After early start, worst of flu season may be over

NEW YORK (AP) — The worst of the flu season appears to be over.

The number of states reporting intense or widespread illnesses dropped again last week, and in a few states there was very little flu going around, U.S. health officials said Friday.

The season started earlier than normal, first in the Southeast and then spreading. But now, by some measures, flu activity has been ebbing for at least four weeks in much of the country. Flu and pneumonia deaths also dropped the last two weeks, the Centers for Disease Control and Prevention reported.

"It's likely that the worst of the current flu season is over," CDC spokesman Tom Skinner said.

But flu is hard to predict, he and others stressed, and there have been spikes late in the season in the past.

For now, states like Georgia and New York — where doctor's offices were jammed a few weeks ago — are reporting low flu activity. The hot spots are now the West Coast and the Southwest.

Among the places that have seen a drop: Lehigh Valley Hospital-Cedar Crest in Allentown, Pa., which put up a tent outside its emergency room last month to help deal with the steady stream of patients. There were about 100 patients each day back then. Now it's down to 25 and the hospital may pack up its tent next week, said Terry Burger, director of infection control and prevention for the hospital.

"There's no question that we're seeing a decline," she said.

In early December, CDC officials announced flu season had arrived, a month earlier than usual. They were worried, saying it had been nine years since a winter flu season started like this one. That was 2003-04 — one of the deadliest seasons in the past 35 years, with more than 48,000 deaths.

Like this year, the major flu strain was one that tends to make people sicker, especially the elderly, who are most vulnerable to flu and its complications

But back then, that year's flu vaccine wasn't made to protect against that bug, and fewer people got flu shots. The vaccine is reformulated almost every year, and the CDC has said this year's vaccine is a good match to the types that are circulating. A preliminary CDC study showed it is about 60 percent effective, which is close to the average.

So far, the season has been labeled moderately severe.

Like others, Lehigh Valley's Burger was cautious about making predictions. "I'm not certain we're completely out of the woods," with more wintry weather ahead and people likely to be packed indoors where flu can spread around, she said.

The government does not keep a running tally of flu-related deaths in adults, but has received reports of 59 deaths in children. The most — nine — were in Texas, where flu activity was still high last week. Roughly 100 children die in an average flu season, the CDC says

On average, about 24,000 Americans die each flu season, according to the CDC.

According to the CDC report, the number of states with intense activity is down to 19, from 24 the previous week, and flu is widespread in 38 states, down from 42.

Flu is now minimal in Florida, Kentucky, Maine, Montana, New Hampshire and South Carolina.

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Online:

CDC: http://www.cdc.gov/flu/

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Southern diet, fried foods, may raise stroke risk

Deep-fried foods may be causing trouble in the Deep South. People whose diets are heavy on them and sugary drinks like sweet tea and soda were more likely to suffer a stroke, a new study finds.

It's the first big look at diet and strokes, and researchers say it might help explain why blacks in the Southeast — the nation's "stroke belt" — suffer more of them.

Blacks were five times more likely than whites to have the Southern dietary pattern linked with the highest stroke risk. And blacks and whites who live in the South were more likely to eat this way than people in other parts of the country were. Diet might explain as much as two-thirds of the excess stroke risk seen in blacks versus whites, researchers concluded.

"We're talking about fried foods, french fries, hamburgers, processed meats, hot dogs," bacon, ham, liver, gizzards and sugary drinks, said the study's leader, Suzanne Judd of the University of Alabama in Birmingham.

People who ate about six meals a week featuring these sorts of foods had a 41 percent higher stroke risk than people who ate that way about once a month, researchers found.

In contrast, people whose diets were high in fruits, vegetables, whole grains and fish had a 29 percent lower stroke risk.

"It's a very big difference," Judd said. "The message for people in the middle is there's a graded risk" — the likelihood of suffering a stroke rises in proportion to each Southern meal in a week.

Results were reported Thursday at an American Stroke Association conference in Honolulu.

The federally funded study was launched in 2002 to explore regional variations in stroke risks and reasons for them. More than 20,000 people 45 or older — half of them black — from all 48 mainland states filled out food surveys and were sorted into one of five diet styles:

—Southern: Fried foods, processed meats (lunchmeat, jerky), red meat, eggs, sweet drinks and whole milk.

—Convenience: Mexican and Chinese food, pizza, pasta.

—Plant-based: Fruits, vegetables, juice, cereal, fish, poultry, yogurt, nuts and whole-grain bread.

—Sweets: Added fats, breads, chocolate, desserts, sweet breakfast foods.

—Alcohol: Beer, wine, liquor, green leafy vegetables, salad dressings, nuts and seeds, coffee.

"They're not mutually exclusive" — for example, hamburgers fall into both convenience and Southern diets, Judd said. Each person got a score for each diet, depending on how many meals leaned that way.

Over more than five years of follow-up, nearly 500 strokes occurred. Researchers saw clear patterns with the Southern and plant-based diets; the other three didn't seem to affect stroke risk.

There were 138 strokes among the 4,977 who ate the most Southern food, compared to 109 strokes among the 5,156 people eating the least of it.

There were 122 strokes among the 5,076 who ate the most plant-based meals, compared to 135 strokes among the 5,056 people who seldom ate that way.

The trends held up after researchers took into account other factors such as age, income, smoking, education, exercise and total calories consumed.

Fried foods tend to be eaten with lots of salt, which raises blood pressure — a known stroke risk factor, Judd said. And sweet drinks can contribute to diabetes, the disease that celebrity chef Paula Deen — the queen of Southern cuisine — revealed she had a year ago.

The National Institute of Neurological Disorders and Stroke, drugmaker Amgen Inc. and General Mills Inc. funded the study.

"This study does strongly suggest that food does have an influence and people should be trying to avoid these kinds of fatty foods and high sugar content," said an independent expert, Dr. Brian Silver, a Brown University neurologist and stroke center director at Rhode Island Hospital.

"I don't mean to sound like an ogre. I know when I'm in New Orleans I certainly enjoy the food there. But you don't have to make a regular habit of eating all this stuff."

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Marilynn Marchione can be followed at http://twitter.com/MMarchioneAP

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Critics seek to delay NYC sugary drinks size limit

NEW YORK (AP) — Opponents are pressing to delay enforcement of the city's novel plan to crack down on supersized, sugary drinks, saying businesses shouldn't have to spend millions of dollars to comply until a court rules on whether the measure is legal.

With the rule set to take effect March 12, beverage industry, restaurant and other business groups have asked a judge to put it on hold at least until there's a ruling on their lawsuit seeking to block it altogether. The measure would bar many eateries from selling high-sugar drinks in cups or containers bigger than 16 ounces.

"It would be a tremendous waste of expense, time, and effort for our members to incur all of the harm and costs associated with the ban if this court decides that the ban is illegal," Chong Sik Le, president of the New York Korean-American Grocers Association, said in court papers filed Friday.

City lawyers are fighting the lawsuit and oppose postponing the restriction, which the city Board of Health approved in September. They said Tuesday they expect to prevail.

