Chronic obstructive pulmonary disease (COPD) is a common problem—24 million people in the U.S. are thought to have it—but few people have a grasp of what it is.

In fact, half of the people who have COPD don’t even know it. Why? COPD symptoms can creep up gradually or be mistaken for something else, such as a cough, allergies, cold, flu, or other less serious ailments.

If you have COPD, you have emphysema or chronic bronchitis, or—most often—both. Read on to find out more about the symptoms of COPD.

Shortness of breath

In technical terms, this is called dyspnea. In real life, you may feel shortness of breath that gets worse during exercise or exertion.

With time, people with COPD can struggle to catch their breath even when getting dressed or doing other daily activities.

The difficulty comes from a lack of flexibility in the lungs and an inability to compress the lungs enough to expel air, says Jeffrey D. Cirillo, PhD, of the Texas A&M Health Science Center College of Medicine in College Station.

Coughing

A chronic cough, which you first attribute to a cold or other minor condition, can be an early sign of COPD. Unlike other coughs, however, it doesn’t go away—or go away for long.

The coughing is a sign your body is trying to move mucus out of the lungs or reacting to irritants.

This symptom, like others, might actually improve initially with some kind of treatment, but it doesn’t get better over the long term, Cirillo said.

Coughing up phlegm (also known as sputum or mucus) is a common symptom of COPD.

Excess phlegm

Even healthy people produce mucus to keep the airways moist. But in COPD, too much mucus is produced, and it can act like a spider’s web, trapping smoke, bacteria, or other particles that would normally be expelled.

Clear-colored sputum is most common, but sputum that turns deep yellow, green, brown, or red or is blood-tinged probably could mean that the lungs have an infection.

Wheezing

When the airways narrow (from too much mucus or other problems), the air trying to force its way in or out of the lungs can cause a whistling sound, known as wheezing.

“One of the measures of COPD that people use frequently is wheezing, so it feels like the lungs are making a noise when they’re breathing,” Cirillo explains.

Chest pain

Chest pain is another symptom that can affect people with COPD.

“It can arise because of the effort involved in breathing, so you get sore,” Cirillo says. “It’s also the inability to exhale. The chest can’t really relax.” Coughing really hard can also strain the chest muscles.

Chronic bronchitis

Chronic bronchitis, an inflammation of the lining of the bronchial tubes, is a type of COPD. The symptoms include a chronic cough that produces phlegm or mucus.

While similar to chronic bronchitis, acute bronchitis doesn’t last as long and won’t necessarily recur. The chronic form of the condition, on the other hand, lingers for months and will often come back.

Excess mucus can allow bacteria to flourish in the lungs. If this occurs, chronic bronchitis symptoms can include a mild fever and chills.

Lung infections

People with COPD are highly vulnerable to lung infections, whether viral or bacterial.

You should get an annual flu shot and any other vaccines that protect against respiratory infections.

The H1N1 vaccine and the regular seasonal flu vaccine can be taken in one shot, making it that much simpler to protect your health. Pneumovax vaccine is also recommended, because it protects against the types of bacteria that are the common causes of pneumonia.

Fatigue

Feeling tired is a common problem with COPD, mainly because the body has to work so much harder to breathe.

One study, in the journal Chest, found that COPD patients who complained of being tired tended to have worse lung function and, not surprising, a reduced ability to exercise.

Fever

People with COPD may experience a fever, but not that often. Generally fevers are associated with infectious diseases, says Cirillo.

Smoking is the most common cause of COPD, not a bacteria or virus.

However, COPD can increase the risk of lung infections, which can bring on a higher-than-usual body temperature.

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Some risk factors for heart disease can be controlled, and some can't. According to the American Heart Association, these are the leading factors that put you at risk for coronary artery disease or a heart attack.

* Age: More than 83% of people who die from coronary heart disease are 65 or older. Older women are more likely to die of heart attacks within a few weeks of the attack than older men.

* Being male: Men have a greater risk of heart attack than women do, and they have attacks earlier in life. Even after menopause, when women's death rate from heart disease increases, it's not as great as men's.

* Family history. Those with parents or close relatives with heart disease are more likely to develop it themselves.

* Race: Heart disease risk is higher among African Americans, Mexican Americans, American Indians, native Hawaiians, and some Asian Americans compared to Caucasians.

* Smoking: Cigarette smoking increases your risk of developing heart disease by two to four times.

* High cholesterol: As blood cholesterol rises, so does risk of coronary heart disease.

* High blood pressure: High blood pressure increases the heart's workload, causing the heart to thicken and become stiffer. It also increases your risk of stroke, heart attack, kidney failure, and congestive heart failure. When high blood pressure exists with obesity, smoking, high blood cholesterol levels, or diabetes, the risk of heart attack or stroke increases several times.


* Sedentary lifestyle. Inactivity is a risk factor for coronary heart disease.

* Excess weight: People who have excess body fat—especially if a lot of it is at the waist—are more likely to develop heart disease and stroke even if they have no other risk factors.

* Diabetes: Having diabetes seriously increases your risk of developing cardiovascular disease. About three-quarters of people with diabetes die from some form of heart or blood vessel disease.

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The first question many infertile couples ask when considering in vitro fertilization (IVF) is whether children born using the reproductive technology will be as healthy as those conceived the old-fashioned way. But the answer is a tricky one because there has been little definitive research to date on the potential long-term health risks of IVF.

The data is accumulating, however. Roughly 3.5 million children worldwide have been conceived by IVF over the past three decades, and many of them are now entering adulthood. With the growing population, researchers have begun pursuing larger studies on various aspects of development in IVF children — including the risks of conditions like autism, diabetes and cancer — and the results have hinted at some possible long-term health problems. (See pictures of a journey into the world of autism.)

The latest of these studies, published in the July issue of the medical journal Pediatrics, sought to evaluate the risk of cancer in childhood and early adulthood in IVF children. First, the bad news: the current study, the largest one of its kind so far, found a statistically significant increase in cancer risk in children conceived via IVF, compared with those who were traditionally conceived. Now the good news: the absolute risk of cancer in these children was still very low, and the authors think it may be due to other factors related to the parents' infertility, rather than the process of IVF itself.

