People worried about having to pay a fine for not carrying health insurance coverage got a little more guidance this week with some new federal regulations. The bottom line: Hardly anyone will end up paying the tax when the health reform law takes full effect in 2014.

The Urban Institute has projected that only about 2 percent of Americans would likely have to pay what the government calls the “shared responsibility payment.” The new regulations from the Internal Revenue Service and the Health and Human Services Department explain all the ways people can get out of paying it.

“What we are talking about is a relatively small slice of the population,” says Linda Blumberg, senior fellow at the Urban Institute’s health policy center.

The Congressional Budget Office has said that 80 percent of the non-elderly population would have some sort of health insurance even without the health reform law.

The so-called individual mandate, one of the least popular provisions of the 2010 health reform law, is meant to make sure that people don’t wait until they are sick to buy health insurance—especially as the law makes health insurance available more easily to more people, including those who are already sick.

The idea is that people will have many more chances to get health insurance because of the exchanges, the marketplaces where private insurance plans will offer policies for people to buy if they are not covered by an employer or by government-sponsored insurance such as Medicare, Medicaid and Tricare.

And the federal government is subsidizing all but the wealthiest buyers. The Supreme Court ruled it constitutional and says the payment is actually a tax.

It’s a nominal tax at first -- $95 in 2014, $325 in 2015 and $695 or 2.5 percent of household income in 2016. The IRS will make sure people pay it. Starting next year, you’ll have to declare where you get your health insurance on your income tax form.

“If you don’t pay on your tax returns if you own an assessment, what they are going to do is take it out of possible future tax refunds,” Blumberg said in a telephone interview.

One way the law aimed to get more people covered by health insurance was by making Medicaid more widely available. But the Supreme Court ruled last summer that states, which administer Medicaid and pay for part of it, could opt out.

The regulations make it clear there are plenty of exemptions. For instance, people who live in a state that has decided against expanding Medicaid won’t have to pay the tax if they would have been eligible for Medicaid.

So, if people live in a state that isn’t expanding Medicaid, they might not be on the hook to buy health insurance for themselves, although the government recommends they do.

“That’s an important clarification,” Blumberg says.

Also, people get one three-month slide. You can go for as long as three months, one time, without health insurance before the payment kicks in. After that, the IRS rules say people will be assessed 1/12^th of the annual payment for each month they or their legal dependents lack coverage.

“For each month during the taxable year, a nonexempt individual must have minimum essential coverage or pay the shared responsibility payment,” the regulation reads.

People are exempt if they are in jail or prison, if they make too little money to file an income tax return ($9,500 a year for an individual), if their health insurance premium would cost them more than 8 percent of annual income, members of Indian tribes, those whose religion forbids buying health insurance, illegal immigrants, Americans living abroad, and members of a health care sharing ministry.

The IRS has a public hearing scheduled for May 29 on the new regulations.

Related stories:

• Government releases long-awaited health reform rules
• State elections decide health care's future
• Lots left to do on health reform after Supreme Court ruling

Don’t miss the latest health news on NBCNews.com

By Associated Press

Need a condom delivered to your doorstep in an hour? Then Dubai is the place to be.

Already the launching pad for American fast-food restaurants and a Canadian coffee shop, the glittering Gulf metropolis now features a service from Durex and Buzzman Middle East called SOS Condoms.

Starting this week, users can have Durex products delivered within an hour to anywhere in the city from 4 p.m. to 4 a.m. Users order condoms from their smartphone or a website.

Sandrine Girard, a spokesman for Buzzman, said Thursday that the service will expand to other cities with the next city decided by a competition on SOS Condoms' Facebook page.

Dubai has strict laws on sex-related issues, but is more liberal than the rest of the Persian Gulf.

By Rachael Rettner
MyHealthNewsDaily

A salmonella outbreak linked to pet hedgehogs has sickened 20 people in eight states, according to a new report from the Centers for Disease Control and Prevention (CDC).

All the patients were infected with a strain of bacteria called Salmonella typhimurium. Fourteen of the ill people reported direct contact with hedgehogs, the CDC said.

The outbreak began in December 2011, and has continued into 2013. So far, four people have been hospitalized, and one has died. Many of the affected have been children, the CDC said.

Related story: Pet hedgehogs sicken 14 with salmonella, CDC says

Washington state has reported the most cases, seven, followed by Michigan, Minnesota and Ohio, which have each reported three cases. Other states that have reported infections are Alabama, Illinois, Indiana and Oregon.

Although the most common source of salmonella infections is food poisoning, animals can spread the disease as well. Besides hedgehogs, salmonella outbreaks have also been linked to pet turtles.

To reduce the risk of infection, it's important to wash your hands after handling hedgehogs, or anything the animals come in contact with, the CDC said. Adults should supervise children around hedgehogs and make sure the youngsters wash their hands after touching the animal or anything the hedgehog has been in contact with.

The report will be published this week in the CDC's Morbidity and Mortality Weekly Report.

Follow Rachael Rettner on Twitter@RachaelRettner, or MyHealthNewsDaily@MyHealth_MHND. We're also onFacebook&Google+.

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The Hartz Mountain Corp. is withdrawing some 20,000 packages of chicken jerky pet treats in the U.S. after the firm's own tests found trace amounts of antibiotic residue, the same problem that led to earlier recalls by top suppliers. 

Hartz Chicken Chews and Hartz Oinkies Pig Skin Twists Wrapped with Chicken for dogs have been pulled voluntarily from retail shelves nationwide, according to the Secaucus, N.J., firm. 

Company officials said they conducted independent laboratory tests after New York state agriculture officials found evidence of antibiotic residue in treats produced by Nestle Purina PetCare Corp. and Del Monte Corp. Nestle withdrew Waggin' Train and Canyon Creek Ranch brand dog treats and Del Monte pulled its Milo's Kitchen Chicken Jerky and Chicken Grillers home-style dog treats from shelves nationwide.

