Health-Medical-Fitness-Diet-zx: 2012

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.

___

Online:

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

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

___

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

___

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.

___

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.

___

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.

___

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.

___

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.

___

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.

___

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.

___

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.

___

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.

___

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

Más signos de que IRM son seguras para personas con marcapasos

pruebas de que las imágenes por resonancia magnética (IRM)

serían un examen seguro para las personas con marcapasos o

desfibriladores implantables.

Los fabricantes no recomiendan colocar los dispositivos en

los escáneres de MRI porque el campo magnético recalentaría los

cables metálicos, que quemarían el tejido cardíaco. También

podría alterar las características eléctricas de esos

dispositivos tan delicados.

Pero cada vez más estudios sugieren que esas preocupaciones,

que son puramente teóricas, podrían ser infundadas, según dijo

el doctor Christopher Kramer, vocero de la Asociación

Estadounidense del Corazón (AHA, por su nombre en inglés).

"Con éste y otros estudios previos, podríamos decir que el

99,9 por ciento de los dispositivos no sufren modificaciones

clínicamente relevantes", dijo Kramer, que no participó del

estudio.

AHA no recomienda exponer a personas con marcapasos a MRI y

Medicare no cubre el examen, salvo que el paciente sea parte de

un estudio para investigar la seguridad del procedimiento.

El equipo del doctor Robert Russo, de la Clínica Scripps, La

Jolla, California, revisó las historias clínicas de 109

pacientes con marcapasos o desfibriladores cardioversores

implantables (DCI). A cada uno se le había realizado una o más

MRI clínicamente necesarias.

Los dispositivos estaban apagados durante el procedimiento

o, si los pacientes carecían de un latido viable, se los

colocaba en un ritmo constante que el campo magnético del

escáner no podría alterar.

No se registraron muertes ni fallas de los dispositivos o

arritmias en los pacientes, según publica el equipo en American

Journal of Cardiology.

Y mientras que se registraron variaciones leves en las

determinaciones eléctricas antes y después del procedimiento, no

fueron lo suficientemente grandes como para tener algún efecto

en los pacientes.

Es más: el equipo detectó variaciones de la misma magnitud

al revisar a 50 pacientes con dispositivos cardíacos que no

habían sido sometidos a MRI, lo que indica que el cambio es

normal.

Russo aclaró que los resultados deben confirmarse con un

estudio más grande, como el Registro MagnaSafe que está llevando

adelante.

Russo y Kramer comentaron que cada vez más centros están

realizando MRI en pacientes con dispositivos cardíacos cuando no

existe una alternativa mejor.

Aunque las autoridades regulatorias de Estados Unidos ya

aprobaron un marcapasos compatible con MRI, hay miles de

pacientes con los modelos anteriores. Y el 50-70 por ciento de

ellos podría necesitar una MRI, sostuvo Russo.

FUENTE: American Journal of Cardiology, online 27 de agosto

del 2012.

Ireland cuts elderly care, overtime to plug health overspend

Ireland has diligently adhered to the terms of its 85 billion euro EU/IMF bailout and is set to meet its deficit reduction targets for this year, mainly thanks to better-than-expected revenue growth.

However, the social protection and health departments have spent more than anticipated and in a draft document seen by Reuters on Wednesday, the European Commission gave an unusually frank assessment of the performance of the health ministry.

It said that while stubbornly high unemployment had led to larger-than-budgeted demand for free healthcare, the inability to deliver savings "pointed to weaknesses in budget management and accountability".

Ireland's Health Service Executive (HSE) responded by announcing a raft of emergency cuts that included a halving in the use of staff not directly employed by the executive, a 10 percent cut in overtime and a 6 percent reduction in the hours of those who care for the elderly in their homes.

"In compiling these measures, every effort has been taken to target areas that do not impact on direct patient services, with a view to protecting, inasmuch as is possible, the most essential frontline services," the HSE said in a statement.

