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Health & Fitness (233)
David Kwiatkowski (kwiht-KOW'-skee) agreed to plead guilty to 14 drug theft and tampering charges in New Hampshire and two in Kansas in exchange for a 30- to 40-year prison sentence. He will be sentenced Dec. 3.
Kwiatkowski was accused of stealing painkiller syringes from Exeter Hospital and replacing them with saline-filled syringes tainted with his blood. U.S. Attorney John Kacavas said the guilty pleas are too little, too late given the harm Kwiatkowski caused.
A Michigan native, Kwiatkowski worked in 18 hospitals in eight states before his arrest last year. Forty-six people have been diagnosed with the same strain of hepatitis C he carries.
THIS IS A BREAKING NEWS UPDATE. Check back soon for further information. AP's earlier story is below.
A traveling hospital technician accused of causing a multistate outbreak of hepatitis C last year pleaded guilty Wednesday to federal drug charges in New Hampshire under an agreement that calls for him to serve 30 to 40 years in prison.
The judge asked 34-year-old David Kwiatkowski why he wasn't going to trial. "Because I'm guilty," Kwiatkowski responded. He said he was addicted to drugs and alcohol and was recently diagnosed with depression, for which he is taking several medications.
Kwiatkowski pleaded guilty to 14 charges of drug theft and tampering in New Hampshire, along with two similar counts in Kansas, although he was never formally charged there. Sentencing was set for Dec. 3.
At least two dozen civil lawsuits related to his case are pending, most of them against New Hampshire's Exeter Hospital, where he worked for 13 months.
Originally from Michigan, Kwiatkowski worked in 18 hospitals in seven states before being hired in New Hampshire in 2011. As a traveling hospital technician, he was assigned by staffing agencies to fill temporary openings around the country. Along the way, he contracted hepatitis C, and is accused of infecting others by stealing painkiller syringes and replacing them with saline-filled syringes tainted with his blood.
According to the plea agreement filed Monday, Kwiatkowski told investigators he had been stealing drugs since 2002 - the year before he finished his medical training - and that his actions were "killing a lot of people." His lawyers have declined numerous interview requests.
Forty-six people in four states in hospitals where Kwiatkowski worked have been diagnosed with the same strain of hepatitis C he carries: 32 patients in New Hampshire, seven in Maryland, six in Kansas, and one in Pennsylvania. One of the Kansas patients died, and authorities say hepatitis C, which can cause liver disease and chronic health problems, played a contributing role.
In New Hampshire, some of the infected patients have suffered serious physical and emotional issues, according to the plea agreement. Among the seven whose experiences led to the 14 charges, one man hasn't been able to work since developing hepatitis C, another has had trouble controlling his diabetes and sleeping at night and a third is afraid to kiss his wife on the lips, even though the blood-borne virus can't be transmitted that way.
In most of those seven cases, Kwiatkowski was not assigned to assist with the procedures but hospital records showed him accessing the painkillers. In one case, he came in on his day off and insisted on staying even after being told he could go home. One patient remembers not feeling much different after receiving two doses of what was supposed to be a powerful painkiller.
In an address at the Disabled American Veterans' convention in Orlando, Obama also announced a national plan to guide mental health research, as well as commitments from 250 community colleges and universities to help veterans earn college degrees or get the credentials they need to find jobs.
A chief concern for veterans is the backlog of disability claims for compensation for illness and injury caused by military service.
"After years of military service, you shouldn't have to wait years for the benefits you've earned," Obama said.
The number of claims ballooned after Obama made it easier for Vietnam veterans who were exposed to the herbicide Agent Orange to get benefits. Access to benefits also was eased for sufferers of post-traumatic stress disorder and Gulf War veterans afflicted with malaria, West Nile virus or other infectious diseases.
The backlog is shrinking due to some aggressive steps taken by the Department of Veterans Affairs, including requiring claims processors in its 56 regional benefits offices to work overtime and moving from a manual to a computerized system to help speed the judgment of claims, administration officials said.