"The obesity epidemic kills nearly 6,000 New Yorkers each year. We see no reason to delay the Board of Health's reasonable and legal actions to combat this major, growing problem," Mark Muschenheim, a city attorney, said in a statement.

Another city lawyer, Thomas Merrill, has said officials believe businesses have had enough time to get ready for the new rule. He has noted that the city doesn't plan to seek fines until June.

Mayor Michael Bloomberg and other city officials see the first-of-its-kind limit as a coup for public health. The city's obesity rate is rising, and studies have linked sugary drinks to weight gain, they note.

"This is the biggest step a city has taken to curb obesity," Bloomberg said when the measure passed.

Soda makers and other critics view the rule as an unwarranted intrusion into people's dietary choices and an unfair, uneven burden on business. The restriction won't apply at supermarkets and many convenience stores because the city doesn't regulate them.

While the dispute plays out in court, "the impacted businesses would like some more certainty on when and how they might need to adjust operations," American Beverage Industry spokesman Christopher Gindlesperger said Tuesday.

Those adjustments are expected to cost the association's members about $600,000 in labeling and other expenses for bottles, Vice President Mike Redman said in court papers. Reconfiguring "16-ounce" cups that are actually made slightly bigger, to leave room at the top, is expected to take cup manufacturers three months to a year and cost them anywhere from more than $100,000 to several millions of dollars, Foodservice Packaging Institute President Lynn Dyer said in court documents.

Movie theaters, meanwhile, are concerned because beverages account for more than 20 percent of their overall profits and about 98 percent of soda sales are in containers greater than 16 ounces, according to Robert Sunshine, executive director of the National Association of Theatre Owners of New York State.

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Critics seek to delay NYC sugary drinks size limit

NEW YORK (AP) — Opponents of the city's plan to crack down on supersized, sugary drinks have asked a judge to delay enforcement of it, saying beverage makers and sellers shouldn't have to spend millions of dollars to comply until a court rules on whether the measure is legal.

With the rule set to take effect March 12, beverage industry, restaurant and other business groups want to put it on hold at least until there's a ruling on their lawsuit seeking to block it altogether. The measure would bar many eateries from selling high-sugar drinks in cups or containers bigger than 16 ounces.

"It would be a tremendous waste of expense, time, and effort for our members to incur all of the harm and costs associated with the ban if this court decides that the ban is illegal," Chong Sik Le, president of the New York Korean-American Grocers Association, said in court papers filed Friday.

City lawyers are fighting the lawsuit and have said they'll oppose postponing the restriction, which the city Board of Health approved in September.

"We think that there's been time to comply," a city lawyer, Thomas Merrill, said after the critics indicated last month that they planned to seek a delay. Merrill noted that the city has said it won't seek fines until June.

Mayor Michael Bloomberg and other city officials see the first-of-its-kind limit as a coup for public health. The city's obesity rate is rising, and studies have linked sugary drinks to weight gain, they note.

"This is the biggest step a city has taken to curb obesity," Bloomberg said when the measure passed.

Soda makers and other critics view the rule as an unwarranted intrusion into people's dietary choices and an unfair, uneven burden on business. The restriction won't apply at supermarkets and many convenience stores because the city doesn't regulate them.

While the dispute plays out in court, "the impacted businesses would like some more certainty on when and how they might need to adjust operations," American Beverage Industry spokesman Christopher Gindlesperger said Tuesday.

Those adjustments are expected to cost the association's members about $600,000 in labeling and other expenses for bottles, Vice President Mike Redman said in court papers. Reconfiguring "16-ounce" cups that are actually made slightly bigger, to leave room at the top, is expected to take cup manufacturers three months to a year and cost them anywhere from more than $100,000 to several millions of dollars, Foodservice Packaging Institute President Lynn Dyer said in court documents.

Movie theaters, meanwhile, are concerned because beverages account for more than 20 percent of their overall profits and about 98 percent of soda sales are in containers greater than 16 ounces, according to Robert Sunshine, executive director of the National Association of Theatre Owners of New York State.

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Bullying study: It does get better for gay teens

CHICAGO (AP) — It really does get better for gay and bisexual teens when it comes to being bullied, although young gay men have it worse than their lesbian peers, according to the first long-term scientific evidence on how the problem changes over time.

The seven-year study involved more than 4,000 teens in England who were questioned yearly through 2010, until they were 19 and 20 years old. At the start, just over half of the 187 gay, lesbian and bisexual teens said they had been bullied; by 2010 that dropped to 9 percent of gay and bisexual boys and 6 percent of lesbian and bisexual girls.

The researchers said the same results likely would be found in the United States.

In both countries, a "sea change" in cultural acceptance of gays and growing intolerance for bullying occurred during the study years, which partly explains the results, said study co-author Ian Rivers, a psychologist and professor of human development at Brunel University in London.

That includes a government mandate in England that schools work to prevent bullying, and changes in the United States permitting same-sex marriage in several states.

In 2010, syndicated columnist Dan Savage launched the "It Gets Better" video project to encourage bullied gay teens. It was prompted by widely publicized suicides of young gays, and includes videos from politicians and celebrities.

"Bullying tends to decline with age regardless of sexual orientation and gender," and the study confirms that, said co-author Joseph Robinson, a researcher and assistant professor of educational psychology at the University of Illinois in Urbana-Champaign. "In absolute terms, this would suggest that yes, it gets better."

The study appears online Monday in the journal Pediatrics.

Eliza Byard, executive director of the Gay, Lesbian & Straight Education Network, said the results mirror surveys by her anti-bullying advocacy group that show bullying is more common in U.S. middle schools than in high schools.

But the researchers said their results show the situation is more nuanced for young gay men.

In the first years of the study, gay boys and girls were almost twice as likely to be bullied as their straight peers. By the last year, bullying dropped overall and was at about the same level for lesbians and straight girls. But the difference between men got worse by ages 19 and 20, with gay young men almost four times more likely than their straight peers to be bullied.

The mixed results for young gay men may reflect the fact that masculine tendencies in girls and women are more culturally acceptable than femininity in boys and men, Robinson said.

Savage, who was not involved in the study, agreed.

"A lot of the disgust that people feel when you bring up homosexuality ... centers around gay male sexuality," Savage said. "There's more of a comfort level" around gay women, he said.

Kendall Johnson, 21, a junior theater major at the University of Illinois, said he was bullied for being gay in high school, mostly when he brought boyfriends to school dances or football games.

"One year at prom, I had a guy tell us that we were disgusting and he didn't want to see us dancing anymore," Johnson said. A football player and the president of the drama club intervened on his behalf, he recalled.

Johnson hasn't been bullied in college, but he said that's partly because he hangs out with the theater crowd and avoids the fraternity scene. Still, he agreed, that it generally gets better for gays as they mature.

"As you grow older, you become more accepting of yourself," Johnson said.

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Online:

Pediatrics: http://www.pediatrics.org

It Gets Better: http://www.itgetsbetter.org

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

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New rules aim to get rid of junk foods in schools

WASHINGTON (AP) — Most candy, high-calorie drinks and greasy meals could soon be on a food blacklist in the nation's schools.

