Publisher Health

In a study aimed at assessing the impact of washing poultry on kitchen contamination, researchers found that more than a quarter of study participants contaminated salad with raw poultry — including many study participants who did not wash the poultry. The study highlights the importance of hand-washing and cleaning and sanitizing the kitchen in order to reduce the risk of foodborne illness when cooking at home.
Washing raw poultry is not recommended, due to concerns about inadvertently contaminating other foods and surfaces — and increasing the risk of foodborne illness.
“We wanted to know what effect an educational intervention would have on getting people to stop washing poultry before cooking, and what effect any resulting change in behavior might have on reducing contamination in the kitchen,” says Ellen Shumaker, corresponding author of the study and an extension associate at North Carolina State University. “We also wanted to get a better idea of how, if at all, washing poultry actually led to increased contamination in the kitchen.”
For the study, researchers recruited 300 home cooks who said they washed poultry before cooking it. The researchers sent food safety information to 142 of the study participants via email, outlining risk-reduction efforts — including the recommendation to not wash raw poultry during food preparation. The remaining 158 study participants did not receive the education intervention.
All 300 study participants were then invited to test kitchens equipped with video cameras that filmed meal preparation. Participants were asked to cook chicken thighs and prepare a salad. After preparing the chicken thighs, but before putting the chicken in the oven, participants were called out of the kitchen to conduct a short interview. Participants were then sent back into the kitchen to cook the chicken thighs, prepare the salad, and clean the kitchen as they would at home.
What the study participants didn’t know was that the chicken thighs were inoculated with a harmless strain of bacteria, which the researchers would be able to detect. This allowed researchers to swab surfaces in the kitchen to see whether any cross-contamination occurred during the food preparation and cooking process.

For some parents who share custody, the Covid vaccine has created a minefield of issues that initial divorce decrees could not have anticipated.In late 2021, Adele Grote, a divorced mother of two in Minneapolis, took her children to a vaccination clinic at the Mall of America. But when her 13-year-old daughter called her father to let him know they were getting the shot, Ms. Grote knew they would have to leave without it.Just over a quarter of children between ages 5 and 11 in the United States are fully vaccinated, according to a New York Times database; among older kids, ages 12 to 17, the rate is 59 percent. For parents who have yet to vaccinate their children, the reasons for hesitation vary. In an October 2021 survey from the Kaiser Foundation, many cited concerns about long-term side effects, including how vaccines might later affect their child’s fertility (though there is no evidence indicating that the vaccines impact fertility). And after a widely shared study about the risk of myocarditis and the Covid-19 vaccine, the C.D.C. affirmed that the vaccine is safe and cases of heart inflammation after vaccination are rare.In most cases, whether they have decided to vaccinate now, later or never, doctors say the parents they counsel have agreed with each other. But when they do not, the battle is part of a new pandemic front in divorce custody battles, one that is poised to expand with the imminent approval of vaccines for children under 5. Last month, Moderna announced plans to seek emergency authorization of their coronavirus vaccine for babies and toddlers after seeing promising results in a clinical study.Ms. Grote, who wants to vaccinate her children, while her ex-spouse does not, has been divorced since 2019. She and her ex share custody of their daughter and 11-year-old son. As a nurse in an intensive care unit, Ms. Grote has cared for many critically ill Covid-19 patients, but her children remain unvaccinated, a status, she said, that is a result of how her custody proceedings continue to unfold in family court.“I’m a single mom. I don’t have a ton of money,” she said. “But the money I’ve spent battling this, I could have taken my kids to Disney World, twice.”Her custodial agreement with her ex-husband, drawn up before the pandemic, stipulates that when it comes to medical decisions for the children, both parents follow the recommendations of their pediatrician. If either disagrees with what the doctor says, they need to see a court-appointed mediator, who can write up contracts that are enforceable in court. The process is slow, Ms. Grote said, and often spirals into demands put forth by one parent and thrown out by the other. So when the vaccine became available for children under 12, she tried just taking them to the clinic, an approach that didn’t work out.