In addition, two more firms recalled their treats as well, including Publix stores, which recalled its private brand Chicken Tenders Dog Chew Treats and IMS Pet Industries Inc., which withdrew its Cadet Brand Chicken Jerky Treats sold in the U.S.

Hartz officials said they found evidence of antibiotic residue in about a third of the treats they tested, but removed all the products as a precaution. They were not contacted by the New York officials, but lab tests found the same unapproved drugs including sulfaclozine, tilmicosin, trimethoprim, enrofloxacin and sulfaquinoxaline.

Four of the antibiotics are approved in China, where most of the treats are made, and in other countries, but not in the U.S. A fifth is allowed in the U.S., but in virtually undetectable amounts in finished products. 

There is no indication that the detection of antibiotic residue is related to an ongoing investigation into deaths and illnesses of dogs and cats linked to chicken jerky pet treats made in China, treat manufacturers and Food and Drug Administration officials agree. The trace antibiotic pose no health threat to pets or humans, FDA officials said. 

The agency is continuing to investigate what may be behind reports of 500 deaths and more than 2,700 illnesses in dogs and cats who consumed chicken jerky pet treats made in China. 

Related stories:

• Deaths of 500 dogs blamed on jerky treats 
• Firms withdraw jerky treats over antibiotics

By Rachael Rettner
MyHealthNewsDaily

Very obese children and teens may be at risk for multiple sclerosis, a new study suggests.

In the study, very obese girls (those who had a body mass index (BMI) of 35 or higher) were nearly four times more likely to be diagnosed with multiple sclerosis (MS) within the study period, compared with girls who were normal weight. The link was strongest among teenagers.

No link between obesity and multiple sclerosis was found for girls in other weight classes, or for boys.

In people with MS, the immune system attacks the nerve cells of the brain and spinal cord, producing symptoms such as numbness, loss of balance, weakness and tremors. MS is rare in children — about one to two kids out of every 100,000 will develop the condition. Symptoms are similar in children and adults, although youngsters may also experience symptoms not typical of MS, such as seizures or lethargy, according to the National Multiple Sclerosis Society.

The findings suggest that, as the prevalence of childhood obesity increases, so will cases of multiple sclerosis, said study researcher Dr. Annette Langer-Gould, of Kaiser Permanente Southern California Department of Research & Evaluation in Pasadena, Calif.

"Our study suggests that parents or caregivers of obese girls and teenagers should pay attention to symptoms such as tingling and numbness or limb weakness, and bring them to a doctor's attention," said Langer-Gould.

However, the study only found an association, and cannot prove that obesity causes multiple sclerosis. It could be that an aspect of the condition itself — such as having trouble exercising before the condition is diagnosed — predisposes youngsters to obesity. But if this were the case, researchers would expect to see the same link in girls and boys, which the study did not find, Langer-Gould said.

The researchers analyzed information from 75 children and teens ages 2 to 18 who were diagnosed with pediatric MS, and compared them with more than 913,000 children and teens who did not have MS. For those with MS, BMI was measured before the condition was diagnosed.

Obesity is known to increase inflammation in the body, which may be involved in the development of MS, Langer-Gould said. Estrogen, a female hormone, also increases inflammation, and together with other inflammatory factors released from fat cells, could accelerate the development of MS, Langer-Gould said. The involvement of estrogen might explain why the link was only seen in girls.

"The authors certainly have opened the door to an interesting association," said Dr. Michael Duchowny, a pediatric neurologist and director of academic affairs at Miami Children's Hospital Research Institute, who was not involved in the study. "These findings need to be repeated, expanded and clarified further" with additional research, including studies that test the estrogen hypothesis, Duchowny said.

Previous studies in adults have suggested that obesity, or related factors, such as levels of appetite hormones, play a role in the development of MS, said Dr. Steven Mandel,  a neurologist at Lenox Hill Hospital in New York City.

"It doesn't mean that if you're obese or overweight ,you're going to develop MS," but rather, that a link between the two conditions exists, Mandel said. The findings may be another reason to bring childhood obesity under control, he said.

Although preliminary, some saw the findings as hopeful.

"We're beginning to accumulate a good deal of information about some of the environmental factors that may play a role in MS, and environmental factors that are possible to be modified," such as smoking and obesity, said Dr. Nicholas LaRocca, vice president of health care delivery at the National Multiple Sclerosis Society. "That’s a very exciting possibility," LaRocca said.

The study will be published today (Jan. 30) in the journal Neurology.

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New research strongly reinforces the notion that prostate cancer is vastly overtreated with often dire results.

A study out Wednesday in the New England Journal of Medicine focused on treatment side effects, following a group of 3,533 men for 15 years after they got either surgery (called prostatectomy) or radiation for cancer that had not spread beyond the prostate. Radiation produced fewer side effects -- especially in the first years after treatments-- but both groups experienced huge impacts.

“This paper tells you that if you get treatment there are a lot of side effects regardless of the therapy you chose,” the senior author Dr. David Penson, professor of urologic surgery at Vanderbilt University Medical Center, said in an interview.

Most men were in their sixties when they were first treated. Two years after treatment 60.8 percent of the men who had undergone radiation had erectile dysfunction, compared to 78.8 percent of those who chose surgery. By 15 years, the numbers became 87 percent and 93.9 percent. Many men also suffered urinary and bowel problems and those, too, grew worse with time.

A rational argument is that such side effects are acceptable if the treatment is saving lives. But the paper raises serious doubts.

“So many of these men have low-risk disease that probably doesn't need to be treated,” Penson said.

Men typically undergo needle biopsies because they have elevated levels of the blood test called prostate-specific antigen (PSA). If the needle finds cancer cells, a pathologist measures their severity, resulting in what is called a combined Gleason score that ranges from 1-- the least severe-- to 10. Most prostate cancers score between 6-7. Several top urologists at university medical centers agreed that prostate cancer below a score of 6 should be watched, but not treated. Yet in this latest study, which is a reliable cross-section of how medicine is actually practiced, about 60 percent of the men who underwent treatment had scores of 2 to 4.

