ScienceDaily
A new study suggests that sleep problems lead to increased pain and fatigue in cancer patients. The results indicate that interventions aimed at trouble sleeping would be expected to improve both pain and fatigue in this patient population.
Results show that more than half the sample reported having trouble sleeping, with 26 percent reporting moderate or severe trouble sleeping. Compared with patients who reported no trouble sleeping, patients with moderate to severe trouble sleeping reported significantly more fatigue, pain and depressed mood. Using structural equation modeling analysis to evaluate causal relations and directions of effect, the best-fitting model indicates that trouble sleeping led to increased ratings of pain.
According to the authors, the relationship between pain and sleep often has been assumed to be reciprocal. In the present study, however, a model of reciprocal causation could not be fit to the data, and models in which pain caused trouble sleeping did not fit as well as the model in which trouble sleeping caused pain.
“We believed we would find a bi-directional relationship between insomnia and pain, but instead found that trouble sleeping was more likely a cause, rather than a consequence, of pain in patients with cancer,” said lead author Edward J. Stepanski, chief operational officer at the Accelerated Community Oncology Research Network in Memphis, Tenn.
The study included demographic, clinical and patient-reported outcomes data from 11,445 cancer patients undergoing treatment at the West Clinic, a large community oncology practice in Memphis. Participants had an average age of 61.5 years, and 74 percent were female. Breast cancer was the most common form of cancer, and about 25 percent of study subjects had received chemotherapy in the last 30 days. Increases in depressed mood also led to increased ratings of pain.
Younger age and recent administration of chemotherapy were both associated with increased trouble sleeping. According to the authors, younger patients often receive more aggressive chemotherapy than older patients; therefore, younger patients may be exposed to more treatment-related toxicity.
Stepanski stated that several studies have shown that cognitive behavioral therapy (CBT) improves sleep in cancer patients who have insomnia. He believes that this type of intervention may decrease patients’ pain and fatigue by improving their sleep.

Adapted from materials provided by American Academy of Sleep Medicine, via EurekAlert!, a service of AAAS.
Journal Reference:
1.The Relation of Trouble Sleeping, Depressed Mood, Pain, and Fatigue in Patients with Cancer. Journal of Clinical Sleep Medicine, April 15, 2009

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ScienceDaily (Mar. 2, 2010) — A new University of Illinois study touts the benefits of soluble fiber — found in oats, apples, and nuts, for starters — saying that it reduces the inflammation associated with obesity-related diseases and strengthens the immune system.
“Soluble fiber changes the personality of immune cells — they go from being pro-inflammatory, angry cells to anti-inflammatory, healing cells that help us recover faster from infection,” said Gregory Freund, a professor in the U of I’s College of Medicine and a faculty member in the College of Agriculture, Consumer and Environmental Sciences’ Division of Nutritional Sciences.
This happens because soluble fiber causes increased production of an anti-inflammatory protein called interleukin-4, he said.
The study will appear in the May 2010 issue of Brain, Behavior, and Immunity and is available online now.
In the experiment, laboratory mice consumed low-fat diets that were identical except that they contained either soluble or insoluble fiber. After six weeks on the diet, the animals had distinctly different responses when the scientists induced illness by introducing a substance (lipopolysaccharide) that causes the body to mimic a bacterial infection.
“Two hours after lipopolysaccharide injection, the mice fed soluble fiber were only half as sick as the other group, and they recovered 50 percent sooner. And the differences between the groups continued to be pronounced all the way out to 24 hours,” said Christina Sherry, who also worked on the study.
“In only six weeks, these animals had profound, positive changes in their immune systems,” she said.
known that obesity is linked to inflammatory conditions, such as diabetes and heart disease.
Yet, in a recent study, the U of I scientists demonstrated that fat tissue produces hormones that appear to compensate for this inflammation. “There are significant anti-inflammatory components in fat tissue and, if they were strategically unleashed, they could potentially protect obese people from further inflammatory insults, such as a heart attack or stroke. In obese animals, you can see the body compensating in an effort to protect itself,” he said.
Not all fat is bad, the researcher noted. The Mediterranean diet, which receives high marks for its health benefits, includes such foods as olive oil; salmon, tuna, sardines, and trout, which contain important omega-3 and -6 fatty acids; and plant sources of fat, such as flaxseed.
“Now we’d like to find a way to keep some of the anti-inflammatory, positive effects that develop over time with a high-fat diet while reducing that diet’s negative effects, such as high blood glucose and high triglycerides. It’s possible that supplementing a high-fat diet with soluble fiber could do that, even delaying the onset of diabetes,” he said.
This study is one of the first to provide two valuable lessons, said Sherry. The first, already noted, is that soluble fiber has direct anti-inflammatory effects and builds up the immune system. The second is that the amount of soluble fiber necessary to achieve these health benefits is a reasonable, not a pharmacological, amount.
The recommended daily dietary recommendation is 28 to 35 grams of total fiber, but most of the FDA’s health claims are for insoluble fiber, and that’s where things get a bit complicated, she said.
“Not all fiber is created equal, although you wouldn’t know that by reading nutrition labels,” said Sherry. “Most manufacturers don’t tell you how much of each type of fiber a food contains, and we think it’s important that this information be included on a product’s packaging.”
Good sources of soluble fiber are oat bran, barley, nuts, seeds, lentils, citrus fruits, apples, strawberries, and carrots. “We used a citrus-based pectin in our study,” Sherry said.
Insoluble fiber, found in whole wheat and whole-grain products, wheat bran, and green, leafy vegetables, is also valuable for providing bulk and helping food move through the digestive system, but it doesn’t provide the boost to the immune system that soluble fiber provides.
Co-authors are Stephanie S. Kim, Ryan N. Dilger, Laura L. Bauer, Morgan L. Moon, Richard I. Tapping, George C. Fahey Jr., and Kelly A. Tappenden, all from the U of I. Sherry is now a postdoctoral fellow at the University of Michigan. The research was funded by the National Institutes of Health, the American Heart Association, and the USDA among others.

