Recipes for Health: Apple Pear Strudel — Recipes for Health

Andrew Scrivani for The New York Times

This strudel is made with phyllo dough. When I tested it the first time, I found that I had enough filling for two strudels. Rather than cut the amount of filling, I increased the number of strudels to 2, as this is a dessert you can assemble and keep, unbaked, in the freezer.

Filling for 2 strudels:

1/2 pound mixed dried fruit, like raisins, currants, chopped dried figs, chopped dried apricots, dried cranberries

1 1/2 pounds apples (3 large) (I recommend Braeburns), peeled, cored and cut in 1/2-inch dice

1 tablespoon fresh lemon juice

2 tablespoons unsalted butter for cooking the apples

1/4 cup (50 grams) brown sugar

1 teaspoon vanilla

1 teaspoon cinnamon

1/2 teaspoon freshly grated nutmeg

1/4 cup (30 grams) chopped or slivered almonds

3/4 pound (1 large or 2 small) ripe but firm pears, peeled, cored and cut in 1/2-inch dice

For each strudel:

8 sheets phyllo dough

7/8 cup (100 grams) almond powder, divided

1 1/2 ounces butter, melted, for brushing the phyllo

1. Preheat the oven to 375 degrees. Line 2 sheet pans with parchment.

2. Place the dried fruit in a bowl and pour on hot or boiling water to cover. Let sit 5 minutes, and drain. Toss the apples with the lemon juice.

3. Heat a large, heavy frying pan over high heat and add 2 tablespoons butter. Wait until it becomes light brown and carefully add the apples and the sugar. Do not add the apples until the pan and the butter are hot enough, or they won’t sear properly and retain their juice. But be careful when you add them so that the hot butter doesn’t splatter. When the apples are brown on one side, add the vanilla, cinnamon, nutmeg and almonds, flip the apples and continue to sauté until golden brown, about 5 to 7 minutes. Stir in the pears and dried fruit, then scrape out onto one of the lined sheet pans and allow to cool completely. Divide into two equal portions (easiest to do this if you weigh it).

4. Place 8 sheets of phyllo dough on your work surface. Cover with a dish towel and place another, damp dish towel on top of the first towel. Place a sheet of parchment on your work surface horizontally, with the long edge close to you. Lay a sheet of phyllo dough on the parchment. Brush lightly with butter and top with the next sheet. Continue to layer all eight sheets, brushing each one with butter before topping with the next one.

5. Brush the top sheet of phyllo dough with butter. Sprinkle on half of the almond powder (50 grams). With the other half, create a line 3 inches from the base of the dough, leaving a 2 1/2-inch margin on the sides. Top this line with one portion of the fruit mixture. Fold the bottom edge of the phyllo up over the filling, then fold the ends over and roll up like a burrito. Using the parchment paper to help you, lift the strudel and place it on the other parchment-lined baking sheet. Brush with butter and make 3 or 4 slits on the diagonal along the length of the strudel. Repeat with the other sheets of phyllo to make a second strudel. If you are freezing one of them, double-wrap tightly in plastic.

6. Place the strudel in the oven and bake 20 minutes. Remove from the oven, brush again with butter, rotate the pan and return to the oven. Continue to bake for another 20 to 25 minutes, or until golden brown. Remove from the heat and allow to cool for at least 15 minutes. Serve warm or room temperature.

Yield: 2 strudels, each serving 8

Advance preparation: The fruit filling will keep for a couple of days in the refrigerator. The strudel can be baked a few hours before serving it. Recrisp in a medium oven for 10 minutes. It can also be frozen before baking, double-wrapped in plastic. Transfer directly from the freezer to the oven and add 10 minutes to the baking time.

Nutritional information per serving: 259 calories; 13 grams fat; 4 grams saturated fat; 3 grams polyunsaturated fat; 5 grams monounsaturated fat; 15 milligrams cholesterol; 34 grams carbohydrates; 4 grams dietary fiber; 91 milligrams sodium; 4 grams protein

Martha Rose Shulman is the author of “The Very Best of Recipes for Health.”

Read More..

Ask an Expert: Ask and Expert About Alzheimer’s, Part 3

(Some questions published here have been edited, and not all questions can be answered.)

The doctor’s answers are meant for educational purposes and are not meant to be a substitute for advice from your own doctor. Readers should contact their physician before making health care decisions.

Q. What practical steps can a baby boomer take to stave off dementia of any type? — Canoe9, Hawaii

Q. My dad’s family has a history of Alzheimer’s disease: my grandfather and many of his brothers have either passed away from the disease, or are currently suffering from it. The disease can be traced back for many generations. My father has not yet started to show symptoms. Are there any medications he can take as a preventative measure? What are the best diet and lifestyle choices a person can make who has an increased risk of developing the disease? — VB, Canada

Q. Both of my inlaws have Alzheimer’s. What steps can my husband and his brothers take now to delay/prevent the disease? And should he be monitored at an Alzheimer’s center? — lbs, New Jersey

Q. My mother, two older brothers and two older sisters all had progressive mental dementia (I believe Alzheimer’s ) before age of 65. I am 64 and had extensive mental exam that found no symptoms. For prevention I am doing it as follows. 1. Have become a Vegan with very little use of vegetable oils after reading China Study by Campbell and Starch Solution by McDougall. 2. I use lots of turmeric, ginger, cinnamon in my food. 3. I have run 20 to 30 miles a week for the last 10 years. 4. I retired to reduce work related stress. Is there any other preventive measures you recommend? — Jaque, Champaign, Ill.

Q. My mother had a form or dementia, not sure if it was Alzheimer’s, and she lived to 96. And what can I do to improve my chances? I work out and am not overweight and am in good health otherwise. — Mitchellmcg, New York

A. There are dozens of causes of dementia and steps for prevention are different for each one. We have no proven preventive strategies for Alzheimer’s. The decision to monitor people at risk is made on a case by case basis, but I don’t usually recommend any monitoring until someone is about five years within the age their relative developed it; or they note changes in their memory. My top strategies to keep your brain healthy are listed below.

1. Vascular risks: Minimize your risk for strokes, heart disease and diabetes (keep your body weight, blood pressure, cholesterol and sugar in normal range). Studies find strong links between vascular risks and Alzheimer’s.

2. Exercise regularly: Regular aerobic activities, such as walking, may reduce risk for dementia by keeping the brain’s blood vessels healthy, boosting nerve growth chemicals and slowing age-related brain shrinkage.

3. Stimulate your mind: Socialize actively, make new friends, try new activities, travel to new places and be passionate about learning new things. Adult brains can grow new brain cell connections and developing a greater cognitive reserve might help the buffer against dementia pathology.

4. Heart healthy diet: follow a heart healthy diet such as a Mediterranean diet but heed the old Okinawan saying Hari Hachi Bu – eat only till you are 80 percent full; drink in moderation (but not till you cannot remember what happened the prior night!)

5. Minimize your risk for head injury by wearing helmets. (The Hovding is a new invisible helmet that promises to keeps your hair looking pretty and your head safe!)

6. Take part in clinical trials – pros are that trials may offer regular check-ups and you are helping science; cons are that there are safety risks. Our book, The Alzheimer’s Action Plan gives a step-by-step guide to evaluate which clinical trials are best for you. You might enjoy reading the new book, “Super Brain.” It’s coauthored by the dementia scientist Rudolf Tanzi and the mind-body guru, Deepak Chopra.

Q. I can´t find a Spanish version of “The Alzheimer’s Action Plan.” Will we have it soon? — Marisabel Neuman, Orlando, Fla.

