The Truth Behind Cancer Myths

Every day, we read or hear about something we eat or do that can cause or prevent cancer. Often, what we hear one day will be the exact opposite of what we hear the next day. Dr. Joseph Imperato, medical director of radiation oncology at Lake Forest Hospital, sets the record straight on some of what has been said to cause cancer or help prevent it.

Antiperspirants

"One of the most common myths is that antiperspirants cause breast cancer," Imperato said. Proponents of this myth say when we use aluminum-based antiperspirants under our arms, our bodies absorb this aluminum, which goes into the lymph nodes and blocks them. These blocked lymph nodes, they believe, cannot effectively remove toxins, and breast cancer subsequently develops.

"In reality, when pathologists examine lymph nodes of patients with breast cancer, they never actually find a build-up of aluminum in the lymph nodes of the breast," said Imperato. "There is no truth to this myth."

Artificial sweeteners

Aspartame (aka Nutrasweet and Equal), approved in 1981 by the FDA, has also been a frequent target of cancer myths. Vocal groups have claimed aspartame is linked to increased incidence of brain and central nervous system cancers. Studies conducted to evaluate the truth of this claim found that the increased incidence of brain and nervous system cancers actually began to rise in 1973, eight years before aspartame went on the market.

EMFs

Electro-magnetic fields are emitted by devices that produce, use or transmit electric power, such as power lines and household electronics like microwaves, televisions and electric blankets. Over the past 15 years, several studies have evaluated the effect of residential exposure to EMFs and its relationship to an increased risk of cancer.

Most findings have been inconclusive, but the National Institute of Environmental Health Sciences recommends increasing the space between people and devices that emit EMFs, as well as discouraging children from playing near power lines.

With the widespread use of cellular phones, people have also become concerned about the effect of EMFs so close to the brain. Studies have been conducted, but it's difficult to draw conclusions because cell phones have only been around for a short time, and because technology changes so quickly.

While no study has conclusively proven that cell phones cause brain tumors, the FDA has suggested that those concerned should reserve cell phones for shorter conversations and switch to hand-free devices that place more distance between the antenna and the phone user.

Stress

Myths about stress causing cancer are particularly disturbing in that they blame the victim. The myth insinuates that our responses to day-to-day life stressors cause cancer. While major stressors may have an impact on the immune system, Imperato said responses to day-to-day stressors do not cause cancer. "In fact, since primitive times, man has always dealt with day-to-day stressors," he said.

Yoga or meditative activities have been touted to prevent or cure cancer. Imperato noted that while yoga and meditative activities do not prevent or cure cancer, activities that strengthen the mind-body connection do help people come to terms with their situation and may help them to maintain a positive outlook.

While it is not possible to achieve zero risk of cancer, actions that consistently prove to have some protection against cancer include eating a healthy diet with a variety of fruits and vegetables and exercising. And don't smoke, because even small amounts of cigarette smoke have been linked to cancer.

Protect yourself from the sun

Summer sun brings more to worry about than a burn. Melanoma, a very common and deadly form of skin cancer, is most often caused by spending too much time in the sun without protection from ultraviolet (UV) radiation. People with fair skin and lighter hair are at greatest risk but anyone, regardless of skin color, is at risk from excessive sun exposure.

Cases of melanoma have been rising at an alarming rate, faster than any other form of cancer, and will affect one person in 50 by 2010 -- that compares to one in 1,500 people just 70 years ago.

Helping kids protect themselves and learn good skin care habits is especially important. Sunburn at any age can cause melanoma, but 80 percent of sun damage occurs before the age of 18.

"Parents play a key role in stemming the tide of melanoma," said Dr. Moira Ariano, M.D., a Wheaton dermatologist and supporter of the Glen Ellyn-based Jack H. Marston II Melanoma Fund, which raises funds and awareness to fight melanoma. "Kids need to learn good habits early and parents can set a good example."

Jack's Fund offers these sun protection tips to help reduce the risks of skin cancer:

* Don't burn. Always use sunscreen, even on cloudy days. This applies to all outdoor activities: sports, shopping, picnicking, walking or jogging, gardening, even waiting for a bus.

* Use sunscreen with sun protection factor (SPF) 15 or higher, and with ingredients that block both UVB and UVA rays. Apply sunscreen liberally and reapply every two hours.

* Cover up with clothing, including a broad-brimmed hat and UV-blocking sunglasses.

* Be sure to apply sunscreen all over, including your ears, lips, neck, hands and feet.

* Stay out of the sun when it's strongest, between 10 a.m. and 2 p.m.

* Avoid tanning and UV tanning booths. The UV radiation emitted by indoor tanning lamps is many times more intense than natural sunlight. Dangers include burns, premature aging of the skin, and the increased risk of skin cancer.

* Keep newborns out of the sun. Sunscreens should be used on babies over the age of six months. Zinc sunscreen is especially good for small children.

* Examine your skin head-to-toe every month and see a dermatologist for a skin and mole check. Early detection is the key to beating melanoma.

Exercise and Health

A recent study in the Journal of the American Medical Association shows that even exercising less than standard recommendations offers some health benefits. But it was published just one month after another study found that getting beyond the standard 30 minutes of daily moderate activity brings dramatically better weight control.

The emerging message of these and previous studies seems to be: The benefits of physical activity vary with how much you do.

The good news that every little bit helps comes from a study of 464 sedentary, post-menopausal women who were all either overweight or obese.

The women were randomly assigned to one of four activity-level groups:

Three of the groups provided supervised exercise at either 50, 100 or 150 percent of the National Institutes of Health recommended physical activity, which aims for about 30 minutes five days a week.

The fourth group was a non-exercising group. The group at 50 percent exercised for an average of 72 minutes weekly. The group at 150 percent got in an average 192 minutes of weekly exercise.

Participants were not instructed to cut calories. After six months, three different measurements showed all three activity groups were more fit, even in the 50 percent group that exercised the equivalent of 15 minutes five days a week. Each increase in exercise brought a greater improvement in fitness.

The JAMA study adds further support to the 2001 findings from the Women's Health Study that those who walked even 60 to 90 minutes weekly developed about half the heart disease as sedentary women. However, in this new study, only the group exercising the longest showed a drop in blood pressure.

The other recently published study found that it may take a lot of exercise to affect weight loss.

The study randomly assigned 202 men and women ages 25 to 50 to either be on a standard behavior change weight reduction program or one that required more exercise. Participants were about 30 to 70 pounds overweight. Both programs included a low-calorie diet. The standard program instructed members to burn about 1,000 calories per week (about 30 minutes a day of moderate activity, such as walking); the high-exercise group was asked to burn about 2,500 calories per week (about 75 minutes of exercise a day).

After one year without group support, average exercise levels were roughly the same for both groups and the high-exercise group had lost only slightly more weight than the standard group.
However, there remained a link between participants who exercised the most and weight loss.

Those who were exercising the equivalent of at least 75 minutes five days a week lost more than 10 times as much weight as those exercising less than 30 minutes five times a week. Participants exercising the most also showed much less weight regain.

A variety of studies over the years have shown an association between 30 minutes of daily moderate exercise and reduced heart disease and diabetes. Some studies have shown 30 minutes of daily exercise can lead to weight loss and/or a fitter body. However, as these studies show, if you've been exercising and not losing weight, you may need to add another 15 to 30 minutes of activity, change what you eat, or both.

Medicare to cover sleep apnea testing

Loud snoring doesn't just annoy your spouse. It could signal dangerous sleep apnea, yet millions go undiagnosed.

A government move may help change that: Medicare is poised to allow at-home testing for sleep apnea -- letting people snooze in their own beds instead of spending the night in a sleep laboratory.

It's a controversial proposal, but potentially a far-reaching one. Some 18 million Americans are estimated to suffer from sleep apnea, yet specialists think fewer than half know it.

"It's been awkward and inconvenient and expensive to get a sleep test, and now that should be improved," said Dr. Terence Davidson of the University of California, San Diego, a longtime proponent of home-testing.

Today, Medicare pays for sleep apnea treatment -- called CPAP, a mask that blows air through the nose while sleeping -- only for seniors diagnosed in a sleep lab. Last month, Medicare proposed covering those diagnosed with cheaper home tests, too. Final approval is expected in March.

While sleep apnea is a problem for seniors, it is most common in middle-aged men. But private insurers now reluctant to cover home apnea testing are expected to follow the government's lead, thus easing access for all ages.

Sleep apnea doesn't just deprive family members of their own zzzzs. Sufferers actually quit breathing for 30 seconds or so at a time, as their throat muscles temporarily collapse. They jerk awake to gasp in air, sometimes more than 15 times an hour. They're fatigued the next day because their brains never got enough deep sleep.

Severe apnea increases the chance of a car crash sevenfold. Research from UCSD suggests 1,400 deaths each year are caused by drivers with sleep apnea.

Worse, sleep apnea stresses the body in ways that also increase risk of high blood pressure, heart attack, stroke and diabetes.

Not every apnea patient is a bad snorer, and a low rumble may not be cause for concern. But sleep apnea's trademark is bad snoring, the snorting, choking kind. Other risk factors: Being overweight, having small airways and apnea in the family.

Yet patients don't remember the nightly breathing struggle, and often don't see a doctor unless a family member complains about snoring -- or until daytime sleepiness gets so bad they can't function.

Only then comes the test debate.

There are dozens of sleep disorders. A night slumbering in a sleep lab, hooked to monitors that measure both breathing and brain waves while health workers watch, has long been the standard for telling who has sleep apnea or another disorder.

But this lab-based polysomnography, or PSG, can cost $1,500. And while access has improved, there are swaths of the country where reaching a sleep lab can mean a few hundred miles drive.

For about $500, home tests use primarily breathing monitors to detect only sleep apnea, not other disorders. Hook it up at bedtime, and a doctor checks the recordings later.