The study of 2.4 million births, including 26,692 children born via IVF, between 1982 and 2005 found 56 cases of childhood and early adulthood cancers in IVF children, versus 38 cases that would be expected in other children of the same age-group. That's an increase in risk of 42%. While that figure sounds a little scary, lead author Dr. Bengt Kallen of the University of Lund in Sweden says the cancers his team studied, which included central-nervous-system tumors and a form of leukemia, are so rare to begin with that the excess risk translates to just one extra case of cancer per every 1,000 babies conceived by IVF. (Comment on this story.)

"There has been some uncertainty about this, and we just haven't had data good enough to show whether the risk is three or five times greater, as some people in the field believed. This paper shows us the risk in absolute terms is very small. That is the main message," says Kallen, adding that the findings persisted after controlling for age, weight and smoking status, among other characteristics, of the mother.

Why IVF babies may be at greater risk for cancer is not clear, but Kallen notes that these children are more likely than other babies to be born preterm and to suffer breathing problems that require oxygen therapy — factors that have been previously associated with an increased risk of cancer.

On the whole, IVF babies also tend to weigh less at birth than traditionally conceived babies — while low birth weight is not a risk factor for cancer, it is associated with other later health problems such as diabetes and obesity. Some researchers have also found epigenetic differences in the DNA of children conceived via IVF, compared with those conceived naturally, which may play a role in the long-term development of disease. (See how to prevent illness at any age.)

But the million-dollar question is whether any of the differences seen in IVF babies — from birth weight and preterm delivery to cancer risk — are the result of IVF treatment or the underlying infertility that caused mothers to pursue IVF in the first place. The new Swedish study cannot answer that question because it compared IVF children with those from the general population — that is, from families with no fertility problems.

According to Dr. William Gibbons, a professor at Baylor College of Medicine and the president of the American Society for Reproductive Medicine (ASRM), other studies conducted in Scandinavian countries have used different control groups and revealed interesting findings. Gibbons says that studies comparing IVF children with children of women who were infertile but conceived without IVF found no association between the fertility treatment and preterm birth, low birth weight or cancer risk. One Danish study published in 2007 in the journal Obstetrics and Gynecology reported no difference in babies' size for gestational age whether they were born to couples who used IVF to treat their infertility or those who did not. Another study from Norway, published in the Lancet in 2008, compared siblings conceived naturally and by IVF and also found no difference in babies' birth weight or size for gestational age. "There was no effect of IVF on these phenomena," says Gibbons.

University of North Carolina epidemiologist Andrew Olshan agrees that unknown factors relating to underlying infertility may well be contributing to many health conditions in children, but that it is very difficult to tease these factors out in a large enough study. Olshan says the Swedish study is a good one, but it is unlikely to be a game changer in the world of pediatric cancers. "We don't have a lot of leads as to what factors cause childhood cancers. IVF has been on the list of possible risk factors. It is still on the list, but I don't think this study moves it up the list. We'd need to see a collection of studies pointing in the same direction," he says.

Even if the study had confirmed IVF as a risk factor, experts say the level of increased risk is not enough to deter parents from undergoing the treatment. While IVF may bump up a tiny risk of childhood cancer, without it, many infertile couples may not have a baby at all.

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One study has found that salmonella and other bacteria can live up to four weeks on dry surfaces and be immediately transferred to food.

The controversial "five-second rule" — the one that allows us to eat dropped food if it's quickly scooped off the floor — is a bunch of baloney, according to Clemson University food scientist Paul Dawson, who stirred up the long-debated issue in this month's National Geographic.

Though previous research has shown we may have up to a minute to rescue certain types of spilled food before it becomes contaminated, Dawson and his students made a strong case for the "zero-second rule." They found that salmonella and other bacteria can live up to four weeks on dry surfaces and be immediately transferred to food.

The zero-tolerance standard, however, conflicts with the findings of two Connecticut College student researchers who sprinkled apple slices and Skittles candies in the college dining hall and snack bar for five, 10, 30 and 60-second intervals. The apple slices picked up bacteria after one minute; nearly five minutes elapsed before the Skittles attracted any. .

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Still, most researchers agree that the critical thing is not time, but location. It's OK to brush off the bagel that fell from the stroller onto the sidewalk and give it to your screaming child, for example, because the pavement is cleaner than the kitchen floor in terms of the types of germs that cause illnesses, said Dr. Harley Rotbart, a professor of microbiology and pediatric infectious diseases at the University of Colorado School of Medicine.

"The kitchen floor, however, is probably a zero-second zone because the bacteria from uncooked meat and chicken juices are more hazardous than the 'soil' bacteria outside," said Rotbart. The bathroom floor is another zero-second zone because "it's a great potential source of bacteria and shorter-lived viruses that can cause gastrointestinal illness if ingested," said Rotbart, the author of "Germ Proof Your Kids."

100 billion: The number of bacteria in our mouths

100 trillion: The number of bacteria in our gastrointestinal tracts

2.5 billion: The number of bacteria found in one gram of garden soil

7.2 billion: The number of germs in the average kitchen sponge

25,000: The number of germs, per square inch, on an office telephone

49: The number of germs, per square inch, on a toilet seat

SOURCE: "The Germ Freak's Guide to Outwitting Colds and Flu"; "Germ Proof Your Kids"

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Since the days of Reefer Madness, scientists have sought to understand the complex connection between marijuana and psychosis. Cannabis can cause short-term psychotic experiences, such as hallucinations and paranoia, even in healthy people, but researchers have also long noted a link between marijuana use and the chronic psychotic disorder, schizophrenia.

Repeatedly, studies have found that people with schizophrenia are about twice as likely to smoke pot as those who are unaffected. Conversely, data suggest that those who smoke cannabis are twice as likely to develop schizophrenia as nonsmokers. One widely publicized 2007 review of the research even concluded that trying marijuana just once was associated with a 40% increase in risk of schizophrenia and other psychotic disorders. (See photos of cannabis conventions around the country.)

