Concussion Damage Looks Much Like Early Alzheimer's: Study

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Preliminary finding suggests mild brain injury triggers long-lasting abnormalities in white matter

By Dennis Thompson

HealthDay Reporter

TUESDAY, June 18 (HealthDay News) -- Concussion can lead to damage in the white matter of the brain that resembles abnormalities found in people in the early stages of Alzheimer's disease, a new study suggests.

Researchers at the University of Pittsburgh School of Medicine said their findings should prompt a re-evaluation of the long-term effects of concussion, which affects more than 1.7 million people in the United States annually. About 15 percent of concussion patients suffer persistent neurological symptoms.

"The previous thinking before was you get a concussion, and that causes a certain damage from bopping your head and you get these symptoms," said study author Dr. Saeed Fakhran, an assistant professor of radiology at the University of Pittsburgh School of Medicine. "We found it acts as a kind of trigger, and lights a fuse that causes a neurodegenerative cascade that causes all these symptoms down the line. Once you've hit your head, the injury isn't done."

The findings are published online June 18 in the journal Radiology.

The study drew some criticism from concussion and Alzheimer's disease experts who said the findings, while provocative, should not be interpreted as drawing a clear link between a concussion suffered early in life with the development of Alzheimer's.

"I don't want a mom to pick this up and say, 'Oh my god, my 10-year-old is going to get Alzheimer's now,' because that is not the case," said Dr. Ken Podell, a neuropsychologist and co-director of the Methodist Concussion Center in Houston. "It's very inconclusive at this time, and there's no clinical application of this at this point of time."

White matter serves as the tissue through which messages pass between different areas of gray matter within the brain and spinal cord. Think of gray matter as the individual computers in a network, and white matter as the cables that connect the computer.

The researchers reviewed past brain scans of 64 people who had suffered a concussion, focusing on scans that used an advanced MRI technique called diffusion-tensor imaging, which spots microscopic changes in the brain's white matter.

The investigators then compared these brain scans to symptoms reported by concussed patients in a post-concussion questionnaire. They focused on symptoms shared with Alzheimer's patients, including memory problems, disturbances in sleep cycles and hearing problems.

The results showed a significant correlation between high concussion symptom scores and reduced water movement in the parts of the brain's white matter related to auditory processing and sleep-wake disturbances. Further, the researchers said, the distribution of white matter abnormalities in mildly concussed patients resembled the distribution of abnormalities in people with Alzheimer's disease.

"Basically, it looks a lot like Alzheimer's," said study co-author Dr. Lea Alhilali, an assistant professor of radiology at the University of Pittsburgh School of Medicine. "You get the same distribution of damage in the way that Alzheimer's disease affects the brain."

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HPV Vaccine Lowering Infection Rates Among Girls: CDC

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Extent of protection from sexually transmitted virus higher than expected, suggesting 'herd immunity' is at work, experts say

By Dennis Thompson

HealthDay Reporter

WEDNESDAY, June 19 (HealthDay News) -- Vaccination against the cancer-causing human papillomavirus (HPV) is proving highly effective in reducing the spread of the sexually transmitted virus among young women, new research shows.

The rate of new infections with strains of HPV targeted by the vaccine have dropped by 56 percent among females aged 14 to 19 since the first vaccine was approved in 2006, report researchers at the U.S. Centers for Disease Control and Prevention.

According to the CDC, HPV infection is known to be the major cause of cervical cancer, and has also been strongly linked to vulvar, vaginal, penile, anal, and certain throat/oral cancers.

The new findings "are striking results, and I think they should be a wake-up call that we should increase vaccination rates, because we can protect the next generation of adolescents and young girls against cancer," CDC director Dr. Tom Frieden said in a press conference held Wednesday.

The findings are published in the June issue of The Journal of Infectious Diseases.

Each year in the United States about 19,000 cancers caused by HPV occur in women, with cervical cancer being the most common. Virtually all cases of cervical cancer are caused by HPV, and just two HPV subtypes, 16 and 18, are responsible for seven out of every 10 cervical cancers.

About 8,000 cancers caused by HPV occur each year in men in the United States, most commonly being throat cancer.

The decline in HPV infections among girls is actually higher than had been expected, indicating that "herd immunity" may have taken effect as more girls receive the vaccine, study lead author Dr. Lauri Markowitz said at the press conference.

Herd immunity occurs when widespread vaccination shrinks the pool of infected people to the point that it becomes less likely that a person can catch the disease from someone else. In this type of scenario, "even people who aren't vaccinated will have some protection due to the vaccination program," Markowitz said.

Another possible reason for the better-than-expected results could be that the vaccine is so effective that a girl receives protection from HPV even if she receives only one or two shots out of the full recommended three-dose series of vaccination.

Whatever the reason, the new statistics are "great news," according to Dr. Jay Brooks, chairman of hematology/oncology at Ochsner Health System in Baton Rouge, La. "I think every young woman should have the opportunity to have this vaccine. That's what I've been telling people for however long the vaccine has been available."

HPV is highly infectious. In fact, about 79 million Americans, most in their late teens and early 20s, are thought to be currently infected with HPV, and each year about 14 million people become newly infected.

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U.S. Doctors' Group Labels Obesity a Disease

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Advocates say AMA's move will boost resources to fight weight-gain epidemic, but others question decision

By Steven Reinberg

HealthDay Reporter

WEDNESDAY, June 19 (HealthDay News) -- In an effort to focus greater attention on the weight-gain epidemic plaguing the United States, the American Medical Association has now classified obesity as a disease.

The decision will hopefully pave the way for more attention by doctors on obesity and its dangerous complications, and may even increase insurance coverage for treatments, experts said.

"Recognizing obesity as a disease will help change the way the medical community tackles this complex issue that affects approximately one in three Americans," AMA board member Dr. Patrice Harris said in a statement Tuesday. "The AMA is committed to improving health outcomes and is working to reduce the incidence of cardiovascular disease and type 2 diabetes, which are often linked to obesity."

One expert thinks the AMA's decision, approved Tuesday at the group's annual meeting, could lead to greater coverage by insurance companies of treatments for obesity.

"We already treat obesity as a chronic illness," said Dr. Esa Matius Davis, an assistant professor of medicine at the University of Pittsburgh. "But this decision will bring more resources into the picture because it will, hopefully, allow for more insurance coverage and that really has been the issue of getting people the help that they need," she said.

Treatments for obesity -- including drugs, nutritional counseling and surgery, if needed -- often don't get reimbursed by insurance companies, Davis said. That means many patients aren't getting the care they need because they can't afford to pay the out-of-pocket costs, she said.

If insurance covered these services "it would increase referrals and treatment and that would be a huge step in the right direction," Davis said.

Right now, Davis gets insurance coverage for her obese patients by diagnosing them with high blood pressure or high cholesterol or diabetes, or other obesity-related conditions. But, that still leaves many obese patients out in the cold, she said.

The Obesity Society, which calls itself the leading scientific society dedicated to the study of obesity, applauded the AMA's decision. "The passage of a new American Medical Association policy classifying obesity as a disease reinforces the science behind obesity prevention and treatment," Theodore Kyle, advocacy chair, said in a statement.

"This vital recognition of obesity as a disease can help to ensure more resources are dedicated to needed research, prevention and treatment; encourage health care professionals to recognize obesity treatment as a needed and respected vocation; and, reduce the stigma and discrimination experienced by the millions affected," he said.

Kyle said the AMA has now joined a number of organizations that have previously made this classification, including the U.S. National Institutes of Health, the Social Security Administration, and the Centers for Medicare and Medicaid Services.

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Iron Supplements May Prevent Anemia During Pregnancy

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The benefits also include improved birth weights, analysis shows

By Robert Preidt

HealthDay Reporter

FRIDAY, June 21 (HealthDay News) -- Taking iron supplements during pregnancy reduces women's risk of anemia and is linked with an increase in birth weight and a reduced risk of low birth weight, a new analysis finds.

Researchers examined more than 90 studies that included a total of nearly 2 million pregnant women and found that daily iron supplements significantly reduced women's risk of anemia during pregnancy.

Anemia during the first or second trimester was associated with a significantly higher risk of low birth weight and preterm birth, according to the study, which was published online June 20 in the journal BMJ.

In addition, the investigators found that for every 10 milligram increase in iron dose per day (up to 66 mg), mothers had a 12 percent lower risk of anemia, birth weight increased by 15 grams and the risk of low birth weight fell by 3 percent.

The World Health Organization recommends that pregnant women take 60 mg of iron per day, the study authors noted in a journal news release.

They also said iron deficiency is the most common nutritional deficiency in the world, and the most common cause of anemia during pregnancy, particularly in low- and middle-income countries. It is estimated that iron deficiency affected 32 million pregnant women worldwide in 2011.

"Our findings suggest that use of iron in women during pregnancy may be used as a preventive strategy to improve maternal [blood] status and birth weight," Batool Haider, of the departments of epidemiology and nutrition at Harvard School of Public Health in Boston, and colleagues wrote.

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Early, Severe Flu Season Caused Big Rise in Child Deaths: CDC

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Senior hospitalizations also up during 2012-13 onslaught, U.S. health officials say

By Steven Reinberg

HealthDay Reporter

THURSDAY, June 13 (HealthDay News) -- This past flu season started earlier, peaked earlier and led to more adult hospitalizations and child deaths than most flu seasons, U.S. health officials reported Thursday.

At least 149 children died, compared to the usual range of 34 to 123, according to the U.S. Centers for Disease Control and Prevention.

The predominant strain of flu circulating in 2012-13 -- H3N2 -- made the illness deadlier for children, explained Lynnette Brammer, an epidemiologist with the CDC.

"With children H3 viruses can be severe, but there was also a lot of influenza B viruses circulating . . . and for kids they can be bad, too," she said.

