WGBH News: Health

Why You Should Wash A Melon Before Chowing Down

Wed, 14 Sep 2011 21:12:00 GMT

Have you ever heeded the advice to wash and dry a melon before digging in? Does anyone actually eat the skin of a honeydew or a cantaloupe anyway?

Well, even if you're not planning on a mega-dose of fibrous skin and rind, there is a good reason to rinse off that melon: germs. The knife that cuts through the melon's tough exterior can transfer nasty bugs to the sweet flesh you do consume.

That's why the Centers for Disease Control and Prevention and other public health agencies are reminding people to wash produce, including cantaloupes, amid an investigation into an outbreak of listeriosis reported in a half-dozen states that so far has been linked to the deaths of four people.

Interviews with people who got sick "strongly suggest that illnesses are linked to consumption of cantaloupes," the CDC said. Most of the cases have occurred in Colorado and New Mexico.

Some of the people recalled that the cantaloupes they ate came from the Rocky Ford area of Colorado. Colorado health officials warned people especially vulnerable to listeriosis, a bacterial infection marked by fever and muscle aches, to avoid the suspected melons:

Although washing and drying produce is a good practice, it does not reduce the chance of listeriosis for those who are at high risk. If you are at high risk for listeriosis, do not eat Rocky Ford cantaloupe.

Who's at risk? Pregnant women, newborns, people with weak immune systems, including those with AIDS. The elderly are also at greater risk.

For help with washing technique, check out this handy NPR guide from few years back. The experts and a mom give their two cents. [Copyright 2011 National Public Radio]

Susan G. Komen Founder Discusses Her Book

Wed, 14 Sep 2011 19:00:00 GMT

CDC Basks In 'Contagion's' Admiring Take On Disease Detectives

Wed, 14 Sep 2011 18:22:00 GMT

It's not often that a federal health agency gets to toot its horn about its portrayal in a Hollywood thriller. But the Centers for Disease Control and Prevention took full advantage of the opportunity Tuesday, on the heels of the release of Contagion, a feature film about a deadly global pandemic and the public health workers who try to stop it.

The panel, sponsored by the nonprofit CDC Foundation, reinforced the idea that epidemiology is exciting, if often unsung, and is worthy of Hollywood's attention. It was also an opportunity for CDC officials to talk about how they prevent real-life deadly disease outbreaks, but how that's getting harder to do.

In the 2012 budget bill signed in February, the CDC suffered $1.3 billion in cuts, which officials say has lead to an erosion in public health infrastructure.

"The world is a very, very dangerous place," said Ali Khan, assistant surgeon general and director for Office of Public Health Preparedness and Response at CDC, who sat on the panel. "We need the CDC there, and it's not just about disasters. It's about everyday public health."

The CDC officials, including director Dr. Thomas Frieden, were careful to note that the film's scenario, in which a billion people are infected with a new virus, was designed for entertainment purposes. Still, they said they saw it as one plausible worst-case scenario. "We can't know what's going to happen," said Frieden.

The CDC's darling in the film is Kate Winslet who plays Dr. Erin Mears, a disease detective in the CDC's elite Epidemic Intelligence Service who is dispatched to track the outbreak.

Dr. Anne Schuchat, the petite, salt-and-pepper-haired director of CDC's National Center for Immunization and Respiratory Diseases, says Winslet's character was modeled on her career, and particularly her experience tracking SARS in China in 2003. (Schuchat is also well-known for leading CDC's response to the H1N1 outbreak.) Winslet even consulted Schuchat on makeup and wardrobe tips, but "I don't wear much make up ... so it wasn't a glamorous part for her," Schuchat said.

The CDC's excitement aside, two NPR film critics liked the film — Jeannette Catsoulis, for one called it "an engrossing, believable search for patient zero and an effective vaccine." [Copyright 2011 National Public Radio]

How To Help Your Child's Brain Grow Up Strong

Wed, 14 Sep 2011 16:02:00 GMT

Babies may look helpless but as soon as they come into the world, they're able to do a number of important things. They can recognize faces and moving objects. They're attracted to language. And from very early on, they can differentiate their mother from other humans.

"They really come equipped to learn about the world in a way that wasn't appreciated until recently," says neuroscientist Dr. Sandra Aamodt. "It look scientists a long time to realize that their brains are doing some very complicated things."

Aamodt and fellow neuroscientist Sam Wang explain how the human brain develops from infancy to adolescence in their new book Welcome to Your Child's Brain. The two researchers also offer tips for parents to help their children eat their spinach, learn their ABCs and navigate elementary school.