But here's the conundrum: while marijuana went from being a secret shared by a small community of hepcats and beatniks in the 1940s and '50s to a rite of passage for some 70% of youth by the turn of the century, rates of schizophrenia in the U.S. have remained flat, or possibly declined. For as long as it has been tracked, schizophrenia has been found to affect about 1% of the population. (See a photoessay on a father with mental illness.)

One explanation may be that the two factors are coincidental, not causal: perhaps people who have a genetic susceptibility to schizophrenia also happen to especially enjoy marijuana. Still, some studies suggest that smoking pot can actually trigger the disease earlier in individuals who are predisposed, and yet researchers still aren't seeing increases in the overall schizophrenia rate or decreases in the average age of onset. (Comment on this story.)

In recent months, new research has explored some of these issues. One study led by Dr. Serge Sevy, an associate professor of psychiatry at the Albert Einstein College of Medicine in New York City, looked at 100 patients between the ages of 16 and 40 with schizophrenia, half of whom smoked marijuana. Sevy and colleagues found that among the marijuana users, 75% had begun smoking before the onset of schizophrenia and that their disease appeared about two years earlier than in those who did not use the drug. But when the researchers controlled for other factors known to influence schizophrenia risk, including gender, education and socioeconomic status, the association between disease onset and marijuana disappeared. (See TIME's special on preventing mental illness disorders.)

Gender alone accounted for a large proportion of the risk of early onset in Sevy's study, which included 69 men and 31 women. "Males in general have earlier age of onset of schizophrenia," says Sevy. In men, the disease tends to take hold around age 19, while in women it isn't typically seen until 22 — irrespective of marijuana use. But, typically, teenage boys are four times more likely than girls to be heavy pot smokers, which may create an illusory association between the drug and onset of the disease.

Yet past studies limited to males have found exactly such a link, associating marijuana use with earlier development of full-blown psychosis. And other research has found that ongoing cannabis use increases hospitalizations for psychotic symptoms in schizophrenic patients and decreases social and cognitive functioning. A 2008 review of the data found that relapse and failure to take prescribed medication was consistently associated with cannabis use, although, again, controlling for other factors weakened the link.

One explanation could be that the effects of marijuana vary depending on the genetics of the individual patient's schizophrenia. Marie-Odile Krebs, professor of psychiatry at the National Institute of Health and Medical Research (INSERM) laboratory in France, and her colleagues published a study in June that identified two broad groups of people with schizophrenia who used cannabis: those whose disease was profoundly affected by their drug use and those who were not.

Within Krebs's study population of 190 patients (121 of whom had used cannabis), researchers found a subgroup of 44 whose disease was powerfully affected by the drug. These patients either developed schizophrenia within a month of beginning to smoke pot or saw their existing psychosis severely exacerbated with each successive exposure to the drug. Schizophrenia appeared in these patients nearly three years earlier than in other marijuana-users with the disease.

The key difference between the cannabis-sensitive patients and the nonaffected group was a family history of disease: those in the former group had three times the number of close relatives with psychotic disorders, says Krebs. Further, the sensitive group started smoking pot at a younger age — before age 17, compared with 18 in patients without marijuana sensitivity — and Krebs thinks the early exposure may have critically altered the development of brain receptors affected by marijuana.

These receptors, known as endocannabinoid receptors, affect the action of the brain's dopamine systems, fine-tuning the response of the neurons involved. Although this process is not yet completely understood, changing the way endocannabinoids influence dopamine during development could result in a chronically high level of dopamine in some regions of the brain, which may increase the likelihood of psychotic episodes. Stimulant drugs such as amphetamine and cocaine, which increase the action of the dopamine system, for instance, are known to produce psychotic experiences, while antipsychotic drugs work by blocking the brain's dopamine receptors. (Does teen drug rehab cure addiction or create it?)

Given that an estimated 50% of the risk for schizophrenia is attributable to genes and family history, disseminating the results of research like Krebs's could help delay the onset of disease in thousands of people and prevent years of severe disability in those with a family history of schizophrenia. Although the disease itself affects only 1% of the population, about 10% of healthy people have personality features that, when intensified, may characterize schizophrenia — such as paranoia — meaning that the proportion of the population who may be sensitive to marijuana could be larger than expected, Krebs says. (See a brief history of medical marijuana.)

However, discouraging marijuana use in patients who have schizophrenia or are at high risk of developing it is a complicated task, not least because the drug is extremely popular with this group. Their affinity for the drug may be related to a phenomenon recently described in a study published in the British Journal of Psychiatry: The research tracked the moods of 80 marijuana smokers, 42 of whom had psychotic disorders like schizophrenia. Participants were asked to record their moods at various points over the course of six days, determined by a watch that beeped periodically to signal the volunteers. All participants, not surprisingly, reported feeling happier when they were high, but the mood-lifting effect of marijuana was stronger among smokers with schizophrenia. Unlike people without the disease, schizophrenia patients also reported a reduction in negative feelings after smoking marijuana. "Everyone feels better," explains lead author Cecile Henquet, an assistant professor of psychology and psychiatry at Maastricht University in Holland. "But [schizophrenia] patients also have less anxiety and are less socially withdrawn."

But which is the chicken and which is the egg? In another study by Sevy at Albert Einstein College of Medicine, researchers interviewed adults with schizophrenia (and their families) who smoked marijuana, and found that they reported being better adjusted during childhood than those who did not indulge. It makes sense when you consider the practicalities and social nature of drug use. Being at least somewhat socially connected is necessary to be able to obtain an illegal drug — if you appear too "crazy," people are less likely to befriend you and dealers may be too wary to sell to you. Many people with schizophrenia exhibit odd behavior that puts them at risk for social rejection years before they develop full-blown delusions and hallucinations in adulthood. (See a video on home delivery of medical marijuana.

