The prospect of a double whammy has made hospitals shift their disaster teams into high gear for the second time in a week, making sleeping arrangements for clinical staff and in some cases canceling elective surgeries. 

Howard Gwon, administrator for Johns Hopkins emergency management, said the needs are unprecedented.

"We’ve never had to activate our command center a second time in one winter -- this is record history for not only the state but Hopkins," said Gwon, Hopkins' incident commander for the last 20 years.

The hospital had some 2,000 staffers sleep at the hospital over last weekend's storm and is preparing for more tonight arranging empty hospital beds and air mattresses around the campus, he said. About 70 staffers are prepared to shuttle people to and from the hospital if the snow makes it impossible for them to travel on their own.

At Greater Baltimore Medical Center in Towson, the majority of physician practices affiliated with the hospital plan to close Wednesday, but patients should check first with their doctors, said Michael Schwartzberg, a GBMC spokesman.

The hospital, where some 4,500 births take place each year, has rescheduled some c-sections planned for tomorrow as well as some elective procedures, he said.

With this snowfall coming during a weekday -- typically busier for hospitals than weekends -- among the most important preparations is having enough staff and keeping roadways clear, he said.

Some clinicians have already put in marathon hours. Schwartzberg told me the story of a nurse who stayed in the emergency room last Friday through Sunday, catching a few hours of sleep here and there on a stretcher. She's back today, with an overnight bag, and expected to stay until Friday.

"People are really coming together, doing jobs that aren’t normally their jobs," he said. "People are going above and beyond."

Known as Let's Move, the campaign focuses on better informing parents of the importance of nutrition and exercise, decreasing fat and sugar in school lunches, making healthy food more accessible to families and more emphasis on physical education.

The administration plans to get the FDA and the American Beverage Association to use better labeling of nutritional information, according to the Politico. The American Academy of Pediatrics will also work to educate their members on better obesity monitoring.

This falls in line with news we reported a few weeks ago that a government task force now recommends screening children as young as 6 for obesity and referring them to a weight loss program.

While government statistics released last month suggest the stunning three-decade rise in child obesity rates is leveling off, the rate is still too high, say public health officials. A third of U.S. children are obese or overweight, putting them at risk for diabetes, high blood pressure, sleep problems and depression.

Michelle Obama has spoken candidly about why this is a priority for her -- and the nation. Her own children had troubles with fluctuating weight, leading to Obama to make changes in their eating habits and exercise. Obama told NPR:

I thought my kids were perfect," Mrs. Obama said. "They are and always will be." She hadn't realized that her daughters were in danger of becoming obese. She wasn't sure what to do, but she knew she had to do something she said.

Over the course of a few months, the Obama family started making what seemed like minor changes. "We did things like limit TV time," she said.

(Of course, the first lady's gotten a heap of criticism for being so forthcoming about the issue. Who knew trying to get kids to eat right and exercise could be controversial?)

AP photo Michelle Obama and helpers tend to the white house garden.

For years, researchers have known that the age of the parents affects a child's risk for having autism. But experts couldn't say for sure whether the risk was higher for older mothers, older fathers or both. 

In fact, some studies suggested that it was the father's age that increased the autism risk. The new study, published in the journal Autism Research, found the father's age increased the chance of a child having autism only when the dad is over 40 and the mother is under 30. 

The risk of having a child with autism increased by 18 percent for every five-year increase in the mother's age, according to the study which examined nearly 5 million births in California in the 1990s. A 40-year-old woman's risk of having a child diagnosed with autism was 50 percent greater than that of a woman between 25 and 29 years old.

Researchers at UC Davis Health System compared the 4.9 million electronic birth records, noting the parents ages, with cases of autism diagnosed before age 6 as classified by the California's department of developmental services.

Other experts warned that the increased risks are small, even for older mothers. The overal low risk for autism "may be the most important take-away message," Maureen Durkin, a University of Wisconsin researcher told the AP.

While interesting, the new study tells us nothing why the risk of autism may be linked to a mother's age. The authors say more study is needed to explain the connection, although they have a few theories.

For now, though, add this to the multitude of incremental findings as researchers work to unlock the mysteries of the puzzling disorder, affecting as many as 1 in 100 children.

We wrote a story recently about how the vaccine has been successful with kids, but adults have been underusing it. And that's been a problem because pneumonia is a common complication of the flu. This new study of 2008 figures by the Trust for America’s Health, the Infectious Diseases Society of America and the Robert Wood Johnson Foundation, offers the latest numbers on vaccine use among adults in states across the country.

The District of Columbia had the highest percentage of adults who had not been immunized -- nearly half, while Maryland was slightly higher than the national average with nearly 40 percent of seniors not getting the vaccination. Just about a quarter of seniors in Oregon hadn't been vaccinated.

