Healthcare Concerns

Archive for August, 2011

Story By: by Jenny Gold

To those who believe the federal Supplemental Security Income program for severely disabled children is a lifesaver and not a boondoggle, Hulston Poe is a great example.

The 4-year-old was diagnosed with severe ADHD last October, after more than a year of violent temper tantrums, and kicked out of preschool. Case workers said there wasn’t much they could do for him.

“We were at a standstill,” says his mother, Suzanne Poe, who was scraping by as a single parent of two in Des Moines, Iowa.

Then doctors recommended that she enroll her son in the SSI program this year, and everything changed. A monthly check of $674 helps pay for Hulston’s day care, a private tutor and medicines. Perhaps most importantly, the program made Hulston newly eligible for Medicaid, the joint state-federal health insurance program for the poor. He gained access to the doctors he needed.

“I can see a light in his eyes again,” Poe says. “He just looks so much happier.”

A Question Of Eligibility

The SSI program for children is rapidly expanding, with the biggest increase among kids with mental, behavioral and learning disorders, including ADHD, speech delays, autism and bipolar disorder. But as it pulls in children like Hulston, the program is sparking criticism in Congress.

The Boston Globe fueled a lot of the backlash with a series last December that termed the children’s SSI program “The Other Welfare” and followed several families whose children’s eligibility for the program was questionable. Several of the families, the articles reported, believed that they had to medicate their children with psychotropic drugs in order to qualify for the benefit.

The Globe series spurred Reps. Geoff Davis (R-KY) and Richard E. Neal (D-MA) and Sen. Scott Brown (R-MA) to request an investigation by the Government Accountability Office, which is expected to be released by the end of the year.

In a January letter to the GAO, the three lawmakers expressed concern about “recent reports in the media and elsewhere” that “have identified potentially alarming practices … [that raise] numerous concerns, including the potential for fraud and abuse in the program.”

Fighting (For) Potential Cuts

Republicans in Congress are not waiting for the results of the GAO study; they have twice proposed limiting SSI benefits. The House budget resolution passed earlier this year by Republicans, for example, proposed that the government could save $1.4 billion over 10 years by reducing incentives in the SSI program “for parents to place their children on medication solely to receive SSI benefits.” The resolution didn’t mention ADHD, but it was specifically cited in a separate budget proposal by Rep. Eric Cantor (R-VA) during the debt-ceiling debate.

Neither proposal provided details of how the savings would be achieved, and a preliminary study from the Social Security Administration found that children with ADHD taking medication were not more likely to be approved for benefits than those who were not medicated. It’s unclear whether any savings would result from the proposals.

Advocates for children and people with mental illness have rallied against the potential cuts. Sixteen of the largest advocacy groups, including the Bazelon Center for Mental Health Law, the American Psychiatric Association, the American Academy of Pediatrics, and Children and Adults with Attention Deficit/Hyperactivity Disorder, have formed a coalition to protect the SSI program for kids and launched a major campaign to lobby Congress.

SSI currently provides cash assistance and Medicaid to the families of 1.2 million low-income children who struggle from severe disabilities, at a cost of $10 billion a year. Since 2000, the program has grown by about 40 percent.

“Cutting the SSI program could have disastrous consequences for families, many of which already are struggling well below the poverty line,” says Rebecca Vallas, a lawyer at Community Legal Services, a Philadelphia nonprofit that also is part of the coalition.

Explaining The Program’s Growth

Vallas says the increase in the SSI program can be explained by a national increase in child poverty and increased access to health care for kids, who get diagnosed earlier and more frequently with disabilities that might otherwise be missed.

She also says some children who were once characterized as mentally retarded may now be diagnosed as having autism or another mental disability. Overall, the percentage of kids in the program with any form of mental disability, including retardation, has remained largely stable since the early 1990s, according to Vallas.

“I think a lot of the skepticism about the children’s SSI program really is just thinly veiled skepticism about the legitimacy of mental health disorders,” she says.

