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May 2009 Briefing - Critical Care

Here are what the editors at HealthDay consider to be the most important developments in Critical Care for May 2009. This roundup includes the latest research news from journal articles, as well as the FDA approvals and regulatory changes that are the most likely to affect clinical practice.

Links Between Bleeding, PCI, Mortality Explored

FRIDAY, May 29 (HealthDay News) -- Major bleeding may play a causal role in mortality in patients undergoing percutaneous coronary intervention (PCI), according to a paper published in the June 2 Journal of the American College of Cardiology.

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Window for Stroke Treatment Opened to 4.5 Hours

FRIDAY, May 29 (HealthDay News) -- The clot-busting drug recombinant tissue plasminogen activator (rtPA) can be given to eligible stroke victims as long as 4.5 hours after onset of symptoms, according to a new scientific advisory published online May 28 in Stroke: Journal of the American Heart Association, but the American Heart Association (AHA)/American Stroke Association (ASA) still urge further analyses.

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Watching Advanced Dementia Video Affects Care Decisions

FRIDAY, May 29 (HealthDay News) -- Showing elderly people a video depicting advanced dementia after they hear a verbal description, affects the choices they make about end-of-life care, according to a study published online May 28 in BMJ.

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Cancer Physicians Often Do Not Take Part in Bereavement

FRIDAY, May 29 (HealthDay News) -- Many cancer physicians do not routinely participate in the bereavement process after patients die, and terminally ill lung cancer patients often have not discussed hospice with their health care providers, according to a pair of studies in the May 25 issue of the Archives of Internal Medicine.

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Cell Transplantation May Improve Bladder Function

FRIDAY, May 29 (HealthDay News) -- In rats with spinal cord injury, transplantation of neuronal-glial restricted precursors or bone marrow stromal cells leads to significant improvement in bladder function but falls short of inducing full recovery, according to a study published in the June issue of The Journal of Urology.

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Music May Lessen Pain for Premature Babies

FRIDAY, May 29 (HealthDay News) -- Playing music in neonatal units may help premature babies to feed better and reduce their pain, according to a review published online on May 28 in the Archives of Disease in Childhood: Fetal & Neonatal Edition.

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Electrophysiology Predicts Tachycardia After Heart Failure

THURSDAY, May 28 (HealthDay News) -- Patients with ischemic cardiomyopathy who go on to develop ventricular tachycardia have differences in the electrophysiology and electroanatomy of the scarred areas, according to a study published online May 27 in the Journal of the American College of Cardiology.

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Stockings Do Not Appear to Cut Thrombosis Risk After Stroke

THURSDAY, May 28 (HealthDay News) -- Thigh-length graduated compression stockings do not reduce the risk of deep vein thrombosis in patients with acute stroke, according to a study published online on May 27 in The Lancet.

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Decision Makers Can't Delay Until H1N1's Scale Is Clear

THURSDAY, May 28 (HealthDay News) -- Officials must decide what actions to take before the severity and scale of the H1N1 virus are certain, and geography plays an important role in the incidence of the virus, according to perspectives published online May 27 in the New England Journal of Medicine.

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Computerized Prescription Order Errors a Risk for Patients

THURSDAY, May 28 (HealthDay News) -- Computerized provider order entry systems are prone to input errors that may put patients at risk, according to a study published in the May 25 issue of the Archives of Internal Medicine.

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Focus on Meaningful Work Protects Doctors From Burnout

THURSDAY, May 27 (HealthDay News) -- Academic faculty physicians who focus on what they find most meaningful are less likely to experience burnout, according to a study published in the May 25 issue of the Archives of Internal Medicine.

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Colorectal Cancer Outcomes Improve at Two Cancer Centers

WEDNESDAY, May 27 (HealthDay News) -- Outcomes for patients with metastatic colorectal cancer have markedly improved at two leading cancer centers since 1997 because of increased use of liver resection and the introduction of new cancer drugs, according to a study published online May 26 in the Journal of Clinical Oncology.