A home test can miss apnea, because it won't signal if someone never fell into that deep REM sleep where breathing is most likely to falter, said Dr. Thomas Gravelyn of the Saint Joseph Mercy Hospital sleep center in Ann Arbor, Mich., who opposes the Medicare change.

"You have this good feeling that everything was taken care of, when in fact it wasn't," he said.
"It certainly is possible to diagnose severe apnea at home," added Dr. Joyce Walsleben, chief of New York University's sleep center. "What if it isn't severe? Are you willing to say it doesn't exist at all if you get a negative study?"

Still, a Canadian study published last year randomly assigned suspected apnea sufferers to either a sleep lab or home testing, and found they worked equally well.

Last month, the American Academy of Sleep Medicine, which represents sleep centers, changed its position to say home tests can help certain high-risk patients -- but should be administered by sleep specialists.

Medicare's proposal wouldn't limit which doctors offer home tests. The American Academy of Otolaryngology, head-and-neck surgeons, requested the change.

In fact, Medicare concluded a sleep-lab test isn't perfect, either -- and thus proposed that all patients get a 12-week trial of CPAP treatment. Only if their doctors certify they're being helped would treatment continue.

That's important, because about half of apnea patients prescribed CPAP struggle to use it, said Dr. Charles Atwood of the University of Pittsburgh Medical Center, a home-test proponent.

What he calls tricks of the trade -- trying differently shaped masks, adjusting the air pressure, adding a humidifier to moisten nostrils -- early could keep more of them in care.

Consider Raymond Miles, 57, diagnosed with a sleep-lab study a few years ago. While he felt better with CPAP treatment, Miles quit it in frustration when he couldn't get help maintaining it.
Two weeks ago, nudged by his wife, Miles underwent a home test with a different doctor to see if it's time to try care again.

"There's a different level of comfort being at home," Miles said.

Healthy Trust Immediate Medical Care serves the Chicago North Shore Communities of Lake County, Wheeling, Prospect Heights, Lincolnshire, Deerfield, Buffalo Grove, Northbrook, Highland Park, Long Grove, Riverwoods, Des Plaines, Palatine, Glenview, Highwood, Northfield, Libertyville, Winnetka, Arlington Heights, Mount Prospect, Lake Bluff, Lake Forest, Mundelein, and Bannockburn.

UV Rays can harm eyes

Most people know the harmful effects that ultraviolet rays can have on the skin. But many are not aware of the damage that they can cause to the eyes. Possibly the most frightening aspect of UV damage is that it is cumulative, meaning the negative effects may not present themselves until years later.

A recent survey, sponsored by Transitions Optical, Inc., revealed that although 82 percent of respondents knew that extended exposure to the sun could cause skin cancer, only 9 percent knew it could damage vision. Additionally, only one in six respondents said they wear sunglasses when they prepare for extended exposure to the sun and only approximately one third said they wear a hat.

"Most of us wouldn't dream of staying outside in the sun without putting on sunscreen lotion," said Daniel D. Garrett, senior vice president of Prevent Blindness America. "But we also have to remember to wear both UV-blocking lenses and a brimmed hat to protect our eyes as well."
Prevent Blindness America offers an online resource for patients and their loved ones to learn more about what they can do to protect their eyes.

Extended UV exposure has been linked to eye damage including:

* Cataracts -- a major cause of visual impairment and blindness worldwide. Cataracts are a cloudiness of the lens inside the eye that develops over a period of many years. Laboratory studies have implicated UV radiation as a cause of cataract. Furthermore, studies have shown that certain types of cataract are associated with a history of higher ocular exposure to UV and especially UV-B radiation.

* Age-related macular degeneration -- a leading cause of vision loss in the United States for people age 55 and older. Exposure to UV and intense violet/blue visible radiation is damaging to retinal tissue and scientists have speculated that chronic UV or intense violet/blue light exposure may contribute to degenerative processes in the retina.

* Pterygium -- a growth of tissue on the white of the eye that may extend onto the clear cornea where it can block vision. It can be removed surgically, but often recurs, and can cause cosmetic concerns and vision loss if untreated.

* Photokeratitis -- essentially, a reversible sunburn of the cornea resulting from excessive UV-B exposure. It can be extremely painful and can result in temporary loss of vision. There is some indication that long-term exposure to UV-B can result in corneal and conjunctival degenerative changes.

Fortunately, eye protection doesn't have to be expensive to be effective. Quality sunglasses should block out 99 to 100 percent of both UV-A and UV-B radiation and prices vary. For UV protection in everyday eyewear, there are several options like UV-blocking lens materials, coatings and photochromic lenses.

Recognizing Anaphylaxis

An anaphylactic reaction may start off innocently enough, with a tingling or itching sensation or a strange metallic taste. Other common symptoms include hives, a sensation of warmth, trouble breathing or swelling of the mouth and throat. Symptoms may develop within minutes or as long as two hours after exposure, but life-threatening reactions may take up to several hours to appear.

Because exposure to any offending substance can quickly progress to severe anaphylaxis and even death, persons experiencing a combination of the following symptoms are advised to seek emergency care right away:

* Difficulty breathing due to narrowing of airways and swelling of the throat
* Wheezing, coughing or unusual (high-pitched) breathing sounds
* Confusion, slurred speech or anxiety
* Difficulty swallowing
* Swelling of the tongue, throat and nasal passages
* Localized edema or swelling, especially involving the face
* Itchiness and redness on the skin, lips, eyelids or other areas of the body
* Skin eruptions and large welts or hives
* Skin redness, at the site of a bee sting, for example
* Bluish skin color, especially the lips or nail beds, or grayish in darker complexions
* Nausea, stomach cramping, vomiting/diarrhea
* Heart palpitations (feeling the heart beating)
* Weak and rapid pulse
* Dizziness, a drop in blood pressure, fainting or unconsciousness, which can lead to shock and heart failure

115-year-old's brain worked perfectly

A Dutch woman who was the oldest person in the world when she died at age 115 in 2005 appeared sharp right up to the end, joking that pickled herring was the secret to her longevity.

Scientists say that Henrikje van Andel-Schipper's mind was probably as good as it seemed: a post-mortem analysis of her brain revealed few signs of Alzheimer's or other diseases commonly associated with a decline in mental ability in old age.

That came as something of a surprise, said Gert Holstege, a professor at Groningen University, whose findings will be published in the August edition of Neurobiology of Aging.

"Everybody was thinking that when you have a brain over 100 years, you have a lot of problems," he said in a telephone interview with The Associated Press on Friday.

He cited a common hardening of arteries and the build up of proteins associated with Alzheimer's disease as examples.

"This is the first (extremely old) brain that did not have these problems."

Van Andel was the oldest living person in the world at the time of her death in 2005 in the Dutch city of Hoogeveen, according to the Guinness Book of World Records.

In 1972, the then 82-year-old Van Andel called the University of Groningen in order to donate her body to science. She called again at age 111 because she worried she might no longer be of interest. At that time Holstege began to interview her, testing her cognitive abilities at ages 112 and 113. Though she had problems with her eyesight, she was alert and performing better than the average 60- to 75-year-old.

Dr. Murali Doraiswamy of the Center for Aging at Duke University, not associated with the study, said it is unusual and valuable.

In the first place there are few "super-centenarians" - people 110 and older - alive at any one time, a slim proportion of the world's population and a scant number even compared to those who reach 100 years.

As a result, he said, there are few chances to study brains as old as hers.

"It's very rare to be able to do not only a post-mortem, but also be able to have tested her two, three years before she died," said Doraiswamy.

"For a scientist, getting the opportunity to study someone like that is like winning the lottery."
Doraiswamy, an Alzheimer's expert, said that the proportion of brains with some buildup of proteins associated with the disease increases with age. As a result, experts theorize anybody who lives long enough will get them eventually.

When Van Andel died, the director of the elderly home where she was living declined to give a cause of death, pointing to her extremely advanced years.

Holstege said she died of cancer.

"She died from stomach cancer, and you and I can also die from stomach cancer," he said, adding that her case demonstrates that very old people die of diseases, not simply old age.

"It is very important to treat the elderly as normal people, as if they are 50 or 60."

He noted that Van Andel was operated on at age 100 for breast cancer and survived 15 more years.

When she was born in 1890, she weighed only 3.5 pounds, and her mother expected her to die in infancy. Van Andel's husband died in 1959. She had no children.

Longevity was in her genes, as all her siblings lived past 70, and her mother died at the age of 100.

Asked what advice she would give to people who want to live a long time, she once quipped: "Keep breathing."

Can drinking flat soda ease an upset stomach?

THE BELIEF:

Drinking flat soda can ease an upset stomach.

THE FACTS:

It is not often that a soft drink is seen as medicinal. But when it comes to stomach distress, many people view a cup of flat soda as just what the doctor ordered.

The quick and popular remedy -- usually in the form of cola, ginger ale or clear sodas -- is said to help settle the stomach with its slight fizz and replenish fluids and glucose lost by vomiting and diarrhea. Parents also find that children who are verging on dehydration but reluctant to consume any liquids are more amenable to soda.

However, research shows that may not be a great idea. In a recent study, British researchers conducted a review of the medical literature going back to the 1950s in search of scientific evidence supporting the claim. They found none. Then, after a biochemical analysis, they compared the contents of colas and other sodas with over-the-counter oral rehydration solutions containing electrolytes and small amounts of sugar.

The soft drinks, the authors found, not only contained very low amounts of potassium, sodium and other electrolytes, but also in some cases as much as seven times the glucose recommended by the World Health Organization for rehydration. "Carbonated drinks, flat or otherwise, including cola, provide inadequate fluid and electrolyte replacement and cannot be recommended," they said.

THE BOTTOM LINE:

Flat soda, a popular remedy for upset stomach, may do more harm than good.