It's not just low rates of pneumonia vaccinations. Just 2 percent of adults had tetanus, diphtheria and whooping cough vaccine in the previous two years and a little over a third had received the seasonal flu vaccine. Overall, the report found that the millions of adults who go without routine vaccines leads to an estimated 40,000 to 50,000 preventable deaths, thousands of preventable illnesses and $10 billion in preventable health care costs each year. 

So why don't we get vaccinations?

Here are a few good tips from the American Physical Therapy Association that could spare your back and shoulders.

· Lift smaller loads of snow, bend your knees and lift with your legs rather than with your back.

·         Use a shovel with a handle that lets you keep your back straight while lifting. A short handle will cause you to bend more to lift the load. A long one makes the load heavier.

·         Avoid twisting as much as possible. The spine can't tolerate twisting as well as it can other movements.

·         Step in the direction that you're throwing snow to prevent low back twisting. This will help avoid the “next-day back fatigue."

·         Take breaks. Stand up straight and walk around every so often. Standing backbends help reverse all that forward bending that occurs while shoveling. To do this, stand straight and tall, place your hands toward the back of your hips and bend backward slightly for a few seconds.

Also, the American Academy of Orthopaedic Surgeons has more tips on preventing shoveling injuries.

And for all you with fancy snow removing equipment, remember that snowblowers can be dangerous too. Sunday, the folks at Union Memorial Hospital's Curtis National Hand Center  treated 8 patients in just 3 hours for snowblower injuries. Here are some tips on how to use that equipment safely.

Baltimore Sun photo

The Baltimore health department was fine-tuning emergency plans Friday to shuttle dialysis patients between their homes and treatment centers over the weekend. The department covers transportation for patients on medical assistance, as required by federal law. The safety-net program also offers transportation to patients who need chemotherapy and radiation. But among the most challenging logistically for the department are those patients who need three-times-a-week dialysis, said Pamela Somers, program director of field health services for the health department.

The program ferries 446 dialysis patients to and from their treatments, some of whom have a strict Tuesday, Thursday, Saturday schedule to adhere to. The threat of a blizzard means trying to reschedule some patients, a challenge in itself, while arranging a fleet of vans to go out on snow-covered roads to transport patients who cannot change their schedule.

“It’s also a huge challenge for patients, said Somers. “For folks whose times are being shifted, they need to change their diet a bit and watch their fluids,” she said. “There are medications that we can give them to have them hold out an extra day.”

Somers' team has been working on contingency plans since Tuesday.

“This is not something you do at 5 p.m. when the snow is starting,” she said. “This is something you that you have to plan for several days, and that the patients themselves need to think about.”

Meanwhile, Somers will be carefully monitoring the safety of van drivers. During December’s record-setting blizzard, several drivers got into accidents skidding down slick roads, although there were no serious injuries, Somers said.

“I don’t think enough of us gave enough weight to how bad conditions deteriorated throughout the day,” she said. “This time, we’re ready.”

In fact, even though infections are below baseline for this time of year, deaths due to influenza and pneumonia rose sharply nationwide and have been up over the last three weeks, said the CDC's Anne Schuchat in an update to reporters. 

At the same time, seasonal flu appears nearly nonexistent, with the swine flu remaining the dominant strain circulating.

So, what does it all mean? It's not too late to get vaccinated, the CDC urges. Supply is plentiful and a shot can still protect you through the season. "We are remaining vigilant here," said Schuchat. "Many people believe the outbreak is over. It’s too soon for us to have that kind of complacency."

Still, public health officials can't say whether we are in for a third wave of the virus, which infected 55 million people in the United States from April through December, resulting in 246,000 hospitalizations and 11,160 deaths, the CDC said last month. It's more likely, however, that transmission will continue and so, hospitalizations and more deaths are possible, Schuchat said.

Nevertheless, nearly half of Americans think the whole swine flu deal is over, according to a new survey by Harvard researchers. And just 18 percent think it's "very likely" that we're in for a third outbreak of infections in the next year, the study of about 1,400 adults conducted between Jan. 20 and Jan. 24.

The survey also revealed ongoing skepticism about the vaccine. About 35 percent said they had concerns about the vaccine's safety and another 30 percent don't think they are at risk of serious illness.

Meanwhile, about 23 percent of Americans -- 70 million people -- have been vaccinated against the H1N1 virus, according to a new CDC survey of about 4,100 adults conducted between Jan. 24 and Jan. 30.

Schuchat said she was encouraged that it seems more parents want to get their children vaccinated. About half of parents either got the vaccine for their children or intend to get it before the end of February, the Harvard survey found. She said CDC data show about 37 percent of children had been vaccinated, but not all of them had received the booster shot recommended for children under 10.