“So we still exist in this limbo. I’m fully vaccinated, and I pray to God that they don’t get sick,” Ms. Grote said. The court’s stance, which requires processes to stall when one parent contests the medical decisions of another, she said, has given her ex-husband de facto veto power on getting vaccinated. “He’s making all of the decisions, because anytime the doctors try to do anything for our kids, he says no,” she said.Her ex-husband, Jamey Groethe, sees it differently. “I want what’s best for our children no matter what,” said Mr. Groethe, who stressed that while he is opposed to his children receiving the Covid-19 vaccine because he is worried about how safe it is, he is not anti-vaccine in general.Joshua Rogers, a small-business owner in Los Angeles, is the father of two boys. He and his ex-girlfriend had only recently begun custody proceedings for the boys last year when a vaccine was cleared for children ages 5 and up, making their older son eligible. But while he was anxious to get him inoculated, his ex was not.As soon as the shot was made available, Mr. Rogers filed an application for a family court hearing and marked it ex parte, or urgent. The judge didn’t agree on the urgency.“It was rubber-stamp denied, quite literally, with a stamp on it that said ‘no exigent circumstances,’” Mr. Rogers said. “And I was like, of course there are exigent circumstances. We have a global pandemic, we have to get these kids vaccinated ASAP.”When contacted, Mr. Rogers’ ex-girlfriend declined to comment.But at a court hearing in mid-February, the judge granted Mr. Rogers decision-making power over issues of vaccination, and the boy is now vaccinated. “It’s really whatever the judge says. Whatever this one man thinks, that’s what goes,” Mr. Rogers said, pointing out that he still doesn’t fully understand why he was able to move forward.That sort of clarification is necessary, said Tim Miranda, founding partner of Antonyan Miranda, a family law firm in San Diego. “If the court doesn’t make a specific order about things like medical care, then both parents can individually take whatever action they would like in that realm.” Parents who are currently navigating the custody process should be clear with their legal teams if they disagree with the vaccination stance of their ex, said Mr. Miranda, and be prepared to argue as to why they, and not the other parent, should be vested with medical decision-making powers for their child. They should also be sure that their pediatrician or therapist has views that align with their own.“The courts give a lot of credence to the treating therapist or doctor, because they’re the ones dealing within the realm of the patient,” Mr. Miranda said. “The standard is to decide what is in the best interest of the child.” If parents can’t come to a mutual agreement over what “best interest” means, however, courts generally opt to grant one parent power to make the decision, as they did with Mr. Rogers.Laws vary slightly from state to state, Mr. Miranda said, but in general, “it’s a pretty high bar with something like a vaccination. If you’re going to oppose it, you’d have to have a pretty good reason, like a religious conviction or a medical condition.”The American Academy of Pediatrics does not have an official stance on vaccinating children in situations of custodial disputes, said Dr. Tiffany Kimbrough, an A.A.P. member and medical director of the mother-infant unit of the medical center at Virginia Commonwealth University. (They do, however, state, “It is prudent for the physician to inquire about marital status and custody issues when relevant” in this 2017 report.)“This has become such a hot-button issue,” she said. “We’re seeing a lot more difference of opinion than with traditional medical therapies and preventative care.”In New York, the courts will almost always favor vaccination, said Naomi Schanfield, a New York City lawyer specializing in family and marriage law.“Our office has been inundated with calls from parents saying, ‘I’m boosted and triple vaxxed, but I’m opposed to the vaccine for my child. What can you do to help me?’” The answer, at least in New York State, is not much, said Ms. Schanfield. “If the pediatrician recommends the vaccine, that’s what the court will rule.”In situations where custody agreements are not yet clear-cut, however, the process to wrest power over vaccine decisions can feel frustratingly slow for an anxious parent. Those who opt to bypass court regulations and — as Ms. Grote tried to do — take their child to be vaccinated without the consent of their ex-partner run the risk of being held in contempt of court. But the likelihood of losing custody over such an action is slim, Mr. Miranda said.“They’d have to determine that the parent was acting detrimentally to the health, safety or welfare of the child,” said Mr. Miranda, who added that it would be a tough sell in court.

