Small changes in kids' fast food meal cut calories

By Shereen Jegtvig

NEW YORK Fri Dec 27, 2013 4:16pm EST

NEW YORK (Reuters Health) – Changes made last year to McDonald’s Happy Meals selections for children may be helping kids to cut calories, according to a new study.

“We were curious to know how diners might have changed what they were ordering in order to make up for the reduction of calories,” Andrew Hanks, one of the study’s authors, told Reuters Health.

Hanks is a post-doctoral research associate in the Department of Applied Economics and Management at Cornell University in Ithaca, New York.

“That was the component we were really interested in because there’s evidence of compensation when your calories decrease,” he said.

In addition to adding apple slices, the new Happy Meals contain a smaller portion of French fries and non-fat chocolate milk was offered along with 1 percent-fat white milk. McDonalds still offers the same entrée choices for the meal – four chicken nuggets, a hamburger or a cheeseburger. But the change in side items results in 98 fewer calories per meal, researchers say.

They had access to transaction records for June, July and August of 2011 and 2012 for 30 McDonalds restaurants located throughout the United States. They found 232,424 transactions that included the purchase of a Happy Meal.

They looked at whether the reduction of calories in the new version of the Happy Meal caused consumers to order more hamburgers and cheeseburgers versus the chicken nuggets, which are lower in calories.

But they found that the selection of chicken nuggets remained the same – about 61 percent. More chocolate milk was ordered, 20 percent compared to 16.5 percent before the meal change, but since it was a new offering, it’s not possible to determine if the additional orders were due to calorie compensation or restaurant promotion, they report in the journal Obesity.

More white milk was also ordered, rising from 5 percent of orders to 6.5 percent, and regular soft drink orders dropped from 58 percent to 52 percent.

The researchers don’t know how much of the food was consumed, whether or not children ate more later to make up the difference in calories or how many of the meals were ordered by the children or by the parents.

The McDonald’s Corporation partially funded the study.

“In March 2012, we began automatically including apple slices in McDonald’s Happy Meals. Since then, we have introduced more than 770 million packages/bags of apples slices as a part of Happy Meals. Also, we have reduced the number of calories in our most popular Happy Meals by an average of 20 percent,” Cindy Goody, senior director of Menu Innovation and Nutrition for McDonald’s USA, LLC, told Reuters Health in an email.

“The changes we made to our Happy Meal reflects our ongoing progress towards our multi-year Commitments to Offer Improved Nutrition Choices, which include a commitment to automatically include produce or low-fat dairy in each Happy Meal,” Goody added.

A study that looked at children’s meals across the U.S. in 2008 found “the overwhelming majority” were of “poor nutritional quality.”

Ameena Batada of the University of North Carolina wrote in a 2012 report in the journal Childhood Obesity, after reviewing menus at the 50 largest U.S. restaurant chains, that at two-thirds of the chains, 100 percent of children’s meals failed to meet nutritional standards for things like calories, salt, sugar and fats.

“There were some healthier meals available, which suggests that restaurant chains should be able to reformulate their existing menu items to reduce calories, saturated and trans fat, and sodium and add more healthy options like fruits, vegetables, and whole grains,” Batada wrote.

“We were able to find that calories fell by about 104 from the three-item meal to the four-item meal,” Hanks said. “We also found that there was no substitution for a higher calorie entrée. The diners stayed with the chicken nuggets. But there was this increase in the purchases in milk, which is beneficial. It was a win on those accounts.”

Hanks noted that his team’s study doesn’t mean fast foods are healthy foods but that adding apples and increasing milk consumption is a step in the right direction.

SOURCE: bit.ly/1a6vSFL Obesity, online December 23, 2013.

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Lundbeck gets EU marketing approval for Brintellix

COPENHAGEN Fri Dec 27, 2013 12:25pm EST

COPENHAGEN (Reuters) – Danish drugmaker Lundbeck has received marketing authorization from the European Commission for its antidepressant Brintellix following approval in the United States in September, it said on Friday.

Brintellix is important for Lundbeck, which hopes it will provide a new source of revenue as its existing antidepressant Cipralex – sold as Lexapro in the United States and Japan – comes off patent.

Cipralex is Lundbeck’s single biggest source of revenue.

The approval for Brintellix will cover all 28 European Union member states plus Iceland, Liechtenstein and Norway.

“Lundbeck expects to launch Brintellix in its first markets in the second half of 2014,” the company said in a statement.