A. Not yet, but we are open to it if you know an interested publisher! But your question does highlight the fact that many Spanish only speakers in the United States and elsewhere are often left out of the mainstream of information on Alzheimer’s. Hispanics in the United States may be at a slightly greater risk for Alzheimer’s due to higher rates of heart disease. Gracias por su interes!

Q. Since my mother developed Alzheimer’s in her mid-80’s, presumably I am at greater risk than the general population, should I live to a similar age. What is your best guess about the likelihood of preventative medications or treatments being developed in the next 25 years? — Beth, Singapore

A. The track record of scientists at predicting a “cure” is not very good (about the same as that of stock analysts predicting the market). The last dozen or so experimental medicines for Alzheimer’s (all touted as the next big thing) have not only failed but results have often been the opposite of what was predicted.

That said, in the next 5-10 years, we will have the results from over 25 trials testing a broad range of strategies such as drugs targeting plaques, drugs targeting tangles, drugs boosting brain memory chemicals, aerobic exercise, different types of diets and medical foods, gene therapy, as well as novel devices to stimulate the brain’s memory centers. (You can check clinicaltrials.org or adcs.org for more information). So the odds are quite good that we will have one or more new treatments by 2025. But even if a cure were in a test tube today, it would take ten years to get to the market. That’s why it’s critical that individuals, such as yourself, sign up for clinical trials.

You may be surprised to learn that one type of “cure” is already available. About 10 years ago, a woman with familial early onset Alzheimer’s successfully conceived a healthy baby free of the harmful APP gene mutation through a technique called preimplantation genetic diagnosis (PGD) at a fertility clinic run by the doctor, Yuri Verlinski. That baby, who would now be 10 years old, has hopefully been cured of familial Alzheimer’s and will in turn be able to have risk free children.

Q. My father, his mother, his mother’s sister, my maternal grandmother and her sister and my maternal aunt all had or have Alzheimer’s - symptomatic onset at 70 and in the early 80’s. I have just turned 60 and think I’d be a great research subject in terms of lifestyle. Can you suggest any research projects that might use me? I understand that some very important studies are being run through Duke. — Kristin Pop’s daughter, Ithaca.

Q. Kristin’s background, age, concerns, and interest in research studies mirror mine - which I have posted. Please inform us of potential studies. I am willing to travel, even to Duke, which she mentioned in her post. —Mary Christian Madden, East Greenwich, RI

A. Thanks for the offer! Most research studies require people to come for multiple visits over several months/years which would be difficult for people living far away. A university affiliated medical center closer to your home might be more ideal. Clinicaltrials.gov has a listing of all ongoing prevention studies. Many such studies are also advertised in pages of local newspapers. The Alzheimer’s Association chapter in your home town may be able to guide you to find a suitable research study in your town. Don’t sign up for a trial just because you have a spare half day. Make sure you thoroughly research the pros and cons. Fewer than 1 percent of drug trials are positive, but 100 percent of all drug trials carry risks. So the odds of you personally benefiting are the same as in a lottery.

Q. Her whole life my mother drank four cups of tea every day, read two to three books a week, ate mostly vegetables, didn’t smoke, drank wine moderately, and stayed slim. She started showing signs of Alzheimers in her mid 50’s and has been steadly declining for 15 years now. Although a bad lifestyle can cause dementia in many people, it is more complicated than that. — Joseph, Fla.

Read More..

Responding to Illnesses Manifesting Amid Recovery From Storm

Nicole Bengiveno/The New York Times

Dr. Aaron Gardener, center, attended to a patient at an ad hoc medical unit in Long Beach, N.Y. Many people have coughs, rashes and other ailments.

Day and night, victims of Hurricane Sandy have been streaming into ad hoc emergency rooms and relief centers, like the MASH-type medical unit on an athletic field in Long Beach, and the warming tent in the Rockaways the size of a small high school gym.

They complain of rashes, asthma and coughing. They need tetanus shots because — house-proud and armed with survivalist instincts — they have been ripping out waterlogged boards and getting poked by rusty nails. Those with back pain from sifting through debris receive muscle relaxants; those with chest pain from overexertion are hooked up to cardiac monitors.

“I’ve been coughing,” said Gabriel McAuley, 46, who has been working 16-hour days gutting homes and hauling debris in the Rockaways since the storm hit. “I’ve never felt a cough like that before. It’s deeper down.”

It is impossible to say how many people have been sickened by what Hurricane Sandy left behind: mold from damp drywall; spills from oil tanks; sewage from floodwater and unflushable toilets; tons upon tons of debris and dust. But interviews with hurricane victims, recovery workers, health officials and medical experts over the last week reveal that some of the illnesses that they feared would occur, based on the toxic substances unleashed by the storm and the experience of other disasters, notably Hurricane Katrina, have begun to manifest themselves.

Emergency rooms and poison control centers have reported cases of carbon monoxide exposure — and in New Jersey, several deaths have been attributed to it — from the misuse of generators to provide power and stoves to provide heat.

In Livingston, N.J., the Burn Center at St. Barnabas Medical Center had 16 burn cases over about six days, three times as many as usual, from people trying to dispel the cold and darkness with boiling water, gasoline, candles and lighter fluid.

Raw sewage spilled into homes in Baldwin and East Rockaway, in Nassau County, when a sewage plant shut down because of the surge and the system could not handle the backup. Sewage also spilled from a huge plant in Newark. “We tried to limit our presence in the house because the stink was horrible,” said Jennifer Ayres, 34, of Baldwin, who has been staying temporarily in West Hempstead. She said that she felt ill for several days, that her son had a scratchy throat, and that her mother, who lives in the house, had difficulty breathing, all problems she attributed to the two days they spent inside their house cleaning up last week. “I had stomach problems. I felt itchy beyond itchy on my face.”

Coughing — locally known as the Rockaway cough — is a common symptom that health officials said could come from mold, or from the haze of dust and sand kicked up by the storm and demolitions. The air in the Rockaways is so full of particles that the traffic police wear masks — though many recovery workers do not, worrying people who recall the fallout of another disaster.

“It’s just like 9/11,” said Kathy Smilardi, sitting inside the skeleton of her gutted home in Broad Channel, wrapped in a white puffy jacket, her breath visible in the afternoon cold. “Everyone runs in to clean up, and they’re not wearing masks. Are we going to wait 20 years to figure out that people are dying?”

Health officials and experts say the risks are real, but are cautioning against hysteria. Some coughing could be due to cold, damp weather. Lasting health effects from mold, dust and other environmental hazards generally require long-term, continuous exposure, they said. And the short-term effects can be mitigated by taking precautions like wearing masks, gloves and boots and removing mold-infested wallboard. “The reality is that cleaning up both muck and sewage and spills and removing walls and reconstruction and dealing with debris all do in fact pose concerns,” Daniel Kass, New York City’s deputy commissioner for environmental health, said Friday. “Are they vast or uncontrollable? No. But they depend on people doing work correctly and taking basic precautions.”

The Katrina cough was found to be temporary, said Roy J. Rando, a professor at Tulane’s School of Public Health and Tropical Medicine. Felicia Rabito, an epidemiologist at the school, said that healthy children exposed to mold after Hurricane Katrina showed no lasting respiratory symptoms when they moved back to new or renovated homes.

Immediately after Hurricane Katrina, lead levels in New Orleans’s soil dropped after the top layers of dirt, where lead from paint and gasoline can accumulate, were washed away. But in the two years afterward, soil testing found extremely high lead levels, Dr. Rabito said, which she theorized came from renovating old homes. “That’s a cautionary tale,” she said. Lead in soil can be tracked into homes and pose a health hazard to children playing inside or outside.