The access issue may also help explain why some studies find better — not worse — cognitive functioning in people with schizophrenia who smoke marijuana. That's what Pamela DeRosse, a research scientist at Long Island's Feinstein Institute for Medical Research, and her colleagues found in a study of 455 people with schizophrenia published in Schizophrenia Research in July. The research showed that patients who smoked marijuana had faster brain processing speed, greater verbal ability and better memory than patients who didn't smoke — not attributes usually associated with being high. "I can't really tell you why they aren't doing worse," says DeRosse. "But in order to go out to even find cannabis, enough to become dependent or abuse it, requires that you be more cognitively intact than the average patient with schizophrenia."

Indeed, many schizophrenia patients who smoke pot smoke enough to become addicted. As Henquet's study showed, the drug's mood-boosting effects appear immediately after smoking, as do some hallucinations, but the bulk of negative marijuana-related effects appear later on, as an increased rate of hallucination that affects patients even when they are not high. This is the exact type of drug effect that raises addiction risk: The user's experience is one of short-term gain associated with the drug, with long-term pain that seems unrelated. "This is what explains why patients with schizophrenia use cannabis for longer and more frequently than controls," says Henquet. "They are apparently more sensitive to the addictive potential than other people."

That marijuana can have such incompatible effects in schizophrenia patients — enhancing mood while exacerbating hallucinations and delusions — is not surprising, when its chemical makeup is considered. One chemical called delta-9 tetrahydocannabinol (THC) is known to cause hallucinations and in high doses can even make healthy people feel paranoid or suffer brief attacks of psychosis. But another component of marijuana called cannabidiol (CBD) has anti-psychotic effects.

Consequently, researchers who study the knotty relationship between drug use and schizophrenia hope that patients may one day benefit from cannabis-derived drugs. The key is to replicate the antipsychotic properties of CBD without triggering the risks carried by THC. But in the meantime, scientists are still trying to identify which patients, based on genes and family history, may be most helped by potential new pharmaceutical drugs and who may be spared harm by avoiding illicit drug use now.

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Community-based programs to halt childhood obesity are gaining popularity as schools, local governments, parents and health clubs work together to help children slim down and eat more healthfully.

First lady Michelle Obama's Let's Move campaign has helped push the issue to the forefront.

But some interventions may be working better than others, according to a study presented this week at the International Congress on Obesity in Stockholm. Researchers studied the success of three three-year community intervention programs, each targeting a different age group of more than 1,000 children — those younger than 5, primary school-age children and teens. Each group had a similar control population that received no intervention.

The interventions targeted healthful eating and physical activity, and included strategies to continue the community programs once after the study.

Children younger than 5 had the best results. This group included 12,000 children in preschools, day care facilities, homes and maternal and child health services. After three years, the prevalence of overweight or obese children was about 3 percent lower than in the control group.

Children in the primary school group didn't see any reductions in overweight or obesity levels, but weight gain rates did slow. After three years, the children gained about 2 pounds less on average than their intervention-less counterparts.

Interventions in the teen group, which were done in Australia, Fiji, Tonga and New Zealand, had varying results. Australian teens (who were mostly of European ancestry) lost weight, but those in other countries who were from the Pacific Islands or were of Indian heritage showed mixed outcomes.

"Once you get to high school-aged children, trying to implement an intervention at the whole community level becomes more difficult," Boyd Swinburn, the director of the World Health Organization Collaborating Center for Obesity Prevention at Deakin University in Australia, who presented the study, said in a statement.

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Studies have shown yoga has many health benefits, including increased flexibility and strength and reduced stress. But starting a program can be intimidating. Here are tips from yoga instructors:

* Check with your doctor. Yoga postures might not be good for people with certain chronic health conditions or injuries.

* Look up some basic moves before a class. You can find instructions online or in books and videos for beginners. Some common postures are Downward-Facing Dog, Forward Bend, The Bridge, Warrior II and The Cobra. Start with the ones you think you could do.

* Work on your flexibility. Do some light stretching at home in the morning and before you go to bed.

* Tell the class instructor you're a beginner. Never be afraid to ask for help.

* Watch others in a class … You can learn a lot about postures — and how to adapt them based on individual fitness levels — from more experienced students.

* … but don't compare yourself to them. Yoga takes time to master, so be patient and don't strain your muscles too much. Aim to improve your postures and how long you can hold them with each class. Note: You might not see body changes right away.

* Dress correctly. Wear a comfortable but somewhat form-fitting shirt, so it won't flop over your head as you bend over. No special shoes are required; yoga is usually done barefoot.

* Don't eat right before class. Have a light meal or snack a few hours beforehand, and drink a glass of water before you begin.

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WASHINGTON - An MRI is much better for diagnosing a stroke than a CT scan, the current standard test, the American Academy of Neurology said in new guidelines released Monday.

Magnetic resonance imaging, or MRI, detected strokes 83% of the time, compared to just 26% for computed tomography or CT scans, the group said.

CT scans are a specialized series of X-rays; MRIs use magnets and radio waves. Both use computer programs to arrange the data into an image.

Most strokes are ischemic, caused by a blood clot in the brain, and patients do far better when treated within three hours.

Symptoms of a stroke can be subtle and include sudden numbness or weakness of the face or a limb, sudden confusion, trouble speaking and walking, and a sudden headache.

Stroke is the third leading cause of death in the United States, after heart disease and cancer.

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If you ever think that guys have it easier, here’s some news that may comfort you: Guys may get hot flashes, too.

Some men experience a decrease in hormones when they hit middle age, according to a study in the New England Journal of Medicine that was reported in the Daily Mail. And reduced levels of testosterone can cause everything from lowered libido to fatigue, just like menopause does.

Still, male menopause is an uncommon condition that affects only a small minority: 3% of men actually experience physical symptoms from less testosterone, according to the study, and lower testosterone levels are a natural part of aging.

Older men generally have lower hormone levels than younger ones, with testosterone levels decreasing about 1% a year after age 30, according to the Mayo Clinic. By a man’s 70th birthday, the levels may be as much as 50% lower. Other medical conditions, like obstructive sleep apnea, also can cause testosterone levels to decline.

Medical experts say men should get a physical to see if they need testosterone-replacement therapy.