"However, it is inevitable that some impact on service delivery will be experienced through the implementation of these measures."

The HSE said that were it not to begin to implement the measures through the rest of this year and early next, its deficit, which will stand at 259 million euros by the end of August, would balloon to 500 million euros within four months.

It said the 130 million euro package would be introduced in addition to other non-operational measures, including cash acceleration of receipts from health insurers.

Ireland's health department, which accounts for almost a third of all government spending, was tasked with finding savings of over 500 million euros this year and the Commission's report found that to date, only 22 percent had been achieved.

With Ireland's budget deficit still set to be above 8 percent of gross domestic product (GDP) this year, almost one billion euros of new spending cuts are needed across government in both 2013 and 2014, and charity groups feared the worse.

"The cuts announced today by HSE will inevitably hit the most vulnerable in our community. They will mean that many people desperately in need of care will either be unable to access services or will have their already overstretched services reduced even further," Age Action Ireland said. ($1 = 0.7982 euros)

(Reporting by Padraic Halpin; editing by Stephen Nisbet)

How Old Is Too Old to Drive?

A driver who will be 101 in September backed out of a parking lot near an elementary school in Los Angeles, plowing into 11 people, including nine children. Fortunately no one died as a result of the incident on Wednesday, but it highlights the challenge that aging drivers and their families face in deciding when it's time to get off the road.

Although they only account for about 9 percent of the population, National Highway Traffic Safety Administration statistics show senior drivers account for 14 percent of all traffic fatalities and 17 percent of all pedestrian fatalities.

A recent report by Carnegie Mellon University in Pittsburgh and the AAA Foundation for Traffic Safety found the rate of deaths involving drivers 75 to 84 is about three per million miles driven - on par with teen drivers. Once they pass age 85, vehicular fatality rates jump to nearly four times that of teens.

Richard Nix, executive director of Agingcare.com, says many senior drivers don't realize their eyesight, hearing and reflexes aren't as sharp as they used to be. They may be taking medication that impairs judgment, memory or coordination or suffer from arthritis or Alzheimer's. Consequently they may not realize it when they blow past a stop sign, forget to signal a right turn or confuse the gas pedal with the brake.

Even when they admit to themselves that they're driving skills may not be up to par, some older drivers are still reluctant to hand over their keys. According to Nix, loss of driving privileges is a difficult and emotional issue for many.

"People have been driving their whole life and have trouble believing they're incapable of continuing," he said. "They feel like their independence has been taken away."

And Nix points out, it's frequently a difficult subject for loved ones to face as well. They may feel a pang of fear every time their elderly parent gets behind the wheel but are reluctant to confront them for fear of hurting their feelings are starting a battle.

Nix says that if need be enlist the help of other family members, friends or their physician when a loved one presents a danger on the road. In some cases, it may even be appropriate to take legal action, though laws vary from state to state.

Whether an elderly driver comes to the conclusion on their own that it's time to surrender their license or they're forced to do so, it's a big moment and it can be devastating. But the consequences of not doing so may be even more devastating.

Consider the case of George Russell Weller, an 86-year-old Los Angeles driver who suffered from arthritis, nausea as a side-effect of medication, and reduced mobility from a hip replacement. Weller's car struck another car then accelerated around a road closure sign, crashed through wooden sawhorses, and plowed through a busy marketplace crowd, killing 10 people and injuring another 63. Weller told investigators he had accidentally placed his foot on the accelerator pedal instead of the brake.

Agingcare.com offers the following advice for senior drivers to evaluate when it's time to stop driving:

Conditions like cataracts and glaucoma can diminish sight and hamper driving ability. An eye doctor can help establish whether your sight is good enough to drive safely.

Many older drivers no longer have the strength or dexterity to handle a car. They may shrink in height so much they can no longer see over the windshield. This is especially true for seniors who do little or no physical activity.