No belly full of laughs: Bigger waistlines and stroke linked

The connection between belly fat and the brain intensified last week. Many Americans have obsessed about abdominal fat for, oh, decades. A new study from the Oakland, Calif.-based Kaiser Permanente Division of Research revealed that people who have large waistlines in their 40s are more likely to develop Alzheimer's disease and other dementia conditions in their 70s.

Individuals in the study with the biggest bellies had a risk factor two times that of the leanest people. And belly fat was deemed a more significant risk factor than family history, even if both parents suffered from Alzheimer's.

"If (baby boomers) are not frightened enough about heart disease, maybe they will worry about losing their mental function," said Dr. Sam Gandy, a spokesman for the Alzheimer's Association, in a wire service story.

Well, there's more than heart disease and Alzheimer's/dementia for the belly-fat worry list. In one of those findings covered by media outlets but not getting large headlines or much air time, a University of Southern California study presented at a medical conference in February connected excess abdominal fat among women 35 to 54 to a fast-rising rate of stroke among females in that age group. The rate has tripled in recent years, said USC neurologist Dr. Amytis Towfighi at the International Stroke Conference in New Orleans.

Female waistlines, on average, are two inches bigger than they were a decade ago. Plus, the USC study showed the percentage of women with "abdominal obesity" rose from 47 to 59 percent. Towfighi and other researchers commenting on the study generally agree that this abdominal fat and a continuing rise in obesity are at the root cause of causing more strokes.

A couple of points that got the attention of scientists and public health officials if not the media:
The stroke rate among middle-age men stayed about the same during the time period of federal data examined, which was 1999 to 2004.

While stroke generally is considered to be a disease among the elderly, the sudden spike in middle-age female stroke and belly-fat numbers (men's statistics stayed the same in both categories) alarms health care professionals.

There's more. Doctors have long considered men to be more susceptible to strokes in middle age, with women having strokes at more equal rates once they are five to 10 years into menopause.

It's clearly time to rethink the probabilities -- and maybe even consider that women with excess abdominal fat are even more at risk for stroke than men with expanded waistlines.

Women and stroke incidence were a topic at medical student rounds last week at Swedish Medical Center. Third-year University of Washington med student Corinne Taraska updated the group about the strong link between stroke and women with migraines who also take birth control medication and smoke cigarettes.

"Women who have regular migraine headaches with an aura, plus use birth control and smoke, are seven times more at risk for stroke than women who have regular migraines with an aura but don't smoke or use birth control," said Taraska, who will earn her medical degree this spring and spend a postgraduate year researching melanoma. "It's 10 times the risk if compared to women who don't have migraines."

About a third of all women suffer migraine headaches. The ratio is one in 10 among men.

"We have known for a long time that migraines are associated with higher risk for stroke," said Dr. Bill Likosky, director of the stroke program at Swedish. "What's new is the heightened adverse effect if you choose to use birth control medication or use tobacco."

Likosky acknowledged birth control is a personal decision, but emphasized not smoking "is within everyone's grasp" as a positive step to protect against stroke.

A stroke affects the brain and not the heart. It occurs when there is a loss of sufficient blood flow to the brain, typically caused by a blocked or ruptured artery in the neck region. Likosky said migraines, birth control medicine and smoking even one cigarette can have a clotting or clogging effect on the arteries. Putting two or all three together exacerbates the risk.

In the past decade there have been successful campaigns to raise awareness about the dangers of heart attacks and cardiovascular disease among women. Likosky said stroke awareness "cuts across gender lines" in that women just as much as men are reluctant to go to an emergency room with stroke symptoms -- either because those symptoms are not as jarring as crushing chest pain (which women typically don't feel during heart attack as well) or because people don't know the symptoms, period.

"We talk to people about the acronym FAST," said Likosky. "F is for face (numbness or weakness), A is for arms, S is for speech (or slurring) and T is for 'time is brain.' When in doubt, don't hesitate to call 911. There is a lot that can be done in the early hours of stroke treatment."

KNOW THE FIVE MAJOR SIGNS SIGNS OF STROKE

Here are the five major signs of stroke, as outlined by the National Institute of Neurological Disorders and Stroke:

• Sudden numbness or weakness in the face, arm or leg, especially on one side.
• Sudden confusion or trouble speaking or understanding.
• Sudden trouble seeing in one or both eyes.
• Sudden trouble walking, dizziness or loss of balance.
• Sudden, severe headache with no known cause.

Fake patients test Vermont medical students

The patient talked a mile a minute, hopped off the exam table, paced around and poked through the cupboards when the medical students entered the exam room.

The "patient" had spent hours training how to fake it - in the interest of science. It was "Mania Day" at the University of Vermont's medical school.

One part drama, two parts science as doctors-in-training test their diagnostic skills and bedside manner by assessing the ailments of patients played by real people in a program that's growing in popularity at U.S. medical schools.

"This environment allows them to practice and make mistakes in an environment conducive to learning before they go to the patient," said Tamara Owens, president of the Association of Standardized Patient Educators.

Most health care institutions now have some sort of standardized patient program or simulation center, practicing everything performing exams to suturing mannequins. Medical students now also are required to take a national exam involving standardized patients.

But the training does much more than prepare them for the test.

"The idea is that if we want every student to handle or work with a patient with a migraine, schizophrenia, bipolar, knee pain, back pain, we can't assume or hope that patients with those problems are going to present in the hospital or in the office," said Nicholas.

"So what we can do here is to create any kind of scenario that our clinical faculty want to teach."
Dr. Howard Barrows came up with the idea in the 1960s at the University of California at San Diego.

UVM, which Owens said considers to be one of the pioneers in the methodology, along with San Diego and University of Texas Medical Branch at Galveston, started doing it the 1970s to teach doctors how to perform pelvic exams in women. The school expanded the practice to other areas in the mid-1990s as it considered changing its curriculum and became clearer about the skills that students needed, said Cate Nicholas, director of the program.

"We really needed to spend more time on some real, basic clinical exam skills, professionalism - how do you present yourself to a patient - communication-interpersonal skills, history taking skills, physical exam skills, clinical reasoning," she said.

That's when the concept of practicing on fake patients was introduced.

The "patients" at UVM come from all backgrounds - nurses, dancers, actors, teachers, a boat maker - and need to have some level of acting ability to be effective.

They meet with doctors to learn how to act out their symptoms the same way others do, so that students get the same experience and can be assessed uniformly.

"It might take up to 8 to 12 hours of training to prepare them for a project," Owens said. "So it requires them to have the ability to recall at a 90 percent or better rate in order to be included in the project."

For $20 an hour, they not only act, they also instruct students and offer feedback.

"You can see them grow," said Jim Conan, a retired state trooper and sometime actor.

At first, Ben Higgins, 24, of Mount Desert, Maine, had a hard time interrupting his manic patient - Morris - with questions.

Played by Conan, Morris talked rapidly about a home office he was building, his inability to install the dropped ceiling, and asked Higgins to help. He repeated himself, lost focus and changed the subject. He mentioned that his girlfriend was going to kick him out and urged the doctor to call and reassure her he was fine.

Midway through the half-hour session, Higgins and fellow student Elizabeth Cipolla, of New York City, took time out to discuss his case. They decided to ask Morris about medication and sleep. A doctor who stepped into the room to observe advised them to ask about his work, his level of functioning, to determine his concentration level.

The students learned Morris had been taking Zoloft and had felt euphoric ever since, sleeping only several hours a night.

The students then presented a list of findings - from the patient's neat appearance to his rapid speech, energy level, euphoric mood, and warped sense of reality - to the doctor.

"When they're in role like that, it feels very real," Higgins said. "It's fun to have real situations like that, so you can practice and know how to try and work on skills to interact with someone who might be in a manic state or a really depressed state."

House Calls Making a Comeback

John Devine is 82 years old and has no interest in leaving home to socialize with others.
He'll pass on the so-called "senior activities" and get-togethers. He would rather read in the library of his assisted-living facility in Burien.

Wanting to stay home makes doctor visits and routine checkups a bit difficult, though. But Devine, a small, spry man with a Scottish brogue and a mischievous smile, has that taken care of. He has a doctor make a house call to him about once a month for a checkup and to help coordinate any other medical care he needs.

Once considered on the verge of extinction, house calls are making a comeback.

In 1997, The New England Journal of Medicine called doctor house calls a "vanishing practice." But eight years later, a Journal of the American Medical Association article found from 1998 to 2004 the annual number of house calls increased 43 percent, to just over 2 million. For Devine, who doesn't have major medical problems and jokes he specializes in inactivity, having a doctor come to him is ideal. Though a bit forgetful about everyday things, he can easily recite Shakespeare from memory.

"To hell with the medicine, it's wonderful having her here," Devine said, sitting in his blue recliner while his physician, Dr. Sarah Babineau, checked his blood pressure, listened to his heart and went over some medical concerns and upcoming appointments. "There's nothing like it. We can talk and have conversations and I get my checkups."

Babineau works part time for Providence ElderPlace, a nonprofit for older adults that aims to keep them out of nursing homes and living in the community. The costs often are cheaper than nursing homes, said the program's referral specialist, Corina Kroll. Medicare or Medicaid pay for most services, which include hospitalizations, dental, vision, home care and prescriptions. The program also provides transportation for members to see physicians and participate in activities at its Rainier Valley facility. And it provides house calls.

For those who pay out of pocket, the costs are between $3,700 and $4,200 a month, which includes housing.

After his checkup is complete, Devine's routine with Babineau, who he says reminds him of his three daughters, is to walk down the hall for some coffee, then sit briefly in front of the fireplace in the library. The slower pace gives her more time to really care for her patients.

"Seeing people in their environment I get a better grasp of what their lives are like," said Babineau, who also is a full-time family doctor at Swedish Medical Center. "(In the clinic) time crunch is a huge thing for me. At home, I get to share special moments with these patients."