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Story Source:
Adapted from materials provided by University of Illinois at Urbana-Champaign, via EurekAlert!, a service of AAAS.

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Health and Nutritional Supplements, You Need Both

By: Tan Kim Kia

Health is the greatest treasure a man can have.

There are several factors that influence our health. Among them we find the pollution, stress, inadequate nutrition. All these factors are hurtful to our body.

Did you know that in a whole year we consume over four kilos and a half to five kilos of poisonous substances present in our food?

If not eliminated, these substances create a chaotic movement of our body cells and generate a favorable ground for the action of free radicals. These free radicals generate a great diversity of cancer forms.

Health depends on an adequate diet too. “Scientific evidence in support of the health benefits of nutritional supplements has grown dramatically in recent years,” said Jeffrey Blumberg, Ph.D., a professor in the School of Nutrition Science and Policy at Tufts University in Boston. “We must now work to translate this knowledge to health care providers, policy makers and consumers so the simple actions people can take to promote their health and prevent disease can be more fully realized. The impact of a rational use of dietary supplements can also help reduce health care costs which escalate every year as our population grows older.

Symptoms

Many problems such as : lack of energy, insomnia, headaches, depression, mood swings, anxiety, easy bruising, bleeding gums, slow wound healing etc. can be traced directly to deficiencies in specific vitamins and minerals.

Circumstances

Because of the methods applied nowadays in agriculture, which destroy the natural mineral substances, we cannot be sure that the agricultural products ensure us the necessary vitamins and minerals. Although all people should try to have healthy and balanced diet, few in reality do.

Nutritional Supplements to bridge your nutrition gaps

More and more people try the nutritional supplements as a way to combat the nutritional deficiencies and to ensure the necessary of vital nutrients for maintaining the quality of their life. Before you start taking nutritional supplements you must know a few things about them.

Nutritional supplements represent a support to our body. The nutritional supplements clean the human body and restore the deficiencies present inside. While taken constantly, nutritional supplements promote good health and help prevent disease. Nutritional supplements represent a good thing that we need . Here are a few things that you might consider before taking nutritional supplements:

1. Everybody can consume nutritional supplement and mostly if is diagnosed with a nutritional deficiency.

2. You must find out if you have a nutritional deficiency.

3. Ask your physician if it is safe for you to take nutritional supplements.

4. Does this supplement interacts with any drug or food you are consuming?

5. If you want to know more you can read about it or you can find more information at nutritional supplements guide from the Internet.

Quality

Regarding their quality, the nutritional supplements must be natural, easy to assimilate, must have a high nutritional value, must come from ecologically non-polluted areas and must be certified.

On the market are thousands of dietary supplements. Great companies fight for a place on the market. Each of them offers a diversity of products. These products seem to bring the same benefits to our body but they are in fact very different one from another. The difference is obvious when you read the label and you see the ingredients. The ingredients are the ones which make the products so valuable.

Research

The nutritional supplements are usually obtained after a period of research.

The research services work hard in order to offer us good products having great and rapid effects. It would be good for you when you choose to take nutritional supplements to inform upon the company which produces the products. If it is a world leadership or if it is among the greatest in the world than you may decide to consume the products it proposes to you. They are first tested over and over again and are only then offered to the public.

So we must be very careful when choosing nutritional supplements and do not forget to consult your physician!