But Richard Burkhauser, a professor at Cornell University who recently wrote a book about disability benefits, says the increase in kids on SSI, especially those with disorders that can be difficult to diagnose, is troubling. He points to a long history of expanding the benefits.

“The issue is: Has there been a stupendous increase in the number of kids out there with other mental conditions, or is the SSI kids program increasingly being used as a more general welfare program to help poor kids?” Burkhauser says.

When the program began in 1974, the majority of recipients had disabilities such as Down syndrome, cerebral palsy, blindness and mental retardation. In 1990, a class action lawsuit that reached the Supreme Court led to a fundamental change in the way Social Security Administration made eligibility determinations for children and expanded the number of kids who were eligible for the program.

The Incentives

In addition, Burkhauser argues, a major overhaul of the welfare program in 1996 led some low-income families to apply for SSI instead. SSI is an attractive option because, relative to welfare, it provides a higher benefit level and has no work requirements or time limits.

States also acquired a financial incentive to shift both low-income kids and adults off welfare benefits and onto SSI, which is fully funded by the federal government. States now have staff members whose job is to evaluate whether welfare recipients can be switched over to SSI instead.

Among all poor children, the percent on SSI has quadrupled over the past 30 years, due in large part to program eligibility and other policy changes. Much of the growth has come from kids like Hulston, with ADHD or what’s called “other mental disorders,” who now make up more than half of recipients.

Burkhauser says that while he’s not against providing more assistance for needy families, SSI is the wrong way to do it because it creates perverse incentives for families. If the child’s disability improves or the family finds other ways to climb out of poverty, they lose their SSI benefits. Two-thirds of kids on SSI stay on the program as adults and “never enter the workforce,” he says.

A ‘Fundamental Rethinking’

While the program is easy to target for cuts, “it’s easier said than done,” says Mark Duggan, a professor of business and public policy at the Wharton School at the University of Pennsylvania. He compares it to lawmakers seeking to cut down on waste, fraud and abuse in health care.

David Wittenburg, a senior researcher at Mathematica Policy Research, says cuts could prove expensive in the long term.

“Given that SSI is the program of last resort and many of these youth live in families that were on other programs that have been cut back, a key question is where would they go now?” he says.

What’s really needed, he continues, is a “fundamental rethinking of how cash supports are provided to youth with disabilities,” so that there are incentives to promote their long-term employment as adults.

President Obama’s 2012 budget proposed another approach: Increase funding for the SSA to do more regular medical reviews that evaluate whether SSI recipients are still eligible for the benefits. If the reviews find people receiving benefits who are no longer disabled, they can result in significant savings.

Poe feels so strongly about SSI that she recently traveled to Washington to testify at a congressional briefing and lobby her representatives to preserve the program. She says the SSI program is holding her family together. After her son Hulston was kicked out of preschool, she had to drop two college classes to care for him.

“I can’t even express to you how much it was disrupting my household,” Poe says.

She says she’d be thrilled if Hulston’s ADHD improved enough to get off of the SSI program.

“The reason I applied for disability was not because that’s what I want to live on for the rest of my life or my kid’s life. I want to achieve things in life. I want my family to be self-sufficient,” Poe says. “Right now, that isn’t happening.”

This story was produced through collaboration between NPR and Kaiser Health News (KHN), an editorially independent program of the Henry J. Kaiser Family Foundation, a nonpartisan health-care policy research organization. The Kaiser Family Foundation is not affiliated with Kaiser Permanente.

Originally Published On: www.npr.org – Original Article Here

Giving vitamin A supplements to children under the age of five in developing countries could save 600,000 lives a year, researchers claim.

They found vitamin A supplements reduced child mortality by 24% in low- and middle-income countries.

They calculate that, considering the estimated 190m children who are vitamin A deficient, reducing deaths by 24% would save more than 600,000 lives each year.

Dr Evan Mayo-Wilson from the University of Oxford, who worked on the study, said: "Until other sources are available, supplements should be given to all children who are at risk of vitamin A deficiency.

"After just one year, children who had taken supplements were less likely to have died than children who received a placebo [dummy version].