Men may feel depressed for other reasons as well. They frequently decline physically more dramatically OR RAPIDLY???? than women and may experience a sense of growing mortality. Men tend to die several years earlier than women.

While male menopause is uncommon, guys also are prone to a kind of psychological menopause at middle age when, as the Daily Mail reports, they come to realize they’re actually more like bumbling Clark Kent than Superman. And that realization’s sobering enough to put anyone in a bad mood.

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Swatting skeeters may be especially important in the Sunshine State this summer.

A dozen cases of dengue, which is transmitted by mosquitoes, have been confirmed in the Key West, Florida area by the Centers for Disease Control and the Florida Department of Health. Dengue causes nearly 100 million infections and kills 25,000 people annually, according to CNN.

Some 5 percent of Key West residents (about 1,000 people) were exposed to dengue last year, according to the report, which was released on Tuesday. The last dengue outbreak in the Sunshine State was back in 1934.

None of the people who came down with dengue in this recent outbreak had traveled outside of Florida, according to a CDC press release. “So we need to determine if these cases are an isolated occurrence or if dengue has once again become endemic in the continental Unites States,” said the CDC’s chief of the dengue branch, Harold Margolis. “We are concerned that if dengue gains a foothold in Key West, it will travel to other southern cities….like Miami.”

Typically found in tropical and sub-tropical climates around the world, it usually is confined to urban and semi-urban areas, reports the World Health Organization. Although there is no vaccine against dengue, early detection and treatment reduces the risk of serious illness. While locally acquired dengue outbreaks in this country are uncommon, there have been several confirmed cases along the Texas-Mexico border recently.

A single mosquito bite can result in a case of dengue, according to the CDC, and the bite risk is highest in the early morning, several hours past daybreak, and in the late afternoon. That’s when the female mosquito typically feeds – or bites. Symptoms of dengue include high fever, severe headache and joint pain.

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Measuring children's neck circumference could provide a quick, simple way to screen them for weight problems, a new study suggests.

Such screening is recommended by the U.S. Preventive Services Task Force, an influential panel sponsored by the government's Agency for Healthcare Research and Quality, starting at the age of 6. Right now, doctors usually use body mass index, or BMI, to gauge whether a child (or adult) is overweight or obese. But BMI, which is a ratio of weight to height, is not a good indicator of how much body fat a person has.

Because pounds due to excess body fat -- rather than larger bones or greater muscle mass -- are the health concern, researchers have been looking for more precise ways to gauge fat levels. One way is to measure waist circumference, which studies suggest is better than BMI alone in assessing abdominal fat and health risks, such as high blood pressure, diabetes and heart disease, in adults.

Another tactic is to measure neck circumference -- which, although less studied, seems to be a potential marker of obesity and health risks in adults.

The new study, published in the journal Pediatrics, looked at whether measuring neck circumference has any value in screening children for excess pounds and obesity.

Since BMI is not a precise indicator of body fat, adding a neck circumference measurement could improve childhood obesity screening, lead researcher Dr. Olubukola Nafiu, of the University of Michigan in Ann Arbor, told Reuters Health.

And compared with waistline measurements, measuring the neck would also be quicker and more comfortable for children, Nafiu said, since they can keep all their clothes on for the latter.

Neck circumference is also more consistent in comparison to waist size -- which can swell after a big lunch, for instance.

For their study, Nafiu and his colleagues measured weight, height, waist circumference and neck circumference in 1,102 children and teenagers ages 6 to 18 who were undergoing surgery at their center.

They found that neck circumference correlated well with both BMI and waist size in boys and girls, as well as younger children and teenagers.

The researchers also pinpointed "optimal" cutoff points for neck circumference that identified a majority of kids with a high BMI. For example, a 6-year-old boy with a neck circumference of greater than 28.5 centimeters - about 11.2 inches -- was nearly four times more likely to be overweight or obese, based on BMI, as a 6-year-old boy with a smaller neck circumference.

In addition to helping screen for obesity, the researchers note, neck measurements might also be useful for spotting kids at risk of sleep apnea, a disorder in which tissues at the back the throat temporarily collapse during sleep to create repeated stops and starts in breathing. Obesity, particularly excess weight in the upper body, is a risk factor.

Nafiu said that in earlier studies, he and his colleagues found that children with a high BMI were at relatively greater risk of certain post-surgery problems; they tend, for instance, to take longer to wake up from anesthesia because the drugs concentrate in body fat.

In the future, Nafiu said, the researchers want to look at whether measuring neck circumference before surgery can identify children at greater risk of such problems.
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American researchers are one step closer to developing a vaccine against the deadly AIDS virus.

Government scientists discovered three potent antibodies – including one that neutralizes more than 91% of HIV strains – in cells of a 60-year-old African American gay man dubbed Donor 45, the Wall Street Journal reports.

The man's body made the antibodies naturally.

Researchers are now hoping to create a vaccine that would allow anyone's body to make those antibodies. The research could pave the way to create vaccines that would be effective not just against the AIDS virus but other viral illnesses as well.

Coming up with a vaccine "will require work," Gary Nabel, who directs the Vaccine Research Center at the National Institute of Allergy and Infectious Diseases, told the Wall Street Journal.

Added Nabel, who was a leader of the research, "We're going to be at this for awhile," before any benefits are apparent. Vaccines, thought to work by turning on the body's own ability to make antibodies, have been an important part of AIDS research.

Last year, the first HIV vaccine to show any effectiveness proved to be a disappointment. Success rates on that vaccine, following a trial in Thailand, ranged from statistically insignificant to 30%. But the discovery of these new antibodies may yield a more promising treatment.

"The antibodies attach to a virtually unchanging part of the virus, and this explains why they can neutralize such an extraordinary range of HIV strains," Dr. John Mascola, a study researcher, said in a statement, according to AOL News.

Turning the discovery of the antibodies into an effective HIV vaccine would be difficult, since researchers would have to zero in on a crucial part of the virus that the antibodies fasten onto, and then design a vaccine using that viral part to prod the body to make the antibodies found in Donor 45.

