Good Health And Wellness For Life

8 Democrats Pose Hurdle for Children’s Health Bill

WASHINGTON, Nov. 14 — Congressional efforts to expand the State Children’s Health Insurance Program have run into a new roadblock. Eight Democratic senators say they cannot support any compromise that limits their states’ ability to cover parents along with children.

Democratic leaders had been considering such a compromise. But in their effort to mollify Republicans, the Democrats have begun to alienate some members of their own party on this and other issues.

The eight senators told Democratic leaders this week that they could not support any bill if their states lost money for the coverage of parents.

A compromise bill must “protect state flexibility to cover parents,” the senators said in a letter to Speaker Nancy Pelosi of California and the House majority leader, Steny H. Hoyer of Maryland. “Our states have taken the lead to provide health care to this specific population, and we do not want to inhibit their ability to continue providing this important coverage.”

The letter is signed by senators from five states that together cover more than 250,000 parents. The senators are Amy Klobuchar of Minnesota, Frank R. Lautenberg and Robert Menendez of New Jersey, Jeff Bingaman of New Mexico, Jack Reed and Sheldon Whitehouse of Rhode Island, and Russ Feingold and Herb Kohl of Wisconsin.

Republicans said they could not believe that these senators would walk away from a deal if they did not get what they wanted for the coverage of parents.

But in their letter, the Democratic senators warned Congressional leaders against “further compromise,” saying it would erode their support for the bill.

President Bush and Congressional Republicans say that covering adults, including parents, violates the purpose of the program, which is to cover children.

But Senator Bingaman said, “Parent coverage is an important part of keeping families healthy, and I don’t believe we should roll back the gains we’ve made in this area.”

Some state officials agree. “When you cover parents, you get more children enrolled,” said Heather Howard, policy counsel to Gov. Jon Corzine of New Jersey, which has 83,200 parents and 112,200 children in the program.

House Democratic leaders have been in intensive negotiations with Republicans since Oct. 18, when the House sustained Mr. Bush’s veto of a bill to expand the child health program. By revising the bill to address Republican concerns, the Democratic leaders hope to pick up enough votes to override another veto.

In an interview, Representative Carolyn Cheeks Kilpatrick, chairwoman of the Congressional Black Caucus, said she was disappointed that Democratic leaders had been “negotiating with 15 or 20 House Republicans, not the 43 members of the black caucus” who have deep concerns about some of the proposed changes.

“We have not been involved,” said Ms. Kilpatrick, Democrat of Michigan.

One of the Republicans’ chief concerns is that the bill “would provide free taxpayer-funded health care to illegal immigrants,” in the words of Representative Marsha Blackburn, Republican of Tennessee. The bill itself says that nothing in the legislation allows federal payment for illegal immigrants, but that is not enough for some Republicans, who want to establish tougher requirements for low-income families to prove they are citizens or legal immigrants.

Hispanic Democrats are balking at the proposed “citizenship documentation” requirements. Representatives Joe Baca and Hilda L. Solis, California Democrats who are leaders of the Congressional Hispanic Caucus, said that such requirements, though aimed at illegal immigrants, would hurt citizens unable to produce birth certificates or other documents.

Cecilia Muñoz, a vice president of the National Council of La Raza, a Hispanic rights group, said: “The whole purpose of this legislation is to cover more children. Under some of the concessions being offered by Democratic leaders, we may end up covering fewer Latino and black kids.”

Ms. Pelosi and Mr. Hoyer said they were still firmly committed to covering 10 million children. “That is not subject to negotiation,” Mr. Hoyer said Wednesday.

Fitness: The Fonda Factor

IF Debbie Hollingshead hadn’t fallen in love with Cathe Friedrich’s hairdo — a soft, feathered pixie cut evocative of Dorothy Hamill — her life would not be what it is today.

After stumbling across a photograph of Ms. Friedrich in a fitness magazine in 1999, Ms. Hollingshead showed the picture to her stylist and asked him to replicate it. Later, she logged on to Ms. Friedrich’s Web site, Cathe.com, to see the woman behind the hair: a hard-bodied mother of two, who has been a video fitness star for more than two decades. Ms. Hollingshead bought a DVD, and that was the beginning of a beautiful relationship.

“I get a better workout with Cathe than I’ve gotten anyplace else,” said Ms. Hollingshead, 54, an aerobics teacher in Uniontown, Ohio. “She’s incredible.”

