Renowned Mexican painter Frida Kahlo, shown with her husband, Diego Rivera, desperately wanted to have children but was never able to carry a pregnancy to term.
By Rita Rubin
When Dr. Fernando Antelo looks at “The Broken Column,” one of many self-portraits depicting artist Frida Kahlo’s chronic pain and health problems, he feels like he’s having a conversation with a colleague as well as a patient.
The piece, painted shortly after Kahlo underwent spinal surgery at around age 37, shows the artist, who had taken pre-med courses in high school, encased in a body brace. The flesh down the middle of her neck, chest and abdomen is missing, exposing a broken column where her spine should be. Nails pierce her face and body as tears stream down her cheeks.
“I see her as a patient wanting to tell me about her symptoms, and at the same time I see her advanced knowledge, her ability to tell me about it as another physician would,” Antelo says. “Seeing that painting made me want to ask more questions.”
A surgical pathologist at the Harbor-UCLA Medical Center in Los Angeles, Antelo decided to investigate why Kahlo, who died in 1954 at age 47, suffered numerous miscarriages and underwent at least three therapeutic abortions.
“I think it’s one of those things where we owe it to Frida,” says Antelo, noting that many of Kahlo’s paintings contain images related to reproduction and fertility, but only historians, not doctors, have delved into why the artist was unable to have a baby. Articles in the medical literature have focused on her chronic pain and orthopedic and neurological issues.
Antelo’s conclusion, which he presented Sunday at the annual meeting of the American Association of Anatomists in San Diego, is that Kahlo suffered from a rare condition called Asherman’s syndrome.
First described in 1894, Asherman’s syndrome occurs when the lining of the uterus, or endometrium, is damaged and scar tissue forms. In most cases today, it results from repeated dilatation and curettage (commonly known as D & C), a procedure used to clear out the uterine cavity after childbirth, miscarriage or abortion.
Reed Saxon / AP
A visitor views "Las Dos Fridas (The Two Fridas)," a 1939 oil on canvas painting by Frida Kahlo at the Los Angeles County Museum of Art on Feb. 1, 2012.
Today, doctors treat the condition by peering into the uterus with a special magnifying camera on the end of a tube and carefully removing the scar tissue. But even if Kahlo had been diagnosed, Antelo says, “with the technology that they had then, they really couldn’t treat it.”
Kahlo’s condition originated with a streetcar accident when she was a teenager, according to the surgical pathologist. A metal handrail penetrated her abdomen, severely damaging the skeletal framework and internal organs, including her uterus. Among other things, the accident dashed her dream of attending medical school.
“She kept attempting to have children with a uterus that wasn’t in any condition to do that,” he says, and the resulting therapeutic abortions and miscarriages likely exacerbated her Asherman’s syndrome.
While numerous historians have offered reasons for Kahlo’s infertility, none of them have connected it to the streetcar accident, Antelo writes in his abstract.
Some colleagues have suggested that Kahlo’s inability to carry a pregnancy to term stemmed from a problem with the fetus or maybe a blood disorder, he says.
“There could be other contributing factors,” Antelo acknowledges, “but in my mind, this has got to be a key thing. We have major injury to the uterus.”
What other medical mysteries of the past would you like to see today's doctor's solve? Tell us on Facebook.
Correction: An earlier version of this story cited the wrong year for Frida Kahlo's death. It has been updated with the accurate year.
Spearheaded by physicians, Mount Sinai in New York has opened an emergency room dedicated to seniors. NBC's Dr. Nancy Snyderman reports.
By Joyce Ho and Dr. Nancy Snyderman, NBC News
Will Turner, 94, has never had an emergency room experience quite like this.
At Mount Sinai Hospital in New York City, he found thick mattresses to prevent bedsores, skid-proof floors, and curtains designed to produce less noise. It’s only a few examples of the features designed specifically for senior citizens.
“This is very far from the tumultuous feeling you have in other emergency rooms,” Turner said. “The others, there’s clatter going on, there’s litter, and people walk by who never look in your direction to see if you need something. This is different.”
According to the Centers for Disease Control and Prevention, individuals 65 years and older typically make up nearly 25 percent of adult emergency room visits. The creation of the geriatric centered emergency department, or geri-ed, at Mount Sinai Hospital represents a shift towards catering to the health needs of the growing aging population.
Mount Sinai’s geri-ed follows the opening of a similar one at St. Joseph’s Regional Medical Center in Paterson, N.J., three years ago. More than 50 such departments will be opening in the health care system’s hospitals from New Jersey to California, according to Dr. Mark Rosenberg, the chief of geriatric emergency medicine at St. Joseph's. Rosenberg, who also serves as chairman of the American College of Emergency Medicine's (ACEP) geriatric section, has assisted many efforts to build geriatric emergency departments, from hospital systems to emergency medicine management groups.
“I predict that hundreds of ED’s will move in this direction over the next several years,” Rosenberg said.
Since the creation of Mount Sinai’s unit on Feb. 17, older patients coming to the general emergency room are moved to the geri-ed, as long as they meet a certain number of clinical criteria, such as ability to remember their names or not needing resuscitation. In each of the eight bedrooms and six exam rooms, patients experience a quieter and calmer setting where they can wait and receive care from professionals specially trained in elderly care.
Dr. Kevin Baumlin, the vice chairman of emergency medicine at Mount Sinai, received inspiration for this facility from personal experience, when his grandmother broke her pelvis and was sent to a regular emergency room.
“It was really frustrating that no one seemed to be paying attention to her, that she was kind of lost in the shuffle,” he said.
Baumlin noticed the discrepancy – pediatric emergency departments have bright primary colors, toys, and child specialists tailored towards younger patients, but nothing similar existed for the elderly, who have equally specific needs.
The geriatric emergency department Baumlin spearheaded was designed with the intention of creating a safer and calmer atmosphere for the older demographic, he said. An example of the attention to detail is highlighted by the installation of fake skylights in the unit. Elderly patients, especially if they have dementia, tend to become confused in general emergency rooms that are brightly lit 24 hours a day. The Mount Sinai geri-ed is outfitted with skylights that tell elderly brains what time of day it is, and helps them adjust their body’s sleep and wake patterns.
A unique feature of the geri-ed is what Baumlin calls the geriPad – iPads that allow the patient and nurse to videochat for clinical needs. Requesting juice or food is as easy as a touch of a button on the screen.
Response to the new unit has been positive, and patient satisfaction ratings have been very high.
Turner is one of those satisfied customers. “I’m overwhelmed at the interest, the warmth and the service at this emergency room,” he said. “This is an extraordinary experience.”
An article just published in the highly respected journal Fertility and Sterility ought to give anyone thinking about using “test tube” baby technology pause. A review of 124,000 children born through two very common infertility treatments -- in vitro fertilization, creating embryos in a dish and transferring them to a womb and ICSI, in which a single sperm is injected directly into an egg -- showed large increase in the risk of having a child with a birth defect. The risk was 37 percent higher than that seen in children made the old fashioned way. That is a huge number.
There is some danger that this message will not get heard by those thinking about using infertility treatments or considering putting off having a baby until later in life figuring they can use IVF if they need to.
Celebrities continue to appear on television gab shows proclaiming that they used infertility treatment to have a child and that it was a breeze. Stories about Nadya Suleman and other super-multiple pregnancies rarely mention the grim facts about disability and premature death that accompany these morally dubious pregnancies. Too many clinics providing reproductive services for cash fail to emphasize the risks faced by kids made technologically.
I am not anti-technology when it comes to making babies. The position of the Catholic Church and some social conservatives in opposing the creation of life with a technological assist when infertility prevents a married couple from reproduction strikes me as cruel and anti-life. And those who worry about turning baby-making into manufacturing when it is done in a clinic seem to me to have a very optimistic view about the circumstances that accompany the creation of a huge number of kids when sex is used.
That said, the large risk factor now on the table needs to be a key part of how everyone thinks about making babies in medical settings. The authors of the study say they do not know why the risk is so large. And it has taken far too long for this question to get asked. We need to be sure that long-term monitoring of children born by means of infertility treatment is routine and that more research is done into the causes of health problems for kids who cannot make choices about facing risk.
Infertility treatments have brought a great deal of joy to many. But, the price is high -- so high that we need to be sure it is a key element in thinking about using these treatments.
The twin babies of an American woman, born abroad through in-vitro fertilization, are being denied U.S. citizenship because there is no proof that either the egg donor or sperm donor is American. NBC's Martin Fletcher reports.
The number of boys born in any human population should be similar to the number of girls born, but the boy-to-girl ratio in any given country can vary depending on practices of sex selection. In Iran, about 105 boys are born for every 100 girls, according to the Central Intelligence Agency. In the heart disease study, 32 boys were born for every 100 girls.
The reason for the skewed sex ratio among babies born to women with heart disease is not known. The researchers, from Tabriz University in Iran, said they hope their study spurs additional research into the link. The study was presented April 20 at the World Congress of Cardiology in Dubai.
"Chromosomes in a man's sperm are responsible for the sex of a baby," Dr. Kathryn Taubert, chief science officer at the World Heart Federation, said in a statement. "But this study does suggest that there may be a relationship between the health status of the mother and the sex of the babies that she is able to carry to full-term," said Taubert, who was not involved in the study.
The average age of women in the study was 29. Most women (64 percent) had a form of heart disease than involves problems with the heart valve. Nineteen percent had dilated cardiomyopathy, a condition in which the heart becomes weakened and enlarged, and is not able to pump blood efficiently. Fourteen percent had a problem with their heart's structure and function that was present since birth.
Sperm carry either an X or Y chromosome, while eggs carry only an X chromosome. When a sperm cell with an X chromosome unites with an egg, a female born. When a sperm with a Y chromosome unites with an egg, a male is born.
A study published last month suggested women are more likely to give birth to girls during a famine. Those researchers speculated this might be because, in a famine, male sperm carrying a Y chromosome were less likely to fertilize eggs. It could also be that, during famine, fetuses carrying a Y chromosome were more likely to be miscarried, the researchers said.
The chemicals that help corals and sponges survive are also helping people. Halaven, a drug derived from a sea sponge compound came on the market in Nov. 2010, and has improved survival among women who have metastatic breast cancer. NBC's Anne Thompson reports.
By Christina Caron NBC News
KEY WEST -- The kaleidoscope of life in the coral reefs under the turquoise waters of the Florida Keys is a magnet for tourists, but it’s not just a pretty view.
The same chemistry that helps corals and sponges survive is also helping people fight cancer.
