BERLIN — The German manufacturer of a drug that caused thousands of babies to be born with shortened arms and legs, or no limbs at all, issued its first ever apology Friday — 50 years after pulling the drug off the market. 

Gruenenthal Group's chief executive said the company wanted to apologize to mothers who took the drug during the 1950s and 1960s and to their children who suffered congenital birth defects as a result. 

"We ask for forgiveness that for nearly 50 years we didn't find a way of reaching out to you from human being to human being," said Harald Stock. "We ask that you regard our long silence as a sign of the shock that your fate caused in us." 

Stock spoke in the west German city of Stolberg, where the company is based, during the unveiling of a bronze statue symbolizing a child born without limbs because of thalidomide. 

The drug, which was sold under the brand name Contergan in Germany, was given to pregnant women to combat morning sickness but led to a wave of birth defects in Europe, Australia, Canada and Japan. Thalidomide was never approved for sale in the United States. 

Gruenenthal settled a lawsuit in Germany in 1972 — 11 years after stopping sales of the drug — and voiced its regret to the victims. But for decades the company refused to admit liability, saying it had conducted all necessary clinical trial required at the time. 

Stock reiterated that position Friday, insisting that "the suffering that occurred with Contergan 50 years ago happened in a world that is completely different from today" and the pharmaceutical industry had learned a valuable lesson from the incident. 

"When it developed Contergan Gruenenthal acted on the basis of the available scientific knowledge at the time and met all the industry standards for the testing of new drugs that were known in the 1950s and 1960s," he said. 

A German victims group rejected the company's apology as too little, too late. 

"The apology as such doesn't help us deal with our everyday life," said Ilonka Stebritz, a spokeswoman for the Association of Contergan Victims. "What we need are other things." 

Stebritz said that the 1972 settlement in Germany led to the creation of a €150 million fund for some 3,000 German victims, but that with a normal life expectancy of 85 years the money wasn't enough. In many other countries victims are still waiting for compensation from Gruenenthal or its local distributors. 

In July, an Australian woman won a multimillion dollar payout from UK company Diageo Plc, the local distributor of thalidomide. Lynette Rowe, 50, was born without arms and legs after her mother took thalidomide, made by Grunenthal, for a month while pregnant. 

Thalidomide is still sold today, but as a treatment for multiple myeloma and leprosy. 

Information from The Associated Press and Reuters was included in this report.

More in Vitals

• Breast cancer survivors may face second threat: heart failure
• Bagged lettuce or bulk? Experts offer food safety advice
• Two more Yosemite visitors infected with deadly mouse-borne hantavirus

Ben Margot / AP

At least five hantavirus infections have been linked to the tent cabins in Yosemite's Curry Village.

About 10,000 people who stayed in tent cabins at Yosemite National Park over the summer may be at risk for hantavirus, the U.S. Centers for Disease Control and Prevention said on Friday in a health advisory. 

"People who stayed in the tents between June 10 and Aug. 24 may be at risk of developing (hantavirus) in the next six weeks," the CDC said in the release.

Earlier, two more Yosemite National Park visitors were found with a mouse-borne virus blamed for the deaths of two people, bringing the total number of infections to six, state health officials said.

The new discoveries were made during the agency's investigation into cases of hantavirus pulmonary syndrome at the famed park, California Department of Public Health Anita Gore spokeswoman said.

The infections spurred park officials to close 91 tent cabins at Curry Village in Yosemite Valley, where five of the six infections occurred. Gore said one of the infected people may have been in another area of the park.

"Our investigation is trying to determine which area of the park that person visited," she said.

Over the past three weeks, two people have died of hantavirus pulmonary syndrome after staying in cabins at Curry Village in Yosemite Valley.

Park officials said the double-walled design of the cabins that were closed Tuesday made it easy for mice to nest between the walls. The disease is carried in the feces, urine and saliva of deer mice and other rodents.

The illness begins as flu-like symptoms, including including headache, fever, muscle ache, shortness of breath and cough. Initial symptoms may appear up to six weeks after exposure and can lead to severe breathing difficulties and death.  

Although there is no cure for hantavirus, treatment after early detection through blood tests can save lives. The virus, which has never been known to be transmitted between humans, kills 38 percent of those it infects.

"The earlier it's caught and supportive care is given, the better the survival rate," said Dr. Vicki Kramer, chief of vector-borne diseases at the state Public Health Department.

Dr. Charles Chiu, an infectious disease specialist at the University of California, San Francisco, said he made a habit of airing out his tent-cabin before occupying it as a precaution against possible virus-carrying dust particles when he stayed in Curry Village a few years ago.

But even Chiu said he was surprised to learn that a hantavirus had killed two people and stricken others who slept in the same structures this summer.

"It wasn't something even I had thought of at the time," Chiu, who studies hantavirus, told Reuters.

Five of the people who fell ill are known to have stayed in the tent cabins in June or July, and warnings have gone out to visitors who stayed in Curry Village in June, July or August.

The hantavirus outbreak occurred despite efforts by park officials to step up protection efforts last April. A 2010 report from the state health department warned park officials that rodent inspection efforts should be increased after a visitor to the Tuolumne Meadows area of the park fell ill.

The new hantavirus policy, enacted April 25, was designed to provide a safe place, "free from recognized hazards that may cause serious physical harm or death."

It came after the state report revealed that 18 percent of mice trapped for testing at various locations around the park were positive for hantavirus.

"Inspections for rodent infestations and appropriate exclusion efforts, particularly for buildings where people sleep, should be enhanced," it said.

Melanie Norall of Palo Alto, California, is monitoring her 8-year-old daughter's every sniffle. They stayed in a cabin outside Yosemite's north entrance at the end of July and awoke to mice scurrying and eating nuts out of their luggage.

In 2009, the park installed the 91 new, higher-end cabins to replace some that had been closed or damaged after parts of Curry Village, which sits below the 3,000-foot Glacier Point promontory, were determined to be in a rock-fall hazard zone.

The new cabins have canvas exteriors and drywall or plywood inside, with insulation in between. Park officials found this week when they tried to shore up some of the cabins that mice had built nests in the walls.

The deer mice most prone to carrying the virus can squeeze through holes just one-quarter-inch in diameter. They are distinguished from solid-colored house mice by their white bellies and gray and brown bodies.

The park sent warning emails and letters Wednesday to another 1,000 people who stayed in tent cabins, after officials found that a computer glitch had stopped the notices from going out with the original 1,700 warnings Monday. The warning says anyone with flu-like symptoms or respiratory problems should seek immediate medical attention.

In 2011, half of the 24 U.S. hantavirus cases ended in death. But since 1993, when the virus first was identified, the average death rate is 36.39 percent, according to the Centers for Disease Control.

The vast majority of hantavirus victims are young and middle-age adults, Chiu said, probably because they are mostly likely to engage in activities that would readily expose them, such as chopping and carrying fire wood or sweeping the floors.

"The message should not be you should stop camping. The important thing is general awareness of this disease and to avoid wild rodents in general," Chiu said.

The Associated Press and Reuters contributed to this report

More hantavirus news:

Yosemite closes cabins after hantavirus deaths 

Hantavirus cluster worries officials

Women who have survived breast cancer may have to fight another killer down the road -- heart failure, researchers report.

They found a much higher rate of heart failure among breast cancer survivors than has previously been reported, and said their findings likely reflect the real-world risks that women have. The 12,000 women studied for the report had a 20 percent risk of developing heart failure over just five years if they got a common chemotherapy regimen, compared to just 3.5 percent of breast cancer patients who did not get chemo.

"I think these drugs are critical to improving breast cancer survival," said Erin Aiello Bowles of the Seattle-based Group Health Research Institute, who led the study published in the Journal of the National Cancer Institute. "But these drugs are toxic. They are meant to target disease but they can often damage other parts of the body."

Clinical trials of breast cancer patients -- designed to discover whether drugs fight disease and to show how safe they are -- have shown that the drugs can damage the heart and cause higher rates of heart failure. They generally demonstrate about a 4 percent increase in heart failure over three to five years for women getting chemo. But clinical trials usually involve a select group of patients who are healthy in other ways.

Bowles said her team set out to look at real-world patients of all ages and with a range of health conditions on top of their breast cancer. They went through the medical records of women at eight health systems who were treated between 1999 and 2007 with two very common cancer drugs: a group of drugs called anthracyclines, such as adriamycin, and a targeted antibody drug called Herceptin or trastuzumab.

Each drug raised the risk on its own, but the combination greatly raised heart failure rates.

"It is important to note that these rates do vary by age," Bowles said in a telephone interview.  "They are much lower in the younger women." More than 40 percent of the women over the age of 75 who got a combination of an anthracycline and Herceptin also developed heart failure within five years. Just 13.7 percent of the breast cancer patients that age who did not get chemo developed heart failure.

The study highlights a growing problem. The American Cancer Society estimates there are 12 million cancer survivors alive in the United States now. As many cancer patients survive their disease and lead ever-longer lives, they find they must fight second battles against the long-term effects of the treatments that saved their lives. Even so-called targeted therapies, which were designed to better target tumor cells while leaving healthy tissue alone, have been shown to cause long-lasting damage.

And as they leave the care of a specialized oncologist and return to day-to-day care, they may not know they’re at special risk of other conditions – and their primary care doctors may not be aware, either. The American Society of Clinical Oncology has been warning about the problem for years, and released research at its annual meeting last June showing that 94 percent of primary care doctors didn't know about the potential long-term effects of drugs commonly used to treat breast and prostate cancer.

Breast cancer is the leading cancer killer of U.S. women, after lung cancer. It is diagnosed in more than 220,000 women a year, according to the American Cancer Society, and will kill nearly 40,000 this year. About 20 percent of cases are a kind called HER-2 positive, and Herceptin was formulated to especially target this kind. It’s very effective and has saved thousands of lives, but it was known to also damage the heart, although doctors don’t understand just how.

