Mexico CITY - medical authorities in Haiti defended Tuesday not to concentrate its decision in search of the origins of a cholera-outbreak which killed, more than 1,000 people and stoked violent demonstrations against the United Nations peacekeeping forces, which many people blamed for the introduction of the disease.
Protests, began the Monday and wore their wrath on the peacekeeping forces in Tuesday in some places, two people dead as protesters, a 12,000 strong, multinational force, which in Haiti in 2004 in response to political conflict arrived addressed.
A spokesman for the UN force said the protesters were with the growing cholera epidemic as an excuse to push out troops and the country before the Nov.28 Presidential election to destabilize.
"" These are not real demonstrations", said the spokesman, Vincenzo Pugliese.""Are spoilers to create use paid to chaos."United Nations health workers said the demonstrations were the treatment of victims in Cap Haïtien, hinder, where supplies are running low and the death rate is high.
Some see the peacekeeping forces occupying forces as hardliners, while others you support out of concern that are the national police unable to maintain order.
Tensions over the power have increased after the cholera root as from South Asia identified health officials and found that the bacteria that lives in feces, had contaminated River where Nepalese troops arrived, began in October shortly before the outbreak.
Reporter in Haiti found signs of poor sanitation in the camp, but the UN mission has steadfastly refused, that the troops are to blame, and has said that repeated tests failed cholera, these mesh. South Asia is home to many cholera strains.
Scientists have said that based on initial testing of its genetic traits seems that load the cholera in contaminated food, Haiti were placed water or in an individual.Before this, cholera in Haiti had documented at least in the last century.
And not the disease to the troops who said World Health Organisation (WHO) has joined during the tests, it could not exclude werden.Eine of full investigation's outbreak origin has not been performed.
"We are focused on treatment of people getting a handle on this and rescue of life," said Daniel B. Epstein, a spokesman for the Pan American Health Organization, the branch of the WHO in Haiti active.
Dr. Jordan Tappero, an epidemiologist with the centers for disease control and prevention, leading medical investigator in Haiti, said U.S. phone it would unlikely that scientists pinpoint where the outbreak began and he don't think mounting an all-out effort to find the answer was "Is a good use of resources."
Outside epidemiologists said it was agreed that the treatment of victims was more important to study the bacteria and where it came from understanding how disease travels and mutates to extend but you important, generally about.
Studying the genetics of the root "would give a better idea where it came from", said Dr. David bag, an epidemiologist at Johns Hopkins Bloomberg School of public health the cholera outbreak, studied "but I agree, it is more important, disease prevention and control should killing es.Es not be."
The Haitian Government said on Tuesday that the death of toll 1.034 16,799 people for cholera or symptoms of the disease had reached treated.
Health officials in the Dominican Republic Tuesday said that you had found the first confirmed case of cholera in a Haitian citizens who returned recently from his home, the associated press reported.
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United Nations New grander gets Penn Station remains penal: this is a rule of New York City, Lawrence Downes writes.
Our brains to confuse the real and the symbolic are cabled. And the effects are serious as war and peace.
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Researchers drugs used finally discovered as ivermectin, one of the main worm killing both animals and humans in decades, actually works.
Ivermectin, extracted from a soil fungus in the 1970s was originally known as Merioux years, pets deworm sold.
1987 Merck started on donations to fight million doses onchocerciasis or river blindness caused by microscopic worms spread by black fly bites are and in the sacrifice migrieren.Es is used eyes against lymphatic filariasis, that is by worms that spread by mosquitoes. Worms, the boxes in the lymph nodes warp and create the grotesque swollen legs and Scrotums as elephantiasis known.
Researchers from McGill and Michigan State universities were posted online in a study in The Proceedings of the National Academy of Sciences ivermectin directly kills the worms.It binds to proteins that apart from young worms, immune system to blockieren.Mit below the host move the worm's defence after white blood cells for the kill.Fortunately said Charles D. Mackenzie, Michigan State Professor of Veterinary Pathology and study author, drugs for humans, killing slowly, the worms leaving the eyes. Elder, he said killed, so fast, the dead body worm deteriorated blindness.
"Ivermectin"is an extremely safe drug", added Dr. Mackenzie.""We have given out 25 million doses in Tanzania and had only two minor side effects."
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Alcohol energy drinks under consideration "will treat it just like any other type of alcohol", a journalist student saysAdministrators in Maryland Gazette does not ban beverage, but to say students should watch Washington and Michigan ban of malt liquor beverageThe caffeinated says the product's manufacturer is safe when consumed responsibly "
Leonardtown, Maryland (CNN)--nine Central Washington University students was obtain treatment after drinking Four Loko, but students at the University of Maryland, College Park, say that you are aware of the consequences of the drink and know their own limits.
So it is surprising that the impending ban on caffeinated malt liquor in Washington State and Michigan is hard to swallow.
Aaron Feierstein, 21-year-old student in Maryland, said drinks is similar to another crowd favorite and should not be prohibited.
"Could you go to the line, and you could have a vodka and Red Bull, and could have the same effect as a fourth Loko," he said. "I don't see the difference ".
His friend Feierstein, Luke Alexander also 21-year-old student in Maryland, agreed.
Students "employs more how it helps them find what they want to be when they're having by what it does to house them," he said.
Senior Ben Present, student journalism covered Four Loko for Journal student, took a more neutral approach.
"Treat this just like any other alcohol type," he said, but "it has become a decent multiple during the month that was popular here, and students know at this point that if they are going to drink, keep one."
Four Loko maker Phusion Projects said "when consumed responsibly," the product is just as safe as any other spirit drinks "and that" consumption of caffeine and alcohol together has been safely for years. "
The campus of the College Park has not received reports of adverse events with four Loko or competitors such as sparks, slope and Joose, said Amanda Long, Coordinator of the University's campus alcohol programs.
Administrators are aware of student use, but rather than encourage a prohibition, they've chosen for increased education and outreach through a section of centered health website dedicated to drinks and presentations student performance on the dangers of drinking too much from it.
Students should be cautious, Long said, why drink contain both stimulants and depressants--and why the high by caffeine can veil how alcohol is inside.
"We have students who are not aware that getting more and more behind, because caffeine is masking posts you're used to feeling," he said. "The more they drink, I am going to get to where you've had too much, and they may not realize it until it is too late. "
The spirits of energy come flame in a 23.5-ounce can contain alcohol both approximately five beers and caffeine a small coffee.
Today, 22, was quick to note that are similar to their counterparts upper shelf, except for one way.
"It is different from your Red Bull-vodka, because I know what you have ordered with a Red Bull and vodka," he said. "With a fourth Loko, is a large, tall, and you don't know everything that is in him. "
Another difference: the One can in value; College Park sells for between $ 2.50 to $ 3.00 or drink half of the cost of a typical line.
"It's a cheap instrument, and is a quick way end," said today.
The metal casing, so bright that you can see your reflection in this almost, or below, essential and fancy symbol today said drink stand out from others in a liquor store when searching for "pre-gaming"--drinking before you go out to drink.
While hedging instruments for the four Loko could push students to sample one of curiosity, Long said, be served largely as a learning tool.
"Our goal is to try and make sure they are as educated as far as possible, so if these articles containing educational information related to health and helping students to find out more," he said, "we are prepared to accept".
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2 Garlic cloves, chopped
1 Cup green or brown lenses, washed and took over
1 Bay leaf
1 / 2 medium onion
Salt to taste
1 water-packed tuna, drained
1/4 Cup chopped flat parsley
1 Tablespoon chopped chives
1 Tbsp fresh lemon juice
1 Tablespoon sherry vinegar or red wine vinegar
1 Tsp Dijon mustard
1/4 Cup olive oil extra vergine
1. Place of the lenses, half the garlic, the bay leaf and the onion in a medium sized pot or soup pot. Add 1 litre Wasser.Zum cooking bring, reduce the heat and add salt to taste (approximately 1 teaspoon add).Cover and simmer allow 30 minutes for the lenses are just tender.Remove the onion and bay leaf and discard.Drain the lenses set through a strainer over a bowl.