Dr. Marc Siegel, an associate professor of medicine at NYU Langone Medical Center in New York City, added that H3N2 is easily transmitted from person to person and has a high rate of complications, which accounts for the increased hospitalizations.

"This is the kind of flu that enables other infections like pneumonia," he said. "Really what people need to know is that flu isn't the problem. The flu's effect on the immune system and fatigue is the problem."

The flu season started in September, which is unusually early, and peaked at the end of December, which is also unusual, Siegel said.

Flu season typically begins in December and peaks in late January or February.

Texas, New York and Florida had the most reported pediatric deaths. Except for the 2009-10 H1N1 flu pandemic, which killed at least 348 children, the past flu season was the deadliest since the CDC began collecting data on child flu deaths, according to the report, published in the June 14 issue of the Morbidity and Mortality Weekly Report.

Older adults were targeted heavily by the 2012-13 flu. Those aged 65 and older accounted for more than half of all reported flu-associated hospitalizations in the 2012-13 flu season -- the most since the CDC started collecting data on flu hospitalizations in 2005-06, the agency reported.

In addition, more Americans saw a doctor for flu than in recent flu seasons, the CDC noted.

The flu vaccine was well matched to the circulating strains, but less effective than health officials had hoped. In January, the CDC reported that the vaccine was about 60 percent effective, which meant it offered "moderate" protection from the flu.

Siegel said even a moderately effective vaccine is better than not getting vaccinated at all because flu symptoms will be milder, with a lower chance of complications.

According to Brammer, decisions about the vaccine for this coming season were made in February so manufacturers could make a sufficient supply for fall. The makeup will be basically the same as the 2012-13 vaccine with some tweaks to some of the strains so they better match changes in the viruses, she said.

The CDC recommends that everyone 6 months and older get vaccinated. The agency urges people at higher risk for severe disease -- including young children, pregnant women, anyone with a chronic health problem and the elderly -- to get the vaccine.

Don't make any assumptions about the course of next season's flu based on the recent past, these experts added.

"I wouldn't assume next year's flu season is going to be milder or that it's going to be early," Siegel said. "The flu is unpredictable."

Because the 2012-13 flu season started several months earlier than usual, the CDC also advised doctors to consider influenza as the source of respiratory illnesses that occur beyond the typical flu window.

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A Deadly Form of Diabetes That Doctors Sometimes Miss

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Common signs of type 1 diabetes often resemble symptoms of other illnesses

By Serena Gordon

HealthDay Reporter

WEDNESDAY, June 19 (HealthDay News) -- Addie Parker was a happy 4-year-old who appeared to have the flu. But within hours she was in a coma.

Tragically, her parents weren't familiar with the signs of type 1 diabetes -- extreme fatigue, thirst and sweet-smelling breath, among others -- in time to save their little girl. Soon after she was diagnosed, Addie's brain hemorrhaged. She died six days later, about a month shy of her fifth birthday.

Experts say a lack of awareness of the signs of type 1 diabetes is all too common. Just this month, a Wisconsin toddler died apparently because of undiagnosed type 1 diabetes.

"Addie had flu symptoms," recalled her mother, Micki Parker, who works in the operating room at a nearby hospital but was unfamiliar with type 1 diabetes.

"By the next morning, she was throwing up every hour," Parker said. Addie didn't have a fever, but later that day, she couldn't get up from the bathroom floor because she was so dizzy.

Eventually, the Parkers learned that Addie's blood sugar level was 543 milligrams per deciliter (mg/dL) -- more than four times higher than normal, according to the American Diabetes Association.

Most people have heard of type 2 diabetes, but type 1 diabetes is far less common. It can strike at any age -- even though it used to be known as juvenile diabetes -- and it always requires treatment with injected insulin or insulin delivered through a pump. People with type 1 diabetes don't produce insulin, a hormone needed to convert the food you eat into fuel for the body. Without insulin, glucose (blood sugar) rises to unhealthy levels.

Untreated, type 1 diabetes causes serious complications and even death. But it's often mistaken for other illnesses -- even by doctors.

"There's an underawareness of type 1 diabetes in the public, and in the healthcare system," said Dr. Richard Insel, chief scientific officer for JDRF (formerly the Juvenile Diabetes Research Foundation). "Missed diagnoses even occur in emergency rooms; people don't always think of it."

Every day, about 80 Americans are diagnosed with type 1 diabetes, and the total number rose 23 percent between 2000 and 2009 in children under 20. Currently, about 3 million Americans -- most of them adults -- are living with type 1 diabetes, according to the JDRF.

One of them is 20-year-old Amanda Di Lella, who was 13 when she knew something was seriously wrong.

"I was losing weight, but I was always hungry. I was always tired. My symptoms weren't extreme at first, but they quickly got worse," she said. "I went from being tired to not being able to get out of bed, from being thirsty to drinking 10 bottles of water in the middle of the night. I had lost 15 pounds, and only weighed 75 pounds when I begged my mother to take me to the doctor."

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Endoscopes Not Always Cleaned Properly: Study

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Used to examine patients' gastrointestinal tracts, dirty devices might pose infection risk

By Robert Preidt

HealthDay Reporter

THURSDAY, June 13 (HealthDay News) -- Three of every 20 flexible endoscopes used to examine patients' gastrointestinal tracts and colons were improperly cleaned, a new study finds.

Those 15 percent of endoscopes had unacceptable levels of "bio dirt" -- cells and matter from a patient's body that could pose a potential infection risk to other patients, according to the researchers.

They examined 275 flexible duodenoscopes, gastroscopes, and colonoscopes used at five U.S. hospitals and found that 30 percent, 24 percent and 3 percent, respectively, did not pass a cleanliness rating.

The study findings were to be presented last weekend at the annual meeting of the Association for Professionals in Infection Control and Epidemiology (APIC).

"Three out of 20 is an unexpectedly high number of endoscopes failing a cleanliness criterion," lead investigator Marco Bommarito, lead research specialist at 3M Infection Prevention Division, said in an APIC news release. "Clearly, we'd like no endoscopes to fail a cleanliness rating."

In recent years, improperly cleaned endoscopes at medical facilities in the United States have resulted in thousands of patients having to be checked for HIV and hepatitis B and C, according to the news release. More health-care-associated outbreaks have been linked to contaminated endoscopes than to any other medical device, the U.S. Centers for Disease Control and Prevention has reported.

Each year in the United States, between 15 million and 20 million endoscopy procedures are conducted with reusable endoscope devices to screen various parts of patients' gastrointestinal tracts and look for problems such as cancer.

Duodenoscopes examine the duodenum (the first section of the small intestine), while gastroscopes examine the stomach and colonoscopes examine the colon.

"The cleaning protocols for flexible endoscopes need improvement, such as guidelines tailored to the type of scope or identifying if there is a critical step missing in the manual cleaning process, and documented quality-control measures," Bommarito said. "These types of improvements could have a positive impact on patient safety."

Because this study was presented at a medical meeting, the data and conclusions should be viewed as preliminary until published in a peer-reviewed journal.

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Polluted Air Linked to Autism Risk

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Pregnant women who live with smog at higher risk, but experts caution the finding is not definitive

By Denise Mann

HealthDay Reporter

TUESDAY, June 18 (HealthDay News) -- Pregnant women who live in smog-filled areas may be twice as likely to have children with autism, a new study suggests.

"The study does not prove that pollution increases risk for autism. It found an association," cautioned lead author Andrea Roberts, a research associate at the Harvard School of Public Health in Boston. "It adds to the weight of the evidence that there may be something in air pollution that increases risk for autism."

Researchers compared exposure to air pollution among 325 women who had a child with autism and 22,000 women who did not. The women were participants in the Nurses' Health Study II. Pollutants measured included diesel particulate matter, lead, manganese, mercury, methylene chloride, and a combined measure of metal exposure.

Twenty percent to 60 percent of the women lived in areas considered highly polluted. And the study showed that: those women who lived in the 20 percent of locations that had the highest levels of diesel particulates or mercury in the air were twice as likely to have a child with autism, compared to those who lived in the 20 percent of areas with the lowest levels of these pollutants.

In addition, those who lived in the 20 percent of locations with the highest levels of lead, manganese, methylene chloride, and combined metal exposure were about 50 percent more likely to have a child with autism than those who lived in the 20 percent of areas with the lowest concentrations.

The findings held even after the researchers took into account other factors known to affect autism risk, such as income, education and smoking during pregnancy. Overall, the association was stronger for boys than it was for girls, but the number of girls included in the new study was too low to draw any firm conclusions.

The findings, which were published June 18 online in Environmental Health Perspectives, do add to a growing body of research that suggests the air women breathe while pregnant is one of many factors linked to autism risk. Previous studies have shown that pregnant women who live in polluted areas or close to freeways are more likely to have a child with autism, but the studies were done regionally. The new data is nationwide.

Exactly how, or even if, air pollution affects the developing brain is murky. "By definition, pollution is stuff that is not good for us," Roberts said.

Still, the overall increase in autism risk that may be attributed to pollution is low. "Let's say a woman's risk for having a child with autism is one in 100, women who live in the most polluted cities have a risk that is about one in 50, which means that 49 children would not have autism," Roberts said.

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Volunteering May Be Good for the Heart in More Ways Than One

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Time spent helping others linked to lower blood pressure in older adults, study finds

By Robert Preidt

HealthDay Reporter

FRIDAY, June 14 (HealthDay News) -- Anyone who has ever been a volunteer knows that it feels good to help others, but researchers have found a less obvious benefit: volunteering can help reduce older adults' risk of high blood pressure.

The new study included more than 1,100 adults, aged 51 to 91, who were interviewed about their volunteering and had their blood pressure checked in 2006 and 2010. All of them had normal blood pressure at the time of the first interview.

