Health & Fitness | Nutrition-supplements

"It was humbling," she said of her visit to the state's Department of Social Services office. "For lack of a better way to put it, that was for other people. It wasn't for me."

Around the country, similar stories are playing out for thousands of families.

Since the recession began a year ago, many states have seen increases in the Medicaid rolls just as tax revenues are falling below projections. Governors have lobbied President-elect Barack Obama and Congress to help them weather the downturn by increasing the federal government's share of Medicaid spending for at least two years.

The governors said the extra $40 billion would ease the service cuts or tax increases that legislatures need to balance state budgets.

The unemployment rate has jumped from about 4.7 percent last December, when the recession began, to 6.7 percent today. Economists estimated in a Kaiser Family Foundation report that each 1 percent gain in the unemployment rate adds 1 million people to the Medicaid and State Children's Health Insurance Program.

In Connecticut, a state faring better than many, enrollment in the Medicaid program has climbed from about 312,000 last December to about 329,500 in November - a 6 percent increase. Many who lost their jobs were eligible to continue group health insurance. But that is not an option in most cases because they no longer have an employer picking up a large share of their premiums.

Medicaid insures nearly one in six low-income people in the U.S. The program typically covers the very poor and about half of enrollees are children. Spending came to $333 billion in the budget year ending Sept. 30, 2007. Washington picks up about 57 percent of that; the states cover the remainder.

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On the Net:

Kaiser Family Foundation: http://www.kff.org

Centers for Medicare and Medicaid Services: http://www.cms.hhs.gov

Families USA: http://www.familiesusa.org

© 2008 The Associated Press.

Health officials say they aren't too worried, for several reasons. First, it's early in the flu season, and it's not clear this strain will dominate through the next several months. Second, not many people take antiviral medications for the flu.

Third, the flu vaccine - the primary weapon against flu - seems well matched against the circulating bugs.

But doctors need to take it seriously, said William Schaffner, a Vanderbilt University infectious diseases expert.

"Each influenza seasons provides a bit of a surprise and we got our (surprise) a little early this year," he added.

The flu causes 200,000 hospitalizations and 36,000 deaths annually, according to official estimates. The elderly, young children and people with chronic illnesses are considered at greatest risk.

For the public, the best course of action is vaccination, health officials said. Only about 30 percent of U.S. adults had gotten a flu vaccination this flu season, according to an online survey conducted by the RAND Corporation in November. A flu shot is recommended for those 50 and older, children from 6 months to 18 years, pregnant women, nursing home patients and those with certain medical conditions or who care for people with those conditions.

For people who get the flu, the two most commonly used antivirals are Tamiflu, a pill also known as oseltamivir, and Relenza, an inhaled drug also called zanamivir. The drugs are most effective if taken within two days of getting sick but most people don't see a doctor that quickly.

Early tests indicate that 49 of 50 samples of the main flu virus circulating this year - H1N1 - were resistant to Tamiflu. The samples came mainly from Hawaii, Texas and ten other states. Widespread flu has not yet been reported in most of the country.

"It could fizzle out," or H1N1 could become the dominant strain, Gerberding said.

A spokesman for Tamiflu's manufacturer - Roche, a Swiss company - said it's too early to draw strong conclusions about the drug's usefulness this flu season. The basis of the CDC's alert "is a small sample in a limited number of states, and Tamiflu is showing good activity against other circulating viruses," said spokesman Terry Hurley.

For those sick with the flu, doctors cannot simply choose Relenza instead of Tamiflu. That treatment is not approved for children younger than 7 or people who have asthma or certain other breathing problems. GlaxoSmithKline PLC, which makes Relenza, said Friday it has enough to meet the demands of the current flu season.

An option for some patients, Gerberding said, may be a combination of Tamiflu and rimantadine, another antiviral medication that works against H1N1 but lost effectiveness against another kind of flu virus.

However, it's not clear how well that combination will work, Schaffner said.

