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Friday, July 29, 2011

Pregnancy and the Flu

Pregnancy and the Flu

One simple step Ð which takes seconds to do Ð can help pregnant women keep their babies safe from the flu after they're born.

Hi, I'm Dr. Cindy Haines, host of HealthDay TV.

The flu poses special health threats to pregnant women. Babies are also at high risk of flu-related complications, but they can't be vaccinated against the disease until they're 6 months old.

New research supports the later benefits when pregnant women get a flu shot. The study, published in the American Journal of Obstetrics & Gynecology, included 1,510 babies who were hospitalized with flu-like symptoms before the age of 6 months. Testing found that most didn't actually have the flu, however.

The researchers found that when the mothers had a flu vaccination during pregnancy, their babies were about 48 percent less likely to need to be hospitalized for the flu

According to the CDC, pregnant women can have a flu shot at any point during any trimester. The organization also points out that millions of pregnant women have had the flu vaccine, which has not been found to be harmful to the mom or the baby.

I'm Dr. Cindy Haines of HealthDay TV, with the news that doctors are reading; health news that matters to you.

Thursday, July 28, 2011

Study: IUD Users Have Fewer Repeat Abortions

Study: IUD Users Have Fewer Repeat Abortions

Giving women free access to long-term birth control after they've had an abortion may help them avoid a second one, New Zealand researchers suggest.

Of 510 women who'd been offered contraceptives free of charge at an abortion clinic, less than six percent of those who went on to use an intrauterine device, or IUD, ended up having another abortion within two years.

Among those women who said they were taking birth control pills, 13 percent had a repeat abortion. For condom users, the number was 17 percent.

The results suggest long-acting birth control methods should be promoted to women following an abortion, according to the researchers.

"In the United States, widespread access to IUDs has been hampered by barriers including costs, lack of provider training, and misconceptions held by both patients and providers," Sally Rose and Dr. Beverley Lawton of the University of Otago in Wellington write in the American Journal of Obstetrics and Gynecology.

Their study comes on the heels of a new proposal from the U.S.-based Institute of Medicine calling on insurers to cover all birth control methods.

The Institute also recommends that birth control should be available without co-pays in order to reduce upfront costs and encourage its use.

Currently, two types of IUDs are available: a plastic model that releases hormones (sold as Mirena) and a copper model (Paraguard).

The devices, which cost between $500 and $1,000, prevent pregnancy more than 99 percent of the time, according to Planned Parenthood. They have to be inserted and removed by a health care provider, but can last as long as 12 years.

In the New Zealand study, women who'd had an abortion were offered a choice between different contraceptives. After six months, they were contacted and asked what kind of birth control they used, if any.

Nearly one in 10 women had a repeat abortion at the clinic within two years. Those who'd said they used an IUD had a 64-percent lower chance of ending up at the clinic again compared to women on the pill.

IUDs and similar devices "can go a long way to reducing unintended pregnancies, and as a consequence, abortions," said Adam Sonfield of the Guttmacher Institute in Washington DC, an organization that researches sexual and reproductive health.

Even though IUDs are considered the most effective type of birth control, the high cost of inserting the device often prevents people opting for it, Sonfield told Reuters Health.

"If you can take away those up-front costs as a barrier and allow women to choose among the different options ...most women end up choosing IUDs" or similar devices, he said.

Over time, the device may end up being less costly than birth control pills because it lasts for many years.

According to Dr. Joseph Speidel, who heads the Bixby Center for Global Reproductive Health at the University of California, San Francisco, unintended pregnancies rack up a bill of over $10 billion a year.

So curbing abortions with increased access to long-acting birth control might also cut U.S. healthcare spending, he told Reuters Health.

Inserting an IUD can carry some risk of side effects, including moderate pain and cramps shortly after it's put in, and changes in menstrual bleeding. Over the long term, there is a small risk of infection, and the IUD can become dislodged in rare instances.

Although less than one in 100 women become pregnant when using an IUD, those who do become pregnant are at a higher risk for miscarriage or early delivery.

An alternative to the IUD is a matchstick-sized rod (sold as Implanon), which releases hormones and is implanted into the patient's arm. It can last for three years and costs between $400 and $800.

