 women who completed the study had no idea what it was actually about.)

Six months later, the women returned to the lab where they were weighed and asked to fill out a questionnaire. Those whose accumbens reacted especially strongly to food cues had gained more weight. And those who reacted to sexual cues most strongly were more likely to have had sex and report stronger sexual desire.

Interestingly, their "appetites" did not cross over. The women with hyperactive responses to sex cues did not have a hyperactive response to food and vice versa.

Bill Kelley, associate professor of Dartmouth's department of psychological and brain sciences, says the study shows that the activation of one brain region proved to be a strong predictor of later behavior, demonstrating that the stronger the “liking” response to a stimulus, the less able we are to “hear” our rational brain saying “no.” 

But are we born this way, or do we acquire stronger craving for specific rewards?

“That’s a great question,” said Kathryn Demos, who led the study and is now an assistant professor of psychiatry and human behavior at Brown University.

Kelley thinks that since different women were tempted by different things, their brain wiring has developed through experience, aided by a genetic component.

Luckily, there are tools that can help people blunt the power of their brain wiring. Behavioral therapies, for example, have had some limited success in people who seem strongly stimulated by food. 

People can also try to replace various cravings with something more healthful, for instance, going for a run whenever they're tempted to eat a cheeseburger.

As for the findings, Demos says the idea that all people are equally capable of self-control is naïve.

Reward, she says, “is a very powerful system.”

Brian Alexander (www.BrianRAlexander.com) is co-author, with Larry Young PhD., of The Chemistry Between Us: Love Sex and the Science of Attraction, to be published September 13.

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