“What we’re doing is taking advantage of that chemistry and turning those chemicals into drugs to save lives,” said Stephanie Wear, director of coral reef conservation at the Nature Conservancy.
Wear describes the reefs as the "New York City" of the oceans, “where everything is happening,” because it is 400 to 600 times more likely to find a source for a drug in the ocean than on land -- and the densely packed coral reefs are an even more plentiful source.
But climate change and waterway pollution threaten the sea life that house these healing properties.
“The [coral reef] population is diminished by about 90 percent across the Caribbean,” said James Byrne, the marine science program manager at the Nature Conservancy.
With corals under siege, scientists at the Nature Conservancy have created coral farms --- currently supporting more than 30,000 corals across Florida and the U.S. Virgin Islands -- to sustainably harvest the life-saving properties of the reef.
“We’re taking these corals and growing them out in nurseries just like a tree farm would and replanting them back on the reef and doing it in a way that we’re really maximizing that potential for reproduction in the future,” said Byrne.
In the clear waters of the Florida Keys, scientists glue some of the corals to cinder blocks on the ocean floor, and hang others from a rope resembling a laundry line, allowing them to float in the water. Eventually, they hope to put out up to 4,000 corals a year – all to battle some of the worst diseases known to humankind: cancer, leukemia, AIDS -- and perhaps even Lupus, Alzheimer’s, and Parkinson’s.
The Staghorn coral population has been decimated by warming oceans and disease. The Nature Conservancy scuba team is working to regrow coral in nurseries on the ocean floor.
Arden O'Connor, a 34-year-old who lives in Boston, Mass., beat leukemia with help from Ara-C, a chemotherapy drug originally derived from sea sponges that thrive in the coral reefs.
Without it, O'Connor said, she could have died at age 26.
“I’ve spent most of my life swimming in the ocean but absolutely didn’t assume it would have anything to do with my cancer,” said O’Connor, who has been cancer-free for seven years.
Halaven, another drug also derived from a sea sponge, came on the market in Nov. 2010, and has improved survival among women who have metastatic breast cancer.
“Without the reefs and without doing that biodiversity conservation, we have no starting points,” said Dr. Edward Suh, who develops new drugs at Japanese pharmaceutical company Eisai, the lab that produces Halaven.
Caption: The Earth's oceans are natural medicine chests and scientists derive medications from sea sponges to treat diseases like breast cancer. Dr. Linda Vahdat, Director of the Breast Cancer Research Program at Weill Cornell Medical College, discusses Halaven, a new cancer drug.
Using the chemicals present in the sea sponge saves time during the drug production process, he added.
“In order to make this natural product a drug by synthesis, we would require over 60 steps,” he said. “And the typical drug is about 10 steps or less.”
For many doctors, the drug has proven to be an exciting option for their patients.
“Sometimes patients are interested in where the drugs come from … and it’s interesting because when you mention to them that it’s derived from a natural product they seem to be a little bit better with the concept of getting these types of therapies,” said Dr. Linda Vahdat, the director of the breast cancer research program at Weill Cornell Medical College. “For millennia there have been natural products used to treat tumors and we know it from the ancient Egyptian writings -- and certainly moving into contemporary space we use a lot of natural products to treat our patients with breast cancer.”
Natasha Harris, stay-at-home mother of eight, died of a heart attack in February 2010. Experts say the New Zealand woman's two-gallon-a-day Coca-Cola habit probably contributed to her death, a conclusion that led the soft-drink giant to note that even water can be deadly in excessive amounts.
By The Associated Press
WELLINGTON, New Zealand -- Experts say a New Zealand woman's 2-gallon-a-day Coca-Cola habit probably contributed to her death, a conclusion that led the soft-drink giant to note that even water can be deadly in excessive amounts.
Natasha Harris, a 30-year-old, stay-at-home mother of eight from Invercargill, died of a heart attack in February 2010. Fairfax Media reported that a pathologist, Dr. Dan Mornin, testified at an inquest Thursday that she probably suffered from hypokalemia, or low potassium, which he thinks was caused by her excessive consumption of Coke and overall poor nutrition.
Symptoms of hypokalemia can include abnormal heart rhythms, according to the U.S. National Institutes of Health.
Mornin said that toxic levels of caffeine, a stimulant found in Coke, also may have contributed to her death, according to Fairfax.
Harris' partner, Chris Hodgkinson, testified that Harris drank between 8 and 10 liters (2.1 and 2.6 gallons) of regular Coke every day.
"The first thing she would do in the morning was to have a drink of Coke beside her bed and the last thing she would do at night was have a drink of Coke," Hodgkinson said in a deposition. "She was addicted to Coke."
Hodgkinson also said Harris ate little and smoked about 30 cigarettes a day. In the months before her death, he said, Harris experienced blood pressure problems and lacked energy.
He said that on the morning of her death, Harris helped get her children ready for school before slumping against a wall. He called emergency services and tried mouth-to-mouth resuscitation but couldn't revive her.
Another pathologist, Dr. Martin Sage, said in a deposition that "it is certainly well demonstrated that excessive long or short term cola ingestion can be dramatically symptomatic, and there are strong hypothetical grounds for this becoming fatal in individual cases."
Inquests such as this are sometimes held for unusual or unexplained deaths in New Zealand, and can help shape future health policies. With the evidence in the case now complete, the coroner's office will compile and issue a final report into the death.
In an interview with The Associated Press, Lisa Te Morenga, a nutritionist at the University of Otago, said excessive consumption of any type of liquid in a cool climate would be likely to play havoc with the body's natural systems and balance.
Karen Thompson, a spokeswoman for Coca-Cola Oceania, said in a statement that its products are safe.
"We concur with the information shared by the coroner's office that the grossly excessive ingestion of any food product, including water, over a short period of time with the inadequate consumption of essential nutrients, and the failure to seek appropriate medical intervention when needed, can be dramatically symptomatic."
Amy Karfonta, a 22-year-old from Wisconsin, came down with salmonella symptoms days after eating a tuna roll at a sushi restaurant.
By Bill Briggs1
The first lawsuit spawned by a salmonella outbreak that appears to be linked to sushi -- which has now sickened 141 people in 20 states plus the District of Columbia -- was filed late Wednesday against Moon Marine U.S.A. Corp, a Cupertino, Calif., seafood importer.
The suit alleges that two Wisconsin women, ages 22 and 33, were hospitalized and still are recovering from salmonella poisoning contracted six to nine weeks ago when they dined, separately, at the same local restaurant, both consuming tuna rolls originally sold by Moon Marine.
“I was just in complete body pain from head to toe and the next day I got bloody diarrhea. I couldn’t even drink water,” said Amy Karfonta, 22, of Muskego, Wisc. Her symptoms appeared six days after she ate the suspect sushi. She then made two trips to local emergency rooms where doctors obtained a stool sample, re-hydrated her with intravenous fluids and examined her colon via a CT scan.
“When they saw how bad my colon was ulcerated, they first thought it could have been Crohn’s disease, or something where I may have had to have my colon removed at 22,” Karfonta said. Her most severe symptoms began to wane after the ER treatments.
The suit, filed by the Houston-based lawfirm Simon & Luke, with co-counsel the Gomez Law Firm, centers on a product called “Nakaochi Scrape” -- frozen backmeat shaved from fish bones and sold by Moon Marine to retailers and distributors across the nation. The “Scrape” wound up in nearly 60,000 pounds of raw, ground yellowfin tuna later recalled by Moon Marine after it was linked to hundreds of salmonella infections during the past two months.
A phone call made by msnbc.com to Moon Marine USA was routed to voicemail and the company did not immediately respond with a comment.
Nakaochi Scrape, injected inside tuna sushi rolls, “looks like ground tuna hamburger,” said Ron Simon, managing partner of Simon & Luke.
“The problem is this (Moon Marine) product got repackaged and resold. There are sushi restaurants that may not even know they’re serving this tuna; they may not even know it’s been recalled,” Simon said. “Also, it comes as a frozen product so it sits on the shelves for as long as six months.
“We’ve got 58,000 pounds of this stuff out there. That’s a lot of sushi -- 29 tons of scraped tuna back.”
Furious, on-the-ground detective work has been conducted, Simon said, to isolate the type of salmonella involved, find the 141 known victims of this outbreak, and determine the U.S. source of the tainted sushi. That work, executed in recent weeks by federal and state health agents, continues as authorities now work to retrace the overseas plant that originally produced this batch of Nakaochi Scrape.
More than 2,500 forms of salmonella are known to exist. When people come to doctor’s offices, clinics or hospitals complaining of severe abdominal pain and diarrhea, medical attendants typically obtain stool samples. Those specimens are sent to the state health departments for DNA typing to pinpoint which of the 2,500 salmonella strains the patients are harboring.
In this outbreak, the tests showed 141 ill sushi eaters all were hit with a rare type called salmonella bareilly, Simon said.
“It has a certain genetic code. When these people test positive, the health departments upload that DNA code into the computer that connects the U.S. Centers for Disease Control and all the other state health departments to see if anybody else has a genetic match. And bam, all of the sudden, there are 141 people that all share the same genetic code,” Simon said. “They are in 20 states and the District of Columbia.”
Health officials have interviewed many or most of those 141 people to ask what they ate the week before getting sick. Those answers also were uploaded into the national computer system -- “and I’ll say that about 80 percent recalled eating sushi,” Simon said. “The investigators dug a little deeper and found out everybody was eating spicy tuna rolls.”
This outbreak is uncommon, the lawyer added, because salmonella is routinely found in the guts of cattle, sheep, hens and infected humans -- not fish.
Simon’s second initial plaintiff is another Wisconsin woman, Amber Azzolina. She ate at the same local sushi restaurant on Feb. 14, consuming a spicy tuna roll, she told her lawyer. Two days later, Azzolina began feeling abdominal pain and passing bloody stools. Two days after that, her husband, Carmen, complained of a stomachache and headache. Amber Azzolina later spiked a fever of 101, was vomiting and still had bloody diarrhea nine days after that meal. On Feb. 23, she checked into a local emergency room where she was treated.
For Amy Karfonta, the salmonella symptoms caused her to miss a planned physical and agility test to land a job with her local police department. She’s not sure, she said, when another opening at the department will occur.
Her health still has not fully restored, she added. She lost eight pounds due to the illness. She still faces a follow-up scope exam to determine how much her colon was damaged.
“That will be in late April because if there’s something still tender in there,” Karfonta said, “they don’t want to rupture it.”
Watching pornography would seem to be a vision-intensive task. But new research finds that looking at erotic movies can actually quiet the part of the brain that processes visual stimuli.
