Rate of Childhood Obesity Falls in Several Cities

Jessica Kourkounis for The New York Times

At William H. Ziegler Elementary in Northeast Philadelphia, students are getting acquainted with vegetables and healthy snacks.

PHILADELPHIA — After decades of rising childhood obesity rates, several American cities are reporting their first declines.

The trend has emerged in big cities like New York and Los Angeles, as well as smaller places like Anchorage, Alaska, and Kearney, Neb. The state of Mississippi has also registered a drop, but only among white students.

“It’s been nothing but bad news for 30 years, so the fact that we have any good news is a big story,” said Dr. Thomas Farley, the health commissioner in New York City, which reported a 5.5 percent decline in the number of obese schoolchildren from 2007 to 2011.

The drops are small, just 5 percent here in Philadelphia and 3 percent in Los Angeles. But experts say they are significant because they offer the first indication that the obesity epidemic, one of the nation’s most intractable health problems, may actually be reversing course.

The first dips — noted in a September report by the Robert Wood Johnson Foundation — were so surprising that some researchers did not believe them.

Deanna M. Hoelscher, a researcher at the University of Texas, who in 2010 recorded one of the earliest declines — among mostly poor Hispanic fourth graders in the El Paso area — did a double-take. “We reran the numbers a couple of times,” she said. “I kept saying, ‘Will you please check that again for me?’ ”

Researchers say they are not sure what is behind the declines. They may be an early sign of a national shift that is visible only in cities that routinely measure the height and weight of schoolchildren. The decline in Los Angeles, for instance, was for fifth, seventh and ninth graders — the grades that are measured each year — between 2005 and 2010. Nor is it clear whether the drops have more to do with fewer obese children entering school or currently enrolled children losing weight. But researchers note that declines occurred in cities that have had obesity reduction policies in place for a number of years.

Though obesity is now part of the national conversation, with aggressive advertising campaigns in major cities and a push by Michelle Obama, many scientists doubt that anti-obesity programs actually work. Individual efforts like one-time exercise programs have rarely produced results. Researchers say that it will take a broad set of policies applied systematically to effectively reverse the trend, a conclusion underscored by an Institute of Medicine report released in May.

Philadelphia has undertaken a broad assault on childhood obesity for years. Sugary drinks like sweetened iced tea, fruit punch and sports drinks started to disappear from school vending machines in 2004. A year later, new snack guidelines set calorie and fat limits, which reduced the size of snack foods like potato chips to single servings. By 2009, deep fryers were gone from cafeterias and whole milk had been replaced by one percent and skim.

Change has been slow. Schools made money on sugary drinks, and some set up rogue drink machines that had to be hunted down. Deep fat fryers, favored by school administrators who did not want to lose popular items like French fries, were unplugged only after Wayne T. Grasela, the head of food services for the school district, stopped buying oil to fill them.

But the message seems to be getting through, even if acting on it is daunting. Josh Monserrat, an eighth grader at John Welsh Elementary, uses words like “carbs,” and “portion size.” He is part of a student group that promotes healthy eating. He has even dressed as an orange to try to get other children to eat better. Still, he struggles with his own weight. He is 5-foot-3 but weighed nearly 200 pounds at his last doctor’s visit.

“I was thinking, ‘Wow, I’m obese for my age,’ ” said Josh, who is 13. “I set a goal for myself to lose 50 pounds.”

Nationally, about 17 percent of children under 20 are obese, or about 12.5 million people, according to the Centers for Disease Control and Prevention, which defines childhood obesity as a body mass index at or above the 95th percentile for children of the same age and sex. That rate, which has tripled since 1980, has leveled off in recent years but has remained at historical highs, and public health experts warn that it could bring long-term health risks.

Obese children are more likely to be obese as adults, creating a higher risk of heart disease and stroke. The American Cancer Society says that being overweight or obese is the culprit in one of seven cancer deaths. Diabetes in children is up by a fifth since 2000, according to federal data.

“I’m deeply worried about it,” said Francis S. Collins, the director of the National Institutes of Health, who added that obesity is “almost certain to result in a serious downturn in longevity based on the risks people are taking on.”

Read More..

Rate of Childhood Obesity Falls in Several Cities

Jessica Kourkounis for The New York Times

At William H. Ziegler Elementary in Northeast Philadelphia, students are getting acquainted with vegetables and healthy snacks.

PHILADELPHIA — After decades of rising childhood obesity rates, several American cities are reporting their first declines.

The trend has emerged in big cities like New York and Los Angeles, as well as smaller places like Anchorage, Alaska, and Kearney, Neb. The state of Mississippi has also registered a drop, but only among white students.

“It’s been nothing but bad news for 30 years, so the fact that we have any good news is a big story,” said Dr. Thomas Farley, the health commissioner in New York City, which reported a 5.5 percent decline in the number of obese schoolchildren from 2007 to 2011.

The drops are small, just 5 percent here in Philadelphia and 3 percent in Los Angeles. But experts say they are significant because they offer the first indication that the obesity epidemic, one of the nation’s most intractable health problems, may actually be reversing course.

The first dips — noted in a September report by the Robert Wood Johnson Foundation — were so surprising that some researchers did not believe them.