The company had said in October that it expected a European launch in the first half of next year.

A Lundbeck spokesman said the later start was the result of a more conservative approach by the company in estimating the date but that nothing significant had changed since October.

“It is still possible that the launch will take place in the first half of 2014”, the spokesman said.

The U.S. Food and Drug Administration approved Brintellix in September and the EU decision had been expected after recommendations from the European Medicine Agency’s Committee for Medicinal Products for Human Use (CHMP) in October.

The drug will be co-marketed with Japan’s Takeda Pharmaceutical.

(Reporting by Stine Jacobsen; Editing by Anthony Barker)

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Strict parenting may reduce teen smoking

By Benjamin Stix

NEW YORK Fri Dec 27, 2013 12:24pm EST

Cigarette butts fill an ashtray outside a construction site in Central, a business district in Hong Kong, October 18, 2006. REUTERS/Paul Yeung

Cigarette butts fill an ashtray outside a construction site in Central, a business district in Hong Kong, October 18, 2006.

Credit: Reuters/Paul Yeung

NEW YORK (Reuters Health) – Parents who set limits are less likely to have kids who smoke, regardless of their ethnic and racial backgrounds, according to a new U.S. study.

Researchers surveyed middle schoolers from diverse backgrounds and found those whose parents had an “authoritative” and “structured” parenting style were also more likely to be discouraged from smoking by their parents and less likely to become smokers.

“Many past studies have examined broad parenting styles, however this study looked at how specific parenting strategies may help protect youth from cigarette smoking initiation,” said Cassandra Stanton, an assistant professor in the oncology department at Georgetown University, who led the study.

“We also note that unlike many studies in the area that are conducted in largely white middle class samples, this study was conducted in an urban multi-ethnic low-income school district,” Stanton told Reuters Health.

It’s important to identify ways of helping parents prevent kids from starting to smoke, Stanton’s team writes in the Journal of Pediatric Psychology, because the majority of lifetime smokers begin before the age of 18.

Although the number of teenage smokers has declined significantly, one in three young adults reports smoking at least once in the past 30 days, according to a 2012 report by the U.S. Surgeon General.

Past research has found links between low discipline, parental disengagement and increased risk of smoking, Stanton’s team notes. Rates of smoking vary among ethnic groups, with white students smoking daily at a rate twice that of African American and Latino students. However, African Americans and Latinos experience significantly higher rates of smoking-related health complications later in life compared with whites.

To delve deeper into which parenting strategies are effective among a diverse set of families, the researchers recruited 459 eighth graders from two low-income inner-city schools in the Northeast. The students averaged 13-years-old, with 29 percent identifying themselves as Hispanic, 34 percent as African American, 17 percent as non-Hispanic white and 20 percent as other/mixed ethnicity.

The students took a comprehensive survey in class with parental consent. The survey asked about the student’s smoking history and whether the student’s parents smoked. It also asked questions about parenting styles, such as discipline and warmth, and whether the student would receive punishments and discussion of the dangers of tobacco if caught smoking.

The researchers then followed up four years later to assess whether students had smoked.

Stanton’s group found that what they called controlling parenting, which was associated with rule enforcement, curfews and set bedtimes, was more likely than a less strict, more understanding parenting style to go hand in hand with so-called anti-tobacco parenting strategies.

Those anti-tobacco strategies include punishing a child if he or she has been caught smoking and discussing with the child the motivations behind smoking and why smoking is so dangerous. Being on the receiving end of such anti-tobacco strategies was in turn linked to a lower likelihood of lifetime smoking for the student.

The association held regardless of race or ethnicity, which the researchers say should be reassuring because other cultural differences don’t seem to alter the effectiveness of this approach.

It is important for parents to take an active role in protecting their children from developing an addiction to tobacco, Stanton said.

“Setting and enforcing clear standards of behavior and actively monitoring and supervising a teen’s activities are important strategies for protecting youth from risky behavior,” she said.

“To protect youth from experimenting with tobacco and ultimately developing an addiction to tobacco, it is important to talk about the risks of tobacco, as well as set and enforce clear rules and consequences that are specific to tobacco.”

Heather Patrick at the Health Behaviors Research Branch of the National Cancer Institute, who was not involved in this study, believes structure and authority in parenting is an important tool in preventing teens from smoking. However, she cautions, “heavy-handed” parenting can often cause stress and strain in the relationship.

Patrick said smoking cessation interventions should be tailored to different groups to be more effective. “It’s helpful for intervention materials to have images that show a diversity of racial and ethnic groups,” she wrote in an email.