Most of the time, watching movies or conducting any other visual task sends extra blood flow to this brain region. Not so when the movies are explicit, the researchers found. Instead, the brain seems to shunt blood — and therefore energy — elsewhere, perhaps to regions of the brain responsible for sexual arousal.
Turns out, the brain may not need to take in all the visual details of a sex scene, said study researcher Gert Holstege, a uroneurologist at the University of Groningen Medical Center in the Netherlands.
"If you look, for example, at your computer and you have to write something or whatever, then you have to look specifically and carefully at what you're doing because if you don't, it means you make mistakes," Holstege told LiveScience. "But the moment you are watching explicit sexual movies, that's not necessary, because you know exactly what's going on. It's not important that the door is green or yellow."
Anxiety vs. arousal The brain can either be anxious or aroused (or neither), Holstege said, but not both. During orgasm, he has found, activity in brain regions associated with anxiety plummets. This phenomenon may explain why women with low levels of sexual desire often have high levels of anxiety, Holstege said. It makes sense; if you're looking around, focusing on visual details, scanning for danger, it may not be so easy to focus on arousal, he said.
"If you yourself are in a very dangerous situation, whatever the reason, you don't have sexual feelings, because you have to survive for yourself, not survive for the species," Holstege said.
Brain-scan research had previously turned up hints that explicit sexual images might quiet a brain area called Brodmann's area 17, also called the primary visual cortex, a region that does the first processing of incoming visual information in the brain. The data was spotty, however, and no one had looked into the question in women's brains.
As part of a broader series of brain-scanning studies, Holstege examined the primary visual cortexes of 12 healthy heterosexual premenopausal women. All of the women were on hormonal birth control, smoothing out any menstrual-cycle related changes in sexual desire or arousal.
Each woman watched three videos while having her brain imaged by positron emission tomography, better known as a PET scan. These scans detect minute changes in radioactivity in the brain that correspond to the amount of blood flowing to any given region. Regions with more blood flowing to them are considered more active.
One of the videos used in the study was a simple nature documentary about marine life in the Caribbean. The other two were selections from "women-friendly" pornographic movies, one depicting only foreplay and manual stimulation and the other depicting oral sex and vaginal intercourse. Earlier studies had shown that the higher-intensity video showing intercourse produced stronger physical arousal in women than the foreplay-focused movie clip.
Safe sex The scan results revealed that the high-intensity erotic video — and only the high-intensity erotic video — resulted in far less blood being sent to the primary visual cortex. The region is still active, just much less so. Usually, that effect is only seen when people are asked to conduct a nonvisual task, like remembering words, while also watching some sort of visual stimuli.
To Holstege, those results suggest that the brain is focusing on sexual arousal as more important than visual processing during these erotic films.
"You have to realize that the brain wants to spare as much energy as possible, so if some part of the brain is not necessary at a high level of functioning, it immediately goes down," Holstege said.
The findings have implications for sexual dysfunction, Holstege said, as they paint a picture of the brain in which safety is paramount and anxiety is a libido-killer.
"If you want to have sex, as a man, you need to produce a safe situation for the woman," Holstege said. "That is what you want, that is the most important thing."
Holstege reported his results online April 10 in the Journal of Sexual Medicine.
The number of measles cases and outbreaks spiked last year, with unvaccinated people making up the majority of those affected, according to a new report from the Centers for Disease Control and Prevention.
In 2011, there were 222 cases of measles in the United States. That's the highest number reported measles cases in the united states in 15 years, said Dr. Anne Schuchat, director of CDC's Office of Infectious Diseases, speaking to reporters today.
The number is also more than triple the number of cases in 2009 and 2010, according to the report.
About half of the 2011 cases occurred during outbreaks, which are defined as at least three cases that are linked to each other. Last year, there were 17 measles outbreaks, well above the average of four for the previous decade.
Among patients who were U.S. residents, 72 percent of cases developed in people who had not received the measles vaccination, or had unknown vaccination history, despite being eligible for the vaccine. (Twenty-six cases occurred in people living outside the U.S.)
Fifty patients were children between 16 months and 19 years old who had not been vaccinated for philosophic or religious reasons or personal objections, the report says.
Since 2000, measles has been considered eliminated in the United States. The disease occurs here mostly when people become infected after traveling to other countries and transmit the disease to others upon their return. Indeed, 90 percent of the cases in 2011 had their origins in other countries, including 52 U.S. citizens who became ill after traveling abroad.
"The increase in measles importations and outbreaks during 2011 serves as a reminder that measles remains endemic in many parts of the world and unvaccinated U.S. residents continue to place themselves and others in their communities at risk for measles and its complications," the report says.
In 2011, more than 30,000 cases of measles were reported in European countries, with France, Italy, Romania, Spain and Germany having the majority of cases.
The measles, mumps and rubella vaccine is recommended for all children ages 12 to 15 months, with a booster shot at age 4 to 6 years. Children as young as 6 months can recieve the vaccine if there are plans for the family to travel abraod. Adults should be vaccinated if they did not recieve the vaccine when they were younger.
A sharp rise in measles cases in England and Wales have increased fears of an epidemic. Health officials are reminding parents of the importance of inoculations. They are also appealing to young adults to make sure they are fully immunized. ITN's Martha Fairlie reports.
Panida Saengjan became pregnant at 16 years old, when she was just in high school in Bangkok. She is seen her with her now 4-year-old son Haroon who her mother is raising.
By Ploy Bunluesilp , NBC News
BANGKOK, Thailand – If you are a teen with a sexual urge, what should you do?
It's a question faced by young people across the world, and one met with many responses.
So high school seniors in Thailand were perplexed this year when they were asked for the answer in a nationwide multiple-choice test for students hoping to win a coveted place at university. They were given five possible options to choose from:
A: Call friends to go play football (soccer)
B: Talk to your family
C: Try to sleep
D: Go out with a friend of the opposite sex
E: Invite a close friend to see a movie
Most students had no idea how to respond. And it quickly became clear that they were not the only ones who struggled to identify the right answer. Parents and teachers were equally baffled.
The story soon attracted national media attention, and Thai educational experts were interviewed to share their insights. But even they seemed uncertain. The tentative consensus was that students were probably expected to pick option B — “Talk to your family.”
It seemed like the answer adults might want to hear, even though most teenagers in the real world would be appalled at the very idea of discussing their sexual urges with their parents. The most realistic answer was probably option D — go on a date.
So there was widespread incredulity when the preferred answer was eventually revealed by Dr. Samphan Phanphrut, head of the national exam board that drew up the tests. It was option A —“Call friends to go play football.” Regardless of whether they were male or female, Thai youth were supposed to deal with sexual urges by playing soccer.
For many Thais, the key lesson learned from the saga had nothing to do with soccer. Rather, it was that Thai officials have a total lack of understanding about the lives of teenagers and the importance of sensible sex education.
Growing teen pregnancy problem It's an issue that is causing increasing problems in this Southeast Asian country.
Ploy Bunluesilp / NBC News
Haroon, a 4-year-old in Bangkok being raised by his grandmother because his mother was just 16 years old when she became pregnant.
"The number of pregnant teenagers is growing every year. And they are getting younger and younger," said Apiradee Chappanapong of Plan Thailand, an NGO that champions children's rights and education.
In fact, Thailand has the second-highest pregnancy rate among 15-19 year-olds in the world, according to the government’s Office of Welfare Promotion, Protection and Empowerment of Vulnerable Groups. (South Africa has the highest rate).
The issues in Thailand are complex. Contrary to the country's image as a hedonistic sex tourism destination, Thai culture remains highly conservative, but premarital sex is widespread although many older Thais regard it as taboo. (As a result, underage girls are often pressured to marry, especially in rural areas.)
This conservatism means subject is rarely discussed in Thai families, and as the debacle over this year's university exams demonstrated, schools are also failing to teach Thai youth what they need to know.
Many teachers and education ministry bureaucrats refuse to acknowledge that premarital sex is a reality. Instead of teaching teenagers how to avoid pregnancy through the use of contraception, they preach abstinence. And when Thai teenagers become pregnant, they often have nobody to turn to. Legal abortion is only available to teenagers if their parents approve, and many Thai girls don't consider that an option.
“I don’t think my school taught me enough about sex education,” said Nat who asked not to reveal her full name, a 17-year-old who became pregnant after running away from her home in an area of northern Thailand where traditional values remain strong.
Unable to get a legal abortion because she was estranged from her parents, she chose the dangerous option of ordering abortion pills online and taking them without any medical supervision. She told me she suffered severe vaginal bleeding afterwards.
Many conservative Thais deny that outdated and incompetent education is the problem. They say Thai teenagers are being corrupted by dangerous modern influences such as racy movies, social media and Internet chat rooms. Facebook was even cited as one of the causes of Thailand's growing teenage pregnancy crisis in a recent study by the National Economic and Social Development Board (NESDB).
Dangerous illegal abortions Another controversial issue is whether Thailand's abortion laws should be reformed. Approximately 95 percent of Thais are Buddhists, according to the CIA World Factbook, who believe taking any life is a sin. Officially, abortion is illegal except in cases of rape, incest or underage sex, or when the mother's physical or mental health is at risk.
Even when women have a legitimate reason to undergo a legal abortion in Thai hospitals, many are deterred by the judgmental attitude of doctors and nurses, according to 39-year-old activist Supatra Panuthut, who counsels women with unplanned pregnancies at Sahathai Foundation in Bangkok.
For most women who want to terminate a pregnancy, the only option is to do so illegally. In many cases, abortions are conducted using unsafe procedures and in unsanitary conditions. In a notorious case in 2010, more than 2,000 aborted fetuses were discovered at a temple in Bangkok after locals complained of an unpleasant smell. Earlier this April, a five-month-old fetus was found dumped in a hospital bathroom. Newborn babies have also been found abandoned in bus shelters and garbage bins.
A small number of abortion clinics run by NGOs providing safe and compassionate treatment occupy a legal grey area: they are technically illegal, but the authorities have generally allowed them to operate, as long as they do not promote their services too openly.
But recently police raided one of these clinics after a well-known model told the media she had an abortion there. Panuthut fears the raid will end up discouraging some women from seeking abortions at responsible clinics and could lead to more unsafe backstreet abortions.
It seems unlikely that the law will be changed to allow more Thai women to legally terminate their pregnancies. Successive Thai governments have shown no enthusiasm for such a controversial move, and indeed some Thais want to see the law tightened even further so that abortion is totally outlawed.
