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gt;gt;In fact, surgical face masks, which are cheaper and easier to wear, may be just as good as N95 respirators. At the very least, researchers can’t prove that one is better than the other. It’s the latest wrinkle in a continuing debate over how to protect health-care workers from the H1N1 virus, also known as swine flu.gt;gt;Raina MacIntyre, PhD, a professor of infectious diseases epidemiology and the head of the University of New South Wales School of Public Health and Community Medicine, in Sydney, Australia, says the research team didn’t exactly retract the findings.gt;gt; “We simply did the analysis of the same data differently for the final paper,” she explains.gt;gt;For the new analysis, the researchers removed a control group of nearly 500 health-care workers and made other statistical adjustments. Ultimately, the difference in infection rates between mask and respirator users was statistically significant.gt;gt;“[The study] still shows a likely superiority of N95s, with half the rate of infection compared to surgical [masks],” MacIntyre says. “But the study was probably underpowered to pick up statistical significance when we removed the control group.”gt;gt; “I would certainly wear an N95 respirator if I were exposed to infectious patients,” she adds.gt;gt;gt;The N95 respirator is a tightly fitted facial mask designed to filter out even very fine airborne particles, according to the U.S. Food and Drug Administration (FDA). Looser-fitting surgical masks protect against large-particle droplets, splashes, sprays, or splatter, the FDA says, but they don’t completely block the germs from coughs and sneezes.gt;gt;To figure out which protective device is best, MacIntyre and her colleagues tracked hospital workers in Beijing, China, who wore surgical masks or N95 respirators, and compared rates of influenza and respiratory illness. Preliminary findings were presented at a meeting of the Interscience Conference on Antimicrobial Agents and Chemotherapy in September 2009. Final results have yet to be published.gt;gt;The only other randomized clinical trial comparing health-care workers’ use of respirators and surgical masks was published online in October 2009 in the . Canadian researchers reported no difference in influenza rates among nurses using one type of protective device versus the other.gt;gt;Both studies helped inform an Institute of Medicine (IOM) panel that, in September 2009, issued a report recommending the use of fitted N95 respirators by health-care workers who interact with patients with confirmed or suspected cases of H1N1. (MacIntyre was also a member of that panel.) However, because the two studies were preliminary, the committee said that it could not draw conclusions from either.gt;gt;“The take-home message for me is that, in clinical settings, wearing a mask or an N95 appears to be essentially equivalent,” says Mark E. Rupp, MD, a professor of infectious diseases at the University of Nebraska Medical Center in Omaha and president of the Society for Healthcare Epidemiology of America (SHEA).gt;gt;Data presented at the IDSA meeting also highlighted the problems with N95 respirators, Dr. Rupp says. Health-care workers say that the respirators are uncomfortable and more difficult to wear than face masks, and that they make it hard to speak with patients, among other problems, he explains. They’re more expensive too.gt;gt;Although respirator use made sense at the beginning of the swine flu pandemic, it now appears that H1N1 behaves similarly to seasonal influenza, Dr. Rupp says, so “it doesn’t make much sense to be using different precautions for seasonal flu than we use for H1N1.”gt;gt;gt;The SHEA would like to see federal guidelines revised, he says.gt;gt;Still, government health and safety organizations are standing by the more stringent standard of protection.gt;gt;IOM spokeswoman Christine Stencel says that the National Institute for Occupational Safety and Health and others have provided “convincing data” on the ability of the respirators to filter out a large percentage of tiny particles.gt;gt;“Based on all the available evidence and data that the committee had to look at, [it recommended] that the N95 respirator afforded the best potential protection against airborne transmission of the virus, and therefore that was the recommendation for health-care workers in terms of respiratory protection,” she says.gt;gt;The Centers for Disease Control and Prevention (CDC) developed its policy independently of the IOM and the MacIntyre study, explains CDC spokesman Jeff Dimond. However, it’s similar in terms of respirator use. The CDC recommends that health-care workers in close contact with people with suspected or confirmed H1N1 influenza use a properly fitted, disposable N95 respirator, or something that offers