Tomatoes May Not Be Only Source of Salmonella Outbreak

(HealthDay News) -- Experts at the U.S. Centers for Disease Control and Prevention now say they're no longer sure that the nationwide salmonella outbreak is due to tomatoes alone, or some other food source.

"Whatever this produce item is that's causing illness is probably still out there making people sick," Dr. Patricia Griffin, chief of the Enteric Diseases Epidemiology Branch at the CDC, told reporters late Friday at a special press teleconference. She did not say what source other than tomatoes, if any, might be suspected.

The number of people sickened in the outbreak has now jumped to 810 across 36 states, according to the latest CDC numbers presented Friday.

Health officials said the most recent reported case of infection with Salmonella Saintpaul occurred June 15. However, more illnesses may be waiting to be identified: According to experts, it typically takes an average of 16 days before doctors can pinpoint the onset of an infection.

The exact source of the outbreak remains unknown. Tomatoes are still considered the most probable cause, stressed Dr. David Acheson, the U.S. Food and Drug Administration's associate commissioner for food protection.

"The most recent case appeared to have onset just 12 days ago, and that raises the question is there something still out there that people are consuming that is leading to illness," he said. "Just because the outbreak is ongoing doesn't mean it can't be the tomatoes. It certainly could be the tomatoes, there's nothing to indicate that we should be looking at anything else," he said.

"We have no evidence that the outbreak is over... I would say that the source of contamination has been ongoing at least through early June and we don't have any evidence that whatever the source is has been removed from the market," Griffin said.

One factor complicating the search for the cause of the outbreak is a common industry practice called "repacking."

"Repacking is a situation in which a supplier or a distributor will repack tomatoes to meet a specific customer's request," Acheson explained. "So, if a customer is wanting small, ripe tomatoes and the supplier does not have a box of small ripe tomatoes, then they will typically go through multiple boxes and pull out ones that meet customers' specifications and repack them. It's a very, very common practice. We've seen reports that it may be as common as 90 percent of tomatoes get repacked, but we don't have confirmation that the number is that high. Obviously this complicates the trace-back," Acheson said.

He also said that it was possible that tomatoes were contaminated at a packing and distribution center, not a particular farm. That means that produce from states that have been cleared may have gone through packing or distribution houses elsewhere, and become contaminated there.

The food poisoning scare ranks as the largest on record in terms of illnesses linked to tainted produce, the CDC said. "This is so far the biggest outbreak with this number of illnesses confirmed by culture," Griffin noted.

More than 300 of the total cases from the current outbreak come from Texas. Patient ages range from under 1 year old to 99 years old. Half the victims are women.

In addition, at least 95 people have been hospitalized; there have been no deaths, the CDC reported.

The FDA had sent teams of investigators to Florida and Mexico as of last weekend to inspect farms, packing houses and distribution centers. There has been no word yet on what has been found.

The increase in people sickened by salmonella was not unexpected. Three weeks ago, the count was below 200; it jumped to more than 380 a week later.

The CDC had predicted last week that for every reported case, there would be 30 more that had gone unreported.

And health officials had warned that the end was not yet in sight.

"The marked increase is not due to new infections, but mainly because some states improved surveillance in response to this outbreak, and laboratory identification of many other previously submitted strains has now been completed," said Casey Barton Behravesh, an epidemiologist with the U.S. Centers for Disease Control and Prevention, during a June 19 teleconference.

According to the numbers on the CDC's Web site -- which do not include the latest cases -- the victim count breaks down by state to: Arkansas (10 persons), Arizona (38), California (10), Colorado (6), Connecticut (4), Florida (1), Georgia (15), Idaho (3), Illinois (66), Indiana (11), Kansas (11), Kentucky (1), Maryland (25), Massachusetts (17), Michigan (4), Missouri (12), New Hampshire (3), Nevada (4), New Jersey (4), New Mexico (80), New York (18), North Carolina (5), Ohio (3), Oklahoma (17), Oregon (7), Pennsylvania (6), Rhode Island (3), Tennessee (6), Texas (330), Utah (2), Virginia (22), Vermont (1), Washington (4), Wisconsin (6), and the District of Columbia (1).

On June 20, Acheson said the investigation into the outbreak had zeroed in on "a number of farms" in both Florida and Mexico.

Health officials have said all along that the bulk of the tomatoes available at the start of the outbreak in mid-April had come from Mexico and parts of Florida.

Salmonella is a bacteria that can cause bloody diarrhea in humans. Some 40,000 cases of salmonellosis are reported in the United States each year, although the CDC estimates that because milder cases are not diagnosed or reported, the actual number of infections may be 30 or more times greater. Approximately 600 people die each year after being infected.