For the first time, the government is proposing broad new standards to make sure all foods sold in schools are more healthful.

Under the new rules the Agriculture Department proposed Friday, foods like fatty chips, snack cakes, nachos and mozzarella sticks would be taken out of lunch lines and vending machines. In their place would be foods like baked chips, trail mix, diet sodas, lower-calorie sports drinks and low-fat hamburgers.

The rules, required under a child nutrition law passed by Congress in 2010, are part of the government's effort to combat childhood obesity. While many schools already have improved their lunch menus and vending machine choices, others still are selling high-fat, high-calorie foods.

Under the proposal, the Agriculture Department would set fat, calorie, sugar and sodium limits on almost all foods sold in schools. Current standards already regulate the nutritional content of school breakfasts and lunches that are subsidized by the federal government, but most lunchrooms also have "a la carte" lines that sell other foods. Food sold through vending machines and in other ways outside the lunchroom has never before been federally regulated.

"Parents and teachers work hard to instill healthy eating habits in our kids, and these efforts should be supported when kids walk through the schoolhouse door," Agriculture Secretary Tom Vilsack said.

Most snacks sold in school would have to have less than 200 calories. Elementary and middle schools could sell only water, low-fat milk or 100 percent fruit or vegetable juice. High schools could sell some sports drinks, diet sodas and iced teas, but the calories would be limited. Drinks would be limited to 12-ounce portions in middle schools and to 8-ounce portions in elementary schools.

The standards will cover vending machines, the "a la carte" lunch lines, snack bars and any other foods regularly sold around school. They would not apply to in-school fundraisers or bake sales, though states have the power to regulate them. The new guidelines also would not apply to after-school concessions at school games or theater events, goodies brought from home for classroom celebrations, or anything students bring for their own personal consumption.

The new rules are the latest in a long list of changes designed to make foods served in schools more healthful and accessible. Nutritional guidelines for the subsidized lunches were revised last year and put in place last fall. The 2010 child nutrition law also provided more money for schools to serve free and reduced-cost lunches and required more meals to be served to hungry kids.

Sen. Tom Harkin, D-Iowa, has been working for two decades to take junk foods out of schools. He calls the availability of unhealthful foods around campus a "loophole" that undermines the taxpayer money that helps pay for the healthier subsidized lunches.

"USDA's proposed nutrition standards are a critical step in closing that loophole and in ensuring that our schools are places that nurture not just the minds of American children but their bodies as well," Harkin said.

Last year's rules faced criticism from some conservatives, including some Republicans in Congress, who said the government shouldn't be telling kids what to eat. Mindful of that backlash, the Agriculture Department exempted in-school fundraisers from federal regulation and proposed different options for some parts of the rule, including the calorie limits for drinks in high schools, which would be limited to either 60 calories or 75 calories in a 12-ounce portion.

The department also has shown a willingness to work with schools to resolve complaints that some new requirements are hard to meet. Last year, for example, the government relaxed some limits on meats and grains in subsidized lunches after school nutritionists said they weren't working.

Schools, the food industry, interest groups and other critics or supporters of the new proposal will have 60 days to comment and suggest changes. A final rule could be in place as soon as the 2014 school year.

Margo Wootan, a nutrition lobbyist for the Center for Science in the Public Interest, said surveys by her organization show that most parents want changes in the lunchroom.

"Parents aren't going to have to worry that kids are using their lunch money to buy candy bars and a Gatorade instead of a healthy school lunch," she said.

The food industry has been onboard with many of the changes, and several companies worked with Congress on the child nutrition law two years ago. Major beverage companies have already agreed to take the most caloric sodas out of schools. But those same companies, including Coca-Cola and PepsiCo, also sell many of the non-soda options, like sports drinks, and have lobbied to keep them in vending machines.

A spokeswoman for the American Beverage Association, which represents the soda companies, says they already have greatly reduced the number of calories that kids are consuming at school by pulling out the high-calorie sodas.

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Follow Mary Clare Jalonick on Twitter at http://twitter.com/mcjalonick

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New rules aim to get rid of junk foods in schools

WASHINGTON (AP) — Most candy, high-calorie drinks and greasy meals could soon be on a food blacklist in the nation's schools.

For the first time, the government is proposing broad new standards to make sure all foods sold in schools are more healthful.

Under the new rules the Agriculture Department proposed Friday, foods like fatty chips, snack cakes, nachos and mozzarella sticks would be taken out of lunch lines and vending machines. In their place would be foods like baked chips, trail mix, diet sodas, lower-calorie sports drinks and low-fat hamburgers.

The rules, required under a child nutrition law passed by Congress in 2010, are part of the government's effort to combat childhood obesity. While many schools already have improved their lunch menus and vending machine choices, others still are selling high-fat, high-calorie foods.

Under the proposal, the Agriculture Department would set fat, calorie, sugar and sodium limits on almost all foods sold in schools. Current standards already regulate the nutritional content of school breakfasts and lunches that are subsidized by the federal government, but most lunchrooms also have "a la carte" lines that sell other foods. Food sold through vending machines and in other ways outside the lunchroom has never before been federally regulated.

"Parents and teachers work hard to instill healthy eating habits in our kids, and these efforts should be supported when kids walk through the schoolhouse door," Agriculture Secretary Tom Vilsack said.

Most snacks sold in school would have to have less than 200 calories. Elementary and middle schools could sell only water, low-fat milk or 100 percent fruit or vegetable juice. High schools could sell some sports drinks, diet sodas and iced teas, but the calories would be limited. Drinks would be limited to 12-ounce portions in middle schools and to 8-ounce portions in elementary schools.

The standards will cover vending machines, the "a la carte" lunch lines, snack bars and any other foods regularly sold around school. They would not apply to in-school fundraisers or bake sales, though states have the power to regulate them. The new guidelines also would not apply to after-school concessions at school games or theater events, goodies brought from home for classroom celebrations, or anything students bring for their own personal consumption.

The new rules are the latest in a long list of changes designed to make foods served in schools more healthful and accessible. Nutritional guidelines for the subsidized lunches were revised last year and put in place last fall. The 2010 child nutrition law also provided more money for schools to serve free and reduced-cost lunches and required more meals to be served to hungry kids.

Sen. Tom Harkin, D-Iowa, has been working for two decades to take junk foods out of schools. He calls the availability of unhealthful foods around campus a "loophole" that undermines the taxpayer money that helps pay for the healthier subsidized lunches.

"USDA's proposed nutrition standards are a critical step in closing that loophole and in ensuring that our schools are places that nurture not just the minds of American children but their bodies as well," Harkin said.

Last year's rules faced criticism from some conservatives, including some Republicans in Congress, who said the government shouldn't be telling kids what to eat. Mindful of that backlash, the Agriculture Department exempted in-school fundraisers from federal regulation and proposed different options for some parts of the rule, including the calorie limits for drinks in high schools, which would be limited to either 60 calories or 75 calories in a 12-ounce portion.

The department also has shown a willingness to work with schools to resolve complaints that some new requirements are hard to meet. Last year, for example, the government relaxed some limits on meats and grains in subsidized lunches after school nutritionists said they weren't working.