The findings prove that “a staggering percentage of men with totally inconsequential prostate cancer got treated and suffered the consequences,” says oncologist Dr. Marc Garnick of Beth Israel Deaconess Medical Center and Harvard Medical School, who was not involved the study.

Undoubtedly, prostate cancer can be deadly. Estimates are that it will kill almost 30,000 men in the United States this year, second only to lung disease as the major cause of cancer deaths in men. But the problem is, there are at least two kinds of prostate cancer.

The common form appears in the majority of men over age 50, grows slowly, and never presents a health threat. The other form spreads rapidly and can lead to a horribly painful death, usually from malignant cells invading the bones. Doctors cannot tell the difference between the dangerous and harmless cancers. Researchers are looking for genetic markers that would make the critical distinction, but they have yet to find them.

Meanwhile, increasing numbers of prostate cancer specialists argue that the sensible path is for men with lower combined Gleason scores to undergo active surveillance (formerly called watchful waiting), come back for future tests and forgo treatment until it is indicated. Often they will never need treatment.

That doesn’t happen, however. Penson said recent surveys show that fewer than one in four men who are candidates gets active surveillance. The majority get surgery or radiation.

One reason for the intervention is “incentives for the facility and for the providers” -- in other words, money for hospitals and doctors. “Also,” he adds, “patients don't like to hear 'I have cancer and I'm just going to watch it.’” But patients should demand and doctors should educate that “just watching it” is perfectly safe in many cases. 

Learning that lesson could spare an enormous amount of misery and money.

Related:

Erectile dysfunction may increase heart risks
Shorter penis alarms some men after prostate treatment
Caffeine linked to leaky bladder in men

By MATTHEW DALY
AP
The Environmental Protection Agency is moving to ban the sale of a dozen rat and mouse poisons sold under the popular D-Con brand in an effort to protect children and pets.

The agency said Wednesday it hopes to reduce the thousands of accidental exposures that occur every year from rodent-control products. Children and pets are at risk for exposure because the products typically are placed on floors.

The agency had targeted a handful of companies two years ago, saying they needed to develop new products that are safer for children, pets and wildlife. All but Reckitt Benckiser Inc., manufacturer of D-Con, did so.

The company will have at least 30 days to request a hearing before an administrative law judge. If no hearing is requested, the ban will take effect.

Courtesy Minnesota Department of Health via AP

Vials of injectable steroid drugs made by the New England Compounding Center in Framingham, Mass., have been blamed for fungal meningitis and other infections that have caused 45 deaths and nearly 700 illnesses. Now, a new survey says that 13 percent of pharmacists and others polled said they found contamination in their sterile drugs last year.

As deaths continue to climb in the ongoing outbreak of fungal meningitis infections caused by contaminated pain shots, a new survey of hospital pharmacists shows that they believe it could happen again.

About 13 percent of pharmacists, pharmacy technicians and others who responded to a poll from the Institute for Safe Medication Practices said that they believed contamination had occurred in the compounded sterile drugs made by their shops last year.

Those are the same types of drugs now blamed for 45 deaths and nearly 700 infections in people who received tainted injectable steroids made by the shuttered New England Compounding Center of Framingham, Mass., according to the Centers for Disease Control and Prevention.

Only about half of staff pharmacists in the ISMP poll were confident that contamination had not occurred at their site in the past year. And nearly three-quarters of the 412 health care practitioners who responded said that contamination certainly could occur in drugs from their sites that were supposed to be sterile.

“We’ve known that this is a risk and a hazard for a long, long time,” said Mike Cohen, president of the ISMP, which monitors medication safety. “Consumers are still at risk. And they need to know.”

The fungal meningitis outbreak, which has left hundreds of people facing months or years of treatment, is among the “worst public health disasters related to medication in my lifetime,” Cohen said.

ISMP officials wanted to understand if the problems of properly managing high-risk compounded sterile preparations -- known as CSPs -- were as widespread as they thought.

It appears that the answer is yes.

The poll, which included mostly pharmacists, but also pharmacy techs, doctors and nurses, was conducted last November and December, at the height of the meningitis investigation, which was first detected in September.

It focused on how hospitals are managing CSPs, which are either made on-site by trained staff, or purchased from external compounding pharmacies, which includes companies such as NECC.

Sterile injectable drugs are particularly difficult to produce because they require mixing non-sterile drugs and other ingredients, which must be then terminally sterilized to ensure that no contamination such as bacteria, mold or fungi get into the final products.

In the case of NECC, federal inspectors found significant contamination throughout the site, including in the company’s so-called clean room.

But the new poll shows that problems may be present in other places, too. Eleven percent of the pharmacists and 29 percent of pharmacy techs in the study reported they believed there had been contamination of CSPs on site in the previous year. It’s not clear from the poll whether the contamination was detected before distribution, or whether the drugs made it to patients. Nor is it clear whether they reported the problems to hospital authorities or others.

Those are important questions, said Bona Benjamin, director of medication use quality improvement at the American Society for Health-System Pharmacists. If techs responsible for enforcing sterilization requirements under the strict USP 797 guidelines detected contamination as a result of careful testing, then it's a good sign. If the drugs were dispensed, then it's not. 

"Contamination is a well-known risk of compounding sterile products," Benjamin said. "I think the results are very interesting and I think it would bear a little bit of a deeper dive."

The poll also showed that half of the pharmacists were confident that contamination had not occurred on their watch, but that dropped to 38 percent when the pharmacy techs were asked.

Of the quarter of respondents who said that contamination could not occur in their facility, most noted that it was because high-risk CSPs were not prepared in their hospital pharmacies.

Ryan Forrey, associate pharmacy director at The Ohio State University Medical Center, said the ISMP poll underscores that hospitals should use high-risk CSPs only when they're necessary -- and that they should follow strict guidelines. 

"It highlights the need for work practices that are followed consistently and that are effective for reducing contamination," said Forrey, who is affiliated with the James Cancer Hospital and the Solove Research Institute.

