Health-Medical-Fitness-Diet-zx

duminică, 2 septembrie 2012

Can drug coverage erase the income gap in diabetes?

Researchers found that much of the income gap in heart risks among diabetic adults disappeared after the age of 65 - the age at which universal drug coverage kicks in for Canadians.

Canada has universal healthcare, but when it comes to medications, people younger than 65 either pay out-of-pocket or have private drug coverage through work - similar to Americans their age.

In the new study of more than 600,000 Ontario residents with diabetes, researchers found that lower-income people had higher risks of heart attack, stroke and death. But the disparity largely disappeared after age 65.

The findings, reported in the journal Diabetes Care, do not prove that universal drug coverage erased the income gap.

But there is no other obvious factor that would explain the "sudden shift" at age 65, said lead researcher Dr. Gillian L. Booth, of the University of Toronto and St. Michael's Hospital in Ontario.

"This also fits in with what's been seen in other studies," Booth said in an interview.

Research has shown that a growing number of people with diabetes cannot afford their medications - which include not only drugs to control blood sugar, but also those for high blood pressure, high cholesterol and other problems that commonly go hand-in-hand with diabetes.

Another study in Ontario also found a widening gap in death rates between the rich and poor with diabetes - but the trend is mainly among people younger than 65.

"I feel confident that expanding drug coverage could help save some lives," Booth said.

Her team's findings are based on health records for 606,051 Ontario adults who were followed over six years. During that time, over 48,000 of those people were hospitalized for a heart attack or stroke, and just over 111,000 died of any cause.

Booth's team found that among people younger than 65, those in the bottom 20 percent for income had a higher rate of heart attack, stroke and death: just over two percent per year, versus 1.4 percent among the wealthiest 20 percent.

Even when the researchers considered certain other factors - like people's history of heart problems before the study - low income was still linked to a 51 percent higher risk.

But when the researchers looked at older adults, the gap between the rich and poor was much smaller: the lowest-income group had a 12-percent higher risk of heart attack, stroke or death than the most affluent group.

Even though Booth thinks universal drug coverage helps explains the findings, she said it is not the sole reason for the gap between the rich and poor.

"It's more complicated than that," Booth said. Diabetes is a complex condition that requires people to keep up a healthy lifestyle, and tackle daily tasks like measuring blood sugar.

So differences in diet, exercise, smoking and general "health literacy" - a person's ability to read and understand information about a health condition - are all important, according to Booth.

"Drug coverage is one piece," she said. "We think it's an important piece, but it's not the only one."

Booth also said she thinks her findings are relevant to other countries, including the U.S., where the Medicare program for older Americans has covered the cost of prescriptions since 2006.

Studies have shown that since that benefit started, Medicare recipients' adherence to their medications has generally improved. That includes the poorest and sickest beneficiaries.

Those studies have also found that "non-drug" spending - mostly for hospitalizations - has declined among Medicare recipients who previously had only limited drug coverage.

Medicare drug coverage is subject to coverage gaps, in which seniors have to pay full price for their prescriptions. Recent studies have found that participants often drop their medications when they hit that so-called "donut hole" in coverage, but have not documented any health consequences from that choice. (See Reuters Health stories of July 2, 2012 and August 17, 2012.

Still, Booth said the overall evidence argues for better drug coverage for younger people as well. "More and more people are being diagnosed with diabetes at younger ages," she noted.

Older age is a major risk factor for type 2 diabetes, by far the most common form of diabetes. But so is obesity. And in the U.S., about 36 percent of all adults are now obese.

An estimated 26 million Americans have diabetes, including 14 percent of all people between the ages of 45 and 64, according to the Centers for Disease Control and Prevention.

SOURCE: http://bit.ly/RLDmqT Diabetes Care, online August 13, 2012.

Forget Marcus Welby: Today's docs want a real life

True, they may shun a 24/7 on-call solo practice and try to have a life outside of work.

Yet they say they're just as committed to medicine as kindly Marcus Welby from 1970s TV, or even grumpy Dr. House.

The practice of medicine is in the midst of an evolution, and millennial and Gen X doctors seem to be perfectly suited for it and in some ways may be driving it. The federal health care law is speeding some of these changes, too.

"It's a fortunate accident," said economist and health policy expert Robert Reischauer. "The two will reinforce each other."

These doctors embrace technology and teamwork. They like electronic medical records and smartphone apps. And they like sharing the load with other doctors on the team.