Heart failure is also very common. The National Heart, Lung and Blood Institute estimates 4.8 million Americans have congestive heart failure, which is a chronic condition in which the heart doesn’t pump blood effectively. Half of patients with heart failure die within five years, and 400,000 people get newly diagnosed every year.

So what can women do if they’ve had chemo for breast cancer and want to watch their hearts?

Cardiologist Dr. Larry Allen of the University of Colorado in Denver, who also worked on the study, said they first of all need to be educated about what drugs they have taken and what the side-effects are.

“Second, patients should ask about what heart tests may be indicated before, during, and after treatment,” Allen said in a statement. These may include tests of how well the heart is pumping blood – tests that most women won’t get during a routine physical or well-woman visit.

“Third, in addition to allowing doctors to monitor for heart problems, patients can monitor themselves for worsening heart function by understanding how heart problems may present -- including shortness of breath especially when lying flat, leg swelling, palpitations/heart fluttering, and exercise intolerance (these symptoms can represent non-heart disease too, but generally warrant additional evaluation),” Allen added.

“Unfortunately, it is unknown if medications that are typically used to treat heart failure (such as beta-blockers and ACE inhibitors) might protect against heart damage from certain chemotherapy.”

Related:

• Cancer patients face long-term risks
• Childhood cancer leaves real lifetime scars

Benjamin Sklar / AP

Prewashed, packaged salad may be more convenient for consumers, but some worry that bagged lettuce is more likely to be contaminated.

A recall this week of 8,000 cases of Fresh Express Hearts of Romaine salad marks the sixth time since April that the nation’s top producers of bagged lettuce have pulled products because of worries about food safety.

Listeria was the problem that forced Fresh Express officials to recall certain 10-ounce bags of the greens, the same potentially dangerous bug that led Dole Fresh Vegetables to withdraw bagged salads four times since spring, most recently on Aug. 22.

No illnesses have been tied to the voluntary withdrawals and company press releases describe each one as an “isolated incident” unlikely to harm human health.

But for consumers roaming the produce aisles at the grocery store, each new recall raises the question: How safe is my salad?

Food safety experts say they hear all the time from shoppers wondering which is better, bagged lettuce or the loose variety.

“We call it faith-based food safety,” says Doug Powell, a professor of food safety of Kansas State University. “And most of it is faith-based.”

Powell and Christina Bruhn, a researcher in food science and technology at UC Davis, say that while figuring out what fraction of the lettuce may make you sick is a gamble, they still place their bets on the bagged stuff.

“I do know some professionals who do not buy bagged lettuce,” says Bruhn. “I buy it. I like the convenience. I think they do the best job of anyone of cleaning the product, better than I do. They use chlorinated water. They wash it really thoroughly.”

She figures the big manufacturers, including Dole and Fresh Express, have a huge stake in safety and an incentive to get it right.

“They have the size of staff and the resources to use the most up-to-date processes,” she said.

Powell, too, says he usually opts for bagged lettuce.

“I go to the biggest grocery store I can find,” he said. “They have requirements for what they put on the shelf.”

Some consumers, haunted by the 2006 outbreak of E. coli O157 in spinach that sickened 205 people and killed three, have sworn off bagged greens.

Others, worried about contamination from fields and shipping, cringe at the thought of gritty bulk lettuce and take comfort in the “triple-washed” claims on the shiny bags. Still others swear by farmer’s market produce -- or eat only the greens they grow themselves.

About 9 billion pounds of lettuce is produced in the U.S. each year, according to the U.S. Department of Agriculture, and, to be sure, the vast proportion of it is safe.

Story: Garden Fresh recalling 7 tons of packaged salads

Indeed, Marty Ordman, a spokesman for Dole, said the company has hired two third-party listeria experts in the wake of the recent recalls, which were prompted in part by Food and Drug Administration inspections. The experts hope to help identify any potential improvements to the processes and procedures used in Dole's bagged salad plants. 

Additionally, Dole scientists have been working "very closely" with the FDA to find alternative methods of sanitizing products to control contamination while still providing fresh, high quality products, Ordman added.

But Seattle food safety lawyer Bill Marler, who regularly represents clients hurt or killed by tainted produce, isn't convinced. Asked what kind of lettuce he prefers, he said: "Not bagged."

Even the crisp heads of lettuce in a farmer's market stall can be suspect, said Powell. They may be fresh and local, but that’s no guarantee of safety.

“The lettuce was sitting swamped in water for days,” he said. “If I go to a farmer’s market, I don’t want to know that it’s lovingly grown. I want to know you’ve taken steps for microbiological safety. If you can't answer those questions, I don't want to buy your lettuce."

Both Bruhn and Powell acknowledge that the big growers can have problems, as evidenced by the recent recalls. And both are big proponents of companies posting their food testing results publicly and marketing the safety of their products as a selling point.

Bruhn is also a staunch advocate of irradiation, which she says can ensure food safety.

She encourages consumers to take steps to avoid compromising bagged lettuce. Buy only bags kept very cold in the grocery store and pay attention to sell-by dates. Once you’ve got it home, open the bag and dump it directly into a clean bowl.

“Don’t stick your own hands in there,” she said.

She also urges home cooks not to re-wash bagged greens because of the possibility of cross-contamination with other bacteria already in the kitchen.

If you want to use bulk lettuce, make sure to clean it correctly, Bruhn said. First, wash your hands and also the sink with hot soapy water.

Then, break off each lettuce leaf individually, rinse it under cold running water while rubbing gently. Dry in a salad spinner or with paper towels, not with cloth towels, which may transmit bacteria.

“Keep in mind, you only get about 90 percent (of the pathogens) off,” she said. “Ninety percent sounds like a lot to a lay person, but to a microbiologist, it’s hardly anything. You can’t get it all off.”

Related stories: 

• Home cooks' safety flubs caught on camera
• Listeria prompts recall of 1,000 cases of Dole bagged salads
• Listeria fears trigger recall of 2,598 cases of Dole salad

U.S. health officials say the number of people sickened with the strain of salmonella linked to cantaloupe from an Indiana farm has grown to 204 in 22 states. 

At least 78 people have been hospitalized as a result of the infection caused by salmonella Typhimurium, and two deaths have been reported in Kentucky. Here's a list of the number of ill people identified by state, according to the Centers for Disease Control: 

Alabama (13), Arkansas (5), California (2), Florida (1), Georgia (4), Illinois (24), Indiana (22), Iowa (8), Kentucky (63), Massachusetts (2), Michigan (6), Minnesota (5), Mississippi (5), Missouri (13), New Jersey (2), North Carolina (5), Ohio (5), Pennsylvania (2), South Carolina (3), Tennessee (8), Texas (2), and Wisconsin (4).

Regulatory agencies and public health officials at the federal, local and state levels believe the illness outbreak to be linked to cantaloupe from Chamberlain Farms Produce, Inc. of Owensville, Ind. On Aug. 22, the U.S. Food and Drug Administration announced a recall of cantaloupes from Chamberlain Farms. The melons had been shipped to Indiana, Kentucky, Missouri, Tennessee, Ohio, Illinois and Wisconsin, according to available records. 

If you currently have cantaloupe at home, check to make sure it didn't come from Chamberlain Farms -- many melons have a sticker on them that lets you know where they were grown. No sticker? As the CDC advises, "When in doubt, throw it out." 

Related:

• Salmonella in cantaloupes sickens 141, kills 2
• FDA IDs farm in salmonella cantaloupe outbreak

UPDATE: Yosemite National Park officials have indefinitely closed 91 cabins at the center of a probe into the deaths of two people from a mouse-borne virus.

Officials say the double-walled design of the cabins made it easy for mice to nest between the walls.

Over the past three weeks, two people have died of hantavirus pulmonary syndrome after staying in one of the so-called "Signature" cabins. Another person is confirmed ill and one more likely has the virus that kills 36 percent of the people it infects.

All of the victims stayed in the only tent-style cabins in Curry Village that are insulated.

Mike Gauthier, Yosemite chief of staff, said the design allowed for rodent infestation.

The disease is carried in the feces, urine and saliva of deer mice and other rodents.

ORIGINAL STORY: Report: Yosemite was warned about rodents and deadly hantavirus

The National Park Service was warned in 2010 that efforts should be stepped up to inspect for rodents in Yosemite and prevent them from entering areas where people sleep, according to a report obtained Thursday.

The disclosure came just days after a Pennsylvania visitor became the second park guest confirmed to have died of hantavirus pulmonary syndrome. Public health officials were able to confirm both victims had stayed at the park's Curry Village in Yosemite Valley.

Earlier story: Cluster of deadly hantavirus cases worries officials

The 2010 report issued by the California Department of Public Health was commissioned by the park service.

"Inspections for rodent infestations and appropriate exclusion efforts, particularly for buildings were people sleep, should be enhanced," it said.

"We worked with Yosemite to evaluate risk and make recommendations to reduce the possibility of transmission to people," said Vicki Kramer, chief of the vector borne disease section of the health department. "That included reducing the number of mice, and excluding them from structures."

Further details were not immediately available. The health department said it was preparing a statement.

The report was commissioned after two park visitors became ill after staying in Tuolumne Meadows, about 4,000 feet higher than Yosemite Valley. It said that 18 percent of mice trapped for testing at various locations around the park were positive for hantavirus.

"The identification of the second case ... underscores the ongoing risk and need for dutiful adherence to a rodent exclusion and control program," the report said.

Officials with Yosemite National Park and public health officials with the National Park Service did not immediately return calls seeking comment.

Meanwhile, public health workers sent warnings to more people who visited Yosemite this summer, saying they could have been exposed to the deadly rodent-borne disease. They also handed out warnings to people entering park gates.

Officials sent emails and letters on Wednesday to another 1,000 people who stayed in tent cabins in Curry Village. That was in addition to 1,700 Curry Village guests who had previously been sent such warnings.