"This is a 'best advice with our back against the wall' kind of thing," he said.

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On the Net:

The CDC flu report: http://www.cdc.gov/flu/weekly/

© 2008 The Associated Press.

Critics say the protections are so broad they limit a patient's right to get care and accurate information. For example, they fear the rule could make it possible for a pharmacy clerk to refuse to sell birth control pills without ramifications from an employer.

Under long-standing federal law, institutions may not discriminate against individuals who refuse to perform abortions or provide a referral for one. The administration's rule is intended to ensure that federal funds don't flow to providers who violate those laws, Health and Human Services officials said.

"Doctors and other health care providers should not be forced to choose between good professional standing and violating their conscience," said HHS Secretary Mike Leavitt.

The rule requires recipients of federal funding to certify their compliance with laws protecting conscience rights.

Despite multiple laws on the books protecting health providers, the administration argued that the rule was needed "to raise awareness of federal conscience protections and provide for their enforcement."

But many groups described the rule as a last-minute push designed to make it harder for women to get services such as contraception or counseling in the event they are pregnant and want to learn all of their options.

Several medical associations, more than 100 members of Congress, governors and 13 attorneys general were among the many thousands who wrote the department to protest the rule after it was proposed. Opponents didn't like the rule any better after it was finalized.

"In just a matter of months, the Bush administration has undone three decades of federal protections for both medical professionals and their patients," said Nancy Northup, president of the Center for Reproductive Rights. "It replaced them with a policy that seriously risks the health of millions of women, then tried to pass it off as benevolent."

Abortion opponents hailed the regulation because they said the lack of regulation had resulted in confusion and a lack of awareness.

"This is a huge victory for religious freedom and the First Amendment," said Tony Perkins, president of the Family Research Council.

The administration estimated the cost of complying with the rule at $43.6 million annually, which is spread throughout the hundreds of thousands of health providers subject to the rule - from hospitals and physician offices to medical schools and pharmacies.

Several lawmakers have promised to take up legislation that would overturn the rule once Congress reconvenes in January. Another option is for the Obama administration to issue new regulations that would trump it. The rule will take effect on Jan. 18, two days before Obama takes office.

Obama's transition team did not specifically address the rule Thursday, but spokesman Nick Shapiro issued a statement that said Obama "will review all eleventh-hour regulations and will address them once he is president."

While campaigning in August, Obama criticized the proposal: "This proposed regulation complicates, rather than clarifies the law. It raises troubling issues about access to basic health care for women, particularly access to contraceptives," he said.

The 127-page rule disputed concerns that the protections being proposed were too broad and would affect too many workers in the health care industry, not just doctors or nurses involved with an abortion or sterilization.

"These laws are intended to protect the conscience rights of all individuals participating in health care services, and research programs and activities receiving certain federal funds, or that are administered by the department," the rule said.

Opponents consistently described the rule as a last-minute effort that would reduce access to health care services, particularly access to birth control.

"Making birth control more - not less - accessible is the best way to prevent unintended pregnancies and reduce abortion," said Rep. Nita Lowey, D-N.Y.

Others said the rule would go so far as to protect providers who refuse to give rape victims emergency contraceptives.

The Planned Parenthood Federation of America said about 200,000 people submitted comments opposing the rule, including about 90,000 comments from its supporters.

"This midnight regulation, issued in the last days of the Bush administration, undermines this country's fragile health care system as well as patients' access to health care information and services," said the group's president, Cecile Richards.

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On the Net:

Health and Human Services Department: http://www.hhs.gov

Planned Parenthood: http://www.plannedparenthood.org

© 2008 The Associated Press.

For Lozoya, 17, not having a driver's license was part of the challenge. But the dearth of supermarkets in her South Los Angeles neighborhood choked with liquor stores, auto repair shops and warehouses made it even harder.

"I can't drive yet so I'm not gonna do anything extraordinary like jump on my bike and ride it for two or three miles and ride it back with tons of stuff on it, oh no," said Lozoya.