similar or better protection.gt;gt;The current recommendation is based on unique conditions associated with the current pandemic, including low levels of population immunity to 2009 H1N1, the potential for health-care personnel to be exposed to H1N1 patients, and other factors, Dimond says.gt;gt;In October 2009, the Occupational Safety and Health Administration (OSHA) said it would soon issue a “compliance directive” to ensure that health-care facilities have controls in place to protect workers from occupational exposures to swine flu. OSHA said its directive would closely follow the CDC’s guidance.gt;gt;In Dr. Rupp’s opinion, the respiratory protection debate has distracted from other crucial flu-fighting measures. These include:gt;gt;gt;gt;Quickly identifying and isolating patients with influenza-like illness.gt;gt;Preaching respiratory etiquette programs. Patients who are ill should be asked to wear a surgical mask to contain their secretions, he says, and they should use tissues and wash their hands frequently to prevent touch contamination.gt;gt;Encouraging hospital visitors to stay home if they’re sick and urging health-care workers to stay home when they’re sick.gt;gt;Getting seasonal and H1N1 vaccines. “For health-care workers, that is by far the best way to protect them,” he says.gt;gt;]]> Istockphoto

gt;gt;Jessica Capelle, a 35-year-old part-time lawyer from Houston, wants to get a flu shot this year. But as her fibromyalgia has worsened over time, she says she's become more sensitive to vaccines—a side effect often reported by people with chronic pain.gt;gt;Based on anecdotal evidence, it does seem that vaccines, for influenza or otherwise, could temporarily increase or trigger fibromyalgia symptoms. Seasonal flu shots are made from inactivated (dead) viruses, which could theoretically trigger flu-like symptoms or allergic reactions. (Another type of flu vaccine, administered through a nasal spray, is made from live, weakened influenza viruses and is not recommended for people with underlying medical conditions.)gt;gt;Since there is little formal research backing these experiences, however, doctors' recommendations vary almost as much as patients' opinions. While the gt;Centers for Disease Control and Preventiongt; states that you cannot catch the flu from a vaccine, it does note that minor side effects from the shot can include soreness at the injection site, aches, and a low-grade fever—and that's in perfectly healthy people.gt;gt; gt;Added swine flu concerngt;gt;There are even more questions to be answered this year, thanks to the outbreak of the H1N1 influenza virus, commonly referred to as gt;swine flugt;. Two vaccines for swine flu—a nasal spray that contains weakened virus and a shot that contains inactivated virus—were approved in September, but skepticism and worry about such new vaccines may prevent people from taking advantage of them.gt;gt;Despite potential complications, fibromyalgia patients should consider getting both vaccinations, says Jacob Teitelbaum, MD, the medical director of the gt;Fibromyalgia and Fatigue Centersgt;, which are located throughout the United States. "People with severe chronic illnesses that put them more at risk [for dangerous complications of the flu] are more likely to get benefit than harm from the vaccine," he says.gt;gt; But that doesn't mean fibromyalgia patients must get either vaccine. The decision for many, like Capelle, to vaccinate or not to vaccinate can be a frustrating toss-up. "The last three times I've gotten a flu shot, I ended up in bed for three weeks just from the shot," she says. "Last year I didn't get one and got the flu."gt;gt;gt;gt;Who should get vaccinated?gt;gt;It's hard to say, even for experts. "If you feel like getting the shot, if you're the type who catches everything, or if you find vaccines have been well-tolerated in the past, it's not a big deal; go get it," Dr. Teitelbaum says. "If past vaccines have knocked you for a loop, or your gut feeling is you don't feel comfortable, don't feel like you have to get it."gt;gt; Indeed, some fibromyalgia patients tolerate shots just fine. Lavila Weckwerth, of Watervliet, Mich., has gotten a seasonal flu shot for the past seven years—despite being diagnosed with fibromyalgia three years ago—and has never noticed any side effects. Weckwerth works in a hospital and knows she's at increased risk of getting sick; however, when it comes to H1N1, she's uncomfortable with the new vaccine's lack of testing and doesn't plan on getting it unless it's required by her job.gt;gt;Andrea Nixon, of Pahrump, Nev., on the other hand, has never received a flu shot (and luckily has never gotten the flu) and does not plan on getting one.gt;gt; "Earlier this year I was given a B-12 shot [to help with fibromyalgia and chronic fatigue symptoms]; it nearly paralyzed my left arm for six