The disease can be transmitted by inhaling airborne particles of the feces, urine and saliva of deer mice and other rodents. At least one other person was sickened, and public health officials are awaiting tests on a fourth possible case.

The rustic tent cabins of historic Curry Village are a favorite among families looking to rough it in one of the nation's most majestic settings. All of the guests sent warnings stayed in the park's only tent cabins that are insulated against the elements.

Park employees removing insulation have found mouse nests and droppings in some of the 91 so-called Signature cabins they are attempting to seal up to make entry more difficult. The deer mice most prone to carrying hantavirus pulmonary syndrome can squeeze through holes just one-quarter-inch in diameter.

The guests being warned stayed in Curry Village's tent cabins in June, July or August. All four victims so far stayed in the cabins in June.

The illness begins as flu-like symptoms but can quickly affect the lungs. It can take up to six weeks to incubate.

In issuing the new warnings it was unclear whether authorities expanded the boundary of potential exposure or extended the dates.

In 2011, half of the 24 reported U.S. hantavirus victims died. But since 1993, when the virus first was identified, the average death rate has been 36 percent, according to the Centers for Disease Control and Prevention.

Most of the nearly 600 cases reported since 1993 have been in New Mexico, Colorado, Washington, Arizona and California. Most often they are isolated, so having this cluster of cases from a small area in Yosemite has perplexed public health officials.

The federal government has two epidemiologists working in the park. They are trapping mice and rodents in an effort to determine how much of the population carries the virus and to see whether there are more mice in Yosemite Valley this year than in other years.

Deer mice are distinguished from solid-colored house mice by their white bellies and gray and brown bodies.

Kramer warned people never to sweep or vacuum mouse droppings. Instead spray them with a mixture of bleach and water, then use paper towels or a mop.

This past spring the California health department gave Yosemite a cleanup plan, Kramer said. "Yosemite, to their credit, has taken quite a few steps to address this," she said. "But it's a wilderness area and these buildings aren't going to be tight. It's impossible to get rid of the deer mice, so there is going to be some risk to being in a wilderness area."

Copyright 2012 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.

Related stories:

Second Yosemite visitor dies of rodent-borne illness

West Nile virus outbreak affects 1,100

New pig flu spreads to people at state fairs

Reuters

Scientists have found an alarming number of cases of the lung disease tuberculosis in Africa, Asia, Europe and Latin America that are resistant to up to four powerful antibiotic drugs.

In a large international study published in the Lancet medical journal on Thursday, researchers found rates of both multi drug-resistant TB (MDR-TB) and extensively drug-resistant TB (XDR-TB) were higher than previously thought and were threatening global efforts to curb the spread of the disease.

"Most international recommendations for TB control have been developed for MDR-TB prevalence of up to around 5 percent. Yet now we face prevalence up to 10 times higher in some places, where almost half of the patients ... are transmitting MDR strains," Sven Hoffner of the Swedish Institute for Communicable Disease Control, said in a commentary on the study.

TB is already a worldwide pandemic that infected 8.8 million people and killed 1.4 million in 2010.

Drug-resistant TB is more difficult and costly than normal TB to treat, and is more often fatal.

MDR-TB is resistant to at least two first-line drugs — isoniazid and rifampicin - while XDR-TB is resistant to those two drugs as well as a powerful antibiotic type called a fluoroquinolone and a second-line injectable antibiotic.

Treating even normal TB is a long process, with patients needing to take a cocktail of powerful antibiotics for six months. Many patients fail to complete their treatment correctly, a factor which has fuelled a rise in the drug-resistant forms.

Researchers who studied rates of the disease in Estonia, Latvia, Peru, the Philippines, Russia, South Africa, South Korea and Thailand found almost 44 percent of cases of MDR TB were also resistant to at least one second-line drug.

Tom Evans, chief scientific officer at Aeras, a non-profit group working to develop new TB vaccines, told Reuters treatment options for XDR-TB patients were "limited, expensive and toxic".

Treatments for drug-resistant TB can cost 200 times more than those for normal TB, he said in an emailed statement. They can also cause severe side effects like deafness and psychosis, and can take two years to complete, he added.

In the United States, MDR-TB treatment can cost $250,000 or more per patient, and in many poorer countries costs can be catastrophic to health systems and patients' families.

"Without a robust pipeline of new drugs to stay one step ahead, it will be nearly impossible to treat our way out of this epidemic," Evans said.

Spreads through air
Tracy Dalton from the United States Centers for Disease Control and Prevention, who led the Lancet study, said that so far, XDR-TB has been reported in 77 countries worldwide.

"As more individuals are diagnosed with, and treated for, drug-resistant TB, more resistance to second-line drugs is expected to emerge," she said.

The spread of these drug-resistant strains was "particularly worrisome" in areas with poor healthcare resources and limited access to effective drugs, she added.

TB is a bacterial infection that destroys patients' lung tissue, making them cough and sneeze and spread germs through the air. Experts say anyone with active TB can easily infect another 10 to 15 people a year.

The World Health Organization (WHO) predicts more than 2 million people will contract MDR TB by 2015.

A report by non-governmental organizations in March said a $1.7 billion shortfall in funds to fight TB over the next five years meant 3.4 million patients would go untreated and gains made against the disease will be reversed.

In their research, Dalton and colleagues found rates of resistance varied widely between countries.

Overall, resistance to any second-line drug was detected in nearly 44 percent of patients, ranging from 33 percent in Thailand to 62 percent in Latvia.

In about a fifth of cases, they found resistance to at least one second-line injectable drug. This ranged from 2 percent in the Philippines to 47 percent in Latvia.

XDR-TB was found in 6.7 percent of patients overall. Rates in South Korea, at 15.2 percent, and Russia at 11.3 percent, were more than twice the WHO's global estimate of 5.4 percent at that time.

(c) Copyright Thomson Reuters 2012. Check for restrictions at: http://about.reuters.com/fulllegal.asp

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New tick-borne virus puts the bite on Missouri farmers

Cluster of deadly hantavirus worries officials

Chris Graythen / Getty Images

LAPLACE, LA - AUGUST 29: Rescue workers transport residents trapped by rising water from Hurricane Isaac in the River Forest subdivision on August 29, 2012 in LaPlace, Louisiana. The large Level 1 hurricane slowly moved across southeast Louisiana, dumping huge amounts of rain and knocking out power to Louisianans in scattered parts of the state. (Photo by Chris Graythen/Getty Images)

It’s the question so many of us have while watching news coverage of a hurricane or tropical storm like Isaac: Who are these people who don’t leave home even as an angry storm is advancing – and what are they thinking?!

The short answer: For some, the up-and-leaving idea isn’t as easy as it sounds to those of us watching from a safe and dry distance. Actually, a 2009 article published in the journal Psychological Science sought to examine the reasons some people won’t evacuate, despite the urging or even mandates of city and state officials, by asking a group who would know: Hurricane Katrina survivors who weathered the storm at home.

“It seems like asking ‘Why didn't people leave?’ presumes that that's the best option for everyone to make,” says Hilary Bergsieker, who worked with Nicole Stephens, now of Northwestern University, on the study. The fact is, many people lack the resources to escape. Having no money, no mode of transportation and no friends or family in safe places means no choice but to weather the storm. 

In the case of Katrina, those who evacuated before the storm hit were mostly white, mostly middle class; on the other hand, those who stayed were mostly black, mostly working class. The “leavers,” as the Psychological Science paper terms those who fled before the storm, had privileges that they probably took for granted: more education, more money, reliable access to transportation, social networks that extended farther away from the hurricane-hit area, and more access to news reports to warn them of the storm’s severity.

"Middle- and upper-class Americans are more geographically mobile and have more experience traveling nationally and internationally. I think that the familiarity with moving or traveling would contribute to the ability to make a plan for how to evacuate,” says Stephens, who is an assistant professor at the Kellogg School of Management at Northwestern. "On the other hand, if you have spent most of your life in the same community, then you would likely feel more attachment to your home and feel less comfortable as well as less equipped to quickly uproot yourself in response to evacuation orders." 

Even if a person does have the resources at hand to make an escape, it might be unthinkable to leave behind a tightknit community like those you’d find in many parts of coastal Louisiana and Mississippi.

Slideshow: Isaac moves inland

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A downgraded Isaac floods coastal communities and forces new evacuations, but levees still hold.

Launch slideshow

“There's sort of the physical resources factor, but there's also the psychological factors. That's your world; that's all you know,” says Bergsieker, who is now an assistant professor of psychology at the University of Waterloo in Ontario, Canada. And, as the thinking goes, if your neighbor tells you he’s staying, then you might stay, too – after all, if something happened to him, who would be there to take care of him if you leave? Some of the 79 Katrina survivors interviewed in the 2009 study did have the resources to go, but they didn’t have the heart to leave.

Ariella Cohen moved to New Orleans in 2007, so she wasn’t there when Katrina hit. But in 2008, when Hurricane Gustav started moving toward her city, she decided to stick it out, despite the city's mandatory evacuation order.

“I had friends who had stayed through Katrina, and I had heard all their stories about it, and so I think I also inherited all their jadedness, too,” says Cohen, who wrote about her Gustav close encounter for the website Next American City. “You know, just kind of that New Orleanian attitude of, ‘Whatever! We’re going to stay here. Do you want another beer?’” On a more serious note, her rationale for staying was: 'I’m young, I’m able-bodied and relatively fit. What if someone older and weaker needs me?' “I was, like, 27 at the time, so I was young and strong, and I would be able to help people if the time came,” says Choen, now 31, who lives in Philadelphia, where she works as an editor for the same site that published her 2008 essay.

Mistrust of outsiders – as in, people who aren’t from your community who are claiming to know more than you do about your own home by telling you to leave it – can play a part, too. “This is where you've always been your whole life, and suddenly people on the radio are telling you you have to leave? That may seem like a much more dangerous choice than to stay with people from your church, or people from your block,” Bergsieker says.