Dr. Suzan Goodman, who teaches family and community medicine at the University of California, San Francisco, said offering birth control immediately after an abortion has several advantages.

Those include "high motivation, less discomfort, assurance a woman is not pregnant and reduced burden on both the patient and the healthcare system," she said in an e-mail to Reuters Health.

Wednesday, July 27, 2011

Menopause Does Not Boost Diabetes Risk, Study Finds

Menopause Does Not Boost Diabetes Risk, Study Finds
Exercise and weight control can cut the odds for older women even further, researchers say
Menopause does not raise a woman's odds of developing diabetes, according to a new study.

Researchers from the University of Michigan Health System found this was true for both women who underwent natural menopause and those who had their ovaries removed.

"In our study, menopause had no additional effect on risk for diabetes," the study's lead author, Dr. Catherine Kim, associate professor of internal medicine and obstetrics and gynecology at the University of Michigan Health System, said in a universitynews release. "Menopause is one of many small steps in aging and it doesn't mean women's health will be worse after going through this transition."

In conducting the study, published in the August issue of Menopause, researchers examined more than 1,200 women between the ages of 40 and 65 with what's known as glucose intolerance (a pre-stage to diabetes characterized by high blood sugar levels).

The study found that for every year 100 women were observed, 11.8 premenopausal women developed diabetes, compared to 10.5 among women in natural menopause and 12.9 cases among women who had their ovaries removed.

Meanwhile, women who had their ovaries removed but also lost 7 percent of their body weight and exercised for at least 150 minutes per week actually saw a decline in their risk for diabetes. The researchers found that for every year 100 of these women were followed, only 1.1 of them developed the disease.

The results among this group, the study authors pointed out, were surprising considering that nearly all of the women who had their ovaries removed were on hormone replacement therapy -- a treatment that may put them at risk for an array of health problems. They added that additional research is needed on the role of hormone therapy and diabetes risk.

"Physicians can be empowered to tell women that lifestyle changes can be very effective, and that menopause does not mean that they have a higher risk of diabetes," concluded Kim.

More information

The U.S. National Library of Medicine provides more information on menopause

Tuesday, July 26, 2011

Doctors group contradicts U.S. mammogram advice

Doctors group contradicts U.S. mammogram advice

Victoria Colliver

Less than two years after a key government task force recommended that most women in their 40s may not need mammograms, the nation's largest group representing obstetricians and gynecologists has advised women in that age group to have annual mammograms.
The American College of Obstetricians and Gynecologists on Wednesday issued the new guidelines, which recommend that woman get annual mammograms starting at age 40. Previously, the group recommended mammograms every one to two years starting at age 40, and annually beginning at age 50.
"We know mammography saves lives. If you can find cancer earlier, we know we're doing some good," said Dr. Mary Gemignani, an associate attending physician in breast surgery at Memorial Sloan-Kettering Cancer Center in New York City who helped write the new screening guidelines.
"We know from a cancer perspective that women in their 40s often have more aggressive tumors and by shortening the interval (between screenings), the cancer may be detected earlier," she said.
The new guidelines put the group in line with other organizations, including the American Cancer Society, the American College of Radiology and the Society of Breast Imaging.
But in November 2009, the U.S. Preventive Services Task Force, a government-sponsored group that provides guidance to doctors, insurance companies and policymakers, came out with controversial guidelines that suggested women in their 40s may not need regular mammograms and that women 50 and older should get them every other year instead of annually.

The risks for women

Women have a lifetime risk of about 12 percent of developing breast cancer, but less than 2 percent of women in their 40s develop the disease.
The 2009 recommendations acknowledged that mammograms were found to reduce breast cancer deaths in women aged 40-49 by 15 percent, but determined that wasn't enough to warrant routine mammography at age 40. The risks include radiation exposure and unnecessary biopsies. The group also found insufficient evidence to support screening after age 74.
Dr. George Sawaya, a UCSF professor in obstetrics, gynecology and reproductive sciences who served on the U.S. task force and voted for its new guidelines, said the two recommendations are not as different as they appear.
Sawaya, who is also a member of the American College of Obstetricians and Gynecologists, said the task force did not discourage women in their 40s from having mammograms but, instead, suggested they discuss the potential risks of screenings with their doctors.
"The task force said for women in their 40s and older, it's an individual decision based on their values and the benefits and harms," he said.
Nancy Brinker, founder and chief executive officer of Susan G. Komen for the Cure, lauded the new guidelines issued Wednesday and called the task force's 2009 recommendations "confusing and clumsy."
"The more confused the public is, the less screenings that will occur," Brinker said. "Every time we have one of these debates, more people are confused. These guidelines go a long way at clearing up some of those issues."