Coping with unwanted pregnancies Meanwhile, out of the approximately 250,000 Thai teenagers who become pregnant each year, half of them seek abortions, according to Dr. Yongyut Wongpiromsarn, Senior Expert in Mental Health, Thai Ministry of Public Health.
That means more than 100,000 children are being born each year to teenage mothers who in many cases cannot properly look after them.
Often these children are raised by their grandparents or other relatives, rather than their biological mothers.
This was how Panida Saengjan coped when she became pregnant at the age of 16 while she was a high school student in Bangkok. She told me she was terrified of the dangers of an illegal abortion, but admitted she was also too immature to look after her baby, a boy she named Haroon.
Now 4 years old, Haroon has been raised by Saengjan's mother. When I met them at their home, Saengjan was laughing and playing with Haroon, whom she said was more like a little brother to her than a son.
Many teenage mothers end up giving their children to foster homes. Palm, an 18-year-old I interviewed who spoke on the condition of anonymity, wept as she told me about how she had to give away her 5-month-old son after her boyfriend broke up with her.
Government officials insist they are taking the problem of teen pregnancy seriously. But while Thai bureaucrats remain so detached from reality that they consider it appropriate to tell teenagers to choose soccer instead of sex, there seems little prospect of a sensible solution any time soon.
Preventing heart disease is not as easy as brushing your teeth.
While numerous studies have linked gum disease with an increased risk of heart disease and stroke, there is no proof that bad gums actually cause heart disease or strokes, an American Heart Association committee said after reviewing 500 journal articles and studies.
Moreover, claims that dental treatment may prevent heart attack or stroke are unwarranted, the committee of doctors, dentists and infectious-disease researchers said in a statement.
"The message sent out by some in health care professions – that heart attack and stroke are directly linked to gum disease – can distort the facts, alarm patients and perhaps shift the focus of prevention away from well-known risk factors for these diseases," said committee member Dr. Peter Lockhart, a professor of oral medicine at the Carolinas Medical Center in Charlotte, N.C.
It is biologically plausible, the committee acknowledged, that oral bacteria infections could cause heart disease. Mouth bacteria can enter the bloodstream during dental procedures and tooth brushing.
However, gum disease and heart disease share many common risk factors, including cigarette smoking, age and diabetes, and these factors are more likely to explain why diseases of the blood vessels and mouth occur in tandem.
Studies that show a strong relationship between gum disease and heart disease have failed to account for these common factors, the committee said.
"Individuals who do not pay attention to the very powerful and well-proven risk factors like smoking, diabetes or high blood pressure may not pay close attention to their oral health, either," Lockhart said.
One study even found invasive dental procedures, which include some treatments for gum disease, could increase the risk of heart attack and stroke.
A large, long-term study would be needed to prove whether dental disease causes heart disease and stroke, Lockhart said. Such a study isn't likely to be done in the near future, and it's most important to let patients know "what we know now, and what we don't know," he added.
Good oral hygiene is still important for overall health, and some studies show treatment of gum disease reduces markers of inflammation in the body, the committee said.
The committee statement will be published in the journal Circulation. It was endorsed by the American Dental Association Council on Scientific Affairs and the World Heart Federation.
Even people in their 80s may be able to lower the risk of Alzheimer’s simply by increasing how much they move around each day, a new study suggests.
In a four-year study of 716 elderly Americans, researchers found that the least active seniors were more than twice as likely to develop Alzheimer’s disease compared to the most active.
Seniors’ activity levels were measured with an actigraph, a watch-sized device worn on the wrist that detects movements all through the day and night.
Intriguingly, much of the movement measured by the actigraphs came from regular daily activities, such as cooking, washing dishes, or cleaning, rather than formal exercise, said the study’s lead author, Dr. Aron Buchman, a professor of neurological sciences at the Rush Alzheimer’s Disease Center at the Rush University Medical Center.
The take home message, Buchman said, is that even people who have disabilities that prevent them from exercising can benefit just by making sure they move around a lot. “So even if you’re housebound, you may benefit from increasing whatever you do in the house,” he added.
An Alzheimer’s expert who is unaffiliated with the new study called the results “a fabulous finding.”
“I think this study is very simple and it has a very simple and very clear message: move more,” said Dr. Steven Arnold, a professor of psychiatry and neurology at the University of Pennsylvania and director of the Penn Memory Center. “The bottom line is that people who tend to be more active than others have a lower risk.”
For the new study, Buchman and his colleagues asked 716 volunteers without dementia to wear an actigraph on their non-dominant wrist continuously for 10 days. The volunteers had an average age of 82.
The volunteers were given annual cognitive tests to measure memory and thinking abilities. They were also asked to fill out surveys that asked about physical and social activities.
Because the new research is part of a larger, ongoing long-term study, Buchman and his colleagues also had information on volunteers’ health before the activity measurements. “There was no association between activity level and prior rate of cognitive decline,” Buchman said. “So it’s not like people with low activity were already on a trajectory toward dementia or more rapid cognitive decline.”
Four years after the volunteers had done the actigraph experiment, 71 had developed dementia. When the researchers compared physical activity of the volunteers, they determined that those in the bottom 10 percent of intensity of physical activity were 2.8 times as likely to develop Alzheimer’s disease compared to those in the top 10 percent. And those results held up even when the researchers accounted for factors such as age, gender, chronic illness and depression.
Arnold isn’t surprised to see that risk went down with the intensity of physical activity. Animal studies have shown that the brain actually makes new cells when animals exercise. But that’s only when the animals choose to exercise, Arnold said.
“It’s interesting that if the mouse is forced to run on a wheel, it doesn’t have as good an effect as when the exercise is voluntary,” Arnold said. “Usually if you put them on a wheel they’ll just run for fun.”
A promising study funded by the National Institutes of Health found that a spritz of insulin may improve memory in Alzheimer's patients. NBC's Robert Bazell has more.
Jan Christian couldn't speak above a whisper for decades after her throat was crushed in a car accident.
By Bill Briggs1
Silenced for 35 years by a crushing injury to her throat, Jan Christian is regaining her voice, thanks to several complex surgeries and some jet-engine technology.
But the Kentucky woman isn’t simply speaking for the first time since she was a teenager. She’s singing in her church choir. She’s giving her dog commands. And she’s re-learning the art of tact: words that enter her mind should not always flow out of her mouth.
“I’m still trying to swallow the fact that I can talk, that people can hear me - I sometimes have to pull my foot out of my mouth now. You know: ‘Oops, I said that out loud?,” Christian told msnbc.com. Her new voice is hoarse and raspy but clear and gaining strength.
Her original voice was lost – she thought forever – when a car in which she was riding rammed into a telephone pole, causing Christian’s head to jerk forward and her neck to collide with the dashboard. The impact flattened the cartilage enveloping her vocal cords, preventing the cords from vibrating via normal airflow, blocking the cords from making noise.
Since her accident at age 17, Christian only could mouth words or communicate through hand signals and facial expressions. About two years ago, a stranger in a grocery store heard her struggling to speak and handed her a business card for Dr. Sid Khosla, an otolaryngologist and head of the Voice and Swallowing Center at the University of Cincinnati, WLWT.com first reported.She soon allowed Khosla to examine her throat with a scope.
Several weeks later – after Christian “made a list of the pros and cons” of doing the surgery – Khosla transplanted muscle and fat from the inside of Christian’s cheek to rebuild the vocal cords in her neck. He has performed that procedure about 25 times, according to media reports. His medical aim was to allow air to glide over those revamped cords.
And, according to his patient, Khosla’s theoretical model for that vocal blueprint: a powerful airplane.
“The doctor learned how to do this procedure by studying jet engines – how the air flows inside of those engines,” she said.
After the operation, Christian had to remain silent for eight months to allow her restored throat to heal. Later, Khosla teamed Christian with a speech therapist at University Hospital in Cincinnati.
“It was the therapist’s first day on the job. Dr. Khosla said, ‘Make her talk.’ So I think she was kind of stressed. No pressure or anything,” Christian recalled with a giggle. “The first thing I could really do was just make the sound, ‘eeee,’ I couldn’t get a word out at that point.”
As she slowly re-learned how to move air over her vocal cords and control her breaths, her first words finally came – in the form of a question: “Did you hear that?” she asked the therapist.
“It used to be very painful to speak. There’s no pain now,” says Christian, 53, a resident of Alexandria, Ky.
“In that moment of my first words, you have every feeling in the book. There’s joy and happiness. And you’re scared. Just everything all at once. Your emotions rise all at once. And then all you can do is cry.
“I didn’t realize it would be such a hard road to learn to talk again,” she added. “But my doctor said there’s no reason why my voice shouldn’t continue to get stronger.”
On Easter, she sang her in church choir. Now, she is taking singing lessons with a coach who is teaching her more about air placement and air control in order to improve her musical pitch and delivery.
As evidence of her fresh vocal muscles, she paused during a phone interview Wednesday to scold her dog.
“Drop it! Drop it!” Christian said. “Oh, he’s got a bug in his mouth. I hope it’s not poisonous. Drop it!! OK, he dropped it.”
Warren Buffett’s revelation that his prostate cancer was diagnosed with the help of a prostate-specific antigen (PSA) test threatens to reignite controversy that the medical community hoped had been settled last year over the usefulness of the test.
In November, the U.S. Preventive Services Task Force issued a draft recommendation that routine PSA testing be dropped, concluding that the benefits of finding cancers did not outweigh the risks of needless biopsies, and overtreatment that could lead to serious complications like impotence and incontinence. They gave PSA testing a “grade D” rating for healthy men of all ages.
That was controversial because, of course, some men have been saved by early detection via PSA screening. Many more men, the expert panel concluded, had unnecessary biopsies and damaging surgeries for cancers that would never have killed them, because the PSA test isn’t very good at distinguishing between aggressive and non-aggressive cancers.
What wasn’t controversial, however, was the idea of dropping routine PSA testing in men over 75. That 2008 recommendation reasoned that prostate cancers detected in men of such an advanced age were usually slow growing, and that given life expectancies, men that age and older would be much more likely to die of something else.
Now Warren Buffett, 81, who happens to be one of the wealthiest and most famous men in the United States, has received a PSA test that led his doctors to initiate treatment for prostate cancer. It’s just the sort of scenario that leads many people to question the guidelines, which drives some experts crazy.
There are always exceptions, explained Dr. Michael Barry, president of the Informed Medical Decisions Foundation and a clinical professor of medicine at Harvard Medical School. But the recommendations, especially for men over 75, are still very sound.