Besides, those who live in a hurricane-prone area hear these warnings all the time. It can be easy to stay in denial about an impending storm’s ferocity when the local news station has cried “hurricane” so many times before. (Sometimes that tack pans out: In Cohen’s lucky case, Gustav bypassed New Orleans.)

Read this far and still think anyone who’d ignore a hurricane evacuation mandate must be just plain crazy? That sounds about right. A second piece of the study asked both Katrina relief workers and regular folks to describe the “leavers” and the “stayers” in three words. The leavers were called independent, self-reliant, responsible, hard-working, conscientious. The stayers, on the other hand, were described mostly in negative terms: Passive. Crazy. Lazy. Irresponsible. Careless. Hopeless. 

Take a dive into the comments section on this NBCNews.com story on Isaac, and the sentiment sounds about the same. Like this one: "What part of MANDATORY EVACUATION do these people NOT UNDERSTAND!" (Bold text and gratuitous use of the caps-lock key are the commenter's own.) Or this: "You were told to evacuate! Now you should be on your own and not expect others to put themselves in harms way!"

In the study, relief workers and others alike acknowledged that many of the stayers might have lacked the financial resources to leave, and yet they still used mostly negative terms to describe them. That disconnect is what Stephens was interested in exploring in the 2009 article, which argues that maybe people who “choose” to dig in their heels and remain in their communities, even when a storm’s a-comin’, actually don’t feel like they ever had a choice. Whether for financial or psychological motives, they're staying. 

 “In retrospect, definitely I was a bit naïve. Natural disasters don’t go by the logic of human psychology,” Cohen acknowledges. “I think that there’s a lot of it that’s hard to conceive – like, it’s hard to conceive of your own death, it’s difficult to conceive of natural disaster. It just seemed unbelievable that another storm could hit the city hard. And so I stayed.”

Keep up with NBCNews.com health editor Melissa Dahl on Twitter.

Related stories:

• More evacuations as Isaac dumps rain on Gulf
• The long road back from Katrina
• Horrible memories for New Orleanians

Getty Images file

Rosacea can cause reddish skin, bumps, small visible blood vessels on the face and more. The skin condition affects an estimated 16 million in a U.S., according to The National Rosacea Society.

Scientists may have finally found what sparks the inflamed and reddened skin in people suffering from rosacea: tiny mites that crawl across most of our faces, unseen and unfelt.

The new finding may eventually lead to more effective treatments, researchers say.

As it turns out, the mites, which spend daytime hours in the glands that produce sweat and sebum, harbor a certain kind of bacteria in their digestive tracts. When the mites die, the bacteria spill out into the glands, according to a new report published in the Journal of Medical Microbiology.

That’s not a problem for most of us, says the study’s lead author Kevin Kavanagh, a researcher at the National University of Ireland. But when people have an especially heavy infestation of the little bugs, the release of bacteria can set off rosacea.

“In normal skin, the density of mites is low,” Kavanagh explains. “In rosacea there is a high density and therefore a large number of bacteria are released. We believe that the high level of bacterial toxins overwhelms the immune response and leads to the inflammation. It is interesting to note that [the mites] do not have an anus and therefore all their waste is stored until they die and then it is released in one go.”

Skin problems only occur when mites die while in the glands during the day. At night they pop out and crawl around the surface of the skin often in search of a mate. Kavanagh notes that the mites can cover a lot of ground – moving as much as 4 inches before heading back to the glands.

Kavanagh and his colleagues came to their conclusions after reviewing the available literature on rosacea and mites. Looking at all the findings together, the researchers realized that the most likely culprit in the rosacea scenario was the bacteria in the gut of a certain type of mite, Demodex folliculorum.

And this new understanding explains why antibiotics work, but only temporarily, Kavanagh says. 

“Antibiotics are used to treat rosacea but they have no effect on the Demodex,” he explains. “However they do kill the Bacillus within the Demodex that produces the toxins. Once the antibiotic therapy is stopped the condition returns – possibly because patients pick up Bacillus-infected mites from relatives and friends.”

Another, better, approach may simply involve dietary changes, such as avoiding high fat foods, Kavanagh says.

Demodex feeds on dead skin cells and sebum, the oily substance released by subaceous glands.

“Recent work has shown that the sebum in rosacea patients is different from that in controls,” Kavanagh says. “Therefore a change in diet may lead to the appearance of more ‘normal’ sebum,’ that might prevent Demodex from proliferating.”  

Related stories:

Deadly, rare virus cluster worries officials

New tick-borne virus puts bite on Mo. farmers

West Nile spreads across U.S., but don't expect hurricane effect

An outbreak of salmonella poisoning in mangoes has sickened 105 people from 16 states in the U.S., in addition to at least 22 people who became ill in Canada, government health officials said Wednesday.

Most of the U.S. victims are in California, where 78 people have been confirmed ill with the outbreak strain of Salmonella Braenderup since July 1, according the Centers for Disease Control and Prevention.

Six people became ill in Washington state, according to health officials there. CDC has not yet identified the numbers of victims in remaining states.

So far, patients range in age from 1 to 86, with a median age of 32. Twenty-five victims have been hospitalized, CDC said. Most became ill from July 3 to Aug. 11, 2012, although infections contracted after Aug. 5 might not yet be reported.   

CDC officials said they have not confirmed a specific source or identified the type of mangoes associated with the outbreak. “Therefore, we do not have specific consumer advice at this time regarding eating mangoes,” the agency said.

Once a specific source is identified, CDC said public health officials will offer advice and take steps to prevent illness.

However, CDC officials did confirm that the genetic fingerprint of the salmonella strain was identical to that found in the recalled mangoes that made people sick in Canada, which were identified as Daniella brand mangoes imported from Mexico.

A U.S. importer of those mangoes, Splendid Products of Burlingame, Calif., has voluntarily recalled nationwide shipments of Daniella mangoes with PLUs #4959, 3114, 4051, 4311 or 4584.  Several U.S. grocery stores have pulled the fruit from their shelves, the Food and Drug Administration said Wednesday. They were sold at retail locations across the U.S. from July 12 to Aug. 29.

Officials in Canada and the U.S. are continuing to work with state and local agencies to investigate the outbreak.

Salmonella poisoning can cause mild illness in otherwise healthy people 12 to 72 hours after infection. Symptoms include fever, diarrhea and abdominal cramping. In some people, usually those with weak immune systems, salmonella can cause severe illness requiring hospitalization.

Related stories:

• Mexican mangoes may have sickened 100
• Salmonella in cantaloupe sickens 141, kills 2

CDC

The Lone Star tick, or A. americanum, shown here, may be responsible for the spread of a never-before-seen virus that hospitalized two Missouri farmers.

When two Missouri farmers wound up hospitalized with fever, fatigue, low blood cell counts and elevated liver enzymes in 2009, doctors suspected ticks were to blame.

Both men recently had reported tick bites, including a 57-year-old whose wife plucked a single critter off his abdomen with tweezers and a 67-year-old man who figured he was bitten 20 times a day for two weeks while rebuilding fences on his 40-acre farm.

"I was getting worse and worse," recalled Robert Wonderly, now 60, of Sheridan, Mo., the victim with the single bite.

The men had all the symptoms of ehrlichiosis, a potentially dangerous bacterial infection spread by, yes, ticks. But when scientists cultured samples of the farmers’ blood, the bacteria were nowhere to be found.

“We placed it into the culture and then we didn’t get anything,” recalled Dr. William L. Nicholson, a research microbiologist who specializes in emerging and zoonotic infectious with the Centers for Disease Control and Prevention. “And that, to us, indicated that we had something else in there that we weren’t testing for.”

That something turned out to be an entirely new virus discovered only through sophisticated genetic analysis conducted by Nicholson’s colleagues at the CDC’s Viral Special Pathogens branch. The scientists reported their findings in this week's issue of the New England Journal of Medicine.

“This particular virus has never been detected before,” said Nicholson. “This is unique to the world.”

So far, the Missouri men are the only known victims of the new germ, which has been identified as a phlebovirus, part of the Bunyaviridae family of potentially serious bugs. Hantavirus, spread by deer mice, comes from that group. So does the deadly Crimean-Congo hemorrhagic fever.

But Nicholson, along with state and local health officials, has been scouring the region where the men were infected. They’re looking for additional signs of what has been dubbed “the Heartland virus,” after Heartland Regional Medical Center in St. Joseph, Mo., where the men were treated -- and because it was discovered in the nation’s heartland.

The new virus appears to be very rare. Although there are plenty of phleboviruses around -- more than 70 -- they are divided by the ways that they’re spread. Some are carried by sand flies, for instance. Others, like the Rift Valley fever virus, are spread by mosquitoes.

The only other tick-borne phlebovirus known to cause disease in humans is called SFTSV -- severe fever with thrombocytopenia syndrome virus -- which was recently identified in central and northeastern China.

“Even though the Chinese virus is similar, it is still quite distinct,” said Nicholson.

Researchers were able to identify the Heartland virus by using electron microscopes and next-generation genomic sequencing including total RNA analysis.

It’s not clear yet exactly how the new virus may be spread. Ticks appear to be the culprits. Nicholson and others suspect that A. americanum, the Lone Star tick found widely in northwestern Missouri and elsewhere, may be be a carrier. But other critters may be responsible as well. It’s also not clear what animals may serve as hosts, noted Dr. Scott M. Folk, the infectious disease expert at Heartland Regional who treated the two farmers.

Finding those answers will be imperative, because although the Heartland virus appears to be rare, it may not be.

“It could be responsible for more illness than we think,” Folk said.

In many ways, the new virus is just one more tick-borne problem to worry patients and doctors. The CDC lists 10 tick-borne diseases in the U.S.