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Repeat Caesareans Linked to Neonatal Respiratory Problems

WEDNESDAY, May 27 (HealthDay News) -- Infants born via elective repeat Caesarean delivery may face a higher risk of certain adverse outcomes, and the rate of delivery hospitalizations involving hypertensive disorders has risen significantly in recent years, according to two studies published in the June issue of Obstetrics & Gynecology.

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Acid Suppressors Linked to Hospital-Acquired Pneumonia

TUESDAY, May 26 (HealthDay News) -- Among inpatients, treatment with acid-suppressive medication -- particularly proton-pump inhibitors -- may significantly increase the risk of hospital-acquired pneumonia, according to a study published in the May 27 issue of the Journal of the American Medical Association.

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Dispatching Software Misses More Than Half of Strokes

TUESDAY, May 26 (HealthDay News) -- The telephone-based software used to prioritize emergency ambulance response failed to identify more than half the incidents of stroke over a six-month period, according to a study in the June Emergency Medicine Journal.

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Intensive Glucose Lowering Reduces Diabetics' Heart Risks

FRIDAY, May 22 (HealthDay News) -- In patients with type 2 diabetes, an intensive glucose-lowering regimen significantly reduces coronary events without increasing the risk of death, according to a study published in the May 23 issue of The Lancet.

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Drug-Resistant Pneumonia Emerging in Healthy People

FRIDAY, May 22 (HealthDay News) -- Community-acquired meticillin-resistant Staphylococcus aureus (MRSA) is an emerging cause of pneumonia in otherwise healthy individuals, according to a case report and review in the June issue of The Lancet Infectious Diseases.

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Echocardiography in CRT Patient Selection Controversial

FRIDAY, May 22 (HealthDay News) -- Research should continue into the use of echocardiography as a means to select candidates for implant of cardiac resynchronization therapy (CRT) devices, but QRS prolongation remains the recommended criterion in making that decision. That was the apparent consensus of a trio of papers arguing the question in the May 26 issue of the Journal of the American College of Cardiology.

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Exercise Echocardiography Can Predict Cardiac Events, Death

THURSDAY, May 21 (HealthDay News) -- Exercise echocardiography (EE) can help predict major cardiac events and mortality in patients who appear normal on electrocardiogram (ECG) tests, according to a study in the May 26 Journal of the American College of Cardiology.

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Democrats Set Ambitious Goal for Health Care Reform

THURSDAY, May 21 (HealthDay News) -- Congressional Democrats face formidable challenges in their efforts to pass health care reform legislation by July 31, but physicians can take the lead to ensure changes are enacted, according to two perspectives published online May 20 in the New England Journal of Medicine.

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ARBs Found Ineffective for Renal Function in Diabetes

THURSDAY, May 21 (HealthDay News) -- Two angiotensin receptor blockers are ineffective in reducing renal dysfunction in patients at high risk of vascular disease such as diabetics, according to two studies published online May 19 in the Annals of Internal Medicine.

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Sticking to Work Hours Limits Very Costly

WEDNESDAY, May 20 (HealthDay News) -- Adherence to the 2003 Accreditation Council for Graduate Medical Education (ACGME) limits on work hours, and other measures aimed at reducing fatigue among residents, would be costly with no proven benefits, according to an article published in the May 21 issue of the New England Journal of Medicine.

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Early Angiography Benefits High-Risk Coronary Patients

WEDNESDAY, May 20 (HealthDay News) -- For high-risk patients with acute coronary syndrome, coronary angiography within hours after presentation can reduce the chance of subsequent death, heart attack and stroke, according to a study in the May 21 issue of the New England Journal of Medicine.

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Pain Management May Be Best Option for Critically Ill

WEDNESDAY, May 20 (HealthDay News) -- Pain management and end-of-life care may be the most beneficial treatment for patients in the intensive care unit (ICU) and should focus on communicating with the patient and family and clearing up misconceptions about the use of palliative treatments, according to a review in the May issue of Chest.

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Antihypertensive Drugs Also Benefit Non-Hypertensives

WEDNESDAY, May 20 (HealthDay News) -- In everyone at risk for heart attack or stroke -- including those with normal blood pressure -- antihypertensive treatment significantly reduces the risk of coronary heart disease events and stroke, according to a study published online May 19 in BMJ.

