A jump in jellyfish?

The death of a 32-year-old Argentinean triathlete created a minor media storm in New York City recently when newspapers reported that dozens of the athletes had been stung by jellyfish during the swimming portion of the New York City Triathlon. The participant died after being pulled unconscious from the Hudson River causing speculation that a jellyfish was the culprit. The initial autopsy was inconclusive.

In fact, deaths caused by jellyfish stings in the U.S. are rare, but they do happen occasionally. And it appears that human contact with the gelatinous floating animals may be on the rise, so pack some caution with you during your summer beach trips.

Paul Sieswerda, curator of the New York Aquarium, confirmed a jump in jellyfish around New York City this year. And researchers are looking into similar recent increases in jellyfish around the world, including those on the West Coast of the U.S., and in the Bering Sea near Alaska. Scientists are also exploring possible links between jellyfish populations and potential human factors, such as over fishing, global warming, and fertilizer run-off.

There are many species of jellyfish, some of which cause no harm to humans. Common species of stinging jellyfish in the U.S. include, Sea Nettle, Lion’s Mane (the reported species in the triathlon stingings), and the Portuguese Man-of-War, which is technically not a jellyfish, but a colony of multiple organisms that resemble a jellyfish.

Smoking still targets kids

A new study by the American Journal of Preventative Medicine shows that outdoor marketing of tobacco in places where it can reach children and adolescents persists despite widespread bans and voluntary pledges by industry groups.

Unfortunately, this breach is nothing new. In 1996, Consumer Reports teamed up with HBO to make a short documentary called "Smoke Alarm: The Unfiltered Truth about Cigarettes," which is airing today at 6:00 pm Eastern time and 9:00 pm Pacific on HBO Family. (See if you can pick up some of the celebrity voices, which include Tony Danza, Lou Diamond Phillips, and rapper Tone Loc.) Blending animation, skits, quizzes and interviews, the program was designed to help young people cope with the tactics tobacco companies use to hook kids on smoking. It was nominated for an Emmy for outstanding children’s programming.

In 1998, 46 states reached a joint settlement with tobacco companies outlawing the use of billboards and transit benches to promote tobacco. Additionally, a voluntary pledge of the Outdoor Advertising Association of America restricts outdoor ads for products that are illegal to sell to minors, including tobacco and alcohol, from within 500 feet of schools playgrounds and places of worship.

Q&A: Are the preservatives in cosmetics safe?

I've noticed that lots of cosmetics and personal-hygiene products contain the preservative methylparaben. Is that substance safe? —Cherry Hill, N.J.

It is generally thought to be safe, though research is ongoing. Methylparaben and related substances, known collectively as "parabens," are frequently used as preservatives in shampoos, lotions, makeup, and other products. While they are generally considered safe to use on skin, they can in some cases cause irritation to the skin or eyes or allergic skin reactions. In addition, some limited evidence suggests that certain types of parabens may mimic the effects of estrogen, but whether there are any health implications of those findings is still under evaluation. So unless the preservatives irritate your skin or eyes, there’s currently no convincing reason to avoid them.

This article first appeared in the April 2008 issue of Consumer Reports on Health.

What type of diet works best for weight loss?

If you've ever tried to lose weight, you'll know it's not easy. For many years, people wanting to lose weight have been advised to follow a low-fat, calorie-controlled diet. This means cutting down on fats and sugar, but eating plenty of fiber, fruits, vegetables, and complex carbohydrates like rice and whole-grain bread or pasta.

For some people, this works well. But a big new study shows that this type of diet isn't the only option for long-term weight loss. In fact, other types of diet may work even better, although it's a bit early to say for sure.

The new study also looks at the Mediterranean diet and the low-carb diet. On the Mediterranean diet, you prepare meals using olive oil instead of saturated fats like butter, eat plenty of fruit and vegetables, and eat fish or chicken instead of red meat. On the low-carb diet, you cut down on carbohydrates such as pasta and bread rather than on fat. This last type of diet includes more fat from meat and dairy products.

