What surface is the most friendly to the flu virus? Where’s the best place to stand when you’re talking to a sick person? And how are Australians curbing germs in schools? To find out these answers and more, take the Well Flu Quiz.
With contributions from Laura Geggel and Tara Parker-Pope.
SungEun Grace Lee, who was at the center of a struggle pitting her right to die against her family’s wish to keep her alive, died on Sunday, according to her family. She was 28.
Last fall, Ms. Lee’s relatives posted a video of her, paralyzed from the neck down by a brainstem tumor, on YouTube. They wanted to gain public support for their battle to prevent her from being removed from life support, an act they saw as a violation of their evangelical Christian faith.
Ms. Lee lived five months longer than she would have had her family not gone to court to keep her alive, one of her brothers, Paul Lee, said.
“I think it almost feels like Grace gave us time to get ready,†Mr. Lee said on Tuesday. “She was giving my parents time to do stuff with her.â€
In the final months of her life, Ms. Lee cuddled under her favorite blanket in her childhood bedroom and looked at pictures from the life in South Korea that she left when she was about 10.
At a court hearing in September, doctors who were treating her at North Shore University Hospital in Manhasset, N.Y., testified that Ms. Lee, a former honors student and corporate finance officer, wanted to die because she could not bear to live such a diminished life. But in the YouTube video, Ms. Lee seemed to mouth, “Yes†when asked if she wanted her father to make decisions for her.
Her parents, the Rev. Man Ho Lee and Jin Ah Lee, said she was being manipulated by the hospital staff. Ultimately, she agreed to go home and was discharged a few days before Thanksgiving to her parents’ house in Douglaston, Queens. She settled into her room, her brother said, and her family covered her with the baby blanket, which had been so comforting to her that she had taken it to the University of North Carolina at Chapel Hill, where she majored in business.
SungEun Grace Lee had attended a selective program in high school, the North Carolina School of Science and Mathematics, her brother said. She was working for Bank of America and training for a marathon when she fell ill in October 2011.
Ms. Lee was unconscious for the last week of her life, her brother said. About 5 p.m. Sunday, he recalled, “she couldn’t breathe, which doesn’t really make sense because the machine was breathing for her.†He said she died at a hospital about an hour later, surrounded by her parents, him and her other brother, Danny. Members of her father’s church, Antioch Missionary Church in Flushing, Queens, arrived soon after to pray for her. Her funeral will be held at 8 p.m. Thursday at the church.
“Our thoughts and prayers are with her family and friends,†Terry Lynam, a spokesman for North Shore, where she was on life support last fall, said on Tuesday.
Paul Lee said that after his sister came home in November, he asked her several times whether they had made a mistake by insisting that she live. “She always told us that it was the right choice,†he said.
Gretchen Reynolds on the science of fitness.
A common concern about exercise is that if you don’t do it almost every day, you won’t achieve much health benefit. But a commendable new study suggests otherwise, showing that a fairly leisurely approach to scheduling workouts may actually be more beneficial than working out almost daily.
For the new study, published this month in Exercise & Science in Sports & Medicine, researchers at the University of Alabama at Birmingham gathered 72 older, sedentary women and randomly assigned them to one of three exercise groups.
One gr oup began lifting weights once a week and performing an endurance-style workout, like jogging or bike riding, on another day.
Another group lifted weights twice a week and jogged or rode an exercise bike twice a week.
The final group, as you may have guessed, completed three weight-lifting and three endurance sessions, or six weekly workouts.
The exercise, which was supervised by researchers, was easy at first and meant to elicit changes in both muscles and endurance. Over the course of four months, the intensity and duration gradually increased, until the women were jogging moderately for 40 minutes and lifting weights for about the same amount of time.
The researchers were hoping to find out which number of weekly workouts would be, Goldilocks-like, just right for increasing the women’s fitness and overall weekly energy expenditure.
Some previous studies had suggested that working out only once or twice a week produced few gains in fitness, while exercising vigorously almost every day sometimes led people to become less physically active, over all, than those formally exercising less. Researchers theorized that the more grueling workout schedule caused the central nervous system to respond as if people were overdoing things, sending out physiological signals that, in an unconscious internal reaction, prompted them to feel tired or lethargic and stop moving so much.