Deanna M. Hoelscher, a researcher at the University of Texas, who in 2010 recorded one of the earliest declines — among mostly poor Hispanic fourth graders in the El Paso area — did a double-take. “We reran the numbers a couple of times,” she said. “I kept saying, ‘Will you please check that again for me?’ ”

Researchers say they are not sure what is behind the declines. They may be an early sign of a national shift that is visible only in cities that routinely measure the height and weight of schoolchildren. The decline in Los Angeles, for instance, was for fifth, seventh and ninth graders — the grades that are measured each year — between 2005 and 2010. Nor is it clear whether the drops have more to do with fewer obese children entering school or currently enrolled children losing weight. But researchers note that declines occurred in cities that have had obesity reduction policies in place for a number of years.

Though obesity is now part of the national conversation, with aggressive advertising campaigns in major cities and a push by Michelle Obama, many scientists doubt that anti-obesity programs actually work. Individual efforts like one-time exercise programs have rarely produced results. Researchers say that it will take a broad set of policies applied systematically to effectively reverse the trend, a conclusion underscored by an Institute of Medicine report released in May.

Philadelphia has undertaken a broad assault on childhood obesity for years. Sugary drinks like sweetened iced tea, fruit punch and sports drinks started to disappear from school vending machines in 2004. A year later, new snack guidelines set calorie and fat limits, which reduced the size of snack foods like potato chips to single servings. By 2009, deep fryers were gone from cafeterias and whole milk had been replaced by one percent and skim.

Change has been slow. Schools made money on sugary drinks, and some set up rogue drink machines that had to be hunted down. Deep fat fryers, favored by school administrators who did not want to lose popular items like French fries, were unplugged only after Wayne T. Grasela, the head of food services for the school district, stopped buying oil to fill them.

But the message seems to be getting through, even if acting on it is daunting. Josh Monserrat, an eighth grader at John Welsh Elementary, uses words like “carbs,” and “portion size.” He is part of a student group that promotes healthy eating. He has even dressed as an orange to try to get other children to eat better. Still, he struggles with his own weight. He is 5-foot-3 but weighed nearly 200 pounds at his last doctor’s visit.

“I was thinking, ‘Wow, I’m obese for my age,’ ” said Josh, who is 13. “I set a goal for myself to lose 50 pounds.”

Nationally, about 17 percent of children under 20 are obese, or about 12.5 million people, according to the Centers for Disease Control and Prevention, which defines childhood obesity as a body mass index at or above the 95th percentile for children of the same age and sex. That rate, which has tripled since 1980, has leveled off in recent years but has remained at historical highs, and public health experts warn that it could bring long-term health risks.

Obese children are more likely to be obese as adults, creating a higher risk of heart disease and stroke. The American Cancer Society says that being overweight or obese is the culprit in one of seven cancer deaths. Diabetes in children is up by a fifth since 2000, according to federal data.

“I’m deeply worried about it,” said Francis S. Collins, the director of the National Institutes of Health, who added that obesity is “almost certain to result in a serious downturn in longevity based on the risks people are taking on.”

Read More..

Huawei to Open Research Center in Finland

PARIS — Huawei Technologies, a Chinese maker of telecommunications equipment, said on Monday that it planned to open a research and development center in Helsinki next year, accelerating its investments in Europe, where its business is expanding rapidly.

The move illustrates a trans-Atlantic difference in attitudes toward Huawei. The company has been largely shut out of the United States market for network gear because of Congressional concerns about possible security threats — fears the company insists are unfounded.

While Huawei has faced difficulties in some European markets, like France, it has done better elsewhere. Huawei employs more than 7,000 people in the region, and it says that total could double in the next three to five years. Huawei already has a research center in Italy and is studying the possibility of opening one in Spain. It also recently announced a $2 billion investment in Britain.

The planned center in Helsinki, involving an investment of 70 million euros, or about $90 million, will work on smartphone development, including features like user interfaces and power management, the company said. When the center opens next year, it will employ 30 people, but this could grow to 100 over the next five years, the company said.

The announcement is a plus for the Finnish technology industry, which has been suffering from the woes at Nokia. The company was once the world’s biggest cellphone maker, but its market share has fallen sharply in recent years.

“The open and innovative environment in Finland,” Huawei said, “is an ideal place for Huawei to strengthen our global R.& D. capabilities for devices, creating opportunities for both Huawei and the Finnish telecommunications industry.”

Huawei has been known mostly for its network equipment, but the company is pushing to make a name for itself with its handsets.

Mobile devices accounted for 22 percent of its revenue last year, an increase of 37 percent. That compares with growth of 12 percent for the overall business.

Read More..

Euro Watch: Bonds in Spain and Italy Shaken by Italian Politics

ROME — Italian stock and bond prices fell on Monday after a weekend of political turmoil in Italy gave rise to fears that the country was headed for renewed instability.

Shares of Italian banks, which are big holders of the government’s bonds, were among the hardest hit.

The action occurred in the first day of trading after Prime Minister Mario Monti said over the weekend that he would soon step down after his predecessor, Silvio Berlusconi, withdrew his party’s support from Mr. Monti and said he would again seek election as prime minister.

Mr. Berlusconi, who was elected prime minister three times, left office a year ago as markets pushed Italy to the brink of financial collapse. Mr. Monti, an economist who was appointed as his temporary successor, has restored Italy’s credibility with investors, who have given the country a break on its borrowing costs. But those gains have come at the cost of painful austerity measures that have worsened the country’s economic situation and given Mr. Berlusconi an opening to attack.