2. In a large bowl, combine the tuna, parsley, chives, draining lenses.
Whisk 3. in a small bowl or measuring cup, the lemon juice, vinegar, mustard, remaining clove of garlic and salt and pepper together after Geschmack.Schneebesen in olive oil and 2 tablespoons of broth from the lenses.Taking tuna with lenses and serve.
Yield:Four acts.
Preparation ahead:This keeps for four or five days in the refrigerator.
Nutritional information per serving: 327 calories; 16 grams of fat 2 g saturated fat; 15 milligrams cholesterol; 30 grams carbohydrates; 8 grams of dietary fiber; 167 mg sodium; 19 grams protein
Martha rose Shulman can Martha rose shulman.com werden.Ihr reached's latest book "the very best of recipes for health."
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The Ministry of Health reported that after the Friday, 917 had it dead and more than 14.600 were hospitalized with cholera-like symptoms in the hospital. That is until from 724 11,125 hospitalizations and deaths reported a few days ago.
The disease was in 6 of Haiti's 10 provinces, known as departments, found and where it arose Artibonite, which accounts for almost two-thirds of the deaths.
Several epidemiologists have said the disease has passed its peak and will likely worsen and break health officials out in other regions of the country, with un, the estimate approximately 270,000 ill may be made in the coming years.Several new cholera treatment centres are springing up in the capital and other areas.
"The trend is rising and it's material from Department to Department," ROC Magloire, Ministry of Health's said epidemiologist in a telephone interview on the Sonntag.Er referred questions the Ministry Director General, Gabriel Timothée, who could not be reached.
Hospitals in Port-au-Prince, where more than one million earthquakes refugees in congested, squalid tent camps live are overflowing with patients, the cholera symptoms and the death of toll has reached 27.The disease was first reported in the capital on November 8.
President René Préval, at a conference about the disease on Sunday in Port-au-Prince, urged people to wash your hands frequently and drink only water, the associated press reported.But even before the earthquake, the majority of the population lack access to clean water and sanitation.
Cholera, a bacterium that lives in feces contaminated water, causes severe diarrhea and vomiting, dehydration, and his victims in hours without killing format.the treatment rate of serious cases, 30 to 40 percent, is that cholera there for 40 years in Haiti as the 25 percent during a typical outbreak due to extreme poverty, unsanitary conditions and the fact far higher.
"If we around and give advice on food hygiene, tell me," Let me have SOAP, I can't afford it,' "Leonard Doyle, a spokesman for the International Organization for migration, said is an agency, the distribution of Wasserreinigungs tablets and cleaning supplies."
On Friday, $ 164 million of humanitarian organisations called the United Nations and a strategy to support the Government on the disease geschaffen.Das respond donors biggest piece of the plan is $ 89 million for clean water, sanitation and hygiene.
Officials in the neighbouring country, the Dominican Republic, say are markets bordering limit and cholera reached the other steps the country where thousands of people live and work.
One suspected case turned out to be cholera, the country's Health Minister listin Diario which said that the Dominican Republic said Sunday, after a Dominican newspaper, 7,500 to 10,000 treat cholera patients.
This article has been revised to reflect the following correction:
FIX: November 16, 2010
An article on Monday about the rising death toll of the cholera epidemic spreading in Haiti wrong is the name of the chief epidemiologist in the Gesundheitsministerium.Er ROC Magloire, not Magliore.
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Is healthy people rarely contract listeriosis, but can spread through contaminated foods. The products may be contaminated with Listeria monocytogenesThey sold from New Braunfels SmokehouseListeriosis is an unusual but potentially fatal illness
(CNN)--A Texas company has recalled approximately 2,600 pounds of fully cooked, ready-to-eat smoked breast products because they may be contaminated with bacteria which can cause a potentially fatal disease.
Products from New Braunfels Smokehouse distributed nationwide, including through Internet and catalog sales, the US Department of agriculture said Sunday.
The meat may be contaminated with Listeria monocytogenes risk for, said the Agency.
Products subject to revocation is:
--1-pound packages of New Braunfels Smokehouse slices of smoked Turkey, with the package code "2210" on the label.
--4-to 6-pound packages of New Braunfels Honey-Glazed Spiral sliced Smokehouse Chicago smoked boneless breast of Turkey with the package code "3355" on the label.
--4-to 6-pound whole breast packages Stegall boneless smoked Turkey breast, Chicago with the package code "2210" on the label.
--4-to 6-pounds whole breast packages Stegall Spiral sliced smoked Turkey breast, Chicago code packet "3355" or "2210" on the label.
Each packaging bearing the mark of USDA inspection and the number "P-975" inside the mark of the inspection.
The information obtained on 4 August.
Consumption of food contaminated with Listeria monocytogenes, Listeria can cause an unusual but potentially fatal illness, the Department of agriculture said.
Healthy people contract rarely listeriwsis. but that can cause can cause high fever, severe headaches, neck stiffness and nausea. can also cause miscarriages and stillbirths, said the Agency.
Consumers with questions about withdrawal may call the company at 1-800-537-6932.
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A complaint against Dr. James E. Mitchell is now before the Texas State Board of psychologists, claiming, develop professional codes of practice in promoting the c.i.a. injured "Advanced interrogation techniques" for use in its so-called black prison sites during the Bush administration war on terror. Together with Dr. Bruce Jessen, a fellow military psychologist, Dr. Mitchell was 11 c.i.a. interrogation methods, a primary developer of post Sept. currently under a criminal torture investigation by the Ministry of justice.
Dr. Mitchell, who has not responded to repeated requests for comment for this article, closed with company its experience in training soldiers as prisoners of war to a lucrative consulting with the CIA ÜberlebenEr orchestrated - and, according to the complaint involved - the harsh interrogation of terror suspect technique called waterboarding with sexual humiliation and the drowning.
Joseph Margulies, a Northwestern University law professor and Dicky Grigg, an Austin lawyer, worked with a Texas psychologists, Jim L. H. Cox, the complaint which documents in lurid detail Dr. Mitchell's role in the interrogation of prisoners to bring.
The complaint that launched in June, claims that the doctor put his qualifications, the CIA, "His own career and financial expectations about the safety of others" when designing a "Torture regime" misrepresented, with a "complete lack of scientific basis."
Mr. Margulies he pursued the possibility of a similar action against Dr. Jessen, who is licensed in Idaho said.
Mr. Margulies, said Dr. Mitchell never psychology in Texas had practiced although over the years he had maintained its license and it renewed.
The seriousness of the allegations led the American Psychological Association, the rare step of filing public comment in the Texas Licensing Board.The Group's letter said Dr. Mitchell were Member of professional association - he is not - and if the allegations were true, he would be expelled.
Of the Association ethics guidelines prohibit inhuman or abusive treatment of anyone, and it "no circumstances that are not so," including war or threat of terrorism Rhea Farberman, a spokeswoman said.
A spokeswoman for the Texas Board, said not could express, in the complaint and to say that the Board had disciplinary action against Dr. Mitchell, yet only one process to take, which takes about six months.
Mr. Margulies stressed the members of the Management Board importance in the process, called the "only gatekeeper" of the profession.
"" Are either up to the challenge or does is your responsibility,"he said.""It is a psychologist out there, which gives this Dinge.Es no credible question whether passiert.Es is again and again Bestätigt.Und so the question is whether it matters."