Incredible. Awesome. Amazing. These are just some of the adjectives grown women use to describe the fitness instructors who motivate them while they exercise at home. Despite the easy availability of group fitness classes and online workouts, many women over 35 prefer to exercise in private, with an instructor who can guide them past the burn of a deep lunge. Their fearless leaders are not perky 22-year-olds with dewy faces, but women in their 40s. In this world, the real stars are less pretty young thing and more yummy mummy.

Among them is Ms. Friedrich, 43, the aerobics boot-camp-and-kickboxing queen who has released more than 80 videos and DVDs since 1989 and has taught on FitTV, part of the Discovery network, three hours a day for the last four years. And Jari Love, 42, whose abs look as if they could deflect an oncoming bus and whose weight-training videos inspire an international following.

And, of course, the peppy “Walking Woman,” Leslie Sansone, 45, whose devoted power-walkers have even taken to following her around the supermarket. Her “Walk Away Your Waistline” was No. 6 in sales earlier this month at Collage Video, a fitness video clearinghouse in Minneapolis whose rankings have become an industry yardstick. (Ms. Love’s “Get Ripped and Chiseled” is No. 1, and Ms. Friedrich’s “4-Day Split” is No. 2).

Video

“Leslie had a way of touching me through her video that was incredible,” said Kathy Halderman, 39, an administrative assistant and waitress in Liberty Township, Ohio, who credits Ms. Sansone with the 250 pounds she lost over four years. “I began to cry during the first workout not just because it hurt physically, but she was touching my soul and making me feel like I had a purpose and everything she was doing I could do.”

The video fitness world has evolved since a soufflé-haired Jane Fonda in leg warmers released her first VHS in 1982. It is no longer enough to merely look good in spandex (though that’s clearly a requirement), so today’s video fitness stars are selling the idea that their bodies look buff despite their having given birth multiple times. That age has not withered them. That exercise — not plastic surgery or Botox — has given them that youthful glow. (Ms. Love, Ms. Sansone and Ms. Friedrich all insist that they have had no plastic surgery on their faces or bodies). And that their workout plan is the key.

Many of their acolytes are busy women who not only find it more efficient to exercise at home, but more comfortable. Lorrayne Schaeffer, 41, a computer engineer in San Diego, exercises only at home, and only with Ms. Friedrich. “I feel intimidated at a gym,” she said. “At home I can do it on my own time not have to compete for the equipment — just me and Cathe and the crew.”

According to Jill Ross, director of product acquisition at Collage Video, 8.5 million fitness DVDs were sold in the United States from July 2006 through June 2007; the average home video user is about 45, and most instructors don’t hit their stride with viewers until around age 37. “You need a certain commanding presence,” she said. “If Oprah was 22, would she be fun to watch?” (Incidentally, Ms. Ross said, brunet video stars generally are more popular than blond ones, because they are perceived as more serious.)

Many of those making popular DVDs, like Kathy Smith, now 55, and Denise Austin, 50, witnessed the birth of the fitness industry. “Back then, the industry was so young, and so were the people in it,” said Carol Scott, the president of ECA World Fitness, an industry organization that offers training and workshops for fitness professionals. “What’s happened is that the same people are still doing it.” Exercise video producers are having difficulty finding new talent, she said: “In years prior, there weren’t a lot of big chains, there were exercise studios. They mentored the instructors. It doesn’t really exist on the same level anymore.”

Whatever their experience, older video stars appeal to consumers on a visceral level. “If you’re down in your basement every morning following someone,” said Denise Brodey, the editor in chief of Fitness magazine, “you like the idea that they look like you.”

Or how you’d like to look, anyway. Jari Love is a walking — and sculpturing and toning — billboard for what women covet and has found success despite her blindingly blond hair. (For the record, the color comes from a bottle.) A former model, actress and singer, and now the mother of two, Ms. Love entered the video arena at 38, after teaching strength training and aerobics for almost 20 years at a fitness club in Calgary, Alberta, that she is a partner in.

Since the release of the first weight-training DVD, “Get Ripped!” in 2005, she has developed a wide following. Jeffrey Fergason, president of Razor Digital Entertainment, which distributes Ms. Love’s videos, said the four titles have sold more than 250,000 copies. Ms. Love, who said she once weighed 165 pounds, has nary a centimeter of fat on her 5-foot-7, 122-pound body.

This inspires consumers. “Young girls already have that nice tight figure,” said Nash Cajee, 33, a yoga teacher in Vancouver, British Columbia, who owns Ms. Love’s “Get Ripped!” weight-training series. “They don’t have a lot of cellulite or saddlebags. But Jari’s 10 years older than me.” The fact that she’s 42, Ms. Cajee said, “and has a way better body than I do — a body that I would only dream of having — that’s incredible in itself.”