Before all of those things, however, children have to learn how to talk. Babies can differentiate syllables and new sounds from very early on, but there are ways for parents to help their children develop their language skills faster and more efficiently.

"The most simple way is to talk to your baby and around your baby a lot," says Aamodt. "And the other thing that parents can do is to respond when the baby speaks, even if the baby isn't forming the words correctly or you don't understand it. Just act like some communication has occurred — smile and give the baby a little pat — and that encourages the baby to continue to try to communicate."

But because language is so social, says Wang, passive exposure to words really doesn't help babies learn in any way.

"For instance, videos that are often shown to babies containing language are not nearly so effective," he says. "In some cases, people try to teach babies language by showing them videos in a foreign language. It doesn't work very well at all because these are not social ways of exposing a child to language."

Parents should also realize that their children may reach certain intellectual milestones at different times — and that's okay.

"Language is acquired quite well before the age of 6 but trying to force your children to read before the age of 4 is an effort that doesn't work very well because the brain is not very well-equipped to tell the letter 'b' from the letter 'd' and so on," says Wang. "[But] it's something that older children can do without any effort at all."

And children who grow up in bilingual households have a distinct advantage over their peers.

"Kids who learn two languages young are better able to learn abstract rules and to reverse rules that they've already learned," says Aamodt. "They're less likely to have difficulty choosing between conflicting possibilities when there are two possible responses that both present themselves. They're also better at figuring out what other people are thinking, which is probably because they have to figure out which language to use every time they talk to somebody in order to communicate."

Teaching Self-Control

Aamodt and Wang also emphasize the importance of teaching your children self-control from an early age.

"This is really critical because there are so many things parents want to do when they read parenting books," he says. "They take steps to teach their children math or reading ... but a big thing we can do for our children is to do the best to foster the development of self-control and willpower. Self-control and the ability to restrain impulses is associated with success at every age, whether it means being able to read at age 4 or being able to restrain impulses at a later age or even what your peers think of you in high school. At all of these ages, willpower and self-control is a strong predictor of academic success than IQ."

When children are young, they can learn self-control by focusing on any fun activity — whether that means studying martial arts or playing with dolls and planning a make-believe tea party.

"It gives the child practice at planning and organizing a series of topics to achieve a desired goal," says Aamodt. "When you're planning a tea party, you can't be acting like a fighter pilot. You have to be acting like a lady having a tea party. So pretending is one of the earliest types of exposure most kids get to planning and organizing their actions. And the more you practice that, the better you're going to be at it."

Making sure your child has fun while learning self-control is vitally important. Aamodt and Wang recommend, for instance, telling your child to pretend he or she is protecting a castle instead of just saying 'Stand still.'

"Taking advantage of a child's natural sense of fun is a terrific way to instill these things," says Wang. "This is not the kind of thing that works well if it's forced. It can be something as easy as pretending to guard the castle or playing a take-turns game where you say 'I'm going to draw an ear on this piece of paper and when you see an ear, then it's your time to listen and if you see a mouth on this other piece of paper, then it's your time to talk.' So all of these things can be done in very simple ways — in ways that are often fun — and the more fun it is, the more likely the child is to pay attention for a longer period of time. These things are fun, they don't cost money and anybody can do it."

Dr. Sam Wang is an associate professor of neuroscience at Princeton University. Dr. Sandra Aamodt is a former editor in chief of Nature Neuroscience. They are also the co-authors of Welcome to Your Brain: Why You Lose Your Car Keys but Never Forget How to Drive and Other Puzzles of Everyday Life.

Interview Highlights

On rewards vs. punishment

Dr. Aamodt: "With a child, you're not only concerned with getting a child to behave. You're also concerned with building a good relationship with your child. You want your child to think of you as a wonderful person to be around. You also don't want to teach our kids that the way we solve our interpersonal problems is with violence."

Dr. Wang: "Negative reinforcement is often not very effective with deterring behavior. ... negative reinforcement punishment tends to not be very general. So the child will avoid doing the specific thing that led to the punishment and not learn some broader rule. From a practical standpoint, negative reinforcement is not terribly effective."

On time out

Dr. Wang: "One thing that's similar between how children and non-human animals learn best is the phenomenon of time out which has entered the lexicon as a means of getting a child to avoid doing something later. It comes from technical literature from which the long phrase is 'time out and reinforcement' which is if the kid does something undesirable, you simply take the child go to the corner and just sit there. And you don't say anything at all. You don't have to be negative. You don't have to mete out a punishment. You just have to say 'Sit there for 3 minutes and when I come back, we're done.' And then you forget about it and move on. This works at all ages."