Anger over confusion

Another breast cancer advocacy group, Breast Cancer Action in San Francisco, agreed that the dueling guidelines create confusion. The organization supports the task force's 2009 approach, contending scientific evidence does not warrant mammography in younger women at low risk.
"We are incensed about this confusion. Our concern is that putting out new recommendations without any supporting evidence puts women in an impossible situation," said Karuna Jaggar, executive director of the group.
Jaggar said the focus needs to shift to preventing breast cancer in the first place. "Mammography works in some situations, but there are limits and there are risks," she said. "Screening is always going to be a tool. It will never be the answer. We need to get at the root of this problem."

New guidelines

The American College of Obstetricians and Gynecologists on Wednesday issued screening guidelines for breast cancer that recommend:
-- Women 40 and older be offered mammography every year rather than every other year, as previously recommended.
-- Women 50 and older be offered annual mammograms, as previously recommended.
-- Clinical breast exams be conducted annually for all women 40 and older.
-- Women ages 20 to 29 receive clinical breast examinations every one to three years.
-- Women be informed about the potential for false negative and false positive results, and that additional imaging or biopsies may be needed.
-- Women at high risk of breast cancer receive enhanced screening opportunities.
Source: American College of Obstetricians and Gynecologists

Monday, July 25, 2011

Low Newborn Apgar Score Linked To Lower Academic Achievement At Age 16

Low Newborn Apgar Score Linked To Lower Academic Achievement At Age 16

Babies with low Apgar scores at birth have a higher risk of having special education needs during adolescence, Swedish researchers reported in Obstetrics & Gynecology.

Apgar is a way of evaluating the health of a newborn shortly after birth. The Apgar score is a number which is added up by scoring respiratory effort, heart rate, skin color, response to a catheter in the nostril, and muscle tone. Each objective sign can receive a score from 0 to 2 points. The highest total Apgar score is ten - a baby with a score between 0 and 3 needs to be resuscitated immediately.

Dr. Andrea Stuart of Central Hospital in Helsingborg, Sweden, and team set out to estimate what the link might be between low Apgar score and long-term cognitive function. The scores are taken within five minutes of the baby being born. They were specifically looking at scores below 7.

The researchers gathered Apgar score data from the Swedish Medical Birth Registry and academic performance from the Swedish School Grade Registry. They were specifically trying to link low Apgar scores with the likelihood of a child having to go to a special-education school. The database included information on 877,618 babies from 1973 to 1986. 23,000 kids were attending a special-education school.

The vast majority of the newborns had Apgar scores of 9 or ten, and 1% had a score below 7. Of those with a score below 7, one third had a score below 4.

The team calculated that a newborn with an Apgar score below 7 within five minutes of being born had twice the risk of subsequently going to a special school, compared to those with high scores. The risk was three times greater for those whose Apgar scores were 2 or 3.

Those with an Apgar score of less than seven had a much higher chance of never receiving graduation grades.

Dr. Andrea Stuart said:

"It is not the Apgar score in itself that leads to lower cognitive abilities. It is the reasons leading to a low Apgar score (including asphyxiation, preterm delivery, maternal drug use, infections) that might have an impact on future brain function."

Even though the risk is higher, the authors stressed that it is still low. A newborn with a score below seven has only a 2.27% chance of needing to go to a special-education school as a teenager.

The authors concluded:

"An Apgar score of less than 7 at 5 minutes after birth is associated with subtle cognitive impairment, as measured by academic achievement at 16 years of age."

