Antibiotic 'cerebral palsy link'

By Michelle Roberts Health reporter, BBC News

Antibiotics appeared to treble the risk of cerebral palsy
A study has linked a small number of cases of cerebral palsy to antibiotics given to women in premature labour.
The UK study found 35 cases of cerebral palsy in 769 children of women without early broken waters given antibiotics.
This compared with 12 cases among 735 children of women not given the drugs. Advice is being sent to the study's 4,148 mothers and a helpline set up.

Medical experts stressed pregnant women should not feel concerned about taking antibiotics to treat infections.

The Oracle study was the largest trial in the world into premature labour and was set up to investigate whether giving antibiotics - which might tackle an underlying symptomless infection - to women with signs of premature labour would improve outcomes for babies.

One in eight babies in the UK is born prematurely and prematurity is the leading cause of disability and of infant death in the first month after birth.

Premature labour
In 2001, ORACLE found the antibiotic erythromycin had immediate benefits for women in premature labour (before 37 weeks gestation) whose waters had broken. It delayed onset of labour and reduced the risk of infections and breathing problems in babies.

Erythromycin and the other antibiotic studied - co-amoxiclav - showed no benefit or harm for the women whose waters were still intact, however, and doctors were advised not to routinely prescribe them in such circumstances.
To study the longer-term outcomes, the Medical Research Council-funded scientists followed up the children seven years later.

Unexpectedly, both antibiotics appeared to increase the risk of functional impairment - such as difficulty walking or problems with day to day problem solving - and treble the chance of cerebral palsy in the children of the women whose waters had not broken.

Of the 769 children born to mothers without early broken waters and given both antibiotics, 35 had cerebral palsy, compared with 12 out of 735 whose mothers did not receive antibiotics in the same circumstances.
The reasons behind this link are unclear, particularly as there was no increased risk of cerebral palsy in women whose waters had broken.

Hostile environment
The researchers believe cerebral palsy is unlikely to be a direct effect of the antibiotic but rather due to factors involved in prolonging a pregnancy that might otherwise have delivered early.
Researcher Professor Peter Brocklehurst of Oxford University said: "We have a suspicion that infection is implicated in premature labour.

"Antibiotics may merely suppress levels of infection to stop preterm labour, but the baby remains in a hostile environment."
Infections during pregnancy or infancy are known to cause cerebral palsy.

In a letter to doctors and midwives advising them about the findings, Chief Medical Officer Sir Liam Donaldson says: "Pregnant women should not feel concerned about taking antibiotics to treat infections.

"It is important to note that these women had no evidence of infection and would not routinely be given antibiotics."
Where there is obvious infection, antibiotics can be life-saving for both mother and baby, the CMO says.

The Royal College of Obstetricians and Gynaecologists said: "These findings do not mean that antibiotics are unsafe for use in pregnancy. Pregnant women showing signs of infection should be treated promptly with antibiotics."
Cerebral palsy can cause physical impairments and mobility problems.

It results from the failure of a part of the brain to develop before birth or in early childhood or brain damage and affects one in 400 births.

Arthritis knee op 'does not work'

The surgery is not recommended in the UK
An operation offered to ease the symptoms of osteoarthritis makes no difference, say Canadian doctors.
Patients given knee arthroscopy showed no improvement beyond that provided by physiotherapy and painkillers.
Arthritis experts in the UK said some surgeons were still carrying out the operation, against national guidance.
They said New England Journal of Medicine study showed doctors still relying on the technique to treat osteoarthritis were misguided.

Thousands of people in the UK suffer from osteoarthritis in the knee, which can be painful and limit movement.
The operation involves inserting instruments through small incisions to try to flush out loose fragments of cartilage, and to smooth the surfaces of the joints, in the hope that this will relieve symptoms.
A group of 178 men and women, with an average age of 60, were enrolled in the trial at the University of Western Ontario.
All of them were given physiotherapy and painkilling drugs such as ibuprofen, but half of the volunteers were also given the "lavage and debridement" procedure.