Though at least one outbreak of norovirus, a contagious gastrointestinal virus, occurred in a Brooklyn high school that was used as a shelter, New York and New Jersey health officials said they had not seen any significant spike in respiratory or gastrointestinal diseases related to the storm.

In Broad Channel, most homes on Noel Road, where Ms. Smilardi lives, have outdoor oil tanks that were overturned by the storm. The innards of many homes, built when asbestos was used, lie spilled among major and minor roads.

Ominous red spots covered both sides of Paul Nowinski’s burly torso. After the storm, Mr. Nowinski, a musician, waded into the basement of his childhood home on Beach 146th Street in the Rockaways to try to salvage records, books and instruments. He was up to his chest in water, which he thinks might have been contaminated with sewage. He said that he did not know the cause of the red marks; and that he had been too busy “schlepping” to go to the doctor.

Angela Macropoulos contributed reporting.

Read More..

Teenage Boys, Worried About Body Image, Take Health Risks

Béatrice de Géa for The New York Times

David Abusheikh at a gym in Brooklyn. He goes six days a week and says he uses protein supplements to help build muscle.

It is not just girls these days who are consumed by an unattainable body image.

Take David Abusheikh. At age 15, he started lifting weights for two hours a day, six days a week. Now that he is a senior at Fort Hamilton High School in Brooklyn, he has been adding protein bars and shakes to his diet to put on muscle without gaining fat.

“I didn’t used to be into supplements,” said Mr. Abusheikh, 18, who plans on a career in engineering, “but I wanted something that would help me get bigger a little faster.”

Pediatricians are starting to sound alarm bells about boys who take unhealthy measures to try to achieve Charles Atlas bodies that only genetics can truly confer. Whether it is long hours in the gym, allowances blown on expensive supplements or even risky experiments with illegal steroids, the price American boys are willing to pay for the perfect body appears to be on the rise.

In a study to be published on Monday in the journal Pediatrics, more than 40 percent of boys in middle school and high school said they regularly exercised with the goal of increasing muscle mass. Thirty-eight percent said they used protein supplements, and nearly 6 percent said they had experimented with steroids.

Over all, 90 percent of the 1,307 boys in the survey — who lived in the Minneapolis-St. Paul area, but typify what doctors say is a national phenomenon — said they exercised at least occasionally to add muscle.

“There has been a striking change in attitudes toward male body image in the last 30 years,” said Dr. Harrison Pope, a psychiatry professor at Harvard who studies bodybuilding culture and was not involved in the study. The portrayal of men as fat-free and chiseled “is dramatically more prevalent in society than it was a generation ago,” he said.

While college-age men have long been interested in bodybuilding, pediatricians say they have been surprised to find that now even middle school boys are so absorbed with building muscles. And their youth adds an element of risk.

Just as girls who count every calorie in an effort to be thin may do themselves more harm than good, boys who chase an illusory image of manhood may end up stunting their development, doctors say, particularly when they turn to supplements — or, worse, steroids — to supercharge their results.

“The problem with supplements is they’re not regulated like drugs, so it’s very hard to know what’s in them,” said Dr. Shalender Bhasin, a professor of medicine at Boston University School of Medicine. Some contain anabolic steroids, and even high-quality protein supplements might be dangerous in large amounts, or if taken to replace meals, he said. “These things just haven’t been studied very well,” he said.

Anabolic steroids pose a special danger to developing bodies, Dr. Bhasin said. Steroids “stop testosterone production in men,” he said, leading to terrible withdrawal problems when still-growing boys try to stop taking them. Still, the constant association of steroids with elite athletes like Lance Armstrong and Barry Bonds perpetuates the notion that they can be managed successfully.

Online, in bodybuilding forums for teenagers, boys barely out of puberty share weight-lifting regimens and body fat percentages, and judge one another’s progress. On Tumblr and Facebook, teenagers post images of ripped athletes under the heading “fitspo” or “fitspiraton,” which are short for “fitness inspiration.” The tags are spinoffs of “thinspo” and “thinspiration” pictures and videos, which have been banned from many sites for promoting anorexia.

“Lifted b4 school today felt good but was weak as hell,” wrote one boy who said he was 15 and from Tallahassee, Fla., on a message board on Bodybuilding.com in September, saying he bench-pressed 245 pounds. “Barely got it.”

Many of these boys probably see themselves in Mike Sorrentino, “The Situation” from the “Jersey Shore” series on MTV, or the Adam Sackler character, on the HBO series “Girls,” who rarely wears a shirt or takes a break from his crunches.

Mr. Abusheikh, for instance, has a Facebook page full of photos of himself shirtless or showing off his six-pack abs. At his high school, participation in the annual bodybuilding competition hit an all-time high of 30 students this year.

“They ask us about everything,” said Peter Rivera, a physical education teacher at Fort Hamilton High School who helps oversee the competition. “How do I lose weight? How do I gain muscle? How many times a week should I work out?” Some boys want to be stronger for sports, Mr. Rivera said, but others “want to change their body type.”

Compared with a sedentary lifestyle of video games and TV, an obsession with working out may not quite qualify as a health hazard. And instructors like Mr. Rivera say most boys are eager for advice on the healthiest, drug-free ways to get in shape.

With so little known about supplements, it can be difficult, particularly for teenagers, to make wise decisions.

This article has been revised to reflect the following correction:

Correction: November 19, 2012

An earlier version of this article gave an incorrect nationality for the soccer player Cristiano Ronaldo. He is Portuguese, not Brazilian. Because of an editing error, it misstated the number of boys included in the survey. The researchers interviewed 2,793 boys and girls, not 2,800 boys. It also described incorrectly the title of Dr. Shalender Bhasin. He is a professor of medicine at Boston University School of Medicine, not at the Boston Medical Center.

Read More..

The Neediest Cases: Emerging From a Bleak Life to Become Fabulous Phil

For years, Phillip Johnson was caught in what seemed like an endless trench of bad luck. He was fired from a job, experienced intensifying psychological problems, lost his apartment and spent time in homeless shelters. At one point, he was hospitalized after overdosing on an antipsychotic drug.

“I had a rough road,” he said.

Since his hospital stay two years ago, and despite setbacks, Mr. Johnson, 27, has been getting his life on track. At Brooklyn Community Services, where he goes for daily counseling and therapy, everybody knows him as Fabulous Phil.

“Phillip is a light, the way he evokes happiness in other people,” his former caseworker, Teresa O’Brien, said. “Phillip’s character led directly to his nickname.”

About six months ago, with Ms. O’Brien’s help, Mr. Johnson started an event: Fabulous Phil Friday Dance Party Fridays.

One recent afternoon at the agency, 30 clients and a few counselors were eating cake, drinking soft drinks and juice, and grooving for 45 minutes to Jay-Z and Drake pulsating from a boom box.

Mr. Johnson’s voice rose with excitement when he talked about the party. Clients and counselors, he said, “enjoy themselves.”

“They connect more; they communicate more,” he continued. “Everybody is celebrating and laughing.”

The leadership Mr. Johnson now displays seems to be a far cry from the excruciatingly introverted person he was.

As an only child living with his single mother in public housing in Bedford-Stuyvesant, Brooklyn, he said, he tended to isolate himself. “A lot of kids my age would say, ‘Come outside,’ but I would always stay in my room,” he said. He occupied himself by writing comic books or reading them, his favorites being Batman and Spiderman because, he said, “they were heroes who saved the day.”