More Americans weighed in as obese during the first year of the COVID-19 pandemic than in the previous year. Anew study in the American Journal of Preventive Medicine, published by Elsevier, presents evidence from a large, nationally representative survey that documents this trend and helps to explain behavior changes that led to widespread weight gain in 2020.
“Previous studies present evidence that intra-pandemic changes in risky dietary and other health-related behaviors likely contributed to the rapid rise in body weight during this period. Adults who reported weight gain also reported more frequent snacking and alcohol intake; increased eating in response to sight, smell, and stress; and decreased physical activity,” explained lead investigator, Brandon J. Restrepo, PhD, US Department of Agriculture, Economic Research Service, Food Economics Division — Diet, Safety and Health Economics Branch, Washington, DC, USA.
Adult obesity in the US was elevated and trending upward prior to the COVID-19 pandemic. While several studies have reported on small and relatively homogenous online surveys that track weight gain in the US adult population during the initial pandemic period, this study is the first to use data from the Behavioral Risk Factor Surveillance System (BRFSS), a larger, nationally representative survey of the US adult population. It contains data on health outcomes, health-related risk behaviors, preventive services, and chronic medical conditions.
To estimate the overall changes in adult obesity prevalence and four obesity-related risk factors during the COVID-19 pandemic, the analysis of the BRFSS data employed linear regression models that control for age, sex, race/ethnicity, education, household income, marital status, number of children, survey year indicators, and state of residence indicators.
According to the analysis of more than 3.5 million US adults (aged 20 and older) from the 2011-2020 BRFSS, obesity was 3% more prevalent during the year beginning March 2020, compared with the 2019 to pre-pandemic 2020 period. The study also found statistically significant changes among US adults in four obesity-related risk factors during the COVID-19 pandemic: exercise participation, sleep duration, alcohol consumption, and cigarette smoking.
While exercise participation and sleep duration were higher by 4.4% and 1.5%, respectively, the number of days in which alcohol was consumed was 2.7% higher and cigarette smoking prevalence was lower by 4%. The overall increases in exercise and sleep were not sufficient to offset the impact of other behaviors, resulting in an average 0.6% rise in body mass index during the COVID-19 pandemic. Although smoking cessation is a healthy step, it is known to cause some weight gain.
“Our results, which are broadly consistent with what prior studies have found using smaller and less representative samples, contribute additional insights that can serve to inform policymakers about the state of the US adult obesity epidemic and obesity-related risk factors,” noted Dr. Restrepo, adding, “Because obesity affects some adults more than others, it would be helpful to further explore the changes in the rates of adult obesity by demographic subgroup and socioeconomic status.”
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Researchers from Children’s Hospital of Philadelphia (CHOP) and the University of Pennsylvania School of Medicine found that opioid prescriptions for children who underwent one of eight common outpatient surgeries declined over a period of five years. These findings suggest that clinicians are using more discretion when considering which pediatric patients require an opioid prescription after their procedures. The findings were published online today by the journal Pediatrics.
Opioids are routinely prescribed after a surgery to help pediatric patients manage mild or moderate pain. However, recent studies have suggested that recovery is similar with limited or no opioid use. Additionally, opioids prescribed to children can result in respiratory depression, which causes carbon dioxide to not be expelled from the lungs properly, and the continued use of those opioids, after acute pain has resolved. Despite these findings, no prior studies had looked at recent data on national opioid trends for surgery in children in the context of whether there has been any shift away from prescribing opioids more broadly.
“Children grow throughout their childhood, and because opioids are often prescribed based on weight, we cannot assume that what is appropriate for a 5-year-old could also apply to an adolescent,” said the study’s lead author Tori N. Sutherland, MD, MPH, an attending anesthesiologist in the Department of Anesthesiology and Critical Care Medicine at CHOP and Assistant Professor of Anesthesiology at Penn Medicine. “In our study, we wanted to be responsible with our data and consider surgical distribution by age group.”