"I encourage parents to get that second dose," she said. 

Hospitals are bracing for it too by fine-tuning contingency plans, jump-starting emergency command centers and making sleeping arrangements for critical staff, from hotel reservations to outfitting hospital units with free beds.

Greater Baltimore Medical Center, Anne Arundel Medical Center and the University of Maryland Medical Center have volunteers with four-wheel-drive vehicles on hand to drive people to work if they can't make it on their own. During December's blizzard, GBMC used its emergency command unit to notify the National Guard to order a Humvee to pick up nurses who lived in rural Harford County and take them to the Towson hospital, said Michael Schwartzberg, a GBMC spokesman.

Hospital administrators said they made improvements after December's record-setting blizzard. "We are reaching out more broadly to the medical staff earlier," said Herbert C. Buchanan Jr., chief operating officer for the University of Maryland Medical Center. "We have tightened up the processes.

Meanwhile, I learned this cool tidbit from the folks at the state's emergency medical systems: most of the state's firetrucks and ambulances are outfitted with technology that with a click, enables chains to be switched onto tires so the vehicles can drive safely through the snow and ice. How very Transformers of them. I so need those on my car.

So, how are you prepping for the big snow? 

Baltimore Sun photo

It was a small study -- of just 54 patients with severe brain injury, 23 in a vegetative state and the rest in a less severe "minimally conscious state." But the British and Belgian researchers think the findings could be quite significant, offering clues for better diagnosis of people with brain injuries and development of a technique to communicate with them.

Patients were placed in an MRI scanner and asked to imagine hitting a tennis ball and walking from room to room in their homes. Four of the 23 vegetative patients responded to the commands by showing brain activity on the scanners.

And one man was even able to detailed yes and no questions about his life before his injury.

The research, appearing in the latest New England Journal of Medicine, also raises ethical dilemmas about how modern medicine should treat such patients, this NYT story explains. 

It also comes with plenty of caveats: Only a small number of patients responded. The scanning technology needs work and isn't ready to be a diagnostic tool just yet. And as an accompanying editorial by Dr. Allan H. Ropper of Brigham and Women's Hospital in Boston states, brain activity as seen on the scanner is not indicative of a "stream of thought," i.e. memory, self-awareness and reflection. 

AFP/Getty images

The lab tests of 208 containers of 16 brands of greens found several types of bacteria, including coliforms and Enterococcus, a type of organism found in the human digestive tract and the environment, which could be a signal of inadequate sanitation, the report states. 

These bacteria don't generally make healthy people sick (nor did the tests find E. coli or salmonella, pathogens that can be deadly). Still, the report calls them "indicator" bacteria, a sign that "not enough is being done to assure the safety or cleanliness of leafy greens," said Michael Hansen, a senior scientists at Consumer Union, the non profit that publishes Consumer Reports, in a statement.

Consumer Union also issued a report urging the FDA to set safety standards for greens.  

We've talked before about how veggies pose some of the biggest food poisoning risks. Your best bet to avoid any problems, rinse those greens, even the ones whose packages claim they have already been washed.

Baltimore Sun photo

This comes after years of mounting evidence, including two review papers from the Institute of Medicine showing no link between the measles, mumps and rubella vaccine and autism. Last week, a British medical panel said Wakefield's work was full of false information and he risks losing his medical practice.

It's highly uncommon for a prestigious medical journal to retract a paper, usually done only in examples of "fraud or misrepresentation," and as Dr. Paul A. Offit, author of "Autism's False Profits" told me yesterday. Offit, chief of infectious diseases at the Children's Hospital of Philadelphia is a huge critic of Wakefield and other vaccine skeptics.

So is this the end of the vaccine-autism debate?

Don't be so sure, said medical experts I spoke to. Despite the evidence, groups such as Jenny McCarthy's Generation Rescue are calling Wakefield a hero and vastly misunderstood. What do you think?

B'More Green posted today about efforts in Annapolis to ban products containing two chemicals that have raised concerns about their toxicity:

At 2 p.m. today (Tuesday), the House Health and Government Operations Committee is scheduled to air HB33, which would ban the sale, manufacture or distribution of children's toys or child-care articles such as baby bottles made with bisphenol-A, or BPA. The bill, sponsored by Del. Jim Hubbard, a Prince George's County Democrat, would prohibit it by Jan. 10, 2011.

The plastic has been widely used as a lining in canned foods and some plastic water and baby bottles. For years, the Food and Drug Administration maintained it was safe, but amid growing scientific evidence of potential harm, the agency last month reversed course and declared concern about the effects of BPA on the brain, behavior, and prostate gland in fetuses, infants, and young children.   The agency now is pushing to end the use of BPA in baby bottles and infant feeding cups and is pressing for safer alternatives to line canned formula and other foods.