About 780,000 claims are pending. About 496,000 are considered backlogged after the 20 percent reduction Obama highlighted, down from 611,000 at the end of March, said White House press secretary Jay Carney. A claim is considered backlogged if it has been in the system for 125 days, or roughly four months.
Even with that progress, Obama acknowledged the amount of work still needed to eliminate the backup by 2015 as VA Secretary Eric Shinseki has promised.
"Today I can report that we are not where we need to be, but we are making progress," Obama said. "So after years when the backlog kept growing, finally the backlog is shrinking."
The president also announced the release of a comprehensive national plan to improve the ability to prevent, diagnose and treat PTSD and traumatic brain injuries and mental health issues earlier and better, and to reduce suicides, according to a briefing paper the White House released Saturday before the president spoke.
Beyond the claims issue, Republican lawmakers have started to hammer the VA on the issue of patient safety.
A congressional hearing in Atlanta this past week focused on poor patient care linked to four deaths. Another hearing is scheduled for next month in Pittsburgh, where five veterans died as a result of a Legionnaire's disease outbreak in 2011-12.
Several dozen protesters greeted Obama as he arrived at the hotel. Some held signs that said "Kenyan Go Home," "Impeach Obama," and "Obama Lies."
Obama met privately with DAV members before the speech, the White House said. Afterward, he headed to Martha's Vineyard, Mass., for a family vacation.
Associated Press writer Kevin Freking contributed to this report.
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It's possible that labor-inducing drugs might increase the risk - or that the problems that lead doctors to start labor explain the results. These include mothers' diabetes and fetal complications, which have previously been linked with autism.
Like most research into autism causes, the study doesn't provide conclusive answers, and the authors say the results shouldn't lead doctors to avoid inducing labor or speeding it up since it can be life-saving for mothers and babies.
Simon Gregory, lead author and an associate professor of medicine and medical genetics at Duke University, emphasized, "We haven't found a connection for cause and effect. One of the things we need to look at is why they were being induced in the first place."
Government data suggest 1 in 5 U.S. women have labor induced - twice as many as in 1990.
Smaller studies suggested a possible tie between induced labor and autism, but the new research is the largest to date, involving more than 600,000 births. The government-funded study was published online Monday in JAMA Pediatrics.
The researchers examined eight years of North Carolina birth records, and matched 625,042 births with public school data from the late 1990s through 2008. Information on autism diagnoses didn't specify whether cases were mild or severe. Labor was induced or hastened in more than 170,000 births.
Overall, 5,648 children developed autism - three times as many boys as girls. Among autistic boys, almost one-third of the mothers had labor started or hastened, versus almost 29 percent of the boys without autism. The differences were less pronounced among girls.
Oxytocin and prostaglandins are used to start or speed up labor but the study doesn't identify specific medications.
The strongest risks were in boys whose mothers had labor started and hastened. They were 35 percent more likely to have autism.
Among girls, autism was not tied to induced labor; it was only more common in those born after labor was accelerated; they were 18 percent more likely to have the developmental disorder than girls whose mothers had neither treatment.
Autism affects about 1 in 88 U.S. children. Symptoms may involve communication problems including avoiding eye contact and unusual repetitive behavior including arm-flapping. Causes are uncertain but experts believe it probably results from a combination of genetics and other factors. These may include mothers' illnesses and medication use while pregnant, fathers' age at conception, and problems affecting the fetus during childbirth - all suggested but not proven in previous research.
The study's biggest strength is bolstering the growing consensus that risks for autism occur before birth or soon after, said Dr. Byron King, director of Seattle Children's Hospital's autism center. He was not involved in the study.
"We're dropping the ball," said Dr. Thomas Frieden, head of the Centers for Disease Control and Prevention. "This is a huge disappointment."
About 54 percent of teenage girls have received at least one of the three HPV shots. Only a third was fully immunized with all three doses.