It’s also helpful, she said, for anti-smoking messages to provide examples, “like how to deal with cravings, how to be smoke free when all of your friends are smoking, or how to deal with conflict at home, to connect with the kinds of experiences real teen smokers face.”

SOURCE: bit.ly/19ogSWV Journal of Pediatric Psychology, online December 4, 2013.

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Rehab Treadmills Meet Gaming, Virtual Reality

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Neurology

Published: Dec 26, 2013

The words treadmill and fun rarely meet. But recent upgrades to the rehab specialists’ tool could change both patient and physical therapist outlooks on treadmill exercises.

In this video, we turn to Fred Frost, MD, chair of the department of physical medicine and rehabilitation at the Cleveland Clinic, to learn about how his team has used virtual reality and game elements to help patients recovering from neurological impairments.

“I think these types of devices are the future of gym-based physical therapy,” Frost said. “It engages the patient, and it includes sensory integration, which is at the forefront of rehabilitation science.”

Frost and his team help multiple sclerosis, stroke, and Parkinson’s patients improve function. They equipped the treadmill with projected visual and acoustic cues for training and evaluation. Patients interact with the visual projections and attempt to step on certain images, while avoiding others. This interactivity refines motor skills, gait, and response time, and is backed by dozens of studies in sensory integration, Frost told MedPage Today.

Costs of implementation vary from $5,000 up to $100,000, according to Frost, but he said they can be captured downstream in the form of higher patient attendance, and therapists report more fun with patients.

Still, the cost factor may limit adoption, particularly outside of large academic centers. “The catch is these are never quick fixes,” said Richard Shields, PT, PhD, chair of the department of physical therapy and rehabilitation science for the Carver College of Medicine at the University of Iowa. Shield acknowledged the research potential for new rehabilitation therapies but said, “We need devices that are low cost and affordable, and available to be used by those individuals on a regular basis.”

And though sensory integration methods have been studied, Shields added, “We really haven’t had head-to-head comparisons between what is done currently and what the new technology has the capacity to do.”

Neither Frost nor Shields reported disclosures.


Elbert Chu, a science and education journalist, has written for The New York Times, Popular Science, Fast Company, and ESPN. Most recently, he produced a multimedia project that investigated abuse of antipsychotics in New York City nursing homes for the Gotham Gazette. In his education mode, Elbert is co-founder of edradar.com, which helps people navigate online education. His documentary photography projects have included Haiti’s earthquake, and the aftermath of a school shooting.

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Extra consultations before cataract surgery rise

By Shereen Jegtvig

NEW YORK Thu Dec 26, 2013 2:30pm EST

NEW YORK (Reuters Health) – A study of U.S. Medicare claims finds a jump in extra doctor consultations before cataract surgery, but no clear medical reason for the added costs.

“The preoperative medical consultation is an understudied area. It’s an intervention that we spend several billion dollars on each year in this country. We know surprisingly little about the process,” Dr. Stephen Thilen told Reuters Health.

“What we’re studying here is how often do we bring a third provider in – a service that is in addition to the others and it’s separately billed. It adds an expense,” said Thilen, an assistant professor of anesthesiology and pain medicine at the University of Washington in Seattle who led the study.

A cataract is a medical condition in which the lens of the eye becomes opaque and causes blurred vision.

Surgery to remove the cataract is generally low-risk, and is the most common elective surgery performed on beneficiaries of Medicare, the U.S. health insurance program for people over 65.

Patients awaiting cataract surgery generally see the ophthalmologist who performs the surgery and the anesthesiologist or anesthetist if one is needed. Both consultations are covered by the flat price Medicare pays those providers for the surgery.

Thilen’s team looked at trends in additional preoperative consultations with the patient’s family doctor, cardiologist, pulmonologist, endocrinologist or other physician not directly involved in the surgery.

So far, little is known about the value of these extra consultations when patients are involved in lower-risk procedures, such as most cataract surgeries, Thilen said.

“There has been more published on high risk patients. Generally we would expect patients coming for heart surgery, liver transplants, vascular surgery – those high risk procedures – we would expect them to often have preoperative medical consultations because they’re high risk patients and they have many issues that need to be addressed,” Thilen said.

No national guidelines indicate whether and when cataract surgery patients need an additional preoperative consultation, Thilen and his colleagues write in JAMA Internal Medicine.