The new discovery, described in the online edition of the journal Science, comes just days before a large International AIDS Conference in Vienna.

Prevention science is expected to be the focus at the meeting. More than 33 million people had HIV at the end of 2008, according to United Nations estimates reported in the Wall Street Journal, and some 2.7 came down with the virus that same year.

In the case of Donor 45, whose antibodies did not save him from getting HIV, researchers screened some 25 million of his cells to find the dozen that produced the powerful antibodies. He most likely already had contracted the virus before his body started to produce antibodies.

The man is still alive, and had been living with HIV for two decades at the time his blood was drawn.

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How "hot" before the worldcup final

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There was lots of spicy talk about salt yesterday at the annual Fancy Food show put on by the $63 billion "specialty food" industry.

Recent warnings by Mayor Bloomberg and the AMA didn't seem to worry many of the 2,400 exhibitors at the Javits Center exhibition, since salt is as vital to chips, dips, cakes and cheeses as bats are to baseball.

Susan Eriksen of Char Crust, which makes meat seasonings, says the company lowered sodium on some flavors, including ginger. They just don't push it.

"Our original hickory goes back to 1957," she says. "People like it the way it is. We see no reason to mess with a good thing."

Jean Erlich of Rock 'N' Roll Gourmet, a new company whose snacks include Buffalo Wing Chips With Blue Cheese Drizzle, says her company keeps sodium down by incorporating other ingredients, like jalapeno.

"I still want flavor," she says. "I don't want a chip that tastes like paint."

So, how do the companies try to lose the bad effects of sodium while keeping the flavor?

Some are gambling on substitutes - like J&D Foods, which sells bacon salt. It also sells "baconnaise" and bacon-flavored lip balm, but salt is the big seller.

"When people discover this, they eat less regular salt," co-owner Dave Lefkow says. "We have 75% less sodium than regular salt."

One bacon salt customer in Texas told Lefkow he puts it on marshmallow Peeps and grills it. Salty and sweet.

Others say the solution is healthier salt.

"The salt the AMA and the mayor are saying is bad for you is refined salt," says Melissa Kushi of HimalaSalt. "Most of the minerals and nutrients have been taken out and what's left is pretty much sodium and garbage."

"People see articles on the effect of too much sodium and they think, 'Oh, salt will kill you,'" says Dianna Ramey of Gold Mine Natural Food Co. "No, salt won't. Pure, unrefined salt is good for you."

"It's not rocket science," says Hernan Fuenzalida of BioSalt. "Just use healthier salt."

Still, low-sodium will never become no-sodium.

"People want taste," she says, "and they're willing to spend for high-end salty snacks. We've never been busier. This business seems to be recession-proof."

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weird dog costumes. The strange funny pictures

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A simple test that could predict menopause well in advance could one day show women just how loudly their biological clock is ticking, and help them answer tough questions like how long they can wait before having children.

The blood test developed by scientists measures the amount of anti-Mullerian Hormone (AMH) in a woman’s blood, which indicates how many eggs remain in a woman’s ovaries, according to the Associated Press.

After measuring the amount of AMH in 266 women between 20 and 40, Iranian scientists consulted a mathematical model that let them estimate when a woman would hit menopause. For the ongoing study, which started in 1998, they took more blood samples and performed physical exams over the following six years. Of the 63 women in the study that have had menopause, researchers accurately predicted the event within four months.

This preliminary research, to be presented Monday in Rome at a European fertility conference, could lead researchers to develop a tool to help women decide the best timing to get pregnant. Though the test can’t predict precisely when a woman will become infertile, which usually happens about 10 years before menopause, it could be useful in figuring out which women may have early menopause.

Such a test could empower women to launch a career without worrying that it would mean they might never have children, says licensed psychotherapist Stacy Kaiser, author of “How to Be a Grownup.”

“The one greatest struggle for women everywhere is not knowing how to balance career and family,” Kaiser said. “Women with a career think they may be missing their window, their ‘having a child’ opportunity. A test like this could give peace of mind and the ability to plan and to control, which right now we don’t have.”

A test to predict menopause could take a lot of the guesswork out of the decision to try for a baby, says Mary Jo Rapini, licensed psychotherapist.

“The age for menopause is so variable,” she said. “Some women don’t go through menopause until the age of 55, which means they could still get pregnant at age 45. So this test could really help with family planning.”

Yet such a menopause test also could make a woman feel anxious or even frantic, says Dr. Daniela Schreier, licensed clinical psychologist and assistant professor at the Chicago School of Professional Psychology.

“If a woman takes the test at age 25 and finds out she will get menopause at age 45, she may feel a lot of pressure to hurry up and meet someone before she can no longer have a baby,” she explains. “So there could be some dangerous anticipation there.”

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Genetic research is shedding more and more light on immune disorders, says Dr. Charlotte Cunningham-Rundles.

The specialist: Dr. Charlotte Cunningham-Rundles on immune deficiency disorders

The director of the Immunodeficiency Clinic at Mount Sinai Medical Center, Cunningham-Rundles specializes in allergy and immunology.

Who's at risk

As the body's defense mechanism against disease, the immune system identifies and kills menaces like pathogens and tumor cells - but in some people, that system breaks down. "With immune deficiency disorders, your immune system doesn't have all the equipment it needs," says Cunningham-Rundles. "You don't have all the capacity to fight infection."

Some relatively mild immune deficiency disorders are fairly common, while the odds of having a more serious variety are 1 in 10,000.

The disorders fall into two main groups. "Primary ­immune deficiency means the disease is genetic, and that is the way your system was created," says Cunningham-Rundles. "Secondary immune deficiency means that your immune system is breaking down because of something in the environment, like chemo, steroids or HIV." While primary immune deficiency runs in some families, in others, it occurs randomly.

As for gender: "Some disorders only run in boys because they are gene defects on the X chromosome, and girls have the backup of the other X," says Cunningham- Rundles. "But globally, these disorders are equal in affecting men and women."