Emal Nasiri and Leana Wen are part of the new breed.

Nasiri, 32, is a medical resident at the University of Oklahoma in Tulsa. He likes the idea of working in a large health plan group where doctors, specialists and other medical staff work as teams, with easy access to patients' electronic medical records. That kind of setup is more likely to be "wired" than smaller practices, and Nasiri can't imagine working without his iPad.

"The older guys carry around little pharmaceutical books" when going room-to-room visiting hospitalized patients, Nasiri said. He thinks that's less efficient than being able to quickly view patients' electronic charts and online drug information.

Wen, 29, will soon finish a residency in emergency medicine at Harvard-affiliated Brigham and Women's Hospital and Massachusetts General Hospital. She's also a newlywed whose husband is an information technology project manager.

"I want to have a balanced life that includes having time for my family," she said.

She chose emergency medicine because the hours are more flexible than those of primary care doctors. That will allow her to work part-time in the ER and follow her other passions — teaching, research, writing and blogging about empowering patients to get the best medical care.

Wen finds her smartphone as handy as her stethoscope. Its apps help her quickly figure out proper medicine doses for critically ill patients, or translate medical instructions for Spanish-speakers. That means she doesn't have to wait for a hospital translator to arrive, and she thinks it makes patient care safer.

She says those who call doctors with outside interests less committed have "a fairly limited world view."

"We need doctors who 'just' practice medicine, but we also need these other doctors who can improve medical care on the larger scale. It is also better to have those taking care of you to take care of themselves and their families, so I would argue that it is a healthier ... and in some ways, more balanced workforce that is emerging," Wen said.

Dr. Darrell Kirch, president of the Association of American Medical Colleges, thinks these new doctors have a broader view of medicine and life than their predecessors, and calls that a positive trend. "I see no evidence that indicates that their ethical commitment is any weaker, that they care any less for patients," he said.

When Kirch graduated from medical school 35 years ago, he envisioned starting a small solo practice, like many of his peers. A mentor steered him into research and work at an academic medical center. But that was not the norm.

"A typical model was of a male physician who plunged into medicine and was supported in doing that by a totally supportive spouse or partner who often gave up any work aspirations of their own," he said.

Newer doctors often have working partners and both share responsibility for raising children or caring for elderly parents, he noted.

Consider some statistics:

— When Kirch graduated in 1977, only about 20 percent of medical school graduates were women; now nearly half are.

—1 in 5 male doctors and 44 percent of female doctors employed by medical groups worked part-time last year, according to an American Medical Group Association survey. That compares with just 7 percent and 29 percent respectively in 2005.

—New doctors in their first year of medical residency training can no longer work 24-hour shifts. Since last year, they've been limited to 16-hour shifts. Stricter limits began in 2003, cutting residents' maximum weekly hours to 80, to improve grueling schedules and reduce medical mistakes.

— A 2011 survey of final-year medical residents conducted by national physician recruitment firm Merritt Hawkins found that only 1 percent wanted to work as solo practitioners, running their own small medical offices.

—Rising numbers of medical school graduates are seeking training programs in high-paying specialties offering flexible hours; emergency medicine and anesthesiology saw some of the biggest increases in this year's medical resident match program.

Those two specialties are popular among young doctors, who on average face more than $150,000 in medical school debt. The others are radiology, ophthalmology and dermatology, all offering better pay and work hours than primary-care medicine.

Also rising in popularity are hospitalists, a specialty that didn't even exist a generation ago. For decades, internists and other primary-care doctors have typically provided part-time care for their patients when they were hospitalized. Increasingly, hospitalists have taken over those duties full time. They often work several 12-hour shifts in a row, with an equal number of days off — the so-called seven on-seven off model.

Dr. John Schumann runs the internal medicine residency program at OU-Tulsa; among the 14 young doctors who finished the program last year, nine became hospitalists, Schumann said.

Nasiri, the tech-loving resident, is also considering hospitalist work.

He's getting married in November and says the long stretches of time off would be more family-friendly and allow him to pursue hobbies, including snowboarding.

He views technology as improving efficiency so that "spending less time doesn't necessarily mean less dedication or worse patient care. More experience with years doesn't necessarily mean better doctors if the older generation isn't keeping up with newer treatment modalities and approaches to patient care."