However, the strain of Salmonella Saintpaul had been previously considered rare. In 2007, according to the CDC, there were only three people infected in the country during April through June.

More information
Visit the CDC for more on the salmonella outbreak.

MS Patients at Higher Risk for Restless Legs Syndrome

(HealthDay News) -- People with mltiple sclerosis is are at a greater risk than the general population for developing rstless legs syndrome (RLS), a new Italian study suggests.

"This is important, because RLS is one of the symptoms that can seriously affect an MS patient's quality of life, even more than a lot of other problems MS patients face," said lead researcher Dr. Giovanni Cossu, a neurologist at Brudzu Hospital in Cagliari, Italy. "Therapies for RLS [such as] dopamine agonists are normally very effective and can restore this quality of life, " he added.

Cossu and his colleagues were expected to present their findings this week at the Movement Disorder Society's International Congress of Parkinson's disease and Movement Disorders, in Chicago.

The authors delved into a possible association between MS and RLS by analyzing questionnaires completed by a little more than 200 Italian male and female MS patients throughout 2007, as well as a similar number of people without MS.

Those indicating symptoms of possible RLS were further examined by a neurologist.

According to the study, almost 15 percent of the MS patients were diagnosed with RLS, while less than 3 percent of those without MS had the syndrome.

Based on these results, MS patients run a significantly higher risk for RLS than the general population, the team concluded. They said MS should be "definitively" noted as being highly associated with RLS.

Cossu said that further research -- focused on crunching MRI and neurological data -- is ongoing in order to "better define the clinical profile of those MS patients who are also likely candidates for RLS."

However, Dr. John Richert, executive vice president of research and clinical programs with the National Multiple Sclerosis Society, New York City, expressed some reservations about the findings.

"A lot of people with MS have involuntary movement of the legs, related to spasticity and jerks during sleep," he observed. "So, my question would be whether or not there is any confusion on the part of the investigators as to what is actually RLS versus what is the kind of abnormal movement that MS patients can have that is not RLS? And so, it would be important to see this study replicated by MS experts to be sure what were looking at."

"But if we assume that this finding is, in fact, accurate, then the obvious message would be that health care professionals taking care of patients with MS need to be alert to the possibility that their patients may be experiencing symptoms of RLS," added Richert. "And be ready to apply the appropriate therapeutic options."

More information
There's more on restless legs syndrome at the RLS Foundation.

Is Your Church Making You Fat?

By Andrea Useem

Plenty of studies have looked at whether being religious improves your health (in the U.S. at least, the current answer is a qualified yes), but Purdue University sociologist Ken Ferraro took a serious look at a different question: How does being religious affect your body mass index (BMI)?
In a 2006 study, Ferraro discovered that Baptists, including Southern Baptists, were most likely to be obese, even when geographic factors were controlled for (i.e., it wasn’t just the southern cookin’). “[Conservative] Protestants tend to have the highest BMIs,” he told me when I called him last week. The explanation? Ferraro has several guesses. Read More

Diabetes: The 2-for-1 Special

By Sean Kelley

In the past few weeks, there have been news stories linking type 2 diabetes to a host of other conditions. We’ve known for a long time that type 2 diabetes was a risk factor for heart disease and stroke, that it’s associated with obesity, and that diabetics can also have depression, erectile dysfunction, and a host of other complications.
What has been less clear (but is becoming more so by the day) is that other diseases can often be a gateway to diabetes. On June 17, researchers at Johns Hopkins University released a study showing that patients with depression have a higher risk of diabetes. A week before that, the International Diabetes Federation issued a statement recommending that patients with obstructive sleep apnea be screened for metabolic disease and type 2 diabetes. Read More

Is My Food-Allergy-Prone Child Getting His Vitamins?

By Sean Kelley

When our 19-month-old son Graeme was diagnosed with food allergies, our allergist sent home excellent documentation on what foods to avoid. Her goal: Prevent the kind of reaction that results in Graeme scratching himself bloody (see photo).

She told us what he couldn’t eat. But she didn’t tell us what we should feed him. When your child has multiple food allergies, the list of dietary options shrinks. I knew things were going to be a challenge as soon as corn, soy, and wheat popped up on his chart. Still, I was dumbfounded by the response of our allergist. Read More

Test-Driving the Wii Fit: Whee!

By Scott Mowbray

Ten minutes after we turned on the Nintendo Wii Fit, my 17-year-old daughter and I reached a verdict: This thing is crazy fun and plausibly healthy. You may be hankering for one of these machines already—there has been no shortage of fuss since the late-May release of the Fit—but I’m here to validate the hankering. I’ve never bought a video game—until now. Read More

Lifestyle Counseling Reduces Heart Risk

(HealthDay News) -- An intensive, across-Europe effort to offer lifestyle advice to people at high risk of heart disease effectively helped them reduce such risk factors as high blood pressure, cholesterol and smoking.