When their symptoms were compared at various points afterwards, the group who had the operation were faring no better than those who had not received it.

Guidelines breached
Dr Brian Feagan, one of the researchers, said: "This is definitive evidence that arthroscopic surgery provides no additional therapeutic value when added to physical therapy and medication for patients with moderate osteoarthritis of the knee."
This type of surgery is still recommended for some other knee conditions, including more severe osteoarthritis where the knee is "locked" in position, but is not recommended for moderate osteoarthritis by the National Institute for Health and Clinical Excellence, which formulates UK guidelines.

A spokesman for the Arthritis Research Campaign said there was no longer any excuse for performing it in patients with less severe arthritis.

"Arthroscopic lavage and debridement is still commonly performed in the US but more rarely in the UK over the past ten years, and is no longer accepted as an effective treatment for osteoarthritis of the knee in this country.
"Surgeons still performing this operation need to ask themselves why they are doing it."

Lead, mercury and arsenic were found in the traditionally Indian herbal mixtures at levels that would surpass California safety guidelines, says a researcher who is calling for FDA curbs.
By Alan Zarembo, Los Angeles Times Staff Writer
August 27, 2008
Ayurvedic medicines -- herbal mixtures dating back thousands of years in India and increasingly popular in the West -- are frequently contaminated with lead, mercury or arsenic, according to a study published today.

A fifth of the nearly 200 concoctions tested contained levels of the toxic metals that, if taken at the maximum recommended doses, would surpass California's safety guidelines.

Dr. Robert Saper, a Boston University professor of family medicine who led the study, said the findings should spur the Food and Drug Administration to start clamping down on the largely unregulated world of pills, herbs and powders classified as dietary supplements.

"It shouldn't be me trying to figure this out," Saper said.

Ayurveda is a traditional Indian practice that takes a holistic approach to wellness, employing herbal medicine, meditation and exercise to promote good health. It exists alongside modern medicine in India, with its own network of clinics, hospitals and colleges serving hundreds of millions of patients.

It has spread to the U.S. and Europe with the migration of South Asians around the world and been popularized by figures such as bestselling author Deepak Chopra.

There are about two dozen ayurvedic training programs in the United States. A 2002 survey estimated that 750,000 U.S. residents have used the herbal preparations, sold under both traditional Indian names and more marketable labels such as GlucoRite and Ezi Slim.

Saper got interested in the supplements in 2003 after a man of Indian origin showed up at a Boston-area emergency room with seizures. The culprit turned out to be lead in the man's ayurvedic medicines. In an initial study published in 2004, Saper bought 70 ayurvedic herbal products imported from India and found that toxic metals were common components.

It was an unsettling finding, because most of the preparations are intended to be taken as part of a daily regimen to improve health.

"Many, many studies are showing that even small levels of lead in the blood can increase the risk of high blood pressure, kidney dysfunction and decreased IQ," Saper said.

Ayurvedic practitioners lashed out at the research as alarmist, saying that it only showed there were problems with mixtures from India, not with U.S.-made products.

They pointed out that in India, many of these metals are purposely blended with herbs as part of the medicinal recipe. Those metallic mixtures are rarely used in the United States, they said.

In the new study, published in the Journal of the American Medical Assn., Saper and his team analyzed 193 products purchased from 25 websites for Indian and U.S. manufacturers. The vast majority supposedly contained only herbs and no metals.

About 80% of the samples showed no detectable metal content.

But among the remaining samples, the toxic metals showed up at similar rates in both U.S. and Indian-made products.

Of the U.S. products, 21% contained lead, 3% contained mercury and 3% had arsenic. Among the Indian-made medicines, 17% had lead, 7% had mercury and none contained arsenic.

The researchers and other experts surmised that the contamination had less to do with the manufacturing process than with the soils in which the herbs were grown.

"The raw material is all coming from India," said Kush Khanna, who runs Bazaar of India in Berkeley, a manufacturer of ayurvedic medicines started by his father in 1971.

Heavy metals showed up in 17 of the products the researchers ordered from his company.

Khanna said two labs in India routinely tested the 80 or so ingredients he imported.