She spends Mondays, Thursdays and occasional Wednesdays driving to see her 55 to 60 patients around the Seattle area. She has so many, she can usually only visit once a month, but will add more appointments if necessary. The patients' average age is 80 and many suffer from advanced dementia. One of her patients is a 100-year-old woman still living on her own on Capitol Hill.

"We take care of a really frail population and if they're living independently we keep an eye on them," Babineau said. "A lot of these people would fall through the cracks and would be sent to a nursing home otherwise."

Several other programs around Seattle offer home visits to older patients. Doctors Home Visits, which calls house calls "an old concept renewed," offers a service area from Seattle to Lynden, just a few miles south of the British Columbia border. Carena Inc., headquartered in downtown Seattle, provides house calls or workplace doctor visits to employees of companies who contract their services.

For 10 years, The Home Doctor, located in the Tacoma suburb of Lakewood, has provided house calls to more than 500 homes in the greater Puget Sound area. The service started in 1998 after someone called the clinic asking if a physician could make a home visit.

The next call was to Medicare and Medicaid for authorization, said Home Doctor President Charles Plunkett. Once they figured out how to bill patients, they started with one home and expanded. Physicians, nurse practitioners and podiatrists visit adult family homes, assisted living facilities, homes for the mentally ill, Alzheimer's residences and skilled nursing homes, Plunkett said.

"Caring for the elderly in all settings is expensive in dollars, time and emotion," Plunkett said. "Just getting Grandma' " (or Grandpa) to the physician takes a toll on the patient, the family member or caregiver. Patients with dementia become agitated when out of their environment. Just sitting in a doctor's waiting room is stressful and exposes this vulnerable population to increased risk of sickness and infection."

He said an increasing number of specialists are not accepting Medicare or are limiting the number of patients. And adult family home and assisted living operators serving those on Medicare and Medicaid are dealing with flat revenues and increasing expenses.

"Care management is needed, but only available with HMO and special needs plans," Plunkett said. "Families are left to fend for themselves" and learn what he calls a Byzantine system.

For Babineau, who tries to recruit patients from her full-time practice to join Providence ElderPlace's program, she said even for her -- someone who is a part of the health care system -- it is difficult to navigate.

"A lot of people caring for their parents are living on the edge and this helps," she said. "This is long-term care the way it should be."

Bird flu detected in Hong Kong market

Hong Kong health workers slaughtered 2,700 poultry in a market Saturday after chickens were found to be carrying the dangerous H5N1 bird flu virus, officials said.

The slaughter may be extended to all live poultry in the territory if the virus is detected in any other locations, Secretary for Food and Health York Chow said.

"Since we have detected the virus in the market, we will cull all the chickens in this market," Chow told reporters. "If we find another positive detection in another market, then we will assume that the risk is much higher and we need to cull all the chickens in all the markets."
Hong Kong TV Cable showed health workers wearing protective gear placing live poultry from nine stalls into bags to prepare for the slaughter.

Routine bird flu checks detected the H5N1 virus in five samples of chicken waste. The samples were collected June 3 from three vendors in the market in the Sham Shui Po residential district, Chow said.

Health officials declared the market an infected area and suspended all sales of live poultry there, a government statement said.

Chow said authorities were tracing the origin of the infected chickens.

Chow also ordered a 21-day ban on the supply of live poultry from mainland China and from local farms.

Occasional H5N1 infections in wild birds are common in Hong Kong but the territory has not suffered a major outbreak of the disease since the virus killed six people in 1997.

That prompted the government to slaughter the territory's entire poultry population of about 1.5 million birds.

At least 241 people have died of bird flu worldwide since 2003, according to the World Health Organization.

Most human cases have been linked to contact with infected birds, but health experts worry the virus could mutate into a form that passes easily among humans, sparking a pandemic that might kill millions of people.

Toe Implants offer Relief from Arthritis

Those who suffer from hallux rigidus, or degenerative arthritis of the big toe, have new reason to lace up their gym shoes. A new cartilage resurfacing implant may allow these patients to maintain their active lifestyle.

Hallux rigidus affects the large joint at the base of the big toe. While some joint wear and tear commonly occurs after age 30, doctors increasingly are seeing this type of arthritis in younger, more active patients, according to Dr. Howard Stone, a podiatrist with the North Shore Podiatry Group in Glenview, Lake Forest and Gurnee. Injury to the big toe joint also can cause arthritis.

People with arthritis of the big toe will have pain and stiffness while walking. Conservative treatments include wearing stiff-soled shoes or inserts. If those treatments don't work, options have included joint fusion or joint replacement. But both have drawbacks. The new Arthrosurface HemiCAP system was approved by the FDA in 2006 for treatment of moderate and advanced arthritis of the big toe. The system replaces damaged cartilage with contoured implants precisely matched to the patient's anatomy using three-dimensional mapping technology. Matching the curvature of the cartilage allows for proper function of the big toe joint.

Because the implant preserves the joint, it allows for an active lifestyle. Independent studies show that after this outpatient procedure, patients experience reduced pain, rapid recovery and significant range of motion. The HemiCAP implant also is being used in the shoulder, hip and knee. "This is the new wave of what's happening in orthopedics," said Dr. Howard Stone, a podiatrist with the North Shore Podiatry Group in Glenview, Lake Forest and Gurnee. "The implant is set into the same level of the remaining cartilage and acts as brand-new cartilage. You're not destroying the joint but resurfacing the joint.

"The procedure takes about 35 to 40 minutes for each foot, done a few months apart. It's done under twilight sedation, which falls between wakefulness and complete unconsciousness, and a local anesthetic. After the procedure, patients wear a removable cast for two weeks and then wear a gym shoe and begin physical therapy. Stone cautions that it's important to choose the patient properly. "This is for people with a moderate of amount of arthritis," he said. "If the joint is really destroyed, you can't do this." The implant should last around 20 years, about as long as an artificial joint, he said.

With joint fusion, surgeons remove the damaged joint between the two bones and allow the bones to grow together. Joint fusion eliminates arthritis pain, but it restricts movement of the big toe joint and limits the shoes that may be worn, especially for women. It's often used for older, less active patients.

Joint replacement involves replacing the joint surface with plastic, metal or a silicone compound. This procedure may relieve the pain and preserve joint motion. But artificial joints made of silicone can cause tissue reactions. And because so much bone and cartilage is removed, any future surgery is more difficult.As for the new treatment, "Long-term studies will show how effective this implant will be in allowing a patient to walk and how long the implant itself will last," said Dr. Tayeb S. Hussain, a podiatrist with Evanston Podiatric Surgeons who has done a few procedures. "I'd give it at least a year and a half until long-term studies are evaluated to know whether it's a standard procedure," he said.

"I reserve it for people with any cartilage deterioration. Women can return to wearing heels within three to four weeks. It's best for patients who have cartilage deterioration under age 60 who still want to be active."

Too Much Medical Care Harmful?

Too much medical care could be harmful to your health.

That's what researchers concluded after examining the nations' hospitals and the care patients receive. Some hospitals and some areas of the country give patients more aggressive care -- meaning more tests, longer hospital stays and more procedures -- than others. And the extra treatment doesn't always translate to longer or better lives.

The 2008 Dartmouth Atlas of Health Care study, released Thursday, studied more than 4 million Medicare patients at nearly 3,000 hospitals across the country from 2001 through 2005 during the last two years of life.

The patients were 65 years and older and were treated for the top nine leading causes of death, including congestive heart failure, chronic pulmonary disease, cancer, dementia, coronary artery disease, chronic kidney failure, peripheral vascular disease, diabetes with organ damage and severe chronic liver disease.

The study found that depending on where patients lived and what hospital they went to, there were big discrepancies in how they were treated.

Researchers reasoned all medical care carries some risk, so the longer a patient is hospitalized and the more procedures and tests performed, the greater the risks, in addition to greater costs.
The more resources available at a hospital equaled more care and in turn, more chances for errors and complications, according to the study.

To help consumers better identify which hospitals are more or less aggressive with their care, Consumer Reports magazine launched the Consumer Reports Health Ratings Center, which ranks hospitals and soon will rate other health care providers.

Launched in conjunction with the Dartmouth study, the online tool at ConsumerReportsHealth.org lets consumers compare treatment approaches among hospitals for the nine serious chronic conditions in the study on a scale from 0 percent to 100 percent (the higher the percentage the more aggressive the treatment).

The percentile rank is based on the total number of hospital days and inpatient physician visits over the last two years of life. Next to each of the nearly 3,000 hospitals, there also are the patient out-of-pocket costs over the last two years of life.

For example, hospitals in New York and Los Angeles top the list of most aggressive care, while Scott & White Memorial Hospital in Temple, Texas, is the most conservative.

Seattle ranks on the lower, more conservative end of the spectrum when treating patients.
Of the 18 Seattle-area hospitals listed on the site, larger ones such as Swedish Medical Center, the University of Washington Medical Center and Virginia Mason had higher percentiles. They ranked 44 percent, 33 percent and 29 percent respectively.

Jefferson Healthcare in Port Townsend, St. Francis Hospital in Federal Way and Olympic Medical Center in Port Angeles ranked on the low end at 2 percent and 3 percent.

The numbers tend to be lower because the larger hospitals usually have more complicated cases, often referred to them by the smaller ones, according to the Washington Hospital Association.
The association said it was pleased with where Seattle and Washington as a whole fall on the Consumer Reports rankings, which indicates Seattle patients are getting the care they need and want, but are not getting a lot of unnecessary care.

"If we had any hospitals with exceptionally high scores, I would worry that patients were getting much more care than they needed or wanted," spokeswoman Cassie Sauer said.

"Spending hours and hours in medical appointments, tests and treatments -- particularly when there's no evidence they will make any difference -- could offer false hope, hurt quality of life, and create significant medical bills. I think many Americans assume that more care is better care, but that is certainly not always the case"

Dust Mites and Allergies

THE BELIEF:

Dust mites make allergies worse.