Seizing control of her kitchen, Lozoya helped her mom shed 50 pounds by banning lard from tamales and poaching chicken instead of frying it - and she is expanding her efforts to help her neighbors.

Lozoya is working to bring better food to one of the poorest communities in America, where neon lights illuminate a greasy fast-food vista and obesity and diabetes are rampant. While grocery stores and healthy restaurants are scarce, corner stores are stocked with beer, cigarettes, fried snacks and fatty sweets.

Lozoya's work with high school classmates to urge bodegas to stock healthier options is part of a larger campaign nationwide by nutritionists and community activists to eradicate so-called food deserts.

"Deserts are naturally occurring things," said Joanne Kim, chief operating officer of the Community Coalition of South Los Angeles. "We call this food apartheid because people have chosen to locate elsewhere even though there is substantial purchasing power here."

Between the three major Southern California grocery chains - Ralphs, Albertsons and Vons - there are six supermarkets in South Los Angeles, serving a population of about 688,000. By comparison, 19 supermarkets serve West Los Angeles' population of about 395,000.

Retailers blame theft in urban supermarkets, high employment turnover and lack of space for choosing to locate their stores elsewhere.

While farmers markets and trucks peddling fruits and vegetables have taken root in South Los Angeles, they are inconsistent and inadequate for the area's population, Kim said.

Some cities are trying to get more supermarkets into urban areas. The state of Pennsylvania invested $30 million five years ago and got 61 supermarkets opened in rural and urban areas.

Chicago and New Orleans are considering similar programs, but legislation to bring the same assistance to California cities died in the Legislature in 2006 due to budget constraints.

The food disparity in South Los Angeles is an echo of the area's history, marked by decades of segregation and racial strife, dating back before the deadly 1965 Watts riots.

In the state's post-riot report, residents alleged price gouging and the sale of stale bread, rancid meat and rotten produce - complaints that re-emerged decades later after race riots erupted in the wake of the Rodney King verdict in 1992, said City Councilwoman Jan Perry.

South Los Angeles has shifted from a mostly black to a mostly Hispanic community in the last decade, with Latinos making up about two-thirds of the population, according to 2006 Census figures.

Today, fast food is king in South L.A. Nearly three-quarters of restaurants offer food on the go, compared to 42 percent in pricier neighboring West Los Angeles.

The city's Community Redevelopment Agency estimates the area could support 14 new grocery stores and 74 more restaurants. But few businesses are biting on incentives that include hiring tax credits, 35 percent electricity discounts for a year and low interest loans.

"You throw public subsidies at them, and they still don't come," Kim said.

Like many residents of Lozoya's community, where 28 percent of households live below the federal poverty line, she relies on the small corner grocery a few blocks from her home for chicken, fruit and vegetables.

Until recently, Los Compadres Market and Restaurant looked like most others. But Lozoya and her classmates gave it a healthy makeover through a grant from The California Endowment, a private health foundation that aims to create healthy communities.

Chips and candy were removed from the front aisle of the store; a large cooler in the back was stocked with fresh fruits and vegetables; fruits were carefully laid out to avoid bruising; milk and cheese chilled alongside beer.

"These problems are really killing our communities," said Marion Standish, a program director for the endowment. "They're really disabling young people all over the state and limiting their potential in very serious ways, and limiting all of our potential as a result."

It's those limitations that Lozoya is trying to push past - even in her own quiet ways at home.

A few times, she's convinced her parents to drive 45 minutes to Beverly Hills, where her father, a contractor who doesn't consider a meal complete without red meat, balks at the price of the perfectly ripe berries Lozoya piles into the cart.

"When we get to the checkout he says, 'This is the last time! Never again!'" Lozoya said, wagging her finger in imitation. "Now, me and my mom try to pay when he isn't looking."

© 2008 The Associated Press.