In this study, the researchers used data from a private insurance database to study opioid-naïve patients under the age of 18 who underwent one of eight surgical procedures between 2014 and 2019. The procedures included in the study ranged from tonsillectomies and dental surgeries to removal of the appendix and knee surgery. The primary outcome of the study was whether a prescription for opioids was filled within 7 days of surgery, and the secondary outcome was the total amount of opioid dispensed. A total of 124,249 patients were included in the study. Patients were separated by age into adolescents, school-aged children and preschool-aged children.
The researchers found that the percentage of children who had an opioid prescription filled after their surgery dropped in all three age categories. For adolescents, prescriptions dropped from 78.2% to 48%; for school-aged children, from 53.9% to 25.5%; and for preschool-aged children, from 30.4% to 11.5%. Additionally, the average morphine milligram equivalent dispensed declined by approximately 50% across all three age groups.
Additionally, the researchers also found that there was a more precipitous decline in opioid prescriptions beginning in late 2017, first in the adolescent group and then followed by school- and preschool-aged children. This trend appeared to represent a “trickle down” effect, but more research is needed to explore the difference in trends by age group.
“Our findings demonstrate that pain treatment for children and adolescents undergoing surgery has changed dramatically over the past 5 years,” said Mark Neuman, MD, senior author and Associate Professor of Anesthesiology and Critical Care at the University of Pennsylvania Perelman School of Medicine. “Understanding what these trends mean for patient experiences and health outcomes is a key next step.”
This study was supported by grant R01DA042299 from the National Institute on Drug Abuse and the University of Pennsylvania’s McCabe Foundation.
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A risk score based on a gene map predicted the likelihood of high blood pressure leading to heart problems or stroke in people with Type 2 diabetes, according to a study published today in the American Heart Association’s peer-reviewed journal Hypertension. This tool may be especially useful in guiding treatment for people who are newly diagnosed with Type 2 diabetes or for those with prediabetes.
Previous research has confirmed adults with Type 2 diabetes are twice as likely to have a heart attack or stroke than people who do not have Type 2 diabetes. Various measures of health status, such as blood pressure, cholesterol and blood sugar levels, are commonly used to determine a person’s risk for developing heart disease. In this study, researchers explored whether genetic variants linked with high blood pressure are also linked to later heart disease or stroke for people with Type 2 diabetes and used that information to determine a risk score.
“Increased genetic risk of high blood pressure may predispose some people with Type 2 diabetes to a higher risk of heart attack, stroke or cardiovascular death,” said lead study author Pankaj Arora, M.D., director of the Cardiogenomics Clinic Program and the Cardiology Clinical and Translational Research Program at the University of Alabama at Birmingham. “We conducted the study to determine if this genetic risk score can identify people with Type 2 diabetes who have a higher risk for cardiovascular events and if tight control of blood sugar impacts the link between genetic hypertension risk and cardiovascular outcomes.”
Arora and colleagues assessed the health records of 6,335 participants in the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial database for whom genetic data were available. The study group consisted of 37% women, and participants self-identified their race or ethnicity: 15% were African American, 6% were Hispanic; 70% were white; and 9% selected the category “other.” All participants had Type 2 diabetes and elevated blood pressure, and they were followed for 3.5 years.
A genetic variant map of more than 1,000 common genetic variants known to affect blood pressure was compared to the DNA of the study participants to determine participants’ genetic risk. More matches among the participant’s DNA and the map of known blood pressure genetic variants equated to a higher genetic risk score.
Researchers found that the genetic risk score identified study participants with a higher risk of cardiovascular events: For people with higher than average genetic risk scores, each degree higher was associated with a 12% higher risk of heart disease or stroke events. The association of genetic risk with cardiovascular events was the same even if participants were taking medicines to manage blood sugar levels.Further evaluation of genetic risk scores in people who do not have Type 2 diabetes is needed to be able to apply these findings more broadly.
Arora and colleagues also noted the findings about differences in individuals’ genetic risk scores for high blood pressure did not entirely explain why intensive glycemic control (aggressive treatment with insulin, medications, diet and exercise) did not appear to have a cardiovascular benefit for people with long-standing Type 2 diabetes.