Alzheimer's can impair memory and judgment. Diabetics risk falling into a coma while driving. Even if you have long periods of time when health issues cause no problems, why risk it?

Medications, especially multiple medications, can greatly impair driving ability. Your doctor should advise you of the dangers your medications present while driving.

If the minor fender-benders are adding up or you simply feel less confident about driving, it's OK to admit it to yourself that your driving days are over.

Medicare's political importance goes beyond seniors

Recent polling data shows that the issue resonates with boomers in key swing states. In Wisconsin, about 80 percent of respondents aged 50 to 64 ranked Medicare as "important" or "very important" in a Quinnipiac University/CBS/New York Times survey taken August 15-21, versus 91 percent for those 65 and older. Florida and Ohio produced comparable results in the same survey.

There are 41 million seniors and 61 million boomers in the United States. With numbers like that vitally interested in a single issue, the importance of Medicare is likely to grow as the presidential campaign and congressional races move into the post-Labor Day home stretch.

Vice presidential nominee Paul Ryan made that clear in his acceptance speech Wednesday at the Republican National Convention in Tampa, Florida.

The Wisconsin congressman did not mention his plan to revamp the healthcare program for the elderly, which would affect people 54 and younger but not current seniors. Instead, he launched an attack on President Barack Obama for diverting money from Medicare to the broader healthcare overhaul.

The next night, Mitt Romney stuck to the script, mentioning Medicare only once in an attack on Obama as part of his presidential nomination acceptance speech.

Democrats responded by pounding at the Republican plan that, as they say in their ads, would "end Medicare as we know it."

Medicare moved to the forefront of the campaign three weeks ago after Romney chose Ryan as his running mate. The "Ryan plan," much of which Republicans incorporated into their party's platform at the convention, would replace Medicare's wide-ranging coverage of health services for the elderly with a voucher program for seniors to buy their own care.

Polls consistently show that Republicans have an edge among seniors, whose defense of Medicare has traditionally made it a politically untouchable issue. Obama and his fellow Democrats hope the Ryan plan will shift some of that support their way.

Party strategists believe even richer spoils could be had among baby boomers. That group, which includes large numbers of the independent middle-class voters Obama needs for re-election, tends to favor Democrats.

"Baby boomers are particularly concerned about the stability of their retirement," said U.S. Representative Steve Israel of New York, chairman of the Democratic Congressional Campaign Committee.

"If you're a baby boomer in the middle class, since 2000 you've seen the value of your paycheck decline, the value of your home decline and you've seen your 401(k) diminish and you're worried about your retirement," Israel said. "What's the Romney-Ryan solution? End Medicare."

Republicans, who spent the better part of two years emphasizing "reform" of Medicare, now portray themselves as the program's protectors.

"Medicare is a promise and we will honor it," Ryan said on Wednesday. "A Romney-Ryan administration will protect and strengthen Medicare for my mom's generation, for my generation and for my kids and yours."

Medicare, which is expected to become financially insolvent in 2024, covers almost 50 million elderly and disabled people. Soaring U.S. healthcare costs have made it a target in efforts to reduce the federal deficit.

Seniors oppose the Ryan plan by 2 to 1, according to recent polls that also show widespread opposition among all registered voters.

After weeks of campaign warfare, however, the Medicare battle has not translated into an electoral advantage for Obama among seniors, according to some polls.

The Quinnipiac University/CBS/New York Times survey showed elderly voters favoring Romney in Florida, where he led Obama by 13 percentage points, and in Ohio, where he led by eight. Romney also had a slight lead in Wisconsin.

"Seniors are split, especially in retiree-rich swing states like Florida, and I don't think they're going to change their opinions about who to vote for based on Medicare," said Susan MacManus, who teaches government and international affairs at the University of South Florida.

BOOMERS, THE REAL TARGET

Baby boomers are more supportive of Obama generally. Voters aged 50 and 64 favored Obama by four to six percentage points in Florida, Ohio and Wisconsin, according to the Quinnipiac poll. They were also more likely than seniors to trust the president on healthcare and Medicare.