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For the lenses:
2 Cups green Le Puy lentils, washed and took over
2 large garlic cloves, crushed
1 Bay leaf
1 medium onion, half reduced
1 medium carrot, quartered
6 Cups water
Salt to taste
Fresh ground pepper
1/4 Cup chopped flat parsley
1/2 Cup walnuts broken
For the dressing:
2 Tablespoons red wine vinegar or sherry vinegar
1 Tablespoon Dijon mustard
Salt
1 Shallot, minced meat, 1 clove garlic, chopped
1/3 Cup walnut oil
Salt and freshly ground pepper
1. Combine oven the lenses, garlic, bay leaf, onion, carrot and water in a large pot or Dutch.Bring to a boil.Add salt to taste (1 to 2 teaspoons), reduce the heat to low ceilings and simmer let 35 to 45 minutes until the lentils are soft.Remove from heat.and dispose of the onion, carrot, garlic and bay leaf.Drain through a sieve set over a bowl.
2. Whisk the vinegar, Dijon mustard, salt and shallot or Knoblauch.Schneebesen in the oil and 2-4 tablespoons of liquid of the lenses.Stir in the Linsen.Die parsley and pepper and taste and adjust salt. spoon on plates, arrange walnuts above on the lenses and serve.
Yield:Six is used.
Preparation ahead:This holds for five days in the Kühlschrank.Wenn you lenses ahead make, not drain, before the Speichern.Sie you continue draining fluid absorb. before dressing, adding liquid from the lenses to taste.
Nutritional information per serving: 380 calories 20 grams of fat 2 g saturated fat; 0Milligrams cholesterol; 38 grams carbohydrates; 10 grams of dietary fiber; 60 mg sodium (includes not salt added during preparation); 16 grams protein
Martha rose Shulman can Martha rose shulman.com werden.Ihr reached's latest book "the very best of recipes for health."
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I love every kind of lens - green, brown or black - but I like especially the kind that hold their shape when cooked green lentils. Taste like other lenses, and are really more Brown than green after cooking. But the texture makes you wonderful especially in salads.
Recently I bought a 1 1/2-pound - bag Green French style lenses (also known as Le Puy lentils) that pantry has been sitting on my shelf. So this week I put together some new lens salads, one with tuna and one with a walnut oil dressing, and couldn't get enough of either.And I protest my son heard no word this week - about the tuna salad we ate for days about the lentil soups and stews, we had for dinner for more than a Woche.Kinder love still lenses, apparently.
Lentil and Escarole soup
The combination of legumes and bitter Greens like Escarole is often Süditalien.Eskariol is a bitter lettuce, the harder a bit like Frisee but with wider leaves sucht.Es is high in vitamin A and a good source of iron and Kalium.Dieses recipe is adapted from the one in "Cucina Rustica," by Evan Kleiman and Viana la place.
2 Tablespoons extra virgin olive oil
1 small onion, finely chopped
1 large or 2 small carrots, cut into small cubes
3-4 garlic cloves, chopped
1 / 4 Teaspoon red pepper flakes
1 14 Oz can chopped tomatoes with juice; or 3 / 4 pounds tomatoes, seeded and grated
1 Cup lentils, washed and took over
A bouquet garni a few sprigs made with a bay leaf, each a Parmesan bark, thyme and parsley
6 Cups water
Salt and freshly ground pepper
1 small head Escarole, washed and coarsely chopped (about 6 cups)
Optional: 4 to 6 slices of country bread, roasted and rubbed with a cut clove garlic
1. Heat 1 tablespoon olive oil over medium heat in a large soup pot or Dutch oven. Add onions and Karotten.Kochen, stir until the onion is tender, about five minutes. Add the garlic and red pepper Flocken.Kochen, stir until the garlic scented is 30 seconds to one minute.Stir in the tomato. Bring a simmer and Cook, stir until slightly cooked tomatoes down and aromatic smell, five to 10 minutes.The lenses and simmer leave with the tomato mixture for a few minutes, then add bouquet garni and water.Bring to a boil, reduce the heat and add salt to taste (1 to 2 teaspoons to).Cover and simmer for 30 minutes.
2. Add the Escarole and bring back to a simmer transfer heat can reduce cover and for 15 to 20 minutes until the Escarole and the lenses simmer supply.Season to taste with salt and pepper.Remove the bouquet garni.
3. Toast slices of country bread, if desired, and rub garlic with a cut.Place a slice in each bowl, ladle into the soup and serve.
Yield:Serves four to six.
Preparation ahead:The soup will keep for three or four days in the fridge.
Nutritional information per serving (4 portions): 289 calories 7 grams of fat 1 G saturated fat; 0Milligrams cholesterol 43 grams carbohydrates; 10 grams of dietary fiber; 262 G sodium; 17 grams protein
Nutritional information per serving (6 servings): 193 calories 5 grams of fat 1 G saturated fat; 0Milligrams cholesterol 29 grams carbohydrates; 7 grams of fiber; 175 mg sodium; 11 grams protein
Martha rose Shulman can Martha rose shulman.com werden.Ihr reached's latest book "the very best of recipes for health."
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Q. My husband weighs, twice as much as I do. How does his blood volume with me?
A. blood volume depends on many factors and is highly variable but estimates based on size, weight and gender can be made, and an online calculator is based on the last research available at easycalculation.com/medical/blood-volume.php.For a 200 pound the blood volume on 7.2 litres or about seven and a half litre appreciated. for a 100 pounds is six foot male, five feet female is the estimate three and a half litres or 3.7 liters.
The normal range for a grown man is usually in five to six quarts.Updated, semiautomated method of getting a fast and reliable estimate of the blood volume using radioactive tracer is in a 2003 article in the journal of technology nuclear medicine diskutiert.abrufen such a reading is important in many areas of treatment as perfusion or injection a therapeutic compound in a patient blood supply."Of course bigger people have varies also larger volumes of blood and blood volume of body composition," the article stated.
"First attempts, normal blood volume forecasts body weight, with different conditions for men used a fixed ratio of blood volume and Frauen.Allerdings is bold much less vascular as lean tissue, two people can equal weight with different body compositions have significantly different normal blood volumes."
C. CLAIBORNE RAY
Readers are invited Avenue, New York, n.y 10018, question, science times, the New York, to ask questions to 620 8th times by post or by E-mail to question@nytimes.com.
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And now, welcome back for the hypothesis of our experiment: Wherever your mind went — the South Seas, your job, your lunch, your unpaid bills — that daydreaming is not likely to make you as happy as focusing intensely on the rest of this column will.
I’m not sure I believe this prediction, but I can assure you it is based on an enormous amount of daydreaming cataloged in the current issue of Science. Using an iPhone app called trackyourhappiness, psychologists at Harvard contacted people around the world at random intervals to ask how they were feeling, what they were doing and what they were thinking.
The least surprising finding, based on a quarter-million responses from more than 2,200 people, was that the happiest people in the world were the ones in the midst of enjoying sex. Or at least they were enjoying it until the iPhone interrupted.
The researchers are not sure how many of them stopped to pick up the phone and how many waited until afterward to respond. Nor, unfortunately, is there any way to gauge what thoughts — happy, unhappy, murderous — went through their partners’ minds when they tried to resume.
When asked to rate their feelings on a scale of 0 to 100, with 100 being “very good,” the people having sex gave an average rating of 90. That was a good 15 points higher than the next-best activity, exercising, which was followed closely by conversation, listening to music, taking a walk, eating, praying and meditating, cooking, shopping, taking care of one’s children and reading. Near the bottom of the list were personal grooming, commuting and working.
When asked their thoughts, the people in flagrante were models of concentration: only 10 percent of the time did their thoughts stray from their endeavors. But when people were doing anything else, their minds wandered at least 30 percent of the time, and as much as 65 percent of the time (recorded during moments of personal grooming, clearly a less than scintillating enterprise).
On average throughout all the quarter-million responses, minds were wandering 47 percent of the time. That figure surprised the researchers, Matthew Killingsworth and Daniel Gilbert.