“However, a genetic risk score maybe helpful for people newly diagnosed with Type 2 diabetes to identify who should have more intense lifestyle changes, such as changes in diet and exercise, and more aggressive management of weight, blood pressure and smoking cessation,” said Arora.
“If you have Type 2 diabetes, there’s a lot you can do to reduce your risk for heart disease,” said Eduardo Sanchez, M.D., M.P.H., FAHA, FAAFP, the American Heart Association’s chief medical officer for prevention, who is the clinical lead for Know Diabetes by Heart, a collaborative initiative between the American Heart Association and the American Diabetes Association addressing the link between diabetes and cardiovascular disease. “In addition to blood sugar control, which is absolutely paramount, we highly encourage people living with Type 2 diabetes to talk with their health care team about other personal and familial risk factors for heart disease or stroke, and what they can do to manage or modify them.”
Co-authors include Vibhu Parcha, M.D.; Akhil Pampana, M.S.; Adam Bress, Pharm.D., M.S.; Marguerite R. Irvin, Ph.D.; and Garima Arora, M.D. 

Physicians may be able to determine if menopause-related bone loss is already in progress or about to begin by measuring the level of a hormone that declines as women approach their final menstrual period, new UCLA research finds.
The findings could help physicians determine when, and how, to treat bone loss in women as they age before that bone loss causes significant health issues, according to the study. Specifically, the study found that for women 42 and older who are not yet postmenopausal, levels of anti-Mullerian hormone, or AMH, can be used to determine if they are experiencing, or about to experience, bone loss related to their transition into menopause.
The findings will be published April 4 in the peer-reviewed Journal of Bone and Mineral Research.
“To be able to intervene and reduce the rate and amount of bone loss, we need to know if this loss is imminent or already ongoing,” said the study’s lead author, Dr. Arun Karlamangla, a professor of medicine in the division of geriatrics at the David Geffen School of Medicine at UCLA. “We do not reliably know before it actually happens when a woman’s last menstrual period will be, so we cannot tell whether it is time to do something about bone loss.”
Bone loss typically begins about a year before a woman’s last menstrual period, Karlamangla said.
Women experience significant bone loss during the menopause transition, a roughly three-year window that brackets the final menstrual period and is accompanied by other symptoms such as irregular menstrual cycles, hot flashes, and mood and sleep disorders. Levels of the AMH decline as a woman’s final menstrual period draws closer.

Deaths at American nursing home residents from Covid appear to be at their lowest levels since the coronavirus first swept the United States more than two years ago, according to the most recent data from the Centers for Disease Control and Prevention.Some 67 residents died during the week ending March 27. While that number could be adjusted in the coming weeks, it mirrors the lows last reached during June 2021 before facilities were hit with the Delta and Omicron variants. Although cases among residents climbed much more sharply in the fall and winter, deaths still reached roughly 1,500 in January before steadily dropping.But experts say there is little reason for complacency. Nursing home residents remain highly vulnerable to the virus because of their age and underlying medical conditions. While booster shots proved to be protective against severe illness during the latest surge, federal regulators already authorized second booster shots of the Pfizer-BioNTech and Moderna coronavirus vaccines last week. There is also growing concern over a highly contagious subvariant of Omicron, known as BA.2.Getting the second booster shot to nursing home residents “is a real policy priority,” said David Grabowski, a health policy researcher at Harvard Medical School who studies nursing homes. “We know this is protective.”While there was a significant push by the federal government and the large pharmacy chains to vaccinate nursing home residents when the initial shots first became available, many facilities were slow to roll out booster shots last fall even as there began to be outbreaks. About 88 percent of residents are fully vaccinated, and about 76 percent have received a booster shot, according to the latest federal data.Immunizing staff members has been harder, with the federal mandate to require health care workers to be vaccinated facing legal challenges. While 86 percent of staff are fully vaccinated, only 43 percent have received a booster shot. In 13 states, fewer than a third of employees have received the added immunizations.“We have a lot of nursing homes around the country that lag behind,” said Dr. Grabowski, adding that he was concerned about residents in facilities that serve predominantly people on Medicaid and people of color. “I think there are going to be real issues of equity here,” he said.The gap between those who received the initial vaccinations and those who receive additional doses could continue to widen, said Brendan Williams, the chief executive of the New Hampshire Health Care Association, a state nursing home trade group. People appear more skeptical over the need for additional shots. “I worry there has been a lot of mixed messages from the federal government,” he said.While many nursing homes say they will provide the additional doses to their staff and residents, there does not seem to be significant urgency, Dr. Grabowski said. In Connecticut, which this year had issued an executive order mandating booster shots for workers in nursing homes, state health officials were reported to have indicated a similar directive for second boosters was not imminent.Mr. Williams remains cautious. “Right now, there doesn’t appear to be a crisis,” he said. “There’s not that attention being paid, but things can always change. It’s concerning.”