Thanks to the Internet, video fitness devotees have a place to congregate, on sites like www.videofitness.com, to extol the virtues of their favorite teachers. Some fans even meet in person. Ms. Friedrich, who said she has sold more than a million DVDs since releasing her first one 18 years ago, has held five gatherings since 1998 (she calls them “road trips”) in her Glassboro, N.J., studio, where women from as far away as Uganda congregate to exercise with her in the flesh. The most recent road trip, in August, sold out in three minutes, attracting 105 women.

“It’s a testament of what a super awesome person and instructor she is,” said Ms. Schaeffer, the computer engineer, who has attended most of the road trips.

Other women swear by Leslie Sansone. Since releasing her first video in 1980, Ms. Sansone, a mother of three in New Castle, Pa., has made over 90 titles. According to her site, lesliesansone.com, her business is worth $200 million.

She is often stopped by fans in airports and on the street, and sometimes sneaks around the supermarket so she isn’t followed. Her biggest selling point is her “real woman” status, she said. “I didn’t go into the industry by saying, ‘Feel my rock hard abs, feel my muscles,’” Ms. Sansone said. “I’m allowed to age. I don’t believe people expect me to be perfect.”

Catherine Saint Louis contributed reporting

Four Transplant Recipients Contract H.I.V.

Four transplant recipients in Chicago have contracted H.I.V. from an organ donor, the first known cases in more than a decade in which the virus was spread by organ transplants.

The organs also gave all four patients hepatitis C, in what health officials said was the first reported instance in which the two viruses were spread simultaneously by a transplant.

Though exceedingly rare, this type of transmission highlights a known weakness in the system for checking organ donors for infection: the most commonly used tests can fail to detect viral diseases if they are performed too early in the course of the infection. Officials say the events in Chicago may lead to widespread changes in testing methods.

“There are important policy implications,” said Dr. Matthew Kuehnert, director of the Office of Blood, Organ and Other Tissue Safety at the federal Centers for Disease Control and Prevention, which is investigating the case. “Clearly, the organ transplant community is going to think about the issues raised by this, and we look forward to being involved in those discussions.”

The cases were first reported yesterday by The Chicago Tribune. Two patients were infected at the University of Chicago Medical Center, and one each at Rush University Medical Center and Northwestern Memorial Hospital. The transplants were coordinated by an organization called the Gift of Hope of Elmhurst, Ill.

Officials would not say what organs were transplanted, but a transplant expert not connected with the case said they were most likely the kidneys, liver and either the heart or lungs. Only four organs, and no other tissue, were taken from the donor.

The University of Chicago said that the operations took place in January, and that the donor was an adult who died in an Illinois hospital “three days after traumatic injury.” Neither the donor’s age nor sex were disclosed. The other hospitals declined to discuss what happened, except to confirm that each had an infected patient.

The situation came to light earlier this month when one of the recipients, who was being evaluated for a retransplant, tested positive for H.I.V. and hepatitis C. At that point, blood preserved from the donor was given a highly sensitive test for viruses, and the infection was found.

Dr. J. Michael Millis, the chief of transplantation at the University of Chicago, said the patients were devastated, and the doctors heartbroken. But Dr. Millis said the diseases were treatable.

Initially, the donor had tested negative for H.I.V. and hepatitis C, apparently because the infection was too recent to be detected by commonly used blood tests. Those tests do not find the virus itself, but instead look for the body’s reaction to the infection — the antibodies produced by the immune system. But the body takes time to react, and if the test is done too soon, within 22 days of H.I.V. infection or 82 days for hepatitis C, antibodies may not yet be detectable.

Doctors say that is what probably occurred in Chicago. It has always been known that this kind of transmission was theoretically possible, but it was considered highly unlikely. And indeed, since 1994 nearly 300,000 transplants from cadavers have occurred without any reported cases of H.I.V. transmission.

Another more sensitive type of test can pick up viral infections earlier, but was not used. That test looks for evidence of the virus itself, and can reduce the “window,” the early period in which the test does not work, to 12 days for H.I.V. and 25 days for hepatitis C.

That test, the nucleic acid amplification test, or Naat, is not widely available, and doctors said it was more difficult and time-consuming than other tests — and there is usually no time to spare with transplants because organs deteriorate quickly when the donor dies. Another concern is that the test is more likely than others to give false-positive results, and lead to the needless destruction of healthy organs, a scarce resource.