Last year's rates were essentially unchanged from 2011, and up only slightly from 2010. Rates for other vaccines aimed at adolescents have risen much faster.
A big part of the problem: Family doctors aren't prodding patients to get HPV shots as forcefully as they recommend other vaccines, health officials said.
The vaccine, introduced in 2006, protects against human papillomavirus, or HPV. The sexually transmitted bug can cause cervical cancer and genital warts. The vaccine was first recommended for girls ages 11 and 12 because it works best if given before a teen starts to have sex. In 2011, it was also recommended for boys that age to help prevent the virus's spread.
More than 20 states have considered adding HPV to the vaccines required for school attendance but only Virginia and the District of Columbia did so. Most states abandoned it after political fights triggered by funding woes, concerns about the vaccine's safety and worries that the shots would promote promiscuity.
CDC studies have shown no significant side effects, and that girls who got the shots did not start having sex earlier than girls who didn't. Still, some parents, teens and their doctors have been hesitant.
Dr. Anne Schuchat, who oversees the CDC's immunization programs, said school requirements aren't necessarily needed because the girls are already coming in for shots against bacterial meningitis and for whooping cough that are required in some states. Those shots have been recommended for teens roughly about as long as HPV but vaccinations rates are much higher - 70 percent in 2011.
The new CDC report shows that 84 percent of the teen girls who hadn't gotten an HPV shot had been to a clinic or doctor for another vaccine. If they had gotten an HPV shot at the same time, the rate for at least one dose could be nearly 93 percent instead of 54 percent, CDC officials estimated.
Price has been an issue in the past - three doses of HPV vaccine sell for more than $400, more than other vaccines. But today, health insurers cover that cost and uninsured kids get the shots paid for through government health programs.
"We can do a better job," said Dr. Thomas McInerny, president of the American Academy of Pediatrics. He joined Frieden on a call with reporters and said his association would push its members to get more teens vaccinated.
The CDC rates are derived from national telephone surveys and checks of medical records for girls ages 13 to 17. Vaccination rates for boys aren't available yet.
HPV is so common that nearly all sexually active men and women will get at least one type of HPV at some point in their lives, health officials say. Most show no obvious symptoms and eventually clear the virus.
Sound like a sales pitch? Get ready for a lot more. As President Barack Obama's health care law moves from theory to reality in the coming months, its success may hinge on whether the best minds in advertising can reach one of the hardest-to-find parts of the population: people without health coverage.
The campaign won't come cheap: The total amount to be spent nationally on publicity, marketing and advertising will be at least $684 million, according to data compiled The Associated Press from federal and state sources.
About 16 percent of Americans are uninsured, but despite years of political debate and media attention, more than three-quarters of them still know little about the law known as "Obamacare," according to recent surveys.
"It's not sugar cereal, beer and detergent," said Brooke Foley, chief executive officer of the Chicago-based Jayne Agency, one of the advertising firms crafting messages to reach the uninsured.
The Obama administration and many states are launching campaigns this summer to get the word out before enrollment for new benefits begins in October.
The targets are mostly the working poor, young people who are disengaged, or those who gave up their insurance because of the cost. Three-quarters are white. Eighty-six percent have a high school education or less. Together they make up a blind spot in the nation's health care system.
"They've been shut out. It's too expensive and it's incredibly confusing," said David Smith of the advertising agency GMMB, pitching the health law's benefits in Washington and Vermont.
Their confusion might only have been magnified by the administration's surprise announcement recently postponing part of the system that affects businesses. But that change should not affect many individuals. A bigger complication is that in about half the states, Republican governors are declining to cooperate, which will limit the marketing.
The states that have been more receptive to the health care overhaul and are further ahead in their planning will receive proportionally more federal money for outreach, advertising and marketing than Republican-led states that have been hostile to the law.
AP research from all 50 states shows the amount of government spending will range from a low of 46 cents per capita in Wisconsin, which has ceded responsibility for its health insurance exchange to the federal government, to $9.23 per capita in West Virginia, which opted for a state-federal partnership.