"Apgar Scores at 5 Minutes After Birth in Relation to School Performance at 16 Years of Age"
Stuart, Andrea MD; Otterblad Olausson, Petra PhD; Källen, Karin PhD
Obstetrics & Gynecology: August 2011 - Volume 118 - Issue 2, Part 1 - pp 201-208 doi: 10.1097/AOG.0b013e31822200eb

Written by Christian Nordqvist 

Friday, July 22, 2011

This Test Given Moments After Birth May Tell How Well Your Kids Do In School

This Test Given Moments After Birth May Tell How Well Your Kids Do In School
By Robert Johnson

A test given to all newborns moments after they're born may reveal how well they'll do in high school.
According to LiveScience, a new study in the journal of Obstetrics & Gynecology looked at 877,000 Swedish children given the Apgar test used to determine an infants health, and compared those scores with graduation rates.
The lower the scores when they were born, the greater the likelihood the children would have learning difficulties later in life.
"It is not the Apgar score in itself that leads to lower cognitive abilities," said study author Dr. Andrea Stuart, an obstetrician at Central Hospital in Helsingborg, Sweden. "It is the reasons leading to a low Apgar score  [including asphyxiation, preterm delivery, maternal drug use, infections] that might have an impact on future brain function."
The Apgar is given between one and five minutes after birth and evaluate an baby's heart rate, muscle tone, breathing, skin color, and reflex irritability -- each on a two-point scale.
The study found that kids with scores below 7 have twice the odds of attending special schools for the learning impaired.

Thursday, July 21, 2011

Screen All Women for Alcohol Use, ACOG Says

Screen All Women for Alcohol Use, ACOG Says
By Todd Neale

Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco.

Pregnant or not, all women seeing their ob/gyn should be screened for alcohol use to identify at-risk drinking and alcohol dependence, according to the American College of Obstetricians & Gynecologists (ACOG).

The screenings should take place at least every year and within the first trimester of pregnancy, stated an opinion from ACOG's committee on healthcare for underserved women, which was published in the August issue of Obstetrics & Gynecology.

"It should be noted that women who drink at risk levels are less likely to maintain routine annual visits, and screening should be considered for episodic visits if not completed within the past 12 months," the authors wrote.

The National Institute on Alcohol Abuse and Alcoholism defines at-risk alcohol use as more than three drinks per occasion (binge drinking) or seven drinks per week for healthy women, and any amount of drinking for women who are pregnant or who are at risk of becoming pregnant.

According to the authors of the ACOG opinion paper, at-risk alcohol use is a greater risk to women than men, with wide-ranging health effects.

Those include negative effects on reproductive function and pregnancy outcomes and greater risks of various cancers, sexually transmitted diseases, menstrual disorders, altered fertility, injuries, and a host of psychosocial problems, such as relationship loss, sexual assault, loss of income, altered judgment, depression, and suicide.

In addition, women who drink during pregnancy place their unborn children at risk of birth defects.

According to ACOG, ob-gyns play an integral part in mitigating the health effects of problem drinking in three main areas -- screening, intervention and education, and treatment referral.

Various screening tools can be used, and the opinion highlighted TACE (Tolerance, Annoyed, Cut down, Eye-opener), which asks about a woman's tolerance to alcohol, annoyance with being criticized for her drinking, feelings about the need to decrease her amount of drinking, and drinking first thing in the morning.

The authors noted that "although the CAGE mnemonic screening tool has been taught in most medical schools and residency programs, it has not proved to be sensitive for women and minorities."

They also noted that women with alcohol use problems are often more likely than men to deny the existence of a problem and often do not have any signs on physical examination.

In terms of intervention, a brief educational session and motivational interviewing by the ob-gyn can be effective in women who are not addicted to alcohol.

The provision of clear advice on avoiding alcohol and achieving abstinence should be used for pregnant women and those at risk for getting pregnant, the authors wrote.

"Women who have already consumed alcohol during a current pregnancy should stop in order to minimize further risk, and those who are considering becoming pregnant should abstain from drinking alcohol," they wrote.

They added that "healthcare providers should advise women that low-level consumption of alcohol in early pregnancy is not an indication for pregnancy termination."

If intervention and education fail to get a woman who is drinking at risky levels to curtail her drinking, the ob-gyn should refer her to a substance abuse specialist, according to the opinion. The appointment should be made with the woman still in the ob-gyn's office.

"It may take a number of offers before the patient is ready to accept a treatment referral," the authors wrote. "The patient's trust in her medical provider may be key in taking the step toward treatment."