Connecticut and Minnesota already have banned BPA in certain children's products, according to legislative analysts, and 18 states last year weighed legislation to curtail the plastic. Several manufacturers already have begun phasing out use of BPA, including Wal-Mart, Toys “R” Us, and Babies “R” Us. For more on the bill, go here.

On Feb. 10, the House Environmental Matters Committee will hear another Hubbard bill, HB35, which would ban the sale of products containing brominated flame retardants.   Decabromodiphenyl ether, or decaBDE, is used in a wide variety of plastic products, including television cabinets and other electronics, in wire insulation and in draperies and upholstered furniture.

Hubbard pressed for a ban before, but his bill failed to pass.  Last year, though the Environmental Protection Agency, citing concerns that exposure to decaBDE may cause cancer and impair brain function, announced an agreement with chemical manufacturers to phase out its use by 2013.   Hubbard reintroduced the bill this year, seeking to ban it in Maryland by January 2011.

Maryland PIRG is backing both measures.

Baltimore Sun file photo of Nalgene travel bottles made without BPA/Jerry Jackson

Finding that you need fewer ZZZs?

Most healthy older adults need less sleep and tend to be less sleepy during the day than healthy younger people, according to a new study in the February issue of the journal SLEEP.

Results of the study showed that older adults slept about 20 minutes less than middle-aged adults, who slept 23 minutes less than young adults. The number of times older people woke up in the night increased and the amount of deep sleep decreased significantly, the report said.

Yet, this didn't seem to be a problem for the older folks without sleep disorders.

When all ages were disrupted multiple times during the night, everyone had the same reaction -- daytime napping. 

"Our findings reaffirm the theory that it is not normal for older people to be sleepy during the daytime," said principal investigator Derk-Jan Dijk, professor of sleep and physiology at the University of Surrey in the United Kingdom, in a statement. "Whether you are young or old, if you are sleepy during the day you either don't get enough sleep or you may suffer from a sleep disorder."

The study was conducted at the Clinical Research Centre of the University of Surrey and involved 110 healthy adults without sleep disorders or sleep complaints.

So, are you a daytime napper? do you feel you need a little less sleep as you have aged?

Associated Press file photo of woman sleeping at an airport

The study, appearing in today's Archives of Pediatrics & Adolescent Medicine suggests that abstinence-only programs that don't preach about morals may be effective in preventing young teens from engaging in sex, according to the authors of the NIH-funded study. 

The research is billed as the first of its kind to measure the effectiveness of abstinence-only programs and comes on the heels of last week's news about a rise in the teen pregnancy rate , which set off yet another round of the contentious contraception vs. abstinence-only debate.

Researchers from the University of Pennsylvania enrolled 622 African-American students in either an 8-hour abstinence-only class, or one of three other classes that focused on condom use, other interventions and general health issues. Black teens are at especially high risk for unintended pregnancies, sexually transmitted diseases and HIV/AIDS.

By the three-year follow up mark, about a third of kids in the abstinence only course had had sex, while nearly half of the kids in the other courses had.

Critics of abstinence-only programs say they actually lead to less condom use if teens do end up having sex. But this study found that wasn't the case.  

The findings don't settle the contraception vs. abstinence only debate, the authors are clear to note. Nor should this study signify that all abstinence only programs work.

"Tackling the problem of STIs among young people requires an array of approaches implemented in a variety of venues," they conclude. "What the present results suggest is that theory-based abstinence-only interventions can be part of this mix. Using theory-based abstinence-only interventions selectively might contribute to the overall goal of curbing the spread of STIs in both the United States and other countries."

"No public policy should be based on the results of one study, nor should policy makers selectively use scientific literature to formulate a policy that meets preconceived ideologies," they write. 

According to a story in today's Sun, Congressional leaders are still trying to figure out a way to pass health care reform -- albiet quietly.

Democrats may try and persuade House members to vote for the Senate package and then go back and fix some things later under a budget procedure that is filibuster proof. Or they may seek a scaled down package that can pass both chambers.

But after the loss of former Sen. Ted Kennedy's seat in Massachusetts to a Republican, possibly due in part to voter anger over the economy, Dems are trying to keep the negotiations low key. They'd like to appear to be working full-time on job creation.

Indeed, President Obama barely touched on the subject of health care reform in his State of the Union message. But you can read more about the President's plan and watch a video at whitehouse.gov.

Meanwhile, some medical groups, including the American College of Physicians, are urging lawmakers not to give up on reform this year.

So, what do you think? Did the Dems overreach? Or, should they keep pushing for coverage for the millions who don't have it and protections for those who do?

Associated Press file photo of the State of the Union speech