Obama spokesman Adam Fetcher declined to discuss the campaign's Medicare strategy in detail, but he acknowledged that the game plan extends beyond senior citizens.

"The unpopularity of the Romney-Ryan Medicare voucher plan is an opportunity for the president to close the gap among seniors as well as other demographics," he said.

Analysts say boomers who are not yet retired could be more receptive than seniors because their retirement is a worrisome unknown. "Boomers are the real target group," MacManus said. "A lot of them have had everything they planned for turn upside down with the recession and housing prices going down. They're the ones in turmoil, and they haven't heard they're going to be exempt from any reforms."

An AARP survey released this month shows retirement to be a major source of anxiety among boomers, with large majorities expressing doubts about their ability to retire comfortably.

Democratic strategists say the Obama campaign will focus on selected races for the U.S. Senate and House where, analysts say, the party could have its best shot at delivering a policy message capable of influencing voters.

"It helps Obama, especially in the swing states that he's got to win. If they can make the case against a Republican Senate candidate on Medicare, that also hurts Romney and helps Obama," said Jennifer Duffy of the Cook Political Report, a nonpartisan group that analyzes U.S. politics.

The political calculation will figure into Democrats' spending on House and Senate race television ads leading up to the November 6 election.

"If we thought Medicaid was an issue that appealed only to senior citizens, we wouldn't be going up on television with it," said a Democratic campaign official.

(Editing by Fred Barbash and Douglas Royalty)

Tiny Singapore risks economic gloom without big baby boom

But after 25 years of state-sponsored matchmaking and fertility-boosting campaigns, the government's attempts to arrest a sliding birth rate are falling flat, with potentially profound consequences for the wealthy Asian city-state.

The calls to conception are now urgent and constant to citizens whose fertility ranks last among 222 nations in the U.S. Central Intelligence Agency's World Factbook.

Faced with dismal statistics like that, the government has begun a review of population and immigration policy and says it plans new measures to encourage births by the time it publishes the results of its consultation early next year.

The message to have more babies is all the more pressing as resentment builds over an influx of foreigners who now make up more than a third of the population of 5.2 million, a factor that is eroding support for the long-ruling People's Action Party.

"We have a problem. The long-term trend is down but we cannot give up," Prime Minister Lee Hsien Loong said in a speech on Sunday about the nation's future. "We need to create the right environment, the right social environment, the right ethos so that Singaporeans want to settle down and have kids."

Social and economic engineering is nothing new in Singapore, where a firm government hand helped to steer a small island with no natural resources into one of the world's most affluent countries in a little over a generation.

But the relentless drop in the birth rate reveals the limits of that influence in what has been described as a "nanny state".

For a global trade and financial center like Singapore, its extremely low fertility rate has implications for economic growth, tax revenues, healthcare costs and immigration policy as the number of elderly people looks set to triple by 2030.

There are now 6.3 Singaporeans of working age for every senior citizen. By 2030, the ratio will be closer to 2:1.

At current levels, the birth rate implies that the local population will fall by half within a generation, said Sanjeev Sanyal, a Singapore-based global strategist at Deutsche Bank.

"Even to attract a pipeline of good quality foreign talent, you need socio-political continuity and stability that can only be provided by a robust anchor population," he said.

WORK/LIFE BALANCE

If there were any doubts about the government's blatant message, the mint maker Mentos put out an advertisement urging married Singaporeans to do their civic duty on the evening of the August 9 National Day festivities.

"I'm talking about making a baby, baby," went the video's rapped lyrics, accompanied by hip-thrusting animated hearts. "It's National Night, let's make Singapore's birthrate spike."

Not long ago, Singapore had the opposite problem.

From the mid-1960s, with post-war baby boomers hitting child-bearing age, the fears were that a population surge would threaten the development of the newly independent nation.