Wednesday, July 20, 2011

Breastfeeding Problems Associated with Depression

Breastfeeding Problems Associated with Depression


Postpartum depression is more common among women who had breastfeeding issues in the first two weeks after giving birth.

Accordingly, researchers say women with breastfeeding difficulties should be screened for depressive symptoms.

“We found that women who said they disliked breastfeeding were 42 percent more likely to experience postpartum depression at two months compared to women who liked breastfeeding,” said Stephanie Watkins, a doctoral student in epidemiology at University of North Carolina at Chapel Hill.

“We also found that women with severe breast pain at day one and also at two weeks postpartum were twice as likely to be depressed compared to women that did not experience pain with nursing.”

The idea for the study, published online ahead of print by the journalObstetrics & Gynecology, grew from the clinical experience of senior author Alison Stuebe, M.D.

“We found that very commonly the same moms who were struggling with breastfeeding were also depressed,” she said. “There was a tremendous clinical overlap.”

In the study, researchers worked to determine if this anecdotal association would be backed up by statistical analysis of relevant data. They used data collected as part of the Infant Feeding and Practices Study II, and assessed the postpartum depression status of the 2,586 women in that study with the Edinburgh Postnatal Depression Scale.

Of those women, 8.6 percent met the criteria for major depression two months after giving birth.

Women who reported disliking breastfeeding during the first week were 1.42 times as likely to be depressed at two months. Women who reported severe breastfeeding pain on their first day were 1.96 times as likely to be depressed at two months.

The finding indicated that mothers with breastfeeding difficulties should be screened for depression and referred to counseling when depression is confirmed.

Further, the study also provides a message for mothers, Stuebe said.

“If they’re struggling with breastfeeding, they should seek help and tell their provider. If they don’t have joy in their life, if they wake up in the morning and think, ‘I just can’t do this another day’ – that’s a medical emergency.

“They shouldn’t just say, ‘I’m going to power through this and snap out of it.’ They should call their provider and say, ‘I just don’t feel right, I’m wondering if I could be depressed, can I come in and talk to you about it?’ ”

Tuesday, July 19, 2011

Birth Control May Become Free After Panel’s Recommendation

Birth Control May Become Free After Panel’s Recommendation

WASHINGTON (CBSMiami.com) – Health experts advising the federal government have recommended that health insurance companiesbe required to cover birth control for women as preventive service, with no copayment.
The Institute of Medicine recommendations also included diabetes tests during pregnancy and screening for the virus that causes cervical as recommended preventive services for women.
The findings were issued as the government begins to implement parts of the federal health care reform law. The law requires most health plans to cover preventive care for both sexes, but the women’s health recommendations were sent to a nonpartisan institute for review.
The final decision from Health and Human Services Secretary Kathleen Sebelius is expected to be issued soon.