After graduating from high school in 2003, he worked odd jobs until 2006, when he took a full-time position at a food court at La Guardia Airport, where he helped to clean up. The steady paycheck allowed him to leave his mother’s apartment and rent a room in Queens.

But the depression and bleak moods that had shadowed him throughout middle and high school asserted themselves.

“My thinking got confused,” he said. “Racing thoughts through my mind. Disorganized thoughts. I had a hard time focusing on one thing.”

In 2008, after two years on the job, Mr. Johnson was fired for loud and inappropriate behavior, and for being “unpredictable,” he said. The boss said he needed counseling. He moved back in with his mother, and in 2009 entered a program at an outpatient addiction treatment service, Bridge Back to Life. It was there, he said, that he received a diagnosis of schizophrenia and help with his depression and marijuana use.

But one evening in May 2010, he had a bout with insomnia.

He realized the antipsychotic medication he had been prescribed, Risperdal, made him feel tired, he said, so he took 12 of the pills, rather than his usual dosage of two pills twice a day. When 12 did not work, he took 6 more.

“The next morning when I woke up, it was hard for me to breathe,” he said.

He called an ambulance, which took to Woodhull Hospital. He was released after about a month.

Not long after, he returned to his mother’s apartment, but by February 2011, they both decided he should leave, and he relocated to a homeless shelter in East New York, where, he said, eight other people were crammed into his cubicle and there were “bedbugs, people lying in your bed, breaking into your locker to steal your stuff.”

In late spring 2011, he found a room for rent in Manhattan, but by Thanksgiving he was hospitalized again. Another stint in a shelter followed in April, when his building was sold.

Finally, in July, Mr. Johnson moved to supported housing on Staten Island, where he lives with a roommate. His monthly $900 Social Security disability check is sent to the residence, which deducts $600 for rent and gives him $175 in spending money; he has breakfast and lunch at the Brooklyn agency. To assist Mr. Johnson with unexpected expenses, a grant of $550 through The New York Times Neediest Cases Fund went to buy him a bed and pay a Medicare prescription plan fee for three months.

“I was so happy I have a bed to sleep on,” he said about the replacement for an air mattress. “When I have a long day, I have a bed to lay in, and I feel good about that.”

Mr. Johnson’s goals include getting his driver’s license — “I already have a learner’s permit,” he said, proudly — finishing his program at the agency, and then entering an apprenticeship program to become a plumber, carpenter or mechanic.

But seeing how his peers have benefited from Fabulous Phil Fridays has made him vow to remain involved with people dealing with mental illnesses or substance abuse.

He was asked at the party: Might he be like the comic-book heroes he loves? A smile spread across his face. He seemed to think so.

Read More..

Well: Meatless Main Dishes for a Holiday Table

Most vegetarian diners are happy to fill their plates with delicious sides and salads, but if you want to make them feel special, consider one of these main course vegetarian dishes from Martha Rose Shulman. All of them are inspired by Greek cooking, which has a rich tradition of vegetarian meals.

I know that Greek food is not exactly what comes to mind when you hear the word “Thanksgiving,” yet why not consider this cuisine if you’re searching for a meatless main dish that will please a crowd? It’s certainly a better idea, in my mind, than Tofurky and all of the other overprocessed attempts at making a vegan turkey. If you want to serve something that will be somewhat reminiscent of a turkey, make the stuffed acorn squashes in this week’s selection, and once they’re out of the oven, stick some feathers in the “rump,” as I did for the first vegetarian Thanksgiving I ever cooked: I stuffed and baked a huge crookneck squash, then decorated it with turkey feathers. The filling wasn’t nearly as good as the one you’ll get this week, but the creation was fun.

Here are five new vegetarian recipes for your Thanksgiving table — or any time.

Giant Beans With Spinach, Tomatoes and Feta: This delicious, dill-infused dish is inspired by a northern Greek recipe from Diane Kochilas’s wonderful new cookbook, “The Country Cooking of Greece.”

---

Northern Greek Mushroom and Onion Pie: Meaty portobello mushrooms make this a very substantial dish.

---

Roasted Eggplant and Chickpeas With Cinnamon-Tinged Tomato Sauce and Feta: This fragrant and comforting dish can easily be modified for vegans.

---

Coiled Greek Winter Squash Pie: The extra time this beautiful vegetable pie takes to assemble is worth it for a holiday dinner.

---

Baked Acorn Squash Stuffed With Wild Rice and Kale Risotto: Serve one squash to each person at your Thanksgiving meal: They’ll be like miniature vegetarian (or vegan) turkeys.

---

Read More..

I Was Misinformed: The Time She Tried Viagra

I have noticed, in the bragging-rights department, that “he doesn’t need Viagra” has become the female equivalent of the male “and, I swear, she’s a real blonde.” Personally, I do not care a bit. To me, anything that keeps you happy and in the game is a good thing.

But then, I am proud to say, I was among the early, and from what I gather, rare female users.

It happened when the drug was introduced around 1998. I was 50, but after chemotherapy for breast cancer — and later, advanced ovarian cancer — I was, hormonally speaking, pretty much running on fumes. Whether this had diminished my sex drive I did not yet know. One may have Zorba-esque impulses when a cancer diagnosis first comes in; but a treatment that leaves you bald, moon-faced and exhausted knocks that out of your system pretty fast.

But by 1998, the cancer was gone, my hair was back and I was ready to get back in the game. I was talking to an endocrinologist when I brought up Viagra. This was not to deal with the age-related physical changes I knew it would not address, it was more along the feminist lines of equal pay for equal work: if men have this new sex drug, I want this new sex drug.

“I know it’s supposed to work by increasing blood flow,” I told the doctor, “But if that’s true for men, shouldn’t it be true for women, too?”

“You’re the third woman who asked me that this week,” he said.

He wrote me a prescription. I was not seeing anyone, so I understood that I would have to do both parts myself, but that was fine. I have a low drug threshold and figured it might be best the first time to fly solo. My memory of the directions are hazy: I think there was a warning that one might have a facial flush or headaches or drop dead of a heart attack; that you were to take a pill at least an hour before you planned to get lucky, and, as zero hour approached, you were supposed to help things along by thinking beautiful thoughts, kind of like Peter Pan teaching Wendy and the boys how to fly.

But you know how it is: It’s hard to think beautiful thoughts when you’re wondering, “Is it happening? Do I feel anything? Woof, woof? Hello, sailor? Naaah.”

After about an hour, however, I was aware of a dramatic change. I had developed a red flush on my face; I was a hot tomato, though not the kind I had planned. I had also developed a horrible headache. The sex pill had turned into a bad joke: Not now, honey, I have a headache.

I put a cold cloth on my head and went to sleep. But here’s where it got good: When I slept, I dreamed; one of those extraordinary, sensual, swimming in silk sort of things. I woke up dazed and glowing with just one thought: I gotta get this baby out on the highway and see what it can do.

A few months later I am fixed up with a guy, and after a time he is, under the Seinfeldian definition of human relations (Saturday night date assumed) my official boyfriend. He is middle aged, in good health. How to describe our romantic life with the delicacy a family publication requires? Perhaps a line from “Veronika, der Lenz ist da” (“Veronica, Spring Is Here”), a song popularized by the German group the Comedian Harmonists: “Veronika, der Spargel Wächst” (“Veronica, the asparagus are blooming”). On the other hand, sometimes not. And so, one day, I put it out there in the manner of sport:

“Want to drop some Viagra?” I say.

Here we go again, falling into what I am beginning to think is an inevitable pattern: lying there like a lox, or two loxes, waiting for the train to pull into the station. (Yes, I know it’s a mixed metaphor, but at least I didn’t bring in the asparagus.) So there we are, waiting. And then, suddenly, spring comes to Suffolk County. It’s such a presence. I’m wondering if I should ask it if it hit traffic on the L.I.E. We sit there staring.

