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go to originalSoaring rates to bring unprecedented medical, economic burdens, study predicts
By Jennifer Thomas
HealthDay Reporter
FRIDAY, Nov. 27 (HealthDay News) -- The number of people with diabetes in the United States is expected to double over the next 25 years, a new study predicts.
That would bring the total by 2034 to about 44.1 million people with the disease, up from 23.7 million today.
At the same time, the cost of treating people with diabetes will triple, the study also warns, rising from an estimated $113 billion in 2009 to $336 billion in 2034.
One factor driving the soaring costs: the number of people living with diabetes for lengthy periods, the researchers said. Over time, the cost of caring for someone with diabetes tends to rise along with their risk for developing complications, such as end-stage renal disease, which requires dialysis.
"We believe our model provides a more precise estimate of what the population size will look like and what it will cost the country and government programs like Medicare," said study author Dr. Elbert Huang, an assistant professor of medicine at the University of Chicago.
Prior forecasts, including the ones currently used by the federal government's budget analysts, have underestimated the burden, the researchers said. A 1991 study, for example, predicted that 11.6 million people would have diabetes in 2030. In 2009, there were already more than twice that many living with diabetes.
"In a similar way, we may be underestimating what's happening, which is actually very disturbing," Huang said.
Among Medicare beneficiaries, the number with diabetes is expected to rise from 8.2 million to 14.6 million in 2034, with an accompanying rise in spending from $45 billion to $171 billion.
"That essentially means that in 2034, half of all direct spending on diabetes care will be coming from the Medicare population," Huang said.
The study is published in the December issue of Diabetes Care.
The high cost of chronic disease is one of the most pressing issues facing the United States as legislators grapple with financial strains on Medicare and the larger issue of health-care reform, the researchers say.
Factors driving the increase in diabetes cases include the aging population and continued high rates of obesity, both of which are risk factors for type 2 diabetes, in which the body does not produce enough insulin or the cells don't use it correctly. In the study, the researchers assumed that the obesity rate would remain relatively stable, topping out at about 30 percent in the next decade and then declining slightly to about 27 percent in 2033.
Dr. David Kendall, chief scientific and medical officer for the American Diabetes Association, said the study is one of several recent papers predicting a dramatic rise in the incidence of diabetes. And though which methodology provides the most accurate predictions is open to debate, he said, the overarching message is that steps need to be taken to prevent diabetes from overwhelming an already overburdened health-care system.
"This is, in a sense, evidence of an iceberg," Kendall said. "What we are seeing currently is only a fraction of the potential future risk."
In making their estimates, the researchers used data on people 24 to 85 years old who took part in the U.S. Centers for Disease Control and Prevention's National Health and Nutrition Examination Survey and the National Health Interview Study.
"This is clearly a very pressing problem," said study co-author Michael O'Grady, a senior fellow at the National Opinion Research Center at the University of Chicago. "It's one of the few chronic illnesses we have that is growing, and the cost of doing nothing is going to be quite high."
Matt Peterson, director of information resources at the American Diabetes Association, said that community-based intervention programs that include dietary counseling and exercise, such as walking for 30 minutes most days of the week, can help combat the trend.
"We're not talking about massive weight loss or for everyone to become marathon runners," Peterson said. "We are talking about modest weight loss of 10 to 15 pounds. It's a challenge, but it's an achievable goal."
For those with diabetes, the American Diabetes Association recommends modest weight loss, increased physical activity, maintaining A1C (blood sugar) levels below 7, cholesterol control and blood pressure control to prevent complications.
More information
The American Diabetes Association has more on living with diabetes.
SOURCES: Elbert Huang, M.D., assistant professor, medicine, University of Chicago Medical Center, Chicago; Michael O'Grady, Ph.D., senior fellow, National Opinion Research Center, University of Chicago; Matt Peterson, director, information resources, American Diabetes Association, Alexandria, Va.; David Kendall, M.D., chief scientific and medical officer, American Diabetes Association, Alexandria, Va.; December 2009 Diabetes Care
Last Updated: Nov. 27, 2009
go to originalBy SHAWN POGATCHNIK
The Associated Press
Thursday, November 26, 2009; 6:12 PM
DUBLIN -- Roman Catholic Church leaders in Dublin spent decades sheltering child-abusing priests from the law and most fellow clerics turned a blind eye, an investigation ordered by Ireland's government concluded Thursday.