The best-known is Lyme disease, which infected about 30,000 people in the U.S. in 2010. Other infections include anaplasmosis and ehrlichiosis, which affect about 1,000 people each a year, and babesiosis, which infected about 1,100 people in the U.S. last year, the CDC said. There's also Rocky Mountain Spotted Fever, an old disease that still strikes about 2,500 people a year.

Pat Smith, president of the Lyme Disease Association Inc., believes the new virus should help bolster growing awareness of the problem of tick-borne diseases and encourage people to realize that they can be serious.

“Maybe you don’t have Lyme. Maybe you have something else,” Smith said. “They can make you sick for a long time.”

The CDC encourages people to check for ticks after they’ve been outdoors, to use insecticides to kill ticks and to monitor dogs and other animals to prevent ticks from being brought indoors.

The two Missouri men were hospitalized for nearly two weeks and took a couple months to recover. Wonderly, who also works at the local Energizer Eveready Battery Co. in nearby Maryville, says he still has problems with short-term memory, fatigue and headaches three years after the infection.

The second victim, now 70, who agreed only to be identified by his first name, Larry, said he's fine now. Neither man seemed much impressed with being infected by a never-before-seen virus, though both are glad it didn't turn out to be worse. 

"I guess I never give it much thought," said Wonderly. "But I was glad they saved my life."

Related stories: 

• JP Morgan exec's Lyme infection spotlights need for quick treatment
• Missing foxes fuel spread of Lyme disease
• Tick trouble: 1,100 people got babesiosis in 2011

West Nile virus is now in 48 states, has made nearly 1,600 people ill and killed 66 of them, federal health officials said on Wednesday. But don’t expect Hurricane Isaac, which is now dumping tons of rain on Louisiana, to make matters any worse, they said.

The case count keeps 2012 on track to be the worst year for West Nile since the virus first came to the United States in 1999, the Centers for Disease Control and Prevention said. And some of the sickest people will never fully recover, the CDC says.

“As of August 28, 2012, 48 states have reported West Nile virus infections in people, birds, or mosquitoes. A total of 1,590 cases of West Nile virus disease in people, including 66 deaths, have been reported to CDC,” the agency says.

“Over 70 percent of the cases have been reported from six states (Texas, South Dakota, Mississippi, Oklahoma, Louisiana, and Michigan) and over 45 percent of all cases have been reported from Texas.”

Health officials are not sure why West Nile is so bad this year or why Texas has been so hard-hit. The very hot summer may have been a factor, but viruses like West Nile have complicated and hard-to-follow life cycles, they said.

West Nile is spread by infected mosquitoes, which breed in water. But CDC officials said they doubted Hurricane Isaac would worsen the epidemic, because mosquitoes like stale, standing water, which is likely to be washed away by a hurricane.

The CDC’s Dr. Lyle Petersen, an expert on mosquito-transmitted disease, says the virus has to pass from mosquitoes to birds and back to mosquitoes to take hold in an area, and big storms mess up that cycle of transmission. “The end result is that hurricanes and floods do not have a major impact,” Petersen told reporters in a conference call.

“Heavy rainfall can certainly eliminate breeding sites rather create them,” he added. But in the weeks after a storm, pools of water can form and make new sites for the insects, he added. After Hurricane Katrina struck the Gulf coast in 2005, a few more cases of West Nile were reported but that was more likely because so many people were outside, repairing homes and cleaning up debris, he said.

“We continue to preach the message of making sure you are raining your yards,” said Texas state health commissioner Dr. David Lakey.

Heat could be a factor, also, if it incompletely dries up pools of standing water. “There has been a lot of speculation about the heat wave this year and could this partially have caused this effect, and the answer is yes,” Petersen said. But, he added, other heat waves have not led to outbreaks.  

 Officials in the Dallas area have been spraying pesticides to kill mosquitoes and Lakey and Peterson both said that should start cutting reported cases of West Nile there. It takes a few weeks for cases to be reported, so they said the number of reported cases will probably rise before it starts to fall.

More than half the cases reported so far this year have been of neuroinvasive disease – meaning the brain and spinal cord are affected. Peterson said it’s unlikely there’s an unusually high proportion of severe cases compared to years past. He notes that 80 percent of people infected with West Nile never even feel particularly sick, and it’s the serious cases that are more likely to get noticed and counted.

But people with neurological symptoms can be in serious trouble. There are three types – meningitis, which is inflammation of the spinal cord; encephalitis, which is when the brain is infected and inflamed; and acute flaccid paralysis, caused when both the brain and spinal cord are damaged. About one in 150 people infected with West Nile develop severe illness, according to the National Institutes of Health.

Patients with meningitis must be hospitalized but usually recover, Petersen said. About 10 percent of patients with encephalitis die, and those who survive may have subtle neurological effects long term. Patients who develop paralysis are in the worst trouble – a third recover, a third have some weakness long term and a third never recover, Petersen said. Some patients have had paralyzed limbs for years now.

Lakey says people of all ages have been affected, but the older people are, the more likely they are to be seriously ill. People with damaged immune systems, such as cancer patients, are at higher risk.

By the time patients with neurological symptoms get to the hospital, the virus has already invaded the nervous system, Petersen says. There’s no drug to treat West Nile virus anyway, and this effect makes it hard to develop one, because it’s hard to make a drug that can penetrate the central nervous system.

And because West Nile is so spread out and sporadic, it’s hard to even try to develop a drug or vaccine to fight it, Petersen said. Drug companies need lots of guaranteed cases of a disease to test whether a new vaccine or drug actually works.

“We are dealing with a low-incidence disease most years, (with) cases that are widely dispersed,” Petersen said. “The thought of trying to produce a phase 3 clinical trial to show efficacy is fairly daunting."

Related links:

Is spraying for West Nile safe?

Cluster of hantavirus cases worries officials

Five things you need to know about West Nile virus

Centers for Disease Control and Prevention

Deer mice, such as this one, can carry the hantavirus, which is now responsible for the deaths of two visitors to Yosemite National Park.

The hantavirus that has killed two California park visitors and infected two others has been known to science for only 20 years. It’s so rare that health officials say it’s unusual and worrying for there to be more than one case at a time in the same place.

National Park Service officials have taken the unusual step of cautioning 1,700 people who stayed in tented cabins at California’s Yosemite park this summer. The hantavirus can take weeks to start making people sick, so victims may not realize when and where they were infected. It kills about a third of its victims, and there’s no good treatment, making it highly dangerous.

The virus was so mystifying when it was first reported in 1993 that it was called the Sin Nombre virus – Spanish for “the virus without a name.” The first known victim was a strapping young New Mexico man who died despite efforts to save him. Others followed, the victims suffocating as their lungs failed or dying of kidney failure. The cases were clustered in the “Four Corners” region, where Arizona, New Mexico, Colorado and Utah come together.

Disease investigators trapped thousands of rodents in their search for the carrier and finally found the deer mouse was the host. The virus, it turned out, was related to a mystery virus that killed U.S. troops during the Korean War and that wasn’t identified until 1976.

It was named hantavirus after the Han river in South Korea. The virus doesn’t harm the mice, and they shed it in their urine and feces. It survives being dried out, and most of the victims appear to have been infected when cleaning or working in dusty buildings that had been closed up – perhaps allowing the mice to nest in it. Hikers and people who sleep outdoors on the ground are also susceptible.

The Centers for Disease Control and Prevention gets about 20 reports a year of hantavirus, says Barbara Knust, of the CDC’s viral special pathogens branch. This year doesn’t look unusual in terms of numbers, she says, but a cluster of four cases in one place is.

“It’s a concern because it is a park where lots of people visit and also it is unusual for more than one hantavirus case to occur in any one location,” Knust said in a telephone interview. “We think the likely reason is that it is an area with a lot of deer mice … and which also has a lot of visitors.”

People are infected when they breathe in dust contaminated with rodent droppings or urine. The Park Service is cautioning people who stayed in "Signature Tent Cabins" at Curry Village in the park. The cabins, with flexible fabric sides, are attractive places for rodents to nest.

“Just having a situation where there is some kind of a mouse infestation and some kind of activity that might stir up the air, or opening a building that might have been closed for a while” can expose people to the virus, Knust said.

“Since hantavirus pulmonary syndrome was first identified in 1993, there have been approximately 60 cases in California and 587 cases nationally,” the National Park Service said in a statement.

There’s no specific treatment for hantavirus infection. Knust said people with serious illness may need help breathing and people showing symptoms need to get to a hospital right away. Infected people are not contagious to other people.  

The National Institutes of Health says symptoms at first look like flu, and include chills, headache or muscle aches and fever. Symptoms progress to dry cough and shortness of breath, which can in turn lead to acute respiratory distress syndrome, kidney failure and dangerously low blood pressure. Patients may need oxygen or a breathing tube, and a generic antiviral drug called ribavirin may help prevent the worst symptoms although it’s not a cure.

The CDC has advice for people working in areas where deer mice might have nested.

• When opening an unused cabin, shed or other building, open all the doors and windows, leave the building and allow the space to air out for 30 minutes.
• Spray the surfaces, carpet and other areas with a disinfectant. Leave the building for another 30 minutes.
• Spray mouse nests and droppings with a 10 percent solution of chlorine bleach or similar disinfectant. Allow it to sit for 30 minutes. Using rubber gloves, place the materials in plastic bags. Seal the bags and throw them in the trash or an incinerator. Dispose of gloves and cleaning materials in the same way.
• Wash all potentially contaminated hard surfaces with a bleach or disinfectant solution. Avoid vacuuming until the area has been thoroughly decontaminated. Then, vacuum the first few times with enough ventilation.

Related links:

Second Yosemite visitor dies of rodent-borne illness

West Nile virus outbreak affects 1,100

New pig flu spreads to people at state fairs

Katharine Gammon, LiveScience

Global baby making seems at no want for a polish, with the world population at 7 billion and rising. But in reality, some evidence suggests part of this picture is breaking down: Sperm may be changing for the worse — at least in some places. The decline has been blamed on everything from cellphones in pockets to hormones in water to fatty food in the Western diet.