With the slogan "Stop at two", the government penalized big families, legalized abortion and rewarded sterilization. It was so effective that, by 1987, the policy was reversed and the slogan became "Have three or more if you can afford it".

Conspiring against more births are powerful contraceptives in the form of intense career pressure, long work hours, small apartments, waiting lists for nursery care and soaring prices.

"Work/life balance is what everybody's after," said Evonne, a marketing professional in her 30s, adding she and her husband plan to have one child. "If you don't want kids, no matter what the government throws at you, I don't think you really care."

The 2010 census showed Singaporeans are marrying later than a decade earlier. In the age group 30-34, a key time for career, 43 percent of men and 31 percent of women were not married.

For women in their 40s who were or had been married, those with only one child rose to 19 percent from 15 percent.

The issue is acute for the ethnic Chinese who make up 74 percent of Singapore's citizens and permanent residents, a majority that has ebbed from nearly 78 percent in 1990. Statistics show ethnic Chinese are having fewer babies than the Malay and Indian communities and are more likely to be single.

Officials have sought to balance the call for more children with a message that the country must remain open to immigration to provide the labor and expertise needed for future growth.

Not all are convinced, as many Internet posts show.

Gilbert Goh, who runs a support group, Transitioning, for the unemployed, decried "relentless messages sent out by the government to accept foreigners" because of the low birth rate.

"Besides seemingly solving the whole birth rate issue here for our government, foreigners also are brought in to solve a bigger issue for employers -- cheap hard-working labor," he wrote on his website.

Simmering anger over immigration is widely believed to have contributed to the People's Action Party's unexpected loss of seats in last year's parliamentary elections.

SINGAPORE "WILL FOLD UP"

Saying it recognizes concerns about jobs, living standards and social cohesion, the government has put tighter controls on the number of foreigners it lets in, particularly lower-skilled and lower-wage workers.

In July, it put out a paper for public input on ways to encourage Singaporeans to marry and have families as part of its review of population and immigration policy.

The paper -- "Our Population Our Future" -- set out a troubling scenario for an ageing society if birth trends persist, including a less vibrant economy, an exodus of major companies and a shrinking number of workers and consumers.

To encourage parenthood, the government gives out baby bonuses of up to S$4,000 ($3,200) for each of the first two children, rising to S$6,000 for the third and fourth. It also matches deposits made into a Child Development Account.

The Social Development Network, part of a government agency, offers free romantic advice by its "Dr Love" and oversees the activities of private dating agencies.

To reverse the trend, Lee said on Sunday, changes in social and workplace attitudes are needed, along with more support for families with housing and affordable, accessible childcare.

If women were having at least two children, that would mean a rise in the population. But at a fertility rate of 0.78, according to the CIA, the number of Singaporeans is waning.

The government has different data showing women, on average, giving birth to 1.2 babies in a lifetime -- down from 1.87 in 1990 and 1.42 in 2001 and far below the replacement rate.

The city-state is not alone. Hong Kong, Taiwan and South Korea also have very low fertility rates and many of the same cost, space and career pressures.

Among Southeast Asian neighbors, Thailand's fertility rate of 1.66 is below replacement but the populations are growing in Indonesia (2.23), Malaysia (2.64) and the Philippines (3.15).

Lee Kuan Yew, the country's founding leader and father of the current prime minister, warned in August that Singapore "will fold up" unless it reverses the drop in the birth rate.

"Do we want to replace ourselves or do we want to shrink and get older and be replaced by migrants and work permit holders?" said Lee, who launched the "Stop at two" campaign in 1966.

Some hope for a zodiac-linked baby boom that is borne out by government figures. Births rose in previous Dragon years in 1976, 1988 and 2000, but those were only minor spikes in a steady decline in Singapore's fertility rate from 3.07 in 1970.

The government is promising new measures to encourage births and help families but unless career and cost pressures change dramatically, there may be little effect.