Dublin Archbishop Diarmuid Martin, who handed over more than 60,000 previously secret church files to the three-year investigation, said he felt deep shame and sorrow for how previous archbishops presided over endemic child abuse - yet claimed afterward not to understand the gravity of their sins.
Martin said his four predecessors in Ireland's capital, including retired Cardinal Desmond Connell, must have understood that priests' molestation and rape of boys and girls "was a crime in both civil and canon law. For some reason or another they felt they could deal with all this in little worlds of their own.
"They were wrong, and children were left to suffer."
There was a similarly shocking investigation into decades of unchecked child abuse in Irish schools, workhouses and orphanages run nationwide by 19 Catholic orders of nuns, priests and brothers.
That report in May sought to document the scale of abuse as well as the reasons why church and state authorities didn't stop it, whereas Thursday's 720-page report focused on why church leaders in the Dublin Archdiocese - home to a quarter of Ireland's 4 million Catholics - did not tell police about a single abuse complaint against a priest until 1995.
By then, the investigators found, successive archbishops and their senior deputies - among them qualified lawyers - already had compiled confidential files on more than 100 parish priests who had sexually abused children since 1940. Those files had remained locked in the Dublin archbishop's private vault.
The investigators also dug up a paper trail documenting the church's long-secret insurance policy, taken out in 1987, to cover potential lawsuits and compensation demands. Dublin church leaders publicly denied the existence of the problem for a decade afterward - but since the mid-1990s have paid out more than euro10 million ($15 million) in settlements and legal bills.
The report cited documents showing how church officials learned about some cases only when devoutly Catholic police received complaints from children or their parents - but handed responsibility back to church leaders to sort out the problems themselves.
Thursday's report detailed "sample" cases of 46 priests who faced 320 documented complaints, although the investigators said they were confident that the priests had abused many more children than that. They cited testimony from one priest who admitted abusing more than 100 children, and another priest who said he abused a child approximately every two weeks for 25 years.
Just 11 of the 46 ultimately were convicted of abusing children - typically decades after church leaders learned of their crimes - while two others are scheduled to face Dublin criminal court actions within months. Fourteen are dead and most of the rest have been defrocked or barred from parish duties. Just six are still active priests.
Three Dublin archbishops - John Charles McQuaid (1940-72), Dermot Ryan (1972-84) and Kevin McNamara (1985-87) - did not tell police about clerical abuse cases, instead opting to avoid public scandals by shuttling offenders from parish to parish and even overseas to U.S. churches, the commission found.
It was not until 1995 that then-Archbishop Connell allowed police to see church files on 17 clerical abuse cases. At that time, Connell actually held records of complaints against at least 29 priests, the report found. Connell later pursued a lawsuit against the investigators in an abandoned bid to keep them from seeing more than 5,500 files documenting the church's knowledge of abusive priests.
The report said all four archbishops sought "the maintenance of secrecy, the avoidance of scandal, the protection of the reputation of the church, and the preservation of its assets. All other considerations, including the welfare of children and justice for victims, were subordinated to these priorities."
The investigators lauded a handful of priests and mostly low-ranking police who pursued complaints and prosecutions, almost always unsuccessfully, from the 1960s to the 1980s.
Senior police officers "clearly regarded priests as being outside their remit" and handed "complaints to the archdiocese instead of investigating them," the report said.
"A few (priests) were courageous and brought complaints to the attention of their superiors. The vast majority simply chose to turn a blind eye," it said.
Ireland's police commander, Commissioner Fachtna Murphy, said he was "deeply sorry" to read that his force failed to provide victims of abusive priests "the level of response or protection which any citizen in trouble is entitled to expect."
The government also apologized for the state's failure to pursue Dublin priests accused of child abuse until recent years.
Justice Minister Dermot Ahern, who received the Dublin Archdiocese report in July but delayed its publication for legal vetting, vowed that the state would never again treat the Catholic Church with deference.
"A priest's collar will protect no criminal," he said.