Schools, the food industry, interest groups and other critics or supporters of the new proposal will have 60 days to comment and suggest changes. A final rule could be in place as soon as the 2014 school year.

Margo Wootan, a nutrition lobbyist for the Center for Science in the Public Interest, said surveys by her organization show that most parents want changes in the lunchroom.

"Parents aren't going to have to worry that kids are using their lunch money to buy candy bars and a Gatorade instead of a healthy school lunch," she said.

The food industry has been onboard with many of the changes, and several companies worked with Congress on the child nutrition law two years ago. Major beverage companies have already agreed to take the most caloric sodas out of schools. But those same companies, including Coca-Cola and PepsiCo, also sell many of the non-soda options, like sports drinks, and have lobbied to keep them in vending machines.

A spokeswoman for the American Beverage Association, which represents the soda companies, says they already have greatly reduced the number of calories that kids are consuming at school by pulling out the high-calorie sodas.

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Follow Mary Clare Jalonick on Twitter at http://twitter.com/mcjalonick

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Hedgehog Alert! Prickly pets can carry salmonella

NEW YORK (AP) — Add those cute little hedgehogs to the list of pets that can make you sick.

In the last year, 20 people were infected by a rare but dangerous form of salmonella bacteria, and one person died in January. The illnesses were linked to contact with hedgehogs kept as pets, according to a report released Thursday by the Centers for Disease Control and Prevention.

Health officials on Thursday say such cases seem to be increasing.

The CDC recommends thoroughly washing your hands after handling hedgehogs and cleaning pet cages and other equipment outside.

Other pets that carry the salmonella bug are frogs, toads, turtles, snakes, lizards, chicks and ducklings.

Seven of the hedgehog illnesses were in Washington state, including the death — an elderly man from Spokane County who died in January. The other cases were in Alabama, Illinois, Indiana, Michigan, Minnesota, Ohio and Oregon.

In years past, only one or two illnesses from this salmonella strain have been reported annually, but the numbers rose to 14 in 2011, 18 last year, and two so far this year.

Children younger than five and the elderly are considered at highest risk for severe illness, CDC officials said.

Hedgehogs are small, insect-eating mammals with a coat of stiff quills. In nature, they sometimes live under hedges and defend themselves by rolling up into a spiky ball.

The critters linked to recent illnesses were purchased from various breeders, many of them licensed by the U.S. Department of Agriculture, CDC officials said. Hedgehogs are native to Western Europe, New Zealand and some other parts of the world, but are bred in the United States.

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Online:

CDC report: http://www.cdc.gov/mmwr

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Sex to burn calories? Authors expose obesity myths

Fact or fiction? Sex burns a lot of calories. Snacking or skipping breakfast is bad. School gym classes make a big difference in kids' weight.

All are myths or at least presumptions that may not be true, say researchers who reviewed the science behind some widely held obesity beliefs and found it lacking.

Their report in Thursday's New England Journal of Medicine says dogma and fallacies are detracting from real solutions to the nation's weight problems.

"The evidence is what matters," and many feel-good ideas repeated by well-meaning health experts just don't have it, said the lead author, David Allison, a biostatistician at the University of Alabama at Birmingham.

Independent researchers say the authors have some valid points. But many of the report's authors also have deep financial ties to food, beverage and weight-loss product makers — the disclosures take up half a page of fine print in the journal.

"It raises questions about what the purpose of this paper is" and whether it's aimed at promoting drugs, meal replacement products and bariatric surgery as solutions, said Marion Nestle, a New York University professor of nutrition and food studies.

"The big issues in weight loss are how you change the food environment in order for people to make healthy choices," such as limits on soda sizes and marketing junk food to children, she said. Some of the myths they cite are "straw men" issues, she said.

But some are pretty interesting.

Sex, for instance. Not that people do it to try to lose weight, but claims that it burns 100 to 300 calories are common, Allison said. Yet the only study that scientifically measured the energy output found that sex lasted six minutes on average — "disappointing, isn't it?" — and burned a mere 21 calories, about as much as walking, he said.

That's for a man. The study was done in 1984 and didn't measure the women's experience.

Among the other myths or assumptions the authors cite, based on their review of the most rigorous studies on each topic:

—Small changes in diet or exercise lead to large, long-term weight changes. Fact: The body adapts to changes, so small steps to cut calories don't have the same effect over time, studies suggest. At least one outside expert agrees with the authors that the "small changes" concept is based on an "oversimplified" 3,500-calorie rule, that adding or cutting that many calories alters weight by one pound.

—School gym classes have a big impact on kids' weight. Fact: Classes typically are not long, often or intense enough to make much difference.

—Losing a lot of weight quickly is worse than losing a little slowly over the long term. Fact: Although many dieters regain weight, those who lose a lot to start with often end up at a lower weight than people who drop more modest amounts.

—Snacking leads to weight gain. Fact: No high quality studies support that, the authors say.

—Regularly eating breakfast helps prevent obesity. Fact: Two studies found no effect on weight and one suggested that the effect depended on whether people were used to skipping breakfast or not.

—Setting overly ambitious goals leads to frustration and less weight loss. Fact: Some studies suggest people do better with high goals.

Some things may not have the strongest evidence for preventing obesity but are good for other reasons, such as breastfeeding and eating plenty of fruits and vegetables, the authors write. And exercise helps prevent a host of health problems regardless of whether it helps a person shed weight.

"I agree with most of the points" except the authors' conclusions that meal replacement products and diet drugs work for battling obesity, said Dr. David Ludwig, a prominent obesity research with Boston Children's Hospital who has no industry ties. Most weight-loss drugs sold over the last century had to be recalled because of serious side effects, so "there's much more evidence of failure than success," he said.

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Online:

Obesity info: http://www.cdc.gov/obesity/data/trends.html

New England Journal: http://www.nejm.org

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Marilynn Marchione can be followed at http://twitter.com/MMarchioneAP

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Soldier with new arms determined to be independent

BALTIMORE (AP) — After weeks of round-the-clock medical care, Brendan Marrocco insisted on rolling his own wheelchair into a news conference using his new transplanted arms. Then he brushed his hair to one side.

Such simple tasks would go unnoticed in most patients. But for Marrocco, who lost all four limbs while serving in Iraq, these little actions demonstrate how far he's come only six weeks after getting a double-arm transplant.

Wounded by a roadside bomb in 2009, the former soldier said he could get by without legs, but he hated living without arms.

"Not having arms takes so much away from you. Even your personality, you know. You talk with your hands. You do everything with your hands, and when you don't have that, you're kind of lost for a while," the 26-year-old New Yorker told reporters Tuesday at Johns Hopkins Hospital.

Doctors don't want him using his new arms too much yet, but his gritty determination to regain independence was one of the chief reasons he was chosen to receive the surgery, which has been performed in the U.S. only seven times.

That's the message Marrocco said he has for other wounded soldiers.

"Just not to give up hope. You know, life always gets better, and you're still alive," he said. "And to be stubborn. There's a lot of people who will say you can't do something. Just be stubborn and do it anyway. Work your ass off and do it."