To determine if either of these possibilities held true among their volunteers, the researchers in the current study tracked the women’s blood levels of cytokines, a substance related to stress that is thought to be one of the signals the nervous system uses to determine if someone is overdoing things physically. They also measured the women’s changing aerobic capacities, muscle strength, body fat, moods and, using sophisticated calorimetry techniques, energy expenditure over the course of each week.
By the end of the four-month experiment, all of the women had gained endurance and strength and shed body fat, although weight loss was not the point of the study. The scientists had not asked the women to change their eating habits.
There were, remarkably, almost no differences in fitness gains among the groups. The women working out twice a week had become as powerful and aerobically fit as those who had worked out six times a week. There were no discernible differences in cytokine levels among the groups, either.
However, the women exercising four times per week were now expending far more energy, over all, than the women in either of the other two groups. They were burning about 225 additional calories each day, beyond what they expended while exercising, compared to their calorie burning at the start of the experiment.
The twice-a-week exercisers also were using more energy each day than they had been at first, burning almost 100 calories more daily, in addition to the calories used during workouts.
But the women who had been assigned to exercise six times per week were now expending considerably less daily energy than they had been at the experiment’s start, the equivalent of almost 200 fewer calories each day, even though they were exercising so assiduously.
“We think that the women in the twice-a-week and four-times-a-week groups felt more energized and physically capable†after several months of training than they had at the start of the study, says Gary Hunter, a U.A.B. professor who led the experiment. Based on conversations with the women, he says he thinks they began opting for stairs over escalators and walking for pleasure.
The women working out six times a week, though, reacted very differently. “They complained to us that working out six times a week took too much time,†Dr. Hunter says. They did not report feeling fatigued or physically droopy. Their bodies were not producing excessive levels of cytokines, sending invisible messages to the body to slow down.
Rather, they felt pressed for time and reacted, it seems, by making choices like driving instead of walking and impatiently avoiding the stairs.
Despite the cautionary note, those who insist on working out six times per week need not feel discouraged. As long as you consciously monitor your activity level, the findings suggest, you won’t necessarily and unconsciously wind up moving less over all.
But the more fundamental finding of this study, Dr. Hunter says, is that “less may be more,†a message that most likely resonates with far more of us. The women exercising four times a week “had the greatest overall increase in energy expenditure,†he says. But those working out only twice a week “weren’t far behind.â€
At a party the other night, a fund-raiser for a literary magazine, I found myself in conversation with a well-known author whose work I greatly admire. I use the term “conversation†loosely. I couldn’t hear a word he said. But worse, the effort I was making to hear was using up so much brain power that I completely forgot the titles of his books.
A senior moment? Maybe. (I’m 65.) But for me, it’s complicated by the fact that I have severe hearing loss, only somewhat eased by a hearing aid and cochlear implant.
Dr. Frank Lin, an otolaryngologist and epidemiologist at Johns Hopkins School of Medicine, describes this phenomenon as “cognitive load.†Cognitive overload is the way it feels. Essentially, the brain is so preoccupied with translating the sounds into words that it seems to have no processing power left to search through the storerooms of memory for a response.< /p>
Katherine Bouton speaks about her own experience with hearing loss.
A transcript of this interview can be found here.
Over the past few years, Dr. Lin has delivered unwelcome news to those of us with hearing loss. His work looks “at the int erface of hearing loss, gerontology and public health,†as he writes on his Web site. The most significant issue is the relation between hearing loss and dementia.
In a 2011 paper in The Archives of Neurology, Dr. Lin and colleagues found a strong association between the two. The researchers looked at 639 subjects, ranging in age at the beginning of the study from 36 to 90 (with the majority between 60 and 80). The subjects were part of the Baltimore Longitudinal Study of Aging. None had cognitive impairment at the beginning of the study, which followed subjects for 18 years; some had hearing loss.