The investigators found that participants who said during the first interview that they volunteered for at least 200 hours per year were 40 percent less likely to have high blood pressure four years later than those who did not volunteer.

It didn't matter what type of activity the volunteers performed. Only the amount of time spent helping others as a volunteer was associated with a reduced risk of high blood pressure, according to the study scheduled for publication in the journal Psychology and Aging.

The findings suggest that volunteering may be an effective medicine-free option to help prevent high blood pressure, which is a major contributor to cardiovascular disease -- the leading cause of death in the United States. High blood pressure, or hypertension, affects about 65 million Americans.

"Every day, we are learning more about how negative lifestyle factors like poor diet and lack of exercise increase hypertension risk," lead author Rodlescia Sneed, a Ph.D. candidate in psychology at Carnegie Mellon University, said in a university news release.

"Here, we wanted to determine if a positive lifestyle factor like volunteer work could actually reduce disease risk. And, the results give older adults an example of something that they can actively do to remain healthy and age successfully," Sneed explained.

"As people get older, social transitions like retirement, bereavement and the departure of children from the home often leave older adults with fewer natural opportunities for social interaction," Sneed noted. "Participating in volunteer activities may provide older adults with social connections that they might not have otherwise. There is strong evidence that having good social connections promotes healthy aging and reduces risk for a number of negative health outcomes."

While the study found an association between time spent volunteering and blood pressure levels, it did not prove a cause-and-effect relationship.

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HIV and Aging: Health, Planning, and More

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Many people think of HIV as a young person's disease, but it's not. "By 2015, half of all people with HIV will be 50 or older," says Brad Hare, MD, director of the HIV/AIDS clinic at San Francisco General Hospital. This greying of the HIV population shows how well today’s HIV treatments can work.

HIV makes aging itself more complicated. But plenty of people have had HIV for years, even decades, and are doing well. 

HIV, AIDS, and Tuberculosis

Tuberculosis (TB) is a serious disease that spreads through the air. It is caused by a bacterium called Mycobacterium tuberculosis. Tuberculosis usually affects the lungs. However, it can affect other parts of the body, such as the central nervous system. About 10-15 million Americans are infected with tuberculosis. For most people with healthy immune systems, this is not a problem. Nine out of 10 of them won't develop active disease with symptoms. The risk is great, however, for people who...

Read the HIV, AIDS, and Tuberculosis article > >

"These days, we fully expect that someone with HIV will live a long, healthy life," says Christine A. Wanke, MD, professor of medicine and director of the nutrition and infection unit at Tufts University School of Medicine. "But that means they have to plan ahead and adopt the healthy habits to stay that way, just like anyone without HIV."

As you get older with HIV, you may face issues including:

1. Other conditions. Just like anybody, getting older means you're more likely to have health problems, and HIV seems to bump up the risk even more. "HIV accelerates the aging process and magnifies its effects," says John G. Bartlett, MD, professor at the Johns Hopkins School of Medicine and director of its AIDS service. So HIV may make you more likely to get heart disease, diabetes, cancer, osteoporosis, kidney problems, and other conditions. 

2. Drug interactions. Since you’re already taking medicines for HIV, additional drugs for other conditions can increase the chance of interactions.

3. Loss of support. Some people become more isolated as they age. That happens more often to people with HIV, who may also be dealing with embarrassment about the condition or strained family relationships. If you're alone and disconnected, you're more likely to get depressed.

4. Changing roles. Like many people without HIV, you may be caring for your aging parents. That can add emotional and financial pressures.

5. Difficulty adjusting. "I talk to people with HIV who say, 'I didn't expect to live to middle age,'" says Hare. "'But now I'm middle-aged and I'm probably going to live another 30 years.'" Many people who got HIV long ago didn't plan for a long life, and adjusting can be a challenge. For instance, you might not have saved for a longer life.

1. See an HIV expert. The more your health is complicated by age and other conditions, the more crucial it is to have an expert overseeing your HIV care.

2. Get good routine medical care. Specialty HIV care is not enough. Because your risks of other medical problems are higher, keep on top of your general health, says Hare. Get your annual physicals, keep tabs on your blood pressure, cholesterol, and other tests your doctor recommends.

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FDA OKs Sale of 'Morning-After' Pill Without Age Limit

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Girls of all ages will now have easier access to the emergency contraceptive

By EJ Mundell

HealthDay Reporter

THURSDAY, June 20 (HealthDay News) -- The so-called morning-after pill is about to go over-the-counter, with the U.S. Food and Drug Administration announcing Thursday that it has approved unrestricted sales of Plan B One-Step.

The move follows a decision earlier this month by the Obama administration to drop its effort to fight a court order that would make the emergency contraceptive pill available over-the-counter to all women and girls, regardless of age.

After fighting for an age threshold on the nonprescription use of the Plan B One-Step pill for months, the FDA said June 10 that it would heed the ruling of Judge Edward Korman, of the United States District Court for the Eastern District of New York. The drug prevents conception if taken within 72 hours of sexual intercourse.

Korman first issued his order April 5, igniting a battle over whether young girls could gain access to emergency contraception without a prescription. Soon after, on April 30, the FDA lowered to 15 the age at which people could purchase the Plan B One-Step pill over-the-counter -- two years younger than the prior age limit of 17.

A day later, on May 1, the Obama administration stepped in to appeal the Korman decision.

At the time of the FDA's move to lower the age limit, agency Commissioner Dr. Margaret Hamburg said that "research has shown that access to emergency contraceptive products has the potential to further decrease the rate of unintended pregnancies in the United States.

"The data reviewed by the agency demonstrated that women 15 years of age and older were able to understand how Plan B One-Step works, how to use it properly and that it does not prevent the transmission of a sexually transmitted disease," she said.

Plan B prevents implantation of a fertilized egg in a woman's uterus through the use of levonorgestrel, a synthetic form of the hormone progesterone used for decades in birth control pills. Plan B contains 1.5 milligrams of levonorgestrel, more than the pill contains. It is considered a form of birth control, not abortion.

The Associated Press reported that the FDA's announcement Thursday only applied to Plan B One-Step. Other brands of emergency contraception include Next Choice and Ella.

Planned Parenthood has long pushed for wider access to emergency contraception. But conservative groups have objected to such a move.

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Skipping Breakfast May Raise Diabetes Risk

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Overweight women who ate morning meal had lower blood sugar, better insulin response in small study

By Kathleen Doheny

HealthDay Reporter

SUNDAY, June 16 (HealthDay News) -- Eating breakfast every day may help overweight women reduce their risk of diabetes, a small new study suggests.

When women skipped the morning meal, they experienced insulin resistance, a condition in which a person requires more insulin to bring their blood sugar into a normal range, explained lead researcher Dr. Elizabeth Thomas, an instructor of medicine at the University of Colorado.

This insulin resistance was short-term in the study, but when the condition is chronic, it is a risk factor for diabetes, Thomas said. She is due to present her findings this weekend at the Endocrine Society's annual meeting in San Francisco.

"Eating a healthy breakfast is probably beneficial," Thomas said. "It may not only help you control your weight but avoid diabetes."

Diabetes has been diagnosed in more than 18 million Americans, according to the American Diabetes Association. Most have type 2 diabetes, in which the body does not make enough insulin or does not use it effectively.

Excess weight is a risk factor for diabetes.

The new study included only nine women. Their average age was 29, and all were overweight or obese.

Thomas measured their levels of insulin and blood sugar on two different days after the women ate lunch. On one day, they had eaten breakfast; on the other day, they had skipped it.

Glucose levels normally rise after eating a meal, and that in turn triggers insulin production, which helps the cells take in the glucose and convert it to energy.

However, the women's insulin and glucose levels after lunch were much higher on the day they skipped breakfast than on the day they ate it.

On the day they did not eat breakfast, Thomas explained, "they required a higher level of insulin to handle the same meal."

"There was a 28 percent increase in the insulin response and a 12 percent increase in the glucose response after skipping breakfast," she said. That's a mild rise in glucose and a moderate rise in insulin, she noted.

Because this study was presented at a medical meeting, the data and conclusions should be viewed as preliminary until published in a peer-reviewed journal.

"Their study doesn't prove causation," said Dr. Joel Zonszein, a professor of clinical medicine at the Albert Einstein College of Medicine and director of the Clinical Diabetes Center at Montefiore Medical Center, in New York City.

The study found only a link or association between breakfast skipping and higher insulin levels. More research is needed for confirmation, another expert said.

"This is a small, but very interesting, study," said Dr. Ping Wang, director of the University of California, Irvine, Health Diabetes Center. "The findings will have to be verified with larger studies."

Whether the effect is short-term or long-term is not known, Wang said.

Zonszein recommends against either skipping meals or eating very frequent meals, the so-called nibbling diet. "Studies done in Europe have shown that a large meal in the middle of the day is better than a large meal at dinner," he said.

However, he acknowledged that pattern is more of a habit in Europe than in the United States. Even so, he advises his patients to eat a good breakfast, a good lunch and a lighter dinner.

Other ways to reduce diabetes risk, according to the American Diabetes Association, are to control weight, blood pressure and cholesterol and to be physically active.

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Statins Plus Certain Antibiotics May Set Off Toxic Reaction: Study

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Harmful effects in older patients include muscle, kidney damage, researchers say

By Steven Reinberg

HealthDay Reporter

MONDAY, June 17 (HealthDay News) -- Doctors should avoid ordering certain antibiotics for older patients who take cholesterol-lowering statin drugs, such as Lipitor, Canadian researchers say.

Statins, which are taken by many millions of people, don't mix well with the antibiotics clarithromycin or erythromycin, according to a study, published in the June 18 issue of the Annals of Internal Medicine.

