• U.S. measles outbreak tied to one person

• New flu pandemic could kill 81 million

• Christmas goodies pack on the pounds

• Psychological treatments ease low back pain

• Thousands of Madagascar children risk malnutrition report

• Diabetes not linked to Alzheimers in seniors

• Even with lung cancer quitting cigarettes helps

U.S. measles outbreak tied to one person

ATLANTA - The biggest U.S. measles outbreak in a decade — 34 people stricken in Indiana and Illinois last year — was traced back to a 17-year-old girl who had traveled to Romania without first getting vaccinated, government health officials said Thursday.
The outbreak accounted for more than half of the 66 measles cases in the United States in 2005. Widespread use of the measles vaccine has dramatically reduced the incidence of the disease over the past four decades; in 2004, there were just 37 cases, the smallest number in nearly 90 years of record-keeping.

The Indiana girl became infected after visiting a Romanian orphanage while on a church-mission trip, health investigators said. The others became infected after they attended a church gathering with her the day after her return.

"Orphanages are known to be higher risk" for measles, said Dr. Philip Gould of the Centers for Disease Control and Prevention. "The main point is to ensure that people do get vaccinated, especially prior to leaving the country, going to a place that physicians suspect that measles is a risk."

Thirty-three people in Indiana and one from Illinois became infected. Three people were hospitalized, but no one died.

Only two of the 34 people had been vaccinated against measles.

"The outbreak occurred because measles was imported into a population of children whose parents had chosen not to vaccinate their children because of safety concerns, despite evidence that measles-containing vaccine is safe and effective," the http://www.cdc.gov/nip/diseases/measles/faqs.htm

New flu pandemic could kill 81 million

LONDON - A flu virus as deadly as the one that caused the 1918 Spanish flu could kill as many as 81 million worldwide if it struck today, a new study estimates. By applying historical death rates to modern population data, the researchers calculated a death toll of 51 million to 81 million, with a median estimate of 62 million.
That's surprisingly high, said lead researcher Chris Murray of Harvard University. He did the analysis, in part, because he thought prior claims of 50 million deaths were wildly inflated.

"We expected to end up with a number between 15 and 20 million," Murray said. "It turns out we were wrong."

The new work is published in Saturday's issue of the journal The Lancet.

The 1918 flu outbreak killed at least 40 million people worldwide. But flu pandemics have varied widely in their severity. The most recent, in 1957 and 1968, were relatively mild, killing 2 million and 1 million people worldwide respectively.

To get their estimates, Murray and his colleagues examined all available death registration data from 1914 to 1923. There was sufficient information from 27 countries, including numbers from 24 U.S. states and nine provinces in India.

The researchers compared death rates during the pandemic to average death rates before and after. That revealed how much the pandemic flu contributed to death rates, a figure called excess mortality. They then applied the excess mortality data to worldwide population data from 2004.

If their median estimate of 62 million flu deaths occurred in a single year, the total number of deaths from all causes worldwide would more than double, jumping by 114 percent.

One surprise in the new study was the huge variation in how different countries would be affected by a pandemic. The study estimates that 96 percent of the deaths would occur in the developing world. Murray and colleagues noted there was a 30-fold or more variation in mortality.

"That tells us it's not just the genetic makeup of the virus that will cause deaths, but that there are a lot of other things that intervene," he said.

Determining the mitigating factors might help avert a catastrophe. "If we can answer that question, we may unlock the mysteries behind which non-pharmaceutical strategies could significantly decrease mortality," said Murray.

Population density, nutrition and immune status could all play roles, he suggests.

"We know that even if we have much lower numbers of deaths worldwide than in 1918, the world will be severely stressed," said Dr. Keiji Fukuda, coordinator of the World Health Organization's Global Influenza Program. "Speculating about the possible numbers is an interesting exercise, but the really important thing is, what do we do about it?"

Since the pandemic threat rose, with circulation of the H5N1 bird flu virus on a large scale in late 2003, the global community has bolstered its pandemic preparedness plans. Medical systems today are far stronger than they were last century, and the availability of antivirals and antibiotics — which did not exist in 1918 — should help greatly. Still, many of these advances remain out of reach for poor countries.

Another question is the impact a flu pandemic would have on those infected with HIV. Seasonal influenza exacts a heavy toll on those with weakened immune systems. So, in the case of a new pandemic flu, Murray's estimate might be optimistic.

And while the Spanish flu often has been regarded as a worst-case scenario, there is no guarantee the next pandemic will not be even more deadly. Despite the tens of millions of deaths the 1918 flu caused, the death rate among those infected was approximately 2 percent. The fatality rate for the H5N1 virus is about 60 percent.