About the Author:

Allan Tan Kim Kia is an nutrition scholar and author of Best Vitamin Supplements Guide who provides tips and advice how to choose and where to buy best vitamin supplements online. http://www.best-vitamin-supplements-guide.com

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Prevention & Treatment of H1Ni ( & season flu)

What can I do to protect myself from getting sick?
There is no vaccine available right now to protect against 2009 H1N1 virus.  However, a 2009 H1N1 vaccine is currently in production and may be ready for the public in the fall. As always, a vaccine will be available to protect against seasonal influenza
There are everyday actions that can help prevent the spread of germs that cause respiratory illnesses like influenza.

Take these everyday steps to protect your health:

• Cover your nose and mouth with a tissue when you cough or sneeze. Throw the tissue in the trash after you use it.
• Wash your hands often with soap and water. If soap and water are not available, use an alcohol-based hand rub.*
• Avoid touching your eyes, nose or mouth. Germs spread this way.
• Try to avoid close contact with sick people.
• If you are sick with flu-like illness, CDC recommends that you stay home for at least 24 hours after your fever is gone except to get medical care or for other necessities. (Your fever should be gone without the use of a fever-reducing medicine.) Keep away from others as much as possible to keep from making others sick.

Other important actions that you can take are:

• Follow public health advice regarding school closures, avoiding crowds and other social distancing measures.
• Be prepared in case you get sick and need to stay home for a week or so; a supply of over-the-counter medicines, alcohol-based hand rubs * (for when soap and water are not available), tissues and other related items could help you to avoid the need to make trips out in public while you are sick and contagious.

What is the best way to keep from spreading the virus through coughing or sneezing?
If you are sick with flu-like illness, CDC recommends that you stay home for at least 24 hours after your fever is gone except to get medical care or for other necessities. (Your fever should be gone without the use of a fever-reducing medicine.)
Keep away from others as much as possible. Cover your mouth and nose with a tissue when coughing or sneezing. Put your used tissue in the waste basket. Then, clean your hands, and do so every time you cough or sneeze.

If I have a family member at home who is sick with 2009 H1N1 flu, should I go to work?
Employees who are well but who have an ill family member at home with 2009 H1N1 flu can go to work as usual. These employees should monitor their health every day, and take everyday precautions including washing their hands often with soap and water, especially after they cough or sneeze. If soap and water are not available, they should use an alcohol-based hand rub.* If they become ill, they should notify their supervisor and stay home. Employees who have an underlying medical condition or who are pregnant should call their health care provider for advice, because they might need to receive influenza antiviral drugs to prevent illness. For more information please see General Business and Workplace Guidance for the Prevention of Novel Influenza A (H1N1) Flu in Workers.

What is the best technique for washing my hands to avoid getting the flu?
Washing your hands often will help protect you from germs. CDC recommends that when you wash your hands — with soap and warm water — that you wash for 15 to 20 seconds. When soap and water are not available, alcohol-based disposable hand wipes or gel sanitizers may be used.* You can find them in most supermarkets and drugstores. If using gel, rub your hands until the gel is dry. The gel doesn’t need water to work; the alcohol in it kills the germs on your hands.

What should I do if I get sick?
If you live in areas where people have been identified with 2009 H1N1 flu and become ill with influenza-like symptoms, including fever, body aches, runny or stuffy nose, sore throat, nausea, or vomiting or diarrhea, you should stay home and avoid contact with other people. CDC recommends that you stay home for at least 24 hours after your fever is gone except to get medical care or for other necessities. (Your fever should be gone without the use of a fever-reducing medicine.) Stay away from others as much as possible to keep from making others sick.Staying at home means that you should not leave your home except to seek medical care. This means avoiding normal activities, including work, school, travel, shopping, social events, and public gatherings.

If you have severe illness or you are at high risk for flu complications, contact your health care provider or seek medical care. Your health care provider will determine whether flu testing or treatment is needed.

If you become ill and experience any of the following warning signs, seek emergency medical care.

In children, emergency warning signs that need urgent medical attention include:

• Fast breathing or trouble breathing
• Bluish or gray skin color
• Not drinking enough fluids
• Severe or persistent vomiting
• Not waking up or not interacting
• Being so irritable that the child does not want to be held
• Flu-like symptoms improve but then return with fever and worse cough

In adults, emergency warning signs that need urgent medical attention include:

• Difficulty breathing or shortness of breath
• Pain or pressure in the chest or abdomen
• Sudden dizziness
• Confusion
• Severe or persistent vomiting
• Flu-like symptoms improve but then return with fever and worse cough

Are there medicines to treat 2009 H1N1 infection?
Yes. CDC recommends the use of oseltamivir or zanamivir for the treatment and/or prevention of infection with 2009 H1N1 flu virus. Antiviral drugs are prescription medicines (pills, liquid or an inhaled powder) that fight against the flu by keeping flu viruses from reproducing in your body. If you get sick, antiviral drugs can make your illness milder and make you feel better faster. They may also prevent serious flu complications. During the current pandemic, the priority use for influenza antiviral drugs is to treat severe influenza illness (for example hospitalized patients) and people who are sick who have a condition that places them at high risk for serious flu-related complications.