Dr. Robert Brown, director of the liver transplant program at NewYork-Presbyterian/Columbia said, “There is always a drive toward better testing, but if it leads to more organ wastage, we’ll probably hurt more people than we help.”

According to the University of Chicago, the organ donor in Illinois was known to be “high risk,” based on a risk factor revealed by a close friend who provided “a health and social history.” The exact nature of the risk was not disclosed. Federal guidelines recommend against transplanting organs from high-risk people unless the recipients are so likely to die for want of a transplant that H.I.V. seems a lesser threat.

Dr. Millis said that he did not know whether the patients there had been informed of the donor’s status.

About 9 percent of organ donors qualify as high-risk based on behaviors like prostitution or drug use with needle-sharing. Transplant experts say the percentage would probably be higher if they had full information on all donors.

Dr. Brown said Columbia got offers of organs from high-risk donors every week.

He also said that at Columbia, patients (or family members) were informed if a donor was high risk, and were required to sign a special consent form acknowledging it.

Dr. Millis said that although the organ supply was generally safe, he hoped it could be made safer, probably by developing regional centers around the country to perform Naat testing reliably and quickly enough to meet transplant needs.

Although it is rare, other diseases like rabies, West Nile fever and a rodent virus called LCMV have also been spread by organ transplants. In all of those cases, patients died.

Sharp Drop Seen in Deaths From Ills Fought by Vaccine

Death rates for 13 diseases that can be prevented by childhood vaccinations are at all-time lows in the United States, according to a study released yesterday.

The study, by the Centers for Disease Control and Prevention in Atlanta, and published in The Journal of the American Medical Association, is the first time that the agency has searched historical records going back to 1900 to compile estimates of cases, hospitalizations and deaths for all the diseases children are routinely vaccinated against.

In nine of the diseases, rates of death or hospitalization declined more than 90 percent since vaccines against them were approved, and in the cases of smallpox, diphtheria and polio, by 100 percent.

In only four diseases — hepatitis A and B, invasive pneumococcal diseases and varicella (the cause of chickenpox and shingles) — did deaths and hospitalizations fall less than 90 percent. Those vaccines are all relatively new — the one for chickenpox, for example, was adopted nationally only in 1995. Also, some diseases like hepatitis typically strike adults, who are less likely to be immunized.

The results “are a testament to the fact that vaccines can drive diseases down to near nil,” said Dr. Gregory A. Poland, chief of the vaccine research group at the Mayo Clinic.

And Dr. Robert W. Sears, an Orange County, Calif., pediatrician who writes popular medicine books for parents, including a new one on vaccines, said the study showed “one of the very positive aspects of vaccination.”

Public health officials are involved in a continuing struggle with antivaccine activists who contend that children’s shots trigger autism, seizures or other serious side effects, and that private pediatricians often cannot make time to answer all the questions worried parents have, Dr. Sears said.

A spokesman for the disease control agency, Curtis Allen, said the study was not done to counter groups that oppose vaccines, “but it does show conclusively the value of vaccines.”

It was in 1796 when Dr. Edward Jenner first vaccinated a boy against smallpox by pricking his arms with pus taken from the sores of a milkmaid with cowpox, a closely related but mild disease. Vaccines against whooping cough were introduced in 1914, against diphtheria in 1928, against tetanus in 1933, and so on, up to the latest introduction, seven years ago, of the pneumococcal vaccine.

The centers’ study estimates the peak years for deaths from each disease: more than 3,000 deaths from polio in 1952, for example, and more than 7,500 from whooping cough in 1934.

But as fewer parents see children killed, scarred or brain-damaged by diseases that were once common, “there’s been a shift in who’s not getting vaccinated,” said Dr. Paul A. Offit, chief of diseases at Children’s Hospital in Philadelphia and a vaccine expert.

Until the 1990s, Dr. Offit said, incomplete vaccination was most common among poor children with no health insurance. But the Vaccines for Children Program, created in 1994 by the Clinton administration, helped end that. It provides vaccines free to any eligible child, which includes 45 percent of American children, Mr. Allen said.

Now, Dr. Offit said, it is more common for children from wealthy or middle-class families to lack some or all shots, presumably because their parents have read about side effects or visited one of the many antivaccine Web sites.

Most children are immunized as part of routine infant care or before they enter day care or school, but the number of states that allow religious or “philosophical” exemptions has increased.

Public health officials worry that those children are vulnerable to diseases that still kill children in poor countries and occasionally arrive from abroad.