Dr. W.P. Andrew Lee, head of the team that conducted the surgery, said the new arms could eventually provide much of the same function as his original arms and hands. Another double-arm transplant patient can now use chopsticks and tie his shoes.

Lee said Marrocco's recovery has been remarkable, and the transplant is helping to "restore physical and psychological well-being."

Tuesday's news conference was held to mark a milestone in his recovery — the day he was to be discharged from the hospital.

Next comes several years of rehabilitation, including physical therapy that is going to become more difficult as feeling returns to the arms.

Before the surgery, he had been living with his older brother in a specially equipped home on New York's Staten Island that had been built with the help of several charities. Shortly after moving in, he said it was "a relief to not have to rely on other people so much."

The home was heavily damaged by Superstorm Sandy last fall.

"We'll get it back together. We've been through a lot worse than that," his father, Alex Marrocco, said.

For the next few months, Marrocco plans to live with his brother in an apartment near the hospital.

The former infantryman said he can already move the elbow on his left arm and rotate it a little bit, but there hasn't been much movement yet for his right arm, which was transplanted higher up.

Marrocco's mother, Michelle Marrocco, said he can't hug her yet, so he brushes his left arm against her face.

The first time he moved his left arm was a complete surprise, an involuntary motion while friends were visiting him in the hospital, he said.

"I had no idea what was going through my mind. I was with my friends, and it happened by accident," he recalled. "One of my friends said 'Did you do that on purpose?' And I didn't know I did it."

Marrocco's operation also involved a technical feat not tried in previous cases, Lee said in an interview after the news conference.

A small part of Marrocco's left forearm remained just below his elbow, and doctors transplanted a whole new forearm around and on top of it, then rewired nerves to serve the old and new muscles in that arm.

"We wanted to save his joint. In the unlucky event we would lose the transplant, we still wanted him to have the elbow joint," Lee said.

He also explained why leg transplants are not done for people missing those limbs — "it's not very practical." That's because nerves regrow at best about an inch a month, so it would be many years before a transplanted leg was useful.

Even if movement returned, a patient might lack sensation on the soles of the feet, which would be unsafe if the person stepped on sharp objects and couldn't feel the pain.

And unlike prosthetic arms and hands, which many patients find frustrating, the ones for legs are good. That makes the risks of a transplant not worth taking.

"It's premature" until there are better ways to help nerves regrow, Lee said.

Now Marrocco, who was the first soldier to survive losing all four limbs in the Iraq War, is looking forward to getting behind the wheel of his black 2006 Dodge Charger and hand-cycling a marathon.

Asked if he could one day throw a football, Dr. Jaimie Shores said sure, but maybe not like Baltimore Ravens quarterback Joe Flacco.

"Thanks for having faith in me," Marrocco interjected, drawing laughter from the crowd.

His mother said Marrocco has always been "a tough cookie."

"He's not changed that, and he's just taken it and made it an art form," Michelle Marrocco said. "He's never going to stop. He's going to be that boy I knew was going to be a pain in my butt forever. And he's going to show people how to live their lives."

___

Associated Press Chief Medical Writer Marilynn Marchione in Milwaukee and AP writer David Dishneau in Hagerstown, Md., contributed to this report.

Read More..

Study says leafy greens top food poisoning source

NEW YORK (AP) — A big government study has fingered leafy greens like lettuce and spinach as the leading source of food poisoning, a perhaps uncomfortable conclusion for health officials who want us to eat our vegetables.

"Most meals are safe," said Dr. Patricia Griffin, a government researcher and one of the study's authors who said the finding shouldn't discourage people from eating produce. Experts repeated often-heard advice: Be sure to wash those foods or cook them thoroughly.

While more people may have gotten sick from plants, more died from contaminated poultry, the study also found. The results were released Tuesday by the Centers for Disease Control and Prevention.

Each year roughly 1 in 6 Americans — or 48 million people— gets sick from food poisoning. That includes 128,000 hospitalization and 3,000 deaths, according to previous CDC estimates.

The new report is the most comprehensive CDC has produced on the sources of food poisoning, covering the years 1998 through 2008. It reflects the agency's growing sophistication at monitoring illnesses and finding their source.

What jumped out at the researchers was the role fruits and vegetables played in food poisonings, said Griffin, who heads the CDC office that handles foodborne infection surveillance and analysis.

About 1 in 5 illnesses were linked to leafy green vegetables — more than any other type of food. And nearly half of all food poisonings were attributed to produce in general, when illnesses from other fruits and vegetables were added in.

It's been kind of a tough month for vegetables. A controversy erupted when Taco Bell started airing a TV ad for its variety 12-pack of tacos, with a voiceover saying that bringing a vegetable tray to a football party is "like punting on fourth-and-1." It said that people secretly hate guests who bring vegetables to parties.

The fast-food chain on Monday announced it was pulling the commercial after receiving complaints that it discouraged people from eating vegetables.

Without actually saying so, the CDC report suggests that the Food and Drug Administration should devote more staff time and other resources to inspection of fruits and vegetables, said Michael Doyle, director of the University of Georgia's Center for Food Safety.

Earlier this month, the FDA released a proposed new rule for produce safety that would set new hygiene standards for farm workers and for trying to reduce contact with animal waste and dirty water.

Meanwhile, CDC officials emphasized that their report should not be seen as discouraging people from eating vegetables.

Many of the vegetable-related illnesses come from norovirus, which is often spread by cooks and food handlers. So contamination sometimes has more to do with the kitchen or restaurant it came from then the food itself, Griffin noted.

Also, while vegetable-related illnesses were more common, they were not the most dangerous. The largest proportion of foodborne illness deaths — about 1 in 5 — were due to poultry. That was partly because three big outbreaks more than 10 years ago linked to turkey deli meat.

But it was close. CDC estimated 277 poultry-related deaths in 1998-2008, compared to 236 vegetable-related deaths.

Fruits and nuts were credited with 96 additional deaths, making 334 total deaths for produce of all types. The CDC estimated 417 deaths from all kinds of meat and poultry, another 140 from dairy and 71 from eggs.

Red meat was once seen as one of the leading sources of food poisoning, partly because of a deadly outbreak of E. coli associated with hamburger. But Griffin and Doyle said there have been significant safety improvements in beef handling. In the study, beef was the source of fewer than 4 percent of food-related deaths and fewer than 7 percent of illnesses.

____

Online:

CDC journal: http://www.cdc.gov/eid/

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Soldier who lost 4 limbs has double-arm transplant

The first soldier to survive after losing all four limbs in the Iraq war has received a double-arm transplant in Baltimore.

His father says Brendan Marrocco (muh-ROCK-oh) had the operation on Dec. 18 at Johns Hopkins Hospital. Marrocco is 26 and lives in New York City. He was injured by a roadside bomb in 2009.

He also received bone marrow from the same dead donor who supplied his new arms. That novel approach is aimed at helping his body accept the new limbs with minimal medication to prevent rejection.

It is the seventh double-hand or double-arm transplant done in the United States. The military is sponsoring operations like these to help wounded troops. About 300 have lost arms or hands in the wars.