Vitamin A supplements are highly effective and cheap to produce and administer."

He said there had been recent criticism of vitamin A programmes – with some saying there were risks that respiratory infection rates could increase, particularly in children who were not vitamin A deficient – but he added there was "little doubt" that vitamin A prevented young children from dying.

In an editorial for BMJ Online, Professor Wafaie Fawzi, from the department of nutrition, epidemiology, and global health at Harvard School of Public Health, added: "Effort should now focus on finding ways to sustain this important child survival initiative and fine tune it to maximise the number of lives saved."

Originally Published On: www.bbc.co.uk – Original Article Here

As rebel forces continue their fight to overthrow Libyan leader Col Muammar Gaddafi, fears are growing of an impending humanitarian crisis in the country.

"We were asked to deliver 50 boxes of medical aid and food supplies to Tripoli," says Khaled. "None of us wanted to refuse to help because we thought 'This is why we're here'."

"But you are so energised in the work that you forget about where you are and the dangers."

She works with families who have fled the centres of conflict in Misrata, Brega and Ajdabiya. Some live in university halls, while others are housed in accommodation meant for migrant workers who fled the area when the uprising began.

Save the Children programmes target education, child protection and health. Aid workers run games and activities to try to reach traumatised youngsters through play, singing, music or art.

Many youngsters now in Benghazi have seen their homes and neighbourhoods destroyed and watched as sons, brothers and fathers go off to war, says Jenny.

"We have seen that children are initially drawing pictures of battles, violence, weapons – and over time, a few weeks or so, these pictures become less violent and focus on normal childhood scenes, such as families, homes and seaside scenes," she adds.

The team trains community members – teachers, social workers and volunteers – to recognise symptoms of distress in children, and to be able to explain that these feelings are natural.

"We're hearing stories talking about children having terrifying nightmares and screaming in the night. Some children have separation anxiety because they can't bear to be apart from their parents."

Jenny says there is a now a sense in Benghazi that life is returning to normal.

"The wonderful thing about Libya, and certainly Benghazi, is that the community spirit and the desire to reach out and help everybody is so strong," she says.

Originally Published On: www.bbc.co.uk – Original Article Here

Autism specialists have long thought the disorder has a strong genetic component -– maybe stronger than any other neurodevelopmental condition.

Now a new study — the largest so far to look at autism in younger brothers and sisters of an affected child — finds their risk of also having autism is higher than previously thought, especially if the younger sibling is a boy.

The overall risk that a younger sibling of an autistic child will have the disorder is 19 percent, the researchers found. Earlier, smaller studies had pegged the risk at 3 to 14 percent.

But if the younger sibling is male, the risk shoots up to more than one in four, according to the study, which appears online in the journal Pediatrics. “That’s a really high rate compared to the risk of autism in the general population, which is 1 in 110,” says Sally Ozonoff of the University of California, Davis, who led the research.

By contrast, if the younger sibling is a girl, her risk of autism is 9 percent.

And if a family has two or more children with autism, the risk among younger siblings goes up even more — to 1 in 3.

The study involved 664 infants in the United States and Canada with at least one older sibling affected by autism, ranging from mild types called “pervasive developmental delay” and Asperger’s syndrome to the most severe forms. These younger siblings were monitored from the age of six to eight months until 3 years to see if they showed signs of having a disorder on the autism spectrum.

The new numbers have implications for researchers, for families affected by autism, and for pediatricians everywhere who see the younger sibs of autistic children during their early well-child visits.

“It’s the first thing families ask: How likely is this to happen again?” Ozonoff says. “Parents are already concerned, already watching their child’s development carefully. We are able to supply some answers.”

But Ozonoff says maybe the most important message is for pediatricians.

“If they have a little boy in their practice who has an older sibling [with autism], that child’s risk is 25 times higher than another infant in their practice,” she told Shots.

“This should mean there is more careful monitoring and screening beyond the usual questions at a normal well-child visit,” Ozonoff continues. “Drilling down into the things that we know are early signs of autism — interest in people, responding to their name, responding to other people, smiling at other people.”