So they looked at Medicare billing data for 556,637 patients who had their first cataract surgeries between 1995 and 2006 and found that the proportion of patients getting preoperative medical consultations rose from 11 percent in 1995 to 18 percent in 2006.

When they analyzed claims for the last two years of that period, they found the patients most likely to have the extra consultations tended to be older and also had anesthesiologists involved in their care. The number of consultations was also higher in urban areas and they were about three times more common in the northeastern U.S. compared to the South.

The researchers did not have access to clinical records so they don’t know why any of the consultations were ordered or if they added any value to patient care.

“We’re only in the beginning of this. We hope to contribute to more cost effective care and peri-operative management. We will study other procedures, we will look at other types of data beyond Medicare data,” Thilen said.

“Ideally we should have more information on whether these consultations improve outcomes in one way or another,” Thilen said.

More than two million Medicare beneficiaries have cataract surgery every year, Thilen and his colleagues note in their report.

“One approach to improving the value equation is the elimination of unnecessary or wasteful tests and procedures. This forms part of the basis of the Choosing Wisely campaign from the American Board of Internal Medicine,” Dr. Lee Fleisher writes in a commentary accompanying the study.

Fleisher is professor and chair of anesthesiology and critical care at the Leonard Davis Institute, Perelman School of Medicine of the University of Pennsylvania in Philadelphia.

“A major theme within the Choosing Wisely campaign has been the elimination of routine preoperative evaluation in low-risk patients. Given that 30 million Americans undergo surgery annually and approximately 60 percent of them undergo a procedure on an ambulatory basis, the elimination of extensive preoperative tests and consultations represents an area of potentially large healthcare savings,” he writes.

But Dr. Daniel Albert thinks preoperative consultations are more common because the standard of care is higher now than in 1995.

The surgeon’s reimbursements for cataract surgery are lower now than in 1995,” said Albert, who is founding director of the University of Wisconsin McPherson Eye Research Institute and a professor in the Department of Ophthalmology and Visual Sciences at the University of Wisconsin. He was not involved in the study.

“The idea that you had to have a more stringent examination and it had to be done within 30 days of the surgery became more widespread over the period they’re looking at,” Albert said.

The type of anesthesia may also have something to do with when preoperative consultations or done, he told Reuters Health.

Albert said most cataract surgeries performed at his institution are done with local (or topical) anesthetics with a ‘regular’ nurse assisting, but some places require monitored anesthesia – the type that requires the presence of an anesthesiologist or nurse anesthetist.

He also points out that the data might be outdated, since the study ended in 2006 and even the surgical procedure has changed considerably since then.

“It’s much quicker now and more technologically driven. It’s much safer and the complication rate is far lower than it was in 1995,” he said.

Albert also said that co-management in cataract surgery usually is between an optometrist and ophthalmologist and usually the family practitioners or internal medicine physicians are not involved.

SOURCE: bit.ly/1e8PEU6 and bit.ly/1cvIJHk JAMA Internal Medicine, online December 23, 2013.

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Benefit of knee supplements still unclear

By Allison Bond

NEW YORK Thu Dec 26, 2013 12:24pm EST

NEW YORK (Reuters) – The dietary supplements glucosamine and chondroitin sulfate might slow joint damage for people with mild arthritis in their knees, according to a new study.

Previous research on the effectiveness of the supplements has been mixed, so experts remain divided on what the findings of this latest study mean for people with knee osteoarthritis, in which wear and tear over time damages the cartilage that lines the joints.

Among more than 30 parts of the knee joint measured in the new study, a handful differed between people who took the supplements and those who didn’t over the course of two years.

The results could also be seen as an indication the supplements do not make a significant difference in arthritis symptoms or severity, one researcher said.

“This is yet another set of data arguing against any disease-modifying benefit of glucosamine and chondroitin sulfate,” said Daniel Solomon, a rheumatologist and pharmacoepidemiologist at Brigham and Women’s Hospital in Boston who was not involved in the study.

But another researcher thought the study might indicate a possible role for glucosamine and chondroitin, if only for people with milder arthritis.

“(The results) may reflect that drugs or therapies that affect joint structure in osteoarthritis are likely to have an effect earlier in the course of the disease,” said Krishna Chaganti, a rheumatologist at the University of California, San Francisco, who also was not involved in the study.

The report’s authors, led by Johanne Martel-Pelletier of the Osteoarthritis Research Unit at the University of Montreal Hospital Research Centre, were unavailable for comment.