These two commonly used antibiotics inhibit the metabolism of statins and increase statin concentration in the blood, which can cause muscle or kidney damage, and even death, the researchers said.

"These drugs do interact and cause difficulties for patients," said lead researcher Dr. Amit Garg, a professor in the department of epidemiology and biostatistics at the University of Western Ontario in London, Ontario.

These adverse reactions are rare, Garg added. "Most people will be fine," he said. "But at a population level, hundreds of preventable hospitalizations are occurring."

For someone taking a statin, the study suggests that substituting a different antibiotic -- azithromycin -- is safer because it doesn't interfere with the metabolism of statins.

Another strategy is to stop the statin until the antibiotic course is finished, Garg said.

The study of more than 144,000 statin users over the age of 65 compared those prescribed clarithromycin or erythromycin with those taking azithromycin.

In terms of absolute risk, the odds of kidney damage increased 26 percent among people who took clarithromycin or erythromycin and statins compared with patients who took azithromycin with statins.

Also, hospitalizations for muscle damage (a condition called rhabdomyolysis) and deaths were slightly higher -- 0.02 percent and 0.25 percent, respectively -- in the clarithromycin or erythromycin groups compared to the azithromycin group, the study authors found.

Dr. Gregg Fonarow, a spokesman for the American Heart Association, said patients should not stop taking statins, which are known to prevent heart disease. Instead, doctors should prescribe another antibiotic, he suggested.

"It is well documented that certain medications that inhibit the liver enzyme cytochrome P450 isoenzyme 3A4 can increase the drug level of statin medications," said Fonarow, a professor of cardiology at the University of California, Los Angeles. "Nevertheless, large-scale randomized clinical trials and clinical effectiveness studies have demonstrated [that] the benefits of statin therapy in reducing fatal and nonfatal cardiovascular events outweigh the potential risks."

The study data included more than 73,000 patients prescribed clarithromycin, about 3,200 prescribed erythromycin and more than 68,000 people who took azithromycin. Almost three-quarters of the statin users were taking atorvastatin (Lipitor). The other commonly used statins were simvastatin (Zocor) and lovastatin (Altoprev, Mevacor).

Clarithromycin and erythromycin are often prescribed for respiratory illness such as pneumonia. Previously, the U.S. Food and Drug Administration warned that statins don't interact well with these and certain other drugs used to treat HIV and hepatitis.

The study authors noted that younger patients are less likely than older adults to experience serious side effects from drug interactions.

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How Estrogen May Help Prevent Urinary Tract Infections After Menopause

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Laboratory study suggests vaginal supplementation would benefit some women

By Serena Gordon

HealthDay Reporter

THURSDAY, June 20 (HealthDay News) -- Estrogen treatment delivered vaginally may help prevent repeat urinary tract infections in postmenopausal women, new laboratory research suggests.

Urinary tract infections are common among women, with one-quarter experiencing recurring infections. And age-related changes increase the likelihood of these infections developing after menopause, when estrogen production plummets.

Until now, taking antibiotics prophylactically -- to ward off recurrent urinary tract infections -- has been the gold standard for these women, said Thomas Hannan, a research instructor in pathology and immunology at Washington University School of Medicine in St. Louis. "But antibiotic resistance is increasing, and some women are resistant to everything we have," Hannan said. "We need other options. We need non-antibiotic options."

This study, published in the June 19 issue of the journal Science Translational Medicine, "suggests a more holistic approach by changing the way women respond to bacteria," said Hannan, co-author of an editorial accompanying the study in the journal.

The results support the use of vaginal estrogen as a preventive measure for postmenopausal women with recurrent urinary tract infections, he wrote in the editorial.

Working in the laboratory and with animal models, the researchers identified a number of ways that estrogen -- the female sex hormone -- helps keep recurrent urinary tract infections at bay.

"This study presents some underlying mechanisms for the beneficial effect of [topical estrogen formulations] after menopause and supports the application of estrogen in postmenopausal women suffering from recurrent UTIs," wrote the study's authors, from the Karolinska Institute in Stockholm, Sweden.

About half of all women will experience at least one urinary tract infection in their lifetime, according to the study. For about 25 percent of these women, the infection will come back again within six months.

Low estrogen levels have previously been linked to recurrent infections, and the new study sought to identify exactly how estrogen might affect a woman's risk of recurrent urinary tract infections.

For the study, the researchers used human cells from postmenopausal women who had used supplemental vaginal estrogen for two weeks. They also worked with mice that were given bacteria that would cause urinary tract infections like those in humans.

They found that estrogen encourages production of natural antimicrobial substances in the bladder. The hormone also makes the urinary tract tissue stronger by closing the gaps between cells that line the bladder. By gluing these gaps together, estrogen makes it harder for bacteria to penetrate the deeper layers of the bladder wall, the study authors said.

Estrogen also helps prevent too many cells from shedding from the top layers of the bladder wall.

"Normally, there's an innate response to infection and some cells die -- sort of taking one for the team -- and then these cells shed," Hannan said. "But shedding too much could allow bacteria to get into the deeper tissue, so this exfoliation is a double-edged sword."

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Rheumatoid Arthritis, Smoking, and Drinking Alcohol

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The potential risks smoking and drinking pose to people with rheumatoid arthritis.By Stephanie Schupska
WebMD Feature

You already know that smoking is bad for you and that it's unhealthy to drink too much alcohol.

But do you know how tobacco and alcohol relate to rheumatoid arthritis -- your odds of developing RA, or, if you already have RA, your odds of making it worse?

What can I do about the RA pain I feel right now?

Pain is not patient. If you’re feeling worse today, you want relief from your rheumatoid arthritis symptoms right away. Unfortunately, none of us is guaranteed a pain-free life. But there are some ways to reduce pain. You may have already tried some, but others may surprise you.   Have you tried avetopical capsaicin? Capsaicin is an ingredient in hot peppers. It's put in creams to rub on painful joints. Studies show that capsaicin stimulates the release of a substance that's involved in communicating...

Read the What can I do about the RA pain I feel right now? article > >

Here's what the research shows.

Smoking may make people more likely to get RA. And, depending on their genes, it may make their RA worse. On top of that, smoking mixed with RA can lead to even greater problems, like heart disease.

“Very clear studies indicate that tobacco is highly associated [with] and probably causal in rheumatoid arthritis and is causal in the worst form of the disease,” says Susan Goodman, MD, an assistant attending rheumatologist and internist at the Hospital for Special Surgery and assistant professor of medicine at Weill Cornell Medical College.

Your genes may also matter. A Swedish study, published in December 2010, shows that the odds of developing RA was related not just to how much a person smokes, but also to their genetic makeup. People with a certain gene variation, called HLA-DRB1, who smoke are much more likely to get rheumatoid arthritis than someone who doesn’t smoke -- and to have severe RA.

“It turns out that people who smoke who bear this genetic factor are much more likely to develop rheumatoid arthritis and do develop more severe disease," Goodman says.

Smoking can also make dealing with the disease more difficult.

“In a lot of the studies on the course of rheumatoid arthritis, patients who smoke do less well, and they’re less likely to achieve remission,” Goodman says. “They’re more likely to have a worse outcome. Smoking gives them a worse prognosis.”

Smoking can increase painful rheumatoid nodules, which form in the joints, she says. It can also lead to heart disease, which -- even on its own -- is a big problem in people with RA. And smoking makes it worse.

“In the last 10 years, there have been studies that show the leading cause of death in patients with RA is cardiovascular disease,” says Walter Moore, MD, senior associate dean for graduate medical education and veteran affairs at Georgia Health Sciences University and chief of rheumatology at Charlie Norwood Department of Veterans Affairs Medical Center. “And smoking itself is clearly associated as a risk factor for cardiovascular disease.”

Stroke is another concern for RA patients.

“RA is an illness like diabetes. In and of itself, it’s a risk factor for heart attack and stroke,” says Andrew Ruthberg, MD, an assistant professor of medicine and an attending physician at Rush University Medical Center and director of Rush Rheumatoid Arthritis Clinic. “And those two things conspire to raise your risk for those other problems to a higher level.”

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Debbie Gisonni: 5 Ways to Enjoy Your Summer Vacation

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Vacations give us a much-needed break from work and responsibilities. They're a time to have fun, new adventures, rest and relaxation. In our fast-paced, over-scheduled and stress-filled lives, we often overlook the value of these benefits.

Here are five ways to ensure that you enjoy your summer vacation.

1. Always use your vacation time.

Compared to most countries, American employees have less paid vacation days, so it's amazing that some of us actually don't use what little vacation time we have! If you're all about work and no play, you are surely headed for a burnout down the road. You can't have an enjoyable vacation if you choose not to have one at all.

2. Define vacation on your own terms.

You don't have to take a trip, spend a lot of money, or even leave your house to have a vacation. All you need to do is take a break from your normal routine or work. If you happen to travel on your job, a staycation may be the perfect retreat for you. Or perhaps you'd like to spend your free time taking a pottery class, planting a garden, reading a good novel, spending time with friends and family, or just listening to the birds sing while you gently swing in your backyard hammock. A vacation is a frame of mind, not a place or schedule.

3. Do your research.

If you do plan on taking a trip, make sure there are no unpleasant surprises when you get there. Call and ask in advance to find out about things like kid-friendly or pet-friendly accommodations, transportation services, safety, climate, etc. There are plenty of travel books and Internet sites that provide all the necessary information to make your trip a pleasant one. Or, you can take the old-fashioned approach and book your travel arrangements through an experienced and knowledgeable travel agent or tour company.

4. Relax and enjoy.

Don't treat your vacation like a work project. Too much planning, organizing, list-making and over-scheduling gives you no time to relax and enjoy yourself. Get out of work mode and kick back. Don't feel as if every day needs an itinerary -- unless you're on a group tour and all you have to do is show up. Try to space out planned activities to every other day with alternate days off for whatever you feel like doing in the moment. You don't want to be exhausted from your vacation when it's all over.