More studies show drugs block HIV

More studies show PrEP prevents HIV infection

The evidence is mounting.  Another study has found that PrEP - pre-exposure prophylaxis – is relatively safe and can prevent HIV transmission in couples where one partner is already infected with the virus.
The data from the study, called the HPTN 052 trial, released Monday in the New England Journal of Medicine  at the International AIDS Society Conference in Rome.  Researchers enrolled nearly 1,800 couples in Botswana, Kenya, Malawi, South Africa, Zimbabwe, Brazil, India, Thailand and the United States.
Fifty-four percent of the couples were from Africa; half of the infected partners were men. Those infected, with CD4 counts between 350 and 550, were randomly broken into two groups. In one group, the infected partner received antiretroviral drugs when they were enrolled. In the other, therapy was delayed until after their CD4 count fell below 250, or they suffered an AIDS related illness.
CD4, or T-Cells are a type of white blood cell that helps the body fight infections like viruses and bacteria. The higher your count, the stronger your immune system which helps reduce complications of HIV. When the CD4 count falls below 200 a person has AIDS.
Researchers found for those who got antiretroviral therapy (ART) early, the rate of transmission dropped by 96% compared with those who were treated later. HIV transmission occurred in just 39 people. Twenty-eight of those were directly linked to the HIV-infected partner. Of that 28, only one was from the group that got early treatment. HIV patients that got early therapy also had less HIV-related illness.
"HPTN 052 demonstrated that early initiation of ART by the infected partner in heterosexual couples, where one partner is HIV-infected and the other not, is highly effective in decreasing transmission of HIV to the uninfected partner," said Dr. Anthony Fauci, director, National Institute of Allergy and Infectious Diseases  at the National Institutes of Health. "With these recent advances, we now have an unprecedented opportunity, based on solid scientific data, to control and ultimately end the AIDS pandemic. Of course, global implementation of HIV interventions, including the scale-up of the delivery of ART, must be accelerated, and this will be costly. A truly global commitment is essential. In this regard, major investments in implementation now will save even greater expenditures in the future; and in the meantime, countless lives will be saved."
The drugs used included Combivir, a combination of zidovudine and lamivudine; lopinavir and ritonavir or Kaletra–also known as Aluvia; and the combination tenofovir and emitricitabine whose brand name is Truvada. Last week, two different African studies, one of uninfected heterosexual men and women in Botswana, and the other of heterosexual couples in Kenya and Uganda, found Truvada significantly reduced the risk of transmission in study participants.
In the HPTN study, 82% of the transmissions occurred in Africa. Researchers say more frequent sexual activity and less condom use could be a reason for increased transmission there. Study investigators also saw higher viral loads in HIV patients in sub-Saharan Africa versus patients from developed countries.
Adverse events most often reported included infections, gastrointestinal problems, nervous system disorders and psychiatric issues. Some patients were found to have pulmonary tuberculosis; the majority of those cases were seen in India. More adverse events were seen in patients that got the drugs early. Study authors say the reason is unclear and more follow-up is necessary.
Researchers admit the study, funded by NIAID, is not without limitations. They say the couples were "stable" and possibly not representative of the general population. They were also counseled and given condoms, which authors say could have contributed to the low rate of infection.
New data from the iPrEx study is also being released this week at international AIDS meeting. In iPrEx, a trial that spanned four continents, daily PrEP with Truvada reduced HIV infections in men who have sex with men, or MSM. It was one of the largest studies ever conducted and the first in Asia or Africa that focused on MSM. Eleven new analyses will be presented.
"These new analyses confirm the safety and efficacy of PrEP in MSM and strengthen our belief that PrEP is an important HIV prevention tool with the potential to prevent significant number s of new HIV infections," said iPrEx Protocol Chair Dr. Robert Grant, Gladstone Institutes and the University of California at San Francisco. "When we viewed along with the Partners PrEP and TD2 data in heterosexual men and women, these findings make a compelling case that providing broad access to PrEP could reduce the human and financial cost of the epidemic significantly."

Monday, July 18, 2011

UK 'has too many hospital births'

UK 'has too many hospital births'
By Branwen Jeffreys

Maternity services across the UK need a radical rethink, the Royal College of Obstetricians and Gynaecologists says.
It wants the number of hospital units cut to ensure 24-hour access to care from senior doctors and says more midwife-led units are needed for women with low-risk pregnancies.
The National Childbirth Trust welcomed the report but says the proposals do not go far enough.
NHS managers said maternity care desperately needed to be reorganised.
'Serious complications'
Too many babies are born in traditional hospital units, says the college, which also warns the current system is neither acceptable nor sustainable in its report on maternity care.
RCOG president Anthony Falconer told the BBC that most out-of-hours care was being provided by junior doctors.