My reaction is less impressive. I don’t get a headache this time. And romantically, things are more so, but not so much that I feel compelled to try the little blue pills again.

Onward roll the years. I have a new man in my life, who is 63. He does have health problems, for which his doctor prescribes an E.D. drug. I no longer have any interest in them. My curiosity has been satisfied. Plus I am deeply in love, an aphrodisiac yet to be encapsulated in pharmaceuticals.

We take a vacation in mountain Mexico. We pop into a drugstore to pick up sunscreen and spot the whole gang, Cialis, Viagra, Levitra, on a shelf at the checkout counter. No prescription needed in Mexico, the clerk says. We buy all three drugs and return to the hotel. I try some, he tries some. In retrospect, given the altitude and his health, we are lucky we did not kill him. I came across an old photo the other day. He is on the bed, the drugs in their boxes lined up a in a semi-circle around him. He looks a bit dazed and his nose is red.

Looking at the picture, I wonder if he had a cold.

Then I remember: the flush, the damn flush. If I had kids, I suppose I would have to lie about it.

Read More..

I Was Misinformed: The Time She Tried Viagra

I have noticed, in the bragging-rights department, that “he doesn’t need Viagra” has become the female equivalent of the male “and, I swear, she’s a real blonde.” Personally, I do not care a bit. To me, anything that keeps you happy and in the game is a good thing.

But then, I am proud to say, I was among the early, and from what I gather, rare female users.

It happened when the drug was introduced around 1998. I was 50, but after chemotherapy for breast cancer — and later, advanced ovarian cancer — I was, hormonally speaking, pretty much running on fumes. Whether this had diminished my sex drive I did not yet know. One may have Zorba-esque impulses when a cancer diagnosis first comes in; but a treatment that leaves you bald, moon-faced and exhausted knocks that out of your system pretty fast.

But by 1998, the cancer was gone, my hair was back and I was ready to get back in the game. I was talking to an endocrinologist when I brought up Viagra. This was not to deal with the age-related physical changes I knew it would not address, it was more along the feminist lines of equal pay for equal work: if men have this new sex drug, I want this new sex drug.

“I know it’s supposed to work by increasing blood flow,” I told the doctor, “But if that’s true for men, shouldn’t it be true for women, too?”

“You’re the third woman who asked me that this week,” he said.

He wrote me a prescription. I was not seeing anyone, so I understood that I would have to do both parts myself, but that was fine. I have a low drug threshold and figured it might be best the first time to fly solo. My memory of the directions are hazy: I think there was a warning that one might have a facial flush or headaches or drop dead of a heart attack; that you were to take a pill at least an hour before you planned to get lucky, and, as zero hour approached, you were supposed to help things along by thinking beautiful thoughts, kind of like Peter Pan teaching Wendy and the boys how to fly.

But you know how it is: It’s hard to think beautiful thoughts when you’re wondering, “Is it happening? Do I feel anything? Woof, woof? Hello, sailor? Naaah.”

After about an hour, however, I was aware of a dramatic change. I had developed a red flush on my face; I was a hot tomato, though not the kind I had planned. I had also developed a horrible headache. The sex pill had turned into a bad joke: Not now, honey, I have a headache.

I put a cold cloth on my head and went to sleep. But here’s where it got good: When I slept, I dreamed; one of those extraordinary, sensual, swimming in silk sort of things. I woke up dazed and glowing with just one thought: I gotta get this baby out on the highway and see what it can do.

A few months later I am fixed up with a guy, and after a time he is, under the Seinfeldian definition of human relations (Saturday night date assumed) my official boyfriend. He is middle aged, in good health. How to describe our romantic life with the delicacy a family publication requires? Perhaps a line from “Veronika, der Lenz ist da” (“Veronica, Spring Is Here”), a song popularized by the German group the Comedian Harmonists: “Veronika, der Spargel Wächst” (“Veronica, the asparagus are blooming”). On the other hand, sometimes not. And so, one day, I put it out there in the manner of sport:

“Want to drop some Viagra?” I say.

Here we go again, falling into what I am beginning to think is an inevitable pattern: lying there like a lox, or two loxes, waiting for the train to pull into the station. (Yes, I know it’s a mixed metaphor, but at least I didn’t bring in the asparagus.) So there we are, waiting. And then, suddenly, spring comes to Suffolk County. It’s such a presence. I’m wondering if I should ask it if it hit traffic on the L.I.E. We sit there staring.

My reaction is less impressive. I don’t get a headache this time. And romantically, things are more so, but not so much that I feel compelled to try the little blue pills again.

Onward roll the years. I have a new man in my life, who is 63. He does have health problems, for which his doctor prescribes an E.D. drug. I no longer have any interest in them. My curiosity has been satisfied. Plus I am deeply in love, an aphrodisiac yet to be encapsulated in pharmaceuticals.

We take a vacation in mountain Mexico. We pop into a drugstore to pick up sunscreen and spot the whole gang, Cialis, Viagra, Levitra, on a shelf at the checkout counter. No prescription needed in Mexico, the clerk says. We buy all three drugs and return to the hotel. I try some, he tries some. In retrospect, given the altitude and his health, we are lucky we did not kill him. I came across an old photo the other day. He is on the bed, the drugs in their boxes lined up a in a semi-circle around him. He looks a bit dazed and his nose is red.

Looking at the picture, I wonder if he had a cold.

Then I remember: the flush, the damn flush. If I had kids, I suppose I would have to lie about it.

Read More..

Q & A: Weighing the Evidence

Q. My husband weighs twice as much as I do, yet we take the same dose of over-the-counter medications, as recommended on the packaging. Shouldn’t weight be a factor?

A. There is little information about using weight as a factor in adjusting doses of either prescription or over-the-counter medications, said Dr. Steven A. Kaplan, director of the Iris Cantor Men’s Health Center at NewYork-Presbyterian/Weill Cornell hospital.

“We are beginning to study different responses by weight,” he said, but he and other researchers have reached no conclusions on recommendations for therapy.

“In my own field, urology,” he added, “my opinion is that it is more likely for the recommended dose to be ineffective in a larger person rather than to be toxic in a thinner adult.”

Some prescription drugs, like chemotherapy agents, already have their dosages adjusted for weight because of their highly toxic nature. As for over-the-counter drugs, recommended doses generally tend to be weighted in favor of safety rather than efficacy, Dr. Kaplan said.

He and other doctors emphasized the importance of following package directions. For example, acetaminophen (like Tylenol) can present a life-threatening risk if the liver cannot process a high dose. If you find that the recommended dose does not work for you, Dr. Kaplan said, speak to your doctor.

C. CLAIBORNE RAY

Readers may submit questions by mail to Question, Science Times, The New York Times, 620 Eighth Avenue, New York, N.Y. 10018, or by e-mail to question@nytimes.com.

Read More..

The New Old Age Blog: What Chemo Can't Do

Let’s start with a simple medical fact: Chemotherapy doesn’t cure people who have very advanced Stage 4 lung or colon cancer.

Chemo can be quite effective at earlier stages. Even in late-stage disease, it may relieve symptoms for a while; it might help someone with tumors in his lungs breathe more easily, for example. Chemo can extend life for weeks or months.

It can also make the recipient feel nauseated, wiped out and generally lousy, and require him to spend more time in clinics and hospitals than a dying person might choose to. But it can’t banish cancer. Many aspects of medical prognosis and treatment are uncertain. Not this one.