Evidence for a drop in sperm quality and quantity has included anecdotal reports from sperm banks as well as larger scientific studies. For instance, one sperm bank in Israel says that when it opened its doors 1991, it turned away about a third of the applicants for low quality. Using the same standard today, it would reject more than 80 percent, according to an article in the LA Times. And while the jury is still out on whether there is a real "sperm decline" and what that means for fertility, scientists say if the little swimmers are truly changing, it may be a red flag for harmful environmental toxins or even physiological changes in the human body.

"I firmly believe there's a decline," said Grace Centola, a sperm bank consultant and president-elect of the Society for Male Reproduction and Urology. Centola said she combed through the past eight years of sperm-donor data in the Boston area, and found "a statistically significant decline in semen volume, sperm count and motility over those years." The age of sperm donors didn't change, so the drop couldn't be attributed to age — and even the technicians who took the samples remained the same. Centola says she will present the data at a conference this fall. [5 Myths About Fertility Treatments]

(Other U.S. sperm banks contacted by LiveScience said they hadn't noticed any changes in sperm quantity or quality.)

The story globally is far from clear. Twenty years ago, a paper published in the British Medical Journal reviewed 61 studies of semen quality carried out between 1938 and 1990 and came to a jolting conclusion: In 50 years, the sperm counts had halved — going from 113 million sperm per milliliter to 66 million sperm per milliliter. (The World Health Organization considers 15 million sperm per milliliter to be a normal sperm concentration.)

But there was a problem, as the studies reviewed only looked at developed countries and may have included people who were already concerned about their sperm count and were turning up for fertility studies to begin with.  

To make matters worse, the baselines for sperm count aren't consistent, and there is nearly no data available before about 1950. A Danish study showed no decrease in the count or quality of sperm in 5,000 men enrolled in military service, while a recent study of men in Finland showed that men born toward the end of the 1980s tended to have lower sperm counts than those born at the beginning of the same decade. In Israel, sperm banks report that sperm quality has plummeted over the past 10 to 15 years — the concentration of sperm in samples collected by the bank dropped 37 percent, according tothe LA Times.

"Semen quality certainly appears to be declining in the regions and in the populations that are traditionally studied," said Raywat Deonandan, an assistant professor and epidemiologist at the University of Ottawa, referring to western, developed countries.

Deonandan's research, detailed online March 22 in the International Journal of General Medicine, suggests many previous semen-quality studies suffer from selection bias; they tended to take samples from more affluent men in more urban areas.

So why care about the muddy picture, if babies are still being born? So far, there has been no global shortage of babies — but in 30 percent of the cases of infertility, there is a male factor, said Wendie Robbins, a professor at the UCLA School of Nursing. Male infertility is suspected in about 70 percent of cases in Israel.

"Many times, there is just no cause that people can find for infertility," she said, adding that she was surprised how interested the men in a new study of hers were about increasing their fertility. "People underestimate how much men are interested in optimizing the possibilities for their offspring." (Robbins and colleagues recently found in a study partially funded by the California Walnut Commission that eating walnuts may boost sperm quality.)

Deonandan says there are two reasons why the sperm situation should be taken seriously. "If the decline is real, then an essential aspect of the human animal is being changed very rapidly in only a few generations," he told LiveScience.

The cause of such a decline could be a canary in a coalmine for other human health problems. If the mechanism is hormonal, linked, for example to an increase of estrogen from plants like soy, then it means that other aspects of human health are also being affected; hormonal systems regulate much of physical and psychological health. If the cause is environmental — pesticides, diet, or even cellphones — then industries could make changes to prevent damaging sperm. Centola gives another possible cause, linked more to behavior than the environment: sexually transmitted infections can hinder sperm production and motility. [Quiz: Test Your STD Smarts]

Studying sperm in men from remote places, like the Pacific islands, said Deonandan, would give a clearer picture of the cause of this drop. Those men are less likely to be exposed to industrial pollutants, less likely to eat so-called modern or Western diets, high in processed fats and simple carbohydrates, and more likely to be involved in hard physical labor.

"In other words, they are less likely to engage in what most of us would consider the modern, Western lifestyle," he said. If those men don't show a decline in sperm quality, then the reason for the drop could be behavioral or environmental, but not a fundamental, genetic change in human physiology.

"Rapid changes in reproductive function may indicate serious changes in our environment, which may be affecting our health in so far undetectable ways," said Deonandan. So, while the global decline in sperm quality may not stand up to rigorous testing, "it's definitely worth taking seriously, since it may open the door to deeper insights into other ways in which changes to our environment, behavior and lifestyles are negatively affecting our biologies."

More from LiveScience:

• Macho Man: 10 Wild Facts About His Body
• The Sex Quiz: Myths, Taboos and Bizarre Facts
• That's Incredible! 9 Brainy Baby Abilities

Susan E. Matthews, MyHealthNewsDaily

Vitamin B3 may offer a new way to treat infections from potentially deadly staph bacteria such as MRSA, according to a new study.

Researchers treated mice and human blood cells in lab dishes with a hefty dose of vitamin B3 and found that the ability of immune system cells to fight a staph infection was increased a thousandfold. In particular, the vitamin helped treat staph infections that are resistant to antibiotics, they said.  

"This could give us a new way to treat staph infections  that can be deadly, and might be used in combination with current antibiotics," said study author Adrian Gombart, an associate professor of microbiology at Oregon State University. "It's a way to tap into the power of the innate immune system and stimulate it to provide a more powerful and natural immune response."

The difference between petri dishes treated vitamin B3, also called niacin, and untreated dishes "indicates that there's a dramatic inhibition" caused by the presence of the vitamin, Gombart said. When applied to human blood, vitamin B3 triggered an immune system attack on the bacteria in a matter of hours. 

The dose of vitamin B3 used in the study could be given a person and not cause health problems, Gombart said.

While the dose would require a prescription and a doctor would have to administer it, the same level of vitamin B3 could be consumed through diet or over-the-counter supplements, Gombart said. However, consistently taking high doses could cause health problems, such as liver damage, or a high level of inflammation that could lead to a heart attack, he said.

"I wouldn’t encourage individuals to go out and load up on vitamin B3," Gombart said.

Dr. Bruce Hirsch, an infectious disease specialist who was not involved in the study, noted that a high-dose vitamin B3 treatment would be used only when someone is infected with staph, rather than as a preventive measure. 

Hirsch, from North Shore University Hospital in Manhasset, N.Y., said the research made use of "elegant biology" and an understanding the body's defenses.

"Antibiotics kill germs, and this treatment increases the body's way of responding to these germs," he  said.

During the study, Gombart said, the high dose of vitamin B3 strengthened white blood cells called neutrophils, which can attack and engulf bacteria. The vitamin may "turn on" genes that are important for killing bacteria, he said.

Combining the vitamin with antibiotics may be a powerful means of treating staph infections, Gombart said.

A combination of antibiotics and vitamin B3 could reduce the bacteria's resistance to antibiotics, Gombart said. "When there are multiple points of attack, it's always harder to develop resistance," he said.

Staph infections are particularly dangerous for people living in crowded conditions, as well as for people in hospitals. One strand of staph bacteria, MRSA, kills 19,000 people a year, according to the Centers for Disease Control and Prevention.

The study was published Aug. 27 in the Journal of Clinical Investigation.

Related content: 

• 4 Easy Ways to Get More Vitamin C
• Top 7 Germs in Food that Make You Sick
• 5 Key Nutrients Women Need As They Age 

M. Spencer Green / AP

A new study adds to a growing body of evidence that the flu shot is safe for pregnant women.

NEW YORK — Adding to evidence that the flu shot is safe for pregnant women, a new study finds no link between the vaccine and the risk of serious birth defects.

The study, of nearly 9,000 pregnant women who got the flu shot, found that about 2 percent had a baby with a major birth defect, such as a malformation in the heart or a cleft lip.

That was identical to the rate among almost 77,000 pregnant women who did not get the vaccine.

What's more, researchers found, women who got vaccinated were less likely to suffer a stillbirth (a pregnancy loss after the 20th week): 0.3 percent did, versus 0.6 percent of unvaccinated women.

Their newborns also had a lower death rate: 0.2 percent died soon after birth, compared with 0.4 percent of babies born to unvaccinated moms.

It's not clear if the flu vaccine deserves the credit. But Dr. Jeanne S. Sheffield, the lead researcher on the work, said it's possible the vaccine helped by preventing severe cases of the flu.

"Can we say for sure that it's the vaccine? No," said Sheffield, a professor of obstetrics and gynecology at the University of Texas Southwestern Medical Center in Dallas.

But, she added, these findings suggest that the flu shot is at least safe, and possibly has a benefit against stillbirth.

Sheffield and her colleagues report the findings in the journal Obstetrics & Gynecology.

The Centers for Disease Control and Prevention (CDC) and other groups recommend that all pregnant women get a seasonal flu shot.

That's because pregnant women are more likely than other women their age to get a severe case of the flu or have complications, such as pneumonia. The flu is also thought to raise the risk of preterm delivery and fetal distress.

Still, Sheffield said, many women and doctors alike still have concerns about flu vaccine safety during pregnancy — especially the first trimester, which is when birth defects form and when most miscarriages happen.

But in this study, the researchers found that vaccination during the first trimester came with no increased risk of birth defects.

Despite recommendations to get the flu shot, most pregnant women do not. In the U.S., only between 10 percent and one-quarter of women have been vaccinated each flu season over the last couple decades, Sheffield's team notes.

Based on studies, that seems largely due to safety worries.

On the other hand, Sheffield said "it's amazing" how many women are unaware that the flu itself is considered a risk during pregnancy.

"The flu is a problem in pregnancy," she said. "But we have a vaccine to prevent it. And it's considered safe and effective in any trimester."