“It is hard for men to benefit if they have less than 10 years of life expectancy,” he said. “Now, like Lake Wobegon, we all hope we will do better than the average… But there is strong scientific consensus that harms outweigh the benefits. That does not mean you can’t find an individual who may benefit, it means the number harmed far outweigh the occasional man who does (benefit).”
Dr. Michael LeFevre, co-vice chair of the U.S. Preventive Services Task Force, professor of family and community medicine at University of Missouri Columbia, agrees with the risk/benefit argument and says that's why the panel made the recommendation it did.
He added, if an 80-year-old man who read about Buffett came to his office and demanded a PSA test, "what I am going to say to that man is 'I don't recommend screening. The chance you have prostate cancer is very high, somewhere between 25 and 50 percent of men your age have it. The problem is, I can't make you live longer or better by trying to find it. If I screen you, I may find it, but likely you'll suffer complications or even die from effects related to the treatment.'"
The issue is one that pits the individual against the collective numbers. Nobody wants to be that one guy who opted not to be tested only to find out he was the outlier who could have been saved. That’s why Barry and some other experts hedge slightly on the recommendations for younger men, arguing in a New England Journal of Medicine opinion piece that “evidence of a possible small but finite benefit from the largest trial would best support a grade C recommendation for men 55 to 69 years of age.”
A grade C is a recommendation against routine screening, but suggests doctors and patients consider it on a case-by-case basis.
But, Barry told msnbc.com, “at some point the chance of doing harm is so great it overwhelms the slender chance of benefitting and although this has been an area of great controversy, there is consensus that after 75, the benefits do not come anywhere close.”
The prostate-specific antigen test that men have come to expect at a certain age is not a good screening tool and does not routinely need to be done, according to the U.S. Preventive Services Task Force. NBC's Nancy Snyderman reports.
Sandra and Shanoop Kothari of Houston, Texas, are shown last year holding a photo of their children Hanna and Harrison. Harry died on Dec. 1, 2010 at the age of 2.
By JoNel Aleccia, Senior Writer, NBC News
The parents of a toddler who died after contracting a rare bacterial infection blamed on contaminated medical wipes have settled their lawsuit against the Wisconsin firms that made them.
Sandra Kothari, 38, of Houston, declined to release details of the financial arrangement reached with the Triad Group and H&P Industries Inc. of Hartland, Wis.
But the mother of 2-year-old Harrison Kothari said she and her husband “reluctantly” sought to settle the case instead of bringing it to trial on the advice of lawyers.
Court records filed Friday confirmed the action.
“Personally, for me, it’s not because I didn’t want to do it,” she said, adding: “It was never about the money.”
The Kotharis sued H&P and the Triad Group in February 2011 after a massive recall of medical prep wipes potentially contaminated with a rare bacterium, Bacillus cereus. They said the wipes led to an infection with the same germ that killed their son.
An msnbc.com investigation showed that federal Food and Drug Administration officials had detected problems with sterilization and contamination for years at the sister firms in Wisconsin, yet had taken no action to stop them.
Additional recalls of other products because of threats of bacterial contamination and the seizure of more than $6 million in medical products and supplies eventually shuttered the Wisconsin firms, which have yet to reopen.
Representatives from H&P and the Triad Group did not immediately respond to requests for comment about the settlement. Company officials have consistently said that there was no conclusive proof that their medical wipes and swabs caused any illness, injury or death.
Sandra Kothari said the expense and stress of a trial would not have accomplished her goal, which was to ensure the company didn’t continue to distribute tainted wipes and to pressure the government for better oversight.
“I wanted [H&P] to be penalized, and I guess, in a way, they have been,” she said.
At least 10 lawsuits nationwide have alleged that tainted H&P and Triad products have caused serious infections, illnesses or deaths. It wasn’t immediately clear if other suits would be dismissed as well.
A second firm, Pacific Disposables Inc. of Orangeburg, N.J., recalled 300 million individual prep pads last fall because of potential contamination with the same kind of bacteria cited in Harry Kothari's death.
The news that financier Warren Buffett, in the public eye lately thanks to the politics of the so-called proposed “Buffett Rule” that would raise taxes on the very wealthy, has been diagnosed with Stage 1 prostate cancer may be noteworthy, but it’s not surprising.
Buffett will be 82 on August 30. It’s a truism among urologists that just about every man who lives long enough will get prostate cancer, but that most men will die with, not of, the disease. In 2011, 240,890 men were diagnosed with prostate cancer, according to the American Cancer Society, and 33,720 men died of it.
As those numbers suggest, most men survive prostate cancer. Stage 1, the phase of disease Buffet announced he has, is the earliest, and least deadly stage. At Stage 1, the cancer is limited to one-half or less of one lobe of the prostate. Buffett's cancer was discovered after routine blood tests showed his PSA level had jumped.
"I feel great — as if I were in my normal excellent health," Buffett said. "And my energy level is 100 percent. I discovered the cancer because my PSA level (an indicator my doctors had regularly checked for many years) recently jumped beyond its normal elevation and a biopsy seemed warranted."
Buffett said he was diagnosed April 11 and has received tests including a CAT scan, a bone scan and an MRI. He said the tests showed no indication of cancer elsewhere in his body.
Buffett has chosen radiation treatment — five days a week for six weeks. During radiation treatment, people feel tired and have some risk of urinary and bowel problems but usually can work and live normally, said Dr. Sean Collins, a radiation oncologist at Georgetown's Lombardi Comprehensive Cancer Center.
In general, treatments for Stage 1 prostate cancer can range from simple watchful waiting to treatments like surgically removing the prostate or implanting radioactive “seeds” to kill the tumor. Doctors in the UK recently announced in the journal Lancet Oncology that a new technique using ultrasound beams treated the cancer in test subjects without some of the serious side-effects like incontinence and impotence most men worry about.
Buffett's case is likely to renew controversy over PSA blood tests. A leading government task force warns against them for men older than 75 because prostate cancer usually grows so slowly in older men that it rarely proves fatal. That means many men are treated and suffer side effects unnecessarily. The American Cancer Society says only men in good health with a life expectancy of at least 10 years should consider a PSA test.
"Mr. Buffett made a decision to get it, but that may not be the right decision for every man in that age group," said Dr. Len Lichtenfeld, the cancer society's deputy chief medical officer.
Likewise for treating the disease. Any man at that age should have "a careful conversation with his physician about the pros and cons of treatment," let alone which type is best, Lichtenfeld said. "We're becoming increasingly aware that not every man needs to be treated."
In a letter to shareholders, Buffett said, "The good news is that I've been told by my doctors that my condition is not remotely life-threatening or even debilitating in any meaningful way," he wrote in the letter.
Dr. Christopher Kane, chief of Urology at the University of California San Diego School of Medicine, told msnbc.com that for patients who are Buffett's age, if the cancer is determined to be slow growing (based on analysis of prostate specific antigen, or PSA), watchful waiting is a common tactic. If it’s more aggressive, then surgery or radiation using seeds or a focused beam may be considered.
Since the cancer is Stage 1, he said, “that implies the cancer is confined to the prostate, or that there is a low risk for metastases to other parts of the body.” Given that, Buffett’s prognosis would be good.
Vitamin D does not protect men from getting prostate cancer, but it may lessen their chances of dying of it.
In a new study, men with the highest levels of vitamin D in their blood were 57 percent less likely than men with the lowest levels to succumb to prostate cancer.
However, no link was found between vitamin D levels and having prostate cancer, the researchers said.
"Prostate cancer is a very heterogeneous disease," said study researcher Irene Shui, an epidemiologist at the Harvard School of Public Health. Some tumors progress quickly, spreading to other sites in the body and causing death, while others stay within the prostate for years and never affect a man's health or life.
It remains unclear exactly why vitamin D would lower men's risk of dying from prostate cancer if it has no influence at all on the risk of developing the cancer, Shui said. It may be that vitamin D specifically influences the cancer cells' abilities to progress to later stages of the disease and spread through the body, but not the actual initiation of the cancer, she said.
Still, the study was observational, and it does not show a cause-and-effect link between vitamin D and prevention of deadly prostate cancer.
The new findings were published in online April 12 in the Journal of the National Cancer Institute.
Vitamin D and prostate cancer "There is abundant laboratory evidence that vitamin D may have anticancer properties," Shui said. But while studies conducted on prostate cancer cells growing in lab dishes have shown that vitamin D may thwart cancer's progression, studies in people have shown that high levels of the vitamin don't lower a man's risk of getting cancer of the prostate, the gland surrounding a man's urethra.
For their study, the researchers gathered data from men who had provided blood samples between 1993 and 1995 as part an ongoing study at Harvard University. The researchers looked at 1,260 men who had developed prostate cancer by 2004, and 1,331 men who were the same age but didn't develop the disease.
By March 2011, when the study ended, 114 of the men with prostate cancer had died. When the researchers looked at these men's levels of vitamin D, they found that 31 of them were among the men with the lowest levels of vitamin D in the study, whereas only 19 of them were among the men with the highest levels of vitamin D in the study.
However, vitamin D levels made no difference in terms of developing any prostate cancer — 310 of the men with the cancer were in the group with the lowest vitamin D levels, and 333 of the men with cancer were among those with the highest levels.
So should men try to get more vitamin D? While the results of this study need to be replicated in future research, Shui said, vitamin D has been shown to have numerous effects on health. "Men who are concerned that they may be deficient in vitamin D should speak with their physicians about taking supplements or eating more foods rich in vitamin D," she said.
The vitamin is also produced naturally by the skin when exposed to the sun. Getting about 30 minutes of sun exposure between 10 a.m. and 3 p.m. twice a week usually leads to sufficient vitamin D synthesis, according to the National Institutes of Health.
The study was limited in that most of the participants were white. "As vitamin D deficiency is even more prevalent in men of African descent, and this population also has a higher prostate cancer risk, studies conducted in men of other ethnicities would be helpful to see of our results are generalizable to those populations," Shui said.
This is how I -- a journalism graduate student with no background in forensics -- became certified as a "Forensic Consultant" by one of the field's largest professional groups.
One afternoon early last year, I punched in my credit card information, paid $495 to the American College of Forensic Examiners International Inc. and registered for an online course.
After about 90 minutes of video instruction, I took an exam on the institute's web site, answering 100 multiple choice questions, aided by several ACFEI study packets.
As soon as I finished the test, a screen popped up saying that I had passed, earning me an impressive-sounding credential that could help establish my qualifications to be an expert witness in criminal and civil trials.
For another $50, ACFEI mailed me a white lab coat after sending my certificate.