Kirch, of the medical college association, agrees. When he visits campuses and asks students how they differ from his generation, "they almost always point to the readiness with which they embrace technology."

He's noticed another trend on those visits. Schools used to show off vast medical libraries, "taking pride in how many volumes were sitting on the shelves," Kirch said.

Now, less is more. At one of the newest medical schools, the University of Central Florida in Orlando, "they point with pride to one small room near the entrance, and in that room they hold the books and journals that cannot be accessed online." Their goal, Kirch said, is for that room to be empty.

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Online:

American Association of Medical Colleges: http://www.aamc.org

National Resident Marching Program: http://www.nrmp.org

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AP Medical Writer Lindsey Tanner can be reached at http://www.twitter.com/LindseyTanner

Boomers retiring to rural areas won't find doctors

After a year of going from doctor to doctor, she finally found one who stuck.

As record numbers of baby boomers go into retirement, many are thinking about moving from the places they needed to live to make a living, and going someplace warmer, quieter or prettier.

If they choose small towns like Grants Pass, 250 miles south of Portland, they could well have a hard time finding a family doctor willing to take Medicare, even supplemental plans, rather than private insurance.

"It's a sad situation for seniors," she said.

There are several reasons boomers, the 78 million Americans born between 1946 and 1964, could face difficulties finding a doctor if they retire to small towns over the next 20 years.

First, many primary care doctors prefer to live and work in urban areas because of greater cultural opportunities, better schools and job opportunities for spouses.

Also, Medicare pays rural doctors less per procedure than urban physicians because their operating costs are supposedly less. That makes rural doctors less likely to accept Medicare patients.

With cuts to Medicare reimbursement for doctors targeted under the federal health care overhaul, the shortage is likely to get even worse, said Mark Pauly, professor of health care management at the University of Pennsylvania.

That is, unless increasing reimbursements for nurse practitioners and physicians' assistants encourages those providers to take up the slack, Pauly said.

If the Medicare cuts go through, "the doctors are saying: "We're out of here,'" Pauly said. "The least they are saying is: 'We'll treat Medicare patients like we treat Medicaid patients,' which is mostly not."

Still, there is some good news, depending on where you live.

Pauly said the Affordable Care Act "puts a lot of emphasis on wellness programs and primary care. Nurses, especially nurse practitioners, are intended to play a major role there."

In Oregon, Washington and 14 other states, nurses and nurse practioners "can operate independently of doctors, writing prescriptions, ordering tests, and even running clinics," Pauly said.

Nationwide, the 22.5 percent of primary care doctors who practice in rural areas roughly matches the 24 percent of Medicare patients living there, said Dr. Roland Goertz, chairman of the American Academy of Family Physicians board.

A survey of academy members nationwide shows 83 percent take new Medicare patients. But there is an overall shortage of primary care physicians that still makes it hard for retirees to find a family doctor.

The real problem, he said, is that the health care system "has not supported a robust, adequate primary care workforce for over 30 years."

According to the American Association of Medical Colleges, rural areas need about 20,000 primary care doctors to make up for the shortages, but only about 16,500 medical doctors and 3,500 doctors of osteopathy graduate yearly.

"We are always trying to recruit doctors. We are barely keeping even," said Lyle Jackson, the medical director at the Mid-Rogue Independent Physician Association, a cooperative of doctors in Josephine County, where Musselman lives.

Taking part in the Medicare Advantage program, which pays a higher rate to doctors than standard Medicare, helps, but is still not enough, said Jackson, a former family physician.

A 2009 survey of doctors in the Oregon Medical Association showed concern over Medicare reimbursement rates topping the list of 23 issues, with 79 percent rating it as very important, said Joy Conklin, an official at the association.

The survey showed 19.1 percent of Oregon doctors had closed their practices to Medicare, and 28.1 percent had restricted the numbers of Medicare patients.

That really becomes evident in Josephine County, which attracted retirees after the timber industry collapsed.

Low taxes, cheap housing, wineries, a symphony and low traffic put it in top 10 lists for retirement communities. The 2010 census puts the number of people older than 65 at 23 percent, compared to 14 percent for the state.

But the website County Health Rankings & Roadmaps, which gathers a wide range of health care data nationwide, shows 933 patients for every primary care physician in the county, nearly 50 percent higher than the national 631-to-one rate.

At the Grants Pass Clinic, Dr. Bruce Stowell said they are no longer taking new Medicare patients. Medicare pays about 45 percent of what commercial insurance pays.