The study showed total or near-total declines in cases of diphtheria, measles, polio, rubella, smallpox and invasive Hib disease, a type of pneumonia for which children are now normally vaccinated at as early as 2 months.

In the 1930s in the United States, there were about 30,000 cases of diphtheria annually, in which a grayish membrane clogs the airways, killing about 10 percent of those infected. The disease virtually never appears in the West now, but in the 1980s, when vaccination stopped in the former Soviet Union in the chaos of its breakup, there were 200,000 cases and 5,000 deaths, by Red Cross estimates.

In the United States, rumors of a link to autism and inflammatory bowel disease are most commonly attached to the measles vaccine, making it one that some parents avoid.

Refusal is much more common in Britain, and in August the national Health Protection Agency warned that Britain was having its worst measles outbreak in 20 years, with 480 confirmed cases and one death.

Sex Diseases Still Rising; Chlamydia Is Leader

The incidence of gonorrhea, which had declined sharply, has risen in the last two years in this country while the number of chlamydia and syphilis cases continue to rise, federal health officials said yesterday.

Chlamydia and gonorrhea are the two most common diseases among those doctors must report in the United States. And the 1,030,911 cases of chlamydia in 2006 are the highest ever recorded for any nationally reported disease in any year, the officials said in releasing their annual report on sexually transmitted diseases. They said that because of underreporting, a more accurate estimate is 2.8 million new chlamydia cases annually.

About 19 million new cases of all kinds of sexually transmitted diseases occur in this country each year, but only the three are nationally reported. Genital herpes, papillomavirus and trichomonas infections account for the vast majority of cases, but doctors are not required to report them nationally.

Different reasons account for the rise of each of the three reportable and curable diseases, and for each a different approach is needed to reduce its incidence, Dr. John M. Douglas Jr., head of the division of sexually transmitted diseases at the Centers for Disease Control and Prevention, told reporters by telephone.

The three reported sexually transmitted diseases affect African-Americans disproportionately. The black to white ratios are gonorrhea 18 to 1, syphilis 6 to 1 and chlamydia 8 to 1, Dr. Douglas said in an interview. The reasons for the disparities are not clear. Lack of access to health care may be one problem.

“Chlamydia is now the most common S.T.D. ever reported,” Dr. Douglas said, but not by much. The next most common is gonorrhea, with just over one million cases reported each year from 1976 to 1980. The peak for gonorrhea was 1,013,00. Gonorrhea cases then declined steadily.

The chlamydia microbe can cause pelvic inflammatory disease and resulting abdominal pain, ectopic pregnancy and infertility in women.

Chlamydia’s rise in incidence is due mainly to urging by the centers for annual testing of sexually active women under age 26. Current tests are more sensitive in detecting chlamydia than those used a few years ago. Most cases were among women who had no symptoms but could transmit the microbe.

Chlamydia screening has led to detection of the microbe among more men as their female partners advise them to get tested and treated to avoid re-infections. Infected individuals are advised to get re-tested about three months after treatment to make sure they are cured.

The centers are also encouraging doctors to give antibiotics and educational material to patients to give to their sexual partners who are reluctant to seek care. One aim of the practice, called expedited partners therapy, is to reduce re-infections. The practice is legal in 11 states and ambiguous or illegal in the 39 others.

From 1975 through 1997 the reported rate of gonorrhea dropped 74 percent, then plateaued, only to rise the last two years to 358,366 cases in 2006. The centers estimate that at least twice that number actually occurred.

Much of the rise seems the result of an increasing tendency to couple gonorrhea and chlamydia testing of urine samples.

African-Americans account for 69 percent of all gonorrhea in this country. “The biggest increase in gonorrhea regionally has been in the South, and we do not have a ready explanation for that,” Dr. Douglas said.

Even in the days before penicillin became available in World War II to cure syphilis, the number of reported syphilis cases peaked at 575,000, and that total included individuals who never could be treated and developed the late stages of the disease that cause brain and heart damage.

Syphilis cases dropped to their lowest ever total in 2000 soon after health officials had announced a national syphilis elimination program.

But cases have risen each year since then to 9,756 cases in 2006. Most cases have involved gay men, who account for about 65 percent of cases, and to a lesser extent women. Also, a small number of cases have occurred among newborns.

Recently, health departments have had to take on more projects with little, if any, increase in budgets, Dr. Douglas said. Outbreaks have occurred in some areas where they were well controlled. Also, health workers have had to decrease partner notification programs and screening in detention centers and jails.