"Can Singaporeans be persuaded to have more children?" was the survey question during a recent television panel discussion on the birth rate. Channel News Asia's telephone poll may not have been completely scientific, but the answer was clear -- a resounding 74 percent of respondents said "no".

($1 = S$1.25)

(Editing by Jason Szep and Nick Macfie)

Surgeon, officials review botched Ohio transplant

The University of Toledo Medical Center apologized and put two nurses and an administrator of surgical services on paid leave without public explanation following the Aug. 10 incident. It also sent letters notifying 975 patients and potential organ donors and recipients that they may need to make other arrangements for services typically provided through the program under review.

UTMC is "committed to ensuring safeguards are put in place to prevent such an incident from ever happening again," Dr. Jeffrey Gold, the vice president for health affairs, said in a statement. The review is expected to take several weeks.

State health officials say they're looking into the botched transplant on behalf of the Centers for Medicare and Medicaid Services, and UTMC hired a Texas surgeon to evaluate its transplant procedures. Dr. Marlon Levy, surgical director for transplantation at Baylor All Saints Medical Center at Fort Worth, was expected to visit Toledo on Thursday and Friday.

The hospital has refused to publicly share much detail about how the kidney was rendered unusable during the transplant, which typically is an hourslong surgery involving a five-person medical team removing the organ from a donor, transferring it to a steel container and transplanting it to a patient in close proximity.

"Somehow, some way, an inexplicable human error made someone think that the kidney apparently was already in the recipient body when it was not," the UTMC president, Dr. Lloyd Jacobs, told The Blade in Toledo.

The local health commissioner, Dr. David Grossman, told the newspaper that a doctor who was involved said a nurse accidentally disposed of the kidney. Grossman did not respond to phone messages from The Associated Press.

The man who donated the kidney and the intended recipient, his sister, have been released from the medical center. The hospital hasn't identified the family, and it can't say whether the sister has received a different kidney, UTMC spokesman Tobin Klinger said. There was a "good chance" of finding another compatible donor, the facility has said.

Kidneys are the most commonly transplanted organ. More than 5,700 kidney transplants involving living donors and 11,000 with deceased donors were performed last year in the United States, according to the Organ Procurement and Transplantation Network, which maintains the national patient waiting list and is administered by the United Network for Organ Sharing. UTMC performed 16 of those living-donor kidney transplants and 37 deceased-donor transplants in 2011.

The types of problems that lead to unsuccessful transplants — and occasionally program suspension or termination — are uncommon but can include an unexpected donor disease transmission or the death of a living donor, said Joel Newman, a spokesman for UNOS, the private, nonprofit, government-contracted organization that manages the organ transplant system in the U.S.

"The occurrence of such events is rare, but in those instances it is a very common procedure for the program to inactivate for a period of time, do some root cause analysis and really try to address any sort of issues that can be corrected," Newman said.

As UTMC takes such steps, three workers are suspended. The administrator of surgical services, Edwin Hall, isn't commenting, according to a woman who answered the phone at his Michigan home on Wednesday. The two suspended nurses, Melanie Lemay and Judith Moore, could not be reached for comment.

The surgeon involved in the transplant has not been suspended.

___

Follow Kantele Franko on Twitter at http://www.twitter.com/kantele10 .

New DNA Analysis Shows Ancient Humans Interbred with Denisovans

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Tens of thousands of years ago modern humans crossed paths with the group of hominins known as the Neandertals. Researchers now think they also met another, less-known group called the Denisovans. The only trace that we have found, however, is a single finger bone and two teeth, but those fragments have been enough to cradle wisps of Denisovan DNA across thousands of years inside a Siberian cave. Now a team of scientists has been able to reconstruct their entire genome from these meager fragments. The analysis adds new twists to prevailing notions about archaic human history.

