Health & Fitness (231)
It's possible that labor-inducing drugs might increase the risk - or that the problems that lead doctors to start labor explain the results. These include mothers' diabetes and fetal complications, which have previously been linked with autism.
Like most research into autism causes, the study doesn't provide conclusive answers, and the authors say the results shouldn't lead doctors to avoid inducing labor or speeding it up since it can be life-saving for mothers and babies.
Simon Gregory, lead author and an associate professor of medicine and medical genetics at Duke University, emphasized, "We haven't found a connection for cause and effect. One of the things we need to look at is why they were being induced in the first place."
Government data suggest 1 in 5 U.S. women have labor induced - twice as many as in 1990.
Smaller studies suggested a possible tie between induced labor and autism, but the new research is the largest to date, involving more than 600,000 births. The government-funded study was published online Monday in JAMA Pediatrics.
The researchers examined eight years of North Carolina birth records, and matched 625,042 births with public school data from the late 1990s through 2008. Information on autism diagnoses didn't specify whether cases were mild or severe. Labor was induced or hastened in more than 170,000 births.
Overall, 5,648 children developed autism - three times as many boys as girls. Among autistic boys, almost one-third of the mothers had labor started or hastened, versus almost 29 percent of the boys without autism. The differences were less pronounced among girls.
Oxytocin and prostaglandins are used to start or speed up labor but the study doesn't identify specific medications.
The strongest risks were in boys whose mothers had labor started and hastened. They were 35 percent more likely to have autism.
Among girls, autism was not tied to induced labor; it was only more common in those born after labor was accelerated; they were 18 percent more likely to have the developmental disorder than girls whose mothers had neither treatment.
Autism affects about 1 in 88 U.S. children. Symptoms may involve communication problems including avoiding eye contact and unusual repetitive behavior including arm-flapping. Causes are uncertain but experts believe it probably results from a combination of genetics and other factors. These may include mothers' illnesses and medication use while pregnant, fathers' age at conception, and problems affecting the fetus during childbirth - all suggested but not proven in previous research.
The study's biggest strength is bolstering the growing consensus that risks for autism occur before birth or soon after, said Dr. Byron King, director of Seattle Children's Hospital's autism center. He was not involved in the study.
"We're dropping the ball," said Dr. Thomas Frieden, head of the Centers for Disease Control and Prevention. "This is a huge disappointment."
About 54 percent of teenage girls have received at least one of the three HPV shots. Only a third was fully immunized with all three doses.
Last year's rates were essentially unchanged from 2011, and up only slightly from 2010. Rates for other vaccines aimed at adolescents have risen much faster.
A big part of the problem: Family doctors aren't prodding patients to get HPV shots as forcefully as they recommend other vaccines, health officials said.
The vaccine, introduced in 2006, protects against human papillomavirus, or HPV. The sexually transmitted bug can cause cervical cancer and genital warts. The vaccine was first recommended for girls ages 11 and 12 because it works best if given before a teen starts to have sex. In 2011, it was also recommended for boys that age to help prevent the virus's spread.
More than 20 states have considered adding HPV to the vaccines required for school attendance but only Virginia and the District of Columbia did so. Most states abandoned it after political fights triggered by funding woes, concerns about the vaccine's safety and worries that the shots would promote promiscuity.
CDC studies have shown no significant side effects, and that girls who got the shots did not start having sex earlier than girls who didn't. Still, some parents, teens and their doctors have been hesitant.
Dr. Anne Schuchat, who oversees the CDC's immunization programs, said school requirements aren't necessarily needed because the girls are already coming in for shots against bacterial meningitis and for whooping cough that are required in some states. Those shots have been recommended for teens roughly about as long as HPV but vaccinations rates are much higher - 70 percent in 2011.
The new CDC report shows that 84 percent of the teen girls who hadn't gotten an HPV shot had been to a clinic or doctor for another vaccine. If they had gotten an HPV shot at the same time, the rate for at least one dose could be nearly 93 percent instead of 54 percent, CDC officials estimated.
Price has been an issue in the past - three doses of HPV vaccine sell for more than $400, more than other vaccines. But today, health insurers cover that cost and uninsured kids get the shots paid for through government health programs.
"We can do a better job," said Dr. Thomas McInerny, president of the American Academy of Pediatrics. He joined Frieden on a call with reporters and said his association would push its members to get more teens vaccinated.
The CDC rates are derived from national telephone surveys and checks of medical records for girls ages 13 to 17. Vaccination rates for boys aren't available yet.
HPV is so common that nearly all sexually active men and women will get at least one type of HPV at some point in their lives, health officials say. Most show no obvious symptoms and eventually clear the virus.
Sound like a sales pitch? Get ready for a lot more. As President Barack Obama's health care law moves from theory to reality in the coming months, its success may hinge on whether the best minds in advertising can reach one of the hardest-to-find parts of the population: people without health coverage.
The campaign won't come cheap: The total amount to be spent nationally on publicity, marketing and advertising will be at least $684 million, according to data compiled The Associated Press from federal and state sources.