They looked at data on 600 participants in an ongoing osteoarthritis study sponsored by the U.S. National Institutes of Health Osteoarthritis Initiative. Some of the study participants were taking bone-building drugs, some were taking pain relievers such as ibuprofen and some were taking glucosamine and chondroitin supplements.

Researchers used magnetic resonance imaging (MRI) to examine the spaces between the joints and monitored the participants’ arthritis symptoms and disease progression over 24 months.

The people who took both anti-inflammatory pain medications and glucosamine and chondroitin supplements had less pain and milder changes due to disease in one part of the knee joint than those who took the pain drugs but no supplements.

Yet among those who were not taking pain medication, there was no difference in pain between people taking the supplements and those who didn’t.

And overall, the people who took supplements had similar disease progression to those who did not take them.

In addition, given the sheer number of comparisons made at numerous points in the knees of each participant, the few statistically significant differences in knee anatomy that were seen may have been due to random variation, Solomon told Reuters Health in an email.

The study was funded in part by Bioiberica, a Spanish pharmaceutical company that manufactures glucosamine and chondroitin supplements.

In general, Solomon says, the results do not change the bottom line for osteoarthritis patients: glucosamine and chondroitin don’t help.

“Few doctors recommend these agents,” Solomon said, “and I doubt that (the study’s results) will impact treatment in the U.S.”

Chaganti thinks people with osteoarthritis can discuss the pros and cons of the supplements with their doctors. But she cautions that aside from questionable effectiveness, the downsides of glucosamine and chondroitin include a hefty price tag and possible safety risks, because supplements such as these are not regulated by the U.S. Food and Drug Administration.

“There are still some uncertainties regarding specifics about these supplements and their use,” Chaganti said.

SOURCE: bit.ly/18GfGA2 Annals of the Rheumatic Diseases, online December 13, 2013.

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Behavioral therapy may treat migraines in kids, teens

By Andrew M. Seaman

NEW YORK Tue Dec 24, 2013 4:08pm EST

NEW YORK (Reuters Health) – Children and teens with chronic migraines may find headache relief when they pair medication with psychotherapy, according to a new study.

Researchers found that kids who received cognitive behavioral therapy, a type of psychotherapy that teaches relaxation and coping techniques, had significantly fewer days with headaches.

“This is a learning based treatment in a sense that you as a young person can learn skills and apply them to everyday life,” Dr. Scott Powers said.

Powers is the study’s lead author and co-director of the Headache Center at Cincinnati Children’s Hospital Medical Center in Ohio.

Migraines are severe headaches – sometimes accompanied by light sensitivity, visual hallucinations or nausea – that can disable a person for hours or even days at a time. The majority of migraine sufferers are women.

About 2 percent of adults suffer from chronic migraine, which is defined as having the severe headaches for at least 15 days per month. About 1.75 percent of children have the chronic condition, Powers and his colleagues write in JAMA.

Despite the severity of chronic migraine and how common the condition is in children and teens, there are currently no treatments for kids approved by the U.S. Food and Drug Administration.

Instead, the antidepressant amitriptyline (first sold as Elavil by AstraZeneca), which has been found to help prevent migraines, is sometimes prescribed for kids.

Some studies have also suggested that cognitive behavioral therapy (CBT), a form of talk therapy that emphasizes changing one’s responses to problems, may help children and teens to manage chronic pain.

To see whether CBT could improve kids’ ability to cope with chronic migraine, the researchers randomly assigned 135 chronic migraine sufferers between the ages of 10 and 17 to undergo either CBT or an education program about headaches. All the participants were also taking amitriptyline.

Each child received eight weekly hour-long sessions of either headache education or CBT. That was followed by booster sessions at 12 and 16 weeks, plus three more booster sessions over the next year.

Children in the CBT group received a modified version of a program that teaches coping skills to help control pain. It includes relaxation skills, such as slow and deep breathing exercises, and a biofeedback component to show kids the body’s response to the techniques.

The children in the education group discussed headache-related topics and received support from therapists during their sessions.

The study was conducted between October 2006 and September 2012.

At the beginning, the children reported having migraines for an average of 21 out of 28 days. On a scale that measures disability from migraine symptoms, where 50 or above is considered severe, they averaged a disability level of 68.

After 12 months, the number of days with migraines had been cut by at least half in 86 percent of children in the CBT group, compared to only 69 percent of kids in the education group.

“We may not get rid of migraines entirely but we can reduce them significantly,” Powers said.