The problem is that there are no unified standards for what is considered safe.

Lead levels allowed by the World Health Organization are 500 times the California limits.

"Based on WHO standards, our products are perfect," Khanna said. "They have not exceeded any limits."

The researchers found only two products that exceeded the WHO standards for lead content. Both mixtures were from India and purposely prepared with metals as ingredients.

In California, the Safe Drinking Water and Toxic Enforcement Act of 1986 requires that products containing certain levels of toxic metals carry warning labels. But the act has no power to ban products, and companies with fewer than 10 employees, such as Khanna's, are exempt from the labeling requirements.

The FDA does not specify any limits for metal content in dietary supplements, leaving it to the manufacturers to ensure that their products are safe.

Jennifer Rioux, a medical anthropologist who runs the Integral Ayurveda clinic in Chapel Hill, N.C., said the research underscored the need for consumers to consult with ayurvedic experts instead of buying and taking products on their own.

She noted that the study showed many medicines to be perfectly safe, but she worried that its conclusions would tar her profession.

"All people need is one study to provoke fear about an entire system of medicine," she said.

Anaesthetics 'could worsen pain'

Some anaesthetics are irritant chemicals
Some general anaesthetics could actually worsen the pain following surgery, say scientists.

So-called "noxious" anaesthesia drugs - used commonly worldwide - stimulate nerves to cause irritation long after the operation is over. The US research, published in Proceedings of the National Academy of Sciences journal, could prompt the choice of different drugs. A UK expert said solving post-surgical pain was a priority for anaesthetists.

Anaesthetists have known for some time that certain drugs, such as the gas isoflurane, while very effective at rendering and keeping patients unconscious, are actually irritant chemicals. Some already use a painkilling drug to lessen this effect before delivering the anaesthetic itself. The latest finding, by research staff at Georgetown University Medical Center however, suggests that effects of the irritant is not just short-lived, but lingers on long after both the painkiller and the anaesthetic have worn off.

The drugs act on the same receptors on nerve cells which are activated by contact with other irritants, such as garlic, mustard or chilli.

Mice bred without these receptors were unaffected by the "noxious" anaesthetic gases.
If strongly activated, these can lead not just to an immediate sensation of pain, but also a longer oversensitisation of pain pathways in the nervous system.

In patients, this might mean that the pain they feel after an operation is significantly increased.

Switching drugs
Dr Gerard Ahern, who led the study, said: "It was not really recognised that use of these drugs results in the release of lots of chemicals that recruit immune cells to the nerves, which causes more pain of inflammation.
"The choice of anaesthetic appears to be an important determinant of post-operative pain."

He said that while this effect could be reduced by using other types of anaesthetic, these might not perform as well in other ways.

Professor Ian Power, from the University of Edinburgh, said that post-operative pain remained a serious problem, despite advances in anaesthesia over the decades.
"We are very aware that acute post-operative pain can persist and become chronic and long-lasting, and we have been looking for reasons for that - perhaps this research may provide those.
"If this research were to be validated and proved correct, it would be fairly easy for anaesthetists to move from one type to another."

Professor Richard Langford, a consultant in anaesthesia and pain management at Bart's and The London NHS Trust, said that while the findings were interesting, there was no guarantee a similar effect would be detected in humans undergoing surgery.
"There are a myriad of different factors that combine to produce the experience of pain, including the degree and size of the surgery, and the mood or level of anxiety in the patient."

Pregnant Women, Children Cautioned on Dental Mercury (Update1)
By Avram Goldstein

June 5 (Bloomberg) -- The mercury in dental fillings may have toxic effects on fetuses and young children, U.S. regulators said for the first time as part of a legal settlement.

After decades of debate about the safety of mercury amalgam dental fillings, the Food and Drug Administration added the statement on ``safety concerns'' to its Web site this week, said agency spokeswoman Peper Long in a telephone interview today. The FDA agreed to post the warning about the dangers for developing human brains to settle a lawsuit by a collection of environmental groups, consumers and state officials.