The Milan benchmark index, MIB, fell more than 2 percent on Monday. Italian banks, which remain sensitive to declines in the country’s bond prices, were among the big losers. Intesa Sanpaolo, the most active stock, fell 5.2 percent, as did UniCredit.

Mr. Monti, who joined other leaders in Oslo on Monday to receive the Nobel Peace Prize awarded to the European Union, said at a news conference that the market reactions “need not be dramatized.”

“I am confident,” he said, that the Italian elections would result in a government “that will be responsible and oriented toward the E.U. and this will be in line with efforts the Italian government has made so far.”

The decline in bond prices sent their yields, or interest rates, higher — an indicator of the Italian government’s borrowing costs. The spread between interest rates on Italian 10-year sovereign bonds and equivalent German securities, the European benchmark for safety, grew to 3.5 percentage points on Monday. That was up from 3.25 percentage points late Friday, suggesting that investors were growing more wary of holding Italian debt.

The yield on Italian 10-year bonds, which breached 7 percent this year, ended trading on Monday at 4.8 percent, up 29 basis points. A basis point is one-hundredth of a percent.

Bonds of Spain, which is the other big economy of concern in the euro zone, also came under renewed pressure on Monday after Mr. Monti’s announcement.

The spread between Spanish 10-year bonds and equivalent German bonds widened to 4.27 percentage points from 4.16 points on Friday. The yield on the benchmark Spanish 10-year rose 10 basis points, to 5.5 percent; it reached 7.1 percent in July amid concerns that Spain would be forced into a full bailout after having to negotiate a 100 billion euro, or $129 billion, rescue package for its banks in June.

Luis de Guindos, the Spanish economy minister, warned that Italy’s political turmoil would affect his country.

“When doubts emerge over the stability of a neighboring country like Italy, which is also seen as vulnerable, there’s an immediate contagion for us,” he said Monday morning on Spanish national radio.

Asked whether Spain would itself seek further European rescue funding, he instead said, “The help that Spain needs is that the doubts over the future of the euro be removed.”

Speaking before the Nobel ceremony on Monday, the European Commission president, José Manuel Barroso, said Italy must “continue on the road of structural reforms.” The elections, Mr. Barroso said on Sky News, “must not be used to postpone reforms.”

A dismal economic report on Monday served as a reminder that despite Mr. Monti’s success with investors, the real economy continues to suffer. Italian industrial production fell a seasonally adjusted 1.1 percent in October from September, and by 6.2 percent from a year earlier, Istat, the national statistics agency, said.

Some analysts said they thought that Mr. Berlusconi’s re-emergence as a political leader was as responsible for unnerving investors as Mr. Monti’s unexpected decision to resign. Nicholas Spiro, managing director of Spiro Sovereign Strategy, a research firm, wrote on Monday in a note that Mr. Berlusconi remained “the boogeyman of investors,” who “epitomizes the dysfunctional nature of Italian politics.”

Angela Merkel, the German chancellor, was to meet on Monday with Mr. Monti on the sidelines of the Nobel ceremony, said Georg Streiter, a spokesman for the chancellor.

Ms. Merkel pushed to have Mr. Monti succeed Mr. Berlusconi. But she ended up facing Mr. Monti’s own ideas for economic change, which focused more on growth and job creation than on the austere fiscal discipline championed by Ms. Merkel.

As a rule, the German government does not comment on its partners’ domestic politics, but Foreign Minister Guido Westerwelle warned that an attempt to scale back Italy’s reform push could result in further destabilization in the euro zone.

“Italy cannot remain stagnant on two-thirds of its reform process,” Mr. Westerwelle said through a spokesman. “This would throw not only Italy but the rest of Europe into turbulence.”

Elisabetta Povoledo reported from Rome and David Jolly from Paris. Raphael Minder contributed reporting from Madrid and Melissa Eddy from Berlin.

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In Pursuit of John McAfee, Media Are Part of Story

Late last month, the editor in chief of Vice magazine, Rocco Castoro, joined by a photographer, Robert King, managed to secure a plum exclusive: an invitation to travel along with the fugitive tech millionaire John McAfee.

Years earlier, Mr. McAfee had relocated to a Colonel Kurtz-like compound in the jungles of Belize, surrounding himself with armed guards and multiple young lovers. Then, with reports that he was a “person of interest” in the death of a neighbor, Mr. McAfee had gone on the lam. Last Monday, after several days of surreptitious travel, Mr. Castoro and Mr. King posted their first dispatch. It bore the smirking headline, “We Are With John McAfee Right Now, Suckers.”

The gloating was short-lived, however. Within minutes, a reader noticed that the photograph posted with the story still contained GPS location data embedded by the iPhone 4S that took it, and sent out a message via Twitter: “Check the metadata in the photo. Oooops ...” Vice quickly replaced the image, but it was too late. “Oops! Did Vice Just Give Away John McAfee’s Location With Photo Metadata?” a Wired.com headline asked. The article included a Google Earth view of the exact spot the picture had been taken — poolside at the Hotel & Marina Nana Juana in Izabal, Guatemala.