“I find it kind of weird now to look down a crowded street and realize that half the people aren’t really there,” Dr. Gilbert says.
You might suppose that if people’s minds wander while they’re having fun, then those stray thoughts are liable to be about something pleasant — and that was indeed the case with those happy campers having sex. But for the other 99.5 percent of the people, there was no correlation between the joy of the activity and the pleasantness of their thoughts.
“Even if you’re doing something that’s really enjoyable,” Mr. Killingsworth says, “that doesn’t seem to protect against negative thoughts. The rate of mind-wandering is lower for more enjoyable activities, but when people wander they are just as likely to wander toward negative thoughts.”
Whatever people were doing, whether it was having sex or reading or shopping, they tended to be happier if they focused on the activity instead of thinking about something else. In fact, whether and where their minds wandered was a better predictor of happiness than what they were doing.
“If you ask people to imagine winning the lottery,” Dr. Gilbert says, “they typically talk about the things they would do — ‘I’d go to Italy, I’d buy a boat, I’d lay on the beach’ — and they rarely mention the things they would think. But our data suggest that the location of the body is much less important than the location of the mind, and that the former has surprisingly little influence on the latter. The heart goes where the head takes it, and neither cares much about the whereabouts of the feet.”
Still, even if people are less happy when their minds wander, which causes which? Could the mind-wandering be a consequence rather than a cause of unhappiness?
To investigate cause and effect, the Harvard psychologists compared each person’s moods and thoughts as the day went on. They found that if someone’s mind wandered at, say, 10 in the morning, then at 10:15 that person was likely to be less happy than at 10 , perhaps because of those stray thoughts. But if people were in a bad mood at 10, they weren’t more likely to be worrying or daydreaming at 10:15.
“We see evidence for mind-wandering causing unhappiness, but no evidence for unhappiness causing mind-wandering,” Mr. Killingsworth says.
This result may disappoint daydreamers, but it’s in keeping with the religious and philosophical admonitions to “Be Here Now,” as the yogi Ram Dass titled his 1971 book. The phrase later became the title of a George Harrison song warning that “a mind that likes to wander ’round the corner is an unwise mind.”
What psychologists call “flow” — immersing your mind fully in activity — has long been advocated by nonpsychologists. “Life is not long,” Samuel Johnson said, “and too much of it must not pass in idle deliberation how it shall be spent.” Henry Ford was more blunt: “Idleness warps the mind.” The iPhone results jibe nicely with one of the favorite sayings of William F. Buckley Jr.: “Industry is the enemy of melancholy.”
Alternatively, you could interpret the iPhone data as support for the philosophical dictum of Bobby McFerrin: “Don’t worry, be happy.” The unhappiness produced by mind-wandering was largely a result of the episodes involving “unpleasant” topics. Such stray thoughts made people more miserable than commuting or working or any other activity.
But the people having stray thoughts on “neutral” topics ranked only a little below the overall average in happiness. And the ones daydreaming about “pleasant” topics were actually a bit above the average, although not quite as happy as the people whose minds were not wandering.
There are times, of course, when unpleasant thoughts are the most useful thoughts. “Happiness in the moment is not the only reason to do something,” says Jonathan Schooler, a psychologist at the University of California, Santa Barbara. His research has shown that mind-wandering can lead people to creative solutions of problems, which could make them happier in the long term.
Over the several months of the iPhone study, though, the more frequent mind-wanderers remained less happy than the rest, and the moral — at least for the short-term — seems to be: you stray, you pay. So if you’ve been able to stay focused to the end of this column, perhaps you’re happier than when you daydreamed at the beginning. If not, you can go back to daydreaming starting...now.
Or you could try focusing on something else that is now, at long last, scientifically guaranteed to improve your mood. Just make sure you turn the phone off.
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Haiti cholera death toll risesMore from 14,000 have hospitalizedThe nationwide Resistencia 917In capital, Port-au-Prince, 27 died with more than 600 hospitalizedAre in Haiti?
Share your photos and videos there. Port-au-Prince, Haiti (CNN)--the death toll from Haiti's month-old cholera outbreak continues to grow.
According to statistics released by the Ministry of Health of Haitian Sunday morning, 917 people died from bacterial infection, while there were some 14,642 hospitalizations.
iReporters share their view of Haiti cholera outbreat
More ominous is the spread of cholera through dirty camps that still House hundreds of thousands of people in the Haitian capital 10 months after a killer earthquake destroyed the town.
"In Port-au-Prince only give an overall deaths of 27 and 607 hospitalizations," said Christian Lindmeier, a representative of the World Health Organization.
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On Monday morning to his financial support of this nation's struggle against the leading cigarette companies commit Mayor Michael R. Bloomberg of New York telephoned the Uruguayan President José Mujica.
Mr. Bloomberg, billionaire with a long record of smokers activism made the announcement after a Front page article on Sunday in the New York Times erschien.Der article detailing some lobbying and marketing court activities of multinational tobacco companies.
Mr. Bloomberg announced on Monday afternoon a press conference that he million direct would some of the $375 to Uruguay legal defense he has set aside in a philanthropy fighting smoking. In a press release he call no precise figure.
Uruguay, regarded as the world's leader in anti smoking laws, cigarette is an affiliate-Washington based World Bank of Philip Morris International verklagt.Die giant objects, two new Uruguayan law. 80 Percent of the front and back of cigarette includes packages with graphic warning health. The more than a kind of every brand of cigarette, such as Marlboro red, gold and silver other prohibitions.
The suit has anti smoking forces global gathering. Interpreted it as an attempt to intimidate Uruguay and send a message to other developing countries on the eve of Conference of tobacco control officials from 171 Nations.The Conference in Punta del Este, Uruguay, plans sponsored by the WHO to recommend policies to enforce a wide smoking contract.
In the press release Mr. Bloomberg money "Uruguayan Government officials will support by legal research and expertise." world launches public awareness campaigns, mass media and hot dip galvanizing support and public opinion
Peter Nixon, a spokesman for Philip Morris International, said in recent interviews that the action was necessary, to which he said message in February regardless of the Conference which was tobacco control officials, company's trademarks and intellectual property to Schützen.Seine.The suit seeks not unspecified damages.
The size of the health warning, Mr. Nixon, said "the previous ones were 50 percent and we thought this was angemessen.sobald take it up to 80 percent, there is no place for trademarks shown werden.so we that went too far thought."The limit for brands, added he forced to remove a number of brands Philip Morris from the market.
A group of non-profit health organizations bought a full-page ad in Uruguay's leading newspaper Monday the President of the country until thanks to stand Tabakunternehmen.Philip Morris International's $66 billion annual turnover is twice the size of the gross domestic product of Uruguay.
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Cardiologist, not to mention Wall Street analysts, are the results of several important studies that meet at the American Heart Association this week presented closely monitor.
In particular, are on Monday morning bring researchers developed the results of the rocket AF a study that compared warfarin, Rivaroxaban, blutgerinnung retardant a new drug from Bayer and Johnson and Johnson to prevent strokes in patients with atrial fibrillation.
The question is not only whether the new pill worked as also warfarin, an older drug to take effective but often uncomfortable for patients, but the new drug was how secure when compared to the older drug caused bleeding.
Johnson and Johnson has a Ð food and Drug Administration to approve that for any other purpose - to reduce the risk of large blood clots Rivaroxaban in people the knee or hip replacement surgery are subject to.
But the f.d.a has already approved the first new generation alternative to warfarin. Pradaxa, also known under its chemical name, made by Boehringer Ingelheim, Dabigatran Agency received approval last month as stroke prevention treatment for people with atrial fibrillation.
Meanwhile researchers will present on Wednesday morning, expected that define a study called includes Anacetrapib, cholesterol-Medikament in the development of Merck.It is designed to increase HDL, also known as "good" cholesterol while reducing LDL, also known as "bad" cholesterol.