Alycia Halladay of the advocacy group Autism Speaks, which partially funded the study along with the National Institutes of Health, agrees that the new data refute a passive wait-and-see attitude toward children who have an older sibling on the autism spectrum — disorders ranging from Asperger’s to being profoundly uncommunicative.

“It is our hope,” Halladay says, “that by encouraging parents to seek careful monitoring of their child, we can really push the whole health care system into doing a better job at providing an earlier diagnosis for those who are affected, so more kids who have autism are identified earlier.”

That can really make a life-changing difference, says Judith Ursitti, a Massachusetts mother of two children with autism spectrum disorders. Her daughter, Amy, who is 11, has Asperger’s, while her son, Jack, 7, has severe autism.

“For decades, many people have heard the word ‘autism’ and they just thought ‘hopeless,’ ” Ursitti says. “But there are therapies that, if done early and intensively by the right sort of professionals, can really cause someone with autism to dramatically improve and overcome the challenges of autism.”

She regrets that her son Jack didn’t get diagnosed until after age 2, when he failed to speak or point, smile at others or wave goodbye — despite the fact that he had excellent pediatric care.

Enrolled in a special school for autistic children, supplemented by behavioral therapy at home, Jack Ursitti is now communicating “more than we ever thought he would,” his mother says.

Judith Ursitti, who works with Autism Speaks as a lobbyist for better insurance coverage of autism diagnosis and treatment, says many parents of autistic children won’t be surprised by the new study. In fact, they might have expected that the chance of a sibling being affected was much higher.

“It’s amazing how families are affected more than once,” Ursitti says. “I remember when Amy started getting intervention for Asperger’s, and she was with a group of girls for therapy. And they all had brothers who had autism. And I thought, ‘Wow, this is incredible!’ “

But Ozonoff, the study leader, says the data might be reassuring for families who mistakenly believed they had a much higher risk of having a second or third child with autism. For every younger sibling who is affected, four others will not be.

“No matter how alarming these statistics are — and truly they are for researchers and clinicians and parents — I also tell people that even in the highest-risk groups … the likelihood of their baby not having autism is always much higher,” Ozonoff says. “So, holding that baby in their arms, there is reason to hope.”

Originally Published On: www.npr.org – Original Article Here

Tougher action – including taxing junk food – is needed by all governments if the obesity crisis is going to be tackled, experts say.

Dr Frank Atherton, president of the Association of Directors of Public Health, also said he was in favour of the interventions being suggested: "Of course we have to work with industry, but there is a feeling that the emphasis of this government has turned too far away from legislation."

However, Terry Jones, of the Food and Drink Federation, said the industry had been taking positive steps.

"The Lancet fails to recognise the lengths to which the UK food and drink industry has gone to help improve the health of the nation, particularly in relation to rising obesity levels," said Mr Jones.

Public health minister Anne Milton said the government believed the best way to achieve results was through a "collective voluntary effort".

She said this was achieving results, citing the pledge by industry to put calorie information on menus.

"We have no current plans to impose a 'fat tax', but we are working with food companies to reduce fat, sugar and salt and ensure healthier options are available.

"We also want to see businesses use more consistent and informative front-of-pack nutrition labelling than has been achieved in the past," she added.

"We recognise the significant threat that obesity poses to society and have taken a proactive part in improving health."

Originally Published On: www.bbc.co.uk – Original Article Here

Complaints of mosquito bites are on the rise in the UK. So should Britons brace themselves for a future mosquito menace?

The Health Protection Agency has organised the Mosquito Recording Scheme to look into where and how mosquitoes live and breed.

While the species does not carry malaria, it does transmit West Nile virus, Yellow fever and dengue.

"It is possible that Aedes albopictus could make its way to the UK," says Dr James Logan, medical entomologist at the London School of Hygiene & Tropical Medicine.

"Because they lay their drought-resistant eggs in transportable materials, like used tyres, there is a possibility that they can be transported to a country where they are not normally found.