5. Leave work behind.

The whole point of vacation is to take a break from work, not to have thoughts and messages from work mixing in with your thirst-quenching Mai Tai on the beach or your daring sky diving lesson. Leave the laptop behind, don't check voicemail, and don't call the office. Change your outgoing phone messages and set up an auto reply on email to make sure everyone knows you're not available until your return date. This is your time to put yourself first, renew your spirit and have a blissful experience!

For more by Debbie Gisonni, click here.

For more on emotional wellness, click here.

Follow Debbie Gisonni on Twitter: www.twitter.com/debbiegisonni

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George W. Bush's Jet Makes Emergency Landing In Kentucky

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DALLAS -- A private jet that had former President George W. Bush on board made an emergency landing Saturday night.

The Federal Aviation Administration said Sunday that the jet was flying from Philadelphia to Dallas, where Bush lives. The FAA said the plane was diverted to Louisville, Ky., after the smell of smoke was reported in the cockpit. No one was hurt.

Bush spokesman Freddy Ford told The Associated Press on Sunday that after a brief stop, the plane continued to Dallas. Ford was on board and said he never saw or smelled smoke.

FAA spokeswoman Holly Baker said the Gulfstream 4 eventually landed at Dallas Love Field.

Bush is honorary chairman of The First Tee, which supports youth education programs through golf, and was returning from an event in Philadelphia.

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Climate-Proofing Cities Is A Hot Topic At Bonn Conference

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BONN, Germany -- From Bangkok to Miami, cities and coastal areas across the globe are already building or planning defenses to protect millions of people and key infrastructure from more powerful storm surges and other effects of global warming.

Some are planning cities that will simply adapt to more water.

But climate-proofing a city or coastline is expensive, as shown by New York Mayor Michael Bloomberg's $20 billion plan to build floodwalls, levees and other defenses against rising seas.

The most vulnerable places are those with the fewest resources to build such defenses, secure their water supplies or move people to higher ground. How to pay for such measures is a burning issue in U.N. climate talks, which just wrapped up a session in the German city of Bonn.

A sampling of cities around the world and what they are doing to prepare for the climatic forces that scientists say are being unleashed by global warming:

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ROTTERDAM, Netherlands. In a country where two-thirds of the population lives below sea level, the battle against the sea has been a matter of life and death for centuries.

The Dutch government devotes roughly 1 percent of its annual budget to its intricate system of dikes, dunes and sea walls. Improvements to cope just with the effects of climate change have been carried out since 2003 – though planning began well before that.

The focus in the 20th century was on a spectacular series of sea defenses, including massive steel and concrete barriers that can be quickly moved to protect against storm surges.

But current techniques embrace a philosophy of "living with water:" Floods are inevitable, and it's better to prepare for them than to build ever-higher dikes that may fail catastrophically.

Thousands of waterways are being connected so the country can essentially act as one big sponge and absorb sudden influxes of water. Some areas have been designated as flood zones. Houses that can float have been a building sensation.

Along the coast, the country has been spouting huge amounts of sand in strategic locations offshore and allowing the natural motion of waves to strengthen defensive dunes.

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VENICE, Italy. Sea level rise is a particular concern for this flood-prone city. It's in the process of realizing an expensive and oft-delayed system of underwater barriers that would be raised in the event of flooding over 43 inches (110 centimeters), higher than the 31-inch (80-centimeter) level that floods the famed St. Mark's Square.

Venice, a system of islands built into a shallow lagoon, is extremely vulnerable to rising seas because the sea floor is also sinking.

The constant flooding puts the city's considerable architectural treasures at risk. Venice has experienced 10 events over 4 feet 7 inches (140 centimeters) since 1950, including a devastating 1966 flood. Plans for the new so-called Moses barriers will cost more than 4 billion euros. The first of these have been moved into place in recent days. Many Venetians remain skeptical of the project due to the high costs and concerns over environmental risks.

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LONDON. The low-lying capital of a perpetually soggy country, London has long been vulnerable to flooding – particularly when powerful storms send seawater racing up the River Thames.

But Londoners already have a powerful flood defense: the 570-yard-long (half-a-kilometer-long) Thames Barrier, composed of 10 massive steel gates, each five stories high when raised against high water.

Some have called for Thames Barrier – in operation since 1982 – to be replaced or supplemented by an even more ambitious flood defense system farther down the river. But Britain's Environment Agency says the defenses should hold until 2070.

Meanwhile, environmentally conscious Londoners have made plans to battle some of the other predicted effects of global warming by promoting better water management, expanding the city's Victorian sewage network, and "urban greening" – the planting of trees and rooftop gardens to help manage the urban heat island effect.

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MIAMI. Southern Florida is one of those places that show up as partially under water in many sea level projections for this century. So it's no surprise local leaders are seeking ways to adapt. Four counties of South Florida, including Miami-Dade, have collaborated on a regional plan to respond to climate change. Their overarching goal: keeping fresh water inland and salt water away.

The first action plan calls for more public transportation, stemming the flow of seawater into freshwater, and managing the region's unique ecosystems so they can adapt.

Before writing the plan, the counties reviewed regional sea level data and projected a rise of 9 to 24 inches (23 to 61 cm) in the next 50 years along a coastline that already has documented a rise of 9 inches over the last 100 years.

"The rate's doubled. It would be disingenuous and sloppy and irresponsible not to respond to it," said Monroe County Administrator Roman Gastesi, who oversees the Florida Keys.

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NEW YORK CITY. Mayor Michael Bloomberg last week announced one of the most ambitious plans for defending a major U.S. city from climate change. Recommendations range from installing removable flood walls in lower Manhattan to restoring marshes in Jamaica Bay in Queens, and from flood-proofing homes to setting repair timeframe standards for phone and Internet service providers.

In lower Manhattan, a removable system of posts and slats could be deployed to form temporary flood walls. The height would depend on the ground elevation and potential surge. The approach is used along some Midwestern rivers and in the Netherlands, city officials said.

Projects also include a 15-to-20-foot levee to guard part of Staten Island, building dunes in the Rockaways, building barrier systems of levees and gates to bar one creek from carrying floodwaters inland, and possibly creating a levee and a sizeable new "Seaport City" development in lower Manhattan.

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BANGLADESH. A low-lying delta nation of 153 million people, Bangladesh is one of Asia's poorest countries, and one that faces extreme risks from rising sea levels. Its capital, Dhaka, is at the top of a list of world cities deemed most vulnerable to climate change, according to a recent survey by risk analysis company Maplecroft. The World Bank says a sea level rise of 5 inches (14 centimeters) would affect 20 million people living along the country's 440-mile (710-kilometer) coast. Many of these people would be homeless.

Bangladesh is implementing two major projects worth $470 million that involve growing forests on the coastal belt and building more multistory shelters to house people after cyclones and tidal surges. Developed nations have so far provided $170 million to the fund.

"Bangladesh is opting for adapting to the climate change impacts as the world's developed nations are not doing enough to cut down carbon emissions," said Forest and Environment Minister Hasan Mahmud in a recent speech in Dhaka. "We want the donors to contribute more to our efforts."

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MALDIVES. The Maldives, an upmarket beach paradise for tourists, has also become a symbol of the dangers of climate change.

Made up of hundreds of islands in the Indian Ocean, it's one of the most low-lying nations in the world, and exceptionally vulnerable to rising seas.

Some scientists have said the Maldives could disappear within decades, and former President Mohamed Nasheed even proposed relocating all 350,000 inhabitants to other countries.

While other researchers say those fears may have been overblown, the country is taking measures to protect itself.

A seawall was built around the capital, Male, after flooding in the 1980s. That wall protected the city from the worst effects of the devastating 2004 tsunami, which temporarily put large swaths of the country under water.

The country's climate adaptation plans call for relocating residents from small vulnerable islands to bigger, better protected ones.

It's also creating new land through land reclamation, expanding existing islands or building new ones, to ease overcrowding. The reclaimed land is being elevated to better withstand rising seas.

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BANGKOK, Thailand. Even before the consequences of climate change became evident, scientists were well aware that Bangkok – whose southern suburbs border the Gulf of Thailand – was under serious threat from land subsidence.

Sea level rise projections show Bangkok could be at risk of inundation in 100 years unless preventive measures are taken. But when the capital and its outskirts were affected in 2011 by the worst flooding in half a century, the immediate trigger was water runoff from the north, where dams failed to hold very heavy rains.

Industrial areas in the capital's suburbs, housing important businesses, were devastated. So the focus was put on a short-term solution for that area.

The government recently announced winning bids totaling 290.9 billion baht ($9.38 million) by Chinese, South Korean and Thai firms to run the flood and water management schemes, including the construction of reservoirs, floodways and barriers.

Solutions to the problem of rising seas are still being studied.

"Construction alone is not sustainable," says Seree Supratid, director of a climate and disaster center at Rangsit University. "People have to adapt to nature. For example, you know Bangkok will be flooded by the rising seas in the next 100 years, then you have to learn to build your houses in a way the floodwater cannot reach it, putting it up high or something."

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CUBA. Officials recently finished a study of the effects of climate change on this island's 3,500 miles (5,630 kilometers) of coastline, and their discoveries were so alarming they didn't immediately share the results with the public to avoid causing panic.

According to the report, which The Associated Press obtained exclusively, rising sea levels would seriously damage 122 Cuban towns or even wipe them off the map by 2100. Scientists found that miles of beaches would be submerged while freshwater sources would be tainted and croplands rendered infertile. In all, seawater would penetrate up to 1.2 miles (2 kilometers) inland in low-lying areas, as oceans rose nearly 3 feet (85 centimeters).