In the settlement, the FDA agreed to bring to a conclusion by July 2009 a regulatory review of mercury in fillings that began in 2002. The process could result in a requirement that prescribing information warn dentists and pregnant women of nervous system dangers to fetuses and young children with developing brains, Long said.

``Gone are all of FDA's claims that no science exists that amalgam is unsafe,'' said Michael Bender of Vermont, a plaintiff in the lawsuit, in a statement today on PR Newswire. ``The FDA has moved to a more neutral course, while still recognizing the serious health risks posed by amalgam in particular for children and unborn children, for pregnant women, and for those with mercury immuno-sensitivity.''

Mercury is a neurotoxin that can interfere with brain growth and has been shown to affect cognitive and motor-skill development, according to the Environmental Protection Agency.

Dental Association

The American Dental Association, the largest group of U.S. dentists, said the settlement amounts to little because it doesn't change the current use of mercury. Cavities are filled with the amalgam, made of mercury and a powder containing silver, tin, copper, zinc and other metals. Dentists have used it for more than 100 years.

``Dental amalgam remains a safe, affordable and durable cavity-filling choice for dental patients,'' the dental group said in a statement today on PR Newswire. That belief, the group said, is based on ``extensive studies and scientific reviews of dental amalgam by government and independent organizations worldwide.''

An FDA panel of independent advisers voted 13 to 7 in 2006 to reject the agency's conclusion that the available literature supports continued use of mercury in fillings. The agency had said it reviewed 34 studies and found no evidence the metal releases harmful mercury vapors in the mouth from chewing or during dental procedures.

Data Sought

Many members of the panel, which included doctors and dentists, said the risks associated with mercury fillings can't be quantified without better data on short-term exposure and certain patient groups. About 30 percent of the more than 150 million fillings placed in the U.S. each year are made of amalgam.

Patient advocates urged the panel to recommend that the FDA ban amalgam in favor of tooth-colored composite resins, which they said are safer and just as effective.

Dentists argued that fillings containing mercury are stronger, cheaper and more durable, and said the amount of mercury exposure from fillings is minuscule when compared with fish and other dietary sources.

The lawsuit was filed in December in U.S. District Court in Washington and then assigned by a federal trial judge to a magistrate who served as a mediator, Long said. FDA officials added the cautionary language to the agency Web site on June 3 with ``uncharacteristic speed,'' Bender said.

The case is: Moms Against Mercury v. Eschenbach, 07cv2332, U.S. District Court for the District of Columbia.

Sitting straight 'bad for backs

Sitting up straight is not the best position for office workers, a study has suggested.

Scottish and Canadian researchers used a new form of magnetic resonance imaging (MRI) to show it places an unnecessary strain on your back.

They told the Radiological Society of North America that the best position in which to sit at your desk is leaning slightly back, at about 135 degrees.

Experts said sitting was known to contribute to lower back pain.

Data from the British Chiropractic Association says 32% of the population spends more than 10 hours a day seated.

Half do not leave their desks, even to have lunch.

Two thirds of people also sit down at home when they get home from work.

Spinal angles

The research was carried out at Woodend Hospital in Aberdeen, Scotland.

Twenty two volunteers with healthy backs were scanned using a positional MRI machine, which allows patients the freedom to move - so they can sit or stand - during the test.

Traditional scanners mean patients have to lie flat, which may mask causes of pain that stem from different movements or postures.

In this study, the patients assumed three different sitting positions: a slouching position, in which the body is hunched forward as if they were leaning over a desk or a video game console, an upright 90-degree sitting position; and a "relaxed" position where they leaned back at 135 degrees while their feet remained on the floor.

The researchers then took measurements of spinal angles and spinal disk height and movement across the different positions.

Spinal disk movement occurs when weight-bearing strain is placed on the spine, causing the disk to move out of place.

Disk movement was found to be most pronounced with a 90-degree upright sitting posture.

It was least pronounced with the 135-degree posture, suggesting less strain is placed on the spinal disks and associated muscles and tendons in a more relaxed sitting position.