What is CDC’s recommendation regarding “swine flu parties”?
“Swine flu parties” are gatherings during which people have close contact with a person who has 2009 H1N1 flu in order to become infected with the virus. The intent of these parties is for a person to become infected with what for many people has been a mild disease, in the hope of having natural immunity 2009 H1N1 flu virus that might circulate later and cause more severe disease.

CDC does not recommend “swine flu parties” as a way to protect against 2009 H1N1 flu in the future. While the disease seen in the current 2009 H1N1 flu outbreak has been mild for many people, it has been severe and even fatal for others. There is no way to predict with certainty what the outcome will be for an individual or, equally important, for others to whom the intentionally infected person may spread the virus.

CDC recommends that people with 2009 H1N1 flu avoid contact with others as much as possible. If you are sick with flu-like illness, CDC recommends that you stay home for at least 24 hours after your fever is gone except to get medical care or for other necessities. (Your fever should be gone without the use of a fever-reducing medicine.) Stay away from others as much as possible to keep from making others sick.

CDC.gov

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2009 H1N1 (referred to as “swine flu” early on) is a new influenza virus causing illness in people. This new virus was first detected in people in the United States in April 2009. This virus is spreading from person-to-person worldwide, probably in much the same way that regular seasonal influenza viruses spread. On June 11, 2009, the World Health Organization (WHO) signaled that a pandemic of 2009 H1N1 flu was underway.
Why is 2009 H1N1 virus sometimes called “swine flu”?
This virus was originally referred to as “swine flu” because laboratory testing showed that many of the genes in this new virus were very similar to influenza viruses that normally occur in pigs (swine) in North America. But further study has shown that this new virus is very different from what normally circulates in North American pigs. It has two genes from flu viruses that normally circulate in pigs in Europe and Asia and bird (avian) genes and human genes. Scientists call this a “quadruple reassortant” virus.

2009 H1N1 Flu in Humans

Are there human infections with 2009 H1N1 virus in the U.S.?
Yes. Human infections with the new H1N1 virus are ongoing in the United States. Most people who have become ill with this new virus have recovered without requiring medical treatment.
CDC routinely works with states to collect, compile and analyze information about influenza, and has done the same for the new H1N1 virus since the beginning of the outbreak. This information is presented in a weekly report, called FluView.
Is 2009 H1N1 virus contagious?
CDC has determined that 2009 H1N1 virus is contagious and is spreading from human to human.
How does 2009 H1N1 virus spread?
Spread of 2009 H1N1 virus is thought to occur in the same way that seasonal flu spreads. Flu viruses are spread mainly from person to person through coughing or sneezing by people with influenza. Sometimes people may become infected by touching something – such as a surface or object – with flu viruses on it and then touching their mouth or nose.
What are the signs and symptoms of this virus in people?
The symptoms of 2009 H1N1 flu virus in people include fever, cough, sore throat, runny or stuffy nose, body aches, headache, chills and fatigue. Some people may have vomiting and diarrhea. People may be infected with the flu, including 2009 H1N1 and have respiratory symptoms without a fever. Severe illnesses and death has occurred as a result of illness associated with this virus.
How severe is illness associated with 2009 H1N1 flu virus?
Illness with the new H1N1 virus has ranged from mild to severe. While most people who have been sick have recovered without needing medical treatment, hospitalizations and deaths from infection with this virus have occurred.
In seasonal flu, certain people are at “high risk” of serious complications. This includes people 65 years and older, children younger than five years old, pregnant women, and people of any age with certain chronic medical conditions. About 70 percent of people who have been hospitalized with this 2009 H1N1 virus have had one or more medical conditions previously recognized as placing people at “high risk” of serious seasonal flu-related complications. This includes pregnancy, diabetes, heart disease, asthma and kidney disease.
One thing that appears to be different from seasonal influenza is that adults older than 64 years do not yet appear to be at increased risk of 2009 H1N1-related complications thus far. CDC laboratory studies have shown that no children and very few adults younger than 60 years old have existing antibody to 2009 H1N1 flu virus; however, about one-third of adults older than 60 may have antibodies against this virus. It is unknown how much, if any, protection may be afforded against 2009 H1N1 flu by any existing antibody.
How does 2009 H1N1 flu compare to seasonal flu in terms of its severity and infection rates?
With seasonal flu, we know that seasons vary in terms of timing, duration and severity. Seasonal influenza can cause mild to severe illness, and at times can lead to death. Each year, in the United States, on average 36,000 people die from flu-related complications and more than 200,000 people are hospitalized from flu-related causes. Of those hospitalized, 20,000 are children younger than 5 years old. Over 90% of deaths and about 60 percent of hospitalization occur in people older than 65.
When the 2009 H1N1 outbreak was first detected in mid-April 2009, CDC began working with states to collect, compile and analyze information regarding the 2009 H1N1 flu outbreak, including the numbers of confirmed and probable cases and the ages of these people. The information analyzed by CDC supports the conclusion that 2009 H1N1 flu has caused greater disease burden in people younger than 25 years of age than older people. At this time, there are few cases and few deaths reported in people older than 64 years old, which is unusual when compared with seasonal flu. However, pregnancy and other previously recognized high risk medical conditions from seasonal influenza appear to be associated with increased risk of complications from this 2009 H1N1. These underlying conditions include asthma, diabetes, suppressed immune systems, heart disease, kidney disease, neurocognitive and neuromuscular disorders and pregnancy.
How long can an infected person spread this virus to others?
People infected with seasonal and 2009 H1N1 flu shed virus and may be able to infect others from 1 day before getting sick to 5 to 7 days after. This can be longer in some people, especially children and people with weakened immune systems and in people infected with the new H1N1 virus.

