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Why do Obstetricians Still Rush to Clamp the Cord?

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For many years, the World Health Organization and the International Federation of Gynecology and Obstetrics have advised against early umbilical cord clamping. But obstetricians have been reluctant to change their habits.

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Although no clamping occurs in nature, cord clamping has become such an accepted norm that delayed clamping is generally considered a new or unproved intervention.

Basic teaching of physiology could be a factor — most textbooks state or imply that the cord circulation closes only because of the application of the cord clamp, which is not accurate.

Writing in the British Medical Journal, Dr. David Hutchon argues:
“Clamping the functioning umbilical cord at birth is an unproved intervention. Lack of awareness of current evidence, pragmatism, and conflicting guidelines are all preventing change. To prevent further injury to babies we would be better to rush to change.”

A separate review in the Journal of Cellular and Molecular Medicine also highlights the importance of delayed cord clamping, stating:

“Many clinical studies have revealed that the delayed cord clamping elevates blood volume and hemoglobin and prevents anemia in infants.

Moreover, since it was known that umbilical cord blood contains various valuable stem cells such as hematopoietic stem cells, endothelial cell precursors, mesenchymal progenitors and multipotent/pluripotent lineage stem cells, the merit of delayed cord clamping has been magnified.”

Resources:
British Medical Journal November 10 2010
Journal of Cellular and Molecular Medicine March 2010; 14(3):488-95
iVillage.com June 1, 2010

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Happiness is ‘Infectious’

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Believe it or not, happiness is “infectious” and can “ripple” through friends, neighbours and family members, a new study has suggested.


Researchers have found that happiness is not just an individual experience or choice, but is dependent on happiness of others to whom individuals are connected either directly or indirectly, and requires close proximity to spread.

According to them, “Changes in individual happiness can ripple through social networks and generate large scale structure in the network, giving rise to clusters of happy and unhappy individuals.” In fact, the researchers, led by Nicholas Christakis of the Harvard Medical School, have based their findings on an analysis of data collected in the Framingham Heart Study, the British Medical Journal reported. In the Framingham Heart Study, 5,124 adults aged 21-70 were recruited and followed between 1971 and 2003, to examine various aspects of their life and health. All the participants were asked to identify their relatives, “close friends,” place of residence, and place of work to ensure they could be contacted every two to four years for follow-up.

The researchers found 53,228 social ties between the 5,124 participants and a total of 12,067 people. They focused on 4,739 people followed from 1983 to ’03 and found a person’s proximity to happy people, specifically partners, siblings and neighbours, could make them happy too. They also found that clusters of happy and unhappy people were visible in the networks and the effect lasted for three degrees of separation — meaning one person benefited from the happiness of their friends’ friends. “Most important from our perspective is the recognition that people are embedded in social networks and that the health and wellbeing of one person affects the health and wellbeing of others.

“This fundamental fact of existence provides a fundamental conceptual justification for the speciality of public health. Human happiness is not merely the province of isolated individuals,” the researchers concluded.

Sources: The Times Of India

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Even a Little Caffeine May Harm F-oetus

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Pregnant women who consume caffeine even about a cup of coffee daily are at higher risk of giving birth to an underweight baby, researchers said.

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The new findings published in the British Medical Journal (BMJ) also linked any source of caffeine, including that from tea, cola, chocolate and some prescription drugs, to relatively slower foetal growth.

The findings are the latest in mounting evidence indicating the amount of caffeine a person consumes may directly impact one’s health, especially when pregnant.

In January, U.S. researchers found that pregnant women who drink two or more cups of coffee a day are at twice the risk of having a miscarriage as those women who avoid caffeine.

Babies born underweight are more likely to develop a range of health conditions when they grow older, including high blood pressure, diabetes and heart problems. Women who drank one to two cups of coffee daily, or between 100-199 milligrams, had a 20 percent increased risk of having a baby of low birth weight, the study found.

This was compared to women who consumed less than 100 milligrams daily. “Caffeine consumption during pregnancy was associated with an increased risk of foetal growth restriction and this association continued throughout pregnancy,” Justin Konje at the University of Leicester in Britain and colleagues wrote.

“Sensible advice would be to reduce caffeine intake before conception and throughout pregnancy.” Konje and his team – which included researchers from the University of Leeds — looked at 2,645 women at an average age of 30 who were between 8 and 12 weeks pregnant.