For the last two years, ProPublica and PBS "Frontline," in concert with other news organizations, have looked in-depth at death investigation in America, finding a pervasive lack of national standards that begins in the autopsy room and ends in court.
Expert witnesses routinely sway trial verdicts with testimony about fingerprints, ballistics, hair and fiber analysis and more, but there are no national standards to measure their competency or ensure that what they say is valid. A landmark 2009 report by the National Academy of Sciences called this lack of standards one of the most pressing problems facing the criminal justice system.
Over the last two decades, ACFEI has emerged as one of the largest forensic credentialing organizations in the country.
Among its members are top names in science and law, from Dr. Henry Lee, the renowned criminalist and pathologist, to John Douglas, the former FBI profiler and bestselling author. Dr. Cyril Wecht, a prominent forensic pathologist and frequent TV commentator on high-profile crimes, chairs the group's executive advisory board.
But ACFEI also has given its stamp of approval to far less celebrated characters. It welcomed Seymour Schlager, whose credentials were mailed to the prison where he was incarcerated for attempted murder. Zoe D. Katz – the name of a house cat enrolled by her owner in 2002 to show how easy it was to become certified by ACFEI -- was issued credentials, too. More recently, Dr. Steven Hayne, a Mississippi pathologist whose testimony helped to convict two innocent men of murder, has used his ACFEI credential to bolster his status as an expert witness.
Several former ACFEI employees call the group a mill designed to churn out and sell as many certificates as possible. They say applicants receive cursory, if any, background checks and that virtually everyone passes the group's certification exams as long as their payments clear.
Some forensic professionals say the organization's willingness to hand out credentials diminishes the integrity of the field.
"I am insulted by it," said Dr. Victor Weedn, a forensic pathologist for Maryland's chief medical examiner office and the vice president of the American Academy of Forensic Sciences. "They seem like an organization that's all about the money."
Robert O'Block, ACFEI's founder, vigilantly defends the group's work, saying it has helped make forensics more accessible. He told ProPublica and PBS "Frontline" that the ACFEI credentials are not designed to qualify experts in court and emphasized only a judge can make that determination.
O'Block also said he's been unfairly criticized by other professional groups that compete with ACFEI in certain regards, including the AAFS, Weedn's group.
"I have been fighting for 20 years for an open educational certification and accreditation in forensic examination," O'Block wrote in an email. "But they have painted me as the bad guy."
* * *
The judges who must determine whether to qualify a witness as an expert face an alphabet's soup of organizations with differing standards. Some, like the American Board of Criminalistics, vet members extensively, requiring them to pass intensive board exams to demonstrate their skills. Others, as noted in the NAS report, are far less stringent.
Experts in the field worry that inconsistent standards and training for forensic examiners can lead to miscarriages of justice — to the guilty walking free and the innocent being locked up or worse.
"There are a lot of people practicing, but there's no assurance that they have the requisite training and board certification to see if they do have the skills to do the practical (work)," said Dr. Marcella Fierro, one of the NAS report's authors and the former chief medical examiner of Virginia.
Under state and federal rules of evidence, judges decide whether prospective expert witnesses can testify, but they sometimes rely heavily on the titles and letters around someone's name.
"Credentials are often appealing shortcuts," Michigan circuit court judge Donald Shelton said. Fancy titles can have a disproportionate effect on juries, he added. "Jurors have no way of knowing that this certifying body, whether it's this one or any other one, exacts scientific standards or is just a diploma mill."
O'Block, 60, founded the organization that grew into ACFEI in Branson, Mo., in 1992, after being rejected for membership by a credentialing organization for forensic handwriting experts.
As chronicled in "United for Truth," ACFEI's self-published history, his goal was to create an alternative group open to those with all levels of experience. "It didn't matter that he, himself, was not then one of the anointed handwriting experts," the book says, "because he already knew that he was an expert at making things happen."
O'Block launched his first credentialing programs while teaching criminal justice at the College of the Ozarks. Initially, the fledgling operation offered correspondence certifications in forensic document examination and behavior profiling for $100 apiece.
Over time, the organization expanded its offerings, adding dozens of courses to certify applicants in various aspects of forensics, from counseling to nursing to accounting. Applicants must become members of ACFEI to become certified; on top of my course fee, I paid $165 in membership dues.
O'Block also founded related associations that offer credentials in other fields, including psychotherapy and integrative medicine. One, the American Board for Certification in Homeland Security, attracted a powerful new client: the Defense Department. Since 2008, the U.S. Navy has paid more than $8.5 million for sailors to obtain credentials in such specialties as "Disaster Preparedness" and "Sensitive Security Information" through a program separate from the one for forensics.
Today, there are two entities that go by the ACFEI acronym — the original, which is a nonprofit, and a related for-profit company called the American College of Forensic Examiners Institute of Forensic Science. O'Block is president of both and, according to tax filings, received total compensation of more than $430,000 in 2010.
ACFEI and its related entities have continued to expand under O'Block's leadership, growing to about 20,000 members combined, despite periodic controversies.
In 1998, when ACFEI proposed offering an online doctorate in forensic science, dozens of forensics professionals and educators wrote to the Missouri Board of Higher Education to protest the plan. "The questions are suitable for a grade school child," wrote one. ACFEI dropped its application.
Then, in 2002, the story broke about the cat. O'Block remains vexed by what he calls a "stunt" orchestrated by a member of a competing professional organization.
"First of all, ACFEI did not certify a cat…(It) certified a human being who used fraudulent credentials and called himself Dr. Katz," O'Block wrote in an email.
Since then, O'Block said, ACFEI has changed its verification process, requiring applicants to submit multiple professional references and be placed on provisional status while their application is pending.
Two days after I passed the Certified Forensic Consultant exam, I received an email from ACFEI asking me for additional materials. I emailed the group my references, a resume and a scanned copy of my college diploma. Less than an hour later, I received an email saying I could start using my forensic consultant designation.
None of my references was contacted by the group.
According to a statement provided by ACFEI's attorney, that step was deemed unnecessary in my case.
"Professional references are requested in the event questions arise concerning an applicant's eligibility for the credentialing program in which they are applying," the statement said. "Since applicant clearly met the requirements for the Certified Forensic Consultant program, professional references were not contacted."
* * *
Among forensic professionals, there continues to be fierce debate over the quality of ACFEI's courses -- and what being certified by the group actually signifies.
ACFEI advertises itself as an educational institution and markets its certificates as building up holders' value as witnesses in court. Expert witnesses are typically paid for their testimony.
The page on its website for the certification I obtained — Certified Forensic Consultant — says, "The CFC credential contributes to the weight of an individual's testimony relating to qualifications, knowledge of the scope of the issues, the validity of the evidence presented, application of specialized knowledge to the facts in the case, and the relevance of the evidence to the issues in the case."
But both O'Block and Wecht, the group's official spokesman, stressed that ACFEI certificates alone don't make you an expert.
"It's designed to make somebody feel good, to make them feel they've accomplished something, and I would hope they have," Wecht said in an interview. "Does it really qualify them to be the expert in a particular field? No."
Wecht also dismissed the notion that the group's use of "college" in its name could be misleading. "That's a play on words," he said. "Nobody believes for one moment that it is a real college."
In an interview and an email, O'Block defended ACFEI's credentialing programs by saying the group held seven outside "accreditations and approvals."
But ACFEI is not recognized as an accredited institution of higher learning by Missouri, where it is incorporated, or by the U.S. Department of Education, which maintains a registry of accredited schools.
A number of organizations, such as the California Board of Registered Nursing and the American Psychological Association, recognize ACFEI as a provider of continuing education. But that's not the same as institution-wide accreditation, said Leroy Wade, the Assistant Commissioner of the Missouri Board of Higher Education.
"There's really no oversight that regulates the CE providers in general, at least not in this state," Wade said. "You can't put any stock in the fact that an organization states it's a continuing education provider."
Several former ACFEI staffers say they came to question how the group writes and administers its exams.
John Bridges was hired as ACFEI's president and chief executive in 2010 after decades in government, most recently as an administrator at the Federal Emergency Management Agency. He left ACFEI after just nine months, frustrated, he says, by the group's practices.
"Based on my perception of what went on related to standards and quality, it operated like a certification mill," he said.
Though ACFEI offers both basic courses and more advanced, specialized certificates, Bridges said, its exams are designed so that anyone can pass. He put the failure rate at less than 1 percent.
"If you want to be validated by somebody," Bridges said, "this organization will validate you."
O'Block initially said that ACFEI did not keep pass/fail rates for its exams. Later, the group's attorney said it did keep such statistics, but he did not provide them upon request.
Other former employees said it was routine for low-level staffers to write exams for ACFEI and its related organizations based on textbooks in subject areas in which they had no expertise.
Tania Miller worked for six months as chief association officer for the American Psychotherapy Association, an ACFEI sister group, beginning in fall 2010. A few weeks into her job, she said, she was asked to author an exam to certify forensic counselors. Miller's background was in marketing and graphic design. She said she declined to write the exam. ACFEI did not respond to questions about Miller.
The Forensic Consultant test I took focused primarily on rules of evidence and courtroom procedure. Some questions required specialized knowledge (i.e., Which rule is known as the "Admissibility of Expert Testimony" rule in the Federal Rules of Evidence? Answer: 702), but ACFEI's study packets helped me fill in the blanks, making it basically an open-book exam. The rest of the questions relied largely on common sense (i.e., When providing testimony, which of the following should you NOT do? Answer: Cross your arms and joke with the jury.)
ACFEI did not answer questions about what level of expertise it requires of those who write its exams. According to its catalog, some of the exams are authored by prominent specialists, including Wecht.
O'Block vehemently denies that ACFEI is a diploma mill, saying the group has thousands of satisfied members. He has filed five lawsuits in the last year against individuals — mostly bloggers — who have posted statements O'Block claims are defamatory about his organizations. One is pending. The others have been dismissed by courts or at the parties' request after bloggers agreed to take down posts.
Wecht, whose signature appears on some ACFEI certificates (including mine), said he didn't know how applicants did on the group's tests, but emphasized that the group's program is mostly about fostering enthusiasm for the field.
"The purpose of the organization is to encourage people who are interested in forensic science to learn more, to study more," he said.
* * *
To critics, the greatest concern about ACFEI is the potential that the organization is giving legitimacy to expert witnesses who don't warrant it.
Among the thousands of people that ACFEI has certified is one particularly controversial expert in forensic pathology: Dr. Steven Hayne.