CDC.gov

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By LAURAN NEERGAARD, AP Medical Writer Lauran Neergaard, Ap Medical Writer Sun Aug 30,

WASHINGTON – When is swine flu just miserable and when do you need a doctor?

If it’s hard to breathe, that’s an emergency. It’s the not-so-obvious cases that can have parents, or the sick of any age, fretting.

“There tends to be a lot of hysteria,” said Dr. Nathan Litman of the Children’s Hospital at Montefiore Medical Center in New York. “We should try to emphasize the prevention mode, and the rational approach to dealing with the illness rather than when the child has a runny nose running to the emergency room.”

Symptoms of any flu include fever of 100 degrees or more, cough, body chills and aches, congestion. Diarrhea and vomiting sometimes occur, particularly with the swine flu that doctors call the 2009 H1N1 flu.

Regardless of the strain, most people who otherwise are healthy need to stay home and rest, and get plenty of fluids, health officials agree.

But there’s a catch. Not everyone with swine flu gets a fever, making it hard to know if they’ve got that or a common cold.

That doesn’t happen too often, although there are no good statistics and no one knows if those people even are as contagious as the fevered, said Dr. Anne Schuchat, director of the Centers for Disease Control and Prevention’s National Center for Immunization and Respiratory Diseases. But generally, people without a fever don’t get as sick.

Signs to seek emergency care include shortness of breath, chest pain or pressure, confusion or seizures, persistent vomiting or inability to hold down liquids, bluish lips.

Who’s at higher risk from any kind of flu?

Pregnant women; people of any age with heart disease, asthma, diabetes and other chronic illnesses; children under 2; people over 65.

While the over-65 tend not to catch swine flu, they are prime targets of the regular winter flu — and there’s no way for patients to tell the two apart.

Litman said doctors would rather get a call from or see a high-risk person “sooner rather than later” to decide if they need the anti-flu medications Tamiflu or Relenza. The drugs work best if taken within the first 48 hours of symptoms.

If fever goes away and then a new one sets in days later, seek medical care, Litman said. That can be a sign of bacterial infections that sometimes follow any type of flu.

For children, pediatricians advise watching activity levels. Being listless or lethargic can be a warning sign of worsening illness.

What if people without insurance can’t afford the $100 or so anti-flu drugs? The government has shipped millions of doses from a federal stockpile to the states, and in what’s being cited as a model program, Texas is using its stockpiled supply in part for those patients.

Doctors certify the person’s lack of insurance coverage when they write the prescription and direct the patient to certain pharmacies. The goal is to have at least one pharmacy in every county that then fills the prescription for free or a nominal fee, said the state’s health commissioner, David Lakey.

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On the Net:

Centers for Disease Control and Prevention background: http://www.cdc.gov/h1n1flu/h1n1flu

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By Maggie Fox, Health and Science Editor Maggie Fox, Health And Science Editor

WASHINGTON (Reuters) – The new H1N1 swine flu is estimated to have infected about 800,000 people in New York City in the spring, a top U.S. health official said on Sunday, citing a study due to be released later this week.

Dr. Thomas Frieden, who heads the U.S. Centers for Disease Control and Prevention, said surveys suggested the virus was widely spread around the city. Frieden was New York City’s health commissioner before taking the top CDC job in June.

“In New York City where we had a lot of H1N1 this last spring the estimate is about 800,000 people, about 10 percent of New York City residents, got infected with the flu,” Frieden said in an interview with C-SPAN television aired on Sunday.

“That’s a lot of people.”

New York City health department officials say the full study is being finished and will be released within days.

Frieden said there had been a twenty-fold variation in influenza infections around the country. “We expect that some places will have more flu. Some places will have less,” he said.