On stress and pregnancy

Dr. Aamodt: "Stress is not good for babies. No ethics review board in the world would approve [an experiment] in which we deliberately damaged [pregnant women's] babies. But there are these so-called experiments of nature. One experiment that was done looked at women who had been evacuated from a hurricane in Louisiana when they were pregnant. What that study found was a substantially increased rate of autism in babies who had been in their fifth or sixth month of gestation at the time they fled the hurricane. The effect was stronger in cases where the hurricane was more dangerous."

On 'tiger parenting'

Dr. Wang: "I'm not very much of a tiger mother. I'm more of a pussy cat dad." [Copyright 2011 National Public Radio]

Fear of Antidepressants Leads People To Shun Treatment

Wed, 14 Sep 2011 15:28:00 GMT

Antidepressants are the second-most-prescribed drug in the U.S., making them seem about as common as Pez candy.

Yet many people won't tell their primary care doctor that they're suffering symptoms of depression because they're afraid they'll be prescribed antidepressants, according to some new research. And the people who are suffering the most are the ones least likely ask for help.

There's long been a stigma about mental illness, and though people are far more upfront about depression than they were in years past, that stigma hasn't gone away. Just ask someone who's been turned down for life insurance because they took antidepressants long ago, or someone who's afraid to tell the boss why they're struggling to make it in to work.

But clinical depression is common, affecting almost 7 percent of adults each year. Given that, and the suffering it causes, you'd think people would be hustling to the doctor's to get help. But you'd be wrong.

Researchers asked more than a thousand Californians if they would tell their primary care doctor about symptoms of depression. Almost half the people said they had their reasons for keeping the symptoms secret. The No. 1 reason: 23 percent said they feared that they would be prescribed antidepressants.

"There's this anxiety about medications in general," Robert Bell, lead author on the study, told Shots. With antidepressants, he said, that anxiety includes worries about side effects as well as stigma.

The findings were published this week in the Annals of Family Medicine.

There were other reasons for not telling. People didn't think that it was a primary care doctor's job to deal with emotional issues. They had fears about confidentiality. They feared being referred to a psychiatrist. And they didn't want to get tagged as a psychiatric patient. The more depressed the people were, the more likely they were to say that these reasons for not seeking care applied to them.

Bell is especially concerned about the notion that people won't seek treatment for depression from a primary care doctor, because that's where care for depression is most readily available.

"Depression is something that the primary care physician is trained to deal with," says Bell, who is a professor of communication and public health at the University of California, Davis. "I think most people assume if you're depressed that you're off to the psychiatrist, and that's not true."

A recent study found that 7 percent of all visits to a primary care doctor include a prescription for antidepressants, but other studies have found that 25 percent of people with depression aren't getting diagnosed or treated in primary care. [Copyright 2011 National Public Radio]

Fatal Car Crashes Drop For 16-Year-Olds, Rise For Older Teens

Wed, 14 Sep 2011 04:01:00 GMT

Terrified to see your teenager behind the wheel? You're not alone. But a new study finds tougher state licensing laws have led to a decrease in fatal accidents, at least among 16-year-olds. That's the good news.

But here's the rub. Some kids are waiting until they're 18-years-old to get their driver's licenses. At this point, they're considered adults, and they don't have to jump through the hoops required of younger teens. They can opt out of driver's ed. And they are not subject to nighttime driving restrictions or passenger restrictions.

"[Older teens] are saying, 'The heck with your more complicated process,'" says Justin McNaull, director of state relations for the American Automobile Association. At 18, teenagers can, in many cases, get their license in a matter of weeks.

It's one explanation for the latest findings published in the Journal of the American Medical Association. Researchers at the University of North Carolina and the California Department of Motor Vehicles analyzed more than 130,000 fatal teen crashes over 22 years.

They found that tougher licensing laws have led to 1,348 fewer fatal car crashes involving 16-year-old drivers. But during the same period, fatal crashes involving 18-year-old drivers increased. They were behind the wheel in 1,086 more fatal accidents.

States have made the licensing process more rigorous in many ways: longer permitting times, driver's ed requirements, and restrictions on nighttime driving and carrying fellow teenage passengers. Experts say all of these requirements help give teenagers the experience they need on the road. "In the last 15 years, we've made great strides in getting the licensing process to do a better job in helping teens get through it safely," says McNaull.

California has seen a big drop in 16-year-olds getting their driver's license. Back in 1986, 27 percent got licensed. By 2007, the figure dropped to 14 percent.

"We have more novices on the road at 18," says Scott Masten of the California DMV and an author of the study. And some of them may not have enough experience under their belts to face risky conditions. Masten says this may help explain the increase in fatal crashes.