The study followed people for two years, as they tried to stick to their diets. Most people lost some weight, no matter which diet they followed. But people on the Mediterranean diet and the low-carb diet lost an average of 3 to 4 pounds more than people on the traditional low-fat diet.

Gardasil vaccine: Don’t let the headlines fool you

Each time a new vaccine is released a flurry of stories soon follows, featuring tragically ill patients and implying a cause-and-effect relationship between the vaccine and the illness. This time media attention is focused on Gardasil, the vaccine that prevents sexually transmitted infections for four strains of human papillomavirus (HPV) that cause roughly 70 percent of cervical cancers and 90 percent of genital warts. Since the vaccine was approved in 2006 for females ages 9 to 26, there have been more than 26 million doses given worldwide and nearly 16 million of those distributed in the U.S. Today the news media are focusing on adverse events, including 31 reported cases of Guillain-Barré syndrome (GBS) collected by the Centers for Disease Control and Prevention’s Vaccine Adverse Event Reporting System (VAERS) between June 2006 and April 2008. As a neurologist, I am well aware of how devastating this usually transient paralytic illness can be, but I was nevertheless outraged when I read careless headlines earlier this month, including: "Is HPV Vaccine to Blame for a Teen’s Paralysis?" and "HPV Vaccine Linked to Teen’s Paralysis?"

"In general, when it comes to vaccine-related illnesses, it's important to distinguish among observations that are true, true and unrelated, and events that are causally linked," says Kenneth C. Gorson, M.D., a neuromuscular specialist and professor of neurology at Tufts University School of Medicine. "In order to investigate whether the vaccine is in fact related to GBS, there needs to be a careful epidemiological study assessing the prevalence of GBS in a cohort of the population who has been vaccinated compared to a matched, unvaccinated control group." He also says that GBS cases have to be verified (only 10 of the 31 have been confirmed by the CDC), and that the illness must occur within six weeks of vaccination to be considered vaccine-related.

Sex and the cyclist

As an occasional cyclist, I've picked up a few injuries over the years. I've learned not to get too close to articulated buses in the city, or bite off more than I can chew when riding off-road. But new research tells me I've also been risking more than cuts or broken bones. Cycling may be hazardous to men's sexual health.

A urologic surgeon, writing in BJU International, has warned that 6 in 10 male cyclists suffer from numbness in their groin. This happens because of "overuse" injuries, where small amounts of damage to the body build up over time.

For some men, the damage is bad enough to lead to erection problems. Although we don't know how often this happens, it's more common in men who train over long distances. The study also tells us that groin injuries are more common in mountain bikers than road cyclists.

The culprit, of course, is the bike's saddle. Padded shorts may help, but the best bet seems to be abandoning the traditional seat completely. Modern designs can look like gimmicks, but there's research suggesting they really work. For example, you can get "no-nose" saddles, which have just the back part of the seat. They take some getting used to, but they can reduce the pressure on your groin.

You can also protect yourself by taking breaks during long rides. You also need to check your bike's condition, make sure your saddle is set to the right height and angle, and be sure you got the right size and type of bike in the first place.

There is some good news. None of the research found a link between infertility in men and cycling.

What you need to know. Take care buying, setting up and maintaining your bike. As with any kind of exercise, listen to your body and give yourself time to recover between sessions. Get medical help if you think you've done yourself damage.

—Philip Wilson, patient editor, BMJ Group

ConsumerReportsHealth.org has partnered with The BMJ Group to monitor the latest medical research and assess the evidence to help you decide which news you should use.

Should we thank cholesterol for our memories?

For years, we've all known about, and worried about, the way cholesterol can affect our health. Too much "bad" cholesterol can clog up the arteries, leading to heart attacks and strokes. "Good" cholesterol seems to protect against these problems.

Doctors are also interested in the theory that cholesterol levels could affect how well our brains work as we get older. Unhealthy cholesterol levels might play a part in memory loss during middle age, or even the development of Alzheimer's disease in the elderly.