The researchers also found that 88 percent of the CBT group scored below 20 on the disability scale at the end of the study. That compared to 76 percent of the headache education group.

A score below 20 on the disability scale signifies mild or no disability.

In an editorial accompanying the new study, Mark Connelly says there had been some evidence that CBT in addition to medication would be effective as treatment for chronic migraines, but that doesn’t mean it will be widely available right away.

“I don’t think right off the bat every provider who sees these kids will have access to people who can help,” Connelly said. He’s co-director of the Comprehensive Headache Clinic at Children’s Mercy Hospitals and Clinics in Kansas City, Missouri.

Children and teens may be unlikely to follow through with a doctor’s recommendation to see a therapist for chronic migraines, he said, and doctors may not have the time or training to properly explain the rationale for CBT.

Also, insurance companies may not pay for CBT and people would need to be trained in the therapy, he noted.

While Powers and his fellow researchers didn’t examine the cost of the program, he said the total cost of treatment may be less than for a typical medical imaging test, such as an MRI.

“You’re talking about the potential of cost being under $2,000 to get these types of results,” Powers said, adding that the ability to spread this type of therapy would also partially depend on whether insurance companies cover it.

Still, Powers said, people may be able to take advantage of the program used in this study if they ask their doctors about CBT.

Connelly, however, said availability of the treatment will still probably depend on doctors’ ability to explain the therapy.

“I think some families will see a summary of the data and potentially pursue it on their own, but more likely it will be providers who need to explain it and push people to do it,” he said.

In the future, Powers said, there may be ways to alter the therapy to make it more accessible. For example, they could modify it to be partially delivered by computer or online.

“We think there are ways through the research on how to improve upon what we’ve done,” Powers said.

SOURCE: bit.ly/JOTmp1 JAMA, online December 24, 2013.

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Obamacare draws last-minute shoppers, deadline is moving target

By Susan Cornwell

WASHINGTON Tue Dec 24, 2013 1:57pm EST

U.S. President Barack Obama pauses while delivering remarks on the Affordable Care Act, commonly known as Obamacare, at an Organizing for Action grassroots supporter event in Washington, November 4, 2013. REUTERS/Jonathan Ernst

U.S. President Barack Obama pauses while delivering remarks on the Affordable Care Act, commonly known as Obamacare, at an Organizing for Action grassroots supporter event in Washington, November 4, 2013.

Credit: Reuters/Jonathan Ernst

WASHINGTON (Reuters) – The main website for enrollment under President Barack Obama’s signature healthcare law has drawn nearly 2 million visits, officials said Tuesday, in a last-minute rush to meet an ever-flexible deadline for people to obtain insurance coverage starting January 1.

Citing high traffic to the HealthCare.gov website and at call centers before Monday’s sign-up deadline, the government allowed people an extra day to complete their enrollment in time to be covered by New Year’s Day. In a blog post on the website on Tuesday, the administration suggested additional flexibility, without specifying a new deadline.

It was the administration’s latest move of the goalposts as it tries to recover from technical failures and political missteps that dogged the enrollment drive for weeks after it opened on October 1. Trying to make up for lost time, the administration has announced a series of last-minute changes and delays to get as many people as possible covered under the Affordable Care Act, Obama’s major domestic policy initiative.

Before Monday’s rush, more than 1 million people had signed up for private coverage through HealthCare.gov – which serves 36 states – and 14 state-run marketplaces, according to state and federal estimates.

The figure, though likely to climb by Christmas, is still short of previous estimates that 7 million people could enroll by the end of March, the last date to obtain health insurance coverage in 2014. About one-third or more will need to be young, healthy adults whose payments into the system would help offset the costs of covering older, sicker people.

“Sometimes despite your best efforts, you might have run into delays caused by heavy traffic to HealthCare.gov, maintenance periods, or other issues with our systems that prevented you from finishing the process on time,” Tuesday’s blog post on HealthCare.gov said. “If this happened to you, don’t worry – we still may be able to help you get covered as soon as January 1.”

MINIMIZING THE CONFUSION

The problematic rollout of the health law known as Obamacare, which was passed in 2010 and survived legal challenges, helped send Obama’s popularity ratings to record lows and stepped up Republican efforts to gut the law and use it against Democrats in 2014 congressional elections.

The more recent changes, which the administration has said are intended to show flexibility, have introduced a new element of confusion for consumers as well as the health insurance companies who have been pressed by the government to allow new members to pay, and even sign up, past January 1 for retroactive coverage. So far the industry has agreed to extend the first payment deadline to January 10.