THE FACTS:

Most people with allergies or asthma know well the hazards of dust mites, the microscopic household critters long said to be one of the most common triggers of allergic symptoms.
But that is not what studies show. Scientists repeatedly have found that various physical and chemical methods recommended for controlling dust mites, such as sprays and impermeable bed covers, do little by themselves to prevent allergies. If they do work, it usually is as one of several steps taken to reduce allergens.

An analysis published in 2008, for example, looked at 54 randomized studies that compared various mite-control measures with placebo interventions, or none at all, in people with asthma. It found that the control measures made no significant difference. A 2007 study followed 126 asthma patients, some of whom were trained to use control measures such as impermeable bed covers and others who used placebo interventions. After two years, the scientists found that the groups showed no difference in their use of inhalers or reductions in symptoms like wheezing and coughing.

These and other studies suggest that people with allergies and asthma would do well to rely on a broad program of interventions, such as frequently washing clothes and blankets, using air conditioning instead of humidifiers, and strictly limiting exposure to allergens such as smoke and strong odors.

THE BOTTOM LINE:

Research suggests that controlling dust mites alone may not prevent allergies.

Think About Green Tea

Tea is the most popular beverage in the world, second only to water. It has been enjoyed in Eastern countries for more than 4,000 years and Chinese and Japanese traditions attribute many healing properties to this beverage. Today, scientists around the world are supporting these traditions as they use rigorous research methods to identify the many health benefits of green tea.

Recent studies reveal green tea's benefits as an antioxidant, promoter of glucose tolerance, and protector of the liver, detoxification system and the cardiovascular system. Two studies also show that green tea is a powerful agent in the prevention and treatment of cancers. The tea is made from unfermented leaves of the Camellia sinensis plant. These leaves contain polyphenols, chemical substances known to have strong antioxidant properties. The polyphenol found in green tea, called catechin, is a powerful antioxidant and is said to inhibit the growth of cancer cells and kills cancer cells without harming healthy tissues.

Green tea, just like all other healthy foods and beverages, should be consumed in moderation. Studies show that consuming between one to four cups of green tea per day offers the most benefit. Other great teas to try, each with various health benefits, include red tea, white tea and black tea. Drinking tea is an excellent way to relax and refresh the body and mind -- while benefiting your health.

Little League Baseball can be Dangerous

No doubt the Little League bleachers are buzzing in Wayne, N.J., and just about any youth baseball diamond that learns about a May 19 lawsuit filed by the Domalewski family.
The New Jersey parents of former pitcher Steven Domalewski sued bat manufacturer Hillerich & Bradsby Co., plus the official Little League organization and the retail outlet Sports Authority, after their then-12-year-old son was struck by a batted ball right above the heart while he was on the mound during a 2006 game.

Steven suffered brain damage from the blow. His heart stopped beating and doctors estimate his brain was deprived of oxygen for about 15 to 20 minutes.

The bat in question was a 31-inch, 19-ounce Louisville Slugger TPX Platinum model. The filing attorney claimed the defendants knew, or should have known, the bat could potentially injure youth players not ready for the velocity of a batted ball coming off this particular make of aluminum bat. A major premise in the suit is that aluminum bats cause the ball to travel faster than wooden bats.

Not surprisingly, legal blogs are robust with comments about whether this is a legitimate or frivolous lawsuit.

Pause. Debate among your own brain synapses. OK, back to the column.

Little League Baseball has denied any wrongdoing. The game in which Steven Domalewski sustained the injury was a Police Athletic League contest rather than a Little League event. Attorney Ernest Fronzuto countered that Little League Baseball officially approved the bat and by its actions led players, coaches and parents to believe the bat was safe for play among 10-, 11- and 12-year-olds.

Fronzuto told The Associated Press he sees this case as raising public awareness about whether youth baseball is safe or if there are precautions that would help protect children.
As it happens, researchers at the Center for Injury Research and Policy at the Nationwide Children's Hospital in Columbus, Ohio, are releasing a study Monday almost squarely on the subject.

Dawn Comstock, a Ph.D. faculty member at The Ohio State University's College of Public Health, has long staked youth sports injuries as her research focus. She and colleague Christy Collins published a study in the June edition of the medical journal Pediatrics that analyzes injuries in high school baseball in the past three seasons, from 2005 through 2007.

The study is the most comprehensive look at high school baseball in the past 10 years and "the first to examine all injuries attributed to being hit by a batted ball at the high school level," wrote journal editors.

While high school baseball has a relatively low rate of injury compared to other sports -- Comstock and Collins are in the midst of comparing nine different sports -- it has the largest proportion of fractures (even more than football) and second-largest proportion of injuries that resulted in a time loss of more than seven days (trailing only boys' soccer).

More than 11 percent of all baseball injuries are caused by a batted ball. Collins said the majority of those injuries, 64 percent, involve the head, face or teeth. Line drives to the chest did not represent a significant incidence level in the high school study. Collins, clearly not intending to directly comment on the New Jersey lawsuit, suggested that high school players are likely to be more coordinated and "better able to shield themselves from the ball and get their gloves up."
Nonetheless, the authors of the study documented severe enough injuries to the head and teeth to recommend that all pitchers and infielders "wear helmets with face shields (a bar to protect but not disrupt vision) or at least mouth guards and eye protection."

Collins acknowledged that any such protective gear is not part of the baseball mind-set.
"We know that mouth guards, face shields and eye protection are proven to be successful," Collins said. "We plan to conduct research on why this protective equipment is not worn, whether it is because coaches and parents are not aware of the equipment or whether it is not part of the culture of the sport."

The temptation is to think more the latter, that adults are just not ready for infielders in helmets with face bars chomping on mouth guards. Infielder chatter might go a bit mushy, among other things. But it doesn't take too many bloody lips or close calls to the eye socket of novice players to reconsider the use of protective gear. Pitchers wearing flak jackets or other chest protectors seems excessive, though the guess here is that might be less a stretch in Wayne, N.J.

"Mouth guards are much more commonly worn in basketball these days, especially here in Ohio where we all watch (Cleveland Cavaliers star) LeBron James always wear one," said Collins.
"There are more youth softball leagues in which pitchers wear helmets. Compared to other sports, baseball is reluctant to change. But even a dental injury, which can be costly for parents, has a permanent effect on a child's life. Lots of those teeth don't grow back."

The Secret World of your Elbow

The crook of your elbow is not just a plain patch of skin. It is a piece of coveted real estate, a special ecosystem, a bountiful home to no fewer than six tribes of bacteria. Even after you have washed the skin, there are 1 million bacteria in every square centimeter.

These are not bad bacteria. They are what biologists call commensals, creatures that eat at the same table with people to everyone's mutual benefit. Though they were not invited to enjoy board and lodging in the skin of your inner elbow, they are giving something of value in return.
They are helping to moisturize the skin by processing the raw fats it produces, said Dr. Julia Segre, of the National Human Genome Research Institute.

Segre and colleagues reported their discovery of the six tribes in a paper published online Friday in Genome Research. The research is part of the human microbiome project, "microbiome" meaning the entourage of all microbes that live in people. The project is a government-financed endeavor to catalog the typical bacterial colonies that inhabit each niche in the human ecosystem.

The project, in its early stages, has established that the bacteria in the human microbiome collectively possess at least 100 times as many genes as the mere 20,000 or so in the human genome.

Since humans depend on their microbiome for various essential services, including digestion, a person should be considered a superorganism, microbiologists said, consisting of his or her own cells and those of all the commensal bacteria. The bacterial cells outnumber human cells by 10-1, meaning that if cells could vote, people would be a minority in their own body.

Segre reckons there are at least 20 different niches for bacteria, and maybe many more, on the skin, each with a characteristic set of favored commensals. The types of bacteria she found in the inner elbow are different from those that another researcher identified a few inches away, on the inner forearm. But each of the five people Segre sampled harbored much the same set of bacteria, suggesting this set is specialized for the precise conditions of nutrients and moisture that prevail in the human elbow.

Microbiologists think humans and their commensal bacteria are continually adapting to one another genetically. The precision of this mutual accommodation is indicated by the presence of particular species of bacteria in different niches on the human body, as Segre has found with denizens of the elbow.

Other researchers have found that most gut bacteria belong to just 2 of the 70 known tribes of bacteria. The gut bacteria perform vital services such as breaking down complex sugars in the diet and converting hydrogen, a byproduct of bacterial fermentation, to methane.

The nature of the gut tribes is heavily influenced by diet, according to a research team led by Dr. Ruth Ley and Dr. Jeffrey Gordon of the Washington University School of Medicine in St. Louis.
With the help of colleagues at the San Diego and St. Louis zoos, Ley and Gordon scanned the gut microbes in the feces of people and 59 other species of mammals, including meat eaters, plant eaters and omnivores. Each of these three groups has a distinctive set of bacteria, they reported in Friday's issue of Science, with the gut flora of people grouping with the other omnivores.
Despite the vast changes that people have made to their diet through cooking and agriculture, their gut bacteria "don't dramatically depart in composition from those of other omnivorous primates," Gordon said.

The lifetime of an individual bacterium in the human superorganism may be short, since millions are shed each day from the skin or gut. But the colonies may survive for a long time, cloning themselves briskly to replace members that are sacrificed. Where these colonies come from and how long they last is not known.

Dr. David Relman of Stanford University has tracked the gut flora of infants and found that their first colonists come from their mother. But after a few weeks the babies acquired distinctive individual sets of bacteria, all except a pair of twins who had the same set. Relman said he was trying to ascertain if the first colonists remain with an individual for many years.

Strong Link Between Crime and Lead Exposure

The first study to follow lead-exposed children from before birth into adulthood has shown that even relatively low levels of lead permanently damage the brain and are linked to higher numbers of arrests, particularly for violent crime.