“Compared to individuals with normal h earing, those individuals with a mild, moderate, and severe hearing loss, respectively, had a 2-, 3- and 5-fold increased risk of developing dementia over the course of the study,†Dr. Lin wrote in an e-mail summarizing the results. The worse the hearing loss, the greater the risk of developing dementia. The correlation remained true even when age, diabetes and hypertension â€" other conditions associated with dementia â€" were ruled out.
In an interview, Dr. Lin discussed some possible explanations for the association. The first is social isolation, which may come with hearing loss, a known risk factor for dementia. Another possibility is cognitive load, and a third is some pathological process that causes both hearing loss and dementia.
In a study last month, Dr. Lin and colleagues looked at 1,984 older adults beginning in 1997-8, again using a well-established database. Their findings reinforced those of the 2011 study, but also found that those with hearing loss had a “30 to 40 percent faster rate of loss of thinking and memory abilities†over a six-year period compared with people with normal hearing. Again, the worse the hearing loss, the worse the rate of cognitive decline.
Both studies also found, somewhat surprisingly, that hearing aids were “not significantly associated with lower risk†for cognitive impairment. But self-reporting of hearing-aid use is unreliable, and Dr. Lin’s next study will focus specifically on the way hearing aids are used: for how long, how frequently, how well they have been fitted, what kind of counseling the user received, what other technologies they used to supplement hearing-aid use.
What about the notion of a common pathological process? In a recent paper in the journal Neurology, John Gallacher and colleagues at Cardiff University suggested the possibility of a genetic or environmental factor that could be causing both hearing loss and dementia â€" and perhaps not in that order. In a phenomenon called reverse causation, a degenerative pathology that leads to early dementia might prove to be a cause of hearing loss.
The work of John T. Cacioppo, director of the Social Neuroscience Laboratory at the University of Chicago, also offers a clue to a pathological link. His multidisciplinary studies on isolation have shown that perceived isolation, or loneliness, is “a more important predictor of a variety of adverse health outcomes than is objective social isolation.†Those with hearing loss, who may sit through a dinner party and not hear a word, frequently experience perceived isolation.
Other research, including the Framingham Heart Study, has found an association between hearing loss and another unexpected condition: cardiovascular disease. Again, the evidence suggests a common pathological cause. Dr. David R. Friedland, a professor of otolaryngology at the Medical College of Wisconsin in Milwaukee, hypothesized in a 2009 paper delivered at a conference that low-frequency loss could be an early indication that a patient has vascular problems: the inner ear is “so sensitive to blood flow†that any vascular abnormalities “could be noted earlier here than in other parts of the body.â€
A common pathological cause might help explain why hearing aids do not seem to reduce the risk of dementia. But those of us with hearing loss hope that is not the case; common sense suggests that if you don’t have to work so hard to hear, you have greater cognitive power to l isten and understand â€" and remember. And the sense of perceived isolation, another risk for dementia, is reduced.
A critical factor may be the way hearing aids are used. A user must practice to maximize their effectiveness and they may need reprogramming by an audiologist. Additional assistive technologies like looping and FM systems may also be required. And people with progressive hearing loss may need new aids every few years.
Increasingly, people buy hearing aids online or from big-box stores like Costco, making it hard for the user to follow up. In the first year I had hearing aids, I saw my audiologist initially every two weeks for reprocessing and then every three months.
In one study, Dr. Lin and his colleague Wade Chien < a title="The study. " href="http://archinte.jamanetwork.com/article.aspx?articleid=1108706" target="_blank">found that only one in seven adults who could benefit from hearing aids used them. One deterrent is cost ($ 2,000 to $ 6,000 per ear), seldom covered by insurance. Another is the stigma of old age.
Hearing loss is a natural part of aging. But for most people with hearing loss, according to the National Institute on Deafness and Other Communication Disorders, the condition begins long before they get old. Almost two-thirds of men with hearing loss began to lose their hearing before age 44. My hearing loss began when I was 30.
Forty-eight million Americans suffer from some degree o f hearing loss. If it can be proved in a clinical trial that hearing aids help delay or offset dementia, the benefits would be immeasurable.
“Could we do something to reduce cognitive decline and delay the onset of dementia?†he asked. “It’s hugely important, because by 2050, 1 in 30 Americans will have dementia.