The meeting continue through Wednesday in Chicago.Can developments in one of my favorite blogs, Larry of cough's CardioBrief or by his Twitter feed @ Cardiobrief follow.
Heart lovers cardiologist, Dr. Harlan Krumholz, the Yale should follow their Twitter feed @ Hmkyale is.
On Monday's Kathleen Sebelius Secretary of health and human services planned the keynote speech at the annual meeting of the National Business Coalition of health liefern.Die non profit group around the country representing more than 7,000 employers, including the implication of the law, discuss employers health overhaul.
About are the f.d.a it a busy week for external experts on Advisory Committee panels, to check the industrial applications for new drugs.
On Tuesday, this is arthritis advisory panel, Benlysta, a human monoclonal antibody of Human Genome Sciences, for the treatment of patients with Lupus prüfen.Am discuss a regulatory path for potential anthrax-Impfstoffe Tuesday the vaccine Advisory Committee and Wednesday, which consider same group approval for Gardasil that Merck to include prevention of anal cancer vaccine of HPV is erweitern.Inzwischen Thursday the Agency plastic surgery Panel, a new handheld device called MelaFind as a system to detect, predict whether moles and skin lesions cancerous device shall be checked.
Towards the end of the week, kidney specialists become aware of developments of the meeting of the American Society of Nephrology in Denver, where late-breaking clinical trials are due will be presented on Saturday.
In particular, presents researcher at Oxford University the results Of the sharp study, one Merck-sponsored study the effectiveness of the use of cholesterol treatments simvastatin and Ezetimibe, also known as the combination tested pill Vytorin on cardiovascular events in patients with chronic kidney disease.
If you want to nominate your favorite blog or Twitter on developments feed in the treatment of kidney disease, please send us a note.
Correction: An earlier version of this post wrong type of specialists who most closely monitor the American Society of Nephrology Conference in Denver running.make are not liver, kidney, specialists.
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The decision makes the fifteenth State have approved a medical marijuana law Arizona. California was the first in 1996, followed by 13 other States and the District of Columbia.
Ballot measure asked proposition 203, won by just 4,341 votes from more than 1.67 million votes counted, according to final results announced on Saturday.
The approval came as something of a surprise.At one point on election day, the measure approx. 7200 votes schleppte.Die gap narrowed gradually, until it edged ahead, while the count at the Freitag.Die was final tally 841,346 in favor and 837,005 opposed.
"We really believe that we have the possibility, an example for the rest of the country on how a good medical marijuana program looks to put", said Andrew Myers, Campaign Manager for the Arizona medical marijuana policy project.
The Arizona action allows patients with diseases such as cancer, AIDS, hepatitis C and all other "chronic or debilitating" disease that guidelines for plants to grow or buy two and a half ounces marijuana corresponds to every two weeks.
Patients must receive a recommendation from your doctor and the Arizona Department of health services registrieren.Das law allows for no more than 124 marijuana dispensaries in the State.
Supporters of the proposition 203 argues that thousands of patients suffering from a "terrible choice" with a serious or even terminal illness or konfrontiert.Sie go to the criminal marijuana market measure on the ballot, collected more than 252,000 signatures, put almost 100,000 more than necessary.
The measure prosecutors, the Governor, the State Attorney general and many other politicians was opposed by all Arizona Sheriff and County.
Carolyn short, keep AZ drug free, the group, the opposition to the initiative, organised, said her group believed that the law would raise crime to outpatient clinic locations, to drive more people lead while impaired and finally to the legalized marijuana for all lead.
She said that it is clear the marijuana policy project, based in Washington, to his ultimate goal the new measure in the major financial backer of: national legalization.
"" All the leaders came out and warned Arizona who was going have very serious impact on a number of levels ", said Mrs short once votes for the measure in the lead late Friday drawn.""I don't think that all Arizona heard these gloomy predictions."
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Ken Burris / food good Inc.Mini Brie and Apple quiches
delicious no-meat recipes for your holiday table.
The popular food magazine good food is known for its delicious, healthy Rezepte.In of recently you have noticed a growing number of meat-eaters, the questions for more vegetable dishes.
"We are not a vegetarian magazine, we are a healthy cooking magazine," says Jessie price, the Deputy food editor."But our readers always say, 'give us more vegetarian recipes.' and it is not only vegetarian." "It is people who eat meat, who want more meals per week, the vegetarian."
As a result, the magazine is your favorite recipes compile meat-free in the new cookbook, "eating well fast and flavorful meatless meals," published in May 2011.The editors provide now readers a sneak peek of the fountain vegetarian Thanksgiving Serie.Die dishes are combinations of dough dough festive and produce including easy Apple and Brie quiche, appetizers and a joyful vegetable pie.
"" It's a special occasion kind of court", Mrs price says.""You want something you're going to bring to the table, which enters the wow people."
Both see recipes, be sure to check out below our interactive recipe page of all courts in the now vegetarian Thanksgiving series.
Food of the well
Mini Brie and Apple quiches
Brie and apples taste wonderfully together in this mini Quiches.Mini Yufka cups make it fast and simply to an elegant appetizer in about 30 minutes to erstellen.Mini Yufka (Fillo) shells are available in the freezer section close to frozen Vorspeisen.Sie must complete before the and baking are thawed.
30 Mini Yufka shells (two 1.9 oz packages)
1 / 2 medium Apple, peeled and diced fine
5 large eggs
1 Tsp Dijon mustard
1 / 4 Teaspoon salt
Pinch of freshly ground pepper
Pinch of ground nutmeg
In 30 squares cut 4 ounces Brie (small bike 1 / 2)
1.-Backofen on 350 degrees Fahrenheit.Yufka shells on a large parchment-lined baking sheet anordnen.Unterteilen you Apple under the shells.
2. Whisk you eggs, mustard, salt, pepper and nutmeg in a large measuring cup.Pour the egg mixture over the Apple (the shells not overflow).Place a Brie square in each bowl.
3. Bake until the egg is set which is melted Brie and begins the Yufka to Brown around the edges, serve something cool before 15 Minuten.Lassen.
Yield: 30 quiches.
Nutritional information per serving(Serving size: a Quiche): 39 calories and 2 grams of fat (1 G saturated, monounsaturated 1 gram); 39 milligrams cholesterol; 3 G carbohydrate; 0Grams sugar; 2 grams protein; 0Grams of fiber; 65 mg sodium 20 mg potassium.
Food of the well
Fried vegetable Galette with olives
The natural sugars in the vegetables caramel during the roasting by giving them a cake incredible sweet savory taste. garlic adds a mellow note Geröstete and moistened the Füllung.Dies is a highly customizable recipe: experimenting with various vegetables eggplant, peppers, Zucchini-and Fontina and Jarlsberg cheese.The vegetables should be cut to a uniform size so you cook evenly.Destination for 3/4-inch pieces.
Crust:
1 1/4 Cups all-purpose flour
1 Cup whole wheat pastry flour
2 Teaspoons baking powder
1 Teaspoon of sugar
1 / 2 Teaspoon salt
1/3 Cup water
1/4 Cup extra virgin olive oil
1/2 Cup chopped pitted kalamata olives
Filling:
1 1/2 Cups diced peeled carrots (3 medium)
1 1/2 Cups diced peeled parsnips (3 medium)
1 1/2 Cups diced peeled butternut squash (1 / 2 medium)
1 Cup diced peeled sugar beet (1 medium)
2 Tablespoons olive oil, divided
2 Teaspoons chopped fresh rosemary or 1 / 2 teaspoon dried
1 / 2 Tsp salt or to taste
Fresh ground pepper to taste
1 Head garlic
1 Cup crumbled goat cheese (4 ounces) creamy, divided
1 Egg mixed with 1 tablespoon water for glazing
1. Prepare crust: combine all purpose flour, whole wheat flour, baking powder, sugar and salt in a food processor; pulse several Male.Mix water and oil; scatter you add mix olives and pulse on the dry ingredients and pulse only, to mixed.(Alternatively, you combine dry ingredients in a large Schüssel.Machen a fountain in the Middle, and add the water-oil mixture, stirring until well vermischt.Stir in olives.)
