“Surprisingly, this age group has the highest rate of smoking compared to any other age group,” psychology professor Robin Mermelstein, principal investigator of the 5-year study, noted in a UIC podcast. “In fact, smoking starts to escalate between the ages of 18 and 24, and even though many young adults think about quitting and actually want to stop, they have among the lowest rates of quitting and trying to quit.”

When young adult smokers do try to kick the habit, Mermelstein said, “they tend not to use what we know works. A lot of young adults don’t actually think that treatments work or they think they are better off using home-grown or naturalistic kinds of approaches and tend to shun evidence-based approaches.”

Mermelstein and colleagues at UIC, in partnership with the University of Iowa and the American Legacy Foundation, will work with the GDS&M Idea City advertising agency to develop interactive, Internet-based ads and evaluate what messages motivate young smokers to use BecomeAnEx.org.

“This is a very effective and engaging evidence-based stop smoking program developed by the American Legacy Foundation,” Mermelstein noted. “To reach young adult smokers, you have to go where they are and the Internet is it,” Mermelstein said.

Another key goal of the project, Mermelstein said, is to find strategies to build their motivation; to get the young adult smoker to think “now is the time to quit — not 5 years from now, not 10 years from now, but right now.”

The nationwide study will enroll more than 3,000 young smokers via the Internet, recruiting through sites like Craigslist.

“Compulsory HIV testing and forced sterilization are counter-productive to the Rwandan government’s goal of improved reproductive health,” said Joe Amon, health and human rights director at Human Rights Watch.

“Provisions in the current bill that increase stigma, rely on coercion, and deny individuals their reproductive rights should be removed,” he said.

The reproductive health bill provides for HIV testing for all individuals who plan to marry, as well as for testing upon the request of a spouse.

A child or incapacitated person may be tested by a doctor without seeking consent, who may then show the result to parents or guardians.

HRW pointed out that mandatory HIV testing and disclosure have been condemned by the UN as a violation of privacy.

The group said “mandatory testing and compulsory disclosure can put women at increased risk of abuse and undermine public trust in the health care system.”

The draft legislation would also oblige the Rwandan government to “suspend fertility for mentally handicapped people,” the rights group said.

“Systematic forced sterilization had been recognised as a crime against humanity by the Rome Statute of the International Criminal Court,” it said.

WHO brought together over 20 independent experts beginning Wednesday for the three-day meeting in Geneva.

“They will be working together to describe and predict the behavior and impact of the pandemic, and demonstrate potential outcomes of proposed intervention efforts,” spokeswoman Aphaluck Bhatiasevi told The Associated Press.

The meeting comes as it becomes clearer that actual case numbers may be far higher than the agency’s tally of officially diagnosed infections.

According to WHO’s latest update Wednesday, a total of 77,201 confirmed cases and 332 deaths have been reported in over 110 countries.

But U.S. health officials said last week the number of Americans infected with the new A(H1N1) virus may be as high as 1 million. The estimate by the U.S. Center for Disease Control and Prevention was based on mathematical modeling and surveys by health officials.

“We’re now probably off by orders of magnitude in terms of the real number of cases versus the number of diagnosed cases,” said Andrew Pekosz, a flu expert at Johns Hopkins University in Baltimore.

In countries where the virus has firmly established, counting individual cases doesn’t paint an accurate picture of the disease anymore, he said.

Still, information about confirmed infections can be fed into mathematical models to predict future developments and detect anomalies.

“A jump from one patient to 60 patients isn’t a concern, but a jump from one to 300 shows you there’s something going on that needs to be looked at carefully,” said Pekosz.

On the other hand, “if you’ve got 100 cases and then week later you’ve got 150, most mathematical models would indicate that either the infection in your country isn’t behaving normally, or you’re not diagnosing all the cases that are occurring.”

WHO’s Bhatiasevi said the experts would be looking not just at case numbers, but also at how many severe infections have occurred and which measures have helped stem the spread of the disease.

This will help WHO advise countries on how to respond to the pandemic and target their supply of anti-viral medication and later vaccines, when those become available.

During the outbreak of SARS in Asia and foot and mouth disease in Britain mathematical models were applied after the event, said Pekosz.

Swine flu may offer the first opportunity to apply the formulas as a pandemic is occurring, he said.

Shares of the French drugmaker, which have stumbled in the past week over Lantus concerns, rose 3.1 percent in Paris after the FDA also said patients should not stop taking their therapy without consulting a physician.

In a communication posted on its website, the agency questioned four recently published studies over the cancer link, saying they did not track patients long enough to properly evaluate any such risk from the drug.