Soon, the Guatemalan police were with John McAfee. This weekend, he is in their custody and is expected to be extradited to Belize, where he faces questioning in connection with the murder of Gregory Faull, a 52-year-old American who was his neighbor. Mr. McAfee’s lawyers are appealing his extradition.

The Vice debacle was just one colorful twist in the relationship between the press, which is always willing to indulge a colorful subject, and Mr. McAfee, who was always eager to bend news coverage to his often inscrutable ends. I first wrote about Mr. McAfee five years before, when he was merely a colorful software pioneer — an apparently clean-living citizen who courted the press mainly to promote his favorite pastime, flying ultralight aircraft. Since then, his life had taken several darker turns. I had only just published a long piece about his purported connections with Belizean drug gangs on the Web site Gizmodo when I received a curt e-mail from a police official in Belize on Nov. 11, “It may interest you to know that there was a murder yesterday in San Pedro Town, Ambergris Caye and McAfee is the prime suspect.”

I passed the information along on Twitter and on Gizmodo and the news took on a life of its own. “It was on all kinds of Tumblr sites, people were talking about it on Twitter, and that fueled a lot of the professional media to say, ‘O.K., everyone’s talking about this, we should have a story on it, too,’ ” said Mat Honan, a senior writer at Wired who has written about the case.

Mr. McAfee went into hiding with a 20-year-old girlfriend, but it was hiding of a uniquely visible kind. Within 36 hours, he began an aggressive campaign to court and spin coverage of his story. He started by calling Joshua Davis, a Wired writer who had spent the summer reporting on a profile for the magazine’s January issue, and fed him fresh details of life on the run every few hours. Mr. Davis passed along his minute-by-minute updates via Twitter and daily blog posts.

News media around the world were rapt: it wasn’t just that Mr. McAfee’s name was stubbornly familiar, a relic of the early days when computer users installed his software to keep viruses away. “A tech millionaire, an exotic Central American locale, murder, the possibility of drugs — the story just has everything,” says Nathalie Malinarich, world editor of the BBC News Web site.

Wired had a problem, though. The murder and Mr. McAfee’s flight had made Mr. Davis’s print article obsolete before it could even hit newsstands. Wired and Mr. Davis updated the material and repackaged it into an e-book that has sold more than 22,000 copies, at one point reaching No. 1 on the Nonfiction Kindle Singles list.

Mr. Davis’s exclusives did not last long. As the week went on, Mr. McAfee granted phone interviews to more reporters (though none to me, with whom he’s declined to communicate since my first Gizmodo piece). Then he set out to spread his message across new electronic platforms. He started a Twitter account and, with the help of a cartoonist he had befriended in Seattle, a blog. To keep the story fresh, Mr. McAfee kept upping his media exposure and the outrageousness of the tales he told. He arranged face-to-face interviews— a Financial Times journalist first, followed by CNN’s Martin Savidge. (Both were told to wait in public places and then were driven to meet Mr. McAfee in locations unknown to them.) Then, in the ultimate act of bravado, he invited Vice’s journalists to tag along.

For reporters, a McAfee exclusive guaranteed a rich share of readers and viewers and social-networking interest. But many found the favor an ambiguous blessing. Mr. McAfee seemed to understand the dynamics of journalism well enough to know which assertions reporters would pass along without double-checking or qualifying — like his claim that he had eluded the police by burying himself in sand and positioning a box over his head — even as his self-created narrative veered ever further into the surreal.

“As soon as reporters start to think, ‘Wait a minute, we’re sort of jeopardizing our objectivity and reputation for this guy,’ he’ll just burn them, and go to the next one,” says the Gizmodo writer Joel Johnson, who found himself cut off after publishing an article Mr. McAfee did not like. “That’s what he did to me, that’s what he’s done to a lot of journalists, and he’s going to do it to the Vice guys, if he hasn’t done it already.”

Vice seemed to remain in Mr. McAfee’s good graces even after the freedom-endangering gaffe. After the secret of his location spread across the Internet, Mr. McAfee quickly went online to claim that the data leak was in fact an intentional piece of misdirection. Mr. King, the Vice photographer, supported the claim on social media. This amounted to following up an “egregiously stupid action with a far worse one,” Mr. Honan wrote in a Wired post later last week, “King apparently lied on his Facebook page and Twitter in order to protect McAfee.”

In a statement, Vice said it would not comment about its reporting in the McAfee case.

“The flight we chronicled was from the start filled with misinformation, rumors, social-media-fed myths, outright lies and overall total weirdness,” the magazine said. “Despite many media outlets’ obvious glee in damning us immediately, Vice has decided to wait and talk to the people on our team who were actually on the ground and who could therefore tell us what actually went down and not just buy into the same rumors, myths and madness that this story has consisted of from the start.”

Indeed, while Mr. McAfee seems determined to drag out his drama as long as he can, some of the journalists who have covered him say they have had enough. “People try to behave ethically,” said Mr. Johnson, who wrote his final post on Mr. McAfee three weeks ago. “And he milks that out of them until they get to the point where they’re like, ‘You know what, you’re just nuts.’ ” He adds, “I know as a journalist I can’t say that, so I’ve got to get out of this story.”

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The New Old Age Blog: Training Needed for Home Care Is Lacking

“H” from Chicago, I heard you when you joined a lively discussion over hospice at home here a couple of weeks ago and asked, “where can family members get the training to do all the nursing tasks?”