2. Press the dough into a disk, if it seems dry, add a little more Wasser.Wickeln sealed in foil and in the refrigerator for 30 minutes or länger.Die unbaked crust will keep, well packaged in the refrigerator for up to 2 days.
3. Meanwhile, you Preheat oven to 400 degrees Celsius.Bestreichen a large baking sheet with cooking spray.
4. Filling prepare: combine carrots, parsnips, squash, sugar beet, 1 tablespoon oil, Rosemary, salt and pepper in a large bowl; take to beschichten.Verbreiten you vegetables prepared Backenblatt.schneiden the top head Knoblauch.legen you click a square of foil with a tablespoon of water and pinching sprinkle the edges of the foil zusammen.Platzieren it on, stir the vegetables the baking sheet with the Gemüse.Braten every 10 minutes, until you are tender and beginning to Brown and the garlic is tender, about 35 minutes.(Garlic may take a little longer.)
5. You transfer the vegetables in a bowl geben.Entwrappen garlic and let some cool. press the garlic in a small bowl; add the remaining 1 tablespoon oil and mash with a fork piercing. Add the crushed garlic, roasted vegetables and toss to mix. Add 3/4 cup goat cheese and toss to coat.
6. Assemble Galette: 1/4 inch dick.Bestreichen roll up the dough into a rough 14-inch circle about baking sheet with cooking spray and place the dough on es.Ordnen roasted vegetables on the dough, a 2-inch frame around verlassen.Falten you the border and make a rim netted, over the fill how gehen.Streuen the remaining 1/4 cup goat cheese over vegetables. stirring egg and water quickly and easily brush over the crust.
7. Bake the Galette at 400 degrees, golden until the crust, 30 to 35 Minuten.Lassen you cool for 10 Minuten.Servieren you warm.
Yield:Makes 8 servings.
Nutritional information per serving: 385 calories; 20 grams of fat (6 grams saturated, monounsaturated 12 grams); 41 milligrams cholesterol 42 grams carbohydrate 10 grams protein; 6 grams of fiber; 667 mg sodium.
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PRAGUE - police and senior officials of the European Union network headquartered in Kosovo, kidneys and other organs impoverished victims for up to $200,000 so far removed from at least seven people with participation in an international organ trafficking patients from like Israel and sold raised Canada, said Monday.
According to the indictment which attracted traffickers people of slums in Istanbul, Moscow, Moldova and Kazakhstan with promises of up to $20,000 for their institutions.Law enforcement officials say many never a dime overview were operations at a private clinic in a run down area on the outskirts of Pristina, Kosovo carried out.
While the ring was discovered first two years ago, the global scale of the network and its victims is finally clear.
Officials said the ringleader was a highly respected surgeon and Professor at the University of Pristina, Dr. Lutfi Dervishi. The clinic was by his son ARBAN ausgeführt.Auch charged Ilir Rrecaj, a senior official in Kosovo's Health Ministry was if the ring was broken.Crime, including trafficking in human beings people and parts of the body, illegal medical activity, participation in organised crime and are abuse of Office and two other vorgeworfen.Alle were released on bail.
The fees have rocked Kosovo, has struggled to integrate with the West because it declared independence from Serbia in February 2008.The case is a test of the nascent legal institutions and rule of law, a culture of endemic lawlessness and corruption that has reached the highest levels of Government as Kosovo is seeking to overcome.
Human trafficking network reached weit.Optionsscheine for a Turkish doctor and an Israeli financier issued tentacles and two other doctors, an Israeli and an Arab became known as co-conspirators.
The police said the ring his roots at a medical Conference in 2006 in Istanbul, Dr. Dervishi had the Turkish doctor completion date, Yusuf Sonmez met. Law enforcement officials describe Dr. Sonmez a notorious international organ touts.
Medicus clinic was founded by a European philanthropist, the ethnic Albanian doctors during the war in Kosovo in the year 1999 aided.Dr. Dervishi, police officers who said secretly turned it into a hub for illegal organ transplants performed by Dr. Sonmez.
The charge was first by the associated press berichtet.In it a EU public prosecutor, Jonathan Ratel, said that in 2008, 20 foreign nationals the in "Extreme poverty or acute financial distress" life "with false promises of payments were recruited."
The police said, broke the ring Yilman Altun, you in November of this year, as a young Turkish man at the airport of Pristina, weak and frail found.Mr Altun said police had stolen his kidney.When the police raided the Medicus clinic, an elderly Israeli man, Mr. of Altun's had received kidney discovered you.
European Union officials said that the charge in the case in the District Court in Kosovo had been filed and that end of the year expected a judge charges confirmed a preliminary hearing which interruption.If a trial will be followed.
The European Union has a great law enforcement mission in Kosovo on the fight of against crime and the Korruption.Aber that fight as difficult, proven with suspicions of bribes has lively money laundering, organised crime, fraud and now organ trafficking, high-level government officials.
Several countries investigate the Kosovo ring combing, with police investigators through telephone records, computer hard drives and bank transfers of the European Union berechnet.Beamten said helping lead the police to the main suspect paid the recipients for the kidneys of bank transfers.
Western law enforcement officials said its nexus in Israel suspected the ring may be part of a larger criminal network, its September dozens of poor Brazilians were the five doctors from South Africa with participation in an international kidney trading syndicate, and beauftragt.Analysten paid Romanians for kidney for wealthy Israelis organ trafficking said case where unscrupulous traffickers continue geschunden using growing waiting lists of desperate patients and the vulnerability of the poor people of the international financial crisis were part of a disturbing global trend.
In the United States, more than 109,000 people usually kidneys are on the waiting list for organ transplants, and 18 die every day according to the United Network for organ that manages the American transplant system.
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November 15
He says New York's Mayor some of his philanthropic resources use is to fight tobacco companies.November 15
A discussion on new trends in health insurance.November 15
Coagulation retardant and cholesterol drugs are developments expected this week.November 12
The campaign for tobacco-free kids takes exception cigarette packaging, the function of the cities with a hip image.November 10
The analysis has been issued, such as Medicare, if it chooses an expensive drug payable Provenge.
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A combination of annual mammography and MRI scans seems for women at high risk of breast cancer saves life, new research shows. The New York Times medical reporter Denise Grady reports on research in today's science times.
The study, the first measure survival in a large number of high women received from MRI's, found that after six years of follow-up, 93 percent of mutation carriers with cancer still alive, were alive when compared to 74 percent in five years in previous Studies….
MRI scans started some years ago experts annually in addition to mammography for high-risk women recommended because MRI improves tumours to find ist.mammographie still detect some cancers that MRI's so can miss, high-risk women generally recommended both tests haben.Aber until now, researchers did not know whether the combined test lives saved.
Learn how, who, read the full story can benefit from the additional testing "MRI's help fight high risk for cancer,' ' and take the discussion below please."
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Any seven Medicare-receiver which is in the hospital it is General for the problems with the medical care according to a new study from the Office of Inspector Department of health and human services damaged.
The study, said unexpected adverse events added at least $4.4 billion per year Government health care costs and helped the deaths of approximately 180,000 patients per year.
In a single month, October 2008, estimates the report that some 134,000 Medicare patients setback, experienced at least one adverse event of a temporary health to death during a hospital stay.It said, 44 percent were "clearly or probably avoidable."
Hospital infections as a major source of problems, but the Inspector General's report cited this study found other events häufiger.Die common problems which classified said it as adverse events relating to drugs, such as excessive bleeding, those relating to patient care, such as intravenous fluid overload and those relating to surgery and infection followed.