The "slouch" position revealed a reduction in spinal disk height, signifying a high rate of wear and tear on the lowest two spinal levels.

When they looked at all test results, the researchers said the 135-degree position was the best for backs, and say this is how people should sit.

'Tendency to slide'

Dr Waseem Bashir of the Department of Radiology and Diagnostic Imaging at the University of Alberta Hospital, Canada, who led the study, said: "Sitting in a sound anatomic position is essential, since the strain put on the spine and its associated ligaments over time can lead to pain, deformity and chronic illness."

Rishi Loatey of the British Chiropractic Association said: "One in three people suffer from lower back pain and to sit for long periods of time certainly contributes to this, as our bodies are not designed to be so sedentary."

Levent Caglar from the charity BackCare, added: "In general, opening up the angle between the trunk and the thighs in a seated posture is a good idea and it will improve the shape of the spine, making it more like the natural S-shape in a standing posture.

"As to what is the best angle between thigh and torso when seated, reclining at 135 degrees can make sitting more difficult as there is a tendency to slide off the seat: 120 degrees or less may be better."

Breastfeeding 'helps to boost IQ'

The government advises breastfeeding for first six months
More evidence is being put forward that breastfed babies eventually become more intelligent than those who are fed with formula milk.

Canada's McGill University found breastfed babies ended up performing better in IQ tests by the age of six.
But the researchers were unsure whether it was related to the breast milk itself or the bond from breastfeeding.
The study of nearly 14,000 children is the latest in a series of reports to have found such a positive link.

However, one problem has been that some of the research has struggled to identify whether the findings were related to the fact that mothers from more affluent backgrounds were more likely to breastfeed and it was factors related to the family circumstances that was really influencing intelligence.

But the latest study attempted to take this into account by following the progress of children born in hospitals in Belarus, some of which ran breastfeeding promotion schemes to boost rates across all groups.
They found that those who breastfed exclusively for the first three months - with many also continuing to 12 months - scored an average of 5.9 points higher on IQ tests in childhood.

Teachers also rated these children significantly higher academically than control children in both reading and writing, the Archives of General Psychiatry reported.

Lead researcher Professor Michael Kramer said: "Long-term, exclusive breastfeeding appears to improve children's cognitive development."

But he added: "Even though the treatment difference appears causal, it remains unclear whether the observed cognitive benefits of breastfeeding are due to some constituents of breast milk or are related to the physical and social interactions inherent in breastfeeding."

Changes
Fatty acids found in breast milk are thought to boost intelligence, but the report said the physical and emotional aspect of breastfeeding may lead to permanent changes to brain development.
The researchers also suggested breastfeeding may increase verbal interaction between mother and child, which in turn could aid their development.

Nonetheless Professor Kramer said more efforts should be made to promote breastfeeding.
In England, the government recommends mothers breastfeed exclusively for the first six months.
But research shows while three quarters start off breastfeeding, just one in four are still doing it by six months.

Rosie Dodds, of the National Childbirth Trust, said: "This research certainly increases the evidence about the impact of breastfeeding. "And I think what we now need is more effort put into supporting it."

Breastfeeding benefits 'instant'

Breastfeeding has many health benefits for mother and child
The benefits of breastfeeding for mother and baby start from day one, say campaigners.
Yet more than half of 500 women did not realise this, the National Childbirth Trust found.

The findings come as the NCT boosts efforts to encourage more breastfeeding.

A government poll of 427 men found 79% would want their baby to be breastfed, contrary to popular belief that they might not.

Breast or bottle?

The UK has one of the lowest breastfeeding rates in Europe - almost a third of women in England and Wales never try to breastfeed, compared with just 2% in Sweden.

In 2003, the government set a target to increase the number of women starting to breastfeed by 2% a year.

But experts acknowledge that breastfeeding is not suitable or the best option for all women and that individual choice is important.

The NCT surveyed women about their breastfeeding knowledge.

Nine out of 10 did not know that breastfeeding for just one month has a lasting impact on health during the first 14 years of a baby's life.