Immune deficiency disorders are present in all populations. "No one is at more at risk than anyone else," says Cunningham-Rundles. Doctors have identified 150 types of immune deficiency disorders, and they continue to discover a few new ones each year. Some types are mild, and others are far more severe.

Many people are familiar with the idea of immune deficiency from the story of "the boy in the bubble." "In that type, severe combined immune deficiency, the immune system has a block on making certain cells, so the disorder becomes obvious when the baby is very young, probably in the first month of life," says Cunningham-Rundles. "In contrast, with some of the mild forms, you might not discover the disease until you're 30 or 40, since the body has found ways to compensate."

Signs and symptoms

Immune deficiency disorders can be easier to diagnose in children, who tend to show more obvious symptoms than adults. "Pediatricians look out for rash, failure to thrive, diarrhea, anemia and recurring pneumonias, especially as the result of an opportunistic organism," says Cunningham-Rundles.

Adults can look pretty healthy despite their immune deficiency disorder and often go years before they're diagnosed. "The most common symptom is a pattern of frequent respiratory problems - sinusitis, bronchitis, pneumonia," says Cunningham-Rundles. "For people with an immune deficiency disorder, they probably will end up in the hospital as the result of the pneumonia."

Suffering from multiple pneumonias that have been diagnosed by chest X-ray, or blood infections that lead to hospitalization, are red flags for immune deficiency.

Many internists aren't trained to spot immune deficiency disorders, and it's harder for a patient visiting lots of specialists to have someone pick up on the pattern of illnesses. By the time they reach an expert, most patients are usually pretty frustrated - and relieved once they are diagnosed. "They feel like some part of the puzzle has been put together," says Cunningham-Rundles. "They finally understand why they had recurrent infections throughout their life."

Traditional treatment

The options depend on the type of disorder and its severity. "Lots and lots of antibiotics" are usually part of the treatment. "For people who lack antibody, we can give injections of intravenous or subcutaneous gamma globulin, which is the antibody that's been extracted from human blood," says Cunningham-Rundles. "Depending on the root and the dose, you get shots as frequently as once a week and as little as once a month." These shots are given for the rest of your life. "It has great results," says Cunningham-Rundles.

More severe defects call for a transplant of either bone marrow or stem cells. Bone-marrow transplants require finding a good match, usually a relative, and then extracting marrow. Stem cells now often come from a stem-cell bank that stores placental blood.

Once there's a match, the recipient usually needs chemotherapy to get his or her bone marrow to make space for the transplant. "In the transplant, we insert the extracted marrow or stem cells through the veins," says Cunningham-Rundles. "The transplant finds its way to the bone marrow and takes up residence there."

Although this treatment can't cure the immune deficiency disorder completely, it can improve quality of life and life span. "When it works, it's wonderful," says Cunningham-Rundles. "Some of our patients who might not have survived before are now 25 or 30 and in medical school."

Research breakthroughs

Doctors' understanding of immune deficiency disorders is growing by leaps and bounds as genetic research becomes more sophisticated. "We keep discovering different defects, two or three a year for the past few years," says Cunningham-Rundles. "When you have a patient with a newly discovered gene defect, that casts light on a lot of other problems." In many cases, researchers have identified the gene that causes the defect, and doctors can use that information to personalize the treatment.

Questions for your doctor

If you've had recurrent significant infections, ask your physicians, "What's going on with my immune system?" And don't be shy about asking, "Can you refer me to an immunologist?" Not all doctors have been trained to spot immune deficiency disorders. "The awareness of these diseases is an issue all around," says Cunningham-Rundles.

What you can do

Get informed.

The Immune Deficiency Foundation (primaryimmune.org) has a "patients and families" section with information on insurance, clinical trials and peer support. The Jeffrey Modell Foundation has lists of warning signs and a search engine for specialists (info4pi.org).

Keep your immune system strong.

Everyday things like exercise, sticking to a healthy lifestyle and not smoking can help boost your immunity. "Doing these things means your system isn't exposed to extra unhealthy particles," says Dr. Cunningham-Rundles.

Pay attention to infections.

Many patients go undiagnosed for years, while suffering through a series of severe infections.

"A couple of bouts of pneumonia that were proven by chest X-ray, or being hospitalized with a bloodstream infection, are big warning signs of immune deficiency," says Cunningham-Rundles.

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Fatal medication errors spike at teaching hospitals in July. Not coincidentally, July is also the month that new, inexperienced doctors start their residences at teaching hospitals, according to a recent study published in the Journal of Internal Medicine.

The so-called “July effect” showed the influx of more than 21,000 newly minted doctors corresponded to a July death rate due to medication errors that was 10 percent higher than the expected level, according to the study.

Still, the researchers at the University of California at San Diego tried hard to let the residents off the hook. Perhaps, they speculated, the effect was due to behavioral changes that occur in the summer, such as a rise in summer alcohol consumption combined with harmful medication reactions or the increase in summer tourism (tourists may receive worse health care.)

But if the change were related to summer behavior, the data would have showed a spike in August as well as July; it didn’t.

The researchers also looked at whether the July effect is a result of the July 4th holiday. But while the holiday is celebrated nationwide, the increased rate in medication errors is only seen in teaching hospital counties. Moreover, medication errors do not spike in other months containing national holidays.

Ultimately, the arrival of the new medical residents was found to be at least partially responsible for increased fatal medication errors. The residents may make more mistakes because they work long hours, are sleep deprived and still learning the system, the researcher said and they should be given increased supervision.

The good news is that the research suggests new residents appear to learn quickly. Within a month, they’re up to speed.

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Lucille Morris was in her mid-50s when she was diagnosed with Type 2 diabetes. Not long after, she began experiencing pain and numbness in her feet from neuropathy.

Walking felt painful and wobbly.

"Sometimes my feet feel like they're frozen and are so stiff they don't want to move," said Morris, 64, of Ballwin, Mo. "When I walk on uneven surfaces, like in the grass, I don't feel like I'm in control of my balance."

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Twenty-five years ago, a hobbled woman in her 50s would have seemed unusual. Not anymore. Health care providers report an increase in the number of patients under age 64 suffering from disabilities in the past decade or so.