The women reported an average caffeine consumption during pregnancy of 159 milligrams per day, lower than new recommended limits of 200 milligrams in Britain. The likelihood of having a low birth weight baby rose to 50% for women who consumed between 200 milligrams and 299 milligrams each day, about two to three cups of coffee.

The impact was about the same as from alcohol and the association with low birth weight was maintained throughout a woman’s pregnancy, the study found. Even small amounts may prove harmful but Konje said in a telephone interview the best advice was to limit caffeine consumption to below 100 milligrams a day. “We couldn’t say that there was a lower limit for which there is no effect,” he said. “My advice is if possible to reduce caffeine intake to a minimum. You have to be realistic because you can’t ask people to stop taking caffeine.”

Sources: The Times Of India

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Polypill for the Heart

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Sixty-five-year-old Virendra Mehta suffers from hypertension, diabetes and heart disease. Every day, he has to take 10 pills to keep his various ailm ents in check.

He finds it expensive and exhausting. ‘‘With so many medicines to take daily, I often forget which ones I have already taken. Besides incurring a huge expense, the sight of these medicines is also a constant psychological reminder that I’m unwell,’’ he says. For Mehta and many others, life would be much simpler if all the drugs they need to stay alive could be combined in a single pill.

This could happen soon. For the past few years, the Hyderabad-based Dr Reddy’s Laboratories has been working on a polypill that will combine four medicines used to treat heart disease – aspirin, (which acts as a blood thinner); two anti-hypertensives (to reduce blood pressure) and a statin (to lower lipid levels).

Researchers at Dr Reddy’s, one of the largest pharmaceutical companies in the country, say that the polypill will be that magic medical potion – cheaper than blockbuster drugs and more effective. For instance, the cost of a month’s medication of the polypill is likely to be less than Rs 100, almost one-third the cost of its component medicines if they’re taken individually.

Clinical trials of the pill have been completed in India and international trials have just started, using 400 patients from India, Australia, Brazil, Netherlands, New Zealand, UK and the US. Officials at Dr Reddy’s say that if all goes well, the pill should be ready for launch in India by next year.

The polypill, incidentally, is a deceptively simple concept. It is essentially a dream pill because it combines the properties of several drugs. But the problem lay in its execution. Anthony Rodgers of the University of Auckland, who is heading the ongoing clinical trials says,‘‘The biggest technical challenge was in getting all the four medicines in one pill, which needs to be a normal size and for its components to remain stable over a long period of time and produce the same effect on the body as if the medicines came from separate pills.’’

In fact,the idea of a polypill to prevent heart disease is just five years old. It was first suggested in the
authoritative British Medical Journal (BMJ) by two professors at London’s Wolfson Institute of Preventive Medicine, Nick J. Wald and Malcolm R. Law.

They claimed that such a pill could prevent 80% of all heart attacks and that anybody with cardiovascular disease could take it, as could everybody over 55. ‘‘It would be acceptably safe and with widespread use, would have a greater impact on the prevention of the disease in the Western world than any other single intervention,’’ they wrote.

Wald & Law’s claim set off intense debate within the medical fraternity about the viability of the polypill. The argument continues but most people agree that it might mean the difference between life and death for millions in developing countries, such as India, where heart disease is a bigger killer than cancer or AIDS. According to a WHO Global Burden of Disease study, there were 1.6 million deaths on account of heart disease in India in 2000. The National Commission on Macroeconomics and Health estimates that the number of Indians suffering from heart disease is set to grow to 62 million by 2015. The WHO adds that 17 million people die of heart disease and strokes every year and 80% of these deaths are in developing countries.

Clearly, a successful polypill could count on a vast market. That’s why, when the idea of the pill was suggested to Dr Reddy’s chairman, Dr Anji Reddy by Dr K Srinath Reddy, former head of cardiology, AIIMS, the company took it up with zest. G V Prasad, vice-chairman & CEO of Dr Reddy’s Labs, says ‘‘there will be significant demand for the polypill from those with heart disease or at high risk of developing it.’’ He says that heart disease is ‘‘globally the leading cause of death in developing and developed nations and will continue to remain so in the foreseeable future.’’