months," says Nixon, who was diagnosed with fibromyalgia in 2006. "Before being diagnosed, I was taking the Depo-Provera injection when numerous debilitating symptoms began occurring. So needless to say, I'm not much into receiving injections of any type!"gt;gt;Capelle, who says she had gt;the flugt;, three gt;coldsgt;, and five gt;sinus infectionsgt; just this past summer, may simply be more susceptible to viruses, and therefore a better candidate for vaccination. In addition to evaluating your susceptibility to the flu, also consider your risk of exposure to the virus as you make your decision to get vaccinated. If you don't spend much time around other people, you may not come into contact with the virus. But if you are in frequent contact with children or sick individuals, like nurses or teachers are, you are probably at increased risk.gt;gt; gt;What's worse, flu or fibro?gt;gt;Many patients are hesitant to get the vaccine in fear of bad fibro flare-ups. When deciding whether to get vaccinated, consider past flare-ups in comparison to past bouts with the flu, advises Dr. Teitelbaum.gt;gt; "How your body has reacted in the past is the best predictor of how it'll react in the future," he explains. If a past vaccine triggered severe symptoms, maybe you'd be better off with a mild case of the flu.gt;gt; In fact, Dr. Teitelbaum has observed that some patients actually feel a lessening of their gt;fibromyalgia symptomsgt; when they have the flu. "I've had people come to me and say, 'The only days that I've felt half-decent in the last eight years are when I've had the flu or some other virus,'" he says.gt;gt; Although the flu's effects on fibro are nearly impossible to quantify, Dr. Teitelbaum says, doctors believe that when the virus stimulates the immune system, it naturally improves other immune-system conditions, including fibromyalgia.gt;gt; Others, however, would take a vaccine's side effects over the flu any day. "I decided to get a flu vaccination this year, and I also plan to get the H1N1 vaccination, despite the side effects," says Deborah J. Norris, of Glendale, Ariz. "With [fibromyalgia], my immune system is impaired, and illness hits harder and takes longer to recover from." gt;gt; If you've never had a flu shot before, or never even had the flu, you won't have any measure for comparison. For these rare cases, Dr. Teitelbaum says he would question why you want to start with vaccinations now. If it's because of the gt;panic surrounding the swine flugt;, he recommends looking at the facts: In the United States, seasonal flu kills tens of thousands more people every year than swine flu has so far in 2009.gt;gt; Instead of putting your faith in the new H1N1 vaccine, he recommends getting a regular seasonal vaccine—at least at first. Although the swine-flu shot has successfully made it through clinical trials, has been approved by the Food and Drug Administration, and gt;has been deemed safe for people with weakened immune systemsgt;, its large-scale distribution hasn't yet been evaluated. "This is a whole new strain, and no one knows what the reactions are," Dr. Teitelbaum says. "Why not wait and start with something a little more proven?"gt;gt; gt;Protect yourself, shot or notgt;gt;In the meantime, be sure to take the necessary precautions against the flu—and fibro. Common stressors that trigger fibromyalgia flare-ups—including cold or damp weather, poor sleep, fatigue, physical or emotional stress, and overexertion—can also leave you more susceptible to the flu.gt;gt; Fibromyalgia doctors recommend gt;avoiding these triggersgt; whenever possible and reducing their effects by lowering stress and improving sleep habits. Dr. Teitelbaum also recommends washing your hands, staying hydrated, and adding extra gt;vitamin C and zincgt; to your diet to help boost immunity.]]> A shot may trigger fibro flare-ups, but offers protection from more serious flu complications. Getty Images

gt;Pseudoephedrinegt;gt;
gt;gt;gt;What is it?gt; Commonly found in nonprescription cold and allergy medications like Sudafed and Advil Cold & Sinus, pseudoephedrine eases stuffy noses by shrinking swollen blood vessels in your nasal passages, says John Sundy, MD, an asthma and allergy specialist at Duke University Medical Center.gt;gt;gt;The buzz:gt; Meds with pseudoephedrine were moved behind the pharmacy counter in 2006, and limits were imposed on how much you can buy. Why? The stuff can be used to make methamphetamine, an illegal drug.gt;gt;gt;You need to know:gt; If you buy a cold or allergy medication and don’t get your usual relief, it may be because the product contains phenylephrine (available over the counter), not pseudoephedrine, Dr. Sundy says. New research shows that some people with stuffy noses get more relief from pseudoephedrine than phenylephrine.gt;gt;gt;The bottom line:gt; Read labels so you know your phenyl from your pseudo, and ask your pharmacist for a pseudoephedrine product if you think you need it. Know that the drug slightly raises your risk for high blood pressure and might make you jumpy, Dr. Sundy says.gt;gt; gt;Health gt;]]> (ISTOCKPHOTO)