Hayne, the longtime pathologist for the state of Mississippi, performed the autopsies in two shocking 1990s cases in which three-year-old girls were abducted, sexually assaulted and murdered.
In both cases, Hayne testified he had observed bite marks on the young girls. He said he had called in a forensic dentist who confirmed that the marks were human and matched them to dental impressions from the defendants in each case. These findings aided in the convictions of Levon Brooks for the first murder and of Kennedy Brewer for the second. Brooks was sentenced to life in prison. Brewer was sentenced to death.
After the men spent more than 30 years combined incarcerated, the Innocence Project recovered DNA evidence that led investigators to the real killer. He confessed to both crimes, but denied biting the victims.
Hayne no longer conducts autopsies for the state, but continues to give testimony as an expert witness. Testifying in March 2010 in Lamar County Circuit Court, Hayne was asked what board certifications he held. "I'm board certified in anatomic pathology, clinical pathology, forensic pathology and forensic medicine," he replied.
Hayne has credentials in anatomic and clinical pathology from the American Board of Pathology, considered the gold standard, but not in forensic pathology, the branch of medicine focused on the mechanics of death. For that, he cites his Certified Forensic Physician credential from ACFEI and certification in forensic pathology from the American Academy of Neurological and Orthopaedic Surgeons.
When attorneys for the Innocence Project submitted a wide-ranging complaint about Hayne to the Mississippi board of licensure, they cited Hayne's reliance on these organizations to allege he had misrepresented his credentials.
"Certification by these organizations is not at all what the medical community and public understand when a doctor claims to be 'board certified,'" the complaint said, referring to ACFEI and the other group.
Citing ongoing litigation, Hayne declined to be interviewed by ProPublica and PBS "Frontline" beyond confirming that he is certified by ACFEI. He has sued the Innocence Project for defamation in the U.S. District Court for the Southern District of Mississippi.
Wecht acknowledged he knew of Hayne by reputation, but told ProPublica and PBS "Frontline" that he had not known Hayne was certified by ACFEI.
* * *
In its 2009 report, the National Academy of Sciences called for several measures to address systemic flaws involving forensic examiners and expert testimony.
Certification should be mandatory for forensics professionals and should be overseen by a centralized credentialing agency, the report said.
One of the report's primary authors, Harry T. Edwards -- a federal appeals court judge for the District of Columbia – said these changes were critical to imposing rigorous standards on the field.
"There are certifiers, but it's not what you and I are talking about -- that is, real certification programs that train, give serious tests and will revoke your license and affect your job and ability to testify in the event that you do something wrong or fail," Edwards said in an interview. "That doesn't exist now."
Despite the controversies that dog it, ACFEI may aspire to fill that role. In a promotional video filmed after the NAS report's release, Wecht said its findings presented the group with a unique opportunity.
"We can play a role, the challenge has been issued," he said. "The NAS report can be a blessing to our organization."
I've never tested whether my $495 forensic consultant credential from ACFEI would carry any weight on the witness stand.
Asked about my certification, O'Block responded this way:
"Congratulate Leah for passing the CFC," he wrote in an August 2011 email. "That course was designed as entry level to educate professionals about the justice system."
Wecht said he doubted that having the certificate on my resume would be enough to persuade a court to allow me to give expert testimony. Any decent lawyer, he said, could easily cast doubt upon my qualifications.
"A kid right out of law school would say, ‘Ma'am, just exactly what is your training?'" Wecht said. "The point I'm making, you see, is that that piece of paper doesn't mean that much."
Leah Bartos graduated from UC Berkeley Graduate School of Journalism in May 2011. Since then, she's been a reporter-in-residence at the Investigative Reporting Program at UC Berkeley.
This story was co-published with PBS Frontline. Andrés Cediel, the producer of PBS Frontline's "The Real CSI" and Lowell Bergman, the film's correspondent, contributed to this report.
A mother's depression may affect her baby's sleep, a new study suggests.
The results show depressed mothers are more likely to needlessly wake up their infants at night than mothers who are not depressed, the researchers said.
"When depressed mothers sought out their infants at night, their infants did not appear to be in need of parental help. They were either sound asleep or perhaps awake, but not distressed," said study researcher Douglas Teti, professor of human development, psychology, and pediatrics at the Pennsylvania State University.
Depressed mothers who worry excessively about their babies' well-being at night may respond to infant sounds that don't necessarily require response, or move their babies into their own beds to alleviate their own anxieties about whether their infants are hungry, thirsty and comfortable, the researchers said. Mothers who are feeling depressed also may seek out their infants at night for their own emotional comfort, they said.
"Sleep problems often endure beyond early childhood, and can have a negative effect on various aspects of development, including emotional, behavioral, and academic functioning," Teti said. "Understanding how maternal depression and sleep problems combine to affect children's development is important to developing interventions to help reduce these negative consequences."
Teti and colleagues collected data on 45 infants, ages 1 month to 2 years old, and their parents over seven consecutive days. The mothers kept a diary of their infants' sleeping habits, and they also completed a survey to assess their depressive symptoms and worries about their infants.
On the sixth day of the study, the researchers set up video cameras around each baby's bed, and other rooms in the house where mothers took their babies during the night. The cameras captured between 10 and 12 hours of video. What the researchers observed on the videos agreed with what the parents reported.
Mothers with higher levels of depression and more worries about their children's sleep had children whose sleep was more disrupted.
Previous studies had found a link between depression in moms and disturbed sleep in babies, and some researchers had suggested that infants' who slept poorly could affect their mothers' mental health. But the new study shows that it was most likely the mothers' behavior, and not the infants, that played the larger role in the link, the researchers said.
Moms with more symptoms of depression and worries behaved in ways that disrupted their infants' sleep — for example, picking up babies who were sleeping.
If parental depression or worry disrupts both a parent's and an infant's sleep, it could have negative consequences for the parent-child relationship over the long term. In situations like these, steps might be considered to help reduce parents' distress, the researchers wrote in the April 17 issue of the journal Child Development.
TODAY's Ann Curry talks with author Lisa Earle McLeod and psychiatrist Dr. Janet Taylor about a new study that claims "supermoms," women who set the unattainable goal of being perfect, are more likely to suffer from depression. NBC's Kate Snow reports.
A simple blood test may one day be all that’s needed to help parents figure out whether a child is suffering from clinical depression or normal teenage angst, a new study suggests.
In a pilot study of 28 adolescents, scientists showed that teenage depression could be diagnosed through a panel of 11 genetic markers, according to a report published in the journal Translational Psychiatry.
If the results are confirmed in larger trials, doctors may one day be able to screen for depression just as they do for diabetes, says study co-author Eva Redei, the David Lawrence Stein professor of psychiatric diseases affecting children and adolescents at Northwestern University's Feinberg School of Medicine.
This new research could help not only teens, but also adults suffering from depression, says Dr. Michael Thase, a professor of psychiatry at the Perelman School of Medicine at the University of Pennsylvania.
“This is very interesting early research that could point to the development of not just biomarkers, but also help with the identification of new genes that are involved with the expression of this common illness,” he says. “And that could potentially lead to new treatments.”
With no actual test, diagnosis of depression is currently subjective and depends on a person's ability to identify and describe symptoms. This is especially difficult for teens who may be particularly out of touch with what's going on.
Researchers developed their test by first studying rats specially bred to model human depression. While rats don’t experience all the symptoms of depression, they do show many of the same signs.
“They huddle together,” says Redei. “They don’t move around a lot. They aren’t much interested in playing. They’re less interested in food than normal rats. And they don’t sleep well.”
Intriguingly, the "depressed" rats also respond well to certain antidepressants, says Redei.
"In reality, depression affects our ancient brains as much as our new brain,” she says. “And the ancient brain is the same in humans as it is in rats.”
Severe depression is thought to be caused by a combination of environmental and complicated genetic factors, she explains, and given the right genetics, can be kicked off by “any kind of environmental challenge such as trauma or life stresses."
To see how the depressive brain reacts to environmental triggers, Redei and her colleagues looked at differences in the way normal rats and depression-model rats behaved in response to stress. They pulled blood samples from all the rats and found a host of markers that differed between the two groups.
In the second part of their study, the researchers examined blood from 14 depressed and 14 healthy teens, looking at the levels of 26 markers that had been identified in the depression-model rats.
They found that 11 of those markers, taken together, accurately predicted which teens were clinically depressed.
Thase, of the University of Pennsylvania, says further research might be a boon to diagnosing both teen -- and adult -- depression.
"Now you would want to see if they get the same results with older people," he says. "Or does it have something to do specifically with early onset depression?"
TODAY's Ann Curry talks with author Lisa Earle McLeod and psychiatrist Dr. Janet Taylor about a new study that claims "supermoms," women who set the unattainable goal of being perfect, are more likely to suffer from depression. NBC's Kate Snow reports.
People with tattoos drink more than their tattoo-less peers, a new study from France suggests.
The researchers asked nearly 3,000 young men and women as they were exiting bars on a Saturday night if they would take a breathalyzer test. Of those who agreed to take it, the researchers found that people with tattoos had consumed more alcohol than those without tattoos, the researchers said.
Previous studies have shown that tattooed individuals are more likely to engage in risky behaviors, such as unprotected sex, theft, violence and alcohol consumption, compared to people without tattoos.
The researchers suggest educators, parents and physicians consider tattoos and piercings as potential "markers" of drinking, using them to begin a conversation about alcohol consumption and other risky behaviors.
However, doctors should not stereotype individuals with tattoos as heavy drinkers, the researchers cautioned.
Clinicians should spend time "talking to them about safe tattooing, etc., and alcohol in general … not because they have tattoos or piercings but because they are in a high-risk age group," Myrna Armstrong, Professor Emerita at the Texas Tech University Health Sciences Center, who was not involved in the study, said in a statement.
Previous studies have also shown those with only one tattoo have similar alcohol consumption habits as those with no tattoos, while those with seven or more tattoos are more likely to fall into the "high risk" group, Armstrong said.
The study is published in the July issue of the journal Alcoholism: Clinical & Experimental Research.
The percentage of children who die from unintentional injuries, such as car accidents, falls and drowning, is on the decline, according to a new report from the Centers for Disease Control and Prevention.
Between 2000 and 2009, death rates from unintentional injuries among children and teens declined 30 percent — from 15.5 deaths per 100,000 children to 11.0 deaths per 100,000 children.
However, death rates from some types of injuries, including suffocation and poisoning are on the rise, the report says.
Over the study period, there was a 54 percent increase in reported suffocation among infants less than 1 year old. There were 526 reported deaths nationwide due to suffocation reported in the age group in 2000; there were 907 in 2009.