"Denisova is a big surprise," says John Hawks, a biological anthropologist at the University of Wisconsin–Madison who was not involved in the new research. On its own, a simple finger bone in a cave would have been assumed to belong to a human, Neandertal or other hominin. But when researchers first sequenced a small section of DNA in 2010—a section that covered about 1.9 percent of the genome—they were able to tell that the specimen was neither. "It was the first time a new group of distinct humans was discovered" via genetic analysis rather than by anatomical description, said Svante Pääbo, a researcher at the Max Planck Institute (M.P.I.) for Evolutionary Anthropology in Germany, in a conference call with reporters.

Now Pääbo and his colleagues have devised a new method of genetic analysis that allowed them to reconstruct the entire Denisovan genome with nearly all of the genome sequenced approximately 30 times over akin to what we can do for modern humans. Within this genome, researchers have found clues into not only this group of mysterious hominins, but also our own evolutionary past. Denisovans appear to have been more closely related to Neandertals than to humans, but the evidence also suggests that Denisovans and humans interbred. The new analysis also suggests new ways that early humans may have spread across the globe. The findings were published online August 30 in Science.

Who were the Denisovans?
Unfortunately, the Denisovan genome doesn't provide many more clues about what this hominin looked like than a pinky bone does. The researchers will only conclude that Denisovans likely had dark skin. They also note that there are alleles "consistent" with those known to call for brown hair and brown eyes. Other than that, they cannot say.

Yet the new genetic analysis does support the hypothesis that Neandertals and Denisovans were more closely related to one another than either was to modern humans. The analysis suggests that the modern human line diverged from what would become the Denisovan line as long as 700,000 years ago—but possibly as recently as 170,000 years ago.

Denisovans also interbred with ancient modern humans, according to Pääbo and his team. Even though the sole fossil specimen was found in the mountains of Siberia, contemporary humans from Melanesia (a region in the South Pacific) seem to be the most likely to harbor Denisovan DNA. The researchers estimate that some 6 percent of contemporary Papuans' genomes come from Denisovans. Australian aborigines and those from Southeast Asian islands also have traces of Denisovan DNA. This suggests that the two groups might have crossed paths in central Asia and then the modern humans continued on to colonize the islands of Oceania.

Yet contemporary residents of mainland Asia do not seem to posses Denisovian traces in their DNA, a "very curious" fact, Hawks says. "We're looking at a very interesting population scenario"—one that does not jibe entirely with what we thought we knew about how waves modern human populations migrated into and through Asia and out to Oceania's islands. This new genetic evidence might indicate that perhaps an early wave of humans moved through Asia, mixed with Denisovans and then relocated to the islands—to be replaced in Asia by later waves of human migrants from Africa. "It's not totally obvious that that works really well with what we know about the diversity of Asians and Australians," Hawks says. But further genetic analysis and study should help to clarify these early migrations.

Just as with modern Homo sapiens, the genome of a single individual cannot tell us exactly what genes and traits are specific to all Denisovans. Yet, just one genome can reveal the genetic diversity of an entire population. Each of our genomes contains information about generations far beyond those of our parents and grandparents, said David Reich, a researcher at the Massachusetts Institute of Technology–Harvard University Broad Institute and a co-author on the paper. Scientists can compare and contrast the set of genes on each chromosome—passed down from each parent—and extrapolate this process back through the generations. "You contain a multitude of ancestors within you," Reich said, borrowing from Walt Whitman.

The new research reveals that the Denisovans had low genetic diversity—just 26 to 33 percent of the genetic diversity of contemporary European or Asian populations. And for the Denisovans, the population on the whole seems to have been very small for hundreds of thousands of years, with relatively little genetic diversity throughout their history.

Curiously, the researchers noted in their paper, the Denisovan population shows "a drastic decline in size at the time when the modern human population began to expand."

Why were modern humans so successful whereas Denisovans (and Neandertals) went extinct? Pääbo and his co-authors could not resist looking into the genetic factors that might be at work. Some of the key differences, they note, center around brain development and synaptic connectivity. "It makes sense that what pops up is connectivity in the brain," Pääbo noted. Neandertals had a similar brain size–to-body ratio as we do, so rather than cranial capacity, it might have been underlying neurological differences that could explain why we flourished while they died out, he said.