“If we could delay the onset by even one year, the prevalence of dementia drops by 15 percent down the road. You’re talking about billions of dollars in health care savings.â€
Should studies establish definitively that correcting hearing loss decreases the potential for early-onset dementia, we might finally overcome the stigma of hearing loss. Get your hearing tested, get it corrected, and enjoy a longer cognitively active life. Establishing the dangers of uncorrected hearing might even convince private insurers and Medicare that covering the cost of hearing aids is a small price to pay to offset the cost of dementia.
Katherine Bouton is the author of the new book, “Shouting Won’t Help: Why I â€" and 50 Million Other Americans â€" Can’t Hear You,†from which this essay is adapted.
This post has been revised to reflect the following correction:
Correction: February 12, 2013
An earlier version of this article misstated the location of the Medical College of Wisconsin. It is in Milwaukee, not Madison.
Lean Cuisine lovers, check your freezers: Nestle is voluntarily recalling more than 500,000 dishes of frozen Lean Cuisine mushroom ravioli because three customers reported finding glass fragments in the entrees, the company says. No injuries have been reported, according to a < a href="http://www.prnewswire.com/news-releases/nestle-prepared-foods-company-announces-voluntary-recall-of-lean-cuisine-culinary-collection-mushroom-mezzaluna-ravioli-190453551.html" title="http://www.prnewswire.com/news-releases/nestle-prepared-foods-company-announces-voluntary-recall-of-lean-cuisine-culinary-collection-mushroom-mezzaluna-ravioli-190453551.html">company press release.
The recall covers packages of Culinary Collection Mushroom Mezzaluna Ravioli produced in early November and distributed nationwide. The suspect packages are marked with:
No other products are involved, the company says. Customers who find the recalled products should not eat them and should contact Nestle Consumer Services at (866) 586-9424 or leancuisine@casupport.com.
In 2011, Nestle recalled some other Lean Cuisine dinners after customers found red plastic in their food. A 2008 recall of Lean Cuisine entrees was linked to chunks of blue plastic in some meals.
Too little of the money the federal government spends on breast cancer research goes toward finding environmental causes of the disease and ways to prevent it, according to a new report from a group of scientists, government officials and patient advocates established by Congress to examine the research.
The report, “Breast Cancer and the Environment â€" Prioritizing Prevention,†published on Tuesday, focuses on environmental factors, which it defines broadly to include behaviors, like alcohol intake and exercise; exposures to chemicals like pesticides, industrial pollutants, consumer products and drugs; radiation; and social and socioeconomic factors.
The 270-page report notes that scientists have long known that genetic and environmental factors contribute individually and also interact with one another to affect breast cancer risk. Studies of women who have moved from Japan to the United States, for instance, show that their breast cancer risk increases to match that of American women. Their genetics have not changed, so something in the environment must be having an effect. But what? Not much is known about exactly what the environmental factors are or how they affect the breast.
“We know things like radiation might cause breast cancer, but we don’t know much that we can say specifically causes breast cancer in terms of chemicals,†said Michael Gould, a professor of oncology at the University of Wisconsin, Madison, and a co-chairman of the 23-member committee that prepared the report.
At the two federal agencies that spend the most on breast cancer, only about 10 percent of the research in recent years involved environment and prevention. From 2008 to 2010, the National Institutes of Health spent $ 357 million on environmental and prevention-related research in breast cancer, about 16 percent of all the financing for the disease. From 2006 to 2010, the Department of Defense spent $ 52.2 million on prevention-oriented research, about 8.6 percent of the money devoted to breast cancer. Those proportions were too low, the group said, though it declined to say what the level should be.
“We’re hedging on that on purpose,†Dr. Gould said. “It wasn’t the role of the committee to suggest how much.â€
He added, “We’re saying: ‘We’re not getting the job done. We don’t have the money to get the job done.’ The government will have to figure out what we need.â€
Jeanne Rizzo, another member of the committee and a member of the Breast Cancer Fund, an advocacy group, said there was an urgent need to study and regulate chemical exposures and inform the public about potential risks. “We’re extending life with breast cancer, making it a chronic disease, but we’re not preventing it,†she said.