However, experts think that if H5N1 were to evolve into a strain easily transmissible between people, it would also become less deadly.

"It's not in a virus' interest to kill its hosts so readily, otherwise it can't reproduce," said Dr. Ian Gust, a flu expert at the University of Melbourne, Australia.
Still, there is no guarantee that H5N1 would become less deadly.
If it doesn't, "we would be in for a devastating impact," said Gust. "All bets would be off."

Christmas goodies pack on the pounds

MIAMI - Oh, those holiday pitfalls: a martini and a handful of Chex mix at the office party, Grandma's fruitcake, the plate of gingerbread cookies from your neighbor. Eating all those goodies will definitely cost you.
To burn off the calories in one gingerbread cookie, you will have to swim 18 minutes. The martini and party mix will take 47 minutes on the bike.

And the fruitcake? Take an 84-minute walk.

Those are the calculations in a new book that lists the calorie content of 7,500 foods and tells you just how long it will take to work it off.

"Most of us have no idea what a calorie is worth," said Charles Stuart Platkin, author of "The Diet Detective's Count Down" and other books.

Platkin, a Miami-based public health advocate, spent nearly a year compiling the list, which includes fast-food dishes, popular restaurant menu fare and most grocery items. The exercise calculations are for a 155-pound person; add time if you're lighter, subtract time if you're heavier.

Some of the numbers are downright depressing.

A half-pound of prime rib will cost you 230 minutes of yoga. A Starbucks Caramel Macchiato is 38 minutes on the bike — add 81 minutes if you grab a piece of coffee cake. You'll have to walk 173 minutes to burn off a Whopper from Burger King.

Platkin, 44, said it is like money: Once diners know a food's caloric value, they can weigh in their mind whether it is "splurge worthy."

Some of the biggest food rip-offs include crackers, at 12 to 20 calories apiece, and premium ice creams, Platkin said. It will take 72 minutes to walk off a half-cup of Ben and Jerry's Butter Pecan, versus 31 minutes for Edy's Slow Churned Light version of the same flavor. Predictably, fruits and veggies provided the best bargains.

The holidays are one of the trickiest seasons for dieters. Research shows people tend to gain just under a pound during the holidays. It only takes an extra hundred calories a day over the holiday season to gain a pound. And they don't typically lose it by spring.

"People tend to relax their guard and let themselves go during the holidays. And there's also more food around so we also consume more," said Platkin, who became his own diet detective after losing 50 pounds 14 years ago.

The book could come in especially handy for nibblers.

"Nibblers tend to be worse estimators because they feel like they're not eating anything — a few fries, a bit of cookie. But they add up to be significant calories," said Platkin, a certified trainer who is finishing up his Ph.D. in public health.

Most Americans underestimate how much they're actually eating by as much as 40 percent, he said.

Experts said the book's premise could encourage or discourage dieters, depending on the reader.

"For some people that's really a helpful thing. It really shows them it takes a fair amount of physical activity," said Jeanne Goldberg of the Friedman School of Nutrition at Tufts University.

On the flip side, she said, the numbers might seem so daunting that others skip exercising altogether.
Platkin said the book is not designed for people to look up every morsel they consume in a day. But it does provide a frame of reference.
Even if dieters don't end up doing the exercises, they will probably think twice before eating that slice of pumpkin pie. .
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On the Net: http://www.dietdetective.com

Psychological treatments ease low back pain

NEW YORK - Pooled results from 22 clinical trials show that psychological interventions help individuals with chronic low back pain experience less actual pain, less pain-related interference with daily living, less depression and work-related disability, and greater health-related quality of life.
Dr. Robert D. Kerns, who led the analysis, told Reuters Health, "The data across randomized, controlled studies are consistent." Psychological interventions for chronic low back pain elicit "positive results."

Kerns, of the VA Connecticut Healthcare System in West Haven and colleagues limited their pooled analysis to studies involving adults with low back pain not related to cancer for at least three months. Most of the study subjects had suffered with low back pain for much longer -- 7-1/2 years on average.

In the overall analysis, psychological treatments -- namely, behavioral and cognitive-behavioral therapies; self-regulatory therapies such as hypnosis, biofeedback and relaxation; and supportive counseling -- either alone or as part of a multidisciplinary approach proved superior to no treatment or "treatment as usual."

"The largest and most consistent effect was a reduction in pain intensity," Kerns told Reuters Health. "This is good news for persons with pain and for providers who struggle to find effective and sustained approaches for reducing unnecessary pain and suffering of the lower back."