The most serious events such as surgery on the wrong patient, amounted to less than 1% of the count according to Ruth Ann Dorrill, team leader for the Inspector General of the study group Ereignisse.Diejenigen are known as "never events" - who said national quality Forum, a leading non-profit group, you "should never occur in a health care setting."
An American Hospital Association official, Nancy Foster, said the study highlighted the importance of improving the procedure, so that the medication errors and other problems, described in the report.
"" Hospitals and doctors and nurses to damage prevents", said Ms. foster, Vice President of the Association for quality and patient safety, on Monday.""But as this report suggests, we have a ways to go before we are where we have our performance to want."
Concerned experts reviews a representative sample of 780 Patientendateien.Es is planned the study, visit the Inspector General are booked on Tuesday.
In a written reply, in the report said included Dr. Carolyn M. Clancy, head of the Federal Agency for healthcare concern research and quality that adverse events were hospital patients with an "alarming rate" and promised to work to improve it.
Mrs Dorrill, team leader for the study group, headquartered in Dallas, said it was the seventh and most important 10 reports of adverse events that law by Congress 2006 made the Agency in response to a health care in.
"There were lot of momentum in the late 1970s, early 1980s when the safety of the patients movement began, and a progress check wanted" said Mrs Dorrill.
Kevin k. Golladay who Regional Inspector General for evaluation and inspections, said: "We also recommend a broader view of the damage in a hospital."
The report calls for more supervision and financial incentives for hospitals, error to reduzieren.In of his written answer, Dr. Donald M. Berwick, administrator who said Center for Medicare and Medicaid Services, it would be aggressively pursue recommendations to the definition of adverse events to expand to monitor and prevent that you.
The problem had won widespread attention with a 1999 report by the Institute of medicine, titled "to err is human: building a safer health system."The report cited studies use different methodology to estimate from 44,000 to 98.000 Americans die each year due to a preventable medical errors in hospitals.
The officials said the Chief of staff of the study which was to obtain first a statistically valid national incidence rate of adverse events in a hospital population. previous estimates had more limited data extrapolated.
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Martha Silva poses with her mother, Gabriela Martinez. Silva says that her mother's depression should have been caught 20 years earlier than it was.Bridging the gap between Latinos with mental illness and treatment is a pressing issueWhites are far more likely to receive mental-health treatment than LatinosIn the Latino community, cultural and socioeconomic factors stigmatize people with mental illness
(Health.com) -- Gabriela Martinez always spent a lot of time in bed, and she rarely laughed, or even spoke. For decades, her family shrugged off this unusual behavior as nervios, or "nerve problems."
"We thought, 'That's how she is,'" her daughter, Martha Silva, recalls.
Finally, five years after moving to the United States from Cuba with her family in 1965, Martinez visited a psychiatrist at her daughter's urging and was diagnosed with depression. "My family never knew she had depression," Silva says. "She should've been diagnosed in her 20s and not her 40s."
The Silva family's story is all too common in the Latino community, where a deeply rooted mix of cultural and socioeconomic factors have conspired to stigmatize people with mental illness, in many cases causing them -- and their families -- to delay or avoid seeking professional help.
Health.com: 10 things to say (and not say) to someone with depression
Although the rates of mental illness among Latinos and whites in the U.S. are roughly equivalent, whites are far more likely to receive mental-health treatment (about 60 percent more likely, a 2008 study found). According to a 2001 Surgeon General's report, only about 20 percent of Latinos with a psychological disorder consult a general health-care provider about their symptoms, and just 10 percent contact a mental-health specialist.
"When Latinos think of mental illness, they just think one thing: loco," says Clara Morato, whose son, Rafaello, was diagnosed with bipolar disorder at age 18. "[Latinos] don't want to be labeled, and they don't want to be labeled as the family with a relative who's crazy."
These beliefs represent a serious public-health concern, considering that the 49 million Latinos in the U.S. constitute the country's largest and fastest-growing minority group.
The Latino population has risen by nearly 40 percent in the last decade and is expected to make up close to one-third of the nation's inhabitants by the year 2050. And, thanks to recent health-insurance reforms, more Latinos than ever before may be seeking treatment for the first time in the coming years.
Health.com: Getting the mental health help you need
Delivering appropriate mental-health care to the tens of thousands of Latinos who need it but are hesitant to accept it may not be easy.
"The stigma is a phenomenon that's fairly complicated," says William Vega, Ph.D., a provost professor at the University of Southern California, in Los Angeles, and a leading expert on mental health among Latinos. "It's a major question in the field as to how to manage it, because there are so many cultural nuances."
A complex phenomenon
The stigma surrounding mental illness and the reluctance to get treatment aren't unique to Latinos, of course. Less than one-third of the estimated 18 million American adults who have a mental illness that affects their day-to-day functioning receive treatment, according to a 2008 government survey.
Research and anecdotal evidence suggest that stigma -- and what's known as self-stigma -- is a major factor standing in the way of mental-health care for Latinos.
In a recent study, Vega surveyed 200 depressed and low-income Latinos in Los Angeles; more than half said that depressed people weren't trustworthy and that they'd be unwilling to socialize with someone who's depressed. Those self-stigmatizing respondents were less likely to take medication and keep scheduled appointments with primary-care physicians, the study found.
Health.com: How self-stigma hurts people with depression
Some of the reasons behind the reluctance to seek professional help are cultural. Religion is very important to the Latino community, and some Latinos turn first to their church -- or even to the folk healers known as espiritualistas -- for help with mental-health problems, some experts suggest.
Even more so than American culture as a whole, Latino culture values self-reliance, which can discourage people from talking about their problems, says Jane Delgado, Ph.D., a clinical psychologist and the president of the National Alliance for Hispanic Health.
"They feel they have to resolve issues themselves," she says. "They don't want to be a burden."
This seems to be especially true of men, says Silva, who, spurred by her mother's experience, started leading Spanish-speaking outreach classes for the National Alliance on Mental Health (NAMI) chapter in Hudson, New Jersey. "Men usually don't get involved," she says. "They often get scared."
If Latinos do seek care, more often than not it will be from a clinic or general practitioner rather than a specialist. "They won't say, 'I'm depressed,'" Vega says. "Many Hispanics will go to the primary health-care clinics and complain about physiological symptoms."
Or, as Silva puts it, "They go to regular doctors so it won't make them 'crazy.'"
Health.com: Avoiding the stigma of depression and bipolar disorder
Barriers to care
Even for motivated people, significant barriers to mental-health care exist in the Latino community.
Perhaps most important, Latinos have the highest uninsured rates of any ethnic group in the U.S. In 2007, nearly one-third of all Latinos had no health insurance, compared to 10 percent of whites.
Moreover, a 2006 American Psychological Association survey found that only 41 percent of insured Latinos had mental-health benefits, compared to 65 percent of whites and 63 percent of African-Americans.
Finding the time for care can also be a challenge. Latinos may have manual labor or service jobs -- nearly one-quarter work in the service industry -- that require them to work odd hours, long shifts, and overtime, Silva points out.
And if a Latino with a mental-health problem does visit a health clinic or doctor's office, the language barrier might be insurmountable, as there is a shortage of Spanish-speaking health professionals, especially psychiatrists, psychologists, and therapists.
There are only 29 Latino mental-health professionals for every 100,000 Latinos in the U.S., compared to 173 non-Hispanic white providers per 100,000 non-Hispanic whites.
Recent studies have suggested that specialists need to comprehend different cultural views on mental illness in order to give their patients the best possible care. "Many physicians, psychiatrists, [and] therapists are well-trained," says Delgado, "but they aren't trained in understanding culture and how they're impacting someone's world."
Health.com: 7 types of therapy that can help depression
Help on the horizon
Bridging the gap between Latinos with mental illness and treatment providers is more pressing than ever, due to the changes under way in the American health-care system.