“Health plans will continue to do everything they can to help consumers through the enrollment process and to mitigate potential confusion or disruption caused by all of these last minute changes to the rules and deadlines,” said Robert Zirkelbach, spokesman for American’s Health Insurance Plans, an industry trade and lobbying group.

The Affordable Care Act requires most Americans to be enrolled in coverage by March 31 or face penalties that start at $95. This week’s deadline, which had already been moved to December 23 from December 15, applied to coverage starting on January 1.

Last week, the administration said people whose plans were canceled because they did not meet new standards of coverage under the law would qualify for a “hardship” exemption that allows some people to avoid a penalty for not signing up for health insurance.

Several state-run exchanges have also moved their enrollment deadlines. New York and California, two of the largest, added a one-day grace period similar to the federal insurance marketplace. Massachusetts said on Tuesday it would allow sign-ups until December 31 given heavy volume and technical problems that have hampered its exchange. Rhode Island, Oregon and Maryland had already extended their deadlines beyond Christmas.

(Additional reporting by Michele Gershberg in New York; Writing by Doina Chiacu; Editing by Grant McCool)

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Ackman sticks with Herbalife short sale, promises new information in 2014

By Svea Herbst-Bayliss

BOSTON Mon Dec 23, 2013 3:49pm EST

William Ackman, CEO of Pershing Square Capital Management, speaks at the Partner Connect 2013 conference, sponsored by Thomson Reuters, in Boston in this April 5, 2013, file photo. REUTERS/Brian Snyder

William Ackman, CEO of Pershing Square Capital Management, speaks at the Partner Connect 2013 conference, sponsored by Thomson Reuters, in Boston in this April 5, 2013, file photo.

Credit: Reuters/Brian Snyder

BOSTON (Reuters) – Herbalife is still engaged in improper recruiting tactics and is likely violating multi-level market restrictions in China, activist hedge fund manager William Ackman wrote to his investors on Monday.

The billionaire investor on Monday told clients in a letter, seen by Reuters, that he would soon be releasing findings that his own investigation into the nutrition and weight loss company has turned up. So far, he said that he has shared those findings only with regulators.

“Our next presentation, among other issues, will include an analysis of the three principal sources of revenue growth for the company: Internet-based lead generation, nutrition clubs, and the company’s China operation,” Ackman wrote.

Herbalife prohibited “lead generation” methods to find new distributors at the end of June, but Ackman said the practices, promoted by the company’s top distributors, are still being used.

Herbalife spokeswoman Barbara Henderson said the company has no comment.

The battle over Herbalife as been one of Wall Street’s enduring dramas this year as it pitted Ackman against other prominent hedge fund managers including Carl Icahn, the company’s biggest shareholder.

A year ago Ackman called the company a pyramid scheme, something the company has vehemently denied, and he predicted the share price would sink to zero when regulators shut the company down.

ACKMAN STICKING WITH SHORT POSITION

Ackman also said he was sticking by his $1 billion bet short selling Herbalife’s stock which he made public a year ago and which has cost his $12 billion Pershing Square Capital Management as much as $700 million in losses, people familiar with the fund have estimated.

Herbalife’s stock price has surged 146 percent this year to $81.03, having gotten a sizable boost last week after accountants found no material change in the company’s reaudited financial statements.

However, at the beginning of December, overall Ackman’s fund Pershing Square was up roughly 10 percent for the year and Ackman did not provide updated performance numbers in the letter.

Pershing Square restructured the Herbalife bet in the last few months as the share price kept rising.

“We continue to believe that our Herbalife short position offers an extremely compelling, and, as now structured, even greater asymmetric payoff than before because of the stock price’s substantial rise,” he wrote.

Herbalife, Ackman wrote, has spent tens of millions of dollars to discredit his hedge fund, trying most recently to persuade Pershing Square investors to redeem from the fund.

Investment bank “Moelis & Company even offered to stop this campaign if we would agree to no longer push our regulatory agenda and to refrain from any further public statements,” Ackman wrote. But he said he thinks Herbalife and Moelis may have quit their campaign “as a result of media scrutiny.”

(Reporting by Svea Herbst-Bayliss; editing by Clive McKeef)

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Lactation consultants can boost breastfeeding

By Kathryn Doyle

NEW YORK Mon Dec 23, 2013 2:59pm EST

NEW YORK (Reuters Health) – Having access to even a few hours with a professional specially trained to help women breastfeed may raise the number of women who start breastfeeding and stick with it, according to a new study.