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Door-to-Balloon Delays Increase Risk of Death

WEDNESDAY, May 20 (HealthDay News) -- In patients admitted with ST elevation myocardial infarction, any delay in primary percutaneous coronary intervention is associated with an increased risk of death, according to a study published online May 19 in BMJ.

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Findings Support Clopidogrel Guideline Recommendations

WEDNESDAY, May 20 (HealthDay News) -- The use of clopidogrel in patients with non-ST-segment elevation acute coronary syndromes (NSTE-ACS) is associated with suitable ischemic reduction and bleeding outcomes to support its use before cardiac catheterization, even if patients should need coronary artery bypass grafting (CABG), according to research published in the May 26 issue of the Journal of the American College of Cardiology.

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Coronary Artery Bypass Care Quality Not Tied to Quantity

TUESDAY, May 19 (HealthDay News) -- Adherence to quality measures in coronary artery bypass follow-up care results in similar mortality rates whether the procedure is performed at a high-volume or low-volume cardiac care center, according to a study reported in the May 19 issue of the Annals of Internal Medicine.

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Swine Flu Has Higher Fatality Rate Than Seasonal Flu

MONDAY, May 18 (HealthDay News) -- The fatality rate from H1N1 swine flu is slightly higher than the fatality rate from seasonal flu, according to United States' health officials, but they say most cases of swine flu are no worse than seasonal flu.

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Iron Not Linked to Survival in Primary Myelofibrosis

MONDAY, May 18 (HealthDay News) -- Higher serum ferritin levels weren't associated with decreased survival in patients with primary myelofibrosis, which could be a finding that's relevant to ongoing discussions in hematology regarding the use of iron chelation, according to research published in the May issue of the American Journal of Hematology.

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Elderly Patients Use Multiple Strategies to Combat Dyspnea

MONDAY, May 18 (HealthDay News) -- Elderly patients with chronic obstructive pulmonary disease use a variety of techniques and strategies to cope with the dyspnea associated with their condition, according to a study published in the May issue of Applied Nursing Research.

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Training in Supportive Care Improves Nurses' Performance

MONDAY, May 18 (HealthDay News) -- Nurses who are trained in developmentally supportive care are better able to take care of premature babies than those who do not receive such training, according to a study published in the May issue of Applied Nursing Research.

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Speech Therapy Exercises Relieve Sleep Apnea

FRIDAY, May 15 (HealthDay News) -- The specialized exercises used in speech therapy can be adapted and used to reduce the symptoms of obstructive sleep apnea syndrome (OSAS), according to a study in the American Journal of Respiratory and Critical Care Medicine.

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Imaging Technology Assesses Graft During Off-Pump CABG

FRIDAY, May 15 (HealthDay News) -- Intraoperative fluorescence imaging (IFI) can evaluate graft patency during off-pump coronary artery bypass graft (CABG) surgery, making possible immediate graft revision, if needed, and potentially better clinical outcomes, according to a study in the May issue of the Journal of the American College of Cardiology: Cardiovascular Imaging.

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Maintaining Airway Pressure Benefits Post-Op Patients

FRIDAY, May 15 (HealthDay News) -- Maintaining positive airway pressure in patients after cardiac surgery can improve arterial oxygenation and reduce pulmonary complications, according to a study published in the May issue of Chest.

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Smokers' Lower Body Weight Linked to Airway Gene

FRIDAY, May 15 (HealthDay News) -- The lower body weight in chronic smokers compared to nonsmokers may be caused by the increased expression of a gene in the airways that stimulates fat depletion, according to a study in the May issue of Chest.

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Patient Selection Crucial for Transcatheter AVR

THURSDAY, May 14 (HealthDay News) -- Transcatheter aortic valve replacement (AVR) is becoming an increasingly used option for patients with symptomatic aortic stenosis who aren't good candidates for surgical valve replacement, according to an overview published in the May 19 issue of the Journal of the American College of Cardiology.

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Activity Helps Intensive Care Patients' Functional Outcomes

THURSDAY, May 14 (HealthDay News) -- Patients in the intensive care unit (ICU) return to normal functioning faster when their sedation is interrupted daily by periods of physical activity, according to a study in the May 14 issue of The Lancet.