Start Quote

You need the right person, as senior person, there immediately”
Dr Tony FalconerRoyal College Obstetricians and Gynaecologists
The college estimates there are about 1,000 too few consultants to provide adequate round-the-clock cover for hospital units.
Dr Falconer said: "There is no doubt if you look at the worst scenario of serious complications, you need the right person, a senior person, there immediately."
Previous attempts to re-organise maternity care around a smaller number of hospital units have proved controversial, but Dr Falconer said if women could be convinced of the greater safety they would be prepared to travel to have their babies.
The need for change would be largely in cities or large towns, because in rural areas it might be more important to support smaller units.
The report estimates that across the UK there are 56 units with fewer than 2,500 deliveries of babies a year.
In order to take the pressure off busy hospitals, the college is also calling for an increase in the number of midwife-led units.
'Joined-up care'
Midwives have welcomed the report, saying it could improve the experience for about a third of women who have straightforward deliveries.
The proposals for maternity are part of a wider vision of delivering all women's gynaecology and obstetrics care in networks, similar to the model which has helped improve cancer treatments in England.
The National Childbirth Trust said the idea of having a network to provide joined-up care for women was one it could support but it would prefer care during pregnancy and maternity to be concentrated in one NHS organisation in each area.
The NHS confederation, which speaks for managers, described maternity care as a classic example of a service which desperately needed to be reorganised.
Chief executive Mike Farrar said politicians needed to be prepared to speak up for change.
"Where the case for change is clear, politicians should stand shoulder-to-shoulder with managers and clinicians to provide confidence to their constituents that quality and care will improve as a consequence of this change."
That has not always been the case, with two ministers in the last Labour government campaigning against the closure of units in Greater Manchester.
Hundreds of people turned out to a rally to oppose the closure of maternity services in Salford last autumn. After a review under the coalition, the NHS is pressing ahead with plans to reduce the number of units across the area from 12 to eight.
Although Scotland has reorganised some of its maternity services, there are likely to be pressures for change elsewhere in the UK.
In North Wales maternity care across three hospitals is expected to change after an initial review recently concluded improvement was needed.

Friday, July 15, 2011

Which Summertime Home Remedies Really Work?

Which Summertime Home Remedies Really Work?
Separate fact from fiction when it comes to what soothes sunburns, bug bites and more
By Amanda Greene

As enjoyable as the easy, breezy days of summer are, they also come with a few less-than-welcome seasonal conditions, such as poison ivy, swimmer’s ear and heat rash. Chances are you’ve heard a few homespun theories about how to treat these warm-weather maladies, like applying toothpaste to calm a bee sting or slathering burned skin with aloe. But do these treatments really work? We spoke to the medical experts to find out which solutions are worth trying, and which are best left behind.
1. Aloe to soothe sunburn: Try it!
While the best defense against a painful sunburn is to stay in the shade (especially during the sun's peak hours from 10 a.m. to 4 p.m.) and slather on sunscreen, sometimes you just can’t avoid getting one. So does aloe, and products that contain aloe, really provide relief? “When squeezed, aloe leaves release a colorless gel that contains 99.5% water and a mixture of chemicals, including choline salicylate, which is a relative of aspirin and can relieve mild to moderate pain,” says Josie Tenore, MD, a physician at Fresh Skin aesthetic medical center in Highland Park, Illinois. “Applying the pure gel to your skin may provide anti-inflammatory properties that can soothe a burn.” According to Glenn Kolansky, MD, a board-certified dermatologist in Tinton Falls, New Jersey, in addition to the gel culled from an aloe plant (just snip open the leaf and squeeze), over-the-counter 100% pure aloe gels will also do the trick. However, Dr. Kolansky stresses that this remedy will only help alleviate the pain associated with first-degree, superficial burns. Photo: Thinkstock

2. Baking soda to relieve heat rash: Try it!
Heat rash is an inflammatory reaction to hot weather that occurs when your sweat ducts become blocked, trapping perspiration under your skin. Symptoms include tiny blisters or extremely itchy, prickly red bumps. While it usually goes away on its own after two or three days (see a doctor if it lasts longer or you experience a fever or increased pain in the area), taking a 20-minute bath in baking soda-infused water may help provide some comfort until then. “The active ingredient in baking soda is sodium bicarbonate, which has mild anti-inflammatory properties,” says Howard Podolsky MD, chief medical officer for Nextcare Urgent Care clinics. He recommends filling a bath with lukewarm water and adding three to four tablespoons of baking soda. Photo: iStockphoto

3. Garlic to treat swimmer’s ear: Skip it!
Spending long hours in the water often causes swimmer’s ear, an infection of the ear canal caused by bacterial and fungal growth. Children and adults are both susceptible; however, youngsters tend to be affected more frequently because they often don't dry their ears off properly. While garlic does contain many antibacterial properties, “most garlic pastes that you’ll find at the supermarket aren’t pharmaceutical grade,” says Dr. Podolsky. “I’ve seen it work, but I wouldn’t recommend it because putting non-sterile items in an infected ear canal is a set-up for increased infection.” The trick to clearing things up, he says, is to keep the area dry, since the infection thrives in moisture. Keep your child out of the pool for a few days to see if it improves. You can also try drying the area using a blow-dryer, set to cool, for three to five minutes a day for no more than two days. If the problem persists after 48 hours, visit a doctor to see if prescription drops are necessary. Photo: iStockphoto