Lactation consultants are certified through the International Board of Lactation Consultant Examiners and may work in hospitals, offices or public health programs.

Women in the new study who spent an average total of three hours with a lactation consultant were almost three times more likely to start breastfeeding their newborns and to still be breastfeeding three months later.

The American Academy of Pediatrics and the World Health Organization recommend exclusive breastfeeding for all babies’ first six months. In reality, at least 25 percent of babies in the U.S. are never breastfed at all, according to the Centers for Disease Control and Prevention.

As the amount of a baby’s nourishment coming from breastfeeding increases, and the length of time its mother breastfeeds grows, baby’s risk of pneumonia, colds, leukemia and throat and ear infections goes down, author Karen Bonuck told Reuters Health.

Bonuck, a professor of family and social medicine and of obstetrics & gynecology and women’s health at Albert Einstein College of Medicine in New York City, led the investigation.

Many factors influence whether or not a mother breastfeeds, she said.

“Right after birth, there are often difficulties with positioning the infant and knowing they are drinking enough,” Bonuck said. “Hospital help is great, when a nurse has long enough to spend with you, but they often don’t.”

When mothers get home, few have the energy to seek out breastfeeding resources in the community, she said. Long term, many women are still uncomfortable breastfeeding in public and may not have the time or opportunity to pump milk when they return to work or school.

For the study, Bonuck and her team conducted two clinical trials, one among low-income women and one among more economically diverse women. Participants were primarily Hispanic and black, and two-thirds were overweight or obese.

For the first trial, half of the women had pre- and postnatal lactation consultant visits and their doctors were reminded by electronic prompts to speak to the patients about breastfeeding during office visits. The other half of the women just got usual prenatal care.

Among the women who received extra attention to breastfeeding, 16 percent were feeding their babies only with breast milk at three months of age, compared to 6 percent of the women who got no extra attention.

The second trial included four groups of women: one with lactation consultants, one with electronic prompts for doctors, one with both interventions and one with neither. The women who only got electronic prompts to their doctors didn’t seem to breastfeed any more than the comparison group, but those who got lactation consultants or consultants plus electronic prompts did.

Twenty percent of the women who had lactation consultants only were frequently breastfeeding at three months, compared to 17 percent of those who got the consultant and electronic prompts and only 8 percent in the comparison group, Bonuck’s team reports in the American Journal of Public Health.

Even though most of the women were overweight or obese, a population that usually has particular difficulty breastfeeding, according to Bonuck, lactation consultants did seem to make a measurable difference.

Expectant moms can visit the website of the International Lactation Consultant Organization to find a consultant nearby, Bonuck said.

According to Rebecca L. Mannel, director of lactation services at the University of Oklahoma Health Sciences Center in Oklahoma City, lactation consultants “are the only healthcare professional specifically trained to manage the full spectrum of breastfeeding, from prenatal to postpartum, from normal healthy moms and babies to complicated situations involving maternal risk factors or illness or infants born preterm or with some other health complication.”

Ideally, consultants should be available for women before giving birth and immediately after, not only to help them navigate the physical ins-and-outs of breastfeeding, but to talk through any misconceptions, family or social support needs and make a plan for incorporating breastfeeding into a return to work plan, said Mannel, who was not involved in the new study.

“They should be a standard member of the health care team when it comes to pregnancy, childbirth and infant growth and development,” she added.

Most mothers don’t have easy access to lactation consultants, since hospitals are rarely staffed adequately, Mannel said. Hospitals tend to treat the consultants as luxury items and not necessities, she said.

“While other prenatal providers, including nursing staff can provide some of the basic breastfeeding education to prepare women for the hospital experience and initiation of breastfeeding, this does not happen consistently,” Mannel said. “Other prenatal care providers have multiple issues they need to address with pregnant women and breastfeeding is easy to put off and ultimately not address.”

One of the biggest barriers to accessing lactation consultants, Mannel said echoing the study authors, is insurance coverage. The Patient Protection and Affordable Care Act, commonly called Obamacare, requires coverage of lactation care but does not specify who should provide the care or how many times a mother can access it.

“Many insurance companies haven’t changed anything, other than to say mom can go the MD or nurse practitioner for breastfeeding care – who are often not adequately trained to provide care for breastfeeding difficulties or complications,” Mannel said.

SOURCE: bit.ly/JkRRBB American Journal of Public Health, online December 19, 2013.

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