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Combined Treatment May Offer Bronchiolitis Benefit

WEDNESDAY, May 13 (HealthDay News) -- The use of nebulized epinephrine and oral dexamethasone in infants presenting to emergency departments with bronchiolitis might reduce later hospital admission, according to research published in the May 14 issue of the New England Journal of Medicine.

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Fatal Encephalitis in New York Man Linked to Deer Tick Virus

WEDNESDAY, May 13 (HealthDay News) -- A report of a fatal case of encephalitis related to deer tick virus illustrates that the incidence of infection in humans may be underappreciated, according to research published in the May 14 issue of the New England Journal of Medicine.

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Folate Fortification Law Linked to Decreased Heart Defects

WEDNESDAY, May 13 (HealthDay News) -- After a Canadian law mandating the fortification of flour and pasta products with folate went into effect in 1998, the birth prevalence of severe congenital defects has decreased in Quebec, according to a study published online May 12 in BMJ.

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Child Post-Mortem Organ Donation Procedures Vary

TUESDAY, May 12 (HealthDay News) -- While most children's hospitals have policies for post-mortem organ donation, they vary on key points, such as the processes for pronouncing death and withdrawing life support, according to a study reported in the May 13 issue of the Journal of the American Medical Association.

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Extreme Estradiol Levels Raise Heart Failure Death Risk

TUESDAY, May 12 (HealthDay News) -- Men with heart failure and moderate levels of serum estradiol are at lower risk of death than their counterparts with particularly high and low levels of the hormone, according to a study in the May 13 issue of the Journal of the American Medical Association.

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Number of Swine Flu Cases in U.S. Exceeds 2,500

MONDAY, May 11 (HealthDay News) -- The United States has surpassed Mexico to become the nation with the most confirmed cases of H1N1 swine flu, according to figures released May 11 by the World Health Organization (WHO).

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Learning to Read CT Angiograms a Lengthy Process

MONDAY, May 11 (HealthDay News) -- Developing skill in reading coronary computed tomographic (CT) angiograms is a slow process and may require more training and practice than provided in a typical one-year fellowship, according to a study reported in the May issue of Radiology.

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PAD Frequently Undiagnosed in Heart Disease Patients

FRIDAY, May 8 (HealthDay News) -- As many as one in six patients with coronary artery disease (CAD) may have overlooked peripheral arterial disease (PAD) despite specialist cardiovascular care, according to a study published in the May issue of Catheterization & Cardiovascular Interventions.

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Triple-Reassortant Swine Virus Seen Since 2005 in US

THURSDAY, May 7 (HealthDay News) -- Eleven cases of infection similar to the swine flu outbreak currently under way -- triple-reassortant swine influenza A (H1) viruses -- have been documented since 2005 in the United States, according to a study led by researchers at the U.S. Centers for Disease Control and Prevention in Atlanta and released May 7 by the New England Journal of Medicine. This study was accompanied by another study, two editorials, and three perspectives focused on the swine flu outbreak.

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Drug-Eluting Stents May Help Prevent Restenosis

WEDNESDAY, May 6 (HealthDay News) -- Drug-eluting stents had lower rates of restenosis and lower rates of lesion and vessel revascularization in head-to-head trials against bare-metal stents in two studies published in the May 7 issue of the New England Journal of Medicine.

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Little Evidence to Support Some H1N1 Flu Measures

WEDNESDAY, May 6 (HealthDay News) -- Some of the interventions that have been introduced in the wake of the outbreak of H1N1 flu have little or no evidence to support them, according to an editorial published online May 5 in The Lancet, while a report in the same journal asks whether or not the international response to the outbreak was fast enough.

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CDC Confirms Over 400 H1N1 Flu Cases

WEDNESDAY, May 6 (HealthDay News) -- As of May 5, the U.S. Centers for Disease Control and Prevention (CDC) has confirmed 403 cases of H1N1 flu nationally in 38 states, with over 700 additional probable cases which, if confirmed, will mean the disease has spread across 44 states. The CDC continues to urge the public to rigorously observe preventive measures.