Such patients’ doctors have almost certainly told them their cancer is incurable. Those who opted for chemotherapy anyway had to sign consent forms spelling out the potential side effects. Yet Dr. Jane Weeks, a research oncologist at Dana-Farber Cancer Institute in Boston, knew from previous studies that cancer patients can develop unrealistic ideas about their odds of survival.

So as she and her co-authors began analyzing results from the first representative national study of patients with advanced cancer, all undergoing chemotherapy, to see what they thought about its effects, Dr. Weeks expected many — perhaps a third of them — to get it wrong.

She was staggered to see how mistaken she was.

Nearly 1,200 patients or their surrogates were interviewed within months of a diagnosis of Stage 4 colon or lung cancer. They answered a number of questions during these telephone interviews, but the key one was: “After talking with your doctors, how likely did you think it was that chemotherapy would cure your cancer?” The only correct answer: “Not at all likely.”

But a great majority chose one of the other responses indicating some likelihood of cure or else said they didn’t know. The study, just published in The New England Journal of Medicine, found that 69 percent of lung cancer patients and 81 percent of those with colon cancer misunderstood the purpose of the very treatment they’d been undergoing.

The misperception was significantly higher among African-Americans, Asians and Hispanics than among whites — but not because of education levels, the usual variable in studies of health knowledge. “It suggests that this reflects cultural differences,” Dr. Weeks said.

Strangely, the patients who responded inaccurately also were more likely to highly rate their communications with doctors. Those who grasped that chemo wasn’t curative were, in effect, penalizing the doctors who helped them reach that understanding.

In a way, Dr. Weeks said, this makes sense. It reflects what researchers call optimism bias — or what Dr. Douglas White, a University of Pittsburgh bioethicist, has called “the powerful desire not to be dead.”

These were not very elderly people.  The bulk were ages 55 to 69. Only about a quarter of colon cancer patients and about a third of those with lung cancer were over age 70.

“It’s completely understandable that patients want to believe the chemo will cure them,” Dr. Weeks said. “And it’s understandable that physicians hesitate to take away that false hope.”

But this confusion can have unhappy consequences. For patients to make truly informed decisions, “they need to understand the outcomes,” Dr. Weeks said. “If they’re missing this critical fact, that can’t happen.”

People often hit rough times during weeks of chemotherapy. Common side effects include nausea and vomiting, diarrhea and fatigue; there are many trips to hospitals for IV drugs, X-rays and blood tests. “They’ll soldier on if they think it will cure them,” Dr. Weeks said. “Any of us would.”

But if these patients might respond differently if they understand that chemo is meant to make them feel better but may have the opposite effect, or that it may buy them another 10 to 12 weeks (a reasonable average for lung cancer) or maybe a year (for colon cancer) but won’t prevent their deaths.

Moreover, “if patients think chemo has a chance of curing them, they’ll be less likely to have end-of-life discussions early on,” Dr. Weeks said. “And they pay a price for that later” — if they enter hospice care much too late or die in hospitals instead of at home, as many prefer.

Possibly, at the time of the initial discussions, these patients recognized that chemo didn’t equal cure, she hypothesized. Then, they and their doctors began to focus on doing something, and they stopped seeing their cancer as incurable.

But realism — as palliative care doctors know — doesn’t have to mean despair. “A really good physician can communicate effectively and still maintain patient trust and confidence,” Dr. Weeks said.

“We have the tools to help patients make these difficult decisions,” two Johns Hopkins physicians, Dr. Thomas J. Smith and Dr. Dan Longo, wrote in an editorial published with the study. “We just need the gumption and incentives to use them.”

---

Paula Span is the author of “When the Time Comes: Families With Aging Parents Share Their Struggles and Solutions.”

Read More..

Mind Faded, Darrell Royal’s Wisdom and Humor Intact Till End

Three days before his death last week at 88, Darrell Royal told his wife, Edith: “We need to go back to Hollis” — in Oklahoma. “Uncle Otis died.”

“Oh, Darrell,” she said, “Uncle Otis didn’t die.”

Royal, a former University of Texas football coach, chuckled and said, “Well, Uncle Otis will be glad to hear that.”

The Royal humor never faded, even as he sank deeper into Alzheimer’s disease. The last three years, I came to understand this as well as anyone. We had known each other for more than 40 years. In the 1970s, Royal was a virile, driven, demanding man with a chip on his shoulder bigger than Bevo, the Longhorns mascot. He rarely raised his voice to players. “But we were scared to death of him,” the former quarterback Bill Bradley said.

Royal won 3 national championships and 167 games before retiring at 52. He was a giant in college football, having stood shoulder to shoulder with the Alabama coach Bear Bryant. Royal’s Longhorns defeated one of Bryant’s greatest teams, with Joe Namath at quarterback, in the 1965 Orange Bowl. Royal went 3-0-1 in games against Bryant.

Royal and I were reunited in the spring of 2010. I barely recognized him. The swagger was gone. His mind had faded. Often he stared aimlessly across the room. I scheduled an interview with him for my book “Courage Beyond the Game: The Freddie Steinmark Story.” Still, I worried that his withering mind could no longer conjure up images of Steinmark, the undersize safety who started 21 straight winning games for the Longhorns in the late 1960s. Steinmark later developed bone cancer that robbed him of his left leg.

When I met with Royal and his wife, I quickly learned that his long-term memory was as clear as a church bell. For two hours, Royal took me back to Steinmark’s recruiting trip to Austin in 1967, through the Big Shootout against Arkansas in 1969, to the moment President Richard M. Nixon handed him the national championship trophy in the cramped locker room in Fayetteville. He recalled the day at M. D. Anderson Hospital in Houston the next week when doctors informed Steinmark that his leg would be amputated if a biopsy revealed cancer. Royal never forgot the determined expression on Steinmark’s face, nor the bravery in his heart.

The next morning, Royal paced the crowded waiting room floor and said: “This just can’t be happening to a good kid like Freddie Steinmark. This just can’t be happening.”

With the love of his coach, Steinmark rose to meet the misfortune. Nineteen days after the amputation, he stood with crutches on the sideline at the Cotton Bowl for the Notre Dame game. After the Longhorns defeated the Fighting Irish, Royal tearfully presented the game ball to Steinmark.

Four decades later, while researching the Steinmark book, I became close to Royal again. As I was leaving his condominium the day of the interview, I said, “Coach, do you still remember me?” He smiled and said, “Now, Jim Dent, how could I ever forget you?” My sense of self-importance lasted about three seconds. Royal chuckled. He pointed across the room to the message board next to the front door that read, “Jim Dent appt. at 10 a.m.”

Edith and his assistant, Colleen Kieke, read parts of my book to him. One day, Royal told me, “It’s really a great book.” But I can’t be certain how much he knew of the story.

Like others, I was troubled to see Royal’s memory loss. He didn’t speak for long stretches. He smiled and posed for photographs. He seemed the happiest around his former players. He would call his longtime friend Tom Campbell, an all-Southwest Conference defensive back from the 1960s, and say, “What are you up to?” That always meant, “Let’s go drink a beer.”

As her husband’s memory wore thin, Edith did not hide him. Instead, she organized his 85th birthday party and invited all of his former players. Quarterback James Street, who engineered the famous 15-14 comeback against Arkansas in 1969, sat by Royal’s side and helped him remember faces and names. The players hugged their coach, then turned away to hide the tears.

In the spring of 2010, I was invited to the annual Mexican lunch for Royal attended by about 75 of his former players. A handful of them were designated to stand up and tell Royal what he meant to them. Royal smiled through each speech as his eyes twinkled. I was mesmerized by a story the former defensive tackle Jerrel Bolton told. He recalled that Royal had supported him after the murder of his wife some 30 year earlier.