Previous studies linking lead to such problems have used indirect measures of lead and criminality, and critics have argued that socioeconomic and other factors may be responsible for the observed effects.

But by measuring blood levels of lead before birth and during the first seven years of life and then correlating the levels with arrest records and brain size, Cincinnati researchers have produced the strongest evidence yet that lead plays a major role in crime.

The team also found that lead exposure is a continuing problem despite the efforts of the federal government and cities to minimize exposure.

The average lead levels in the study "unfortunately are still seen in many thousands of children throughout the United States," said Dr. Philip Landrigan, director of the Children's Environmental Health Center at the Mount Sinai School of Medicine in New York.

The link between criminal behavior and lead exposure was found among even the least-contaminated children in the study, who were exposed to amounts of lead similar to what the average U.S. child is exposed to today, said Landrigan, who was not involved in the study.

"People will sometimes say, 'This is in the past. We are cleaning up lead. We don't have lead problems anymore,' " said criminologist Deborah Denno of Fordham University in New York, who was not involved in the study. "The Ohio study says this is still a big problem."
Nationwide, about 310,000 children between 1 and 5 have blood lead levels above the federal guideline of 10 micrograms per deciliter, and experts suspect that many times that number have lower levels that are nonetheless dangerous.

"It is a national disgrace that so many children continue to be exposed at levels known to be neurotoxic," said Dr. David Bellinger, of the Harvard Medical School, who wrote an editorial accompanying the research.

Although some urban soil is contaminated with lead from gasoline, 80 percent of lead exposure comes from houses built before 1978. Paint in such houses often contains up to 50 percent lead and, even though it has been covered by newer, lead-free paints, it flakes or rubs off.
About 38 million U.S. homes, 40 percent of the nation's housing, contain lead-based paint, according to the U.S. Department of Housing and Urban Development. The problem is particularly acute in urban areas, which typically have older housing that has not been renovated.

More recently, parents and authorities have become concerned about lead-based paint in toys imported from China.

Researchers have long known that lead exposure reduces IQ by damaging brain cells in children during their early years.

It is also known that lead increases children's distractibility, impulsiveness and restlessness and leaves them with a shortened attention span, all factors considered precursors of aggressive or violent behavior.

A landmark 1990 paper by Denno linked lead to increases in criminal behavior, but the children in the study were not tested for lead levels. The diagnosis was based on their physicians' evaluation, Denno said.

The Cincinnati Lead Study enrolled 376 pregnant women in Cincinnati between 1979 and 1984, measuring their blood lead levels during pregnancy and the children's levels during the their first seven years.

In the first of the new studies, environmental health research Kim Dietrich of the University of Cincinnati College of Medicine studied 250 of the original group, correlating their lead levels with adult criminal-arrest records from Hamilton County, Ohio.

Controlling for a variety of factors, including parental IQ, education, income and drug use, Dietrich and colleagues found that the more lead in a child's blood from birth through age 7, the more likely he or she was arrested as an adult. The tie between high lead and violent crime was particularly strong.

They found that 55 percent of the subjects (63 percent of males) had been arrested, and that the average was five arrests between the ages of 18 and 24.

The higher the blood-lead level at any time in childhood, the greater the likelihood of arrests. "The strongest association was with violent criminal activity: murder, rape domestic violence, assault, robbery and possession of weapons," Dietrich said.

Blood levels in the children ranged from 4 to 37 micrograms per deciliter.

The researchers found, for example, that every 5-microgram-per-deciliter increase in blood lead level at age 6 was accompanied by a 50 percent increase in violent crime later in life.
Confirming previous findings, the effect of lead was strongest in males, who had an arrest rate 4.5 times that of females.

"We need to be thinking about lead as a drug and a fairly strong one," Dietrich said.

In the second study, radiologist Kim Cecil and her colleagues examined a "representative sample" of 157 members of the same group using whole-brain MRI scans. They found that those with the highest blood levels of lead during childhood had the smallest brain volume.
For those with average lead level in the study, their brains were about 1.2 percent smaller. The most affected regions of the brain were those regulating decision making, impulse control and attention, among other areas.

"The most important message is that lead affects brain volume, independent of demographic and social factors that are often used to explain away poor outcomes" in life, Cecil said. "This is independent biological evidence showing that the brain is affected by lead."

Getting in Shape by Cycling

As the days get warmer and longer, more riders will hop on their bicycles for a spin. Just how fast and where you go will determine if your bike is a piece of fitness equipment or simply a comfortable, recreational way to save gas and enjoy the outdoors.

Ask Craig Undem about bicycling and fitness. He will give you a short but insightful answer.
"Go climb hills," said Undem, a local cycling coach who operates the Cycle U training company in Seattle and regularly serves as an instructor for the Cascade Bicycle Club.

Undem said too few cyclists choose hills for workouts, when doing so a couple times per week can transform your body composition (goodbye, fat) and dispel any doubts that cycling is a top calorie burner among physical activities.

"Hills give you more bang for the buck," Undem said. "You might choose to go on a slow, steady ride for 20 miles (about an hour's worth for experienced riders and more like two hours for novices). But if you do moderate hills for 30 minutes that will burn more calories."

Undem said moderate hills translates to "a grade of 4 to 6 percent, not too steep, especially if you're just getting back into shape." He said you want to work at an exertion rate of 70 to 90 revolutions per minute, or rpm. You can determine this level by purchasing a bicycle computer (about $50 retail) or comparing that pedaling rate of 70 to 90 rpm to how that registers on a indoor stationary bike.

"You want that cadence to be moderately intense," Undem said. "It keeps you in a safe zone and gives you a great workout."

Increasing your intensity levels in short bursts (enough to be out of breath but not gagging) elevates cycling to one of the best calorie-burners among all physical activities. In fact, statistics from the American Council on Exercise (the primary certification group for personal trainers) equates bicycle racing with a vigorous game of basketball and not far off running at a brisk clip that would leave most people gasping.

Adding hills to any bicycle ride is easy enough here in the Pacific Northwest. Undem said to do it most efficiently requires more expertise than you might think. For instance, Cycle U teaches a "boot camp" devoted strictly to going up and down hills. It runs for eight two-hour sessions.
"It's a lot like skiing once you get into it," explained Undem. "There is a lot of technique."
Some highlights: Sit more upright in the bike saddle when you're climbing a hill. Don't pull your arms back too hard or too much when navigating the upward slope. And breathe deeply as you work.

One more tip for climbers that applies to all cyclists as they roll back outside this spring. Undem said too many recreational riders forget to drink water during the ride and eat something if they are going more than a hour nonstop. Sports nutritionist will suggest a snack and water is good idea some time in the hour before your ride.

Cycle U and the Cascade Bicycle Club offers plenty of other courses for beginners as well as the most savvy riders. You can learn how to ride a bike -- "there are plenty of people who come to us that never learned as kids," Undem said -- or perhaps take a refresher course on how to shift gears. Cascade instructors might go to the bike shop with you to pick out just the right model.

Not surprisingly, the Cascade club, the country's largest with a membership base of 10,000, works with a significant percentage of injured athletes from other sports. Basketball, running and tennis lead the list, mostly due to balky knees that are treated less jarringly on a bike.
Lateral movement fells basketball and tennis players, Undem said. Runners tend to not rest their bodies enough and stride themselves right into overuse injuries.

"Cycling has a locked range of motion so those runners, tennis players and basketball players can exercise without doing any more harm to the knees," Undem said.

The key strategy is to add intensity to your bike workouts, whether you are rehabbing an injury, cross training or deciding to make your commute your daily workout. All cycling for fitness will turn up noticeable changes in your body composition and personal energy level if you add some hills and maybe incorporate a few all-out sprints for 30 seconds or less when it is safe to do.

"Cycling is a real tonic for the body," Undem said. "Work harder and it will charge you up. You will feel good even after you're off the bike."

Quality Critical to Health Care Reform

Expanding healthinsurance coverage is a critical step in health reform, but reforms willnot be successful if they fail to also address the quality and cost of care.

That is the conclusion of The Quality Crossroads Group, a broad groupof stakeholders drawn together to identify strategies to address thecomplex challenges confronting the U.S. health care system. The group laysout a five-point agenda in an article published today in Health Affairs that serves as a vision for quality in an election year when patient safety, the plight of the uninsured, and rising costs are making front-pagenews.

"Quality improvement is intricately connected with containing costs andexpanding coverage. Yet too often, quality is left out of the equation,"says co-author Margaret E. O'Kane, president of the National Committee forQuality Assurance. "Poor quality care is a major contributor to runaway health care costs.

Improving quality is a key part of making coverage affordable."

"The future of health care reform rests on the ability for diversegroups, at national, state, and community levels, to work to achieve consensus. We cannot achieve the important policy goals outlined in this paper without collaboration," says co-author Janet Corrigan, president and CEO of the National Quality Forum. "The thinking in this paper, by leadersin the quality movement across the country, represents a successful effort to collaborate in moving beyond rhetoric and sparking real change," sheadded.

If taken up by the new President, Congress and others, the five-point reform plan put forward by the 13 authors of the paper would mobilize true change in the nation's vast, complicated, and expensive health care system.

The reform plan calls for:

A national center to support effectiveness research. The U.S. invests too little in understanding what works and what does not for a whole array of technologies, drugs, and treatments. In order to ensure that our health care dollars are wisely spent, we need to systematically identify where critical gaps in evidence exist and fill them.

Models of accountable health care entities capable of providing integrated and coordinated care. The sickest patients often suffer the most from lack of care coordination across settings. They see multiple specialists, get an array of tests, and take multiple medications - usually without a "health care home" or central coordinator of care. Achieving high levels of coordination will require investments in organizational supports that go beyond information technology. IT is a critical enabler of management, but is not sufficient to produce high-quality, efficient, and patient-centered care.