"Some studies suggest that they could survive the UK winter, however, to date this species has not been found in the UK and the HPA are keeping a watchful eye on it."

Bonsall agrees and adds that predictive models show how malaria-carrying species could even make their way to areas such as the North Kent marshes, Essex, Norfolk and Suffolk.

Mosquitoes are becoming immune to the insecticides used to treat them – via spray or bed nets, according to a recent study from Senegal. Between 2007 and 2010, insects with a resistance to a popular type of pesticide rose from 8% to 48%.

"This could be a big problem for future control," says Dr Hilary Ranson, head of the vector group at the Liverpool School of Tropical Medicine.

But according to Dr Logan, the health infrastructure and access to drugs in the UK means malaria is unlikely to take hold and cause major problems.

Unlike much of the world, the rise of the mosquito will be a nuisance in the UK rather than a serious threat.

Originally Published On: www.bbc.co.uk – Original Article Here

Scientists hope to harness coral's natural defence against the sun's harmful ultraviolet rays to make a sunscreen pill for humans.

Dr Long said: "We couldn't and wouldn't want to use the coral itself as it is an endangered species."

He said scientists had known for some time that coral and some algae could protect themselves from the harsh UV rays in tropical climates by producing their own sunscreens but, until now, they didn't know how.

"What we have found is that the algae living within the coral makes a compound that we think is transported to the coral, which then modifies it into a sunscreen for the benefit of both the coral and the algae.

"Not only does this protect them both from UV damage, but we have seen that fish that feed on the coral also benefit from this sunscreen protection, so it is clearly passed up the food chain."

This could ultimately mean that people might be able to get inbuilt sun protection for their skin and eyes by taking a tablet containing the compounds. But for now, Dr Long's team are focusing their efforts on a lotion.

"Once we recreate the compounds we can put them into a lotion and test them on skin discarded after cosmetic surgery tummy tucks.

"We will not know how much protection against the sun it might give until we being testing.

"But there is a need for better sunscreens."

Another long-term goal of the Biotechnology and Biological Sciences Research Council-funded study is to look at whether the processes could also be used for developing sustainable agriculture in the Third World.

The natural sunscreen compounds found in coral could be used to produce UV-tolerant crop plants capable of withstanding harsh tropical UV light.

Originally Published On: www.bbc.co.uk – Original Article Here

Editor’s note: Coming this fall on CNN, Dr. Sanjay Gupta takes an in-depth look at assisted suicide and families ripped apart by the issue.

Portland, Oregon (CNN) — James Powell could barely speak on the day he died; cancer had confined him to bed and heavy painkillers left him only semi-lucid. Yet the mood was almost celebratory as 25 people — family, friends and volunteers — gathered in a large living room to tell stories and say goodbye on the day Powell chose to end his suffering.

"After he took the medication, he fell asleep really quickly. His body just relaxed. He went into deep snoring. There were tears, but also it felt like a real family gathering of support," his daughter Katy, 61, remembers. "After he died you could pretty much feel the spirit kind of lift in the room. Thank goodness he’s free of that horrible suffering and pain."

Powell, who died at age 82 in 2008, had worked to pass Oregon’s Death With Dignity Act, a law enacted in 1997 that allows terminally ill patients to choose to end their own lives with lethal medications. A similar law was passed in 2009 in Washington. In Montana, the state supreme court ruled in 2009 that doctors in that state cannot be prosecuted for assisting with the death of terminally ill patients, but did not guarantee it as a constitutional right.

This month, in Massachusetts, the Dignity 2012 campaign, which includes members of a local chapter of the national nonprofit group Compassion & Choices, is spearheading a movement to get a Death With Dignity Act on the 2012 ballot. Supporters filed paperwork with the state’s attorney general.

The idea of allowing someone to end his or her own life is undoubtedly controversial. Gallup’s 2011 Values and Beliefs poll found in March that 45% of Americans consider doctor-assisted suicide morally acceptable, and 48% believe it’s morally wrong; the split was closer than on other hot-button issues such as abortion, having a child out of wedlock and cloning animals.