“Coach, you told me it was like a big cut on my arm, that the scab would heal, but that the wound would always come back,” Bolton said. “It always did.”

Royal seemed to drink it all in. But everyone knew his mind would soon dim.

The last time I saw him was June 20 at the County Line, a barbecue restaurant next to Bull Creek in Austin. Because Royal hated wheelchairs and walkers, the former Longhorn Mike Campbell, Tom’s twin, and I helped him down the stairs by wrapping our arms around his waist and gripping the back of his belt. I ordered his lunch, fed him his sandwich and cleaned his face with a napkin. He looked at me and said, “Was I a college player in the 1960s?”

“No, Coach,” I said. “But you were a great player for the Oklahoma Sooners in the late 1940s. You quarterbacked Oklahoma to an 11-0 record and the Sooners’ first national championship in 1949.”

He smiled and said, “Well, I’ll be doggone.”

After lunch, Mike Campbell and I carried him up the stairs. We sat him on a bench outside as Tom Campbell fetched the car. In that moment, the lunch crowd began to spill out of the restaurant. About 20 customers recognized Royal. They took his photograph with camera phones. Royal smiled and welcomed the hugs.

“He didn’t remember a thing about it,” Tom Campbell said later. “But it did his heart a whole lot of good.”

Jim Dent is the author of “The Junction Boys” and eight other books.

Read More..

The New Old Age Blog: The Emotional Aftermath of Hurricane Sandy

Let’s talk about the emotional aftermath of the storm that left tens of thousands of older people on the East Coast without power, bunkered down in their homes, chilled to the bone and out of touch with the outside world.

Let’s name the feelings they may have experienced. Fear. Despair. Hopelessness. Anxiety. Panic.

Linda Leest and her staff at Services Now for Adult Persons in Queens heard this in the voices of the older people they had been calling every day, people who were homebound and at risk because of medical conditions that compromise their physical functioning.

“They’re afraid of being alone,” she said in a telephone interview a few days after the storm. “They’re worried that if anything happens to them, no one is going to know. They feel that they’ve lost their connection with the world.”

What do we know about how older adults fare, emotionally, in a disaster like that devastating storm, which destroyed homes and businesses and isolated older adults in darkened apartment buildings, walk-ups and houses?

Most do well — emotional resilience is an underappreciated characteristic of older age — but those who are dependent on others, with pre-existing physical and mental disabilities, are especially vulnerable.

Most will recover from the disorienting sense that their world has been turned upside down within a few weeks or months. But some will be thrown into a tailspin and will require professional help. The sooner that help is received, the more likely it is to prevent a significant deterioration in their health.

The best overview comes from a November 2008 position paper from the American Association for Geriatric Psychiatry that reviewed the effects of Hurricane Katrina and other disasters. After Katrina, “the elderly had the highest mortality rates, health decline and suicide rates of any subgroup,” that document notes. “High rates of psychosomatic problems were seen, with worsening health problems and increased mortality and disability.”

This is an important point: Emotional trauma in older adults often is hard to detect, and looks different from what occurs in younger people. Instead of acknowledging anxiety or depression, for instance, older people may complain of having a headache, a bad stomachache or some other physical ailment.

“This age group doesn’t generally feel comfortable talking about their feelings; likely, they’ll mask those emotions or minimize what they’re experiencing,” said Dr. Mark Nathanson, a geriatric psychiatrist at Columbia University Medical Center.

Signs that caregivers should watch out for include greater-than-usual confusion in an older relative, a decline in overall functioning and a disregard for “self care such as bathing, eating, dressing properly and taking medication,” Dr. Nathanson said.

As an example, he mentioned an older man who had “been sitting in a cold house for days and decided to stop taking his water pill because he felt it was just too much trouble.” Being distraught or distracted and forgetting or neglecting to take pills for chronic conditions like diabetes or heart disease can have immediate harmful effects.

Especially at risk of emotional disturbances are older adults who are frail and advanced in age, those who have cognitive impairments like Alzheimer’s disease, those with serious mental illnesses like schizophrenia or major depression, and those with chronic medical conditions or otherwise in poor physical health, according to the geriatric psychiatry association’s position paper.

A common thread in all of the above is the depletion of physical and emotional reserves, which impairs an older person’s ability to adapt to adverse circumstances.

“In geriatrics, we have this idea of the ‘geriatric cascade’ that refers to how a seemingly minor thing can set in motion a functional, cognitive and psychological downward spiral” in vulnerable older adults, said Dr. Mark Lachs, chief of the division of geriatrics at Weill Cornell Medical College. “Well, the storm was a major thing — a very large disequilibrating event — and its impact is an enormous concern.”

Of special concern are older people who may be in the early stages of Alzheimer’s disease or other types of dementia who are living alone. For this group, the maintenance of ordinary routines and the sense of a dependable structure in their lives is particularly important, and “a situation like Sandy, which causes so much disruption, can be a tipping point,” Dr. Lachs said.

Also of concern are older people who may have experienced trauma in the past, and who may suffer a reignition of post-traumatic stress symptoms because of the disaster.

Most painful of all, for many older adults, is the sense of profound isolation that can descend on those without working phones, electricity or relatives who can come by to help.

“That isolation, I can’t tell you how disorienting that can be,” said Bobbie Sackman, director of public policy for the Council of Senior Centers and Services of New York City. “They’re scared, but they won’t tell you because they’re too proud and ashamed to ask for help.”

The best remedy, in the short run, is the human touch.

“Now is the time for people to reach out to their neighbors in high-rises or in areas where seniors are clustered, to knock on doors and ask people how they are doing,” said Dr. Gary Kennedy, director of the division of geriatric psychiatry at Montefiore Medical Center in the Bronx.

Don’t make it a one-time thing; let the older person know you’ll call or come by again, and set up a specific time so “there’s something for them to look forward to,” Dr. Kennedy said. So-called naturally occurring retirement communities with large concentrations of older people should be organizing from within to contact residents who may not be connected with social services and find out how they’re doing, he recommended.

In conversations with older adults, offer reassurance and ask open-ended questions like “Are you low on pills?” or “Can I run out and get you something?” rather than trying to get them to open up, experts recommended. Focusing on problem-solving can make people feel that their lives are being put back in order and provide comfort.

Although short-term psychotherapy has positive outcomes for older adults who’ve undergone a disaster, it’s often hard to convince a senior to seek out mental health services because of the perceived stigma associated with psychological conditions. Don’t let that deter you: Keep trying to connect them with services that can be of help.

Be mindful of worrisome signs like unusual listlessness, apathy, unresponsiveness, agitation or confusion. These may signal that an older adult has developed delirium, which can be extremely dangerous if not addressed quickly, Dr. Nathanson said. If you suspect that’s the case, call 911 or make sure you take the person to the nearest hospital emergency room.

This is a safe place to talk about all kinds of issues affecting older adults. Would you be willing to share what kinds of mental health issues you or family members are dealing with since the storm so readers can learn from one another?

Read More..

Malaria Vaccine Candidate Produces Disappointing Results in Clinical Trial

The latest clinical trial of the world’s leading malaria vaccine candidate produced disappointing results on Friday. The infants it was given to had only about a third fewer infections than a control group.

But researchers said they wanted to press on, assuming they keep getting financial support, because the number of children who die of malaria is so great that even an inefficient vaccine can save thousands of lives.