Those frightening calculations have spurred systemic action in Cuba, the largest island in the Caribbean and one that is heavily dependent on beach-loving European and Canadian tourists. In recent months, inspectors and demolition crews have begun fanning out across the island with plans to raze thousands of houses, restaurants, hotels and improvised docks in a race to restore much of the coast to something approaching its natural state.

In the tourist resort of Varadero, the country faces a dilemma: Tearing down seaside restaurants and hotels threatens millions of dollars in yearly tourism revenue, while allowing them to stay puts at risk the very beaches that are the main draw.

___

MBEERE, Kenya. While sea level rise threatens some coastal communities in Africa, the continent faces even bigger climate-related problems inland. Climate scientists have projected shifts in rainfall patterns leading to extended droughts in some areas and increased flooding in other parts. To small-scale farming communities, these shifts could be disastrous, adding further stress to scarce water supplies.

Adaptation therefore is focused on learning to cope with the climatic changes, adjusting farming practices and improving water conservation efforts.

In Kenya's Mbeere district, where people say they're noticing longer dry spells, U.K.-based charity group Christian Aid is teaching farmers to help them predict the seasons and know better what to grow and when to plant.

A text messaging system helps farmers get up-to-date weather reports specific to their locations.

"We are supporting them to access and interpret climate information and help them make forward-looking decisions so that their farming is better suited to the predicted changing conditions," said Mohamed Adow, of Christian Aid. "Farmers live off the land and the weather, and small changes to weather patterns can be a big disaster to small-scale farmers in Africa whose entire livelihoods and well-being depend on farming."

__

Associated Press writers Raphael Satter in London, Jennifer Kay in Miami, Toby Sterling in Amsterdam, Farid Hossain in Dhaka, Bangladesh; Thanyarat Doksone in Bangkok, Paul Haven in Havana and Colleen Barry in Milan, Italy, contributed to this report.

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Mike Weisser: Is the NRA's Opposition to Background Checks Really About the Constitution -- Or Something Else?

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It looks like we may be headed towards Round 2 of the gun control fight in Washington, in which case the NRA will begin kicking and screaming again about how expanding the National Instant Criminal Background Check system (NCIS) will "weaken" the Second Amendment and ultimately lead to the confiscation of guns. But is the argument really about "constitutional rights"? Or is the real argument about something else?

Don't forget that every single gun entering the consumer market for the first time is sold by a federally-licensed dealer to a consumer and every one of these transactions requires a NICS background check. Whether the dealer is sitting behind the counter in a retail store, or sitting behind a table at a gun show, or sitting on the porch of his home, he/she must still dial 877-324-6427 and get a "proceed" from the very efficient NICS examiner before Joe or Jane Customer walks away with the gun. After that, God only knows what happens to the gun, but every first transaction is registered and approved.

The 156 million calls logged by the NICS came from all 50 states, but just under 50 percent of FBI background checks covered residents in just 16 Southern and border states: MD, VA, WV, NC, SC, TN, KY, GA, FL, LA, Al, MS, TX, OK, MO and AR. These states have a combined population of 114 million. In other words, states that contain less than one-third of the nation's population bought half of the guns manufactured and sold since 1998.

Incidentally, the ratio of population to NICS calls actually underestimates the number of guns because when I or any other dealer calls NICS we do not tell them how many guns are actually being purchased by the customer. The NICS data doesn't reflect the fact that if someone walks into my gun shop and purchases one gun, or two guns, or ten guns, I still make only a single NICS call and do not disclose the number of guns being transferred since NICS is verifying background information on the buyer, not on the guns.

With the exception of Maryland, which lies below the Mason-Dixon line but is clearly a "northern" state, the remaining 15 states that gobble up half the new guns sold each year also have the loosest gun controls at the state level. The word "loosest" is something of a misnomer, since the majority of these states, in fact, have no state gun regulations at all. None of them require locking devices on any guns; only one -- Virginia -- imposes any regulations on gun show sales; and only one -- North Carolina -- requires a gun permit issued prior to purchasing a handgun. It goes without saying that none of them mandate any legal requirements over private sales.

Of the remaining 34 states, there are 21 that have regulations covering either gun locks, gun shows or private transfers. Most of the other 13 states that impose no restrictions are Western states which, for the most part, account for a small percentage of national gun sales simply because these states don't have many residents. Montana, for example, is one of three states in which the number of NICS checks between 1998 and 2012 exceeded the total number of residents, but Montana still doesn't have one million people who call the state their home.

Common sense and practical experience tells us that when government regulates any consumer product, either the price goes up or the supply goes down, or both. Fighting against regulations that would be imposed on the gun owners of all 50 states might appear to be a Constitutional issue, but it's a marketing strategy as well. The gun industry and its allies want to push as many guns as possible into parts of the country where government regulation won't dampen sales. The Second Amendment not only protects the rights of individuals to own guns, it also protects the rights of manufacturers to make more guns. Does laissez-faire trump gun control? If the Manchin-Toomey bill is resurrected, we'll soon find out.

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Wyclef Jean: I Didn't Perform At The RNC Because I Don't Support Republicans (VIDEO)

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Grammy Award-winning hip-hop artist, producer and politician Wyclef Jean talks with Marc about his decision not to perform at the Republican National Convention.

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U.S Open 2013, Merion Golf Club: In Final Round, Phil Mickelson And Tiger Woods Take On Merion At The U.S. Open.

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Mickelson will begin the day at Merion Golf Club with a one-shot lead over playing partner Hunter Mahan, Charl Schwartzel and Steve Stricker.

Tiger Woods, on the other hand, will tee off more than three hours behind the leaders and look to make his first charge of the week for a respectable finish, trying to put Saturday's dismal 76 behind him.

We'll keep you updated on the top developments throughout the final round at Merion Golf Club - and scroll down for our previous coverage of U.S. Open week.

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Marwin Meier: G8: It's Time to Be Accountable for Ending Child Deaths

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FRANKFURT, GERMANY -- Little Omar is not agreeing to the routine medical treatment. But what little 11-month old child likes being dragged from his mom, laid on a measuring board and being prodded in the belly by a stranger? Omar vents his disagreement to the entire maternal and child health clinic here in Garowe, the regional capital of Puntland, Somalia.

Omar's mom, however, is happy for the support she is receiving from the government health-workers that monitor the recovery of her little boy. Every two weeks she comes to the clinic to have Omar checked, receive two weeks' worth of therapeutic feeding paste and be counseled on child nutrition. This is a community-based nutrition project jointly run by World Vision in Somalia and the Somalian government. The aim is to treat undernourished children at home, supporting moms with knowledge and therapeutic food, and alleviating a thinly-stretched to non-existing health system.

Recent numbers published by the UN show that the human death toll of the Horn of Africa hunger was much higher for Somalia than thought previously. In total 258,000 Somalis lost their lives during the 2010-2012 famine of which more than half, 133,000, were children under five years. This surpasses even the numbers of the terrible hunger in 1992-93.

As we approach this year's G8 Summit, the news on children and nutrition is not good. A recently published study series by the British medical journal The Lancet shows that we have underestimated the effects of undernutrition on child mortality, and approximately 45 percent of child deaths before their fifth birthday are now attributed to lack of enough or nutritious food as underlying cause, leading to a staggering 3.1 million children losing their young lives in 2012 alone to a cause we know very well how to prevent and treat.

At the 2009 G8 Summit held in the ruins of the heavily earth-quake affected Italian town of l'Aquila, the G8 and partners promised to spend $22 billion on food security by the end of 2012. Yet they have disbursed less than three quarters of that amount. At a time when child mortality could be dropping much faster, the recently published accountability report for the G8 gathering in Lough Erne, UK next week doesn't even contain a section on nutrition, exposing the G8 as giving less focus to this huge child killer at a time when all the evidence points to nutrition being pivotal in our efforts to attain the Millenium Development Goals (MDGs). Well, roughly 900 days before the end-date of the MDGs we're still off track to reduce the target of reducing child deaths to 4 million per year and we know now more than ever the critical contribution of nutrition to reaching this goal.

This is no time for complacency and the good news is that we know exactly what works and what it could mean for the lives of children such as little Omar. This is why at last weekend's Nutrition for Growth Summit in London, World Vision pledged to invest $1.2 billion by 2020 in its nutrition programs. But what is really needed now is a concentrated effort by the donors and the German pledge of $200 million is just not enough. We have had much G8 rhetoric around nutrition and food security over the last several years and the renewed interest in this quintessential intervention for human development is good, but needs to be backed up by a transparent accountability framework that can trace every promised dollar. Whether to report on progress made cannot be left to the gusto of a given G8-host, it must become part and parcel of every G8 accountability report. This we owe to the vulnerable little ones like Omar and his mom, who left the clinic with better knowledge and a two-week ration of therapeutic food thanks to a successful cooperation of a thoughtful donor, a cooperative government and a supportive development organization. We need more of this!

This post is part of a series produced by The Huffington Post and the NGO alliance InterAction around the G8 summit being held in Northern Ireland, June 17-18. For the next eight days, we will be featuring one post from an NGO based in each of the G8 countries -- this piece is from Germany -- and then one blog from the vantage point of the developing world. To see all the posts in the series, click here. For more information on InterAction, click here. And follow the conversation on Twitter with hashtag #DearG8.

Photo: Courtesy of World Vision

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Bjørn Lomborg: How Free Trade Might Be the World's Best Option

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British Prime Minister David Cameron has rightly put free trade on the top of the G8 agenda. It is possibly one of the best ways we could help the world foster economic prosperity and development.

Cameron writes that comprehensive free trade "could boost the income of the whole world by more than $1 trillion." As it turns out, this is likely a serious understatement.