The finding of an actual drop in pain with psychological therapy is also somewhat surprising, the researchers note, because traditionally the goal of psychological therapy for chronic back pain was not to reduce the pain but to help patients learn to live with it more successfully.

The findings appear in the journal Health Psychology.

Kerns hopes to "get the word out" that psychological treatments are effective and cost-effective for people who suffer chronic low back pain. "We need to specifically target health care system administrators and third-party payers to try to engage them in a more productive dialogue about the importance of these interventions," Kerns said in a statement.

Low back pain affects 15 to 45 percent of adults annually and at least 70 percent of adults over their lifetime. "We continue to have a huge, very costly problem in our society, but we have an intervention that is effective, and we need to do a better job of creating access to these services," Kerns said.

SOURCE: Health Psychology, January 2007.

Thousands of Madagascar children risk malnutrition report

ANTANANARIVO - At least 5,500 children in drought-stricken southern Madagascar are at immediate risk of acute malnutrition, the Malagasy National Nutrition Office said.
"There has not yet been a nutritional crisis but the prevalence rate in four rural districts communes is almost there," ONN coordinator Anbinintsoa Raveloharison told AFP.

The data came from a report his office wrote, with the support of Unicef, in the island's south between December 10 and 21.

"We have not reached the critical tipping point, but there are pockets where we need to intervene as a priority," Raveloharison said. "We need to rally with our partners to coordinate an emergency action," he said.

The ONN identified 3,610 families in most urgent need of assistance.

The drought in the south of Madagascar, already one of the world's poorest countries, was caused when rains which should have started in November failed to arrive.

President Marc Ravalomanana called on the international community to help with the shortage of food and water on December 12.

Diabetes not linked to Alzheimers in seniors

NEW YORK - For older people with diabetes, the condition does not increase the likelihood that they'll develop Alzheimer's disease, according to a report in the medical journal Neurology. However, diabetes is associated with areas of brain damage called cerebral infarction which can impair mental capacity.
Dr. Zoe Arvanitakis from Rush University Medical Center, Chicago, Illinois and colleagues reviewed autopsy results from 233 older participants in the Religious Orders Study.

The team found just over one third of participants had one or more cerebral infarctions, and patients with diabetes were about 2.5 times more likely than others to have cerebral infarction.

In contrast, the levels of Alzheimer-type damage were similar between subjects with and without diabetes.

"This finding is interesting," Arvanitakis said, "given that several recent large epidemiologic studies have found that diabetes increases risk of clinically-diagnosed Alzheimer's disease by about two-to-three fold."

"Diabetes increases risk of dementia, clinically-diagnosed Alzheimer's disease, and is associated with cognitive impairment and decline in cognition, Arvanitakis pointed out. "Researchers need to better understand mechanisms underlying these relations. This understanding may contribute toward decreasing effects of diabetes on the brain."

SOURCE: Neurology, December 2006.

Even with lung cancer quitting cigarettes helps

NEW YORK - Once people have been diagnosed with lung cancer they might think it pointless to stop smoking, but in fact it's not too late to benefit from quitting, a new study shows.
Researchers found that among more than 200 lung cancer patients at their center, those who quit smoking after the diagnosis became less severely impaired by the disease than those who kept up the habit.

Specifically, their "performance status" -- a measure of patients' ability to care for themselves and function in daily life -- was generally higher, according to findings published in the medical journal Chest.

Patients who gave up cigarettes did not live appreciably longer than those who continued smoking, the study found, but the difference in quality of life highlights the importance of quitting even after lung cancer develops, according to the study authors.

"To the best of our knowledge, this is the first study to demonstrate a correlation between smoking cessation after diagnosis and performance status," write Dr. Sevin Baser and his colleagues.

The researchers at the University of Texas M.D. Anderson Cancer Center in Houston based their findings on 206 men and women treated at their center for non-small cell lung cancer -- which, of the two major forms of lung cancer, is the less aggressive type.

Of these patients, 93 were smokers at the time of diagnosis, and half subsequently quit.

Over the next year, there was no clear difference in survival odds between the two groups, Baser's team found. However, patients who quit smoking were far more likely to maintain their performance status, which essentially means they had greater well-being.

The difference was seen regardless of a patient's age, overall health or stage of cancer, according to the researchers.

Continued smoking, they note, may deteriorate a lung cancer patient's quality of life by starving their tissues of oxygen, which worsens outcomes from chemotherapy and radiation. It may also speed the weight loss that often comes with cancer.

"Our results," the researchers write, "highlight the importance of smoking cessation in lung cancer patients and provide oncologists with additional evidence for making this recommendation."

SOURCE: Chest, December 2006.