However, not everyone is optimistic. Dr Upendra Kaul, director of the cardiology department at Noida’s Fortis Hospital, says that a polypill does not necessarily help because it offers standard, rather than targeted medication. ‘‘How can you have a pill with fixed dosages of individual medicines to treat patients, when they might need different dosages, depending on their condition?’’ he asks. Many other critics of the polypill have also argued that this is its biggest drawback.

But Dr Reddy’s Labs says that it is working through the problem by manufacturing the polypill with different drugs of varying strength. ‘‘It should be suitable for a significant part of the patient population,’’ says Raghu Cidambi, who is anchoring the polypill project at Dr Reddy’s.

Adds Dr Ashok Seth of Max Devki Devi Heart and Vascular institute, ‘‘The polypill would be a good substitute for patients who have been on heart medication for long. Since their bodies would have adapted to these medicines, it would be easier to titrate their dosage by putting them on the polypill.’’

However, the polypill may still be many clinical trials away before it’s suitable for everyone. Initial trials have indicated that it successfully lowers BP and cholesterol in patients with established heart disease or those at high risk of developing it. But there’s still some way to go before the pill’s efficacy can be established for even those at moderate risk of heart attack.

In case the international trials are successful, says Rodgers, ‘‘it would be a landmark in cardiovascular disease prevention since we can then claim to have a product that can halve cardiovascular risk.’’ If that happens, it might just be a question of popping a pill to keep heart attack away.

Sources:The Times Of India

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Health Moves ‘Halve Early Deaths’

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Women could halve their risk of premature death by adopting a healthier lifestyle, research suggests…..
Smoking accounted for nearly a third of the deaths

By avoiding cigarettes, exercising regularly, eating healthily and keeping weight in check, 55% of early deaths from chronic diseases could be avoided.

Following all four lifestyle tips could cut 44% of cancer deaths and 72% of cardiovascular deaths, the study of nearly 80,000 nurses suggests.

The work is published on the British Medical Journal website.

In the 24-year study, 28% of the 8,882 deaths could be attributed to smoking and 55% to the combination of smoking, being overweight, not doing enough exercise and a poor diet.

Drinking too much alcohol also contributed, but women with “light-to-moderate” alcohol consumption of up to one drink a day were less likely to die from cardiovascular diseases than teetotallers.

Report author Dr Rob van Dam, from the Brigham and Women’s Hospital and Harvard Medical School, said the study’s positive findings on moderate consumption of alcohol should not encourage people to “go overboard”.

“It seems to be that drinking a little alcohol can lower the risk of heart disease, but you have to look at the overall picture too. We also saw in our study that people who drink a lot of alcohol have a higher risk of dying from cancer.”

He said it could be easy for people to adopt the basic lifestyle recommendations.

Simple advice

“In busy, modern life it’s more difficult to adapt to these factors, but people don’t have to spend hours lifting heavy weights.

“It’s simple dietary changes like eating more whole-grains and less red meat, walking to work and to the grocery shop, these really add up. And of course the thing to state is not to smoke.”

According to Dr van Dam, the recommendations in his study could apply to men as well as women.

The 77,782 women aged 34 to 59 who took part in the study completed detailed follow-up questionnaires every two years about their diet, frequency of physical activity, alcohol intake, weight, how much they smoked, and disease history.

Over the follow-up period the authors documented 8,882 deaths including 1,790 from heart disease and 4,527 from cancer.

A spokeswoman from the British Nutrition Foundation said: “This study reaffirms the importance of prevention.

“It is worth making lifestyle changes now, so that our later years are spent free from diseases such as cancer and heart disease.”

“It is worth making lifestyle changes now, so that our later years are spent free from diseases”.as per British Nutrition Foundation spokeswoman

Risk reduction

Meanwhile, a study by the British Heart Foundation has found women at high risk of diabetes can reduce their body’s insulin resistance – the most important biological risk factor for diabetes – by exercising.

After seven weeks of an exercise programme of three 30 minute exercise sessions in the first week, working up to five 60 minute sessions in weeks six and seven, insulin resistance had reduced by 22% in women whose family history put them at a high risk of type 2 diabetes.

Professor Peter Weissberg, medical director at the BHF, said: “I hope the findings will encourage people to get active for their health.”

Sources: BBC NEWS:Sept. 16. ’08

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