With outbreaks striking teenagers and adults, the government soon will decide if it's time for booster shots against the cough so violent it can break a rib. Last week, manufacturer GlaxoSmithKline sought Food and Drug Administration permission to sell a booster; competitor Aventis Pasteur isn't far behind.

While boosters are debated, however, don't lose sight of the real risk: Whooping cough can kill newborns before they start getting their vaccinations - http://www.google.com/search?q=vaccinations&btnI=lucky . And while older patients usually recover, they can easily spread the disease, known medically as pertussis, to infants.

"Parents who have very young infants need to get them vaccinated as early as possible," advises Dr. Trudy Murphy of the Centers for Disease Control and Prevention in Atlanta. Anyone who's coughing should "avoid contact with young infants on the chance this maybe is unrecognized pertussis."

Pertussis is a bacterial infection. Initial coldlike symptoms lead to fits of 15 to 20 coughs in a row that leave patients gasping for air — often, but not always, 여주출장마사지 - https://www.popanma.com/%ec%97%ac%ec%a3%bc%ec%b6%9c%ec%9e%a5%ec%83%b5%cf... with a high-pitched "whoop."

The incidence of pertussis plummeted in industrialized nations after vaccination began in the 1940s. It now is on the rise again globally.

Why isn't clear, but it's thought to be at least partly due to waning immunity. Children get five doses of pertussis vaccine between ages 2 months and 6 years. The protection begins to drop five to 10 years after the last shot.

In the United States, a preliminary CDC count found more than 11,000 pertussis cases last year. That's up from 9,771 the previous year, and the most recorded in three decades.

"We know that's an underestimate," Murphy said.

Experts say there may be 10 times as many cases, even more. Studies suggest almost a quarter of people with coughs that last longer than two weeks have undiagnosed pertussis, says Dr. Kathryn Edwards of Vanderbilt University.

In fact, about a third of CDC-recorded cases are among adolescents, which even health professionals may not realize. So far this year, CDC has counted outbreaks, most involving teens, in 11 states, including a Chicago-area one that has involved more than 100 cases since March.

"I really thought it was a disease of the Depression," said Monika Burke, a Philadelphia nurse who was stunned when her 15-year-old daughter, Sophia, caught whooping cough in May.

A doctor first diagnosed a viral infection. But Sophia was having 30 or 40 coughing fits a day, occasionally so violent they'd trigger vomiting. So the doctor prescribed antibiotics and performed a blood test for pertussis. By the time test results came back a week later, her 12-year-old brother was sick, too.

Enter the booster debate. Proponents say booster shots for older ages could prevent misery and school and work absences, plus indirectly protect vulnerable infants: Since 1990, pertussis has risen 72 percent among babies younger than 4 months, the age when their vaccine protection begins to kick in.

Studies show that giving one-third of youngsters' pertussis vaccine doses to teens and adults can safely boost waning immunity. Already, boosters are offered in Canada, Germany, France and Australia.

Here, Glaxo last week asked the FDA to approve its Boostrix version for teens. The idea: People are supposed to get boosters against two other diseases, tetanus and diphtheria, every decade, including one for 11- to 18-year-olds. Boostrix simply adds a pertussis booster to the scheduled adolescent shot.

Competitor Aventis Pasteur wants to target adults, too. It is preparing to seek FDA approval to sell its Adacel pertussis-tetanus-diphtheria booster to ages 11 through 64.

Once FDA makes sales decisions, expected early next year, a CDC-appointed committee must recommend who should get whichever shots are sold. Adolescents likely will be the first candidates, noted Vanderbilt's Edwards. After all, they wouldn't require an extra doctor's visit or needle prick.

Less is known about adult pertussis risk. Still, new parents and infant caregivers and health workers are logical next choices "so we can cocoon babies," she said. "It's the babies that could die."

By Lauran Neergaard

Just eight federal employees monitor widely varying state efforts to fight Medicaid fraud, the Government Accountability Office said. The federal Centers for Medicare and Medicaid Services - https://www.b2bmarketing.net/search/gss/Medicaid%20Services has been reviewing state programs since 2000 at a pace that will take it until late 2006 to cover all 50 states and the District of Columbia, said GAO, Congress' investigative arm.

The oversight "may be disproportionately small relative to the risk of serious financial loss," GAO said.

CMS administrator Mark McClellan said his agency is beefing up its financial management staff to review Medicaid spending.

Medicaid is the government health care program for the poor. It is run by the states, and its costs are shared by the federal and state governments.

Medicaid reimbursements are expected to top $300 billion this year, more than half of that in federal money.