The law is significant for more than just the few people who actually go through the entire process of obtaining lethal medications and taking them, said Barbara Coombs Lee, president of Compassion & Choices.

"End of life care and empowered patients are better for everyone in the state," she said.

But this creates a double standard for the prevention of suicide, argues Stephen Drake, research analyst for the organization Not Dead Yet, a disability advocacy group that opposes physician-assisted suicide.

In his view, the Death with Dignity Act establishes a two-tiered system in which some people’s suicides are more encouraged than others. It’s the idea that young, healthy and nondisabled people should be prevented from dying, while the deaths of the old, ill and disabled should be facilitated, he said.

"When you look at it that way, it doesn’t look so much like empowerment’s at work," Drake said.

There’s a difference between helping a patient feel comfortable at the end of life and "making killing an acceptable part of medical practice," he said. He said he fears advocates will attempt to expand the established law’s requirements to include more and more people, although Coombs Lee said her organization has no interest in broadening the eligibility rules for the Death with Dignity Act.

Groups like Not Dead Yet and the National Council on Disability are also concerned that the top three reasons for people using the law in Oregon are consistently "loss of autonomy," "decreasing ability to participate in activities that made life enjoyable" and "loss of dignity." These reasons seem to be predicated on the notion that a disabled life is viewed as one that is not worth living, opponents of assisted suicide argue. The disability council would like these reasons examined more closely.

The United States Conference of Catholic Bishops recently approved a statement against "doctor-prescribed suicide," which also brings up the issue of disability. The group cautions that the wishes of others may bias a patient’s choice, especially in a society that undervalues the lives of people who are disabled or dependent on others.

"Those who choose to live may then be seen as selfish or irrational, as a needless burden on others, and even be encouraged to view themselves that way," the group wrote.

The bishops also argue that patients should receive help, in the form of counseling and medication if needed, to alleviate their desire to end their lives, rather than be granted a prescription for it.

But the bishops do support effective palliative care and do not suggest that patients undergo unduly burdensome medical treatments that prolong suffering at the expense of quality of life. They draw the line at physician-assisted death, pointing to the U.S. Declaration of Independence’s emphasis on the inalienable right to life, and to the Christian belief that life is a gift from God.

"A choice to take one’s life is a supreme contradiction of freedom, a choice to eliminate all choice," they write.

The basics

In order to use the law in Oregon, a patient must be over the age of 18 and have a diagnosis of a terminal illness with six months or less to live. The patient must be a resident of the state and capable of making and communicating his or her own health care decisions.

The patient must give an oral request to an attending physician twice, with at least 15 days in between. A consulting physician must also confirm the diagnosis and prognosis.

It’s usually not possible for a person with dementia to use the law, because the patient must be able to make his or her own decisions. If either the physician or consulting physician feels the patient has depression or other mental illness that might affect judgment, he or she must be sent for a further mental evaluation. Further guidelines are available from the state of Oregon.

In the year 2010, 65 patients died by ingesting prescribed lethal medications in Oregon, according to the state’s public health division, corresponding to about 21 deaths out of 10,000. In the state of Washington, 51 people died after ingesting the medications last year. But more people than that go through the process. A total of 96 prescriptions were written in 2010 in Oregon, and 87 were dispensed in Washington.

Patients may die naturally first or decide not to use the drugs. But having the medication gives the patient and family peace of mind, Coombs Lee said.

"They want to have it the same way you want an umbrella or you want fire insurance or you want a safety blanket of some kind," Coombs Lee said.

Once the patient has the medication, the patient begins to have conversations about intentions with his or her family, said Jason Renaud, executive director of the Oregon chapter of Compassion & Choices. The patient starts to say goodbyes in a much more intentional way, and starts to make amends more intentionally, too.

The system may not be perfect. A 2008 British Medical Journal study, led by Linda Ganzini of Oregon Health and Sciences University, found that the Oregon law may not adequately protect all mentally ill patients, and suggested there should be better tools for screening for depression.