As it is, their proportion of Medicare patients is double that of a similar Portland practice.

"We used to get a steady stream of high-quality (resumes) from U.S.-trained and U.S.-born physicians," he said. "Over the last year, that stream has declined into a trickle. Very few (doctors) are choosing to go into primary care."

Schools are turning out more nurse practitioners and physician assistants.

How well they fill the doctor gap will depend largely on how much independence states give them to practice, said Tay Kopanos, director of health care policy for state affairs at the American Academy of Nurse Practitioners.

Meanwhile, overall demand for primary care will be increasing as more people can afford it under the Affordable Care Act, said Joanne Spetz, a health care policy professor at the University of California, San Francisco.

Dr. Atul Grover, chief of public policy for the American Association of Medical Colleges, said the nation is facing a tough time recruiting for primary care as well as other specialties that treat Medicare patients, such as oncologists.

When he decided to become a primary care doctor in the 1990s, it was because of a widespread belief that health maintenance organizations were going to be hiring all the doctors.

He said they wanted primary care doctors to emphasize wellness and prevention. Now, many graduates are moving into specialties that do procedures, such as surgery, because Medicare pays more for them than plain-old office visits.

Also, the Balanced Budget Act of 1997 capped the number of residencies paid by Medicare, so there is no quick way to increase the numbers of doctors in general, let alone in rural areas, he said.

"An entire year's worth of doctor production is needed to deal with the (rural-area) shortage just today," he said.

Is Meditation a Cure for Loneliness?

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CNN reports that a new study led by J. David Creswell, assistant professor of psychology at Carnegie Mellon, confirms some of what science already knows?mindfulness meditation is therapeutic for relieving stress. But in addition to that, Creswell’s study, which focused on the benefits of meditation for seniors, confirmed new and previously unexplored advantages of the practice, such as decreasing loneliness and reducing the bodily inflammation associated with disease in adults.

Creswell notes that loneliness in adults?particularly in the elderly?can be as detrimental to their health as smoking. He explains to CNN, "It's a big problem. Lots of researchers have tried to find ways, like social networks created through community centers, to reduce loneliness in older adults, but none of the approaches really works well."

The difficulty with attacking the problem from that angle, as Creswell explains, is that loneliness isn’t necessarily due to a low number of social contacts. Instead, it’s really about having a subjective perception of feeling disconnected. In his study, Creswell was able to prove that for the participants, mindfulness meditation decreased their feelings of disconnection. Conversely, the control group who abstained from meditation felt their condition stayed the same, or became worse.

But decreased loneliness wasn't the only benefit found during the study. Blood tests were administered to all participants before and after treatment. In comparison to the control group, the meditators showed a significant reduction in blood markers for inflammation after eight weeks of practice. Bodily inflammation plays a key role in the development of diseases, such as Alzheimer's, heart disease, cancer, diabetes, and a multitude of others.

Creswell explains, "It is amazing. For the first time, we are seeing that a behavioral practice?paying attention to your experience from moment to moment?has the power to change the gene expression in your immune cells."

Creswell explains that the next step will be replicating the study on a larger scale and incorporating other age groups.

What would it take for you to incorporate a daily mindfulnes meditation practice into your health regimen?

Related Stories on TakePart:

• Selling Your Life Insurance for Cash May Just Be the New Retirement Fund

• How the Affordable Health Care Act Can Curb Nursing Home Neglect

• Grandma's Nursing Home Nightmare

A Bay Area native, Andri Antoniades previously worked as a fashion industry journalist and medical writer. In addition to reporting the weekend news on TakePart, she volunteers as a web editor for locally-based nonprofits and works as a freelance feature writer for TimeOutLA.com. Email Andri | @andritweets | TakePart.com

Work, mahjong and tea: Hong Kong's secrets to longevity

But new figures show that Hong Kongers are the longest-living people in the world.

Hong Kong men have held the title for more than a decade and recent data show women in the southern Chinese city overtaking their Japanese counterparts for the first time, according to the governments in Tokyo and Hong Kong.

Hong Kong women's life expectancy rose from an average 86 years in 2010 to 86.7 years in 2011, while Japanese women's longevity was hit by last year's earthquake and tsunami, falling to 85.9 years, census figures reveal.

So what is Hong Kong's secret to a long life?