While the report said it could not put a dollar figure on the extent of Medicaid fraud, it detailed several schemes uncovered by state and federal prosecutors. In California, for example, 15 laboratories billed more than $20 million for tests that were never ordered by physicians.

Also in California, an eyeglasses store fraudulently billed Medicaid for 59,574 pairs of glasses between 1995 and 2001, GAO said.

In addition, there are indications that Medicaid fraud involving drug pricing practices is increasing, said Sen. Charles Grassley, R-Iowa, who requested the GAO study.

Federal and state prosecutors are investigating several allegations of improper drug pricing, following settlements - http://www.melodyhome.com/category-0/?u=0&q=settlements in seven cases of alleged pricing and marketing fraud since 2001, said Grassley, 아산출장마사지 - https://www.anmapop.com/%ec%95%84%ec%82%b0%ec%b6%9c%ec%9e%a5%ec%83%b5%cf... chairman of the Senate Finance Committee.

Grassley said the government needs to do more. "CMS has a problem with Medicaid fraud and its limited oversight is insufficient to protect the integrity of the program."

By contrast, he said, the government's Medicare health care program for older and disabled Americans, is more successful in rooting out abuse.

Other studies have found that the federal government recovers 20 times more money from prosecuting fraud in Medicare than in Medicaid - $1 billion compared with $43 million in 2001, according to the Washington-based Taxpayers Against Fraud Education Fund.

McClellan said the government is taking steps to look at both programs together since schemes to defraud one also often target the other.

A pilot program in California in one year produced a reported $58 million in savings and more than 80 cases against health care providers suspected of fraud, GAO said.

By Mark Sherman

But for modest Muslim women, it's an unthinkable indignity.

"I have witnessed their misery and how bad they feel about it. They don't like it. They feel ashamed. It's very embarrassing," said Asha Abdulleh, a native of Kenya and a medical interpreter.

When officials at Maine Medical Center discovered many Muslim women were so ashamed they were canceling doctor visits, the hospital took action, redesigning the standard gown to provide extra coverage for patients who want it. The new hospital gowns have been available for several weeks.

"This is a great example of a challenge raised by a specific community that can ultimately benefit all patients," said Dana Farris Gaya, the hospital's manager of interpreter and cross-cultural services.

The problem was acute for Maine Medical because 2,000 Somali refugees have come to Portland over the past few years and most of them are treated at the hospital's international clinic. As many as three out of 10 women were skipping their appointments, said Osman Hersi, a medical interpreter at the hospital.

Tracked down at home, the women whose religion and culture require them to be covered, described to interpreters - http://www.express.co.uk/search/interpreters/ the horror of being asked to wear the revealing gowns during outpatient procedures.

Furthermore, they were publicly humiliated when they had to wait in a hallway in the radiology department.

On a recent morning after the new patient gowns were provided, Shamso Abdi appeared for her first hospital visit since arriving in Portland.

She and her husband, Aden Ali, came to the United States from Mogadishu, Somalia. They lived in a small town in Kentucky, and then Columbus, Ohio, before coming to Portland.

Abdi, who was clothed in a dress, a sarong and a hijab, a scarf wrapped around her head, said she had canceled appointments in Columbus when she had to see male doctors and wear the standard drafty gown.

The gown created by the Portland hospital is long enough to provide more coverage of a patient's legs and has extra material to ensure that a patient's backside remains covered. Underneath, there's a wraparound sarong for even more coverage.

Abdi said she was grateful to see that Maine Medical had created a patient gown with her principles in mind.

"I'm so happy they made the change. I'm so happy that they considered us," she said, speaking through an interpreter.

Other hospitals are responding to the needs of Muslims. In southeastern Michigan, home to 300,000 Arab-Americans, the University of Michigan Medical Center is also addressing the issue of modesty.

The hospital is thinking of posting signs on the rooms of Muslim women warning male visitors and staff to check with a nurse's station before entering, said spokeswoman Krista Hopson in Ann Arbor, Mich.

As for the gown itself, 김천출장마사지 - https://www.anmastar.com/%ea%b9%80%ec%b2%9c%ec%b6%9c%ec%9e%a5%ec%83%b5%c... Maine Medical isn't the only hospital to try to create a more acceptable version.

Hackensack University Medical Center in New Jersey introduced vibrant colors and funky patterns five years ago. Other hospitals and garment producers have tweaked the traditional design with snaps, Velcro and other changes.

Still, the standard-issue gown will never go away entirely. In some situations, in emergency rooms for example, it's more important to put the interests of doctors and nurses ahead of the interests of patients.