But pressure groups representing more than 15,000 documented victims of abuse by Irish Catholic officials said the government was not doing enough to end the danger of Catholic child abuse - in part because the law still stops short of requiring bishops to report abuse complaints to police.
Maeve Lewis, executive director of an Irish abuse counseling service called One in Four, noted that not a single person in Ireland has been convicted for "recklessly endangering" children, a crime created in 2006 legislation.
Lewis said the archbishops, bishops, monsignors, police and government health officials who suppressed abuse complaints for decades had never faced criminal investigations "even though they are every bit as guilty as the priests who committed the abuse."
And she forecast that, because abused children often do not seek justice until they reach adulthood, children today were still being abused by priests. "It's very likely in 10 or 15 years' time that the children who are being abused today will bring forward allegations," she said.
"As Irish people we like to think we live in a civilized society," she said, "but we need to hang our heads in shame."
---
On the Net:
Report,http://www.justice.ie/en/JELR/Pages/PB09000504
go to original Tue Nov 24, 3:57 pm ET
Ten members of the Republican National Committee are proposing a resolution demanding candidates embrace at least eight of 10 conservative principles if they hope to receive financial support and an official endorsement from the RNC. The "Proposed RNC Resolution on Reagan's Unity Principle for Support of Candidates," is designed to force candidates to prove that they support "conservative principles" while opposing "Obama's socialist agenda," according to The New York Times' Caucus blog. The proposal highlights the ongoing tug-of-war for the ideological soul of the Republican party, and has been met with skepticism both inside and outside of the party.
Some are speculating that the move was inspired by the GOP’s recent loss in New York's 23rd House race, a seat the party had held since the 1800s. That contest saw Dede Scozzafava, a moderate Republican endorsed by the RNC, driven out of the race in favor of Doug Hoffman, a more conservative candidate backed by the likes of Glenn Beck and Sarah Palin. After Scozzafava dropped out of the race, the RNC endorsed Hoffman, who went on to lose to the Democratic candidate, Bill Owens.
James Bopp Jr., an Indiana attorney, initiated the resolution, saying that "conservatives have lost trust in the Republican party." Bopp Jr., who floated a failed proposal earlier this year demanding that Democrats rename their party the "Democrat Socialist Party," was joined by 10 RNC co-sponsors. The group says they cited Ronald Reagan in naming the resolution because the former president said that "someone who agreed with him 8 out of 10 times was his friend, not his opponent." The ten guidelines, distributed to RNC members in recent weeks, are as follows:
(1) We support smaller government, smaller national debt, lower deficits and lower taxes by opposing bills like Obama's "stimulus" bill;
(2) We support market-based health care reform and oppose Obama-style government run healthcare;
(3) We support market-based energy reforms by opposing cap and trade legislation;
(4) We support workers' right to secret ballot by opposing card check;
(5) We support legal immigration and assimilation into American society by opposing amnesty for illegal immigrants;
(6) We support victory in Iraq and Afghanistan by supporting military-recommended troop surges;
(7) We support containment of Iran and North Korea, particularly effective action to eliminate their nuclear weapons threat;
(8) We support retention of the Defense of Marriage Act;
(9) We support protecting the lives of vulnerable persons by opposing health care rationing and denial of health care and government funding of abortion; and
(10) We support the right to keep and bear arms by opposing government restrictions on gun ownership;
Predictably, the proposed resolution has elicited derision from all corners of the political spectrum, including the right wing. In criticizing the proposal, conservative blogger Erick Erickson says that Republicans "risk giving liberal candidates easy opportunities to get conservative endorsements simply by checking the box without ever meaning it," adding that the measure is essentially hollow because the "GOP cannot live up to its own platform adopted at a national convention, it sure as heck won’t live up to any pledge put forward by a group of RNC committeemen."
Meanwhile, liberal blogger Steve Benen wonders if Reagan himself would even pass the 80% threshold mandated by the resolution bearing his name, noting that Reagan "voted for several tax increases, began the modern era of massive federal debt, ran huge deficits, and approved an immigration measure the far-right still resents."