Experts say there is no single elixir, but contributing factors include easy access to modern health care, keeping busy, traditional Cantonese cuisine and even the centuries-old Chinese tile game of mahjong.

-- Rolling stones gather no moss --

"I love travelling, I like to see new things and I meet my friends for 'yum cha' every day," Mak Yin, an 80-year-old grandmother of six says as she practises the slow-motion martial art of tai chi in a park on a Sunday morning.

"Yum cha" is the Cantonese term to describe the tradition of drinking tea with bite-sized delicacies known as dim sum. The tea is free and served non-stop, delivering a healthy dose of antioxidants with the meal.

"My friends are in their 60s -- they think I'm around their age too, although I'm much older than them," Mak laughs.

Mak's favourite food is steamed vegetables, rice and fruit. Cantonese food is famous for steamed fish and vegetables -- dishes that use little or none of the cooking oils blamed for heart disease, obesity and high cholesterol.

But before Mak enjoys her afternoon tea, she joins a group of elderly people for her morning exercise of tai chi, an ancient Chinese practice said to have benefits including improving balance and boosting cardiovascular strength.

A study published in the New England Journal of Medicine in February found that tai chi reduces falls and "appears to reduce balance impairments" in people with mild-to-moderate Parkinson's disease.

Another factor behind Hong Kongers' longevity, experts say, is work. While others long for the day they can retire and kick up their heels, many people in Hong Kong work well into their 70s and even 80s.

Hong Kong does not have a statutory retirement age and it is common to see elderly people working in shops, markets and restaurants alongside younger staff.

"Many old people in our city remain working, that contributes to better psychological and mental health," Hong Kong Association of Gerontology president Edward Leung says.

"For older people, a lot of them are stressed because they have nothing to do and they develop 'emptiness syndrome'. This causes mental stress."

Fishmonger Lee Woo-hing, 67, says he could not bear to sit at home and do nothing. His inspiration is local tycoon Li Ka-shing, Asia's richest man, who still runs his vast business empire in his 80s.

"If Li Ka-shing continues working at the age of 84, why should I retire?" asks the father-of-four during a break from his 14-hour shift at a bustling market in central Hong Kong.

"If I just sit at home and stare at the walls, I'm worried that my brain will degenerate faster. I'm happy to chat with different people here in the market."

-- 'Mahjong delays dementia' --

Hong Kong's cramped living conditions are famously unhealthy, fuelling outbreaks of disease and viruses including bird flu and severe acute respiratory syndrome (SARS) which have killed dozens of people.

The city's reputation won it the dubious distinction of a starring role in director Steven Soderbergh's 2011 disaster thriller "Contagion", about a deadly virus that spreads from Hong Kong to the United States.

But in the day-to-day habits of ordinary people, experts say Hong Kong is a great place to grow old.

A popular local way of keeping busy and meeting friends is mahjong -- a mentally stimulating tile game which can help delay dementia, according to aging expert Alfred Chan, of Hong Kong's Lingnan University.

"It stimulates the parts that control memory and cognitive abilities. It helps old people with their retention of memory," he says.

The complex rules and calculation of scores make mahjong, also known as the Chinese version of dominoes, mentally demanding. But the social aspects of the four-player game are just as important.

"In mahjong you need to play with three other people. It is a very good social activity, you have to interact with each other constantly," says Chan, who has studied the game's effects on the well being of elderly people.

"It is also a self-fulfilling game because if you win -- whether you play with money or not -- it gives you a sense of empowerment."

Mahjong parlours are popular in Hong Kong, and mahjong tables are a must at Chinese wedding banquets.

"I'm in semi-retirement. I work in the morning and hang out with my friends by playing mahjong in the afternoon," says 67-year-old tailor Yeung Fook, on the sidelines of a game in his modest garment shop.

"I'm happier when I work. It's boring to just sit at home."

vineri, 31 august 2012

Analysis: Ryan puts down calculator, picks up bullhorn

In a speech that marked his ascension onto the national stage, Ryan spelled out his conservative vision in the broad brush strokes of the presidential campaign, rather than the pointillistic data sets of the House of Representatives Budget Committee.

But the core message at the Republican National Convention was the same. Ryan said he and his boss, Republican presidential nominee Mitt Romney, must place the federal government on a crash diet and overhaul popular benefit programs in order to avoid a European-style debt crisis.

"The choice is whether to put hard limits on economic growth or hard limits on the size of government, and we choose to limit government," Ryan said.