A new study has looked at 3,673 people with an average age of 55. Everyone had their cholesterol checked and took a memory test where they had to remember a list of 20 words. Five years later, people whose levels of "good" cholesterol had fallen were likely to score lower in the memory test than before.

Medications, diet and exercise can help to control your cholesterol levels. Drugs called statins are often used, and your diet should be low in saturated fats (found in dairy foods and fatty meat) and trans fats (found in some cookies, cakes and fast foods).

However, the researchers didn't look at whether treating unhealthy cholesterol levels could prevent memory loss. Doctors don’t know yet whether improving your cholesterol levels could protect against Alzheimer's disease. Treatment for high cholesterol is still likely to depend on your risk of a heart attack or a stroke, rather than your risk of Alzheimer's disease.

What you need to know. There may be a link between cholesterol levels and memory loss, but the research is at an early stage. Still, it's worth bearing in mind as another reason to keep cholesterol levels healthy.

—Philip Wilson, patient editor, BMJ Group

ConsumerReportsHealth.org has partnered with The BMJ Group to monitor the latest medical research and assess the evidence to help you decide which news you should use.

Read more on ways to keep your memory sharp.

Sun safety: Check for hidden skin cancer signs

People with melanoma on their head or neck are nearly twice as likely to die from the disease as those with the skin cancer on their hands or feet, according to a University of North Carolina study of more than 50,000 melanoma cases. The researchers suspect that's partly because doctors and patients are less likely to spot worrisome skin changes when they're hidden under hair.

So examine your body at least several times a year. Use a blow dryer while checking your scalp and mirrors for the back of your neck and other hard-to-see areas. Go to a physician if you spot suspicious blemishes, and have a doctor examine your skin every year or so.

This article first appeared in the July 2008 issue of Consumer Reports on Health.

Find out how to check for moles on your body (FREE), and take a look at our Ratings for sunscreens (subscribers only).

Q&A: Can you overdose on vitamin D?

My doctor has recommended a large daily dose of vitamin D to counteract osteopenia (thinning bones). Is it possible to overdose on the vitamin? —J.S., Orinda, Calif.

Yes, but it takes huge doses: at least 10,000 international units (IU) a day for several years. Such amounts can damage the kidneys, bones, and nervous and cardiovascular systems. But reaching them would require a lot of pills or even injections. Most people should consume between 600 and 1,000 IU a day from food or supplements, depending on their age and level of sun exposure. Multivitamins usually supply about 400 IU, enough for most people to reach those levels. But you may need a larger supplement if you are older than 50 or so, heavier, have darker skin, or rarely get out in the sun. If the dose your doctor suggests is higher than the 1,000 IU a day typically recommended to strengthen bones and provide other benefits, ask why you need so much.

This article first appeared in the July 2008 issue of Consumer Reports on Health.

Read more on the surprising benefits of vitamin D (free) and on how vitamin D can help in the prevention of osteoporosis (subscribers only).

Prescription for disaster

Diabetes, epilepsy, and high blood pressure are treatable conditions thanks to medications that can keep them under control. But for many Americans, like Kathy from Earlville, N.Y., who doesn’t have health insurance and doesn’t quite qualify for Medicaid, they are simply unaffordable. As she put it, she’s committing suicide slowly because diabetes affects all her organs. Sacrificing her health because she can’t afford her medicine is something no one should have to do. And yet this unfortunate scenario is playing out all too often from coast to coast.

I saw another troubling example of this in a recent e-mail forwarded to me by a neurologist colleague. The young woman wrote to say that she took two types of epilepsy medicine for almost 10 years, which cost her $45 a month. But with a new job came a new health plan, and now she says she has to pay more than $450 a month for the same drugs. She says she has to choose which bills to pay: rent, food, gas for her car, or medicine. “I have no money,” she writes. The worst part is that she is no longer taking any medicine for her epilepsy because she can’t afford the brand-name drugs, and generic versions aren’t available. She says she has applied for a prescription drug assistance program but has been denied because she has health insurance.