However, not everyone finds fault with it. A Republican strategist and former Bush White House official, who asked to remain anonymous, told Yahoo! News that the resolution "bodes well" because "Republicans are continuing to discuss policy positions and principles," adding "this should not be treated as a purge document - as the media is portraying it - but more of a document for discussion as Republicans attempt to rebuild the party in 2010."
Despite the debate that it’s already inspired, whether or not the resolution even gets voted on by the RNC's membership remains up in the air. A spokeswoman for RNC Chairman Michael Steele told The Wall Street Journal that until the deadline for submitting resolutions for the party's winter meeting is reached, "we do not know what resolutions will be submitted, nor what the final language of any resolution ultimately submitted may be."
-- Brett Michael Dykes is a contributor to the Yahoo! News Blog
go to originalBy Gretchen Reynolds
For some time, researchers have been finding that people who exercise don’t necessarily lose weight. A study published online in September in The British Journal of Sports Medicine was the latest to report apparently disappointing slimming results. In the study, 58 obese people completed 12 weeks of supervised aerobic training without changing their diets. The group lost an average of a little more than seven pounds, and many lost barely half that.
How can that be? Exercise, it seems, should make you thin. Activity burns calories. No one doubts that.
“Walking, even at a very easy pace, you’ll probably burn three or four calories a minute,” beyond what you would use quietly sitting in a chair, said Dan Carey, Ph.D., an assistant professor of exercise physiology at the University of St. Thomas in Minnesota, who studies exercise and metabolism.
But few people, an overwhelming body of research shows, achieve significant weight loss with exercise alone, not without changing their eating habits. A new study from scientists at the University of Colorado School of Medicine in Denver offers some reasons why. For the study, the researchers recruited several groups of people. Some were lean endurance athletes; some sedentary and lean; some sedentary and obese. Each of the subjects agreed to spend, over the course of the experiment, several 24-hour periods in a special laboratory room (a walk-in calorimeter) that measures the number of calories a person burns. Using various calculations, the researchers could also tell whether the calories expended were in the form of fat or carbohydrates, the body’s two main fuel sources. Burning more fat than carbohydrates is obviously desirable for weight loss, since the fat being burned comes primarily from body fat stores, and we all, even the leanest among us, have plenty of those.
The Denver researchers were especially interested in how the athletes’ bodies would apportion and use calories. It has been well documented that regular endurance training increases the ability of the body to use fat as a fuel during exercise. They wondered, though, if the athletes — or any of the other subjects — would burn extra fat calories after exercising, a phenomenon that some exercisers (and even more diet and fitness books) call “afterburn.”
“Many people believe that you rev up” your metabolism after an exercise session “so that you burn additional body fat throughout the day,” said Edward Melanson, Ph.D., an associate professor in the division of endocrinology at the School of Medicine and the lead author of the study. If afterburn were found to exist, it would suggest that even if you replaced the calories you used during an exercise session, you should lose weight, without gaining weight — the proverbial free lunch.
Each of Melanson’s subjects spent 24 quiet hours in the calorimeter, followed later by another 24 hours that included an hourlong bout of stationary bicycling. The cycling was deliberately performed at a relatively easy intensity (about 55 percent of each person’s predetermined aerobic capacity). It is well known physiologically that, while high-intensity exercise demands mostly carbohydrate calories (since carbohydrates can quickly reach the bloodstream and, from there, laboring muscles), low-intensity exercise prompts the body to burn at least some stored fat. All of the subjects ate three meals a day.
To their surprise, the researchers found that none of the groups, including the athletes, experienced “afterburn.” They did not use additional body fat on the day when they exercised. In fact, most of the subjects burned slightly less fat over the 24-hour study period when they exercised than when they did not.
“The message of our work is really simple,” although not agreeable to hear, Melanson said. “It all comes down to energy balance,” or, as you might have guessed, calories in and calories out. People “are only burning 200 or 300 calories” in a typical 30-minute exercise session, Melanson points out. “You replace that with one bottle of Gatorade.”
Related
This does not mean that exercise has no impact on body weight, or that you can’t calibrate your workouts to maximize the amount of body fat that you burn, if that’s your goal.