But for many situations, it makes sense to keep patients happy.

Asks Dr. Nat James of the hospital's international clinic: "Why didn't we think of this so long ago?"

The idea of changing the gown isn't completely new.

In 1999, designer Cynthia Rowley unveiled new gowns that offered a mid-calf length with a mock turtleneck and three-quarter length sleeves - http://wordpress.org/search/sleeves with snaps for women and drawstring pants, a short sleeve shirt and a matching robe for men.

That same year, Missouri state Rep. Sam Gaskill pushed a bill that would have required hospitals to provide patients with "dignity gowns," covering the body from neck to knee. The bill, prompted by Gaskill's own hospital experience, never made it out of committee.

With outbreaks striking teenagers and adults, the government soon will decide if it's time for booster shots against the cough so violent it can break a rib. Last week, manufacturer GlaxoSmithKline sought Food and Drug Administration permission to sell a booster; competitor Aventis Pasteur isn't far behind.

While boosters are debated, however, don't lose sight of the real risk: Whooping cough - https://www.google.com/search?hl=en&gl=us&tbm=nws&q=Whooping%20cough&btn... can kill newborns before they start getting their vaccinations. And while older patients usually recover, 과천출장마사지 - https://www.anmapop.com/%ea%b3%bc%ec%b2%9c%ec%b6%9c%ec%9e%a5%ec%83%b5%cf... they can easily spread the disease, known medically as pertussis, to infants.

"Parents who have very young infants need to get them vaccinated as early as possible," advises Dr. Trudy Murphy of the Centers for Disease Control and Prevention in Atlanta. Anyone who's coughing should "avoid contact with young infants on the chance this maybe is unrecognized pertussis."

Pertussis is a bacterial infection. Initial coldlike symptoms lead to fits of 15 to 20 coughs in a row that leave patients gasping for air — often, but not always, with a high-pitched "whoop."

The incidence of pertussis plummeted in industrialized nations after vaccination began in the 1940s. It now is on the rise again globally.

Why isn't clear, but it's thought to be at least partly due to waning immunity. Children get five doses of pertussis vaccine between ages 2 months and 6 years. The protection begins to drop five to 10 years after the last shot.

In the United States, a preliminary CDC count found more than 11,000 pertussis cases last year. That's up from 9,771 the previous year, and the most recorded in three decades.

"We know that's an underestimate," Murphy said.

Experts say there may be 10 times as many cases, even more. Studies suggest almost a quarter of people with coughs that last longer than two weeks have undiagnosed pertussis, says Dr. Kathryn Edwards of Vanderbilt University.

In fact, about a third of CDC-recorded cases are among adolescents, which even health professionals may not realize. So far this year, CDC has counted outbreaks, most involving teens, in 11 states, including a Chicago-area one that has involved more than 100 cases since March.

"I really thought it was a disease of the Depression," said Monika Burke, a Philadelphia nurse who was stunned when her 15-year-old daughter, Sophia, caught whooping - https://knoji.com/search/?query=caught%20whooping cough in May.

A doctor first diagnosed a viral infection. But Sophia was having 30 or 40 coughing fits a day, occasionally so violent they'd trigger vomiting. So the doctor prescribed antibiotics and performed a blood test for pertussis. By the time test results came back a week later, her 12-year-old brother was sick, too.

Enter the booster debate. Proponents say booster shots for older ages could prevent misery and school and work absences, plus indirectly protect vulnerable infants: Since 1990, pertussis has risen 72 percent among babies younger than 4 months, the age when their vaccine protection begins to kick in.

Studies show that giving one-third of youngsters' pertussis vaccine doses to teens and adults can safely boost waning immunity. Already, boosters are offered in Canada, Germany, France and Australia.

Here, Glaxo last week asked the FDA to approve its Boostrix version for teens. The idea: People are supposed to get boosters against two other diseases, tetanus and diphtheria, every decade, including one for 11- to 18-year-olds. Boostrix simply adds a pertussis booster to the scheduled adolescent shot.

Competitor Aventis Pasteur wants to target adults, too. It is preparing to seek FDA approval to sell its Adacel pertussis-tetanus-diphtheria booster to ages 11 through 64.

Once FDA makes sales decisions, expected early next year, a CDC-appointed committee must recommend who should get whichever shots are sold. Adolescents likely will be the first candidates, noted Vanderbilt's Edwards. After all, they wouldn't require an extra doctor's visit or needle prick.

Less is known about adult pertussis risk. Still, new parents and infant caregivers and health workers are logical next choices "so we can cocoon babies," she said. "It's the babies that could die."

By Lauran Neergaard