gt;influenza virusgt; is more likely survive, possibly giving it a better shot at spreading from person to person and making its way to you.gt;gt;The finding also suggests that using a humidifier may be a good idea in places where the spread of influenza poses a serious threat, like intensive care units or even a home with a sick child—as long as sensitivity to moisture-loving mold and spores isn’t a problem, according to Jeffrey Shaman, PhD, of Oregon State University in Corvallis, a coauthor of the new study.gt;gt;“It seems that [the influenza virus’s] ability to survive and be transmitted person-to-person is greatly affected by how dry or wet the air is,” says Shaman, whose study is published in this week’s .gt;gt;The name for this potentially deadly respiratory infection comes from the Italian word for influence; centuries ago, people believed that the influence of the planets made people sick with the disease. Our science is a little more solid today, but researchers still aren’t 100% sure how and why the virus spreads, and they remain stumped about why some parts of the world have such a pronounced winter flu season with almost no flu activity in warmer months.gt;gt;Shaman believes he’s found the answer: It’s all about humidity. Absolute humidity, that is, which is particularly low in cold weather.gt;gt;Shaman and his colleague Melvin Kohn of the Oregon Department of Health Services in Portland revisited a 2007 study that found higher humidity slowed the spread of the flu among guinea pigs. The researchers had measured air dampness using relative humidity, or how saturated the air is with water vapor.gt;gt;For example, 75% relative humidity would mean the air is holding 75% of its total capacity of water vapor. Relative humidity is strongly influenced by temperature; the warmer the air, the more water vapor it can hold, while colder air can’t hold as much water vapor.gt;gt;Absolute humidity, on the other hand, refers to the actual amount of water vapor in the air regardless of saturation. Relative humidity is like a car’s gas gauge, Shaman notes. It tells you how full your tank is. Absolute humidity represents how many gallons you have in your tank, regardless of the tank’s size.gt;gt;Shaman converted the guinea pig data from relative humidity to absolute humidity and found the link between air moisture and flu spread got much stronger. “Absolute humidity, for reasons that remain undetermined, is affecting how long the virus remains viable,” he says. “It really explains why you have this pronounced seasonality in temperate regions.”gt;gt;The researcher also looked at studies dating back to the 1940s of airborne flu virus survival. Some included information on relative humidity, which he converted to absolute humidity. Again, the relationship between survival and air moisture got stronger.gt;gt;gt;For example, in the wettest possible absolute humidity, less than 20% of the virus was still viable after an hour, while at the driest conditions 80% of the virus was still capable of making someone sick. After 23 hours, the viruses in the dampest conditions were all dead, while 60% of those under the most arid conditions were still alive.gt;gt;“The idea that humidity affects the life of virus has been known for decades,” says Michael Gardam, MD, PhD, an infectious disease specialist with the University Health Network in Toronto and Ontario’s public health agency. While Shaman’s findings are “important,” according to Dr. Gardam, the challenge will now be to see if air humidity affects the spread of the disease among humans in the real world. “Based on the papers that have been done thus far, I wouldn’t run out and buy humidifiers, but I would definitely buy humidifiers to study humidifiers.”gt;gt;“This is sort of nibbling around the edges,” he added. “It’s useful, but it’s not sufficient to say, ‘We now have the answer to change the world.’”gt;gt;It’s “frustrating,” Dr. Gardam says, that we still don’t know if the virus is spread mainly by physical contact or through the air or both. For this reason, he adds, there remains no scientific evidence that widely promoted protective measures such as hand washing and mask wearing will actually stop people from getting sick. “We’ve just sort of taken for granted we know how it transmits, and we really don’t know,” he says.gt;gt;“I think they’ve done a good job. I agree with their work,” says Anice Lowen, PhD, a researcher at the Mt. Sinai School of Medicine in New York and one of the authors of the guinea pig study. “I’m not an expert in the methods that they used, but it seems to make sense.”gt;gt;The reasons why the flu virus might survive and spread more easily in dry conditions—and why absolute humidity might be a better gauge of these conditions than relative humidity—are still not clear, Lowen notes. It could have something to do with moisture evaporating from surfaces more speedily when humidity is low, she says.gt;gt;Lowen agrees that keeping indoor air more humid might help slow down the spread of the flu. But, she adds, “the best way to protect yourself against influenza is to get vaccinated.”]]> (GETTY IMAGES)