The classic argument for free trade points out that specialization and exchange benefits everyone, because goods are produced by the countries that specialize in those goods and produce them most efficiently. The standard World Bank models show that realistic free trade, even just by the end of this decade would increase global GDP by several hundred billion dollars per year, with perhaps $50 billion accruing to the developing countries. Towards the end of the century, the annual benefit will likely exceed Cameron's $1 trillion annually, with half going to the developing world.

But a growing number of academic studies now show that the free trade story goes much further than simple specialization. History shows that open economies grow faster. Good examples include Korea from 1965, Chile from 1974 and India from 1991, which all saw their growth rates increase significantly after liberalization. Even modestly freer trade helps domestic markets become more efficient and get supply chains better integrated. At the same time trade transfers knowledge, which spurs innovation. Free trade means we don't all have to reinvent the wheel over and over again.

This is perhaps best captured in a recent state-of-the-art literature review by Professor Kym Anderson for the Copenhagen Consensus think tank. Anderson, one of the World Bank's lead modelers, shows that the long-run benefits from even a modestly successful Doha free trade round would be vast. The annual GDP compared to no extra free trade would in 2020 be about $5 trillion larger, with $3 trillion going to the developing world. Towards the end of the century, slightly higher growth rates will have accumulated to benefits exceeding $100 trillion annually, with most going to the developing world. By then, benefits would add about 20 percent annually to developing world GDP.

It is hard to imagine any other policy that the leaders of G8 could advocate that would generate more prosperity and development in the world. Recall the UK's last G8 summit where Tony Blair promised to fight global warming. Even if the G8 leaders had been successful -- which they predictably were not -- economic models show that they could perhaps have avoided a fraction of one percent of GDP damages towards the end of the century. An outcome orders of magnitude less beneficial, much less achievable and likely with an astonishingly higher price tag.

While the benefits of global free trade seem so starkly obvious to the world, it is also clear that vested interests, especially in agriculture, fight for their privileges. About 40 percent of government expenditure on global subsidies goes to agriculture. Despite farmers comprising a very small proportion of the population in developed countries, agricultural interests seem to have a stranglehold over OECD governments to keep their $252 billion in annual support.

Protecting inefficient agriculture from competition may seem politically convenient but it has huge costs. It means higher food prices which harms consumers. And it ignores one of the most amazing opportunities to grow the developing world and ensure development.

Yet, there are many reasons we need to get farmers and others off subsidies. Even with austerity, the EU's Common Agricultural Policy makes up the biggest share of the EU budget, costing 363 billion euro between 2014 and 2020. The upcoming U.S. farm bill might waste $950 billion over the next decade.[viii] Here, the G8 should take the creative and courageous steps necessary. For example, it could compensate entrenched interests for their losses over the next decade or two, while it phases out subsidies and other trade distortions. This cost would run to another $50 billion per year globally, but would be a miniscule price to pay for the benefits yielded by free trade -- for every dollar spent, the world would see much more than a hundred dollars of long-term growth benefits.

Kick-starting the global free trade agenda would be an ambitious and monumental legacy for the G8, paving the way for negotiations between the EU and USA, and for the WTO meeting in Bali at the end of 2013. The vast majority of the world's people would benefit today and tomorrow from free trade. We have the opportunity to help the world's poor, and help ourselves, if we can just muster the courage.

Bjørn Lomborg is the author of The Skeptical Environmentalist and Cool It, director of the Copenhagen Consensus Center, and adjunct professor at Copenhagen Business School. Lomborg's new book How to Spend $75 Billion to Make the World a Better Place was published on June 1.

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Griffin Ship Search Is On As Divers Look Around Lake Michigan

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ON LAKE MICHIGAN NEAR POVERTY ISLAND, Mich. — Divers began opening an underwater pit Saturday at a remote site in northern Lake Michigan that they say could be the resting place of the Griffin, a ship commanded by the 17th century French explorer La Salle.

U.S. and French archaeologists examined sediment removed from a hole dug near a timber slab that expedition leader Steve Libert discovered wedged in the lakebed in 2001. They found a 15-inch slab of blackened wood that might have been a human-fashioned "cultural artifact," although more analysis will be required to determine whether it was part of a vessel, project manager Ken Vrana said.

Libert, who has spent about three decades searching for the Griffin (also known by its French equivalent Le Griffon), said he hoped that by Sunday, the excavation would reach what sonar readings indicate is a distinct shape beneath several feet of sediment. The object is over 40 feet long and about 18 feet wide – dimensions similar to those the Griffin is believed to have had, Vrana said.

But he said it was too early to declare the site a shipwreck, let alone the object of their quest.

"Soon we will find out whether our assumption is correct or not," Vrana said aboard the Proud Maid, a 45-foot commercial fishing boat that ferried journalists and crew members to the search area near Poverty Island in Michigan waters north of the entrance to Green Bay. "We've got to get those test pits dug and hit (the) structure, because anything else is pure speculation."

After meeting with team members Saturday night, he told reporters that "within a couple of days we should know" whether a ship graveyard lies beneath the surface.

Although Libert and his associates have dived at the site numerous times and conducted several surveys with remote sensing equipment, they hadn't conducted archaeological excavations until receiving a permit from the Michigan Department of Natural Resources this month after years of legal squabbles. The agency claims ownership over all Great Lakes shipwrecks in the state's waters, although it acknowledges France would have rights to the Griffin because it was sailing under the authority of King Louis XIV.

Taking part in the dive Saturday were Michel L'Hour, director of the Department of Underwater Archaeological Research in the French Ministry of Culture and a noted authority on shipwrecks, and associate Olivia Hulot. The U.S. leaders said they hoped the visitors, with their knowledge of design and construction features of French ships from the 17th and 18th century, could help confirm whether the Griffin had been found.

"The Griffin is very important to the early history of America," L'Hour said in an interview before taking his first look at the site. "If this is the Griffin, it will teach us many things."

Rene Robert Cavelier de la Salle ordered the Griffin built near Niagara Falls in 1679 to support his quest for what was widely – but erroneously – believed to be a passageway to China and Japan. It was the first European-style vessel to traverse the upper Great Lakes, crossing Lake Erie and venturing northward to Lake Huron, then across Lake Michigan to the eastern shore of modern-day Wisconsin.

La Salle ordered the ship to return for more supplies and to deliver a load of furs, while he continued his journey by canoe. The Griffin was never heard from again. There are various theories about its fate, but none that have been proven. Libert, who spent years studying the writings of La Salle and a companion, believes it sank in a fierce storm only a few miles after setting sail.

Libert said Saturday the recovery of the slab of wood and prospects for reaching what may be the ship's hull shortly were promising signs.

"Right now I'm pretty excited, from what I know so far," he said, but added: "Scientific (proof) is 100 percent. It's not 99.9 percent."

___

Follow John Flesher on Twitter at http://twitter.com/JohnFlesher

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4 Lebanese Shiites Killed In Ambush Near Syria

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AMMAN, Jordan -- Sunni extremists blew up a Shiite mosque in a village in eastern Syria stormed by rebels earlier this week, another sign of the growing sectarian hatred in the country's civil war, activists said Sunday.

They said al-Qaida's affiliate in Syria carried out the destruction. It showed the determination of extremists to drive Shiites out of the village of Hatla in the Deir el-Zour region near Iraq. Last week rebels battled pro-regime militiamen there, killing more than 60 Shiite fighters and civilians, according to activists.

In Lebanon, gunmen deployed in the streets of the northeast and set up roadblocks in protest following the killing of four Lebanese Shiite men in an ambush, security officials said Sunday.

The security officials, speaking on condition of anonymity in line with regulations, said the four were found dead in the Wadi Rafeq area between Ras Baalbek and al-Qaa near the border with Syria.

They said the men were from the powerful Jaafar and Amhaz clans, triggering fears of retaliation.

It was not immediately clear how they were killed or what the motive was, but Sunday's ambush is believed to be related to sectarian tensions related to the Syrian civil war.

Tensions between Sunnis and Shiites in Lebanon increased after the Shiite Iranian-backed Hezbollah openly joined the fight in Syria on the side of President Bashar Assad.

Most Sunnis in Lebanon support the mostly Sunni rebels fighting to oust Assad.

In amateur videos of the mosque destruction in Syria, fighters walked into the mosque in Hatla and trampled on books, some with covers showing pictures of Shiite clerics. The videos then showed an explosion that brought down the building.

Sunday's video posted on the Internet appeared genuine and corresponded with other Associated Press reporting from the area.

Rami Abdul-Rahman, director of the Britain-based Syrian Observatory for Human Rights, said that the mosque was demolished Friday, three days after the battle. Other videos that emerged earlier have showed rebels cursing Shiites and suggested fighters had burned Shiite homes.

"It's clear that they want to root out Hatla's Shiite inhabitants," he told The Associated Press.

The town is home to several thousand people, about 30 percent of them Shiites. It was considered a pro-regime community in the Euphrates River valley, where rebels – including the al-Qaida-linked group Jabhat el-Nusra – have taken over much of the surrounding territory.

The Syrian uprising began more than two years ago with peaceful protests against President Bashar Assad, but later grew into a civil war that has killed 93,000 people and probably many more, according to the U.N.

Most of the armed rebels in Syria are from the country's Sunni majority, while Assad has retained core support among the minorities, including his own Alawite sect, an offshoot of Shiite Islam, along with Christians and Shiites.

In the past year, sectarian bitterness has grown in the conflict. Each sect has been accused of massacres against the other, and Sunni and Shiite fighters from other countries have increasingly joined the battle.

The prolonged civil war has frayed Syria's traditional relations with Jordan and Egypt.

Jordan's King Abdullah II told graduating military cadets Sunday that his forces were ready to fend off any Syrian threats.

Abdullah said Jordan "will emerge victorious in the face of all challenges, the way we always have in the past." His country hosts more than 500,000 Syrian refugees.