Surgeons plan to discuss the transplant Tuesday.

Read More..

CDC: Flu seems to level off except in the West

New government figures show that flu cases seem to be leveling off nationwide. Flu activity is declining in most regions although still rising in the West.

The Centers for Disease Control and Prevention says hospitalizations and deaths spiked again last week, especially among the elderly. The CDC says quick treatment with antiviral medicines is important, in particular for the very young or old. The season's first flu case resistant to treatment with Tamiflu was reported Friday.

Eight more children have died from the flu, bringing this season's total pediatric deaths to 37. About 100 children die in an average flu season.

There is still vaccine available although it may be hard to find. The CDC has a website that can help.

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CDC: http://www.cdc.gov/flu/

Read More..

CDC: Flu seems to level off except in the West

New government figures show that flu cases seem to be leveling off nationwide. Flu activity is declining in most regions although still rising in the West.

The Centers for Disease Control and Prevention says hospitalizations and deaths spiked again last week, especially among the elderly. The CDC says quick treatment with antiviral medicines is important, in particular for the very young or old. The season's first flu case resistant to treatment with Tamiflu was reported Friday.

Eight more children have died from the flu, bringing this season's total pediatric deaths to 37. About 100 children die in an average flu season.

There is still vaccine available although it may be hard to find. The CDC has a website that can help.

___

CDC: http://www.cdc.gov/flu/

Read More..

Penalty could keep smokers out of health overhaul

WASHINGTON (AP) — Millions of smokers could be priced out of health insurance because of tobacco penalties in President Barack Obama's health care law, according to experts who are just now teasing out the potential impact of a little-noted provision in the massive legislation.

The Affordable Care Act — "Obamacare" to its detractors — allows health insurers to charge smokers buying individual policies up to 50 percent higher premiums starting next Jan. 1.

For a 55-year-old smoker, the penalty could reach nearly $4,250 a year. A 60-year-old could wind up paying nearly $5,100 on top of premiums.

Younger smokers could be charged lower penalties under rules proposed last fall by the Obama administration. But older smokers could face a heavy hit on their household budgets at a time in life when smoking-related illnesses tend to emerge.

Workers covered on the job would be able to avoid tobacco penalties by joining smoking cessation programs, because employer plans operate under different rules. But experts say that option is not guaranteed to smokers trying to purchase coverage individually.

Nearly one of every five U.S. adults smokes. That share is higher among lower-income people, who also are more likely to work in jobs that don't come with health insurance and would therefore depend on the new federal health care law. Smoking increases the risk of developing heart disease, lung problems and cancer, contributing to nearly 450,000 deaths a year.

Insurers won't be allowed to charge more under the overhaul for people who are overweight, or have a health condition like a bad back or a heart that skips beats — but they can charge more if a person smokes.

Starting next Jan. 1, the federal health care law will make it possible for people who can't get coverage now to buy private policies, providing tax credits to keep the premiums affordable. Although the law prohibits insurance companies from turning away the sick, the penalties for smokers could have the same effect in many cases, keeping out potentially costly patients.

"We don't want to create barriers for people to get health care coverage," said California state Assemblyman Richard Pan, who is working on a law in his state that would limit insurers' ability to charge smokers more. The federal law allows states to limit or change the smoking penalty.

"We want people who are smoking to get smoking cessation treatment," added Pan, a pediatrician who represents the Sacramento area.

Obama administration officials declined to be interviewed for this article, but a former consumer protection regulator for the government is raising questions.

"If you are an insurer and there is a group of smokers you don't want in your pool, the ones you really don't want are the ones who have been smoking for 20 or 30 years," said Karen Pollitz, an expert on individual health insurance markets with the nonpartisan Kaiser Family Foundation. "You would have the flexibility to discourage them."

Several provisions in the federal health care law work together to leave older smokers with a bleak set of financial options, said Pollitz, formerly deputy director of the Office of Consumer Support in the federal Health and Human Services Department.

First, the law allows insurers to charge older adults up to three times as much as their youngest customers.

Second, the law allows insurers to levy the full 50 percent penalty on older smokers while charging less to younger ones.

And finally, government tax credits that will be available to help pay premiums cannot be used to offset the cost of penalties for smokers.

Here's how the math would work:

Take a hypothetical 60-year-old smoker making $35,000 a year. Estimated premiums for coverage in the new private health insurance markets under Obama's law would total $10,172. That person would be eligible for a tax credit that brings the cost down to $3,325.

But the smoking penalty could add $5,086 to the cost. And since federal tax credits can't be used to offset the penalty, the smoker's total cost for health insurance would be $8,411, or 24 percent of income. That's considered unaffordable under the federal law. The numbers were estimated using the online Kaiser Health Reform Subsidy Calculator.

"The effect of the smoking (penalty) allowed under the law would be that lower-income smokers could not afford health insurance," said Richard Curtis, president of the Institute for Health Policy Solutions, a nonpartisan research group that called attention to the issue with a study about the potential impact in California.

In today's world, insurers can simply turn down a smoker. Under Obama's overhaul, would they actually charge the full 50 percent? After all, workplace anti-smoking programs that use penalties usually charge far less, maybe $75 or $100 a month.

Robert Laszewski, a consultant who previously worked in the insurance industry, says there's a good reason to charge the maximum.

"If you don't charge the 50 percent, your competitor is going to do it, and you are going to get a disproportionate share of the less-healthy older smokers," said Laszewski. "They are going to have to play defense."

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Online:

Kaiser Health Reform Subsidy Calculator — http://healthreform.kff.org/subsidycalculator.aspx

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CDC: New version of stomach bug causing US illness

NEW YORK (AP) — Health officials say a new strain of stomach bug that's sweeping the globe is taking over in the U.S.

In the last four months, more than 140 outbreaks in the U.S. have been caused by the new Sydney strain of norovirus. These kinds of contagious bugs cause bouts of diarrhea and vomiting.

The new strain may not be unusually dangerous; some scientists don't think it is. But it is different, and many people might not be able to fight off its gut-wrenching effects.

It often spreads in places like schools, cruise ships and nursing homes. The new strain was blamed for a recent outbreak on the Queen Mary 2.

The Centers for Disease Control and Prevention reported on the new strain Thursday.

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Online:

CDC report: http://www.cdc.gov/mmwr

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Flu season fuels debate over paid sick time laws

NEW YORK (AP) — Sniffling, groggy and afraid she had caught the flu, Diana Zavala dragged herself in to work anyway for a day she felt she couldn't afford to miss.

A school speech therapist who works as an independent contractor, she doesn't have paid sick days. So the mother of two reported to work and hoped for the best — and was aching, shivering and coughing by the end of the day. She stayed home the next day, then loaded up on medicine and returned to work.

"It's a balancing act" between physical health and financial well-being, she said.

An unusually early and vigorous flu season is drawing attention to a cause that has scored victories but also hit roadblocks in recent years: mandatory paid sick leave for a third of civilian workers — more than 40 million people — who don't have it.