“We have to look at early life exposures, in utero, childhood, puberty, pregnancy and lactation,†Ms. Rizzo said. “Those are the periods when you get set up for breast cancer. How does a pregnant woman protect her child? How do we create policy so that she doesn’t have to be a toxicologist when she goes shopping?â€
Michele Forman, a co-chairwoman of the committee and an epidemiologist and professor of nutritional sciences at the University of Texas, Austin, said the group found that breast cancer research at various government agencies was not well coordinated and that it was difficult to determine whether there was duplication of efforts.
She said that it was essential to study how environmental exposures at different times of life affected breast-cancer risk, and that certain animals were good models for human breast cancer and should be used more.
The report is the result of the Breast Cancer and Environmental Research Act, which was passed in 2008 and required the secretary of health and human services to create a committee to study breast cancer research. A third of the members were scientists, a third were from government and a third were from advocacy groups. The advocates, Dr. Forman said, brought a sense of urgency to the group
“People who are not survivors need to have that urgency there,†she said.
Pointing to the vaccine now being offered to girls to prevent cervical cancer, Dr. Forman said, “I look forward to the day when we have an early preventive strategy for breast cancer.â€
What's in your vitamin supplement? It could be more or less than you think, according to the latest study to show that what's on a supplement label is not necessarily what's in the bottle.
Researchers who tested vitamin D pills sold in stores found they contained from 9% to 140% of the doses listed on labels, according to a research letter published Monday in JAMA Internal Medicine. Though none of the pills was likely to be dangerous, some contain ed too little of the vitamin to effectively treat someone with a deficiency, the researchers say.
"We found the potency of these vitamin D supplements varied widely," says Erin LeBlanc, an endocrinologist who led the study at the Kaiser Permanente Center for Health Research in Portland, Ore.
Other studies have found similar variations in other supplements. For example, more than one-third of multivitamins tested by ConsumerLab.com in 2009 were contaminated or contained significantly more or less of some ingredients than their labels claimed. The company also recently tested vitamin D samples and found some mislabeling, it says.
About half of adults in the USA take dietary supplements, spending $30 billion a year, according the Office of Dietary Supplements, National Institutes of Health. Vitamin D is particularly popular. The vitamin is essential for bone health and may have other benefits, but most people get enough from food and sun exposure, according to the Institute of Medicine.
LeBlanc decided to test over-the-counter vitamin D pills after testing pills made at a compounding pharmacy for another study. She was surprised to find that those specially made pills contained 52% to 146% of the promised vitamin D doses.
"I was curious about what else was out there," LeBlanc says. She and her team went to five "mainstream grocery stories" in Portland, she says, and bought 55 bottles of vitamin D supplements from 12 different manufacturers. Promised potencies ranged from 1,000 to 10,000 international units (IUs).
The actual amounts in the pills ranged from 9% to 140% of what was on the label. When researchers tested five pills from each bottle and averaged the results, levels were closer to 100%, but in a third of cases, they were still too high or low by the standards set by one independent testing group, the U.S. Pharmacopeial Convention (USP). The closest match was in the one brand with a USP mark, the r esearchers say.
"It's not surprising that they found a lot of products that were not meeting label claims," says John Atwater, director of the verification program at the non-profit USP, one of several groups that offer voluntary testing programs and approval seals. Supplement makers must pay to participate in those programs.
Unlike drug companies, supplement makers are not required to prove their products are safe and effective before selling them. The Food and Drug Administration can inspect supplement plants for good manufacturing practices and has issued warnings to many of them under regulations finalized in 2007. But the FDA does not test every product, even at plants under inspection, Atwater says.
Companies that put out mislabeled products "are breaking the law," says Duffy MacKay, vice president of scientific and regulatory affairs for the Council for Responsible Nutrition, a supplement trade association. He says responsible companies are respond ing to FDA and public pressure to do better. He suggests consumers look for well-known brands and voluntary testing seals.
"We're hoping that soon we'll have a perfect record," MacKay say. "We advocate very strongly for 100% compliance."
LeBlanc says her study is evidence that more regulation is needed to get companies in line.