4. Peppermint to calm insect bites: Try it!
While there aren’t many controlled studies that have proven the effectiveness of peppermint oil in soothing itchy bites, many people do find that it works as long as there is no broken skin on or around the bite. Dr. Podolsky advises first treating the area with antibiotic ointment and then applying a few drops of a mixture that contains several drops of peppermint extract mixed with 8 ounces of water. “Topically, peppermint oil can act as an anti-inflammatory and can be quite soothing,” he says. If you have scratched the bite and created an open wound (where broken skin is present), skip the peppermint mixture. Instead, clean the area with soap and water or hydrogen peroxide and then apply a triple antibiotic ointment, followed by a bandage. Once a scab forms, you can remove the bandage and let it heal naturally. Photo: iStockphoto

5. Honey to heal minor cuts and scrapes: Skip it!
According to Dr. Tenore, applying a layer of honey to a small cut or scrape seals moisture in, allowing minor wounds to heal. But, as with garlic, Dr. Podolsky warns that the honey you find at the supermarket isn’t a safe bet. “Though it’s perfectly fine to eat, the honey we get at the grocery store contains its own set of microbacteria, which is fine for our stomachs but can actually inflame a cut.” Instead, treat cuts by cleaning them with soap and water or hydrogen peroxide, then apply a triple antibiotic ointment and cover with a bandage. Photo:iStockphoto

6. Zinc supplements to fight body odor: Skip it!
Zinc can, in fact, help inhibit bacterial growth in your body, but Dr. Kolansky warns that most people aren’t deficient in zinc and ingesting too much of it can be toxic. Topical deodorants containing zinc may help; Dr. Podolsky notes that they tend to reduce the amount of sweat you produce, which can, in turn, cut down the amount of body odor you have. However, since there is no set rate of zinc absorption, and these deodorants contain varying levels of zinc, it’s not a guaranteed fix. If you're considering using a zinc deodorant or just concerned in general that your body odor isn't normal, your best bet is to see a doctor. “You need to figure out what the underlying cause of the odor is and rule out a problem, like kidney failure, that might be at the root of it,” says Marc Siegel, MD, a practicing internist and associate professor of medicine at New York University. Photo: iStockphoto

7. Oats to soothe poison ivy: Try it!
There's a reason why so many body lotions include oats in their ingredient lists—it's been used to alleviate skin irritations for centuries. “It has an anti-inflammatory effect and is very soothing,” says Dr. Podolsky—just the thing you need when your skin is itchy from coming in contact with poison ivy. If you haven’t broken any skin from excessive scratching, add three to four tablespoons of instant rolled oats to a lukewarm bath and hop in for a soothing soak. If the skin has been broken, clean the area with soap and water or hydrogen peroxide instead, apply a triple antibiotic cream to the open wound and cover it with a bandage. Photo: Thinkstock

8. Toothpaste to ease a bee sting: Skip it!
Peppermint may be soothing to an itchy bite when mixed and applied with water, but picking up peppermint-flavored toothpaste at your drug store isn’t your best bet when you’ve been stung by a bee. Toothpaste contains ingredients like calcium phosphate and aluminum hydroxide, which do a great job of cleaning your teeth, but can be too harsh and irritating on a sting or bite. Instead, Dr. Podolsky advises removing the stinger with a pair of tweezers, then cleaning the area with soap and water and applying triple antibiotic ointment. To reduce inflammation, take ibuprofen as directed on the bottle. Photo: istock

9. Prevent blisters with antiperspirant: Skip it!
Think swiping some deodorant on your feet will keep them dry and blister-free? According to Dr. Tenore, many deodorants and antiperspirants contain talc, which can actually cause—rather than prevent—blisters, since it can clump on your foot and create friction between your skin and your shoes. Instead, try wicking socks, such as those made with COOLMAX fabric, “that actually move the sweat from the surface of the foot to the exterior of the sock,” Dr. Tenore recommends. When wearing sandals, applyBodyGlide, which doesn’t contain talc, or moleskin to blister-prone areas. Photo: istock