Findings from a new Cleveland Clinic-led phase 1 trial show that an experimental “gene silencing” therapy reduced blood levels of lipoprotein(a), a key driver of heart disease risk, by up to 98%.
Findings from the “APOLLO Trial: Magnitude and Duration of Effects of a Short-interfering RNA Targeting Lipoprotein(a): A Placebo-controlled Double-blind Dose-ranging Trial” were presented today during a late-breaking science session at the American College of Cardiology’s 71st Annual Scientific Session and simultaneously published online in the Journal of the American Medical Association.
In the trial, participants who received higher doses of SLN360 — a small interfering RNA (siRNA) therapeutic that “silences” the gene responsible for lipoprotein(a) production — saw their lipoprotein(a) levels drop by as much as 96%-98%. Five months later, these participants’ lipoprotein(a) — also known as Lp(a) — levels remained 71%-81% lower than baseline.
The findings suggest this siRNA therapy could be a promising treatment to help prevent premature heart disease in people with high levels of Lp(a), which is estimated to affect 64 million people in the United States and 1.4 billion people worldwide. It is estimated that nearly 20 to 25% of the world’s population has elevated Lp(a).
“These results showed the safety and strong efficacy of this experimental treatment at reducing levels of Lp(a), a common, but previously untreatable, genetically-determined risk factor that leads to premature heart attack, stroke and aortic stenosis,” said the study’s lead author Steven E. Nissen, M.D., Chief Academic Officer of the Heart, Vascular & Thoracic Institute at Cleveland Clinic. “We hope that further development of this therapy also will be shown to reduce the consequences of Lp(a) in the clinical setting through future studies.”
Lp(a) has similarities to LDL, also known as bad cholesterol. Lp(a) is made in the liver, where an extra protein called apolipoprotein(a) is attached to an LDL-like particle. Unlike other types of cholesterol particles, Lp(a) levels are 80 to 90% genetically determined. The structure of the Lp(a) particle causes the accumulation of plaques in arteries, which play a significant role in heart disease. Elevated Lp(a) greatly increases the risk of heart attacks and strokes.
Although effective therapies to reduce the risk of heart disease by lowering LDL cholesterol and other lipids exist, currently there are no approved treatments to lower Lp(a). Since Lp(a) levels are determined by a person’s genes, lifestyle changes such as diet or exercise have no effect. In the current study, the siRNA therapy reduces Lp(a) levels by “silencing” the gene responsible for Lp(a) production and blocking creation of apolipoprotein(a) in the liver.
In the APOLLO trial, researchers enrolled 32 people at five medical centers in three countries. All participants had Lp(a) levels above 150 nmol/L, with a median level of 224 nmol/L (75 nmol/L or less is considered normal). Eight participants received a placebo and the remaining received one of four doses of SLN360 via a single subcutaneous injection. The doses were 30 mg, 100 mg, 300 mg and 600 mg. Participants were closely observed for the first 24 hours after their injection and then assessed periodically for five months.