In the comments section, many readers wrote in to say that caring for relatives at the end of their lives was a duty and a privilege. Others said they were unprepared for the physical and emotional burdens of doing so.

Your question stood out because of its practical character. Do caregivers have to figure out how to handle all these complicated medical issues on their own? Or is some help out there?

For an answer, I called two of the authors of “Home Alone: Family Caregivers Providing Complex Chronic Care,” put out by the United Hospital Fund and the AARP Public Policy Institute. That study recently made headlines by reporting that 46 percent of the nation’s 42 million caregivers handle medical and nursing tasks such as giving injections, caring for wounds or administering I.V.s.

Susan Reinhard, senior vice president and director of the AARP Public Policy Institute, sighed when I reached her, and said “this is a huge gap,” referring to a notable absence of available training in demanding caregiving tasks.

To the extent training exists through local agencies on aging, disease-specific organizations or social service groups, it deals mostly with so-called “activities of daily living” — helping someone bath, dress, eat, or use the bathroom — not the demands of nursing-style care, Ms. Reinhard observed.

Really, this kind of training should be the responsibility of health care providers, but doctors and nurses often give only cursory, unsatisfactory explanations of complex tasks that fall to caregivers, said Carole Levine, director of the Families and Health Care Project of the United Hospital Fund.

That leaves the burden on caregivers to be assertive and ask for help, these experts agreed. If someone is hospitalized and ready to return home, they suggest asking a nurse or another provider “show me what you are doing so I can learn how to do it,” and then asking “now, watch me do it and tell me if I am doing it wrong or right.”

Don’t give up after the first time if you feel awkward or uncomfortable. Ask to do the task again, and ask again for feedback.

No videos or written manuals, can substitute for this one-on-one, hands-on instruction. If you don’t get it to your satisfaction before a loved-one is ready to go home, don’t sign the form that says you have been given instructions on what to do, Ms. Reinhard advised. The hospital is legally obligated to ensure that discharges are safe, and this operates in your favor.

The same goes for the pharmacy: don’t sign that sheet that the pharmacist hands you indicating that you have been adequately informed about the medications you are purchasing. If you are concerned about the number of prescriptions, what they are for, their possible side effects and whether all are necessary, ask the pharmacist to sit down with you and go over all this information. Again, don’t leave until you are satisfied.

Often, caregiving tasks will change as someone with a chronic condition like Parkinson’s disease or heart failure becomes more frail. Should this happen, consider calling a home care agency and asking for a nurse to come out and teach you how to administer oxygen or help transfer someone safely from a bed to a wheelchair, Ms. Reinhard said.

You may want to videotape the session so you can view it several times; most of us don’t pick these skills up right away and need repeat practice, Ms. Levine said.

Be as specific in your request for help as possible. Rather than complaining that you are overwhelmed, say something along the lines of, “I want to make sure I know how to clean this wound and prevent an infection” or “I need to know what texture the food should be so I can feed mom without having her choke,” Ms. Levine suggested.

Her organization has prepared comprehensive materials for caregivers called “Next Step in Care.” While the focus isn’t on nursing-style caregiving tasks, three might be useful: a self-assessment tool for family caregivers, a medication management guide, and a guide to hospice and palliative care.

Other helpful materials are few and far between. Ms. Levine’s staff identified a $24.95 American Red Cross training manual for family caregivers that has a DVD explaining the mechanics of transfers and a few other complicated tasks. Also, some videos are available for free at www.mmlearn.org, a Web site that says its mission is to provide caregivers with online training and education.

Asked about model programs, Ms. Reinhard said she knew of only one: the Schmieding Home Caregiver Training Program in Arkansas, operated by the Donald W. Reynolds Institute on Aging of the University of Arkansas for Medical Sciences. The Schmieding program trains family caregivers as well as professional caregivers who work in people’s homes or nursing homes.

On the family side, it offers eight hours of instruction in “physical needs” associated with caregiving — managing incontinence, skin care, turning someone regularly in bed, using adaptive equipment, transfers from a bed to a wheelchair, helping patients remain mobile, and more. Classes are offered at five sites and four more are planned in the next several years, said Robin McAtee, associate director of the Reynolds Institute on Aging. If people, churches or senior centers want the instruction, which is free, Schmieding nurses will take the program to them. One-on-one instruction for tasks is also available on request.

A separate eight-hour program is available for caregivers dealing with dementia, who have additional concerns.

At a Web site called Elder Stay at Home, Schmieding sells a package of materials (three DVDs and a booklet, for $99) summarizing the content of its family caregiver training program. Separately, it has begun selling its curriculum for paid caregivers, and programs in California, Hawaii and Texas are among the first buyers. The University of Arkansas for Medical Sciences also has received a $3.7 million innovation grant from the government to expand the caregiver training program more broadly and develop online training materials.

Ms. Reinhard said AARP would like to see Schmieding-style programs rolled out across the country and begin to offer structured, reliable support to caregivers now providing nursing-style care in homes with little or no assistance.

What else am I missing here? Do you know of resources or other organizations providing intensive caregiver training along the lines of what I’ve been discussing? Where would you suggest people turn for this kind of help?

Read More..