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High Urine Albumin Linked to Venous Thromboembolism

TUESDAY, May 5 (HealthDay News) -- Already a recognized risk factor for arterial thromboembolism, microalbuminuria also is a risk factor for venous thromboembolism (VTE), according to a study published in the May 6 issue of the Journal of the American Medical Association.

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Heart Arrhythmias Increase Mortality in Catheterizations

TUESDAY, May 5 (HealthDay News) -- The incidence of ventricular tachycardia or fibrillation (VT/VF) during and after percutaneous coronary intervention (PCI) is associated with higher death rates within 90 days, according to a study published in the May 6 issue of the Journal of the American Medical Association.

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Rivaroxaban Effective in Preventing Thrombosis

TUESDAY, May 5 (HealthDay News) -- A phase III trial of oral rivaroxaban has shown that it is more effective than subcutaneous enoxaparin in preventing venous thromboembolism after total knee arthroplasty, according to a study published online May 5 in The Lancet.

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Medical Center Press Releases Often Lacking Key Details

TUESDAY, May 5 (HealthDay News) -- Press releases from academic medical centers may often overstate the importance of research findings while failing to acknowledge relevant limitations of the studies, according to research published in the May 5 Annals of Internal Medicine.

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Modified Protocol Improves Cardiac Arrest Survival

TUESDAY, May 5 (HealthDay News) -- Modified guidelines on the out-of-hospital management of cardiac arrest patients that optimizes compressions and reduces disruption improves survival rates, according to a study published online on May 4 in Circulation.

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Genotype Linked to Cardiac Surgery Outcomes

TUESDAY, May 5 (HealthDay News) -- Patients who were homozygous for the low activity catechol-O-methyltransferase (COMT) L allele had a higher risk of vasodilatory shock and acute kidney injury following cardiac surgery with cardiopulmonary bypass, according to research published online April 30 in the Journal of the American Society of Nephrology.

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Number of US Swine Flu Cases Climbs to 286 in 36 states

MONDAY, May 4 (HealthDay News) -- The confirmed number of swine flu cases in the United States swelled to 245 in 35 states by May 3, but federal health officials are expressing cautious optimism that the disease may be leveling off and may not be as dangerous as initially feared. The U.S. Centers for Disease Control and Prevention (CDC) has updated the number of confirmed national cases to 286 in 36 states as of late this morning.

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Chemical Explains Problems After External Circulation

MONDAY, May 4 (HealthDay News) -- Cyclohexanone, a compound used to make intravenous bags and extracorporeal circulation equipment, can leach into the contained fluids and cause cardiovascular morbidities similar to those observed after extracorporeal circulation, according to a study published in the May issue of the American Journal of Physiology - Heart and Circulatory Physiology.

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Erythropoietin May Worsen Mortality in Cancer Patients

FRIDAY, May 1 (HealthDay News) -- The use of erythropoiesis-stimulating agents to treat anemia in cancer patients worsens mortality, according to two separate reviews of past clinical studies.

Abstract - Bohlius (The Lancet)
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H1N1 Flu Poses Major Surveillance Challenge

FRIDAY, May 1 (HealthDay News) -- Containment of the influenza A strain H1N1, or swine flu, outbreak is probably impossible because cases are already geographically widespread and countries with fragile health systems lack the ability to properly conduct surveillance and containment activities, according to an editorial published online April 30 in BMJ.

Editorial

More Americans Reporting Disability

FRIDAY, May 1 (HealthDay News) -- The number of Americans reporting disabilities rose by 7.7 percent from 44.1 million in 1999 to 47.5 million in 2005, according to a report in the May 1 issue of the U.S. Centers for Disease Control and Prevention's Morbidity and Mortality Weekly Report.

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CDC: More Than 100 H1N1 Flu Infections in US

FRIDAY, May 1 (HealthDay News) -- As of Thursday, April 30, the U.S. Centers for Disease Control and Prevention (CDC) has confirmed 109 cases of influenza A strain H1N1, or swine flu, in the United States, with 50 cases in New York, 26 in Texas, 14 in California, 10 in South Carolina, and the rest in seven other states. So far, only one death has been recorded.

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Physician's Briefing