The recent poll is only one more indication of the potentially serious problems involving sterile drug contamination, Cohen said. Food and Drug Administration Commissioner Margaret Hamburg faced harsh questioning by Congress in November about the agency’s handling of the fungal outbreak. In December, FDA officials recommended changing the way compounding pharmacies are regulated, in part to keep a closer eye on high-output pharmacies like NECC.

In the meantime, consumers should understand that sterile injectable drugs -- including back pain shots -- may be riskier than even the doctor acknowledges, Cohen said.

“If they’re going to get an epidural injection -- or have concerns about any injection, they should ask,” he said.

Related stories: 

• Lucky phone call alerted CDC to meningitis outbreak
• Fungal meningitis victim hopes Congress hears: 'It's torturous'
• Fallout from fungal meningitis mess: more drug shortages

By Rachael Rettner
MyHealthNewsDaily

The more severe a man's erectile dysfunction is, the greater his risk of being hospitalized for heart problems, a new Australian study finds.

Among men in the study who had no history of heart disease, those with moderate erectile dysfunction (ED) were 23 percent more likely to be hospitalized for a cardiovascular problem, such as a heart attack, during a two-year period compared to men who did not have ED. And those with severe ED were 35 percent more likely to be hospitalized for cardiovascular problems than those without ED.

Men who already had heart problems and severe erectile dysfunction at the study's start were 64 percent more likely to be hospitalized for another heart problem during the study period compared to men without ED.

The results held even after the researchers accounted for factors that might increase the risk of heart problems, such as age, smoking, alcohol consumption and obesity.

The findings agree with previous studies that have linked erectile dysfunction to an increased risk of cardiovascular disease. [See For Men, Sex Life Gets Better with Improved Heart Health.] But the new study is one of the first to investigate whether or not the risk of heart problems increases with the severity of ED.

The findings suggest erectile dysfunction may be a marker that signals underlying heart disease, the researchers, from Australian National University, said. It has been hypothesized that atherosclerosis (plaque in the arteries that limits blood flow) might first manifest itself in smaller blood vessels, such as those in the penis, the researchers said.

When a man sees the doctor for erectile dysfunction, the visit might be an opportunity to evaluate him for other problems, said Dr. Andrew Kramer, a urologist at the University of Maryland Medical Center, who was not involved in the study.

"You can use ED to get men in the door. It might be the only thing that brings them in," Kramer said. Urologists should encourage men with moderate or severe ED to visit a primary care doctor or cardiologist for heart disease screening, he said.

The researchers examined information from more than 95,000 Australian men ages 45 and over who filled out a health questionnaire between 2006 and 2009, and linked this information to records of hospital admissions and deaths in 2010.

During the study period, there were 7,855 hospital admissions related to cardiovascular disease and 2,304 deaths, the researchers said.

Men with erectile dysfunction of any severity (mild, moderate or severe) were at increased risk for hospitalization for heart failure compared to men who did not have ED.

Those with severe ED were about twice as likely to die during the study period than men without ED, the researchers said.

The study only found an association, not a cause-effect link. The researchers also did not have information about any medications participants were taking (some medications have ED as a side effect.)

The study was published today (Jan. 29) in the journal PLOS Medicine.

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Former Israeli Prime Minister Ariel Sharon in June 2005, just over six months before he suffered a massive stroke.

Ariel Sharon, the former prime minister of Israel, has been in a permanent vegetative state since suffering a massive stroke on January 4, 2006. For the past seven years, a respirator and a feeding tube have kept him alive at Sheba Hospital in Tel Hashomer, Israel. He has never shown any reliable signs of awareness or consciousness – until last week.

The stroke left the man once dubbed by Israelis as “the Lion of God” bedbound and technologically dependent on machines for his existence.

In the past, some of his family felt that he was able to slightly move a finger and show some signs of responsiveness but his doctors believed that the strokes so damaged his brain that both recovery and any serious mental activity were impossible.

But last week, a team of doctors and neuroscientists from Israel's Soroka University Medical Center subjected the 84-year-old Sharon to a series of sophisticated brain scans. They were surprised at what they saw.

They showed him pictures of random houses, which he would not be expected to know. Then they flashed a picture of his own house before his eyes. When the images of his own home were shown, areas of his brain "lit up" with activity. Similarly his brain ”fired up” in response to hearing the voices of family members but did not when nonsensical gibberish sounds were presented to him.

Sharon is not the first person to surprise doctors who doubted that anything could be going on in a brain located in a body that was otherwise unresponsive for years. Other patients with massive brain injuries have shown some brain activity included one case in which a 23-year-old woman, when asked to imagine different scenarios including playing tennis, showed strikingly similar patterns of brain activity to those found in scans of healthy volunteers.

So what are we to make of this? Can doctors say with certainty that he won’t recover?  Is Sharon really “in there” unable to move but alert and awake?  Should we ever remove life-support from someone who has been severely brain injured by a stroke or traumatic injury or asphyxiation? These questions are hardly trivial since families and health care teams face them every day all over the world.

Can Sharon come back? Many Israelis and his family fervently hope so but older patients, especially 84-year-olds who have been through two strokes and remained unresponsive for seven years, do not come back.

Is he “in there”? Let’s hope not. Being trapped in your own body year after year unable to move anything or communicate in any way would be horrific.

What about the brain activity? The data that the doctors and scientists see is very hard to interpret.  Something is going on in Sharon’s brain when he sees or hears familiar things. But is he really aware of what he sees or are well-worn neural pathways firing up when familiar stimuli are present without anyone home to appreciate them? No one really knows for certain, but it seems fair to say that a very damaged brain is not ”thinking” or aware or self-conscious in a manner similar to healthy human brains.

So what is the case for keeping Sharon alive?  He is not dead—he has brain activity. Still, he may be suffering if he has any awareness of being trapped inside his own body. Prolonging his life may be causing incredible misery to him and others like him. 