Participants receiving 300 mg and 600 mg of SLN360 had a maximum of 96% and 98% reduction in Lp(a) levels, and a reduction of 71% and 81% at five months compared to baseline. Those receiving a placebo saw no change in Lp(a) levels. The highest doses also reduced LDL cholesterol by about 20%-25%. There were no major safety consequences reported and the most common side effect was temporary soreness at the injection site. The study was extended and researchers will continue to follow participants for a total of one year.
The APOLLO trial was funded by Silence Therapeutics plc (Nasdaq: SLN), London, UK. Dr. Nissen has served as a consultant for many pharmaceutical companies and has overseen clinical trials for Amgen, AstraZeneca, Bristol Myers Squibb, Eli Lilly, Esperion, Novartis, Novo Nordisk, Orexigen, Takeda and Pfizer. However, he does not accept honoraria, consulting fees or other compensation from commercial entities.
The trial was coordinated by the Cleveland Clinic Coordinating Center for Clinical Research (C5Research) and sponsored by Silence Therapeutics plc (Nasdaq: SLN), London, UK.
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For the past century people with weak hearts have been told to lower their salt intake, but until now there has been little scientific evidence behind the recommendation.
The largest randomized clinical trial to look at sodium reduction and heart failure reported results simultaneously in The Lancet and at the American College of Cardiology’s 71st Annual Scientific Session over the weekend, and the findings were mixed.
Though reducing salt intake did not lead to fewer emergency visits, hospitalizations or deaths for patients with heart failure, the researchers did find an improvement in symptoms such as swelling, fatigue and coughing, as well as better overall quality of life.
“We can no longer put a blanket recommendation across all patients and say that limiting sodium intake is going to reduce your chances of either dying or being in hospital, but I can say comfortably that it could improve people’s quality of life overall,” said lead author Justin Ezekowitz, professor in the University of Alberta’s Faculty of Medicine & Dentistry and co-director of the Canadian VIGOUR Centre.
The researchers followed 806 patients at 26 medical centers in Canada, the United States, Columbia, Chile, Mexico and New Zealand. All were suffering from heart failure, a condition in which the heart becomes too weak to pump blood effectively. Half of the study participants were randomly assigned to receive usual care, while the rest received nutritional counseling on how to reduce their dietary salt intake.
Patients in the nutritional counseling arm of the trial were given dietitian-designed menu suggestions using foods from their own region and were encouraged to cook at home without adding salt and to avoid high-salt ingredients. Most dietary sodium is hidden in processed foods or restaurant meals rather than being shaken at the table, Ezekowitz noted.

More than 15 million chickens and turkeys from infected commercial and backyard flocks in 19 states have been killed, officials said.From Wyoming to Maine, an outbreak of the highly contagious bird flu has swept across farms and backyard flocks in the United States this year, prompting millions of chickens and turkeys to be culled.Iowa has been particularly hard hit, with disasters being declared in some counties and the state canceling live bird exhibits in an order that may affect its famed state fair.Here is what we know about the bird flu.What is avian influenza?Better known as the bird flu, avian influenza is a highly contagious and deadly virus that can prey on chickens, turkeys and wild birds, including ducks and geese. It spreads via nasal secretions, saliva and fecal droppings, which experts say makes it difficult to contain.Symptoms of the virus include a sudden increase in the mortality of a flock, a drop in egg production and diminished consumption of feed and water.The virus, Eurasian H5N1, is closely related to an Asian strain that has infected hundreds of people since 2003, mostly those who had worked with infected poultry. Its prevalence in the United States is not unexpected, with outbreaks previously reported in Asia, the Middle East and Europe.Should humans be worried about being infected?The risk to humans is very low, said Ron Kean, a faculty associate and extension specialist in the University of Wisconsin at Madison department of animal and dairy sciences.