A recent USA Today/Kaiser Family Foundation/Harvard School of Public Health survey revealed that in the past two years, 29 percent of respondents have not filled a prescription because of the cost, 23 percent have skipped doses or cut pills in half to make a prescription last longer, and 16 percent say payment for prescription drugs is a serious problem for them and their families.

Even those with “good” prescription plans have seen a rise in co-payments, with average co-pays rising from $8 to $11 for generic drugs, $15 to $22 for preferred drugs, $20 to $35 for nonpreferred drugs, and fourth-tier drug co-pays rising from $48 to $74. Prescription drug assistance programs are designed to help people who don’t have health insurance or drug coverage pay for their prescription medicines, but people like the woman with epilepsy, who has a poor plan, and Kathy, who has some assets, fall between the cracks.  As the Cover America Tour is finding out, flaws in our health-care system have placed many people in no-win situations. Which would you choose to forgo…food, rent, or medications?

—Orly Avitzur, M.D., medical adviser to Consumers Union

Restarting an exercise habit

If your exercise lull lasts more than a few weeks, ease back slowly to avoid injury, particularly as you get older. "Your brain may not think of it as starting over, but your joints and muscles do," says Joseph Houmard, Ph.D., an exercise physiologist and director of the East Carolina University Human Performance Laboratory in Greenville, N.C.

A reasonable starting point is 15 to 30 minutes of moderately intense exercise every other day. Use your day off to gauge what your body can tolerate, Houmard says. If you feel tired or achy, cut back on intensity or time. Once you've established a comfortable level, maintain it for a few weeks before gradually ramping up. Take it easy with strength training, too. Start with less weight than before and limit lifting to no more than three days a week. And give yourself at least a day between sessions.

Luckily, resuming a stalled exercise routine is easier than starting from scratch, since gains made during earlier training seem to return quickly. And having experience with exercise provides an emotional boost: You know how to pace yourself and what to expect.

This article first appeared in the May 2008 issue of Consumer Reports on Health.

Read more on workout needs for every age (free) and the 10 extra perks of exercise (free), and find out what exercise can do for your mental health (subscribers only).

Honoring those harmed by medical errors

Willie Parker loved to entertain a big crowd. So when his wife, Dianne, decided to put together an event to honor her late husband and others who, like him, have died because of medical errors, she opted for an old-fashioned Fourth of July barbecue bash. Had he been there, Willie would have no doubt insisted on manning the grill.

More than 100 people, including the Cover America Tour crew, spent their Independence Day holiday at Dianne's home in Aiken, S.C., at the first South Carolina Patient Safety Day, honoring those harmed by medical errors and those working to improve patient care.

They came from all over—some from as far away as California, New Mexico, and New York, others from just a few towns away. They greeted each other like lifelong friends even though some were meeting for the first time, having built close relationships for months or even years via phone and e-mail.

A diverse group of personalities, they are all bound by the common experience of the loss or harm of someone by a preventable medical mistake: improper medication dosage, hospital-acquired infection, or botched surgery.

Errors like these are responsible for nearly 200,000 deaths each year and more than 2.6 million injuries, making medically induced harm—errors and hospital-acquired infections—the third leading cause of death in the U.S. behind heart disease and cancer.

Many of these victims, or their survivors, are now outspoken advocates for better patient protections. Helen Haskell started a support and advocacy organization called Mothers Against Medical Error after the death of her 15-year-old son, Lewis. Kim Sandstrom is writing and producing a play about the series of errors that led to the death of her duaghter. Others have written books or launched Web sites to tell their stories.

A good number had joined Consumers Union's ongoing patient advocacy campaigns, helping to strengthen laws all across the country to better protect patients. Advocates working with CU's Stop Hospital Infections campaign have achieved victory in 23 states so far by pushing through laws requiring hospitals to publicly report their infection rates. South Carolina's reporting law passed in 2006 with the help of many of those in attendance at the Patient Safety Day. Included were the Toolen family, whose lives have been permanently altered by a MRSA infection, short for methicillin-resistant Staphylococcus aureus—that son Jimmy picked up during a surgery and subsequently passed on to his father.