Supporters and opponents are particularly watching New York City, where lawmakers are weighing a sick leave proposal amid a competitive mayoral race.

Pointing to a flu outbreak that the governor has called a public health emergency, dozens of doctors, nurses, lawmakers and activists — some in surgical masks — rallied Friday on the City Hall steps to call for passage of the measure, which has awaited a City Council vote for nearly three years. Two likely mayoral contenders have also pressed the point.

The flu spike is making people more aware of the argument for sick pay, said Ellen Bravo, executive director of Family Values at Work, which promotes paid sick time initiatives around the country. "There's people who say, 'OK, I get it — you don't want your server coughing on your food,'" she said.

Advocates have cast paid sick time as both a workforce issue akin to parental leave and "living wage" laws, and a public health priority.

But to some business owners, paid sick leave is an impractical and unfair burden for small operations. Critics also say the timing is bad, given the choppy economy and the hardships inflicted by Superstorm Sandy.

Michael Sinensky, an owner of seven bars and restaurants around the city, was against the sick time proposal before Sandy. And after the storm shut down four of his restaurants for days or weeks, costing hundreds of thousands of dollars that his insurers have yet to pay, "we're in survival mode."

"We're at the point, right now, where we cannot afford additional social initiatives," said Sinensky, whose roughly 500 employees switch shifts if they can't work, an arrangement that some restaurateurs say benefits workers because paid sick time wouldn't include tips.

Employees without sick days are more likely to go to work with a contagious illness, send an ill child to school or day care and use hospital emergency rooms for care, according to a 2010 survey by the University of Chicago's National Opinion Research Center. A 2011 study in the American Journal of Public Health estimated that a lack of sick time helped spread 5 million cases of flu-like illness during the 2009 swine flu outbreak.

To be sure, many employees entitled to sick time go to work ill anyway, out of dedication or at least a desire to project it. But the work-through-it ethic is shifting somewhat amid growing awareness about spreading sickness.

"Right now, where companies' incentives lie is butting right up against this concern over people coming into the workplace, infecting others and bringing productivity of a whole company down," said John A. Challenger, CEO of employer consulting firm Challenger, Gray & Christmas.

Paid sick day requirements are often popular in polls, but only four places have them: San Francisco, Seattle, Washington, D.C., and the state of Connecticut. The specific provisions vary.

Milwaukee voters approved a sick time requirement in 2008, but the state Legislature passed a law blocking it. Philadelphia's mayor vetoed a sick leave measure in 2011; lawmakers have since instituted a sick time requirement for businesses with city contracts. Voters rejected a paid sick day measure in Denver in 2011.

In New York, City Councilwoman Gale Brewer's proposal would require up to five paid sick days a year at businesses with at least five employees. It wouldn't include independent contractors, such as Zavala, who supports the idea nonetheless.

The idea boasts such supporters as feminist Gloria Steinem and "Sex and the City" actress Cynthia Nixon, as well as a majority of City Council members and a coalition of unions, women's groups and public health advocates. But it also faces influential opponents, including business groups, Mayor Michael Bloomberg and City Council Speaker Christine Quinn, who has virtually complete control over what matters come to a vote.

Quinn, who is expected to run for mayor, said she considers paid sick leave a worthy goal but doesn't think it would be wise to implement it in a sluggish economy. Two of her likely opponents, Public Advocate Bill de Blasio and Comptroller John Liu, have reiterated calls for paid sick leave in light of the flu season.

While the debate plays out, Emilio Palaguachi is recovering from the flu and looking for a job. The father of four was abruptly fired without explanation earlier this month from his job at a deli after taking a day off to go to a doctor, he said. His former employer couldn't be reached by telephone.

"I needed work," Palaguachi said after Friday's City Hall rally, but "I needed to see the doctor because I'm sick."

___

Associated Press writer Susan Haigh in Hartford, Conn., contributed to this report.

___

Follow Jennifer Peltz at http://twitter.com/jennpeltz

Read More..

Flu season fuels debate over paid sick time laws

NEW YORK (AP) — Sniffling, groggy and afraid she had caught the flu, Diana Zavala dragged herself in to work anyway for a day she felt she couldn't afford to miss.

A school speech therapist who works as an independent contractor, she doesn't have paid sick days. So the mother of two reported to work and hoped for the best — and was aching, shivering and coughing by the end of the day. She stayed home the next day, then loaded up on medicine and returned to work.

"It's a balancing act" between physical health and financial well-being, she said.

An unusually early and vigorous flu season is drawing attention to a cause that has scored victories but also hit roadblocks in recent years: mandatory paid sick leave for a third of civilian workers — more than 40 million people — who don't have it.

Supporters and opponents are particularly watching New York City, where lawmakers are weighing a sick leave proposal amid a competitive mayoral race.

Pointing to a flu outbreak that the governor has called a public health emergency, dozens of doctors, nurses, lawmakers and activists — some in surgical masks — rallied Friday on the City Hall steps to call for passage of the measure, which has awaited a City Council vote for nearly three years. Two likely mayoral contenders have also pressed the point.

The flu spike is making people more aware of the argument for sick pay, said Ellen Bravo, executive director of Family Values at Work, which promotes paid sick time initiatives around the country. "There's people who say, 'OK, I get it — you don't want your server coughing on your food,'" she said.

Advocates have cast paid sick time as both a workforce issue akin to parental leave and "living wage" laws, and a public health priority.

But to some business owners, paid sick leave is an impractical and unfair burden for small operations. Critics also say the timing is bad, given the choppy economy and the hardships inflicted by Superstorm Sandy.

Michael Sinensky, an owner of seven bars and restaurants around the city, was against the sick time proposal before Sandy. And after the storm shut down four of his restaurants for days or weeks, costing hundreds of thousands of dollars that his insurers have yet to pay, "we're in survival mode."

"We're at the point, right now, where we cannot afford additional social initiatives," said Sinensky, whose roughly 500 employees switch shifts if they can't work, an arrangement that some restaurateurs say benefits workers because paid sick time wouldn't include tips.

Employees without sick days are more likely to go to work with a contagious illness, send an ill child to school or day care and use hospital emergency rooms for care, according to a 2010 survey by the University of Chicago's National Opinion Research Center. A 2011 study in the American Journal of Public Health estimated that a lack of sick time helped spread 5 million cases of flu-like illness during the 2009 swine flu outbreak.

To be sure, many employees entitled to sick time go to work ill anyway, out of dedication or at least a desire to project it. But the work-through-it ethic is shifting somewhat amid growing awareness about spreading sickness.

"Right now, where companies' incentives lie is butting right up against this concern over people coming into the workplace, infecting others and bringing productivity of a whole company down," said John A. Challenger, CEO of employer consulting firm Challenger, Gray & Christmas.

Paid sick day requirements are often popular in polls, but only four places have them: San Francisco, Seattle, Washington, D.C., and the state of Connecticut. The specific provisions vary.

Milwaukee voters approved a sick time requirement in 2008, but the state Legislature passed a law blocking it. Philadelphia's mayor vetoed a sick leave measure in 2011; lawmakers have since instituted a sick time requirement for businesses with city contracts. Voters rejected a paid sick day measure in Denver in 2011.

