Beginning in March, 2013, reports started to come out of Eastern China that a new “bird flu” virus was loose and causing infections in humans. The new virus is called H7N9. Should we in the U.S. be worried?
Neither I nor anyone I know can give a confident answer to that question. What makes flu viruses so unpredictable is that they are constantly changing or mutating their genes. They also are constantly swapping their genes with the genes of other flu viruses. When they change or swap their genes, they change their character.
When I hear about a new flu virus, I want to know two things about it: how easily is it spread from one person to another, and how sick does it make the people it infects?
A report from the U.S. Centers for Disease Control and Prevention (CDC), and another from a team from China in this week’s New England Journal of Medicine, indicate that so far the new H7N9 virus has not clearly spread from one person to another, and has not spread outside of Eastern China. But things can change quickly with flu viruses.
H7N9 has made people very sick, however. Indeed, all three of the people infected with virus described in the New England Journal of Medicine died.
As of the end of April, the CDC said that China had reported 126 human cases of the new flu. The people tend to be older (average age in their 60s) and many have had chronic illnesses. Fewer children and young adults have been infected, so far.
The world is full of different flu viruses. Most of them infect just animals, often just one type of animal. Sometimes a flu virus “jumps” from one animal to another. Sometimes, it is even able to jump from animals to humans. That’s what has happened with H7N9. It has jumped from chickens and ducks to humans.
So far, none of the health care workers caring for people stricken with the new virus have contracted the virus. No travelers from China to the U.S. have been found carrying the virus.
In other words, as I write this article, there does not appear to be a clear threat to people outside of Eastern China. But every public health agency around the world is keeping a close eye on China. That’s because a virus that cannot spread easily from one person to another can change or swap genes—and suddenly be capable of spreading easily. We know of no reason why this could not happen with H7N9. And we know that it can produce severe, even fatal, illness.
How bad can a flu virus be? The worst flu outbreak for which we have good records occurred in 1918. A new virus emerged that spread easily between people and made people very sick.
How easily, and how sick? In the course of a few months, 30% of the people in the world caught the virus, and at least 20 million people died. That’s more than were killed in World War I.
Here in Boston, at the height of the pandemic, 200 dead people every day were carried through the streets in horse-drawn wagons, and often buried in mass graves. As in many other cities around the world, overnight there were hundreds and thousands of orphans. The grandmother of one of my colleagues on the faculty here was one of those orphans. I am not being melodramatic: the worse influenza pandemics can be truly awful.
The CDC and scientists at the National Institutes of Health (NIH) are working overtime to protect our health. But these two critically important federal agencies have just had their budgets slashed by the “sequester.”
Regardless of what you think about federal spending in general, if you share my view that we should not be cutting funding for health research and public health, you could do what I have done. Write your representatives in Congress to restore cuts in the CDC and NIH budgets.
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When a heart attack strikes, it doesn’t always feel the same in women as it does in men.
Women don't always get the same classic heart attack symptoms as men, such as crushing chest pain that radiates down one arm. Those heart attack symptoms can certainly happen to women, but many experience vague or even “silent” symptoms that they may miss. Recommended Related to Heart Disease Heart Palpitations
Heart palpitations are a feeling that your heart is beating too hard or too fast, skipping a beat, or fluttering. You may notice heart palpitations in your chest, throat, or neck.Heart palpitations can be bothersome or frightening. They usually aren't serious or harmful, though, and often go away on their own. Most of the time, they're related to stress and anxiety or to consumption of stimulants such as caffeine, nicotine, or alcohol. Palpitations also often occur during pregnancy.In about one...