“It’s not impossible for humans to get this virus, but it’s been pretty rare,” Professor Kean said.The Centers for Disease Control and Prevention said it had been monitoring people in the United States who were exposed to infected poultry and other birds. So far, no cases of H5N1 infection have been found among them, the C.D.C. said.Is it safe to eat poultry and eggs?Yes, according to the U.S. Department of Agriculture, which has said that properly prepared and cooked poultry and eggs should not pose a risk to consumers.The chance of infected poultry entering the food chain is “extremely low,” the agency has said. Under federal guidelines, the Food Safety and Inspection Service, part of the U.S.D.A., is responsible for inspecting all poultry sold in interstate and foreign commerce. Inspectors are required to be present at all times during the slaughtering process, according to the service, which noted that the inspectors have unfettered access to those facilities.Egg-production facilities that are subject to federal regulation are required to undergo daily inspections once per shift, according to the inspection service. State inspection programs, which inspect poultry products sold only within the state they were produced, are additionally monitored by the U.S.D.A.Because of the mandated culling of infected flocks, experts say, the virus is primarily an animal health issue at this time.Still, the U.S.D.A. recommends cooking poultry to an internal temperature of 165 Fahrenheit to reduce the potential for food-borne illness.Can I expect to pay more for poultry products?Egg prices soared when an outbreak ravaged the United States in 2014 and 2015. Recently, the average price of premium large white eggs has been “trending sharply higher,” according to a March 25 national retail report released by the U.S.D.A. If infections course through more flocks, experts said, there could be some shortages of eggs. Prices for white and dark chicken meat were also rising, according to the U.S.D.A. Experts also warned that turkey prices could also become more volatile.How is the virus detected?Testing for the avian flu typically involves swabbing the mouths and tracheal area of chickens and turkeys. The samples are sent to diagnostic labs to be analyzed.Outbreaks have been detected in more than a dozen states.As of March 31, the highly pathogenic form of the avian flu had been detected in 19 states, a tracking page maintained by the U.S.D.A. showed.The combined number of birds in the infected flocks — the commercial and backyard type — totaled more than 17 million, according to the agency. A spokesman for the U.S.D.A. confirmed that those birds would be required to be euthanized to prevent the spread of the virus.An commercial egg production facility in Buena Vista County, Iowa, constituted the largest infected flock and was made up of more than 5.3 million chickens, the U.S.D.A. said.A producer of eggs in Jefferson County, Wis., was next on the list, with more than 2.7 million chickens. A commercial poultry flock in New Castle County, Del., was the third-largest infected flock, with more than 1.1 million chickens.How do these outbreaks compare to previous ones?The outbreak in 2014 and 2015 in the United States was blamed for $3 billion in losses to the agricultural sector and was considered to be the most destructive in the nation’s history. Nearly 50 million birds died, either from the virus or from having to be culled, a majority of them in Iowa or Minnesota.The footprint of the current outbreak, extending from the Midwest and Plains to northern New England, has raised concerns.“I think we’re certainly seeing more geographic spread than what we saw with 2014-2015,” said Dr. Andrew Bowman, associate professor at Ohio State University’s College of Veterinary Medicine.What can be done to stop the spread of the virus?As early as last year, the U.S.D.A. warned of the likelihood of an outbreak of the avian flu and emphasized a hardening of “biosecurity” measures to protect flocks of chickens and turkeys.Biosecurity measures include limiting access to the flocks and requiring farm workers to practice strict hygiene measures like wearing disposable boots and coveralls. Sharing of farm equipment, experts say, can contribute to spreading the virus. So can farm workers having contact with wild birds, including when hunting.“Whether that’s limiting access where we source feed and water, even truck routes, how do we try to limit those connections that might spread pathogens between flocks are all really important,” Dr. Bowman said. “At this point, every person producing poultry has to be considering how to improve their biosecurity.”Is it necessary to kill millions of chickens and turkeys?Infected birds can experience complete paralysis, swelling around the eyes and twisting of the head and neck, according to the U.S.D.A. The virus is so contagious, experts say, that there is little choice but to cull infected flocks.Methods include spraying chickens and turkeys with a foam that causes asphyxiation. In other cases, carbon dioxide is used to kill the birds, whose carcasses are often composted or placed in a landfill.“It’s arguably more humane than letting them die from the virus,” Professor Kean said.