A CDC study published last year found "no unusual patterns" of pregnancy complications or newborn health problems among U.S. women who received the flu shot between 1990 and 2009.

Based on cases reported to the CDC's Vaccine Adverse Event Reporting System, the rate of miscarriage was 1.9 per one million vaccinated pregnant women.

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• Pudge won't budge after menopause? Study offers diet strategies
• Mexican mangoes may have sickened 100
• Drug ingredients made in China entering market with little oversight

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Mangoes have been implicated in a growing outbreak of salmonella poisoning.

Health officials in the U.S. and Canada are investigating a possible outbreak of salmonella poisoning from mangoes imported from Mexico that may have sickened more than 100 people. 

At least 73 people in California have been infected with a strain of salmonella Braenderup linked to mangoes, said Matt Conens, a spokesman for the California Department of Public Health. Of those, about 67 percent reported eating the fruit.

Those cases are in addition to 22 illnesses from the same strain of salmonella confirmed last weekend by officials with the Canadian Food Inspection Agency. And, in late July, six cases of salmonella Braenderup possibly linked to mangoes were reported in residents of Washington state, said Donn Moyer, a health department spokesman. 

Officials with the Centers for Disease Control and Prevention are working with state officials to determine the cause and scope of the outbreak, said spokeswoman Lola Russell. The genetic fingerprint of the cases in the U.S. is the same as that found in the cases in Canada, "therefore, mangoes are the likely source," she added. 

Neither the CDC nor California health officials have confirmed a recall of contaminated mangoes, or named specific brands. 

"We will update the public when more information becomes available," Russell said.

But Larry Nienkirk, founder of Splendid Products, a distributor in Burlingame, Calif., said his firm has issued a voluntary recall of Daniella brand mangoes imported from Mexico, which are shipped to grocery stores and other retailers nationwide. Nienkirk declined to estimate the volume of mangoes recalled since contamination was detected in mid-July.

"Our thoughts are with anybody who has been affected by this," said Nienkirk, whose firm has specialized in mangoes for 37 years. "We're doing everything we can to get to the bottom of this."

Canadian officials warned consumers last week not to eat the Daniella brand mangoes. 

Canadian officials said the mangoes there were sold as individual fruit, with stickers bearing the PLU #4959. They were sold at retail locations between July 12, 2012 and Aug. 14, 2012. 

Health officials in Washington state and California are continuing to investigate the apparent outbreak. 

Salmonella poisoning can cause fever, headache, vomiting nausea, abdominal cramping and diarrhea. In people with weakened immune systems, including children and the elderly, it can cause serious illness and death. 

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SHANGHAI/LONDON — Philippe Andre, a detective in the murky world of Chinese pharmaceuticals, has some alarming tales to tell.

Keith Bedford / Reuters

U.S. Customs and Border Protection officer Boris Sapozhnikov looks at counterfeit drugs seized by the agency on Aug. 15 at its offices at John F. Kennedy Airport in New York.

In May last year, he visited a factory an hour outside Shanghai that supposedly produced a pharmaceutical ingredient. While shown around by men wearing protective clothing and spotless hard hats, Andre noticed oddities: the floor was immaculately clean and some workers sat around idle.

The factory had an inspection log that spanned eight years with perfect record-keeping, but the handwriting was the same for all those years and not a single page was dog-eared. What's more, while the factory had equipment to dry its product, there were no connecting pipes to funnel steam or waste gases out of the plant.

"Obviously the product was not made there," said Andre, a Belgian who runs a pharmaceutical auditing firm in the eastern Chinese city of Tianjin that advises foreign drug companies buying ingredients in China. The building, he says, was just one of the "showroom" factories intended to disguise China's thriving industry in substandard and counterfeit drugs.

Four years ago, Beijing promised to clean up its act following the deaths of at least 149 Americans who received contaminated Chinese supplies of the blood-thinner heparin. But an examination by Reuters has found that unregulated Chinese chemical companies making active pharmaceutical ingredients (API) are still selling their products on the open market with few or no checks.

Interviews with more than a dozen API producers and brokers indicate drug ingredients are entering the global supply chain after being made with no oversight from China's State Food and Drug Administration (SFDA), and with no Good Manufacturing Practice (GMP) certification, an internationally recognized standard of quality assurance.

"There is falsification of APIs going on, we know it," said Lembit Rago, coordinator for Quality Assurance and Safety in Medicines with the World Health Organisation (WHO). "The regulated markets like Europe and the United States are relatively safe because they have well-resourced regulatory authorities. But the situation is different in places like Africa, where there are a lot of local medicine manufacturers who all use APIs from China."

The export of unregulated drug ingredients may be putting lives at risk, particularly in poor countries where local pharmaceutical controls are minimal. Medicines containing faulty active ingredients or the wrong dose do not work properly and can contribute to the emergence of drug-resistant strains of dangerous diseases, such as malaria.

'Crime against public health'
"We see this as a global crime against public health," said Edward Sagebiel, a spokesman for Eli Lilly and Co., a multinational pharmaceutical company that says it imposes high standards on its own products, but has seen the unauthorized production of the active ingredients for its drugs by unsupervised Chinese firms. "Because these bulk chemicals are unregulated, they are inherently unsafe."

China's dominant position in the global market for pharmaceutical ingredients makes the issue both pressing and hard to tackle.

"Illegal ingredients in bulk are a big problem, but nobody talks about it," said Guy Villax, chief executive of Hovione, an API supplier based in Portugal with factories there and in China, the United States and Ireland.

About 70 to 80 percent of all active drug ingredients — the biologically active component in medicines — originate in China and India, estimate industry experts, with China accounting for the lion's share. Its export market in these products is worth $22 billion in annual sales, according to the China Chamber of Commerce for Import and Export of Medicines and Health Products.

"If China for some reason decided to stop exporting APIs, within three months all our pharmacies would be empty," said Villax.

The risks go beyond approved drugs. Unlicensed Chinese chemical firms advertise substances that have been pulled from western markets on safety grounds, such as the weight-loss treatment rimonabant, once sold by French firm Sanofi SA as Acomplia.

Rimonabant was withdrawn in Europe in 2008 after being linked with users having suicidal thoughts, and it was never approved in the United States. Yet in August, Chinese suppliers were advertising the chemical compound online as available for export. Other unlicensed Chinese manufacturers offer active ingredients still protected by patent in western markets.

Meanwhile China's SFDA — the equivalent of the U.S. Food and Drug Administration — says foreign companies should take responsibility for standards by buying products only from properly certified exporters.

A spokesman for the SFDA told Reuters: "We hope drug watchdogs from importing countries give similar suggestions."

After the heparin scandal of 2008, Beijing issued a white paper stating that pharmaceutical companies making any APIs, not just those manufacturing APIs for a designated final product, must have a license from the SFDA. The authorities have also introduced more stringent manufacturing standards.

However, loopholes remain and legal experts say the tougher framework is not strictly enforced.

This year fake versions of Roche's injectable cancer drug Avastin appeared in the United States after transiting Europe. At the time, Roche said it was aware of many cases where counterfeiters had tried to fake other drugs in its portfolio and it was working with law enforcement agencies to stop the trade.

The precise origin of the fake Avastin remains unknown, but in June last year a Shanghai court sentenced 11 people to jail in connection with another case involving bogus Avastin.

A key regulatory weakness in China is the distinction between pharmaceutical and chemical companies. While the former are regulated by the SFDA, the latter, making everything from sweeteners to solvents, are not. Yet many chemical companies also churn out drug ingredients, exploiting a loophole by describing the products as chemicals, which they are, rather than the more specific designation of APIs.

Unregulated trade
The company New-Sensation Chemical, based in Zhengzhou, the capital of China's Henan province, is one chemical company involved in the unregulated trade. It specializes in producing peptides, a relatively complex class of compounds used in a range of drugs.

Grace Xi, a sales representative, said the company does its own manufacturing, quality control and export. While there is no suggestion its products are substandard, the firm is not GMP-certified or registered with the SFDA.

A New-Sensation product list reviewed by Reuters showed the chemical names of APIs used to treat prostate cancer, bone disease and abnormally low blood pressure, alongside growth hormones used by bodybuilders to build muscle.

The list also showed bremelanotide, touted as a female version of Viagra, which is still under testing by the U.S. company Palatin Technologies Inc. Though the drug is not yet approved for use in western markets, the product list of New-Sensation Chemical offered the active ingredient for $13 a vial.

When asked about bremelanotide, Xi said the chemical, though on the product list, was not really for sale. She said the company sold only chemical compounds, "not APIs".

Another chemical company, Jinan Hongfangde Pharmatech (JHP), of Jinan city in Shandong province, had a product list showing at least five patented products for sale. They included tiotropium bromide, a blockbuster lung drug co-promoted by Boehringer-Ingelheim and Pfizer Inc. and sold under the name Spiriva, and Eli Lilly's chemotherapy drug pemetrexed, sold under the name Alimta.

A spokeswoman for Boehringer-Ingelheim said the German group was aware there were problems with unlicensed suppliers, adding that it only bought ingredients to make its branded products from trusted sources and was rigorous on quality controls.

Pfizer and other multinational drug manufacturers, some of which have long-standing deals with respected Chinese companies, also said they were confident in their supplies and only bought from GMP-certified firms.

Allen Li, a sales representative of JHP, said his firm, which has no GMP certification and is not registered with the SFDA, was doing nothing wrong. "We do not infringe on patents, we respect the original manufacturer's research," he said.

When pressed about the production of APIs still under patent, Li said those substances were not for sale despite being advertised. He declined to answer further questions. "I'm tired of the criticism. Internet, print media, newspapers are keen to criticize," he said.

No senior executive from JHP or New-Sensation Chemical was available for comment.

Fatal consequences
The rise of the Internet has facilitated exports of drug ingredients. An online search brings up websites offering hundreds of Chinese API sellers. Those not GMP-certified or SFDA-registered are not necessarily substandard, but buyers lack independent quality assurance.