Payment models that reward high-value care. There are nearly 10,000 codes for payment for medical procedures, but not one for outcomes or results. The Quality Crossroads Group believes that if quality is not tied to payment, providers' behavior will not appreciably change, and if it does not change, access to insurance and care will continue to decline.

We need to aggressively develop models of payment that reward clinically effective and efficient care and yield high patient satisfaction. Those might include innovative ideas like bundled chronic care episodes.

A national strategy for performance measurement, including standardized measures of patient and population health. We need a common vision of what quality care means. To get there, we need to agree on what we are measuring and how we are measuring it. Performance information is a public good and federal funding for the National Quality Forum, a private sector standard-setting organization, will facilitate development of a comprehensive portfolio of standardized measures that is continually assessed and updated.

A multistakeholder approach to improving population health. Obesity is a national crisis that demands solutions that lie mostly outside of health care. The public sector can do much to promote population health. For example, in Arkansas, nearly 38 percent of young people are overweight or at risk of becoming overweight. State officials implemented a strategy to target children in schools, focusing on what they eat and how often they exercise. We must make a concerted public- and private-sector effort -- similar to the one we mounted for tobacco control -- to achieve the outcomes we know are possible.

Executing the most popular Yoga position

HOW TO DO A DOWNWARD DOG

Place your feet hip-width apart on the floor, toes facing forward.

Place your hands shoulder-width apart on the floor, lightly spread the fingers.

Keep your tailbone lifted towards the sky and gently push down through the heels. If you're a beginner, you might not get your heels all the way to the floor at first -- that's OK.

Open your upper back by rotating the shoulder blades away from one another. Keep the shoulders away from the ears and press down firmly through all fingers and thumbs. Place more weight onto your feet than your hands.

Shifting the weight back to the hips is the key element in feeling the energizing effect of this posture. Pull your navel toward your spine and lift the pelvic floor muscles. Lift your kneecaps up and contract the quadriceps muscles.

Maintain this pose for 5 to 10 deep breaths.

Stress Relief From Yoga

Funny thing. When Jenny Hayo first started practicing yoga in 1996, she thought of it as "purely an exercise option." Within two years, she was teaching classes and digging deeper.

Her appreciation of yoga as a personal methodology changed with each new mentor. Hayo realized yoga is energizing in ways beyond the workout, and said she sees no reason why the rest of us can't tap into it for stress relief and everyday vigor.

"The interesting point of modern-day yoga is it is looked at as exercise by most people," says Hayo, who teaches at 8 Limbs Yoga Center in the Capitol Hill neighborhood, plus some classes at the downtown Zum health club. "Ninety-five percent of people get into yoga that way. But no one is complaining. It puts people on the yoga mat and that's great."

In fact, Seattle P-I venture capital columnist and blogger John Cook noted earlier this month in an item about the TeachStreet free online directory that there are no fewer than 984 yoga classes in the Seattle area.

That's a lot of yoga mats.

For her part, Hayo, 33, learned yoga is more than meets the physical plane and any form of the seemingly undoable lotus position.

"The name, '8 Limbs,' comes from the eight principles of yoga," Hayo said. "As you practice yoga, you can begin to feel the physical, emotional, mental and energetic benefits."

There are different interpretations, but fundamentally the "eight limbs" of yoga include body postures, breathing exercises or control of "prana," personal observances, control of the senses, concentration and inner awareness, devotion or meditation, universal morality and union with the divine.

Hayo acknowledged that most of us would recognize the body postures, breathing and meditation components. The remaining "limbs" are less familiar but powerful, even if you commit to just minutes of yoga daily or one session a week.

The ideal strategy for yoga novices is a one-on-one session with an instructor -- "it will cost about the same as an appointment with your massage therapist," Hayo said. But you can certainly get an energy boost from a beginner's class at your local yoga studio (look for a teacher who offers different versions of the same posture depending upon experience and fitness level).

Or you can begin with the "downward-facing dog" pose, which Hayo said is one of the "inversion" postures that can instantly energize the body.

Yoga brings balance, said Hayo, who works with numerous clients to match a customized set of postures to their needs. "The downward dog can help if you feel tired or anxious (or both)."
The downward dog is a more accessible version of the handstand or headstand, which likely most American adults have not done since, oh, fifth grade. Yet maybe there is more to those childhood handstands than just playing or showing off.

"I have teacher who calls headstands and handstand the 'yogi's coffee,' " Hayo said.

The downward dog pose looks, not surprisingly, a lot like a dog stretching its paws in front and its rear high in the air. For us humans, it starts with putting your hands in alignment with your shoulders and hips as you move to hands and feet on the floor. Novices often spread the hands too far apart and the feet too close together.

Next, as you come into all fours, place your knees under your hips and gently extend your spine. As you put your hands on the mats, spread the fingers a bit with the middle finger straight ahead.

Lift your pelvis toward the ceiling and pull the hips back. Your eyes look to the feet. The feet are even with the hips. Resist moving them closer to the hands just put the heels down. If your heels don't touch, they will if you do the downward dog regularly.

Hayo said a good practice is to hold the posture for five slow, purposeful breaths.
"Keep at it," she said. "You will get mental clarity while in the pose. I tell students to experience it until it feels right. You will know."

What keeps yoga regulars coming back is, to be sure, a combination of results. But one of the most satisfying is increased energy, not just after class but the rest of the day or week. You feel more clear-headed. You stand more upright. There is less tiredness midday. Who can resist that in today's hurly-burly?

Well, there is one problem. You might call it the Foot-and-Leg-Over-the-Head mental block.
To that end, 8 Limbs and other local yoga studios are eager to attract beginners with basics classes and special weekend workshops, such as the "Yoga for Men" class, 2:30 to 4:45 p.m. at the 8 Limbs center in West Seattle, on May 18. Instructor Greg Owen will be working to help reluctant men get past "what they feel is their lack of flexibility."

Owen plans to help men connect yoga movement and breathing with ways to ease the strain and pain of "sore lower backs, tight hamstrings and stiff shoulders."

A good deal for at least four limbs.

Stress in the Workplace

The longer he waited, the more David worried. For weeks he had been plagued by aching muscles, loss of appetite, restless sleep, and a complete sense of exhaustion. At first he tried to ignore these problems, but eventually he became so short-tempered and irritable that his wife insisted he get a checkup.

Now, sitting in the doctor's office and wondering what the verdict would be, he didn't even notice when Theresa took the seat beside him. They had been good friends when she worked in the front office at the plant, but he hadn't seen her since she left three years ago to take a job as a customer service representative.

Her gentle poke in the ribs brought him around, and within minutes they were talking and gossiping as if she had never left.

"You got out just in time," he told her. "Since the reorganization, nobody feels safe. It used to be that as long as you did your work, you had a job. That's not for sure anymore. They expect the same production rates even though two guys are now doing the work of three.

We're so backed up I'm working twelve-hour shifts six days a week. I swear I hear those machines humming in my sleep. Guys are calling in sick just to get a break. Morale is so bad they're talking about bringing in some consultants to figure out a better way to get the job done."

"Well, I really miss you guys," she said. "I'm afraid I jumped from the frying pan into the fire. In my new job, the computer routes the calls and they never stop. I even have to schedule my bathroom breaks.

All I hear the whole day are complaints from unhappy customers. I try to be helpful and sympathetic, but I can't promise anything without getting my boss's approval. Most of the time I'm caught between what the customer wants and company policy.

I'm not sure who I'm supposed to keep happy. The other reps are so uptight and tense they don't even talk to one another. We all go to our own little cubicles and stay there until quitting time. To make matters worse, my mother's health is deteriorating. If only I could use some of my sick time to look after her.

No wonder I'm in here with migraine headaches and high blood pressure. A lot of the reps are seeing the employee assistance counselor and taking stress management classes, which seems to help. But sooner or later, someone will have to make some changes in the way the place is run."

Job stress can be defined as the harmful physical and emotional responses that occur when the requirements of the job do not match the capabilities, resources, or needs of the worker. Job stress can lead to poor health and even injury.

The concept of job stress is often confused with challenge, but these concepts are not the same.

Challenge energizes us psychologically and physically, and it motivates us to learn new skills and master our jobs. When a challenge is met, we feel relaxed and satisfied. Thus, challenge is an important ingredient for healthy and productive work. The importance of challenge in our work lives is probably what people are referring to when they say "a little bit of stress is good for you.

But for David and Theresa, the situation is different-the challenge has turned into job demands that cannot be met, relaxation has turned to exhaustion, and a sense of satisfaction has turned into feelings of stress. In short, the stage is set for illness, injury, and job failure.

Nearly everyone agrees that job stress results from the interaction of the worker and the conditions of work. Views differ, however, on the importance of worker characteristics versus working conditions as the primary cause of job stress. These differing viewpoints are important because they suggest different ways to prevent stress at work.

According to one school of thought, differences in individual characteristics such as personality and coping style are most important in predicting whether certain job conditions will result in stress-in other words, what is stressful for one person may not be a problem for someone else. This viewpoint leads to prevention strategies that focus on workers and ways to help them cope with demanding job conditions.

Although the importance of individual differences cannot be ignored, scientific evidence suggests that certain working conditions are stressful to most people. The excessive workload demands and conflicting expectations described in David's and Theresa's stories are good examples. Such evidence argues for a greater emphasis on working conditions as the key source of job stress, and for job redesign as a primary prevention strategy.

Solvents in the Workplace

A solvent is a liquid that can dissolve another material. In industry the term solvent is generally applied to the kinds of substances known as "organic solvents" that are widely used to dissolve organic chemicals such as oils and resins.

Examples of such solvents include kerosene, acetone, petroleum distillates and naphthas. Potential solvent uses are limitless and include degreasing, cleaning, stripping, thinning and finishing. Solvents are used extensively in many industries.

How Can Exposure To Solvents Affect Health?

Excessive solvent exposures can lead to health problems.