About $4.8 million in public money will be spent trying to sign up New Jersey's 1.3 million uninsured, for example, compared to the nearly $28 million spent reaching out to Washington state's much smaller 960,000.
Texas has the highest percentage of uninsured people in the nation, three times more than Illinois. But only a fourth as much public money will be spent on getting people enrolled in Texas.
Austin resident Caryl Mauk, 46, remains confused about the Affordable Care Act even though Texas' federally run exchange is just two months away from opening for enrollment.
She has not had insurance since she had to quit her nursing job in 2011 because of a heart condition. She's been struggling with chest pains, arthritis and fatigue but doesn't know what to make of the new program.
"Sometimes I just get overwhelmed," Mauk said. "I don't want to get bad news again, and that slows me down in making calls."
In the GOP states, community groups with federal grants will lead the effort. Private companies from Walgreens to Cosmopolitan magazine have launched their own educational campaigns.
Ads based on research about the uninsured will soon start popping up on radio, TV and social media. Grassroots organizers are recruiting their pastors, barbers and mothers and arming them with carefully worded messages. In some neighborhoods, volunteers will go door-to-door.
The pitch: If you don't make much money, the government can pick up some of the cost of your health insurance. If you can afford a policy, by law you have to get one. People will be directed to healthcare.gov, a government site, for more information.
The political stakes for the Obama administration in a big response are high. If only the sickest people sign up, the cost of their medical care could overburden insurance carriers and sink the new marketplaces. The new system depends on a balanced pool.
The ad campaign already underway in Colorado demonstrates the search for an effective message.
There, TV commercials show people being magically transformed into champions. One minute they're shopping for health insurance on a computer, the next they're winning at a horse race, in a casino or at the World Series with champagne corks flying. The slogan: "When health insurance companies compete, the only winner is you."
That's because market research shows Coloradans like competition, said Tom Leydon, CEO of Denver-based advertising and digital marketing agency Pilgrim.
The celebratory scenes "remind people of the good feeling they get when they win," he said.
Despite the focus on winning and champions, there may be little if any cooperation for the publicity blitz from the professional sports leagues, which would have the potential to reach tens of millions of people. Two Republican Senate leaders warned the leagues about getting involved in "a highly polarized public debate."
In states where there will be no official cooperation, Enroll America, a coalition of health companies and advocates, has deployed volunteers to hand out brochures at a farmers market in Austin and hold house parties in Cincinnati, and plans a seven-figure ad buy across the nation.
"There has to be an echo chamber," said John Gilbert, national field director for the Enroll America media campaign. "If I'm uninsured and it's October, I won't be able to go anywhere without (hearing) the message of enrollment."
Chicago resident Martin Upshaw, whose fast food job doesn't provide health benefits, said the cost has kept him uninsured.
"The bottom line is the dollar sign," said Upshaw, 27, who survived a shooting three years ago. "I would love to be able to go in and see a doctor and make sure I'm OK."
In Chicago, the Jayne Agency's staff talked to more than 50 patients at an emergency room to hone the best message. The slogan they chose: "Don't Just Get By." The ad campaign features real people and their health stories.
On a recent Sunday in southwest Houston, volunteers recruited by Blue Cross Blue Shield set up information tables at a community center where three Methodist church services are held.
"I'm looking to get where I can go to the doctor and have a $25 to $30 co-pay," said churchgoer Yolanda Boykin, 60, whose current job through a temp agency does not provide health insurance.
Another part of the campaign nationwide, focused on young men, is refining messages for their mothers.
Market research has shown that young adults say it's often a parent, a girlfriend or a sibling who will push them to sign up for something like health insurance, said Julie Bataille, helping lead the outreach for the Obama administration, so the campaign will "make sure moms are aware."
--- AP writer Juan A. Lozano contributed to this report from Houston.