The take-no-prisoners stance has made Ryan a hero to conservatives, but it carries risks with a broader electorate.

While Americans may back the idea of spending cuts in the abstract, they tend to balk when presented with specifics. Polls show that more voters prefer keeping the Medicare health insurance plan for the elderly in place, rather than overhauling it as Ryan proposes.

"As rhetoric, it was an excellent speech in going over those broad principles. Likewise as rhetoric, it glossed over the hard realities of how you would achieve what he was talking about," said Charles Franklin, a professor at Marquette Law School in Milwaukee, Wisconsin.

Perhaps it's not surprising, then, that Ryan used personal stories to illustrate complex economic issues: the shuttered General Motors plant in his hometown of Janesville, Wisconsin, the small business his mother started at age 50, and the importance of Medicare to his mother, who smiled from the audience.

There were sins of omission. Ryan slammed Obama for ignoring a presidential debt panel, but failed to note that he himself served on the panel and voted against its findings. He also failed to mention that the GM plant closed before Obama took office.

Left unsaid were the tradeoffs Ryan and Romney would make in order to scale back the government to the level they envision.

"He didn't say what the tough choices are," said Steven Schier, a political science professor at Carleton College in Northfield, Minnesota. "You get into that in a convention speech, you lose the crowd, you lose the TV audience."

As a vice presidential candidate, Ryan now must play second fiddle to a man who has often been reluctant to provide details of his own economic policies.

Romney has declined to say which tax loopholes he would close in order to lower income tax rates by 20 percent, and his own proposal for Medicare reforms lacks the specifics that would allow independent experts to determine how much they would cost taxpayers and beneficiaries.

Democrats, of course, are happy to fill in the blanks as they argue that Romney and Ryan would gut programs that benefit the middle class and the poor in order to cut taxes for the wealthy. With Ryan's long voting record in Congress and several years of detailed budget proposals, they have plenty of material to work with.

Though Ryan is revered in Washington for his deep knowledge of fiscal policy, his skills as a salesman may be underappreciated.

Only eight of his fellow Republicans in the House of Representatives backed his plan to overhaul the Medicare prescription drug program when he introduced it in 2008. Within three years, nearly all of them supported it.

He has won re-election in his Democratic-leaning district by wide margins.

And he sounded like he was ready for his biggest sales job yet.

"Ladies and gentlemen, our nation needs this debate," he said. "We want this debate. We will win this debate."

(Editing by Leslie Adler)

Basics about hantavirus outbreak in Yosemite

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How common is hantavirus pulmonary syndrome?

Up to 20 percent of all deer mice carry the virus, though levels can be higher. The illness is rare. Through 2011, there have been 587 documented cases since the illness was first identified in 1993.

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How is it spread?

The most prolific carrier is the deer mouse, which prefers woodlands and high elevations, and can be found in desert areas. The virus in the saliva, feces and urine of infected mice is spread to humans who inhale airborne dust and aerosol particles. Symptoms develop in one to six weeks.

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How do you tell a deer mouse from other mice?

House mice have solid colors, but deer mice range from gray to reddish brown, with white on their underbellies and sides of their tails.

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Who is most susceptible?

Unlike the West Nile Virus, which is particularly hard on the elderly and people with compromised immune systems, there is no standard risk factor for humans when it comes to the hantavirus. Among the known cases, 63 percent have been men and 37 percent women. The range of ages was 6 to 83.

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Can I catch it from someone who is sick?

Probably not. There have been no documented cases of hantavirus being spread by human to human contact.

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What is the mortality rate?

More than 36 percent of people stricken with hantavirus have died from it. In 2011, half of the 24 people who got it died.

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What are the signs?

It begins with chills, fever and muscle aches then progresses into a dry cough, headache, nausea and vomiting, then shortness of breath. People with hantavirus are put in intensive care, placed on oxygen and given medicine to prevent kidney failure.

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How can I avoid exposure?

Open buildings that have been closed for a period of time and let them air out for 30 minutes. Spray mouse droppings with a water and bleach mixture, wait 15 minutes and mop up or wipe with paper towels.

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Will I get it if I go to Yosemite National Park?

The chances are slim. More than 4 million people visit the park each year. Since 2000 there have been six suspected and confirmed cases.

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Sources: Centers for Disease Control and Prevention, California Department of Public Health, the U.S. National Library of Medicine, National Park Service.