The Affordable Care Act, which was passed by Congress in March and went into effect in September, could make health care more accessible and affordable to the nearly 16 million Latinos in the U.S. who are currently uninsured.
By 2014, mental-health and substance-abuse services will be an essential component of Medicaid, as well as of the affordable health plans found in the new state-run insurance marketplaces.
In the meantime, according to Vega, so-called safety-net clinics that treat people without health insurance have received additional funding, some of which could go toward expanding mental-health care. As a result of these changes, many Latinos could be seeking care for the first time.
"We have a system that is unprepared," Vega says. "We need to prepare physicians and health-care providers of what's to come -- to not stereotype patients. They need to ask the right questions, ask them how they feel about medication, and advise them on it."
Health.com: 5 questions to ask your doctor about depression
To bridge the gap and to ultimately squash the stigma, mental-health professionals and advocates have to educate Latino families and health-care providers about mental illness, Vega says.
Vega has seen some encouraging developments. There are more Spanish-speaking personnel in mental-health clinics now than at any time in the past 30 years, he says. But the quality of health-care services provided to Latinos still needs improvement: The wait to see a mental-health specialist in a public clinic can be up to two months.
"It's a massive switch [from] what we're seeing right now, and the demand is going to be there," Vega says. "We're just at the first stage of transition."
Family matters
Rafaello Morato is an example of the progress that's been made -- and also the work that remains to be done.
Rafaello, whose family is originally from Colombia, was diagnosed with autism at age 4 and began taking medication. His mother, Clara, was hopeful that his mood swings and violent outbursts would go away as the years went on, but as he got older, his condition only escalated. His troubles culminated during his senior year in high school, when he threatened his school principal with a sharp object during a dispute over a Halloween costume.
After an order from the school to seek psychological evaluation, Rafaello was diagnosed with bipolar disorder. Now 22, Rafaello is taking medication and doing better. Though he still has violent outbursts on occasion, he has a job at a local movie theater and hopes to attend college in the near future.
Health.com: 10 subtle signs of bipolar disorder
Rafaello got the treatment he needed and his condition is under control, but he still puts up with some prejudice from his own family.
"They don't understand what he goes through every day to stay stable," Clara says. "I try to ignore some of the inappropriate remarks they make. But I've learned to fight back by reminding them how much progress we have made, and that always seems to disarm them."
Clara has taken part in the Spanish-language classes that Silva leads at NAMI, which are designed to teach the families and caregivers of mentally ill people about medications, communication strategies, and other aspects of caring for their loved ones. Silva thinks the outreach is making a difference.
In her community, she says, Latinas are "speaking up about mental health more," and "bipolar disorder is becoming more acceptable."
The change can be seen in her own family. Silva's son, who is 40 years old, also suffers from mental illness. He has been diagnosed with bipolar disorder and substance-abuse problems but only recently started taking medication after years of being in denial.
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Health Magazine 2010
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Medical experts say the results, presented Sunday at the American Heart Association meeting, show there is a lesson to be learned about the effectiveness of small studies over all.
The drug, nesiritide, brand name Natrecor, was approved after small studies in carefully selected patients. It seemed to soothe a terrible heart-failure symptom — patients’ lungs fill with fluid and they feel as if they are drowning.
But the large study, with real-world patients, found no significant effect on that symptom.
A few years after its approval, nesiritide fell out of use because small studies seemed to indicate an increased risk of kidney problems and an increased death rate.
The large study showed those risks, too, were wrong.
“Once again, small studies give us the wrong answers,” said Dr. Robert M. Califf, a Duke cardiologist who directed the large study. “There was no safety issue at all.”
“To me, the really important message is that the drug got very widely used for reasons that are incorrect, and then it got bashed for reasons that are incorrect,” Dr. Califf said. “Unless we do these kinds of large clinical trials we are engaged in a comedy of errors,” he added.
The question of how to evaluate rare side effects that seem to arise in small studies plagues medical researchers. Most drug studies are not designed to assess rare effects, but as more drugs are sold to huge numbers of people who often take them for years, the question has become increasingly pressing.
The nesiritide story began in 2005, four years after the drug was approved. At first it was popular, but then researchers, in two analyses, asked if it was really safe. They had lumped together data from several nesiritide studies. One analysis reported damage to kidney functions, and the other found increased death rates. Sales plummeted.
Johnson & Johnson, the drug’s maker, put together an expert panel that said the only way to answer the safety question was to do a large study. That led to the study that Dr. Califf directed, which enrolled anyone who came to any of 450 participating hospitals around the world with heart failure and complaining of difficulty breathing. Participants were randomly assigned to get an infusion of nesiritide or saline. Researchers asked two main questions: Were the patients still alive a month later? And were they readmitted to the hospital?
The study’s executive committee is still debating what to conclude, Dr. Califf said. No one thinks the drug should be pulled from the market, he added, because some patients may get breathing relief even though the drug was not effective for the participants as a whole.
“But the major message is that if you don’t do the right studies you just don’t know” about risks and benefits, Dr. Califf said. “And you are at risk of making serious errors.”
Cardiologists have similar questions about the effectiveness of Zetia, an eight-year-old cholesterol drug that Dr. Califf is also studying. It has been beset by doubts about whether it improves heart health.
The Food and Drug Administration approved Zetia, which lowers LDL, or “bad” cholesterol, in 2002. In 2004, the agency approved a related drug called Vytorin, which combines Zetia and a statin called simvastatin.
Both are made by Merck. Together, they have had worldwide sales of $26.8 billion, according to IMS Health, a firm that tracks drug sales, and have been taken by millions of Americans.
But eight years after Zetia came on the market, many cardiologists say they still don’t know whether taking Vytorin is better for the heart than using a statin alone.
That is because statins like Crestor, which work by blocking the production of cholesterol in the liver, have proven to cut the risk of cardiovascular problems. Zetia, however, acts differently; it works in the gut, where it inhibits the absorption of cholesterol from food. Zetia alone modestly reduces bad cholesterol, and the combination pill significantly reduces LDL.
But studies so far have failed to demonstrate a cardiac benefit to the drugs. Now there is a new Zetia study, due to be presented this week at a kidney conference in Denver, which looked at whether the combined pill reduces heart attacks and strokes in patients with kidney disease, who are at high risk for heart problems.
But the study is unlikely to resolve the Zetia question because it did not involve a group of patients taking a statin alone. Doctors still won’t know whether the combined pill works better than statins, which are available as inexpensive generics.
To try to answer the health-benefit question, Merck has sponsored one of the largest clinical trials ever conducted on cholesterol drugs. The trial, which started in 2005 and is due to be completed in 2013, involves about 18,000 patients at 1,046 sites around the world. It is taking years to complete because researchers set a goal of tallying 5,200 major cardiovascular problems in order for the project to end, said Dr. Luciano Rossetti, the head of global scientific strategy at Merck Research Laboratories.
“I don’t see a problem with the timing considering what it takes to do a trial like this,” Dr. Rossetti said. “I think it is great that we are committed to finding out that answer.”
Dr. Califf, who is one of two principal investigators on the Zetia trial, said it was common for the main outcomes study to lag years behind the approval of a drug, but he said the practice was a problem for doctors who practice evidence-based medicine.
“F.D.A. by mandate could require studies, but that wouldn’t be necessary if clinical trialists and academic medical centers stuck to their guns and demanded the evidence before they used the drugs on a wide scale,” he said, referring to both Zetia and nesiritide.
Drug makers also bear a responsibility to conduct rigorous studies before they start widely promoting medications, he added.
“Huge amounts are spent on marketing that could have been spent on a clinical trial,” he said.
This article has been revised to reflect the following correction:
Correction: November 15, 2010
???An earlier version of this article misstated the number of trial sites in Merck's study of cholesterol drugs. It is 1,046, not 380.
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