The Cover America Tour filmed their story and many others at the event to ensure that the issues of quality and safety were documented. As the attendees of Patient Safety Day can attest, health care that is affordable but of poor quality can sometimes be worse than having no health care at all.

—Meagen Bohne, campaign organizer

Start big for weight loss success

There's one good reason why most diets fail—hunger. My willpower crumbles when those mid-morning munchies come around. So, how to make it to lunch without giving way to double-choc muffins? The answer may be to eat big at breakfast. A new study reported to the Endocrine Society's annual meeting in San Francisco shows that women who eat a big breakfast, as part of a low-carbohydrate diet, lose more weight and keep it off for longer, compared to women who just follow a regular low-carb diet. All the women in the study were obese (very overweight).

The regular low-carb dieters ate 1,085 calories daily, with the smallest meal at breakfast and the biggest meal at lunch. The big breakfast dieters ate 1,240 calories daily, with the biggest meal at breakfast (containing half the daily calories) and the smallest meal in the evening.

But hold the waffles with syrup. The way to a healthy breakfast is through "good" carbohydrates like wholegrain toast, oatmeal and fruits, along with protein such as eggs and dairy products. The study showed women who'd had a big breakfast were less likely to feel hungry just before lunch, and had fewer cravings for carbs.

While both groups of dieters lost about the same amount of weight during the first 16 weeks of the study, the big breakfast dieters did much better in the long term. They continued to lose weight, while the regular dieters regained the pounds. Eight months after the study began, the regular dieters had lost an average 10 pounds from their starting weight, while the big breakfast dieters had lost an impressive 44.5 pounds.

What you need to know. A healthy breakfast is an important part of a weight-loss diet. If you eat your fill first thing in the morning, you're less likely to break your diet before lunch and more likely to lose weight in the long term.

—Anna Sayburn, patient editor, BMJ Group

ConsumerReportsHealth.org has partnered with The BMJ Group to monitor the latest medical research and assess the evidence to help you decide which news you should use.

Read more on the secrets of successful dieters (free) and check out our diet plan ratings (subscribers only).

Please pass the olive oil: Mediterranean diet may cut diabetes risk

Like many people, I find the promises of the Mediterranean diet enticing: a healthy weight and a lower risk of heart disease, all delivered in a palatable array of fruits, vegetables, grains, legumes, nuts and fish, cooked or served with olive oil, and perhaps washed down with a glass of red wine. But have I switched culinary hemispheres to adopt a Mediterranean menu? Not yet. Well, now I may have more reason to do so.

A new study reports that the Mediterranean diet can also lower the risk of type 2 diabetes. Researchers in Spain used detailed questionnaires to track the eating habits of more than 13,000 Spanish university graduates for several years. They found that those who closely followed a Mediterranean diet (which includes little red meat and only a moderate amount of dairy) reduced their risk of developing diabetes by 83 percent.

Interestingly, those people who stuck closest to the diet were more likely to have risk factors for getting diabetes, such as being older, having family members with the disease and having smoked. You might expect this group would still be more likely to get diabetes than other people in the study, despite closely following the diet, but they actually had a lower risk. This, the authors say, suggests that the Mediterranean diet can provide significant protection against diabetes.

What you need to know. Type 2 diabetes is a serious disease that, over time, can lead to problems with your heart, eyes, kidneys and other parts of your body. It's possible that a Mediterranean style diet may help prevent it developing, although we need more research to know for sure. With rates of type 2 diabetes on the rise in the United States, the study provides some welcome good news.

I, for one, am going to rethink my next burger. Fish paella anyone?

—Sophie Ramsey, patient editor, BMJ Group

ConsumerReportsHealth.org has partnered with The BMJ Group to monitor the latest medical research and assess the evidence to help you decide which news you should use.

Read more on type 2 diabetes (free) and our Treatment Ratings (subscribers only) for the disease.