The best we can do is to let families try to decide what to do as long -- as they understand the facts and the uncertainties. And as long as they are willing to help pay the bill.  Keeping Sharon or others like him alive in a very damaged, extremely limited state with no hope of recovery is not something that the government should pay for without some support from those who want life to go on.

The choice to keep Ariel Sharon alive is one that deserves respect but is also one that demands involvement—emotionally and fiscally. The choice to let him go also deserves respect. In this case, uncertain medical science can only give way to well-intentioned ethics.

Arthur Caplan is the head of the Division of Medical Ethics at NYU Langone Medical Center.

Salad greens make the most people sick, but contaminated poultry kills the most Americans, federal researchers report in the first comprehensive look at the foods that cause foodborne illnesses. And there are a few surprises -- the bug most likely to be lurking in a salad is norovirus, and it probably came from the hands of the person who made it.

This doesn’t mean salad is more dangerous, the team at the Centers for Disease Control and Prevention stresses: It just shows what foods are most involved and may reflect how often people eat them.

“When the average American looks at this data, they need to know that we are not trying to make estimates of the risk of illness per serving of any of the food categories,” says the CDC’s  Dr. Patricia Griffin, who heads the agency’s branch that investigates stomach bugs.

“We are just providing information on what are the food categories that are the major sources of illness ... so regulators can take action to make food safer.”

Food poisoning is extremely common.  The CDC estimates that 48 million Americans get some sort of foodborne illness every year, 128,000 of them are sick enough to go to the hospital and 3,000 die. Most of the time, the bacteria, virus or parasite responsible is never identified, and usually the particular food isn’t, either.

Griffin’s team analyzed all the data they could get on every outbreak of foodborne illness reported between 1998 and 2008 in which both the food source and the microbe responsible were known. They broke the food down into 17 categories.

“We attributed 46 percent of illnesses to produce and found that more deaths were attributed to poultry than to any other commodity,” they wrote in their report, published in the journal Emerging Infectious Diseases on Tuesday.

“(The data ) indicate that efforts are particularly needed to prevent contamination of produce and poultry.”

This doesn't mean people should swap out salads for, say, fries.

“We certainly would not want people to avoid any category of food,” Griffin said. “We know that the vast majority of meals are safe. As far as fruits and vegetables in particular, CDC is well aware and promotes the fact that they are an important part of a healthy diet. They are linked to reduced risk of heart attacks, strokes and cancer. “

Cooking food is one of the best ways to prevent illness, as proper cooking will kill most disease-causing agents. As raw meat and eggs are often contaminated, proper food handling techniques are also important.

It’s harder to protect against germs on raw food, however. “Our data found that produce items were a common cause of illness, accounting for almost half of illnesses,” Griffin said in a telephone interview. “Most of those produce items that caused those illnesses were consumed raw.”

And norovirus – also known as Norwalk virus, which causes gastrointestinal upset commonly known as stomach flu or winter vomiting disease – was a major cause of illness contracted from raw vegetables, the CDC finds.

Contaminated meat and poultry accounted for 22 percent of illness but 29 percent of deaths, while dairy and eggs accounted for 20 percent of illnesses and 15 percent of deaths.

Last week, CDC reported 1,527 foodborne disease outbreaks in 2009 and 2010. They said 29,444 people got sick and 23 died in these outbreaks. Norovirus or Salmonella -- especially in eggs, sprouts, tomatoes and peppers -- caused most, while Campylobacter in unpasteurized dairy products, Salmonella in eggs, and E. coli 0157 in beef were also very common causes of food poisoning outbreaks. And nearly half -- 48 percent -- of all outbreaks from a single place were traced to restaurants or delis.

News reports have focused a great deal on outbreaks of diseases such as salmonella, listeria and E. coli, and the Food and Drug Administration, US Department of Agriculture and other regulators have focused on protecting food from animal contamination such as bird droppings and manure from pigs and cows, which carry these agents.

But norovirus is carried and spread only by humans.

“The way that you get it from food is when a food handler doesn’t wash his hands after an episode of diarrhea or vomiting and then prepares food,” Griffin said. This is an area that may require extra focus, she says.

“Washing hands is very, very important,” she added.  Norovirus can be spread before a person feels sick and for days after he or she recovers, also.

Adding to the risk is the issue of sick leave. Many food preparers, restaurant workers and food handlers do not get paid sick leave, and thus are encouraged to work while they are ill.  One study published in 2011 in the American Journal of Public Health projected that workers who did not get paid time off for illness helped spread 5 million cases of respiratory disease during the 2009 H1N1 swine flu pandemic.

The Bureau of Labor Statistics says 39 percent of private sector workers have no paid sick leave, and this number rises to 70 percent for food and hotel workers.

There’s a bill in Congress that would mandate sick leave for many employers,  supported by President Barack Obama and groups including  the National Women’s Health Network, the AFL-CIO,  Families USA and others. It was last considered in 2009.

So besides cooking meat and making sure greens are washed well, how can people protect themselves? “I would advise people to avoid eating raw foods of animal origin, and that includes raw milk,” Griffin said.  Shellfish? “You have to make a decision about raw shellfish and how much you love them, how much risk you want to take and what your risk might be,” she said.

Related stories:

16 sick after eating raw beef

Why norovirus is coming back

New strain of norovirus on the rise

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Shelley Metcalf

Carlo Joyce, right, and Thomas Joyce share a moment on their wedding day on July 10, 2010.

As a teenager, Carlo Joyce’s relationship with his parents was strained. He’s gay, but hid that fact from family and most of his friends. So he usually found himself lying when his folks asked where he was going and with whom.

“After I came out at 19, things got better with my family,” he recalled. But then he joined the Marines and had to hide his sexuality all over again.

He had to go to strip bars to fit in, and when the other guys talked about sex, or dating, he had to be sure he changed the gender in his stories. “It was very stressful to live that double life,” he explained. “I always had to watch what I said.”

Now, in a study released today in the journal Psychosomatic Medicine, a team of psychologists and neurologists from McGill University and the University of Montreal has found that leading that double life affects physical and mental health. Gays, bisexuals and lesbians who disclosed their sexuality to family, friends and co-workers were psychologically healthier and had lower levels of a key stress-related hormone than those who were still “in the closet.”