Jordan, which backs the rebels against Assad's rule, is concerned that the Syrian president may ultimately attack his neighbors with chemical weapons or that the weapons might fall into the hands of militants if the regime collapses.

Jordan is hosting multinational military exercises involving thousands of U.S. troops. The U.S. has also agreed to install Patriot missiles along Jordan's 375-kilometer (235-mile) border with Syria and is allowing a squadron of 12 to 24 F-16 fighter jets to remain after the exercises.

Also Sunday, a Syrian official said Egypt's decision to cut off diplomatic ties with his country is "irresponsible."

His statement, broadcast on Syria's state TV, came a day after Morsi told supporters in Cairo that his country is severing ties with Damascus and closing its embassy there. Morsi's decision followed calls from hard-line Sunni clerics in Egypt and elsewhere in the region to launch a holy war against Assad's regime.

Morsi also called for a no-fly zone over Syria.

The unnamed Syrian official charged that Morsi's call was a violation of Syria's sovereignty "and serves the goals of Israel and the United States."

____

Associated Press writers Sarah El Deeb and Zeina Karam in Beirut contributed to this report.

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10 States Where People Hate Going To Work: 24/7 Wall St.

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24/7 Wall St.: Less than a third of the nation’s workers were actively engaged in their jobs last year, according to a Gallup report released this week.

Gallup’s State of the American Workplace showed that an additional 18% were actively disengaged from their jobs. These workers, according to Gallup, were “more likely to steal from their companies, negatively influence their coworkers, miss workdays, and drive customers away.” In Rhode Island, more than one in five workers was actively disengaged. Based on Gallup’s 2012 survey data, these are the 10 states where people hate going to work.

(Click here to see the 10 states)

Unemployment tends to be higher in the states with the most disengaged workers. Of the 10 states on our list, seven had higher-than-average jobless rates. This includes Rhode Island, which had the third highest unemployment rate in 2012. All 10 states with the smallest proportion of disengaged workers had below-average unemployment in 2012.

This makes sense, explained Jim Hartner, Gallup’s chief scientist. “It might just be a reflection of stable business in those areas, where they’re flourishing and they’re hiring, as opposed to laying people off.” People are more likely to enjoy working at a successful business, he added. They also are more likely to be able to get an interesting job in a state with more job opportunities.

The states where workers are least satisfied were much less likely to have good work environments. All 10 had below-average percentages of workers using their strengths at work. Workers in these states were also among the least likely to report that their supervisor created a trusting environment. Four of the five states with the lowest worker satisfaction levels also had the highest rates of actively disengaged workers.

“When people that are engaged come to work, they know what’s expected, they feel comfortable in the job that they’re in,” Hartner explained. “They feel they have a manager that helps support them and helps develop them.”

Being engaged at work is an important part of an emotionally healthy life. The least-engaged workers tended to be the least likely to report being happy overall. Of the 10 states with the most disengaged workers, eight scored below average for overall emotional health.

24/7 Wall St. reviewed the 10 states with the highest proportion of workers deemed to be “actively disengaged” based on surveys conducted last year by Gallup for its State of the American Workplace report. In addition, we reviewed emotional health and workplace satisfaction data collected by Gallup and Healthways for their annual Well-Being Index, as well as 2012 job market figures from Gallup’s State of the States report. We also considered annual average unemployment rates for 2012, collected from the U.S. Bureau of Labor Statistics.

These are the 10 states where people hate going to work, according to 24/7 Wall St.:

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> Pct. actively disengaged: 19.3% > Pct. engaged: 31.7% (16th highest) > 2012 Unemployment rate: 7.3% (25th highest) > Work environment: 13th worst Workers in West Virginia were among the least likely to say that they were satisfied with their job or that they used their strengths at work. No state was rated worse for emotional health. West Virginians were sadder, angrier and more stressed than Americans living anywhere else last year. Despite all this, and the fact that 19.3% of workers in West Virginia were actively disengaged, 31.7% of employees stated they were engaged in their work — above the 30.3% nationwide. (Read more at 24/7 Wall St.)

> Pct. actively disengaged: 19.5% > Pct. engaged: 27.7% (5th lowest) > 2012 Unemployment rate: 8.9% (10th highest) > Work environment: 23rd worst Only 27.7% of workers in Illinois indicated engagement with their work in 2012, the fifth lowest percentage of all states. Nearly 22% of employees did not think their supervisor created a trusting environment, among the highest percentages of all states. Like most states on this list, joblessness has been more of an issue for Illinois than the country as a whole. The state’s 8.9% unemployment rate in 2012 was among the top 10 in the country. Meanwhile, the underemployment rate of 19.2% was well above the national 17.5% rate. (Read more at 24/7 Wall St.)

> Pct. actively disengaged: 19.6% > Pct. engaged: 28.7% (15th lowest) > 2012 Unemployment rate: 9.1% (8th highest) > Work environment: 16th worst Michigan had one of the nation’s highest unemployment rates in 2012, at 9.1%. According to Gallup, last year only 41% of the population worked full time for an employer, one of the lowest figures in the nation. Worse, nearly 20% of residents were underemployed, meaning they wanted a full-time job but had either only part-time work or none at all. This was also among the highest rates in the United States. Possibly because of the lack of desirable work, many employees were stuck in jobs they found unsatisfying. Only the residents of four states were more likely to tell Gallup they were unsatisfied with their job. (Read more at 24/7 Wall St.)

> Pct. actively disengaged: 19.6% > Pct. engaged: 28.6% (14th lowest) > 2012 Unemployment rate: 8.5% (13th highest) > Work environment: 6th worst Among all Americans polled, New York residents were the least likely to indicate they were satisfied with the job. Moreover, a smaller proportion of New York workers felt their supervisor created a trusting environment than any other state except Connecticut. New York was one of just two states actually to see an increase in unemployment between 2011 and 2012. The unemployment rate in New York was 8.5%, among the highest in the country. This could be weighing down on New Yorkers in their overall well-being, as New Yorkers were the least likely Americans to tell Gallup they had recently been happy. (Read more at 24/7 Wall St.)

> Pct. actively disengaged: 19.7% > Pct. engaged: 26.9% (2nd lowest) > 2012 Unemployment rate: 5.0% (4th lowest) > Work environment: 24th worst Unlike other states where a high percentage of workers were actively disengaged in their job, Vermont had an especially low unemployment rate. Last year, just 5.0% of Vermont workers were unemployed, versus 8.1% across the United States. But while the state’s job market was especially strong, just under 27% of workers were engaged in their job — less than all but one other state. While a large proportion of workers said they were satisfied in their jobs, residents were among the least likely to claim they used their strengths at work, were treated like a partner, or worked in a trusting environment. (Read more at 24/7 Wall St.)

> Pct. actively disengaged: 19.8% > Pct. engaged: 32.1% (15th highest) > 2012 Unemployment rate: 8.2% (18th highest) > Work environment: 20th worst Compared to most states, a smaller proportion of Kentuckians reported satisfaction with their job or that they were treated with respect in the past day. Less than 58% of Kentuckians said they learned something new or interesting in the past day, the second lowest percentage of all states. Fortunately for Kentucky, more workers reporting feeling engaged than most states. (Read more at 24/7 Wall St.)

> Pct. actively disengaged: 20.0% > Pct. engaged: 28.6% (13th lowest) > 2012 Unemployment rate: 7.9% (21st highest) > Work environment: 17th worst Pennsylvania was one of just four states in which at least one in five workers claimed they were actively disengaged in their work. At 7.9% unemployment rate last year, the state was one of just two on this list — along with Vermont — that had an unemployment rate below the national number. Despite its relatively good employment picture, residents still had negative assessments of their work environment. Residents were less likely than most Americans to report having used their strengths at work or were treated like a partner. (Read more at 24/7 Wall St.)

> Pct. actively disengaged: 20.0% > Pct. engaged: 28.3% (9th lowest) > 2012 Unemployment rate: 9.5% (5th highest) > Work environment: 2nd worst Just 28.3% of New Jersey workers were engaged with their work, the ninth lowest percentage of all states. A lower percentage of workers indicated that they were satisfied with their job than any other state except for New York. In addition, the proportion of New Jersey workers who said they were able to use their strengths at work was lower than all but two other states. The unemployment rate in 2012 was 9.5%, the fifth highest in the country and up from 9.4% in 2011. (Read more at 24/7 Wall St.)

> Pct. actively disengaged: 20.2% > Pct. engaged: 28.5% (11th lowest) > 2012 Unemployment rate: 8.4% (15th highest) > Work environment: 22nd worst Connecticut’s gross domestic product shrank by 0.1% in 2012, according to the Bureau of Economic Analysis, making it the only state where output did not rise last year. Although the state’s 8.4% unemployment rate was only slightly worse than the 8.1% national rate, by some measures Connecticut’s job market was one of the nation’s worst. The state received one of the lowest scores from Gallup for job creation in 2012. Just 29.9% of workers claimed their employers were hiring, among the lowest figures in the nation last year, while 19.2% claimed their employers were letting people go, among the highest in the nation. (Read more at 24/7 Wall St.)

> Pct. actively disengaged: 21.0% > Pct. engaged: 27.7% (6th lowest) > 2012 Unemployment rate: 10.4% (3rd highest) > Work environment: The worst No state had a higher percentage of workers that were actively disengaged than Rhode Island. Meanwhile, only 27.7% of workers were engaged, among the lowest in the country. The proportion of Rhode Island workers who indicated satisfaction with their job was lower than all but three other states. Rhode Island was the only state where less than 80% of workers indicated that they used their strengths at work. The unemployment rate in Rhode Island was 10.4% in 2012, higher than all but two other states. (Read more at 24/7 Wall St.)

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