--- AP Medical Writer Carla K. Johnson can be reached at HTTP://WWW.TWITTER.COM/CARLAKJOHNSON
Doctors initially attributed the donor's death to other causes. But during an investigation prompted by the kidney recipient's death in February, lab testing found evidence of rabies in the donor's brain tissue and also detected encephalitis, a brain inflammation that can be caused by rabies.
The virus was consistent with raccoon rabies and was nearly identical to a virus found in the transplanted kidney and other tissue from the recipient, an Army veteran from Maryland, said the report, compiled by researchers from the federal Centers for Disease Control and Prevention and others and published Tuesday in the Journal of the American Medical Association.
Investigators don't know if organs given to three other patients - the North Carolina donor's heart, liver and second kidney-were infected with the rabies virus, but all three were considered at risk. Their recipients received anti-rabies treatment "and to date remain well," said CDC researcher Dr. Neil Vora, the lead author.
While the case is rare, it underscores the need to improve screening for would-be organ donors with suspected encephalitis, the report's authors say. They say a uniform donor questionnaire could help better identify risk factors for the virus and that rabies should be considered in donors with unexplained encephalitis.
The United Network for Organ Sharing issued guidance last year to help organ procurement organizations screen for encephalitis and other central nervous system infections in potential donors. It urged caution in accepting organs from donors with an untreated central nervous system infection.
The researchers want to improve awareness that rabies can be the cause of encephalitis, said co-author Dr. Sridhar Basavaraju, another CDC researcher. But he added, "We wouldn't want to mandate any screening that would potentially exclude transplantable organs."
The study is based on a review of laboratory tests and medical records, and interviews with relatives of the organ donor and recipient. It provides the most detailed account of the chain of events that led to the two deaths and the investigation that followed, which prompted health authorities to recommend vaccines for dozens of people who were in contact with the donor or recipients.
The case attracted public attention because of the rare circumstances, including the long time between infection and death of the transplant recipient - about a year and a half.
It was just the third documented transmission of rabies through a solid organ transplant, the report says.
Also, there are only roughly two human rabies deaths in the United States each year, and all but two domestic cases between 2000 and 2010 were linked to bats, according to the report. The authors say raccoons pose an under-recognized risk for infection and their spread into urban areas raises concern.
The patient who received the North Carolina donor's kidney at the Walter Reed National Military Medical Center in Bethesda, Md. in September 2011 has not been publicly identified.
The donor was 20-year-old William Edward Small, an avid outdoorsman from North Carolina who got sick after a fishing trip in Florida, where he was undergoing Air Force training.
Small's initial symptoms included nausea, vomiting and fever - which could indicate rabies but also other less serious conditions that are much more common. Doctors thought Small had eaten tainted fish.
Questioned during the organ procurement process, relatives said they didn't know of any recent risk of rabies exposure, and doctors did not test him.
Investigators say they learned during subsequent interviews that Small trapped raccoons for use as bait during hunting-dog training exercises, and had been bitten at least twice by the animals, 18 months and seven months before developing symptoms. He was not treated for those bites.
"If you don't ask specific questions, you don't get specific answers," said Dr. Michael Green, chairman of an advisory committee on disease transmission for the United Network for Organ Sharing.
"At the time these questions are being asked initially, families are often traumatized, in shock," Green said. "They're losing a loved one. They may not be thinking normally or straight or remember all those details."
---- JAMA: HTTP://WWW.JAMA.COM
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The manufacturer of the Plan B One Step morning-after contraceptive has been granted exclusive rights by the FDA to market their drug over-the-counter without age restrictions. The decision was released earlier this week.
The Food and Drug Administration approved Teva Pharmaceuticals' Plan B One Step for over the counter sale...no prescription or proof of age required. In its decision, the FDA granted a three year period during which Teva can sell its' single tablet product exclusively on pharmacy shelves, while generic drugs will still require a prescription for young women 16 and younger.
Most metro St. Louis pharmacies carry Teva's Plan B, which is a two-pill dosage and some already have the Plan B One Step in the pharmacy. The FDA decision will now move that product on to the store shelves.