Additionally, the FDA said, “inconsistencies in findings within and across individual studies raise concerns as to whether an association between the use of (Lantus) and cancer truly exists.”

It added that there may be differences in the patients studied that could have contributed to the studies’ findings.

Shares of the French drugmaker have plunged about 13 percent in the last week amid concerns that patients and doctors worried about Lantus’ safety would stop using the product and turn to rival treatments such as Novo Nordisk’s long-acting insulin Levemir.

Lantus is a top seller for Sanofi, and it is seen as particularly important as other key Sanofi products — blood thinners Plavix and Lovenox — face possible generic competition. Lantus tallied 2.45 billion euros ($3.5 billion) in 2008 sales, a figure analysts have expected to grow over the next five years.

Dr. Richard Bergenstal, president-elect of medicine and science with the American Diabetes Association, said it appears the FDA was taking the risk posed by the Lantus studies “seriously but cautiously.”

“I do think they were saying when you get confusing data or conflicting data, don’t make clinical decisions until we get more,” Bergenstal said.

Sanofi has stood behind the safety of its diabetes drug, and a company spokesman in Paris said on Wednesday it was “committed to working with the FDA and other health authorities and scientific experts to clarify the situation.”

The FDA said it would continue reviewing the safety data for Lantus, including the new studies, to better understand any possible cancer risk.

Earlier this week, the European Medicines Agency said it was asking its scientific experts to perform a detailed assessment of the European studies’ results and any other relevant information, since a link between Lantus and cancer “cannot be confirmed nor excluded.”

Mark Dainty, an analyst at Citigroup, said the stock’s recent drop meant the market was already discounting a worst-case scenario.

But the actual decline in Lantus sales might not be as severe as the 60 percent drop seen in global sales of GlaxoSmithKline’s Avandia, which was linked to heart attack risk in 2007, he said.

“Our data add to evidence that environmental influences during intrauterine life alter the trajectory of skeletal development in the offspring,” study presenter Dr. Zoe Cole of the University of Southampton told Reuters Health.

When the researchers assessed the diets of 198 pregnant women, two general patterns began to emerge. The first was a healthy dietary pattern filled with lots of fruits and vegetables, yogurt, whole wheat bread and breakfast cereals. The second diet pattern was less healthy and included large amounts of foods such as chips and roast potatoes, sugar, white bread, processed meat, tinned vegetables and soft drinks.

Bone assessments of the children made up to age 9 years suggested that consuming a healthy maternal diet was associated with greater bone size and density in the offspring.

“Children born to mothers with the healthiest diets, as identified by in the highest quarter of prudent diet score, during late pregnancy had an 11 percent greater whole body bone mineral content and 8 percent great whole body bone area than those born to mothers with the least healthy diet, the lowest quarter of this distribution,” Cole said.

Even when mothers were grouped by smoking status, vitamin D status and social class, the differences in diet still had a significant impact on their children’s bones, the researchers found. The relationship between a healthy maternal diet and healthier bones in offspring remained even after the child’s height, weight, arm circumference and birth weight were considered.

“A healthy diet during pregnancy has long lasting effects on the development of the child’s bones,” Cole said, and this may lower their future risk of osteoporosis, a potentially disabling bone-thinning disease.

Nonpharmacological interventions such as acupuncture, Montessori methods, and massage have all been used to manage agitation and promote relaxation in patients with dementia, the authors explain. A number of studies have tested the effects of these approaches, but the studies had significant limitations.

Dr. Li-Chan Lin from National Yang-Ming University, Taipei, and colleagues explored the effectiveness of acupressure and Montessori-based activities in decreasing agitated behaviors of 133 institutionalized residents with dementia. This was compared with the potentially calming presence of a visitor who acted as a control. All participants underwent all three treatments in three different sequences.

Acupressure daily (6 days weekly) for 4 weeks significantly decreased overall agitated behaviors, the authors report, especially in the Cohen-Mansfield Agitation Inventory (CMAI) subcategories of physically nonaggressive and physically aggressive behaviors.

Montessori-based activities on the same schedule significantly improved aggressive behavior and physically nonaggressive behavior, the researchers note.

Although neither approach decreased verbally agitated behaviors, Montessori treatment was associated with a significant increase in positive affect.

Nurses’ aides noted that ease of care improved when they assisted residents with eating, toileting, bathing, grooming, sleeping, walking, and various other activities after the acupressure or Montessori-based activities.