But Renaud takes issue with that research. "Our folks are within weeks of dying, so it’s quite common and normal for them to be sad and worried about their families and about their health," he said.

Patients come to the Oregon chapter of Compassion & Choices by physician referral, Renaud said. Most patients have cancer.

Coombs Lee’s organization counsels about 2,500 people nationwide every year about end of life options. Professional staff and trained volunteers help individuals navigate their state’s systems and, in places where it’s legal, assist them through the process.

Some call that process "assisted suicide," which Drake fears is "making killing an acceptable part of medical practice," but Compassion & Choices calls it "hastening."

Its volunteers help with that hastening. They may be the ones to prepare the lethal medication and stay at the home until the patient goes into a coma; they’ll wait until death if the family wants. Hospice staff is usually there, too, if the patient is in hospice care. Death usually comes within 20 minutes to two hours, although it can take days in some cases. In two cases in Oregon in 2010, patients who took the medication did not die from it, but passed away from their underlying illness, according to the Oregon Public Health Division.

Before giving the medication, a volunteer will ask two questions: Do you know what happens when you take this, and, are you doing this on your own free will? The patient gets the lethal drugs only if he or she says yes to both.

What it means to hasten

Katy Powell is one of those volunteers. A real estate agent in Portland, she doesn’t advertise the time she has put into helping with end of life choices for the past three years, but she is getting more comfortable talking about it.

"I’m not only honoring my dad and wanting to volunteer, but I’m a huge proponent of personal freedom of choice. I don’t care if people don’t want to use the law. We’re here to help them die in any way they want to," she said

She knows how to mix the medication so the family of the person who is hastening doesn’t have to. The main ingredient is usually about 100 capsules of a drug called Seconal that have to be pulled apart and mixed with water. The result is a bitter drink, the way pure aspirin tastes, she says. In a sense, the foul flavor is another safeguard in case the person had any doubts.

"If someone was confused about what in the heck they were doing, and they tasted this, in one sip they would spit it out if they didn’t want to drink it," Powell said. "When people drink this down, gulp after gulp after gulp, they’re very determined. They don’t stop."

Often, the hastening is a sort of "party with tears," Powell said. The mood all depends on family dynamics; in her experience, women who are choosing death often seem happier than men.

"They’re just like, ‘Cheers, I’ll see you in another life,’ and then they have a whiskey chaser or whatever they want to chase the medication with, and people are laughing and crying," she said.

One patient who chose to hasten was a professional belly dancer who taught belly dancing at a local college, Renaud recalled. She had breast cancer in 2008 and survived a double mastectomy, but when the cancer returned she did not want to go through chemotherapy and radiation again. She quickly became terminally ill. A volunteer from Compassion & Choices arrived at 5 p.m. on the day of the hastening to find a party with 45 people, which lasted until midnight, Renaud said.

"When she died, there were dozens of people in her bedroom. That can’t happen in other states. In other states it’s covert, illegal, frightening," he said.

Why would someone choose to hasten death this way? Pain is part of it, Powell said. Another factor is not wanting to be totally dependent on others, especially strangers if they have to go into a nursing home or other hired-care situation.

"It’s more of just being autonomous and having control over their situation. They don’t want to lose control," she said.

From law to practice

Her father, Jim, wasn’t a control freak, but he was always in charge, she said. He was the head of both a business and a large family, and was a strong leader in his Unitarian church. When he wanted to do something, he was determined and would do it, she said.

Both Powell’s parents were staunch believers in people having freedom of choice in personal matters (Autry, Powell’s mother, is still living, but suffers from Parkinson’s and dementia). The Death With Dignity Act became important to James Powell in particular because he was a friend of the husband of Janet Adkins of Portland, who was the first person Dr. Jack Kevorkian publicly assisted in suicide. At age 54, she had Alzheimer’s disease and was adamant that she did not want it to progress.

"Because of the outrage of what Kevorkian was doing, I think Dad and her husband — they were very educated, intelligent, well-connected people — got these people together and said ‘We need to have a law that legitimizes this.’ "

(The law that was passed, however, would not have applied to Adkins, because she did not have a diagnosis of a terminal illness with six months or less to live).