Swine flu has infected well over 1 million people in the United States, and is now the CDC’s No. 1 priority. Other research also shows that older children and young adults are by far the most likely to be infected with the new virus.

The World Health Organization predicts a third of the world’s population will eventually be infected.

The virus is still circulating and most health experts expect a resurgence in the northern hemisphere’s autumn as temperatures cool and schools, traditional breeding grounds for infection, reopen after summer holidays.

Detailed reports on outbreaks can help health officials prepare for epidemics in their communities.

Every year, seasonal flu infects between 5 percent and 20 percent of a given population and kills between 250,000 and 500,000 people globally. Because hardly anyone has immunity to the new H1N1 virus, experts believe it will infect far more people than usual, as much as a third of the population.

It also disproportionately affects younger people, unlike seasonal flu which mainly burdens the elderly, and as a result may cause more severe illness and deaths among young adults and children than seasonal flu.

Chicago health authorities said last week that the pandemic H1N1 flu infected 14 times as many children as adults over 60 there, and also disproportionately affected blacks and Hispanics.

WHO said pregnant women and people with asthma, diabetes and heart diseases are at special risk of severe complications of death from H1N1 flu.

Some countries are reporting that as many as 15 percent of patients hospitalized with the new H1N1 pandemic virus have needed intensive care, further straining already overburdened healthcare systems, WHO said on Friday.

Companies are preparing vaccines against H1N1, which will be given in addition to the regular seasonal influenza immunization.

(Editing by Paul Simao)

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By LAURAN NEERGAARD, AP Medical Writer Lauran Neergaard, Ap Medical Writer Sun Aug 30,

WASHINGTON – The alarm sounded with two sneezy children in California in April. Just five months later, the never-before-seen swine flu has become the world’s dominant strain of influenza, and it’s putting a shockingly younger face on flu.

So get ready. With flu’s favorite chilly weather fast approaching, we’re going to be a sick nation this fall. The big unknown is how sick. One in five people infected or a worst case — half the population? The usual 36,000 deaths from flu or tens of thousands more?

The World Health Organization predicts that within two years, nearly one-third of the world’s population will have caught it.

“What we know is, it’s brand new and no one really has an immunity to this disease,” Health and Human Services Secretary Kathleen Sebelius says.

A lot depends on whether the swine flu that simmered all summer erupts immediately as students crowd back into schools and colleges — or holds off until millions of vaccine doses start arriving in mid-October.

Only this week do U.S. researchers start blood tests to answer a critical question: How many doses of swine flu vaccine does it take to protect? The answer will determine whether many people need to line up for two flu shots — one against swine flu and one against the regular flu — or three.

The hopeful news: Even with no vaccine, winter is ending in the Southern Hemisphere without as much havoc as doctors had feared, a heavy season that started early but not an overwhelming one. The strain that doctors call the 2009 H1N1 flu isn’t any deadlier than typical winter flu so far. Most people recover without treatment; many become only mildly ill.

Importantly, careful genetic tracking shows no sign yet that the virus is mutating into a harsher strain.

We’re used to regular flu that, sadly, kills mostly grandparents. But the real shock of swine flu is that infections are 20 times more common in the 5- to 24-year-old age group than in people over 65. That older generation appears to have some resistance, probably because of exposure decades ago to viruses similar to the new one.

Worldwide, swine flu is killing mostly people in their 20s, 30s and 40s, ages when influenza usually is shrugged off as a nuisance.

Especially at risk are pregnant women. So are people with chronic conditions such as asthma, diabetes, heart disease and neuromuscular diseases including muscular dystrophy. Some countries report more deaths among the obese.

Still, some of the people who’ve died didn’t have obvious health risks.

“People who argue we’re seeing the same death rates miss the point — they’re in young adults. To me, that shouldn’t happen,” said one infectious disease specialist, Dr. Richard P. Wenzel of Virginia Commonwealth University. He spent the past few months visiting South American hospitals to help gauge what the Northern Hemisphere is about to face.

Children, however, are the flu’s prime spreaders. Already, elementary schools and colleges are reporting small clusters of sick students. For parents, the big fear is how many children will die.

Panicked crowds flooded India’s hospitals in August after a 14-year-old girl became that country’s first death. In the U.S., regular flu kills 80 to 100 children every winter, and the Centers for Disease Control and Prevention has reports of about three dozen child deaths from swine flu.

Even if the risk of death is no higher than in a normal year, the sheer volume of ill youngsters means “a greater than expected number of deaths in children is likely,” said Dr. Anne Schuchat, director of the CDC’s National Center for Immunization and Respiratory Diseases. “As a society, that’s something that’s much harder for us.”

___

Swine flu quietly sickened hundreds in Mexico before U.S. researchers stumbled across two children in San Diego who had the same mystery illness. A world already spooked by the notorious Asian bird flu raced to stem the spread of this surprising new virus. Mexico closed schools and restaurants, and barred spectators from soccer games; China quarantined planeloads of tourists. But there was no stopping the novel H1N1 — named for its influenza family — from becoming the first pandemic in 41 years.