The New Old Age Blog: Training Needed for Home Care Is Lacking

“H” from Chicago, I heard you when you joined a lively discussion over hospice at home here a couple of weeks ago and asked, “where can family members get the training to do all the nursing tasks?”

In the comments section, many readers wrote in to say that caring for relatives at the end of their lives was a duty and a privilege. Others said they were unprepared for the physical and emotional burdens of doing so.

Your question stood out because of its practical character. Do caregivers have to figure out how to handle all these complicated medical issues on their own? Or is some help out there?

For an answer, I called two of the authors of “Home Alone: Family Caregivers Providing Complex Chronic Care,” put out by the United Hospital Fund and the AARP Public Policy Institute. That study recently made headlines by reporting that 46 percent of the nation’s 42 million caregivers handle medical and nursing tasks such as giving injections, caring for wounds or administering I.V.s.

Susan Reinhard, senior vice president and director of the AARP Public Policy Institute, sighed when I reached her, and said “this is a huge gap,” referring to a notable absence of available training in demanding caregiving tasks.

To the extent training exists through local agencies on aging, disease-specific organizations or social service groups, it deals mostly with so-called “activities of daily living” — helping someone bath, dress, eat, or use the bathroom — not the demands of nursing-style care, Ms. Reinhard observed.

Really, this kind of training should be the responsibility of health care providers, but doctors and nurses often give only cursory, unsatisfactory explanations of complex tasks that fall to caregivers, said Carole Levine, director of the Families and Health Care Project of the United Hospital Fund.

That leaves the burden on caregivers to be assertive and ask for help, these experts agreed. If someone is hospitalized and ready to return home, they suggest asking a nurse or another provider “show me what you are doing so I can learn how to do it,” and then asking “now, watch me do it and tell me if I am doing it wrong or right.”

Don’t give up after the first time if you feel awkward or uncomfortable. Ask to do the task again, and ask again for feedback.

No videos or written manuals, can substitute for this one-on-one, hands-on instruction. If you don’t get it to your satisfaction before a loved-one is ready to go home, don’t sign the form that says you have been given instructions on what to do, Ms. Reinhard advised. The hospital is legally obligated to ensure that discharges are safe, and this operates in your favor.

The same goes for the pharmacy: don’t sign that sheet that the pharmacist hands you indicating that you have been adequately informed about the medications you are purchasing. If you are concerned about the number of prescriptions, what they are for, their possible side effects and whether all are necessary, ask the pharmacist to sit down with you and go over all this information. Again, don’t leave until you are satisfied.

Often, caregiving tasks will change as someone with a chronic condition like Parkinson’s disease or heart failure becomes more frail. Should this happen, consider calling a home care agency and asking for a nurse to come out and teach you how to administer oxygen or help transfer someone safely from a bed to a wheelchair, Ms. Reinhard said.

You may want to videotape the session so you can view it several times; most of us don’t pick these skills up right away and need repeat practice, Ms. Levine said.

Be as specific in your request for help as possible. Rather than complaining that you are overwhelmed, say something along the lines of, “I want to make sure I know how to clean this wound and prevent an infection” or “I need to know what texture the food should be so I can feed mom without having her choke,” Ms. Levine suggested.

Her organization has prepared comprehensive materials for caregivers called “Next Step in Care.” While the focus isn’t on nursing-style caregiving tasks, three might be useful: a self-assessment tool for family caregivers, a medication management guide, and a guide to hospice and palliative care.

Other helpful materials are few and far between. Ms. Levine’s staff identified a $24.95 American Red Cross training manual for family caregivers that has a DVD explaining the mechanics of transfers and a few other complicated tasks. Also, some videos are available for free at www.mmlearn.org, a Web site that says its mission is to provide caregivers with online training and education.

Asked about model programs, Ms. Reinhard said she knew of only one: the Schmieding Home Caregiver Training Program in Arkansas, operated by the Donald W. Reynolds Institute on Aging of the University of Arkansas for Medical Sciences. The Schmieding program trains family caregivers as well as professional caregivers who work in people’s homes or nursing homes.

On the family side, it offers eight hours of instruction in “physical needs” associated with caregiving — managing incontinence, skin care, turning someone regularly in bed, using adaptive equipment, transfers from a bed to a wheelchair, helping patients remain mobile, and more. Classes are offered at five sites and four more are planned in the next several years, said Robin McAtee, associate director of the Reynolds Institute on Aging. If people, churches or senior centers want the instruction, which is free, Schmieding nurses will take the program to them. One-on-one instruction for tasks is also available on request.

A separate eight-hour program is available for caregivers dealing with dementia, who have additional concerns.

At a Web site called Elder Stay at Home, Schmieding sells a package of materials (three DVDs and a booklet, for $99) summarizing the content of its family caregiver training program. Separately, it has begun selling its curriculum for paid caregivers, and programs in California, Hawaii and Texas are among the first buyers. The University of Arkansas for Medical Sciences also has received a $3.7 million innovation grant from the government to expand the caregiver training program more broadly and develop online training materials.

Ms. Reinhard said AARP would like to see Schmieding-style programs rolled out across the country and begin to offer structured, reliable support to caregivers now providing nursing-style care in homes with little or no assistance.

What else am I missing here? Do you know of resources or other organizations providing intensive caregiver training along the lines of what I’ve been discussing? Where would you suggest people turn for this kind of help?