Hawks counters that it might be a little early to begin drawing conclusions about human brain evolution from genetic comparisons with archaic relatives. Decoding the genetic map of the brain and cognition from a genome is still a long way off, he notes—unraveling skin color is still difficult enough given our current technologies and knowledge.

New sequencing for old DNA
The Denisovan results rely on a new method of genetic analysis developed by paper co-author Matthias Meyer, also of M.P.I. The procedure allows the researchers to sequence the full genome by using single strands of genetic material rather than the typical double strands required. The technique, which they are calling a single-stranded library preparation, involves stripping the genetic material down to individual strands to copy and avoids a purification step, which can lose precious genetic material.

The finger bone—just one disklike phalanx—is so small that it does not contain enough usable carbon for dating, the researchers note. But by counting the number of genetic mutations in a genome and comparing them with other living relatives, such as modern humans and chimpanzees, given assumed rates of mutations since breaking with a last common ancestor, "for the first time you can try to estimate this number into a date and provide molecular dating of the fossil," Meyer said. With the new resolution, the researchers estimate the age of the bone to 74,000 to 82,000 years ago. But that is a wide window, and previous archaeological estimates for the bone are a bit younger, ranging from 30,000 to 50,000 years old. These genetic estimations are also still in limbo because of ongoing debate about the average rate of genetic mutations over time, which could skew the age. "Nevertheless," the researchers noted in their paper, "the results suggest that in the future it will be possible to determine dates of fossils based on genome sequences."

This new sequencing approach can be used for any DNA that is too fragmented to be read well through more traditional methods. Meyer noted that it could come in handy for analysis of both ancient DNA and contemporary forensic evidence, which also often contains only fragments of genetic material.

Hawks is excited about the new sequencing technology. It is also helpful to have a technology developed specifically for the evolutionary field, he notes. "We're always using the new techniques from other fields, and this is a case where the new technique is developed just for this."

Hawks himself has heard from the researchers that have worked with the Denisovan samples that "the Denisovan pinky is just extraordinary" in terms of the amount of DNA preserved in it. Most bone fragments would be expected to contain less than 5 percent of the individual's endogenous DNA, but this fortuitous finger had a surprising 70 percent, the researchers noted in the study. And many Neandertal fragments have been preserved in vastly different states—many are far worse off than this Denisovan finger bone.

The new sequencing approach could also improve our understanding of known specimens and the evolutionary landscape as a whole. "It's going to increase the yield from other fossils," Hawks notes. Many of the Neandertal specimens, for example, have only a small fraction of their genome sequenced. "If we can go from 2 percent to the whole genome, that opens up a lot more," Hawks says. "Going back further in time will be exciting," he notes, and this new technique should allow us to do that. "There's a huge race on—it's exciting."

The Denisovans might be the first non-Neandertal archaic human to be sequenced, but they are likely not going to be the last. The researchers behind this new study are already at work using the new single-strand sequencing technique to reexamine older specimens. (Meyer said they were working on reassessing old samples but would not specify which specimens they were studying—the mysterious "hobbit" H. floresiensis would be a worthy candidate.) Pääbo suggests Asia as a particularly promising location to look for other Denisovan-like groups. "I would be surprised if there were not other groups to be found there in the future," he said.

Taking this technique to specimens from Africa is also likely to yield some exciting results, Hawks says. Africa, with its rich human evolutionary history, holds the greatest genetic diversity. The genomes of contemporary pygmy and hunter–gatherer tribes in Africa, for example, have roughly as many differences as do those of European modern humans and Neandertals. So "any ancient specimen that we find in Africa might be as different from us as Neandertals," Hawks says. "Anything we find from the right place might be another Denisovan."