It's not clear whether there are significantly fewer 16-year-olds behind the wheel in other states because there's no national database. But anecdotally, experts see this as a trend.

"There's a belief that graduated licensing has led to a delay," says Anne McCart, a senior vice president at the Insurance Institute for Highway Safety.

A survey of teens conducted by the Allstate Foundation found that there are many reasons teens are delaying the process of getting a license. Some say they don't have a car or can't afford it. Others report that their parents are not available to help them, or that they're too busy with other activities.

But parents who do want to be more proactive can refer to the tips the AAA has compiled on how to keep teens behind the wheel safe. And they might also consider another recent study, which showed that starting the school day a little bit later seems to reduce the accident rate for teen drivers. [Copyright 2011 National Public Radio]

Pediatricians Fact-Check Bachmann's Bashing of HPV Vaccine

Tue, 13 Sep 2011 21:54:00 GMT

Now the nation's pediatricians have waded deep and early into the race for the presidency. In a unusual instance of political fact-checking of a candidate's statements by physicians themselves, the American Academy of Pediatrics has a tough prescription for Republican Rep. Michelle Bachmann: Get your facts straight on the HPV vaccine.

In case you missed it, she sparred with Texas Gov. Rick Perry Monday night over his executive order that would have mandated vaccination of state schoolgirls against human papillomavirus, a cause of cervical cancer.

"To have innocent little 12-year-old girls be forced to have a government injection through an executive order is just flat-out wrong," Bachmann said. "Little girls who have a potentially dangerous reaction to this drug don't get a mulligan," she said. "You don't get a do-over."

Perry defended the decision but conceded that the legal mechanism to reach the goal should have been different.

But on the Today show Tuesday morning, Bachmann went further, telling Matt Lauer, that a mother had approached her after the debate to recount the problems her daughter had after being vaccinated against HPV:

She told me that her little daughter took that vaccine, that injection. And she suffered from mental retardation thereafter. The mother was crying when she came up to me last night. I didn't know who she was before the debate. This is the very real concern and people have to draw their own conclusions.

When Lauer pressed Bachmann on whether she would keep pushing on the issue, she answered that it has traction "with a lot of people and we'll see what people say."

Not with kids' doctors it doesn't. In an apparent first for the national pediatricians' group during a political campaign, the AAP called Bachmann out, though it stopped short of doing so by name.

In a statement released late Tuesday, Dr. O. Marion Burton, the president of the group, said:

The American Academy of Pediatrics would like to correct false statements made in the Republican presidential campaign that HPV vaccine is dangerous and can cause mental retardation. There is absolutely no scientific validity to this statement. Since the vaccine has been introduced, more than 35 million doses have been administered, and it has an excellent safety record.

The American Academy of Pediatrics, the Centers for Disease Control and Prevention, and the American Academy of Family Physicians all recommend that girls receive HPV vaccine around age 11 or 12. That's because this is the age at which the vaccine produces the best immune response in the body, and because it's important to protect girls well before the onset of sexual activity. In the U.S., about 6 million people, including teens, become infected with HPV each year, and 4,000 women die from cervical cancer. This is a life-saving vaccine that can protect girls from cervical cancer.

[Copyright 2011 National Public Radio]

The 'Next Big Step': Preventing 1 Million Heart Attacks And Strokes

Tue, 13 Sep 2011 20:03:00 GMT

They're calling it Million Hearts – a newly launched campaign to put a half-dozen simple and proven public health strategies into wider practice. Federal health officials say it can prevent a million heart attacks and strokes between now and 2016.

Federal officials call it "the next big step" in cardiovascular prevention. There's lots of evidence it's an achievable goal.

First, deaths from cardiovascular disease have already been cut by 60 percent over the past generation. About half of that reduction is due to better diet, smoking cessation and other public health measures. The other half comes from from better medical treatment.

"But we still have a long way to go," Dr. Thomas Frieden, director of the Centers for Disease Control and Prevention, told Shots. "We still have 107 million adults — just about half of all adults — who either have blood pressure out of control, cholesterol out of control, or who smoke."

The campaign has two parts. One aims to change the behavior of doctors and patients. The other aims to change what all of us eat. Both are summed up by the acronym ABCS – which stands for aspirin, blood pressure control, cholesterol control and smoking.

In the realm of doctors and patients, Frieden and a phalanx of other federal officials want to expand by 10 million the number of Americans who have their high blood pressure under control and by 20 million those with controlled blood cholesterol levels.