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Huawei to Open Research Center in Finland

PARIS — Huawei, a Chinese maker of telecommunications equipment, said Monday that it planned to open a research and development center in Helsinki next year, accelerating the company’s investments in Europe, where its business is expanding rapidly.

The move emphasizes a trans-Atlantic difference in attitudes toward Huawei, a company that has been largely shut out of the U.S. market for network gear because of congressional concerns about possible security threats — fears that the company insists are unfounded.

While Huawei has faced difficulties in some European markets, like France, it has done better elsewhere. Huawei employs more than 7,000 people in the region, and it says that total could double within the next three to five years. Huawei already has a research center in Italy and is studying the possibility of opening one in Spain. It also recently announced a $2 billion investment in Britain.

The planned center in Helsinki, involving an investment of €70 million, or about $90 million, will work on smartphone development, including things like user interfaces and power management, the company said. When the center opens next year, it will employ 30 people, but this number could grow to 100 over the next five years, the company said.

The announcement is a shot in the arm for the Finnish technology sector, which has been suffering from the woes at Nokia. The company, once the biggest mobile phone manufacturer in the world, has suffered a precipitous fall in market share in recent years.

Although Huawei has been known mostly for its network equipment, the company is pushing to make a name for itself with its handsets. Mobile devices accounted for 22 percent of its revenue last year, growing 37 percent. That compares with growth of 12 percent for the overall business.

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Memo From Italy: In Italy, Mario Monti Morphs From Technocrat to Politician

ROME — For months, he had flirted with the idea of staying out of politics, but in the end former Prime Minister Silvio Berlusconi just could not resist. His statement on Saturday that he would seek office again out of a sense of “responsibility” for Italy effectively ended the mandate of Prime Minister Mario Monti, who said he would step down after Parliament passes a budget bill this month.

Mr. Monti’s surprise announcement on Saturday raised the prospect of more political uncertainty and market turmoil for Italy, Europe’s fourth-largest economy, in what is expected to be a gloves-off political campaign. But it also increased the possibility that Mr. Monti might run as a candidate — a shift from the role of an apolitical leader — who is open to governing if no clear winner emerges from elections expected as soon as February.

Three years into Europe’s debt crisis, the new developments in Italy underscored the clash between the economically sound and the politically sustainable. While Mr. Monti, an economist and a former European commissioner, has reassured investors and helped keep Italian borrowing rates down, the tax increases and spending cuts passed by his Parliament have eroded lawmakers’ standing with voters.

Mr. Monti’s grasp of economics and experience in European politics made him a power broker who took regular calls from the White House and worked with France and Spain to wring euro-zone concessions from a reluctant German chancellor, Angela Merkel.

“He’s ushered in a turning point in Italian politics and has been a major influence in Europe,” said Thomas Klau, director of the Paris office of the European Council on Foreign Relations. “He has helped turn Italy into a serious country again in the eyes of foreign investors and also many of its own citizens.”

Even if Mr. Monti decides not to run as a political candidate, his decision to step down sets the stage for a battle that pits him — a subtly ironic technocrat who attended Wagner’s “Die Lohengrin” at La Scala on Friday — against Mr. Berlusconi, who made his announcement at the training site of his soccer team, A. C. Milan.

“The war will be between Monti and Berlusconi,” said Massimo Franco, chief political commentator for the newspaper Corriere della Sera. “The moderate votes are in play, not the leftist ones.”

Although Mr. Berlusconi said he was motivated by a sense of responsibility, European leaders and market analysts immediately accused him of the opposite. Martin Schulz, president of the European Parliament, called his return to politics “a threat for Italy and Europe,” the ANSA news agency reported.

With the aid of Mario Draghi, president of the European Central Bank, Mr. Monti calmed the financial markets this year, but investors and European leaders now worry that many of Mr. Monti’s initiatives could be undone by future governments.

In an interview with the business newspaper Il Sole 24 Ore, José Manuel Barroso, president of the European Commission, said that Italy was at risk of being hit by deeper financial problems. “The next elections must not serve as a pretext for putting in doubt how indispensable these measures are,” he said. “The relative calm on the markets does not mean we are out of the crisis.”

Analysts said that Mr. Monti’s decision to step down ahead of schedule was aimed at preventing Mr. Berlusconi from running a campaign that undermined him. Mr. Berlusconi, always attuned to the national mood, even of voters increasingly weary of him, now looks poised to run a populist campaign that will criticize Mr. Monti for foisting unpopular measures on Italians and that may attack the adoption of a single currency for eroding Italian sovereignty.

Stepping down now, rather than early next year, as was expected, also puts Mr. Monti in the fray. “Monti becomes a politician at this point,” said Stefano Folli, a political columnist for Il Sole 24 Ore. “If Monti helps create a space on the ballot for an electoral alliance that recognizes the seriousness of what has been achieved, this could create a new political balance. That’s the challenge.”

Polls show that the center-left Democratic Party is likely to place first in elections, but without enough votes for a majority. But the party remains divided over which ally to choose to form a government.

Mr. Berlusconi is expected to secure enough votes to stay in Parliament and keep his immunity from prosecution in various trials, but not enough votes to govern.