“If you work out at an easy intensity, you will burn a higher percentage of fat calories” than if you work out a higher intensity, Carey says, so you should draw down some of the padding you’ve accumulated on the hips or elsewhere — if you don’t replace all of the calories afterward. To help those hoping to reduce their body fat, he published formulas in The Journal of Strength and Conditioning Research last month that detailed the heart rates at which a person could maximize fat burning. “Heart rates of between 105 and 134” beats per minute, Carey said, represent the fat-burning zone. “It’s probably best to work out near the top of that zone,” he says, “so that you burn more calories over all” than at the extremely leisurely lower end.
Perhaps just as important, bear in mind that exercise has benefits beyond weight reduction. In the study of obese people who took up exercise, most became notably healthier, increasing their aerobic capacity, decreasing their blood pressure and resting heart rates, and, the authors write, achieving “an acute exercise-induced increase in positive mood,” leading the authors to conclude that, “significant and meaningful health benefits can be achieved even in the presence of lower than expected exercise-induced weight loss.”
Finally and thankfully, exercise seems to aid, physiologically, in the battle to keep off body fat once it has been, through resolute calorie reduction, chiseled away. In other work by Melanson’s group, published in September, laboratory rats that had been overfed and then slimmed through calorie reduction were able to “defend” their lower weight more effectively if they ran on a treadmill and ate at will than if they had no access to a treadmill. The exercise seemed to reset certain metabolic pathways within the rats, Melanson says, that blunted their body’s drive to replace the lost fat. Similar mechanisms, he adds, probably operate within the bodies of humans, providing scientific justification for signing up for that Thanksgiving Day 5K.
go to original By Mike Soraghan - 11/01/09 01:27 PM ET
Sen. Joe Lieberman said Sunday it's worth defeating a healthcare overhaul in order to prevent the creation of a government-run health insurance program.
Interviewed on CBS's "Face the Nation," the independent member of the Democratic Caucus said doing "nothing" is better than a so-called public option.
"'Nothing' is better than getting that," Lieberman said. "We ought to follow the doctors' oath and say, 'First, let's do no harm.'"
The Connecticut lawmaker said fixing the economy and creating jobs is a higher priority than healthcare, and a government-run insurance plan would damage the economy by hiking premiums, raising taxes or increasing the national debt.
Supporters of the public option say that it would help drive down premiums and lower healthcare costs by competing with private insurance companies who often dominate their markets.
The House bill to be debated next week in the House has a public option. Senate Majority Leader Harry Reid (D-Nev.) has indicated that he will include a public option in the Senate version, despite doubts about whether it can get enough votes to pass.
Those doubts grew last week when Lieberman announced he would join a Republican filibuster to prevent a public option. Lieberman is one of the 60 votes that Senate leaders count on to get the 60 votes they need to end Republican filibusters.
"I'm not going to filibuster to stop the debate on healthcare reform from beginning because I want to have that debate," Lieberman said Sunday. "I want to have healthcare reform. ...But I feel so strongly about the creation of another government health insurance entitlement, the government going into the health insurance business, I think it's such a mistake that I would use the power I have as a single senator to stop a final vote."
Supporters lashed out at Lieberman's announcement last week, saying he was catering to the insurance companies headquartered in his state. One liberal Democrat, Rep. Raul Grijalva (D-Ariz.), tied it to the campaign contributions Lieberman has received from the industry.
Lieberman has gotten $2.6 million from the health sector during his time in the Senate, according to Opensecrets.com, ranking him 15th highest in Congress.
Lieberman rejected that idea Sunday, saying he filed anti-trust cases against companies when he was Connecticut attorney general and supports ending the industry's anti-trust exemption.
"I have never hesitated to get tough on insurance companies when I thought they were wrong," Lieberman said.
He said it was his critics who insist on a public option who threaten the prospects for passing a bill.
"By having a litmus test, they're stopping us from getting anything done," Lieberman said.
Also Sunday, House Minority Leader John Boehner (R-Ohio) outlined how he plans to offer an alternative healthcare proposal in the House. He has previously said he will have an alternative and Democratic leaders have said they will allow a vote on it.
Boehner said the Congressional Budget Office is currently "scoring," or drafting a cost estimate, for a bill that takes "eight or nine" of the principles Republicans have espoused.