That finding could help explain a remarkable study published last year by a group of researchers from Columbia University in the American Journal of Public Health. They found that after Massachusetts enacted its same-sex marriage law in 2003, there was a significant drop in medical and mental health care visits -- and therefore costs – incurred by gay men.

Lead author of the Montreal study, Robert-Paul Juster, a PhD student at the Centre for Studies on Human Stress at the University of Montreal, said “it seems to be that if you’re using more avoidance coping, and wishful thinking, then you get poorer health. If you aren’t dealing with the problem, it affects health in a negative way.”

On the other hand, dealing with the problem by transitioning from “in” to “out” can instill a great sense of accomplishment. “A rebirth happens that makes them feel much more empowered and conscientious” for having taken what many see as a risky action. That sense of empowerment can have ripple effects benefitting overall health and well-being.

Juster’s study was complex. It included 87 people with a mean age of about 25, 46 of whom were lesbian, gay, or bisexual, and 41 of whom were heterosexual. There were slightly more men than women.

All the participants completed a battery of psychological testing to gauge traits like depressive symptoms, chronic stress, burnout, anxiety and conscientiousness. Blood samples were taken by the researchers, and the participants collected their own urine and saliva at five time points each day for two consecutive days. These were tested for a series of 21 biomarkers related to immune function, metabolism, inflammation, the cardiovascular system, and the endocrine system.

When all the numbers were sifted, and differences like social and economic status were controlled for, it turned out that disclosed sexual minorities had fewer symptoms of depression.

They also had lower cortisol levels 30 minutes after waking. That’s important because cortisol, a key stress hormone, spikes about half an hour after we wake up, like an ignition spark getting us ready to face the day. But you don’t want too much or too little. Disclosed gay men and lesbians were just right. In fact, dislcosed gay men also had lower cortsone levels than straight men.     

Juster isn’t sure why, exactly. It could be because the gay men were in better physical shape. It could also be that because heterosexual men have never had to go through the stress of living life undercover, they’re less practiced at coping and so less resilient to life’s stress.

Joyce, now 33, and living in San Diego, has had a lot of practice. He’s an engineer at a large corporation. When he first started that job, he again hid his sexual orientation, from co-workers and bosses.

“It was like I was back in the closet,” he said. The hiding was self-imposed, but stressful all the same. “Once I did come out, it was much less stressful and I found great acceptance and support.” When he married his partner, many of his co-workers attended. (To clarify, the July 10, 2010, wedding was not a legal marriage as recognized by the state.)  “Life’s much easier,” he said.

Brian Alexander (www.BrianRAlexander.com) is co-author, with Larry Young Ph.D., of "The Chemistry Between Us: Love, Sex and the Science of Attraction," (www.TheChemistryBetweenUs.com), now on sale.

 Related:

When depression drugs don't help, talking might

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About 13 percent of double-lung transplants in the U.S. came from donors who were heavy smokers, a new study finds.

Using lung transplants from heavy smokers may sound like a cruel joke, but a new study finds that organs taken from people who puffed a pack a day for more than 20 years are likely safe.

What’s more, the analysis of lung transplant data from the U.S. between 2005 and 2011 confirms what transplant experts say they already know: For some patients on a crowded organ waiting list, lungs from smokers are better than none.

“I think people are grateful just to have a shot at getting lungs,” said Dr. Sharven Taghavi, a cardiovascular surgical resident at Temple University Hospital in Philadelphia, who led the new study.

Surprisingly, however, organ recipients who do get smokers’ lungs often learn about it only afterward -- if at all, experts say.

“If someone had a transplant and after the transplant they say, ‘What can you tell me about the donor?' there are a limited number of characteristics we can tell them,” said Dr. Ramsey Hachem, a pulmonologist at Barnes-Jewish Hospital in St. Louis. “We don’t do that routinely before.”

About 13 percent of double-lung transplants in the U.S. came from donors with a heavy smoking history, according to Taghavi’s new study, presented Tuesday at the annual meeting of the Society of Thoracic Surgeons. He and his colleagues analyzed records of some 5,900 adult procedures in the database maintained by the United Network for Organ Sharing, or UNOS, which manages transplants in the U.S.

Typically, that meant smoking at least a pack of cigarettes a day for more than 20 years, or two packs a day for 10 years.

In the end, after all other variables were accounted for, people who got lungs from heavy smokers lived as long and as well as those who got lungs from the tobacco-free, Taghavi found. There was no significant difference in cancers, though the study didn’t specifically look at lung cancer.

“General guidelines say that donors that have smoked should be excluded, but there are certain circumstances in which they can be used,” Taghavi said. “That can be when the donors are otherwise very healthy and there’s no evidence of the really bad effects of smoking, like emphysema.”

Only about 20 percent of smokers actually develop the worst effects of smoking, noted Hachem.

“It is certainly counterintuitive to say we’re going to use lungs from a donor with a smoking history, but the majority of people who smoke do not have lung disease,” said Hachem, who was not involved in the study.

Some people may have smoked for a long time years ago, then stopped, vastly improving the health of the organs. Others could have been active smokers when they died. The data in the study didn’t include that history, Taghavi said.

Freeing up smokers’ lungs could help reduce a shortage that has left more than 1,650 people on the transplant waiting list -- the “last resort” for those with end-stage lung disease, according to the National Heart Lung and Blood Institute. There were nearly 5,200 liver transplants in the U.S. in 2012, but typically only half the people on the list receive lung transplants in a given year, the NHLBI said. 

Taghavi emphasized that transplant recipients who get lungs from heavy smokers ought to be told in advance.

“This is a very important point,” he said. “None of this should be done without a thorough discussion with the recipient. They have to be aware that there are risks with accepting these lungs, but there are benefits.”

But Hachem said current practice usually doesn’t include that discussion.