Well over 1 million Americans caught swine flu in spring and summer months when influenza hardly ever circulates; more than 500 have died.

In July, England was reporting more than 100,000 infections a week.

Argentina gave pregnant women 15 paid days off last month at the height of its flu season, hoping that staying home would prove protective.

In Saudi Arabia, people younger than 12 and older than 65 are being barred from this November’s hajj, the pilgrimage to holy cities that many Muslims save up their whole lives to make.

And in Australia — closely watched by the U.S. and Europe as a predictor for their own coming flu seasons — hospitals set up clinics outside the main doors to keep possible flu sufferers from entering and infecting other patients.

“While this disease is mild for most people, it does have that severe edge,” said Australia’s health minister Nicola Roxon, who counted over 30,000 cases in a country of nearly 22 million. That’s comparable to its last heavy flu season in 2007.

Cases are dropping fast as winter there ends. But Australia still plans to start the world’s first large-scale vaccinations next month in case of a rebound, inoculating about 4 million high-risk people.

Most amazing to longtime flu researchers, this new H1N1 strain seems to account for about 70 percent of all flu now circulating in the world. In Australia, eight of every 10 people who tested positive for flu had the pandemic strain.

That begs the question: Do people still need to bother with regular flu vaccine?

Definitely, stressed CDC’s Schuchat, who plans to get both kinds. There’s still enough regular flu circulating to endanger people, especially the 65-and-older generation.

Notably, South Africa is having a one-two punch of a flu season, hit first with a seasonal strain known as H3N2 and now seeing swine flu move in.

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Wash your hands, sneeze into your elbow, stay home so you don’t spread illness when you’re sick. That’s the mantra until vaccine arrives.

This week brings a key milestone. Hundreds of U.S. adults who rolled up their sleeves for a first shot in studies of the swine flu vaccine return for a blood test to see if they seem protected. It will take government scientists a few weeks to analyze results, but the volunteers get a second vaccine dose right away, in case the first wasn’t enough.

The vaccine, merely a recipe change from the usual flu vaccine, seems safe. Federal authorities two weeks ago gave the go-ahead to start children’s vaccine trials.

“It’s been a piece of cake,” said Kate Houley of Annapolis, Md., who jumped at the chance to enroll her three sons, ensuring that if the vaccine really works, they’ll have some protection as school gets started. Eleven-year-old Ethan was among the first to be vaccinated by University of Maryland researchers and didn’t even report the main side effect — a sore arm.

In the U.S., Britain and parts of Europe, vaccinations are set to begin in mid-October, assuming those studies show they work. First in line:

_Pregnant women. Despite accounting for about 1 percent of the U.S. population, they’ve been accounting for 6 percent of the swine flu deaths.

_Children and young adults from 6 months to 24 years. Babies younger than 6 months can’t get flu vaccine, so their parents and other caregivers should be inoculated to protect the infant.

_Health care workers.

_Younger adults with risky health conditions.

Schools around the U.S. are preparing to inoculate children in what could be the largest campus vaccinations since the days of polio. The government has bought 195 million doses and will ship them a bit at a time, starting with 45 million doses or so in October, to state health departments to dispense.

The Association of State and Territorial Health Officials is negotiating with pharmacists to help perform those vaccinations. Massachusetts even is deputizing dentists to help give swine flu vaccine, and passed emergency regulations to encourage more health care workers to get either the shot or a nasal spray version.

What if people not on the priority list show up? The idea is for pharmacists to gently encourage them to come back a few weeks later, said the association’s executive director, Dr. Paul Jarris.

A concern is whether enough people are worried about swine flu to get vaccinated.

“Complacency is a big challenge,” said CDC’s Schuchat. “We are trying to strike a balance between complacency and alarm.”

Ten-year-old Isabella Nataro had a cousin sent home from summer camp because of an outbreak, and she readily agreed when her mother, a University of Maryland vaccine researcher, signed her and her brothers up for a study of the new shot. (The store gift card that participating kids receive after each blood test was a bonus.)

“I’m kind of worried about my friends if swine flu does come to our school,” the suburban Baltimore girl said. “I hope everybody else at my school gets a chance to get it.”

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Associated Press writers Kristen Gelineau in Sydney and Michael Warren in Buenos Aires, Argentina, contributed to this report.

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On the Net:

CDC background on swine flu: http://www.cdc.gov/h1n1flu/Return of swine flu: What\'s ahead for Americans?

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ScienceDaily (May 1, 2006) — Breast cancer survivors who suffer from persistent, debilitating fatigue years after their diagnosis have something in common: their immune systems don’t shut down following treatment, according to researchers at UCLA’s Jonsson Cancer Center.