Although formula milk does not negate all the protection offered by breastfeeding, only a third knew that feeding babies under six months on both breast and bottle milk still provides them with a certain amount of protection from infections.

Health benefits

Almost half of respondents did not know that breastfeeding also reduces the risk of osteoporosis and cancer of the ovary for the mother.

Belinda Phipps of the NCT said: "Because the benefits start right from the first feed, any amount of breastfeeding is a reason to feel proud.

"This is especially important for the nine out of 10 women who stop breastfeeding before they want to, generally because of a lack of good information or support from those around them.

"It's encouraging that the majority of men are supportive of breastfeeding.

"However, with over a fifth of men not showing support, there is still more to be done."

Christine Carson, the Department of Health's National Infant Feeding Advisor, said: "We encourage every new mum to try breastfeeding.

"Sometimes it may not be easy, but with the right advice, support and encouragement, particularly from those closest to them, we hope to see a marked increased in the amount of mothers and their babies experiencing the many benefits that breastfeeding brings."

Type of body fat 'boosts health'

Body fat found under the skin - and particularly on the buttocks - may help reduce the risk of developing type 2 diabetes, research suggests

The study contrasts this subcutaneous fat with visceral fat, which is wrapped around the organs, and raises the risk of ill health.

It is thought subcutaneous fat may produce hormones known as adipokines which boost the metabolism.
The Harvard Medical School study appears in the journal Cell Metabolism.

The researchers, who worked on mice, transplanted fat from one part of the animals' body to the other.
When subcutaneous fat was moved to the abdominal area, there was a decrease in body weight, fat mass, and blood sugar levels.

The animals also became more responsive to the hormone insulin, which controls the way the body uses sugar. A lack of response to insulin is often the first stage on the path to type 2 diabetes.
In contrast, moving abdominal visceral fat to other parts of the body had no effect.
Lead researcher Professor Ronald Khan said: "The surprising thing was that it wasn't where the fat was located, it was the kind of fat that was the most important variable.

"Even more surprising, it wasn't that abdominal fat was exerting negative effects, but that subcutaneous fat was producing a good effect."

Previous research has suggested that obese people with high levels of both abdominal and subcutaneous fat are more insulin-sensitive than those with only high levels of abdominal fat.

Professor Khan said it was possible that subcutaneous fat offset the effects of visceral fat.

Dr David Haslam, of the National Obesity Forum, said the finding cast new doubt on the merits of Body Mass Index (BMI) as a way to assess whether somebody was unhealthily overweight, as it did not differentiate between different types of fat.
He said it was still important that people tried to control their weight, as healthy lifestyle choices like a balanced diet and taking exercise would overwhelmingly impact on visceral, and not subcutaneous fat levels.

Women have a tendancy to lay down more subcutaneous fat, particularly on their legs and buttocks than men.
Dr Ian Campbell, medical director of the charity Weight Concern, said: "If there is something about subcutaneous fat which is protective, and actually decreases insulin resistance, this could help open up a whole new debate on the precise role fat has on our metabolism."

Playgroups 'cut leukaemia risk'

Childhood leukaemia is linked to infection

Children who attend daycare or playgroups cut their risk of the most common type of childhood leukaemia by around 30%, a study estimates.

Researchers reviewed 14 studies involving nearly 20,000 children, of which 6,000 developed acute lymphoblastic leukaemia (ALL).

It is thought early infections may help the body fight off the disease.
The University of California, Berkeley study will be presented to a leukaemia conference in London.

Leukaemia is the most common cancer found in children in the industrialised world, affecting about one in 2,000 youngsters.

ALL accounts for more than 80% of leukaemia cases among children, and most often occurs in those aged between two and five. Scientists believe that for most types of childhood leukaemia to develop, there must first be a genetic mutation in the womb, followed by a second trigger - such as an infection - during childhood.

However, it is also thought that contracting some childhood infections - which are often readily spread in environments such as playgroups where children are in close contact with each other - may prime the immune system against leukemia.

Conversely, if the immune system is not challenged in early life, this is thought to raise the risk of an inappropriate response to subsequent infections, making the development of leukaemia more likely.