“This study confirms that a noninvasive, traditional Chinese medical procedure, acupressure, coupled with a Western activities program, could be useful in caring for people with dementia and that in-service training for formal caregivers in private and institutional settings would be beneficial,” the investigators conclude.

With Congress out of session for a week, Obama urged participants at a question-and-answer session in a Washington suburb to be wary of “scare tactics” and hugged a woman who said she did not have health insurance or money of her own to treat a tumor.

“You are what is going to drive this process forward. Because if Congress thinks that the American people don’t want to see change, frankly, the lobbyists and the special interests will end up winning the day,” Obama said at the meeting, which featured questions posed on YouTube and a parallel discussion on the White House Facebook page.

Obama has challenged Congress to send him legislation by the end of the year that will rein in rising healthcare costs and extend insurance to most of the 46 million Americans who lack it.

Obama hopes his top legislative priority will attract support from both parties, and on Tuesday received a welcome boost when Wal-Mart Stores Inc, the world’s largest retailer, said it supported Obama’s push to require large employers to offer healthcare insurance to workers — a key part of the plan.

But an important Republican lawmaker on Wednesday said bipartisan support might not materialize if the Democrats who control both houses of Congress insist on creating a public plan to compete with private insurers, as Obama wants.

“Obviously, I’m not going to be a part of any effort of the government to take over health care in America,” Senator Charles Grassley, the top Republican on the Senate Finance Committee, said on a conference call.

REPUBLICAN SUPPORT

The Finance Committee is one of five panels in the Senate and the House of Representatives that are drafting healthcare legislation, and its version is viewed as the one that has the best chance of winning Republican support.

Obama has sought to build pressure on lawmakers by mobilizing grass-roots supporters and holding several question-and-answer sessions with voters.

But the extent of public support is unclear.

A CNN poll released on Wednesday found that a bare majority, 51 percent, support his healthcare plan and most worry that it would require them to pay more.

A separate Quinnipiac University poll found that 69 percent back Obama’s proposal to make a public plan available, and 49 percent would be willing to pay more for healthcare.

At Wednesday’s session, Obama said he would prefer to pay for reforms by ending subsidies for private insurers and reducing tax exemptions for the nation’s wealthiest rather than taxing health benefits as some Republicans have suggested.

He urged voters to be wary of “scare tactics” put forward by opponents. People will not be forced to switch to a government program, he said, and costs will not suddenly increase.

“Don’t let people scare you out of reforming a system that we know is not working,” Obama said.

Soaring healthcare costs undermine the competitiveness of U.S. businesses, strain state and federal budgets and drive many Americans into bankruptcy.

Virginia residents who get insurance through their employer pay an average of 24 percent of the total cost, the highest rate in the nation, according to 2006 figures from the Kaiser Family Foundation.

The Food and Drug Administration (FDA) ordered Pfizer, which makes Chantix, and GlaxoSmithKline, maker of Zyban, to place a warning highlighting the “risk of serious mental health events” when taking the drugs, including behavior changes, depression, hostility and suicidal thoughts.

“The risk of serious adverse events while taking these products must be weighed against the significant health benefits of quitting smoking,” said Janet Woodcock, director of the FDA’s Center for Drug Evaluation and Research.

Doctors prescribing the two smoking-cessation drugs should also monitor their patients for any unusual mood or behavioral changes after the medicines are taken, she added.

However, Woodcock stressed that the products “are effective aids in helping people quit” smoking, the leading cause of preventable disease and death in the United States.

Pfizer said it had updated its labeling of Chantix using the FDA guidelines, noting it had made the information available “immediately” to US healthcare providers and patients.

“The benefits of Chantix outweigh the risks for many patients when used as directed,” Briggs Morrison, a senior vice president at Pfizer, said in a statement.

Although the cause for the association between the drugs and the mental problems was unknown, the FDA said that some of the symptoms may be due to patients experiencing nicotine withdrawal, although some patients experienced the symptoms while still smoking.

The FDA also required the manufacturers to conduct a clinical trial to determine how often patients using smoking cessation therapies experience serious neuropsychiatric symptoms, noting that the agency had not found a clear link between the medications and suicidal events.

Three studies by a multinational group of researchers analyzed the DNA of 10,000 people with schizophrenia, and 20,000 without, and found 30,000 common gene variations linked with the mental illness.

They also show just how complex such diseases are, the researchers told a news conference.

“It’s like we’ve got a ’join-the-dots picture’, and we now know we have several thousands of dots to be joined,” Mick O’Donovan of London’s Institute of Psychiatry, who worked on one of the studies, told reporters.