"The results we see are very encouraging compared to what we see in usual care," said Dr. David Wood, a cardiology professor at Imperial College in London and the lead author of a report on the trial in the June 13 issue of The Lancet.

But, he added, "there is certainly room for improvement, particularly in relation to helping patients quit smoking."

The program, mainly run by nurses, was developed by the European Society of Cardiology and tested on more than 5,000 people in six pairs of hospitals and six pairs of general practice in eight countries.

"It was for two groups of patients," Wood said. "One was those who already had developed coronary heart disease, another those who were asymptomatic but at high risk because of a combination of risk factors that gives a high chance of developing heart disease over 10 years."

The trial, called the Euroaction study, compared the results of added counseling on lifestyle issues such as diet, physical activity and smoking to the usual care. It included more than 3,000 people with coronary heart disease and 2,300 at high risk. Half got the counseling from a team headed by nurses, assisted by dietitians and physiotherapists, with doctors in the background. The counseling was given to families as well as individuals.

"It was the nurses who coordinated the day-to-day program, with a comprehensive assessment of lifestyle and risk factors such as blood pressure and glucose," Wood said.

In diet, 55 percent of those getting the counseling reduced their intake of saturated fat, compared to 40 percent for those note getting the advice. Increased consumption of fruits and vegetables was seen in 72 percent of the counseled group, and 17 percent of them also increased their consumption of heart-friendly oily fish, compared to 35 percent and 8 percent in the other group.

Similar results were seen for blood pressure, cholesterol and physical activity, but it proved difficult to have people seen in general practice quit smoking, Wood said.

"But the fact that we ran it in eight countries and both in general hospitals and general practice means that we have demonstrated that this nurse-administered program is practical," he said. "We are looking at cost-effectiveness at this moment, and the early data suggest that it is cost-effective in preventing heart attack and stroke."

"What really was new here was that they actually made an effort to give the advice we know should be given but often isn't," said Dr. Dariush Mozaffarian, an assistant professor of medicine at Harvard Medical School and the Harvard School of Public Health, who wrote an accompanying comment in the journal.

While there have been many trials aimed at improving drug treatment in cardiology, "there are few trials in getting doctors and patients to concentrate on lifestyle," Mozaffarian said. "This shows that a relatively modest intervention can bring dramatic improvements in lifestyle."

However, he added, it's not clear whether such a program could be started in many U.S. hospitals and medical practices. "In principle, every physician should be doing it," he said. "But the system would have to change."

For such a program to work, Mozaffarian said, "policy makers, insurance companies and indicators of quality would have to focus on lifestyle and stimulate hospitals to put preventive measures into place."

More information
Recommendations on a healthy diet and lifestyle are given by the American Heart Association.

Let My Nipples Go! In Praise of the Liberated Nip

By Anne Krueger

I don’t know about you, but my nipples have rarely stood at attention to the extent that they need “maximum coverage.” There was that one time when my breast-feeding daughter Hoovered one nipple so hard that I thought my left boob would forever be entering the room six inches ahead of the rest of me…but usually my nips are pretty calm.
That’s why I’m kind of amazed at the wide selection of nipple camouflage on the market, from the Victoria’s Secret IPEX bra with its “patented graduated pads seamlessly integrated at the apex of the bra cup for maximum nipple coverage” to stick-on concealers. Read More

Zimbabwe Crackdown: The Cruel Politics of Refusing Relief

By Scott Mowbray

Earlier this week came the shocking news that the government of Zimbabwe had halted the relief operations of CARE because workers for the aid organization have allegedly been involved in supporting opposition to President Robert Mugabe (a few days later, the government extended the ban to all aid groups). As a former CARE kid (my father worked for more than 13 years in countries such as Afghanistan and Indonesia), this story was sickening to read. CARE and organizations like it provide relief to people in the most dire situations on Earth. I have seen children eating CARE food who otherwise might have starved, and I’ve seen kids given rehydration medicine who probably would have died from diarrhea. CARE’s work in Zimbabwe is reported to reach 500,000 people. Read More

Insomnia at Menopause: Learning to Love My Inner Teenage Night Owl

By Sally Chew

I didn’t mind being an insomniac when I was in high school. Wandering around the house in the middle of the night was annoying, but so was everything else. Besides, like most teenagers (and owls and vampires), I slept fine during daylight hours. Now, as I approach menopause, I find myself returning to those restless teenage nights.

After decades of deep sleep, I’m wide awake again and not amused. Friends traveling with me recently threatened to hit me over the head if that’s what it took to put me out. Read More