Three shots of the vaccine, known as RTS, S or Mosquirix and produced by GlaxoSmithKline, gave babies fewer than 12 weeks old 31 percent protection against detectable malaria and 37 percent protection against severe malaria, according to an announcement by the company at a vaccines conference in Cape Town.

Last year, in a trial in children up to 17 months old, the same vaccine gave 55 percent protection against detectable malaria and 47 percent against severe malaria.

The new trial “is less than we’d hoped for,” Moncef Slaoui, Glaxo’s chairman of research and development said in a telephone interview. “But if a million babies were vaccinated, we would prevent 260,000 cases of malaria a year. This is a disease that kills 655,000 babies a year — 31 percent of that is a very large number.”

The company, which has already spent more than $300 million on the vaccine, wants to keep forging ahead, he said, “but it is not just our decision.”

It also depends on the PATH Malaria Vaccine Initiative, which has put more than $200 million of its Bill and Melinda Gates Foundation financing into the vaccine, and on the World Health Organization, which has helped talk seven African countries into allowing the vaccine to be tested on their children.

The Gates Foundation declined to say how much money it was ultimately prepared to spend on an imperfect vaccine; this set of trials is set to go into 2014.

“The efficacy came back lower than we had hoped, but developing a vaccine against a parasite is a very hard thing to do,” Bill Gates said in a prepared statement. “The trial is continuing, and we look forward to getting more data to help determine whether and how to deploy this vaccine.”

All the families in the trial were given insecticide-impregnated mosquito nets and encouraged to use them; 86 percent did, so the vaccine worked despite other anti-malaria measures.

RTS, S contains a protein found on the parasite’s surface that provokes an immune reaction. It was first identified decades ago by two New York University scientists, Ruth and Victor Nussenzweig. The vaccine was developed by Glaxo in Belgium and initially tested on American volunteers by the Walter Reed Army Institute of Research. When the Gates Foundation began focusing on global health in the early part of this century, it was one of the first projects the foundation adopted. Different ways to make the vaccine more effective, including adding different boosters and giving more shots, are being experimented with. Other vaccines using different ways to provoke an immune reaction exist, but none are as far along in clinical trials.

Like an H.I.V. vaccine, one against malaria has proved an elusive goal. The parasite morphs several times, exhibiting different surface proteins as it goes from mosquito saliva into blood and then into and out of the liver. Also, even the best natural “vaccine” — catching the disease itself — is not very effective. While one bout of measles immunizes a child for life, it usually takes several bouts of malaria to confer even partial immunity. Pregnancy can cause women to stop being immune, and immunity can fade out if someone moves away from a malarial area — presumably because they no longer get “boosters” from repeated mosquito bites.

Read More..

Well: The Presidential Health Quiz

Whether it’s George Washington’s teeth or Bill Clinton’s former hamburger habit, Americans have always been fascinated by the health of the president and presidential candidates.

With help from the Web site DoctorZebra, which has compiled an exhaustive list of the medical history of American presidents, we’ve created an Election Day quiz to test your knowledge of presidential fitness and health.

Read More..

Alarm Over India’s Dengue Fever Epidemic

Enrico Fabian for The New York Times

A man at the Yamuna River, an ideal breeding ground for mosquitoes. Filthy standing water abounds in New Delhi. More Photos »

NEW DELHI — An epidemic of dengue fever in India is fostering a growing sense of alarm even as government officials here have publicly refused to acknowledge the scope of a problem that experts say is threatening hundreds of millions of people, not just in India but around the world.

India has become the focal point for a mosquito-borne plague that is sweeping the globe. Reported in just a handful of countries in the 1950s, dengue (pronounced DEN-gay) is now endemic in half the world’s nations.

“The global dengue problem is far worse than most people know, and it keeps getting worse,” said Dr. Raman Velayudhan, the World Health Organization’s lead dengue coordinator.

The tropical disease, though life-threatening for a tiny fraction of those infected, can be extremely painful. Growing numbers of Western tourists are returning from warm-weather vacations with the disease, which has reached the shores of the United States and Europe. Last month, health officials in Miami announced a case of locally acquired dengue infection.

Here in India’s capital, where areas of standing water contribute to the epidemic’s growth, hospitals are overrun and feverish patients are sharing beds and languishing in hallways. At Kalawati Saran Hospital, a pediatric facility, a large crowd of relatives lay on mats and blankets under the shade of a huge banyan tree outside the hospital entrance recently.

Among them was Neelam, who said her two grandchildren were deathly ill inside. Eight-year-old Sneha got the disease first, followed by Tanya, 7, she said. The girls’ parents treated them at home but then Sneha’s temperature rose to 104 degrees, a rash spread across her legs and shoulders, and her pain grew unbearable.

“Sneha has been given five liters of blood,” said Neelam, who has one name. “It is terrible.”

Officials say that 30,002 people in India had been sickened with dengue fever through October, a 59 percent jump from the 18,860 recorded for all of 2011. But the real number of Indians who get dengue fever annually is in the millions, several experts said.

“I’d conservatively estimate that there are 37 million dengue infections occurring every year in India, and maybe 227,500 hospitalizations,” said Dr. Scott Halstead, a tropical disease expert focused on dengue research.

A senior Indian government health official, who agreed to speak about the matter only on the condition of anonymity, acknowledged that official figures represent a mere sliver of dengue’s actual toll. The government only counts cases of dengue that come from public hospitals and that have been confirmed by laboratories, the official said. Such a census, “which was deliberated at the highest levels,” is a small subset that is nonetheless informative and comparable from one year to the next, he said.

“There is no denying that the actual number of cases would be much, much higher,” the official said. “Our interest has not been to arrive at an exact figure.”

The problem with that policy, said Dr. Manish Kakkar, a specialist at the Public Health Foundation of India, is that India’s “massive underreporting of cases” has contributed to the disease’s spread. Experts from around the world said that India’s failure to construct an adequate dengue surveillance system has impeded awareness of the illness’s vast reach, discouraged efforts to clean up the sources of the disease and slowed the search for a vaccine.

“When you look at the number of reported cases India has, it’s a joke,” said Dr. Harold S. Margolis, chief of the dengue branch at the Centers for Disease Control and Prevention in Atlanta.

Neighboring Sri Lanka, for instance, reported nearly three times as many dengue cases as India through August, according to the World Health Organization, even though India’s population is 60 times larger.

Hari Kumar contributed reporting.

Read More..

Vital Signs: Limits to Resveratrol as a Metabolism Aid

Resveratrol, the red wine component shown to be helpful in improving metabolic function in obese or diabetic people, has no discernible effect on healthy women who are not obese, a new experiment has found.

In a small 12-week randomized, double-blinded trial, researchers gave 29 normal weight postmenopausal women either 75 milligrams a day of resveratrol or a placebo, testing their metabolic function at the start and end of the study.

Blood concentrations of resveratrol increased in the group given the supplements, but the scientists found no difference between them and those given the placebo in body composition, resting metabolic rate or glucose tolerance (a test for insulin resistance and diabetes).

The study, to be published in this week’s issue of the journal Cell Metabolism, found that blood pressure, heart rate, C-reactive protein levels (a measure of inflammation), LDL, HDL and total cholesterol were unaffected by resveratrol. In other words, resveratrol blood concentrations were associated with no quantifiable changes, beneficial or otherwise, in any measure of metabolic function.

Does this mean that resveratrol offers no benefits? Not necessarily, said the senior author, Dr. Samuel Klein, a professor of medicine at Washington University in St. Louis. “We only show that metabolically healthy people get no benefits to begin with,” he said. “We have no way of knowing whether it will prevent future metabolic complications.”

Read More..