ED drugs vs. watermelon: Lessons learned

We thought it sounded too good to be true, and it was: News that watermelon may have effects similar to the erection-boosting drug Viagra was apparently based on no more than some very preliminary plant evidence—and was majorly overstated in the university press release touting the findings, according to an interview with the researcher by the online publication MedPage Today. The revelations were published on Monday—but not before hundreds of news outlets picked up the story, perfectly timed as it was for the Fourth of July holiday. Just one reminder of why health reporters should never get too, well, overexcited.

That watermelon is no cure for erectile dysfunction may not come as a surprise to many people. The bad news is, the three main drugs approved for the condition—sildenafil (Viagra), tadalafil (Cialis), and vardenafil (Levitra)—don’t always work that well either, despite the in-your-face TV advertising suggesting otherwise. And some men taking the drugs may be using them unnecessarily or irresponsibly. This from an online survey of 1,549 men, some with ED and some without, conducted in April by the Consumer Reports National Research Center. We showed the guys a widely aired commercial for Cialis, currently the most-advertised ED drug, then asked them to answer questions related to the ad and to ED in general.

Among the key findings: The men most likely to ask their doctors about Cialis after viewing the ad—those younger than 40—are the least likely to actually need the drug, since the majority of ED sufferers are older than 60. Among men already taking ED drugs, less than half (49 percent) thought they were effective or very effective at managing the condition. And a number of men reported that they or someone they know have taken the drugs without any diagnosis of ED, or even ordered them online without a prescription.

Get the full report on the survey and view the Cialis commercial and our own deconstruction of it—the third in our AdWatch series of video critiques (above). Read more on erectile dysfunction (free) and check out our unbiased Treatment Ratings for ED (subscribers only).

—Jamie Hirsh, associate editor

Salmonella update: Not just tomatoes

Our Safety bloggers have taken a close look at the Salmonella outbreak and investigation—and have recommendations of what to do if you suspect you've eaten something that has made you sick. Nearly 1,000 people in 40 states, the District of Columbia, and Canada have been infected with Salmonella since April.

Read more on how to protect yourself from food-borne illness.

Depressed seniors at risk of falls

Many seniors value their independence, but when old age leads to physical frailty, it can make life difficult. Falls are a common problem in the elderly, and all too often lead to serious injuries.

In a new survey, researchers contacted more than 21,000 Australians over 60 years of age, trying to find out the things that increase the risk of having a fall. Elderly people who showed signs of depression were more likely to fall, as were people taking antidepressant medication.

People with arthritis or multiple health problems were also more at risk, and the risk of falling went up as people got older. A quarter of the people surveyed had fallen at least once in the past year. And 1 in 10 seniors had needed medical attention after injuring themselves in a fall.

A fall can lead to dangerous injuries, so it’s important to do what you can to cut the risk. Here are some things to consider.

• Take exercises to improve your balance and strengthen your legs. Your doctor might know about classes in your area. Or inquire at a local gym.
• Make sure your home is safe. There should be enough lighting and no obstacles you could trip over.
• Think twice before doing things that are physically demanding. Don't stand on a chair to change light bulbs, for example.
• Get your eyesight checked.
• Talk with your doctor about the side effects of your medications. Some drugs can make you dizzy.

Measuring for a healthy weight—and a longer life

Regularly weighing yourself can motivate you to shed excess pounds. Dieters who took action when the scale climbed more than 3 pounds were 82 percent more likely to keep weight off than those who were less vigilant, according to a study published in the New England Journal of Medicine in 2006.

But the scale won't tell you much about your health. For that, the best indicator is turning out to be your waist circumference, which indicates abdominal obesity. That's important, since belly fat is more metabolically active than fat stored in the hips and thighs and is a strong signal of increased risk of disease.

In April, the two largest studies of abdominal obesity—one a nine-year follow-up of about 250,000 middle-aged men and women surveyed by AARP, and the other an analysis of 16 years of data from more than 44,000 women in the ongoing Nurses' Health Study—published remarkably similar findings. Both found that people with a larger waist circumference were more likely to die prematurely than those with smaller waists, regardless of their body mass index, or BMI.