"The people I'm seeing are aging more quickly than the people I used to see, and for what seems appropriate," said Dr. F. David Schneider, chair of family and community medicine at St. Louis University.

Studies show similar findings on a national level. Researchers at the University of Michigan and the RAND Corp. analyzed information from the 1997 to 2007 National Health Interview Survey and found that more than 40 percent of people ages 50 to 64 reported having difficulty doing one of nine physical functions, such as stooping, standing for two hours, walking a quarter mile or climbing 10 steps without resting. The health problems most often cited included neck and back problems, arthritis, diabetes, anxiety and emotional problems.

Researchers noted that the 40 percent figure was in contrast with the older group, age 65 and older, who reported a decrease in disabilities during that same period.

The study, published in the April edition of the journal Health Affairs, also found that some middle-aged respondents — less than 2 percent, but growing — need help with personal care activities. Those include getting out of bed, using the toilet and shopping for groceries.

The national study didn't pinpoint a root cause of the increase in disabilities among middle-aged people, but local health care providers list these as the biggest reasons: obesity, sedentary lifestyles and lack of preventive medical care.

"I don't think people are taking time for themselves to be focused on healthy behaviors," said Carolyn Baum, director of occupational therapy at Washington University.

Dr. Michael Mueller, associate director of the Movement Science Program at Washington University and lead researcher on the study, said it's never too late to make lifestyle improvements. Anyone, with or without disabilities, will see health benefits.

"Any exercise program takes six to 12 weeks before you start to see the effect, although some people report that after just a couple of weeks they feel better and have various improvements," he said.

How weight factors in

As we age, people of all body types are also subject to deterioration of cartilage in joints and the loss of bone density and muscle mass.

Sherry Muir, assistant professor of occupational therapy at St. Louis University, said Johns Hopkins Arthritis Center found that losing 11 pounds decreased the risk of osteoarthritis in the knees by 50 percent.

"We talk so much about obesity, but we forget that even a 10- to 15-pound weight gain causes significant problems in the hips and knees," Muir said. "And our mobility relies primarily on our hips, knees and back."

Plus, she said, the cartilage in the joints between our bones is kept alive and healthy by the fluid that surrounds it. Exercise helps keep the fluid around the cartilage clean.

"It's like a sponge," Muir said. "When you move, you squish the sponge and push out all the waste product and then the joint sucks in all the healthy stuff."

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Opening your medical bills can make you feel as ill as you did when you sought a doctor's attention in the first place. But there are ways to alleviate your wallet's pain.

Angie Hicks, founder of the consumer review Web site Angie's List, says that with a little preparation and a lot of patience, people can lower their health care costs through negotiation, price shopping and catching billing errors. Here are her tips:

Ask for a deal. Find out if there's a discount for paying cash or paying upfront, ask about special rates for senior citizens or students, and see if they will set up a no-interest payment plan.

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Don't be afraid to negotiate with your doctor: "Insurance companies have always negotiated with health care providers, so it's not like it's foreign to the industry," Hicks said. One member of Angie's List talked to her doctor after her insurance company covered just $18,000 of a $22,000 surgery, and the doctor agreed to waive the remaining $4,000, Hicks said.

Get multiple quotes in writing. Before your procedure, shop around to various doctors to find out how much they charge and how much they expect insurance to pay. Get those price quotes in writing, with a name, title and signature, so that you have a paper trail if you end up getting charged more later. Remember to cover all the costs associated with the procedure and every doctor in the room: lab costs, the anesthesiologist, the radiologist, etc.

You may want to consult the "Healthcare Blue Book" beforehand (healthcarebluebook.com). It's a medical pricing guide that states the average compensation that medical providers accept from insurers for services ranging from surgery to dental and eye-care procedures.

It's especially helpful for those with high deductibles or who are paying out of pocket.

"Healthcare Blue Book is a great tool," Hicks said. "We're actually partnering with them, and will have a service in place for our members this summer that will let them click a few buttons to access local medical costs so they can find fair prices and save money. We'll rely on Healthcare Blue Book to provide that information."

Be polite. "Asking questions in a calm manner will always get you further than being overly aggressive," Hicks said. Start with the office clerk you normally check out with, but don't be afraid to ask for a billing manager — nicely — if you don't feel you're getting a full answer.

Review all paperwork carefully. Eight out of 10 medical bills have mistakes in them, according to the Medical Billing Advocates of America, from duplicate charges to overcharges to charges for non-billable serves, to misplaced decimal points. Incorrect coding is a common error that can result in insurance companies not covering something they should. Ask for an itemized bill to see what you're really getting charged for.

If you don't understand the charges or if your insurer didn't cover something you expected them to, call your doctor and insurer and ask. Then call around to other providers and find out if the bill is in line with what they charge. Then go back to your doctor's billing department and argue for a lower bill. "It may take time, it may take a few phone calls, but it's really important," Hicks said.

Hire a medical-billing specialist. A new industry of professional bill reviewers will scour your bills for errors and unjustified charges, and will negotiate with your provider on your behalf to bring down your costs.

Some of these specialists charge a flat fee, but most will charge a percentage, typically 30 percent, of how much they save you, so you pay nothing if you don't get any savings. There's a wealth of information at billadvocates.com, the Web site of Medical Billing Advocates of America.

aelejalderuiz@tribune.com

By the numbers

While consumers will readily fight an incorrect cable or phone bill, they're often more reluctant to take on a suspicious medical bill.

"Health care is a more emotional field, and it can be complicated because it's not something you always understand yourself, so it's easy to get overwhelmed," said Angie's List founder Angie Hicks.

But according to a May poll of 1,237 Angie's List members, it's worthwhile to fight. Among poll respondents:

57% have never negotiated a medical bill.

23% didn't know they had the option of negotiating medical bills.

74% of members who did negotiate were successful.

42% of members who haggled did so because their insurance didn't cover as much as they expected.

17% of members who haggled did so just because they wondered if they could get a better deal.

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