To get there will require raising blood pressure control from less than half the people with hypertension now to 65 percent. Cholesterol control will have to triple.

The other medical-care strategy is to get people at high risk of heart attacks and strokes to take a baby aspirin every day. Fewer than half now do. The government wants to get that up to 65 percent.

Another goal is to get four million smokers to quit by 2016. That target is more modest – lowering smoking prevalence from 19 percent of adults today to 17 percent five years from now.

The smoking-cessation part of the campaign is part medical, part public health. "Less than a quarter of people who smoke get evidence-based help to quit," Frieden says.

Getting doctors to urge patients to quit "doubles the likelihood of a successful quit attempt," Frieden and Dr. Donald Berwick, the chief of Medicare and Medicaid, write in an article posted Tuesday by the New England Journal of Medicine. Prescribing one of the seven approved smoking-cessation drugs further increases quit rates.

The public health part of the stop-smoking initiative is familiar. A year from now it'll be stepped up by graphic new warnings on all cigarette packs – unless the industry gets courts to block them.

All these strategies "could save more than 100,000 lives a year," Frieden and Berwick claim. Over five years that adds up to half the Million Hearts goal.

The rest is supposed to come from two big changes in what Americans eat. Federal officials want to cut average daily salt intake by 20 percent.

But this doesn't mean throwing away the saltshaker, Frieden says. "Most Americans eat about twice as much sodium as we should get," he says. "About 80 percent of that comes in restaurant and packaged foods — it's not what you add at the table.

"What the studies show," he adds, "is that if you take half of the salt out of food and tell people 'put as much salt on as you want,' they only put back about 20 percent of what got taken out."

So the Food and Drug Administration plans to work with the food industry to cut back on the salt that's already in food when it gets on the plate. Other agencies will press for reduced salt in food the government pays for and will try to raise consumer awareness.

Similarly, the government wants to eliminate artificial trans fat in purchased foods — chemicals that raise levels of bad cholesterol and lower good cholesterol. Already, Americans' consumption of trans fat has been reduced by half; going the rest of the way could save 50,000 lives a year, according to Frieden and Berwick.

This is the public face of the campaign. Behind the scenes, one driving force of Million Hearts is the realization that with more doctors using electronic medical records and adopting new medical information technology systems, improving cardiovascular preventive care is "the best place to start," Frieden says.

"Most of us get reminders from our dentists or auto mechanics or our vet if our teeth or car or pet needs maintenance," Frieden says. "But we rarely get a reminder from our doctor."

If Million Hearts works as intended, that will change. [Copyright 2011 National Public Radio]

How Does The CDC Determine Vaccine Schedules?

Tue, 13 Sep 2011 19:00:00 GMT

The Churn Behind The Stable Rate For The Uninsured

Tue, 13 Sep 2011 18:26:00 GMT

At first glance, today's report from the U.S. Census Bureau on the number of Americans without health insurance in 2010 looks, well, a little dull. About 16.3 percent of people in the country were without health insurance, which "was not statistically different from the rate in 2009," the report points out.

But dig a little deeper and there's plenty of action.

Take, for instance, the 2-percentage-point increase in coverage for young adults aged 18 to 24. Long among the most likely to lack insurance, their uninsured rate dropped from 29.3 percent in 2009 to 27.2 percent.

Administration health officials think they know why. One provision of the Affordable Care Act allows young adults up to age 26 to stay on their parents' health plans. The increase reported by census officials "translates into 500,000 more young people with insurance," wrote Health and Human Services Secretary Kathleen Sebelius in a blog post on the department's website.

Now overall, the news remained pretty grim. While the raw number of people with health insurance rose slightly, to 256.2 million in 2010 from 255.3 million in 2009, so did the number of those without insurance, to 49.9 million from 49.0 million.

And the trend away from private coverage and toward public coverage continued. The percentage of the population with employer-provided insurance fell to 55.3 percent, from 56.1 percent the year before. Although, before you start yelling "job-killer" about the Affordable Care Act, that was a far smaller dip than the 3-percentage-point drop reported between 2008 and 2009. Meanwhile, the percentage of people covered by government health insurance grew to 31 percent from 30.6 percent in 2009.

One unexplained oddity is that among the subgroups of the uninsured that grew was the elderly; those over age 65. Thanks to Medicare, nearly all senior citizens have health insurance coverage, so their uninsured rate is traditionally the lowest in the population. In fact, many surveys on health insurance status don't even include seniors because it skews the results. But this year the uninsured rate for seniors popped up slightly, from 1.7 percent to 2 percent. Census officials said they were uncertain why. [Copyright 2011 National Public Radio]