“But we don’t even have numbers on them yet so we don’t know in what order to connect them up.”

The scientists stressed that although the large scale of the combined studies meant their results were robust as building blocks, they could not be used yet to predict an individual’s risk of developing the disease.

“We are far away from being able to tell a family: ’Your child will develop schizophrenia’ or not,” said Pablo Gejman of North Shore University Health System Research Institute in Evanston, Illinois, who worked on one study.

O’Donovan said it would be “entirely unscrupulous” for the studies’ findings to be used to offer any kind of genetic test.

DEVASTATING DISEASES

Schizophrenia is a chronic and often devastating psychiatric disorder that affects about one in 100 people.

Patients experience hallucinations and disordered thinking and although some antipsychotic drugs, such as AstraZeneca’s Seroquel and Eli Lilly’s Zyprexa, can ease symptoms, they do not offer a cure and may have side-effects.

The scientists, working together under the International Schizophrenia Consortium, found the same genetic patterns linked to bipolar disorder — a finding researchers said was significant as it adds to recent evidence challenging previous thinking that the two disorders were distinct.

“Discoveries such as these are crucial for teasing out the biology of the disease making it possible for us to begin to develop drugs targeting the underlying causes and not just the symptoms of the disease,” said Kari Stefansson, chief executive of Decode Genetics of Iceland, who worked on one of the studies published in the journal Nature.

Previous scientific studies have already identified a genetic basis to schizophrenia and suggested that rather than one crucial gene being responsible for the disorder, a large number of genes and genetic combinations could cause it.

Edward Scolnick of the Stanley Center for Psychiatric Research at Massachusetts General Hospital and Harvard Medical School in Boston said work to identify some of the genetic patterns underlying the disorders could eventually “help improve the diagnostic and therapeutic options for patients.”

Only about 18 percent of such patients live long enough to leave the hospital, researchers found. Blacks fared worse than whites a disparity only partly explained by more of them being treated in hospitals that did a poorer job of CPR.

Results were published in Thursday’s New England Journal of Medicine.

Dr. Lance Becker, a University of Pennsylvania emergency medicine specialist and an American Heart Association spokesman, called the findings “grim” and “a wake-up call that we need to redouble our efforts” to find better ways to treat cardiac arrest.

It occurs when the heart quivers or stops beating entirely, because of a heart attack, a sudden heart rhythm problem, a drug overdose or other cause.

CPR, rhythmic chest compressions, can help maintain blood pressure and flow until more advanced treatments can be tried. Those might involve using a defibrillator to shock the heart back into a normal rhythm. Big strides have been made getting bystanders to do cardiopulmonary resuscitation and to use defibrillators, but the new study suggests that less improvement is occurring in the nation’s hospitals.

Researchers led by Dr. William Ehlenbach at the University of Washington in Seattle analyzed the care of 433,985 Medicare patients treated from 1992 through 2005 around the United States.

Survival odds did not substantially change over time, they found. Blacks had survival rates about one-quarter lower than whites. Men, older patients, and people admitted from nursing homes also had lower survival rates after CPR. The study was funded by grants from the federal government and several foundations.

“It’s troubling. We have made a lot of progress in out-of-hospital cardiac arrest,” including a near tripling of survival rates in the Seattle area after community and rescue worker training efforts, said Dr. Paul S. Chan. He is a quality-of-care researcher at St. Luke’s Mid America Heart Institute in Kansas City, Mo.

His own research, published in the New England journal last year, found that one-third of hospitalized patients do not get a potentially live-saving defibrillator shock within the recommended two minutes of suffering cardiac arrest.

Even when CPR is given by these highly trained hospital staffers, chest compressions often are too slow or too shallow to be effective, Chan said.

Guidelines recommend 100 chest compressions per minute, Chan said.

“Our performance in treating people with cardiac arrest is not improving,” said Yale University cardiologist Dr. Harlan Krumholz. “Given that we know that there are delays to treatment across the country and those delays increase risk, there likely exists a big opportunity for hospitals to do better.”

Dr. Gerald Buckberg, a surgeon at the UCLA Medical Center in Los Angeles, is trying radical approaches to improve survival, including use of a heart-lung machine to buy time while doctors try to fix the underlying problem that caused the cardiac arrest, such as clogged arteries triggering a heart attack.

By doing CPR independent of other steps to fix the underlying problem, “we have only treated the symptom of sudden death we haven’t treated the reason,” Buckberg said.

Doctors have become too accepting of the fact CPR saves some patients, he said. “We should not accept the failure” that the vast majority die.