Recipients decide in advance whether to take organs from high-risk donors, including those with a history of infections such as viral hepatitis or HIV. But behavior habits, such as smoking, are almost never disclosed, Hachem said.

“I don’t know what other centers do, but at our center, we don’t get into those details,” he said.

Instead, the organs are inspected carefully and only those found free of disease or disability are approved for transplant. “We’ve sort of screened the organ pretty well,” he said.

Of course, problems can occur. Widespread media reports last year centered on Jennifer Wederell, a 27-year-old British woman with cystic fibrosis who died of lung cancer last year after receiving lungs from a heavy smoker. In 2007, the family of a New Jersey man, Tony Grier, sued the University of Pennsylvania Health System after they said Grier developed lung cancer a month after a 2005 lung transplant. Court records show the case was settled in 2010.

Such cases are very sad -- but also very rare, said Hachem, who noted that all transplants carry inherent risks. And, he said, most transplant recipients are like Randy Cooke, 52, of Chatham, Ill., who received a new set of lungs in 2011.

Cooke, who was diagnosed in 2008 with a degenerative lung disease, said that by the time he was placed on the transplant waiting list, he would have accepted lungs from a heavy smoker -- gladly.

“If I’d have waited another three months, I don’t know if I’d be here talking to you,” he said.

If his lungs had come from a smoker, Cooke trusted that his doctors would have screened out any potential problems.

“You have to take a lot of times what you can get,” he said. “You don’t have a choice. Time is not on your side.”

 Related:

• Competition affects who gets a liver transplant
• Hand-me-down kidney transplanted twice in two weeks
• Best kidneys should go to right recipients, bioethicist says

By Genevra Pittman
Reuters
Moms-to-be should get a booster tetanus, diphtheria and pertussis (Tdap) vaccine during each pregnancy to help protect their infants from whooping cough, according to a new vaccine schedule released today by the Centers for Disease Control and Prevention (CDC).

Babies don't get their first pertussis vaccine until two months of age - and even then, they aren't fully protected until after their third shot, at six months. In the interim, they are at especially high risk of getting very sick from the bacterial disease.

During a 2010 whooping cough outbreak in California, for example, more than 9,000 cases were reported and 10 infants died.

Vaccinating pregnant women serves the dual purpose of keeping moms from contracting whooping cough and passing it to their infants as well as allowing some immune cells to pass to babies through the placenta.

"It turns out that immunity wanes pretty quickly," said Dr. H. Cody Meissner, a pediatrician from the Tufts University School of Medicine in Boston who is on the CDC's immunization committee.

"Without boosting with each pregnancy, a mother's immunity will wane and she will have much less immunity to pass on to the baby," Meissner told Reuters Health.

Although not part of the new immunization schedule, experts recommend immunizing a new baby's father, siblings and other caretakers. That strategy is known as cocooning.

"It's a good time to make sure that everyone who will be caring for the child is also up to date on their vaccines," said Dr. Daniel McGee, a pediatrician with Helen DeVos Children's Hospital in Grand Rapids, Michigan, who wasn't involved in the new guidelines.

"You need to make sure if grandma and grandpa are coming to visit, they're protected as well," he told Reuters Health.

Along with the new guidelines for pregnant women, updates to the CDC's vaccination schedule include a routine Tdap shot for adults age 65 and older and a pneumococcal vaccine approved for adults with immune compromising conditions like kidney failure.

Some children who are ill, such as with sickle cell disease, should get meningococcal vaccines starting at two months of age, according to the schedule. Other kids don't have to start those shots until middle school.

The influenza vaccine is still recommended annually, but will now protect against four strains of flu rather than three, said Erin Kennedy, a medical epidemiologist at the CDC.

Parents should educate themselves as best they can on recommended vaccines, researchers said.

"It's quite complicated, and it does change all the time. But it's imperative for people to stay up to date and informed about which vaccines are available," Meissner said.

"There are 16 vaccine preventable diseases that children receive immunizations against in the first 18 years of life," he added. "If vaccination rates fall, we're going to see increases in some of these diseases."

Because the immunization program has focused on children, Kennedy said some adults don't know the schedule also calls for them to get a range of vaccinations based on their age, health or where they travel.

"Adults need to be aware of the fact that there are vaccines that are recommended throughout the lifespan," she told Reuters Health. "Right now coverage is low for all of these vaccines."

Updates to the CDC's vaccination schedule were published concurrently on Monday in Pediatrics and the Annals of Internal Medicine.

By Genevra Pittman
Reuters
A drug-free placebo pill prevents migraines in kids and teens just as well as most headache medicines, according to a new review of past evidence.

Researchers found only two drugs known to help migraine-plagued adults reduced the frequency of kids' headaches better than a placebo. And even in those cases, the effect was small - a difference of less than one headache per month compared to the dummy pills.

"Parents should be aware that our medication choices aren't as good as they should be," said Dr. Jennifer Bickel, a neurologist and headache specialist at Children's Mercy Hospitals and Clinics in Kansas City, Missouri.

Bickel, who wasn't involved in the new research, said no drugs have been rigorously tested and approved for preventing migraines in kids, so doctors have to rely on headache drugs made for adults.

Those medicines, she added, are "not a miracle cure."

For cases when medication may not be enough, Bickel told Reuters Health, parents may want to look into relaxation techniques - such as meditation - for kids with chronic headaches.

According to data from the Cleveland Clinic, about 2 percent of young children and 7 to 10 percent of older kids and teenagers up to age 15 get migraines.

In their review, Dr. Jeffrey Jackson from the Medical College of Wisconsin in Milwaukee and his colleagues looked at 21 trials comparing headache drugs to each other or to placebos. They found only topiramate (marketed as Topamax) and trazodone (Oleptro and Desyrel) significantly reduced the frequency of headaches in kids and teens who got regular migraines.

Other adult headache prevention medicines, including flunarizine, propranolol and valproate, were of no help.

"All the drugs in our analysis have been found effective in adults with migraine headaches, but few were beneficial among children," Jackson's team wrote.