Solvents are ABSORBED (enter the body) by the following routes:

Inhalation

This is the most important route of exposure for most solvents. Once inhaled, the vapors which arise from solvents can directly irritate the upper respiratory tract (nose, throat and bronchial tubes) and the lungs. Solvent vapors can also be easily absorbed from the lungs into the bloodstream and travel to other parts of the body to produce additional harmful effects.

Skin Contact

Solvents can be absorbed through the skin and travel to other parts of the body. Solvents can also break down the natural protective oils and fats of the skin. This can cause the skin to become dry, cracked and inflamed.

Mouth Contact

Solvents can enter the body and bloodstream through the mouth and digestive system. Although not a common route of entry, mouth contact with contaminated hands, food and cigarettes can occur and be dangerous.

Health Effects Are Dependent On What Factors?

Toxicity of the solvent.
Route of exposure.
Amount of exposure.
Individual worker's susceptibility.
Combination with other chemical exposures.

All of these factors are important in determining whether a person will experience any damaging health effects from solvent exposures. For example, a worker who already has respiratory breathing problems, such as asthma, may experience breathing difficulties while working around solvent vapors that do not produce any health effects in a person without respiratory problems.

What Acute (Short-Term) Effects Can Occur?

Solvent health effects that are ACUTE follow a single or short-term chemical exposure and usually occur soon after the exposure. Acute effects generally last only minutes, hours or days and are reversible once the exposure is over. Since they occur shortly after exposure, they are more easily identified. Common acute effects from solvent exposure include:

Respiratory Irritation

Exposure to solvent vapors can irritate respiratory mucous membranes. This can produce a burning sensation of the nose, throat or chest and lead to coughing. Inhalation of very high concentrations of solvents may result in severe irritation of the lungs and a condition called pulmonary edema, or fluid in the lungs. Symptoms of pulmonary edema include coughing and difficulty in breathing and require prompt medical attention.

Eye Irritation

Exposure to high concentrations of solvent vapors may produce eye irritation. This can lead to burning, tearing, and painful eyes. Dermatitis. Acute contact with a solvent can cause a breakdown of protective fats and oils in the skin. Skin may become reddened, itchy, and blistered. Central Nervous System Depression. The central nervous system consists of the brain and spinal cord. Solvent exposure can affect the brain like alcohol and lead to a state similar to being drunk. Large exposures can produce central nervous system effects including euphoria, feeling "high," dizziness, lack of coordination, headaches, fatigue and nausea.

Heart Arrhythmia

Solvents, particularly chlorinated hydrocarbons (those with chlorine molecules attached to carbon), can increase the irritability of the heart muscle at high exposure levels. This can lead to irregular heartbeats called cardiac arrhythmia.

What Chronic (Long-Term) Effects Can Occur?

Solvent exposures can produce CHRONIC health effects, which occur after repeated exposures and are often long-lasting or irreversible. Symptoms may appear gradually, so they may be initially ignored. This can make it hard to identify the chronic health problems related to solvent exposure.

Chronic health effects include:

Respiratory Effects

Repeated irritation of the respiratory tract may result in bronchitis and produce symptoms of chronic cough and sputum production. Dermatitis. Long-term exposure can lead to chronic dermatitis. The skin can become dry, thickened, cracked, hardened and flaky.

Nervous System

Most organic solvents affect the central nervous system, primarily the brain. With increasing levels of exposure, these effects include feeling "high," irritability, nervousness, weakness, tiredness, dizziness, sleeplessness, disorientation, confusion and even unconsciousness.

Long-term exposure has been associated with effects such as difficulty in thinking and personality changes. A few solvents, such as n-hexane and methyl n-butyl ketone, can damage the peripheral nerves, which are nerves to sensory organs and muscles. Symptoms of nerve damage include pain, loss of sensation, and weakness, usually beginning in the toes, then the fingers and moving up the legs and arms.

Liver

Some solvents, particularly chlorinated types, can damage the liver, causing a type of hepatitis. There may be no symptoms. If there are symptoms, they may include: nausea, pain in the right side, yellow skin and eyes, dark urine and light-colored bowel movements. Hepatitis may be detected by blood tests of liver function.

Blood

A few solvents, such as glycol ethers, affect the blood, either by damaging blood cells that are circulating in the body or decreasing the production of new blood cells. There usually are no symptoms until blood counts are extremely low, resulting in tiredness or infections. Benzene is one solvent that is known to be particularly dangerous; it can cause anemia (low blood counts) and also leukemia (cancer of the white blood cells).

Reproductive Effects

Although chemicals may affect reproduction in females and males, there are no definitive studies that demonstrate the effects of solvents on human reproduction. Cancer. Benzene is the only commonly used solvent that has been associated with cancer in exposed workers. A number of other solvents, including carbon tetrachloride, chloroform, 1,4-dioxane and trichloroethylene have caused cancer in laboratory animals. Vinyl chloride has been known to cause angiosarcoma of the liver in humans.

What Should You Do If You Develop Symptoms That May Be Related To Solvent Exposure?

Inform your employer and consult a physician. Many health problems that can be related to solvent exposures can also be caused by other medical problems which may need immediate treatment. Special laboratory tests can be performed to assess solvent exposures.

How Can Exposure To Solvents Be Reduced or Prevented?

The best way to guard against the harmful health effects of solvents is to prevent or minimize exposure. As a first step, be aware of the hazards and safe handling procedures for materials on the job. This information must be available to you and usually is provided in Material Safety Data Sheets (MSDS), employer instructions and container warning labels.

Secondly, use the procedures and equipment that are available. Employers are responsible for providing safe work conditions.

The most important ways of preventing exposure are:

• Substitution of a solvent with a less hazardous substance.
• Enclosure of the process or containers where the solvent is being used (so it never enters the air you breathe).
• Exhaust ventilation systems that function effectively.
• Redesign of a process (to eliminate a step releasing vapors or requiring liquid contact).
• Personal protective equipment (should be used only when engineering controls such as enclosure of a process are not feasible).
• Respirators should be worn as a part of a comprehensive respiratory protection program. Other protective gear such as gloves, aprons, goggles and face shields should be used when appropriate.
• Good housekeeping practices (essential to ensure exposures are minimal).

What Other Hazards Are Posed By Solvents?

Solvents can be flammable or explosive, and exposing them to flame or hot surfaces can also form highly toxic decomposition products. Ignition sources such as welding torches, lit cigarettes and sparks should be kept away from solvent use and storage areas. I

n addition, some chemicals are incompatible with solvents and mixing will produce toxic gases, heat or fire. Oxidizers (e.g., sodium chlorate) and strong acids and bases (e.g. sulfuric acid, sodium hydroxide) should never come in contact with solvents. Refer to Material Safety Data Sheets or chemical suppliers' information for special hazards.

Protecting your ears

The safest way to protect your ears is to always wear hearing protectors anytime you are around loud noises. You can protect your ears by wearing special earplugs or special earmuffs. There are hundreds of kinds available. There are formable earplugs you can mold to your ears and premolded earplugs that come in several sizes. There are canal caps that are attached to headbands and are very convenient if you work in intermittent noise where you need to take your earplugs on and off throughout the day. Some earplugs have stems so you can insert them without touching the part that goes inside your ear. You can also get earplugs custom molded to fit your ear. Earmuffs come with large and small earcups, different types of headbands, and different types of ear cushions. There is something for everyone and for every environment.

Ventilation for Airborne Hazards.

A good ventilation system at your work site is an effective method of keeping both toxic and nuisance materials out of the air and out of your lungs. Some toxic materials capable of causing chronic lung disease, if inhaled in large enough quantities, include asbestos fibers, chlorine, silica dust (silicon dioxide) and arsenic fumes. Examples of nuisance materials (those that don't usually have a bad effect on the lungs when exposures are kept under reasonable control) include cellulose fibers, glycerin mist, limestone, plaster of paris and tin oxide.

The first step in keeping the air clean is to prevent materials from escaping from their containers by using covers and lids. Solvent vapors can be kept out of the air by keeping solvent tanks covered when not in use. Furthermore, airborne dust levels can be reduced by keeping operations which generate dust, such as sandblasting operations, separated from other work areas.

However, when it is not possible to keep toxic materials contained, it is important to remove dirty or contaminated air from the work area and replace it with clean air.

How Should Dirty Air Be Removed From The Workplace?

The best way to remove contaminated air from the work area is with the use of what is called "local exhaust ventilation." Typical window or cooling fans were not designed to remove contaminated air from individual work areas and are not recommended for this purpose.

What Is Local Exhaust Ventilation?

Local exhaust ventilation is an effective method for removing airborne toxic or nuisance materials at their point of origin, thereby preventing them from entering your lungs. Examples of processes that use local exhaust ventilation include welding and grinding operations. To be effective, a local exhaust ventilation system should include: 1) a collector or hood, 2) ducts to carry the air, 3) the right choice of fan, 4) a device to clean the air if required, and 5) exhaust system.

What Should You Do To Use A Local Exhaust Ventilation System Correctly?

Simple but important points in working with a local exhaust ventilation system include:

Try not to put yourself between the source and the opening of the air exhaust hood. If you do this, you will breathe contaminants as they are drawn into the hood.

• Do not block fresh air supply for the workroom.
• Do not block or obstruct hoods.
• Protect ventilation ducts from damage and holes.
• Keep operation close to the hood to improve capture of vapors and fumes.
• Be aware of special precautions required when ventilating potentially explosive or corrosive vapors.
• Prevent recirculation of exhaust air back into the workplace.
• Evaluate the ventilation system periodically to ensure it is operating as designed.
  

What If You Have Problems With The System?

Problems can occur with ventilation equipment, like any other tool used at work. Contact your employer if you experience problems with a ventilation system. Most often a routine maintenance program of cleaning out ducts, replacing fan blades and repairing leaks will restore a system to full operation.