In New York, City Councilwoman Gale Brewer's proposal would require up to five paid sick days a year at businesses with at least five employees. It wouldn't include independent contractors, such as Zavala, who supports the idea nonetheless.

The idea boasts such supporters as feminist Gloria Steinem and "Sex and the City" actress Cynthia Nixon, as well as a majority of City Council members and a coalition of unions, women's groups and public health advocates. But it also faces influential opponents, including business groups, Mayor Michael Bloomberg and City Council Speaker Christine Quinn, who has virtually complete control over what matters come to a vote.

Quinn, who is expected to run for mayor, said she considers paid sick leave a worthy goal but doesn't think it would be wise to implement it in a sluggish economy. Two of her likely opponents, Public Advocate Bill de Blasio and Comptroller John Liu, have reiterated calls for paid sick leave in light of the flu season.

While the debate plays out, Emilio Palaguachi is recovering from the flu and looking for a job. The father of four was abruptly fired without explanation earlier this month from his job at a deli after taking a day off to go to a doctor, he said. His former employer couldn't be reached by telephone.

"I needed work," Palaguachi said after Friday's City Hall rally, but "I needed to see the doctor because I'm sick."

___

Associated Press writer Susan Haigh in Hartford, Conn., contributed to this report.

___

Follow Jennifer Peltz at http://twitter.com/jennpeltz

Read More..

Flu season fuels debate over paid sick time laws

NEW YORK (AP) — Sniffling, groggy and afraid she had caught the flu, Diana Zavala dragged herself in to work anyway for a day she felt she couldn't afford to miss.

A school speech therapist who works as an independent contractor, she doesn't have paid sick days. So the mother of two reported to work and hoped for the best — and was aching, shivering and coughing by the end of the day. She stayed home the next day, then loaded up on medicine and returned to work.

"It's a balancing act" between physical health and financial well-being, she said.

An unusually early and vigorous flu season is drawing attention to a cause that has scored victories but also hit roadblocks in recent years: mandatory paid sick leave for the 40 percent of American private-sector workers — more than 40 million people — who don't have it.

Supporters and opponents are particularly watching New York City, where lawmakers are weighing a sick leave proposal amid a competitive mayoral race.

Pointing to a flu outbreak that the governor has called a public health emergency, dozens of doctors, nurses, lawmakers and activists — some in surgical masks — rallied Friday on the City Hall steps to call for passage of the measure, which has awaited a City Council vote for nearly three years. Two likely mayoral contenders have also pressed the point.

The flu spike is making people more aware of the argument for sick pay, said Ellen Bravo, executive director of Family Values at Work, which promotes paid sick time initiatives around the country. "There's people who say, 'OK, I get it — you don't want your server coughing on your food,'" she said.

Advocates have cast paid sick time as both a workforce issue akin to parental leave and "living wage" laws, and a public health priority.

But to some business owners, paid sick leave is an impractical and unfair burden for small operations. Critics also say the timing is bad, given the choppy economy and the hardships inflicted by Superstorm Sandy.

Michael Sinesky, an owner of seven bars and restaurants around the city, was against the sick time proposal before Sandy. And after the storm shut down four of his restaurants for days or weeks, costing hundreds of thousands of dollars that his insurers have yet to pay, "we're in survival mode."

"We're at the point, right now, where we cannot afford additional social initiatives," said Sinesky, whose roughly 500 employees switch shifts if they can't work, an arrangement that some restaurateurs say benefits workers because paid sick time wouldn't include tips.

Employees without sick days are more likely to go to work with a contagious illness, send an ill child to school or day care and use hospital emergency rooms for care, according to a 2010 survey by the University of Chicago's National Opinion Research Center. A 2011 study in the American Journal of Public Health estimated that a lack of sick time helped spread 5 million cases of flu-like illness during the 2009 swine flu outbreak.

To be sure, many employees entitled to sick time go to work ill anyway, out of dedication or at least a desire to project it. But the work-through-it ethic is shifting somewhat amid growing awareness about spreading sickness.

"Right now, where companies' incentives lie is butting right up against this concern over people coming into the workplace, infecting others and bringing productivity of a whole company down," said John A. Challenger, CEO of employer consulting firm Challenger, Gray & Christmas.

Paid sick day requirements are often popular in polls, but only four places have them: San Francisco, Seattle, Washington, D.C., and the state of Connecticut. The specific provisions vary.

Milwaukee voters approved a sick time requirement in 2008, but the state Legislature passed a law blocking it. Philadelphia's mayor vetoed a sick leave measure in 2011; lawmakers have since instituted a sick time requirement for businesses with city contracts. Voters rejected a paid sick day measure in Denver in 2011.

In New York, City Councilwoman Gale Brewer's proposal would require up to five paid sick days a year at businesses with at least five employees. It wouldn't include independent contractors, such as Zavala, who supports the idea nonetheless.

The idea boasts such supporters as feminist Gloria Steinem and "Sex and the City" actress Cynthia Nixon, as well as a majority of City Council members and a coalition of unions, women's groups and public health advocates. But it also faces influential opponents, including business groups, Mayor Michael Bloomberg and City Council Speaker Christine Quinn, who has virtually complete control over what matters come to a vote.

Quinn, who is expected to run for mayor, said she considers paid sick leave a worthy goal but doesn't think it would be wise to implement it in a sluggish economy. Two of her likely opponents, Public Advocate Bill de Blasio and Comptroller John Liu, have reiterated calls for paid sick leave in light of the flu season.

While the debate plays out, Emilio Palaguachi is recovering from the flu and looking for a job. The father of four was abruptly fired without explanation earlier this month from his job at a deli after taking a day off to go to a doctor, he said. His former employer couldn't be reached by telephone.

"I needed work," Palaguachi said after Friday's City Hall rally, but "I needed to see the doctor because I'm sick."

___

Associated Press writer Susan Haigh in Hartford, Conn., contributed to this report.

___

Follow Jennifer Peltz at http://twitter.com/jennpeltz

Read More..

Flu remains widespread in US; eases in some areas

Nine more children or teens have died of the flu, bringing the nation's total this flu season to 29, health officials reported Friday.

In a typical season, about 100 children die of the flu, so it is not known whether this year will be better or worse than usual.

So far, half of confirmed flu cases are in people 65 and older, the Centers for Disease Control and Prevention reported.

This year's season is earlier than normal and the dominant flu strain is one that tends to make people sicker. The flu is widespread in all states but Tennessee and Hawaii and is starting to ease in some areas, the CDC said.

Health officials say it's not too late to get a flu shot to help protect against the flu. Vaccinations are recommended for anyone 6 months or older.

Last week, the CDC said the flu again surpassed an "epidemic" threshold, based on monitoring of deaths from flu and a frequent complication, pneumonia. The flu epidemic happens every year and officials say this year's vaccine is a good match for strains that are going around.

The government doesn't keep a running tally of adult deaths from the flu, but estimates that it kills about 24,000 people most years.

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Online:

CDC flu: http://www.cdc.gov/flu/index.htm

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