"This suggests there may be something different about pediatric migraines or that the response to treatment differs between children and adults."

Bickel said there is the least research on the one percent of kids who are most severely affected by migraines - those with chronic daily headaches. For those youth, "we don't have any evidence to suggest that the medications are enough," she added.

Power of placebo?

In the new analysis, published Monday in JAMA Pediatrics, placebo pills alone led to a drop in kids' headache frequency from between five and six headaches per month to three per month.

That may have to do with the effect of seeing a doctor and being reassured the pain isn't due to anything serious, Bickel said.

According to a report from the U.S. Food and Drug Administration published in the same journal issue, two drugs - almotriptan malate (Axert) and rizatriptan benzoate (Maxalt) - are approved to treat (but not prevent) headaches in kids and teens.

In a review of evidence provided to the FDA, Dr. William Rodriguez and his colleagues also found kids tended to get better after treatment with a placebo more often than adults - possibly related to their headaches lasting less time anyway.

For kids who get headaches once a week or less, Bickel said the pain can be treated with over the counter painkillers, or even just waited out in a quiet place.

REUTERS/Lisi Niesner

Paramedics dressed in protective attire enter a German cruise ship quarantined in December after an outbreak suspected to be norovirus. A new strain is making people miserable around the world this year.

It gets in your food, in your laundry, it sticks to plates and it might even float into the air when you flush your toilet. A new strain of norovirus -- often called stomach flu -- is going around and it’s going to be very hard to avoid it, experts say.

Federal health officials say a new strain, called the Sydney strain, is now causing most of the misery across the United States and the world. The virus, sometimes known as Norwalk virus or winter vomiting disease, causes vomiting, diarrhea and that someone-just-hit-me-with-a-plank feeling.

There’s no real treatment for it except for waiting it out, no vaccine, and recent studies show it’s one of the hardest viruses to get rid of. Simple cleaning alone doesn’t always kill it, and it takes just a few particles of virus to sicken a person.

“It is pretty difficult to get rid of,” says Allison Aiello, who studies how viruses spread at the University of Michigan. “It is pretty stable. It lives quite some time on surfaces. It is hard to kill.”

For instance, a few recent studies show that a quick application of hand sanitizer won’t get rid of it, Aiello says. And most people don’t wash their hands properly, either -- it takes about 30 seconds of vigorous rubbing using hot water and soap to wash away the tiny bits of virus, and that means getting under the nails, too.

Perhaps worst of all, people start spreading norovirus before they actually feel sick, and they can spread it for as long as two weeks after they start getting better. 

“Imagine you have a food handler who uses the bathroom and they haven’t washed their hands thoroughly,” Aiello said in a telephone interview. “They can end up preparing a salad for the diners that evening and end up infecting a lot of people because the food isn’t cooked. You can’t really do anything about that.”

Raw shellfish is a notorious source of norovirus and other foodborne germs, but at least one recent study suggests norovirus may be even more insidious than that. In December, a team at Ohio State University found the virus stuck to plates that had been washed in restaurant-like conditions -- and they found sticky dairy products like cheese helped the virus stay there.

Hand-washed dishes are especially likely to carry the virus, the Centers for Disease Control and Prevention says in its website -- which could be one reason norovirus causes so many outbreaks on cruise ships. “You cannot get the water hot enough if you wash by hand,” says Aiello.

Norovirus is spread fecally -- in the poop -- and that means it can get into laundry. Studies show that fecal matter spreads even in ordinary laundry, so if someone is sick, it’s important to use very hot water and bleach to destroy virus that could be on any clothing, sheets or towels.

And regular cleaner won’t get the virus off surfaces. CDC recommends using bleach, including chlorine bleach or hydrogen peroxide.

Complicating the problem, most restaurant workers don’t get paid sick leave, so if they miss work, they don’t get paid. This means many workers come in sick, and they can spread the virus to hundreds of customers. Food handlers, dishwashers, even staff who bus and clear tables, all can spread the germ.

“If they have to go back to work there has to be complete and utter vigilance about washing your hands,” Aiello says.

In June, the Food Chain Workers Alliance issued a report showing that only 21 percent of workers surveyed could take a paid sick day off work. More than half said they come to work sick because they cannot take time off.

The problem extends to the home, too. There, Aiello said, several factors make it hard to keep one sick family member from infecting others.

“It could be the door handle. It could be the toilet tank cover. Some studies show it can be aerosolized. If you throw up and then flush the toilet, how much of the spray gets into the air?” she asked. One study last year showed how the virus spread on a plastic bag that had been in a bathroom where a norovirus patient threw up. 

Norovirus is the most common cause of acute gastroenteritis -- stomach upset -- in the United States. It makes 21 million people sick every year in the United States – 70,000 on average sick enough to go to the hospital. As many as 800 people die, mostly elderly patients who become dehydrated. It’s the the most common cause of foodborne-disease outbreaks, CDC says.

Dr. John Treanor of the University of Rochester Medical Center in New York is working on a vaccine against norovirus. But the same properties that make norovirus so hard to kill also make it hard to make a vaccine.

For one thing, it’s simple. Like all viruses, norovirus hijacks live cells, turning them into virus factories that kick out particles called virions. “There is only one protein they use to make virions,” Treanor says. “If you have that one protein, it will self-assemble.”

The virus is also surrounded by a case called a capsid, which makes it hard to kill. The viruses infect the epithelial cells which line the digestive tract, causing cramps, diarrhea and vomiting, but it’s not understood exactly why.

And the virus mutates. “You typically see a specific strain, and then that strain is replaced by a new strain,” Treanor said. In this case, a strain called New Orleans has been replaced by the Sydney strain. Like with influenza, people who may have had some immunity against one strain aren’t protected agaisnt the new one.

So until there is a vaccine, what can people do? “There really isn’t very much you can do,” says Treanor. “Clearly, washing your hands is important.”

Related stories:

• New strain of norovirus on the rise
• Norovirus vaccine shows promise
• It's not always the flu

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