“It is extremely unlikely that we will see a dynamic unfolding which would bring Mr. Berlusconi back to power,” Mr. Klau said. “So even if Mr. Monti were to leave the political stage for good, we would not go back to the political situation we were in before.”

Although Parliament has blocked some of the measures on Mr. Monti’s agenda — in recent weeks, lawmakers have proposed more than 1,500 amendments to the budget bill — the budget is likely to be approved, as is a law that requires Italy to balance its budget each year.

But analysts said that other changes aimed at improving Italy’s competitiveness were at risk. And before the end of the legislative session this month, lawmakers must also vote on a bill that would simplify the tax code, another meant to streamline the cumbersome bureaucracy and a measure that to allow the Ilva steel plant — a major economic engine for Italy — to stay open while it modernizes to meet environmental standards.

As the debt crisis has lingered, such local issues, as well as Italy’s chaotic political system, have taken on international importance.

On Sunday, Ferruccio de Bortoli, the editor in chief of Corriere della Sera, offered his review of the political drama: “The ‘Lohengrin’ at La Scala ended in applause. The Italian tragedy continues. The libretto still needs writing, so does the music. The guaranteed audience is international, but unfortunately not terribly forgiving about the cast. The curtain never falls.”

Reporting was contributed by Elisabetta Povoledo from Rome, Stephen Castle from London and Jack Ewing from Frankfurt.

This article has been revised to reflect the following correction:

Correction: December 9, 2012

An earlier version of this story stated that the the Ilva steel plan was responsible for 8 million euro. The correct number was 8 billion euro.

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Changes to Agriculture Highlight Cuba’s Problems

HAVANA — Cuba’s liveliest experiment with capitalism unfolds every night in a dirt lot on the edge of the capital, where Truman-era trucks lugging fresh produce meet up with hundreds of buyers on creaking bicycle carts clutching wads of cash.

“This place, it feeds all of Havana,” said Misael Toledo, 37, who owns three small food stores in the city. “Before, you could only buy or sell in the markets of Fidel.”

The agriculture exchange, which sprang up last year after the Cuban government legalized a broader range of small businesses, is a vivid sign of both how much the country has changed, and of all the political and practical limitations that continue to hold it back.

President Raúl Castro has made agriculture priority No. 1 in his attempt to remake the country. He used his first major presidential address in 2007 to zero in on farming, describing weeds conquering fallow fields and the need to ensure that “anyone who wants can drink a glass of milk.”

No other industry has seen as much liberalization, with a steady rollout of incentives for farmers. And Mr. Castro has been explicit about his reasoning: increasing efficiency and food production to replace imports that cost Cuba hundreds of millions of dollars a year is a matter “of national security.”

Yet at this point, by most measures, the project has failed. Because of waste, poor management, policy constraints, transportation limits, theft and other problems, overall efficiency has dropped: many Cubans are actually seeing less food at private markets. That is the case despite an increase in the number of farmers and production gains for certain items. A recent study from the University of Havana showed that market prices jumped by nearly 20 percent in 2011 alone. And food imports increased to an estimated $1.7 billion last year, up from $1.4 billion in 2006.

“It’s the first instance of Cuba’s leader not being able to get done what he said he would,” said Jorge I. Domínguez, vice provost for international affairs at Harvard, who left Cuba as a boy. “The published statistical results are really very discouraging.”

A major cause: poor transportation, as trucks are in short supply, and the aging ones that exist often break down.

In 2009, hundreds of tons of tomatoes, part of a bumper crop that year, rotted because of a lack of transportation by the government agency charged with bringing food to processing centers.

“It’s worse when it rains,” said Javier González, 27, a farmer in Artemisa Province who described often seeing crops wilt and rot because they were not picked up.

Behind him were the 33 fertile, rent-free acres he had been granted as part of a program Mr. Castro introduced in 2008 to encourage rural residents to work the land. After clearing it himself and planting a variety of crops, Mr. Gonzalez said, he was doing relatively well and earned more last year than his father, who is a doctor, did.

But Cuba’s inefficiencies gnawed at him. Smart, strong, and ambitious, he had expansion plans in mind, even as in his hand he held a wrench. He was repairing a tractor part meant to be grading land. It was broken. Again.

The 1980s Soviet model tractor he bought from another farmer was as about good as it gets in Cuba. The Cuban government maintains a monopoly on selling anything new, and there simply is not enough of anything — fertilizer, or sometimes even machetes — to go around.

Government economists are aware of the problem. “If you give people land and no resources, it doesn’t matter what happens on the land,” said Joaquin Infante of the Havana-based Cuban National Association of Economists.

But Mr. Castro has refused to allow what many farmers and experts see as an obvious solution to the shortages of transportation and equipment: Let people import supplies on their own. “It’s about control,” said Philip Peters, a Cuba analyst with the Lexington Institute, a Virginia-based research group.

Other analysts agree, noting that though the agricultural reforms have gone farther than other changes — like those that allow for self-employment — they remain constrained by politics.

“The government is not ready to let go,” said Ted Henken, a Latin American studies professor at Baruch College. “They are sending the message that they want to let go, or are trying to let go, but what they have is still a mechanism of control.”

For many farmers, that explains why land leases last for 10 years with a chance to renew, not indefinitely or the 99 years offered to foreign developers. It is also why many farmers say they will not build homes on the land they lease, despite a concession this year to allow doing so.

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