This constant immune system activation, which researchers discovered by measuring specific proteins in blood samples from survivors, may be causing the fatigue, UCLA researchers theorize. Their discovery may lead to behavioral interventions such as tai chi and yoga that will help alleviate persistent fatigue, which affects about a third of breast cancer survivors for years after they complete treatment.

The study is the first to look at the cellular basis for immune activation in fatigued breast cancer survivors, said Dr. Michael Irwin, a researcher at UCLA’s Jonsson Cancer Center and the study’s lead author. The research appears in the May 1 issue of Clinical Cancer Research, the peer-reviewed journal of the American Association of Cancer Research.

“Without knowing why this fatigue happens at the cellular level, we can’t develop efficient therapies to treat it,” said Irwin, who also serves as director of the Cousins Center for Psychoneuroimmunology at the Semel Institute for Neuroscience and Human Behavior at UCLA.

“Breast cancer survivors can be severely disabled by fatigue and that can dramatically impact their quality of life. That’s the tragedy of our treatments for cancer,” Irwin said. “We have focused on treating the disease, but we should also focus on the patient’s well being later. Right now, we have no treatment for cancer-related fatigue and we need something that will allow patients to return to their prior level of functioning.”

Dr. Patricia Ganz, a nationally renowned expert who has studied quality of life in breast cancer survivors for two decades, agrees that fatigue is a serious problem for survivors, a fact that their primary care physicians don’t always understand.

“When breast cancer survivors talk to their physicians about being tired and how it affects their lives, they’re often told that they survived cancer, so they should be grateful to be alive,” said Ganz, one of the co-authors of the study. “But their fatigue is a very real problem that needs to taken seriously and addressed.”

A small study at UCLA had previously demonstrated abnormalities in immune activation in breast cancer survivors. If researchers could determine the biological factors underlying this activation, and therefore fatigue, they could uncover a biomarker for the condition that could help them predict which patients would suffer from fatigue and which would not, Irwin said.

Irwin and his colleagues took blood samples from breast cancer survivors one to five years out from diagnosis and placed them into two groups, those who suffered from persistent fatigue and those who did not. The researchers measured the levels of a pro-inflammatory cytokine protein in their blood — levels that indicated the immune system was turned on. Irwin said the pro-inflammatory protein levels were significantly different between the two groups. Those with persistent fatigue had 30 percent more of the proteins circulating in their blood. Additionally, their immune cells produced more cytokines in laboratory analyses than the cells from survivors without fatigue, and those cytokines were more efficient at producing the pro-inflammatory proteins driving the immune response.

“This study proved that there is an aberrant immune response in breast cancer survivors with persistent fatigue,” Irwin said. “With this information, we may now be able to identify those patients at greatest risk for persistent fatigue and implement interventions early on that will lessen the severity and duration of the fatigue.”

The immune systems of women undergoing treatment for breast cancer are activated at high levels to help them fight disease and help the body recover from the side effects of chemotherapy and radiation. Some data suggest that survivors who develop fatigue might have immune system changes before the cancer and the treatments may be exacerbating that. Further studies are needed to understand how this immune activation occurs and what clinical factors predispose to it, Irwin said

“We know from studies that animals with immune activation and cytokines circulating in their blood don’t move around a lot, they don’t eat, they don’t engage in sexual activity,” Irwin said. “From our study, we believe that the severity of fatigue in breast cancer survivors is not related to the type of treatment they received or its duration, but rather that the fatigue is driven by constant immune activation. Their immune systems simply don’t shut down after treatment.”

Irwin and his team studied 32 breast cancer survivors with persistent fatigue and compared their blood samples to 18 survivors who did not suffer from fatigue. The pro-inflammatory proteins in the blood of fatigued cancer survivors could be used as a biomarker to classify those women who may suffer from fatigue after treatment. In those who appear to be predisposed to fatigue — the women whose immune systems have not shut off as they should — it may be possible in the future to provide interventions can right away that might eliminate or, at the least, alleviate the severity and duration of the fatigue.

While there are drugs such as statins that can be used to dampen immune response, future studies by Irwin and his team will focus on behavioral interventions such as tai chi and yoga. Exercise and meditation, Irwin said, have been shown to decrease levels of pro-inflammatory cytokine expression in the blood.

“If we can identify survivors at greatest risk of persistent fatigue, we can implement interventions early on to help them,” Irwin said. “That would be good news for the increasing numbers of women who are surviving breast cancer every year.”

The number of breast cancer survivors is steadily increasing due to advances in screening and treatment strategies. More patients are being diagnosed with early stage breast cancer and are surviving longer. In fact, breast cancer survivors are the largest group of patients to overcome any type of cancer in the United States. It is estimated that there are more than 2 million breast cancer survivors in the U.S. today.

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