The pervasive presence of brokers in the supply line is another risk. Pharmaceutical companies looking to source APIs in China typically hire middlemen to help them navigate the language, red tape and protocol. That system helps Chinese companies making substandard APIs avoid detection.

Robert Walsh, managing director of biotech advisers Samsara Biopharma Consulting, which has offices in the United States and China, believes big-name multinational drug companies typically select Chinese suppliers on the basis of quality and core manufacturing competence, but says not all buyers are so picky, particularly low-cost generic drugmakers.

"Any number of foreign pharmaceutical companies go no further than looking for API suppliers at CPhI (an international pharmaceutical fair) based only on price," Walsh said.

Reuters spoke to brokers who said an API made by an unregulated chemical company would cost less than one from a company that had a GMP certificate.

"Different (API) grades have different prices. Sometimes we accept an order sheet and we happen to find a factory that can do it cheaper than our factory, we will outsource to them and make a bigger margin," said one broker based in China who sources for a South African outsourcing firm.

In China there are few legal repercussions for broker firms who relabel or misrepresent products, and tracing counterfeit and substandard APIs is extremely difficult.

"There are a lot of brokers who are relabeling (APIs) which means you can't trace where the API comes from and that adds to the risk," said the WHO's quality assurance expert Rago.

Andre, the Belgian drug detective, estimates he has uncovered fraud or misrepresentations in as many as 25 percent of cases where he has been hired to audit factories all over China. "If you can substitute an API that is expensive to make and manufactured at a high level with something that costs much less, then that can happen," Andre said. "It's impossible to give an exact number, but it's not rare. It's a minority, but not tiny minority."

The human cost can be high. Low-quality and fake anti-malarial drugs accounted for more than a third of samples recently analyzed in sub-Saharan Africa, according to a study in the Lancet Infectious Diseases journal in May. Separate research in the journal Research and Reports in Tropical Medicine found Chinese-made drugs to treat malaria and other common tropical infections performed particularly poorly in tests.

"I think Chinese exporters to Africa know that bad products will be less likely spotted there," said Roger Bate, resident scholar at the American Enterprise Institute, who led the second study.

Sometimes the effects of substandard medicines can be fatal: in 2006 about 100 people died in Panama after taking cough syrups containing a Chinese-made sweetener tainted with diethylene glycol, an industrial chemical used in antifreeze. Other cases, though not immediately lethal, pose long-term health threats. Earlier this year, Chinese authorities announced they had discovered millions of medicine capsules made with industrial gel containing chromium, a carcinogenic heavy metal.

Tougher enforcement
In August, Chinese authorities arrested nearly 2,000 people in a nationwide crackdown on counterfeit drugs, seizing more than $180 million worth of fake products purporting to treat illnesses ranging from diabetes to high blood pressure and rabies.

Officials are also deploying more technology. By 2015, China hopes to be able to electronically track different types of drugs from their production to end-market to prevent counterfeit and inferior drugs from being distributed, although this will only apply to products traded inside the country.

Despite these advances, legal experts and international officials still think China is not doing enough. Eli Lilly says it is unfortunate that the crackdown does not specifically target bulk pharmaceutical ingredients.

At the U.S. FDA, Commissioner Margaret Hamburg said her agency now had three offices in China and had identified a number of other products, in addition to heparin, where there could be particular "vulnerabilities".

She declined to give details, but brokers said any API with a potentially lucrative return was at risk if it could be made more cheaply by unregulated companies. Hamburg said: "We do think there's more work to be done in this area and we're very interested in working closely with China."

The United States and Europe both plan to tighten regulations to control API quality better. Washington recently approved the Generic Drug User Fee Amendments, which require inspections of foreign and domestic generic drug manufacturing facilities once every two years.

From next year the European Union will implement a Falsified Medicines Directive, putting the onus on drug companies to prove the purity of the ingredients they use, whether they are produced in Europe or imported.

These new measures will further protect western markets, where the risk of dangerous or counterfeit medicines entering the legitimate supply chain is already low. But developing countries with weak domestic regulations remain vulnerable.

Melanie Lee reported from Shanghai and Ben Hirschler from London; Additional reporting by Anna Yukhananov in Washington and Bill Berkrot in New York.

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Courtesy of Robin Herman

Robin Herman, 60, says it's harder to keep weight off after menopause. But some simple, subtle changes may help.

Robin Herman has always been slender. She eats right, exercises regularly and keeps an eye on her weight. But middle age and menopause have hit her right in the waistband, and she’s frustrated.

“What is this? I used to be able to look straight down at my feet and now there’s this rounded tummy in the way,” Herman says. While she’s still not overweight, Herman, 60, has gained 11 pounds that she just can’t seem to shake. Her problem illustrates what many women are finding in mid-life -- they are putting on pounds despite their best efforts.

“At first I cut back about a quarter of what I was eating. And then I was just eating about half of what I had been eating. Now I don’t take seconds. I don’t eat a lot of bread. I don’t eat potatoes. I don’t eat empty calories. I don’t drink sodas,” said Herman, who recently retired from the Harvard School of Public Health in Boston.

She joined Weight Watchers, a program that’s been clinically proven to work in helping people lose weight. “I kept a food diary. You could eat as many fruits and vegetables as you wanted. I put in a little more exercise,” she says.

“I got nowhere. It just wasn’t doing anything. And it was making me crazy about following every spoonful I ate.”

Herman sounds like thousands of women across the country who are slowly tipping over the point from being normal weight to overweight, or from being overweight to obese. A study published on Tuesday sheds a little light on what may work and why some approaches that help women shed a few pounds in the short term aren’t helping them keep the weight off long-term.

Bethany Barone Gibbs of the University of Pittsburgh Medical Center and colleagues analyzed data from a study of more than 500 overweight women in their 50s and 60s to see what made a difference. They had been randomly assigned to either intensive nutritional and exercise counseling, or to a more general, less weight-loss-focused program. The woman also reported what and where they ate, for four years.

As expected, more of the women who got specific diet and nutrition counseling lost weight. But Gibbs and colleagues wanted to know what worked for any of the women who managed to lose weight, regardless of which group they were in.

Early on, some of the more obvious diet strategies worked -- eating less fried food, staying away from restaurants, avoiding sweets and eating more fish. But these approaches didn’t work for the women in the long term, Gibbs reported in the Journal of the Academy of Nutrition and Dietetics.

 “What we found at four years is that the women who changed their eating behaviors to eat more fruits and vegetables, who ate less desserts, less sugar-sweetened beverages and less meats and cheeses were more likely to have greater weight loss or less weight gain long term,” says Gibbs, an assistant professor in the Department of Health and Physical Activity.

“But on the other hand, something like eating more fruits and vegetables did not predict weight change at six months but was one of the most important predictors for long-term weight change.”

Avoiding restaurants didn’t seem to make a difference long-term, either, she said. Gibbs said the key to keeping weight off long-term may be a little counter-intuitive. “Short term, people are still motivated when they start a weight loss program,” she said. “They are never going to eat another French fry, eat another piece of pie, so you see the pounds coming off.”

But hardly anyone can keep this kind of abstinent behavior up forever. The women who added fruits and vegetable to their diets, using them to replace higher-calorie meats and cheeses, lost more weight over the long-term. “That small change can give you a big, long-term result,” Gibbs said.

How could something so subtle work better than going for the big effect? In part, it’s because weight gain is often subtle and sneaky, too, says Katherine Tallmadge, a personalized nutrition counselor and speaker and immediate past president of the DC Metro Area Dietetic Association. “When people gain weight, it’s usually a pound or a pound and a half a year,” she says. “It is a very small and creeping kind of weight gain.”

The study also illustrates what many middle-aged women complain about. “I recall at age 25 if I wanted to lose five pounds I could do it in a week.  Now, it takes far longer to lose weight,” says Karen Giblin, president of menopause support organization Red Hot Mamas North America, Inc.   

This doesn’t surprise Dr . Domenica Rubino, an endocrinologist who runs the Washington Center for Weight Management and Research. “As we age, the average person has a tendency to gain weight and to gain more fat than muscle,” Rubino says. On top of this, women are undergoing hormonal changes that can disrupt sleep, stress them out and make them tired, three things also associated with weight gain. “Women are getting early morning awakening  and even though they are exhausted, they are not getting back to sleep,” she says.

Giblin can vouch for what happens next. “My willpower goes down the tube when I'm stressed and I will not do all the good things I should do be doing like eating properly and exercising,” Giblin says.

It all can add up to the muffin top effect: that shift of weight to the abdomen that makes clothes fit poorly, if at all, and that stresses out a woman every time she gets dressed.

“It’s so hard counting calories and keeping food diaries for years and years and years,” Gibbs agreed. “We have a population-sized problem here.” With two-thirds of Americans overweight or obese, she says, people need some simple solutions.  

“I've had to make exercise a lifestyle choice,” says Giblin, who co-authored "Eat to Defeat Menopause" with Dr. Mache Seibel last year. “Never skip a meal,” she advises. “And if you are prone to snacking, grab a piece of fruit or six  to eight almonds.”

Rubino says hormone replacement therapy can help, too, if it helps cut hot flashes and anxiety. “You are sleeping better and not having the hot flashes and your mood is better,” she says.

STOP Obesity Alliance Director Dr. Scott Kahan says managing stress can really help people control weight. “If things are very stressful, things are going on in your life, often stress management techniques can help,” he says.

Kahan and others admit this can be easier said than done. “I think we live in a very difficult time, a toxically busy world,” Tallmadge says. “What really upsets me is when people call themselves lazy or undisciplined when in fact they are running themselves ragged.”

But it’s not exercise.  Many women are busy getting their families ready for the day and then commuting during the very morning hours when they would have been otherwise most likely to exercise.

“It’s a real balancing act.”

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