"We do not increase taxes, we do not cut Medicaid or Medicare, and do not have mandates on individuals or businesses," Boehner said on CNN's "State of the Union."
"I'm hopeful that Speaker Pelosi will allow us to offer an alternative."
House Speaker Nancy Pelosi (D-Calif.) has indicated she may not allow amendments by Republicans or her fellow Democrats. But House Democratic leaders have said Republicans will get a vote on their proposal. Asked last week if the Republican proposal will be available to the public for three days prior to the vote, as he and others have demanded for Pelosi's bill, Boehner was noncommittal.
go to originalWorld's largest cruise ship narrowly clears Danish bridge on maiden voyage to Florida
By JAN M. OLSEN Associated Press Writer
KORSOER, Denmark October 31, 2009 (AP)
The Associated Press
The world's largest cruise ship cleared a crucial obstacle Sunday, lowering its smokestacks to squeeze under a bridge in Denmark.
This Oct. 30, 2009 photo released by Royal Caribbean shows Royal Caribbean's Oasis of the Seas... Expand
This Oct. 30, 2009 photo released by Royal Caribbean shows Royal Caribbean's Oasis of the Seas departing a ship yard in Finland. The Oasis of the Seas, the largest passenger vessel ever built, is set to be handed over to Royal Caribbean International on Wednesday, Oct. 28, 2009. (AP Photo/ Royal Caribbean) NO SALES Collapse
(AP)
The Oasis of the Seas — which rises about 20 stories high — passed below the Great Belt Fixed Link with a slim margin as it left the Baltic Sea on its maiden voyage to Florida.
Bridge operators said that even after lowering its telescopic smokestacks the giant ship had less than a 2-foot (half-meter) gap.
Hundreds of people gathered on beaches at both ends of the bridge, waiting for hours to watch the brightly lit behemoth sail by shortly after midnight (2300GMT; 7 p.m. EDT).
"It was fantastic to see it glide under the bridge. Boy, it was big," said Kurt Hal, 56.
Company officials are banking that its novelty will help guarantee its success. Five times larger than the Titanic, the $1.5 billion ship has seven neighborhoods, an ice rink, a small golf course and a 750-seat outdoor amphitheater. It has 2,700 cabins and can accommodate 6,300 passengers and 2,100 crew members.
Accommodations include loft cabins, with floor-to-ceiling windows, and 1,600-square-foot (487-meter) luxury suites with balconies overlooking the sea or promenades.
The liner also has four swimming pools, volleyball and basketball courts, and a youth zone with theme parks and nurseries for children.
Oasis of the Sea, nearly 40 percent larger than the industry's next-biggest ship, was conceived years before the economic downturn caused desperate cruise lines to slash prices to fill vacant berths.
It was built by STX Finland for Royal Caribbean International and left the shipyard in Finland on Friday. Officials hadn't expected any problems in passing the Great Belt bridge, but traffic was stopped for about 15 minutes as a precaution when the ship approached, Danish navy spokesman Joergen Brand said.
Aboard the Oasis of the Seas, project manager Toivo Ilvonen of STX Finland confirmed that the ship had passed under the bridge without any incidents."Nothing fell off," he said.
The enormous ship features various "neighborhoods" — parks, squares and arenas with special themes. One of them will be a tropical environment, including palm trees and vines among the total 12,000 plants on board. They will be planted after the ship arrives in Fort Lauderdale.
In the stern, a 750-seat outdoor theater — modeled on an ancient Greek amphitheater — doubles as a swimming pool by day and an ocean front theater by night. The pool has a diving tower with spring boards and two 33-foot (10-meter) high-dive platforms. An indoor theater seats 1,300 guests.
One of the "neighborhoods," named Central Park, features a square with boutiques, restaurants and bars, including a bar that moves up and down three decks, allowing customers to get on and off at different levels.
Once home, the $1.5 billion floating extravaganza will have more, if less visible, obstacles to duck: a sagging U.S. economy, questions about the consumer appetite for luxury cruises and criticism that such sailing behemoths are damaging to the environment and diminish the experience of traveling.
It is due to make its U.S. debut on Nov. 20 at its home port, Port Everglades in Florida.