gt;coldgt; or gt;flugt;. But those who persevere when they're sick and don’t break their exercise routine may be on to something. Some experts argue that moderate exercise can actually have a gt;beneficial effect on cold symptomsgt;, according to the American College of Sports Medicine.gt;gt; Exercisers in general tend to catch fewer colds than their sedentary counterparts, research suggests. If done regularly, moderate exercise can halve the number of days you spend with gt;cold symptomsgt;, according to a series of studies conducted in the 1990s. While working out may help fend off viruses, even the most dedicated gymgoer will come down with a cold at some point.gt;gt; Not everyone who feels under the weather should exercise, however.gt;gt;gt;What’s the neck rule?gt;gt;Experts like to cite a rule of thumb known as the “neck rule.” If your symptoms are all located above your neck (stuffy nose, scratchy throat, headache), you almost certainly have a head cold and can hit the road or treadmill safely. If, on the other hand, you have a fever, congestion in your chest and lungs, or feel achy, it is probably a sign of flu, bronchitis, or another more serious ailment, and you should rest up. (Exercising with a fever will make you more vulnerable to dehydration, among other ill effects.)gt;gt;But the neck rule isn’t foolproof, and a little common sense is always a good idea. “The above-the-neck rule is a good one, but I’d say severe above-the-neck symptoms warrant cessation from regular exercise until the symptoms abate,” says Jeffrey Woods, PhD, professor of kinesiology at the University of Illinois at Urbana-Champaign. “ Even gt;Olympic athletesgt; need a day or two off every once in a while.”gt;gt;gt;Even if you pass the neck test and are determined to get a workout in, you should take it easy at first. “To be prudent, I’d recommend cutting exercise duration and intensity when symptoms are present,” says Woods.gt;gt;Daryl Rosenbaum, MD, director of the Sports Medicine Fellowship at the Wake Forest University School of Medicine, recommends that people with colds begin working out at 50% intensity. If symptoms improve after the first 5 to 10 minutes (as they often do), you can gradually increase the length and effort of your workout up to about 80% to 90% of your usual routine.gt;gt;“Moderation is the key,” says Dr. Rosenbaum. “Studies have shown that people suffering from the common cold who get up and get moving actually feel better. If you go too far, however—either with extreme short-term activity or long-term overtraining—the immune system weakens. A viral cold that is allowed to linger for longer than normal could create sinus conditions that are ripe for a gt;bacterial sinusitisgt; to take over.”gt;gt;There are some other precautions to keep in mind. Staying hydrated during exercise is always important; it is especially so if you’re planning to exercise with a cold. The nasal drainage associated with colds can hasten dehydration, and some gt;over-the-counter cold remediesgt; containing antihistamines (many cough syrups, for instance) can dry you out further, Dr. Rosenbaum points out.gt;gt;gt;Don’t spread—or catch—more germs at the gymgt;gt;If you work out in a public gym, be extra vigilant when exercising with a cold. Germs can be transmitted through the air and through any person-to-person contact, so if you use a treadmill, gym mat, or barbells, be sure to be extra careful when it comes to wiping down the equipment. And avoid touching your face after handling equipment; you can pick up germs that will be more likely to infiltrate your body that way.gt;gt; Your vulnerability to upper respiratory tract infections spikes for several hours starting just after a strenuous workout, studies suggest. So if you’ve just stepped off the treadmill after a 10-mile run, give that sweating, coughing, and sniffling stranger in the locker room a wide berth.gt;gt;“Regardless of whether you’re exercising moderately or intensely, you want to take precautions against infection,” says Woods. “Clean your exercise equipment before and after, use a clean cup to get water from the fountain, and try to pick a machine away from other people.”]]> If your symptoms are above the neck (stuffy nose, scratchy throat, headache), it’s probably safe to work out. (GETTY IMAGES)