And there was a 91 percent increase in poisoning rates among teens ages 15 to 19. This increase is largely due to prescription drug overdose, the report said. There were 351 reported cases of fatal poisoning in these teens in 2000; there were 715 in 2009.
"Kids are safer from injuries today than ever before. In fact, the decrease in injury death rates in the past decade has resulted in more than 11,000 children's lives being saved," CDC Director Dr. Thomas Frieden said. "But we can do more. It's tragic and unacceptable when we lose even one child to an avoidable injury," Frieden said.
The United States has one of the highest child injury death rates of all high-income countries, the report said.
For the report, CDC researchers examined death certificates for people ages 19 and under from all 50 states.
In 2009, more than 9,000 children died of unintentional injuries, with motor vehicle crashes being the top cause of death from injury. More than 4,500 children died from motor vehicle crashes, 1,160 from suffocation and 824 from poisoning.
Death rates in 2009 varied by state, ranging from fewer than 5 deaths per 100,000 children in Massachusetts and New Jersey, to more than 23 deaths per 100,000 children in South Dakota and Mississippi.
In that year, more than 5,700 children's lives would have been saved if the lowest state death rate had been achieved nationally, the report says.
To reduce deaths from prescription drug overdose, the CDC recommends appropriate prescribing, proper storage and disposal of medication, and discouraging medication sharing.
The increase in suffocation deaths among infants could be curbed by following the American Academy of Pediatrics recommendations to place sleeping infants on their backs in safe cribs, alone, with no loose bedding or soft toys.
"Child injury remains a serious problem in which everyone — including parents, state health officials, health care providers, government and community groups — has a critical role to play to protect and save the lives of our young people," said Linda C. Degutis, director of the CDC's National Center for Injury Prevention and Control.
Being a good role model, through actions such as wearing a seat belt while in a car and a helmet while on a bicycle, and following other safety tips, can reduce childhood deaths from injury, the report says.
Kids who play the so-called "choking game" are more likely to engage in other risky behaviors, including sex, substance use and gambling, a new study of middle schoolers finds.
The results suggest doctors should consider asking children who exhibit risky behaviors whether they are aware of and have participated in the choking game, a dangerous activity, the researchers said.
In the choking game, pressure is applied to the neck — with a belt, rope or other object — to limit oxygen and blood flow to the brain. When the pressure is released, a "high" or euphoric feeling is sometimes achieved as blood rushes back to the brain.
Sarah Ramowski, of the Oregon Health Authority in Portland, and colleagues surveyed more than 5,300 eighth-graders in Oregon, asking whether they had heard of the choking game, and if so, whether they had participated.
Twenty-two percent of children said they had heard of the game, and 6 percent had participated in it, the study found. These numbers match closely with earlier studies of the activity's prevalence, findings that between 5 and 11 percent of youth have participated in it.
Among those who had participated in the game, 64 percent said they had tried it more than once, and 26 percent said they had tried it more than five times, the researchers said.
Eighth-grade girls who had become sexually active were four times more likely to have participated in the choking game compared with those who had never had sex. Girls who had gambled were nearly twice as likely to have participated in the choking game compared with those who had not gambled.
Boys who had used alcohol in the past month were about four times more likely to have participated in the choking game, compared with those who had not used alcohol in the last month, the researchers said.
The study was limited in that it was conducted in kids in one region, and relied on self-reports of behaviors.
Increasing awareness of the choking game among pediatricians is important because doctors can look for signs of the activity (such as red markers on the throat) and counsel patients about it, the researchers said.
"Clinicians who see adolescents are in a unique position to offer clear messaging about the risks and consequences of choking game participation," the researchers wrote in the April 16 issue of the journal Pediatrics.
Eighty-two children are known to have died from the choking game between 1995 and 2007, though this is likely an underestimation because it includes only deaths covered by the media, the study said.
Some parents are reconsidering whether to let their kids play youth hockey because of the risk of serious injuries. Bioethicist Art Caplan says they have a point.
By Art Caplan, Ph.D.
The NHL hockey playoffs are under way. The contact is fierce and the fans love it. I do, too. But there is big trouble brewing for the future of hockey, football and other contact sports -- concussions. If hockey does not change, it has a dim future. Not because of the injuries being suffered by professional players but because of parents trying to do the right thing by keeping their kids away from a dangerous sport.
The rates of injury in youth hockey, especially concussions, are frightening. Among some 9,000 11- and 12-year-old players in Alberta, Canada, there are some 700 concussions in a season, as the New York Times reported in 2010. They are so bad, it is hard to imagine a parent letting a kid play contact hockey.
Given what is being learned about the long-term damage caused by concussions, how long will parents be willing to let their kids play hockey? Not long, I think.
The number of kids playing contact hockey in Canada is, according to recent studies, dropping. It is easy to see why. With high-profile stars such as Sidney Crosby, Chris Pronger, Claude Giroux, Zbynek Michalek, Jeff Skinner and Mike Richards all sidelined this season for long stints because of concussions, what is a parent to think about encouraging a child to play? The Canadian Medical Association in a just-published article asks a question that parents will dread and the NHL won’t like: “Hockey concussion: Is it child abuse?” The answer for many parents seems to be: yes.
If you listen to sports talk radio, the airwaves are full of hosts and callers decrying the "wussification" of hockey -- and football, too. "You cannot take the big hits out of these games without destroying them," the lamentation goes.
Perhaps. But how many parents are going to let their kids play a game trying to emulate their heroes when the icons are regularly getting their bells rung? It is one thing to face the risk of brain damage as an adult to get a big paycheck. It is another thing for a parent to watch a school-age son get smacked in the head with a stick or have his head knocked into the boards. Parents increasingly are going to feel they ought not let their kids play.
Think I am wrong? Shift over to football.
Not so long ago, I had a chance to talk to former NFL pro middle linebacker Harry Carson, who played with distinction for the New York Giants. I asked him if he would want his son to play college or pro football. He said no, that the game is far too dangerous. The risk of concussion in the game now makes encouraging a kid to play football irresponsible.
Parents are in a horrific bind. Their kids want to play contact sports but their coaches want them to emulate the pros. Oversight groups make noises about a safer game, but the concussion rate grows and grows. Parents want their kids to play sports to keep them out of trouble and to encourage habits and virtues that will help them later in life. But they certainly don't want to see them with headaches, memory loss and learning difficulties later on, either.
The industry that is contact sports in North America is not going away any time soon. But it is in trouble, even if few are willing to say so. If the NHL and NFL cannot make their games safer, those who insist on the big hits will find fewer pros available to play because more parents will chose safety over risk. As evidence grows about the toll concussions take on the pros, the chance that a parent will let a child take those risks gets smaller every day.
Meat producers use blade tenderizers to treat tough cuts of meat, breaking muscle fibers and connective tissues.
By JoNel Aleccia, Senior Writer, NBC News
On the eve of summer grilling season, the recall of more than a ton of beef potentially contaminated with dangerous E. coli bacteria -- including mechanically tenderized sirloin steaks -- is renewing calls for better labeling.
“Thankfully, thus far there have not been any illnesses associated with this recall, but these products must be labeled to protect American consumers in the future,” DeLauro said in a statement.
Mechanical tenderization is typically used on tougher cuts of beef or pork to break down muscle fibers or to inject marinade into meat. About 50 million pounds of needle- or blade-tenderized meat is produced in the U.S. each month, according to a federal study, but it’s not required to be labeled.
Food safety advocates say the tenderized meat may increase the risk of foodborne illness because the needles or blades can drive bacteria deep inside. Federal officials already advise consumers to cook so-called “non-intact” steaks to a higher temperature -- 160 degrees -- for safety.
But meat industry officials and even a former federal agriculture leader say they’re not convinced of the risk of illness -- or that it’s worth slapping a label on every package, possibly discouraging consumption.
“We think it’s important that a good analysis be done before regulatory action is taken,” said Janet Riley, a spokeswoman for the American Meat Institute.
U.S. Department of Agriculture Food Safety and Inspection Service officials said the Town & Country Foods meat was shipped from April 4 to April 10 and included hamburger patties, stewing beef and sirloin fillets. The problem was discovered when company lab tests confirmed E. coli O157:H7 after the meat already had gone out, resulting in the recall.
On Monday, two days before the recall, DeLauro had sent a letter urging the U.S. Department of Agriculture to require labels advising higher cooking temperatures to kill E. coli O157:H7 bacteria. The Democrat has been a longtime advocate of labeling.
“Accurate and appropriate labeling is critical in enabling consumers to make informed purchase decisions and also in ensuring proper food handling and safety,” DeLauro’s letter said.
Her view apparently has the support of Dr. Elisabeth Hagen, the U.S. undersecretary for food safety who told a congressional committee earlier last month: “We do believe they should be labeled,” as the blog Food Safety News reported.
But it’s at odds with meat industry officials, who say there hasn’t been enough research to tell if the mechanical process actually raises the risk of foodborne illness. Riley said some research indicates the problem may be associated with needle-marinated meat and not blade-tenderized meat.
And Dr. Richard Raymond, the former USDA official who previously held Hagen’s job, says he wasn’t convinced in the past and isn’t convinced now that labeling is necessary.
“The risk of choking and dying on that steak is far greater,” than the risk of E. coli poisoning, Raymond said.
He added that reported illnesses associated with tenderized meat have been very small compared to the volume of product.
In December 2009, some 248,000 pounds of tenderized beef were recalled after being linked to 21 E. coli O157:H7 infections in 16 states. Six months earlier, food safety advocates had warned the USDA of the risk of foodborne illness in mechanically tenderized meat.
Since then, the USDA has been considering whether to add labels warning that the products are “non-intact” and should be cooked to a higher temperature. USDA guidelines say that a whole cut steak should be cooked to an internal temperature of 145 degrees. But because the process can introduce bacteria into the middle of the meat, the agency recommends that non-intact steaks be cooked to 160 degrees, like hamburger.
Raymond said that could discourage rare meat fans from buying the product, or encourage consumers to simply ignore the warning.
In her letter to the USDA, DeLauro said she was encouraged that Hagen supported labeling during the hearing of the House agriculture appropriations subcommittee last month.
“But it has been working on the issue since at least 2009,” she noted. “Continued inaction only puts the public at risk.”
Warmer weather means it's grilling time again. Butcher and Food Network host Pat LaFrieda evaluates the best and most affordable cuts of meat for grilling, and cooks up pork chops with a blueberry balsamic marinade.