The study also found a strong association between early death and a large waist-to-hip ratio—a measurement of the narrowest part of the waist compared with the circumference at the broadest part of the hip. Although the waist-to-hip ratio can more precisely differentiate belly fat from hip and bottom fat, it requires two measurements and so is more prone to error and less convenient to calculate.

Fourth of July: Be safe, avoid fireworks injuries

Our Safety bloggers have posted some important reminders from the Consumer Products Safety Commission on how to avoid fireworks injuries this holiday weekend:

• Never allow young children to play with or ignite fireworks.
• Make sure fireworks are legal in your area before buying or using them.
• Avoid buying fireworks that come in brown paper packaging, as this can often be a sign that the fireworks were made for professional displays and could pose a danger to consumers.
• Adults should always supervise fireworks activities. Parents often don’t realize that there are many injuries from sparklers to children under five. Sparklers burn at temperatures of about 2,000 degrees—hot enough to melt some metals.
• Never have any portion of your body directly over a fireworks device when lighting the fuse. Move back a safe distance immediately after lighting.
• Never try to re-light or pick up fireworks that have not fully functioned.
• Never point or throw fireworks at another person.
• Keep a bucket of water or a garden hose handy in case of fire or other mishap.
• Light one item at a time, then move back quickly.
• Never carry fireworks in a pocket or shoot them off in metal or glass containers.

Read more on fireworks safety, and have a happy—injury-free—Independence Day!

And for more warm-weather tips, check out our Guide to Summer Health & Safety.

6 emergency-room survival tips

Patients now wait about 40 percent longer before receiving care in emergency rooms than they did in 1997. And nearly a quarter of heart-attack patients wait at least 50 minutes before seeing a doctor. Those delays can not only deprive you of needed care but also increase your exposure to the germs that often breed in E.R.s, including antibiotic-resistant bacteria.

Some of the delays stem from fewer emergency rooms as hospitals close or consolidate and more uninsured patients resort to E.R.s for basic care. Here’s how to make your trip to an E.R. go more smoothly.

Recognize real emergencies. Get to an E.R. fast if you have severe blood loss or physical trauma, including a possible broken limb, or if you experience sudden chest pain, difficulty breathing, the inability to use a limb, vision loss, or an "explosive" headache.

Don’t go if you don’t have to. Conditions that don’t warrant emergency care include mild respiratory infections, minor aches and sprains, scrapes and bruises, and prescription refills. If your doctor isn’t available, go to an urgent- or immediate-care center.

Don’t drive yourself. Dial 911 for an ambulance. You can ask to be taken to a hospital of your choice. But for true emergencies it's generally best to let the paramedics take you to the nearest E.R. that is accepting patients. You can transfer to a different facility later.

Study suggests lack of "sunshine vitamin" dims health outlook

The old song says, "sunshine on my shoulders makes me happy." But perhaps it should add: "and keeps me healthy." More research is showing that vitamin D, which the skin produces when exposed to sunlight, may do more for the body than experts previously thought. And, according to a new study, a lack of it may be linked to a higher chance of dying early from heart problems and other causes.

We've known for a long time that vitamin D helps our bodies absorb calcium, which our bones need to grow and stay strong. You can get vitamin D from foods and supplements, but the best source is your skin (hence the nickname "the sunshine vitamin").

In the new study, researchers tracked levels of vitamin D in more than 3,200 men and women for nearly eight years. All the people in the study were white and older (the average age was 62) and they'd had symptoms suggesting heart problems. At the end of the study, researchers found that those with low levels of vitamin D were more likely to have died, either from heart and circulation problems or other causes. In fact, 37 percent of the group with the lowest amount of one form of vitamin D had died, compared with 13 percent of the group with the highest amount. These are striking numbers, to be sure, but researchers caution that they can't be certain a lack of vitamin D contributed to their death. The study only shows that there might have been a link.

Although the study is far from conclusive, it does add to growing evidence that the risks of low vitamin D go far beyond our bones. Studies have also found that a lack of vitamin D may increase the problems with the immune system, certain cancers, type 1 and type 2 diabetes, multiple sclerosis, and problems with the heart and circulation.