These six heart attack symptoms are common in women:
Chest pain or discomfort. Chest pain is the most common heart attack symptom, but some women may experience it differently than men. It may feel like a squeezing or fullness, and the pain can be anywhere in the chest, not just on the left side. It's usually "truly uncomfortable" during a heart attack, says cardiologist Rita Redberg, MD, director of Women’s Cardiovascular Services at the University of California, San Francisco. "It feels like a vise being tightened." Pain in your arm(s), back, neck, or jaw. This type of pain is more common in women than in men. It may confuse women who expect their pain to be focused on their chest and left arm, not their back or jaw. The pain can be gradual or sudden, and it may wax and wane before becoming intense. If you're asleep, it may wake you up. You should report any "not typical or unexplained" symptoms in any part of your body above your waist to your doctor or other health care provider, says cardiologist C. Noel Bairey Merz, MD, director of the Barbra Streisand Women's Heart Center at Cedars-Sinai Medical Center in Los Angeles. Stomach pain. Sometimes people mistake stomach pain that signals a heart attack with heartburn, the flu, or a stomach ulcer. Other times, women experience severe abdominal pressure that feels like an elephant sitting on your stomach, says cardiologist Nieca Goldberg, MD, medical director of the Joan H. Tisch Center for Women’s Health at NYU Langone Medical Center in New York. Shortness of breath, nausea, or lightheadedness. If you're having trouble breathing for no apparent reason, you could be having a heart attack, especially if you're also having one or more other symptoms. "It can feel like you have run a marathon, but you didn't make a move," Goldberg says. Sweating. Breaking out in a nervous, cold sweat is common among women who are having a heart attack. It will feel more like stress-related sweating than perspiration from exercising or spending time outside in the heat. "Get it checked out" if you don't typically sweat like that and there is no other reason for it, such as heat or hot flashes, Bairey Merz says. Fatigue. Some women who have heart attacks feel extremely tired, even if they've been sitting still for a while or haven't moved much. "Patients often complain of a tiredness in the chest," Goldberg says. "They say that they can't do simple activities, like walk to the bathroom."
Not everyone gets all of those symptoms. If you have chest discomfort, especially if you also have one or more of the other signs, call 911 immediately.
Jan. 15, 2013 -- The idea that some children recover from autism remains controversial, but new research lends credibility to the notion.
The National Institutes of Health-funded study included children, teens, and young adults who received a diagnosis of autism early in life but moved off the autism spectrum as they grew older.
In earlier work, longtime autism researcher Deborah Fein, PhD, and colleagues at the University of Connecticut concluded that as many as 1 in 5 kids on the autism spectrum can recover to the point where they are no longer considered autistic.
But skeptics have claimed that the children the researchers identified as "optimal outcome" -- a phrase Fein prefers to "recovered" -- were simply misdiagnosed or had a very mild form of autism early in life.
To address this criticism, Fein and colleagues had an expert in the diagnosis of autism review the early diagnostic reports of 34 people with a prior diagnosis of autism, along with those of 44 people with high-functioning autism, and 34 people who had never received a diagnosis of autism.
But the autism diagnosis was deleted from the reports along with any information that would give the diagnosis away, Fein says. And the reviewer had no knowledge of the current status of the children and young adults in the study.
She says the reviewer identified all 34 of the optimal-outcome participants as originally autistic, based on their early diagnostic records, and all 34 of the typically developing participants as non-autistic.
Compared to those in the high-functioning autism group, those in the optimal-outcome group did show fewer social deficits in early childhood, but they were just as likely to have problems communicating and just as likely to engage in repetitive behaviors -- two characteristic early signs of autism.
When the researchers examined the current status of the optimal-outcome participants, who ranged from 8 to 21 years old, they exhibited none of the typical signs of autism, including problems with language, face recognition, communication, and social interaction.
The study appears today in the Journal of Child Psychology and Psychiatry.
Lisa Gilotty, PhD, of the National Institute of Mental Health, says it is increasingly clear that some autistic children do eventually move off the autism spectrum.
“We don’t yet know what percentage of children are capable of doing this, what interventions play a role, or if there is a biological reason for this,” she says.
Fein is a big proponent of very early intensive behavioral therapy, and she says kids who recover are more likely than those who don’t to have had a behavioral therapy known as applied behavioral analysis.
Karen Siff Exkorn began the therapy with her son Jake immediately after he was diagnosed with autism at the age of 2.
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