"Our patient was called names and was humiliated. You need a face to face the world," said Siemionow, the Cleveland Clinic reconstructive surgeon who led the operation about two weeks ago.

During the 22-hour procedure, 80 percent of the patient's face was replaced with bone, muscles, nerves, skin, blood vessels and some teeth taken from a woman who had died hours earlier.

It was the fourth face transplant in the world, though the others were not as extensive as this one.

"I must tell you how happy she was when with both her hands she could go over her face and feel that she has a nose, feel that she has a jaw," Siemionow said. "She wants just to go out and be invisible in the crowd."

The patient's name and age were not released, nor were details on how she was injured, and she did not appear at a hospital news conference Wednesday. Surgeons said she was doing well and showing no signs of rejecting her new face. She was still sedated and unable to speak much, communicating mostly through writing, Siemionow said.

Doctors believe she will eventually be able to eat on her own, breathe normally instead of through a hole in her windpipe, and exhibit a full range of facial expressions, including smiling and frowning.

She is expected to spend weeks in the hospital, after which she will have to undergo periodic checkups for the rest of her life to watch for signs of rejection.

The transplant was fraught with ethical questions.

Unlike operations involving vital organs like hearts and livers, transplants of faces are done to improve quality of life - not extend it. Recipients run the risk of deadly complications and must take immune-suppressing drugs for the rest of their lives to prevent organ rejection, raising their odds of cancer and infections.

But the hospital's bioethics chief, Dr. Eric Kodish, said the circumstances and procedures followed for the donation and transplant were "beyond reproach."

"This is not cosmetic surgery in any conventional sense," Kodish said.

Over the past four years, Siemionow had considered dozens of desperate burn victims and other potential candidates for the operation, and practiced on animals and cadavers to perfect the technique. The woman selected was so badly injured that only her upper eyelids, forehead, lower lip and chin were left.

"She heard people calling her names, children just scared of her, running away from her. When she was on the street, people were turning their heads," Siemionow said.

Previous operations on the woman over several years at the Cleveland Clinic had made little improvement in her looks, doctors said.

"This patient exhausted all conventional means of reconstruction, and is the right patient," Siemionow said.

The donor's family gave specific permission for the face to be used. The removal of a dead person's face would rule out an open-casket funeral.

The recipient was not shown a picture of the donor, and in animal experiments, "the recipient never looks like the donor," especially when the injuries are severe, Siemionow said. That is because the underlying bone structure is different from person to person.

The hospital posted a statement from the woman's sibling on its Web site.

"We never thought for a moment that our sister would ever have a chance at a normal life again, after the trauma she endured," it says. "But thanks to the wonderful person that donated her organs to help another living human being, she has another chance to live a normal life. Our family cannot thank you enough."

After about three months waiting for a donor similar to the recipient in age, gender, tissue type and skin tone, Siemionow again asked her patient if she wanted to go through with it. "She said 'I'm ready. I've been waiting for this,'" the surgeon said.

Disfigured patients are stuck at home, "hiding from society" and afraid to go out, the surgeon said.

Many more like her exist, and a military grant to the clinic will let them explore the possibility of operating on soldiers left severely disfigured, Siemionow said.

The clinic is absorbing the roughly $200,000 cost of this first transplant because it is an experiment and part of research. They hope to offer more, but are taking this one case at a time for now, Siemionow said.

The world's first partial face transplant was performed in France in 2005 on a 38-year-old woman who had been mauled by her dog. Isabelle Dinoire received a new nose, chin and lips from a brain-dead donor. Apart from some rejection episodes, she has done well.

Two others have received partial face transplants since then - a Chinese farmer attacked by a bear and a European man disfigured by a genetic condition.

Leading plastic surgeons praised the operation. It's an example of a medical advance "that gives patients their lives back," Dr. John Canady, president of the American Society of Plastic Surgeons, said in a statement.

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On the Net:

Cleveland Clinic: http://www.clevelandclinic.org/face

© 2008 The Associated Press.

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