Powell’s father was on the committee that wrote the law, she said. Still, when he helped pass it in 1997, he probably didn’t think he’d use it himself one day.

"He always knew it was there, and he was probably happy when the time came," she said.

After her father died, Powell waited the recommended few months before beginning to volunteer with Compassion & Choices. At first, she was a lot more emotional about helping people with the hastening process, as if she were reliving what she went through with her father. She still empathizes with the families, she said, but now doesn’t get as stressed or sad about the hastening itself; she is happy for the patients, who always thank her over and over.

"It’s almost like being at a birth, where you’re emotional about that, too, and it’s more joyous, of course, but it’s still that same wonderful awe-inspiring feeling of taking part in something that’s really important," she said.

Originally Published On: www.cnn.com – Original Article Here

Bed bugs protect their sperm against sexually transmitted infections by producing germ-busting ejaculates, scientists have found.

Suspecting that males load their ejaculates with proteins that protect sperm, Dr Otti carefully extracted sperm from a number of male bed bugs, being sure not to mix it with the seminal fluid that usually makes up the rest of the ejaculate.

He then mixed the sperm with a "soup" of micro-organisms that he had collected from the outer skin of the bed bugs.

To half of these samples he added lysozyme, a bacteria-killing enzyme known to be active in bed bugs, and saw that 40% more sperm survived in its presence.

Females didn't gain any protection from these introduced bacteria-busting enzymes, he explained; the presence of lysozyme in the ejaculate seemed to be purely to protect sperm.

But other work by Dr Otti's colleague Michael Siva-Jothy, who is also based at the University of Sheffield, shows that females protect themselves from the infections introduced during sex with their own lysozymes.

In fact, females ramp up their lysozyme activity just before they are about to feed. Dr Siva-Jothy explained that this is probably because in the bed bug world, feeding is generally always followed by mating.

"Wounding is a very frequent event during and after copulation, and generally genitals are not that clean, " Dr Otti told BBC News.

He explained that the research that has focused on human sexual transmitted diseases has tended to ignore the microbes that coexist with us on our skin; these microbes are likely also transferred during sex.

"It is not clear what the cost of having them around is," Dr Otti added.

The advantage of studying bed bugs, he said, is that we share many components of our immune system. As a result, scientists can learn much from manipulating the bugs' sex lives to study the consequences on lifespan and offspring production – some of these trade-offs could be relevant to humans.

Originally Published On: www.bbc.co.uk – Original Article Here

(CNN) — The United Nations warned Monday of a possible resurgence of the deadly avian flu virus, saying there are indications a mutant strain may be spreading in Asia.

A variant strain of the H5N1 avian influenza virus, which can apparently bypass the defenses of current vaccines with unpredictable risks to humans, has appeared in Vietnam and China, the Food and Agriculture Organization (FAO) stated.

Circulation of the virus in Vietnam threatens Thailand, Malaysia, Cambodia, Japan and the Korean peninsula, the FAO said.

The most recent death caused by avian flu occurred this month in Cambodia, where eight people have died after becoming infected this year, the organization added.

The World Health Organization (WHO) says the virus has infected 565 people since it emerged in 2003, causing 331 deaths.

Avian flu has also directly killed or required the culling of over 400 million poultry and caused economic losses estimated at $20 billion before being eliminated from most of the 63 countries infected at its 2006 peak.

The virus is still present in China, Bangladesh, India, Indonesia, Vietnam and Egypt, while areas recently affected include Nepal, Mongolia, Romania, Bulgaria, Israel and the Palestinian Territories.

A geographical advance in cases of infected poultry and wild birds since 2008 has apparently been due to the movement of migratory birds, said FAO Chief Veterinary Officer Juan Lubroth.

"Wild birds may introduce the virus, but peoples’ actions in poultry production and marketing spread it," he said.

"Preparedness and surveillance remain essential," he warned.

Originally Published On: www.cnn.com – Original Article Here