About 16 percent of Americans are uninsured, but despite years of political debate and media attention, more than three-quarters of them still know little about the law known as "Obamacare," according to recent surveys.
"It's not sugar cereal, beer and detergent," said Brooke Foley, chief executive officer of the Chicago-based Jayne Agency, one of the advertising firms crafting messages to reach the uninsured.
The Obama administration and many states are launching campaigns this summer to get the word out before enrollment for new benefits begins in October.
The targets are mostly the working poor, young people who are disengaged, or those who gave up their insurance because of the cost. Three-quarters are white. Eighty-six percent have a high school education or less. Together they make up a blind spot in the nation's health care system.
"They've been shut out. It's too expensive and it's incredibly confusing," said David Smith of the advertising agency GMMB, pitching the health law's benefits in Washington and Vermont.
Their confusion might only have been magnified by the administration's surprise announcement recently postponing part of the system that affects businesses. But that change should not affect many individuals. A bigger complication is that in about half the states, Republican governors are declining to cooperate, which will limit the marketing.
The states that have been more receptive to the health care overhaul and are further ahead in their planning will receive proportionally more federal money for outreach, advertising and marketing than Republican-led states that have been hostile to the law.
AP research from all 50 states shows the amount of government spending will range from a low of 46 cents per capita in Wisconsin, which has ceded responsibility for its health insurance exchange to the federal government, to $9.23 per capita in West Virginia, which opted for a state-federal partnership.
About $4.8 million in public money will be spent trying to sign up New Jersey's 1.3 million uninsured, for example, compared to the nearly $28 million spent reaching out to Washington state's much smaller 960,000.
Texas has the highest percentage of uninsured people in the nation, three times more than Illinois. But only a fourth as much public money will be spent on getting people enrolled in Texas.
Austin resident Caryl Mauk, 46, remains confused about the Affordable Care Act even though Texas' federally run exchange is just two months away from opening for enrollment.
She has not had insurance since she had to quit her nursing job in 2011 because of a heart condition. She's been struggling with chest pains, arthritis and fatigue but doesn't know what to make of the new program.
"Sometimes I just get overwhelmed," Mauk said. "I don't want to get bad news again, and that slows me down in making calls."
In the GOP states, community groups with federal grants will lead the effort. Private companies from Walgreens to Cosmopolitan magazine have launched their own educational campaigns.
Ads based on research about the uninsured will soon start popping up on radio, TV and social media. Grassroots organizers are recruiting their pastors, barbers and mothers and arming them with carefully worded messages. In some neighborhoods, volunteers will go door-to-door.
The pitch: If you don't make much money, the government can pick up some of the cost of your health insurance. If you can afford a policy, by law you have to get one. People will be directed to healthcare.gov, a government site, for more information.
The political stakes for the Obama administration in a big response are high. If only the sickest people sign up, the cost of their medical care could overburden insurance carriers and sink the new marketplaces. The new system depends on a balanced pool.
The ad campaign already underway in Colorado demonstrates the search for an effective message.
There, TV commercials show people being magically transformed into champions. One minute they're shopping for health insurance on a computer, the next they're winning at a horse race, in a casino or at the World Series with champagne corks flying. The slogan: "When health insurance companies compete, the only winner is you."
That's because market research shows Coloradans like competition, said Tom Leydon, CEO of Denver-based advertising and digital marketing agency Pilgrim.
The celebratory scenes "remind people of the good feeling they get when they win," he said.
Despite the focus on winning and champions, there may be little if any cooperation for the publicity blitz from the professional sports leagues, which would have the potential to reach tens of millions of people. Two Republican Senate leaders warned the leagues about getting involved in "a highly polarized public debate."
In states where there will be no official cooperation, Enroll America, a coalition of health companies and advocates, has deployed volunteers to hand out brochures at a farmers market in Austin and hold house parties in Cincinnati, and plans a seven-figure ad buy across the nation.
"There has to be an echo chamber," said John Gilbert, national field director for the Enroll America media campaign. "If I'm uninsured and it's October, I won't be able to go anywhere without (hearing) the message of enrollment."
Chicago resident Martin Upshaw, whose fast food job doesn't provide health benefits, said the cost has kept him uninsured.
"The bottom line is the dollar sign," said Upshaw, 27, who survived a shooting three years ago. "I would love to be able to go in and see a doctor and make sure I'm OK."
In Chicago, the Jayne Agency's staff talked to more than 50 patients at an emergency room to hone the best message. The slogan they chose: "Don't Just Get By." The ad campaign features real people and their health stories.
On a recent Sunday in southwest Houston, volunteers recruited by Blue Cross Blue Shield set up information tables at a community center where three Methodist church services are held.
"I'm looking to get where I can go to the doctor and have a $25 to $30 co-pay," said churchgoer Yolanda Boykin, 60, whose current job through a temp agency does not provide health insurance.
Another part of the campaign nationwide, focused on young men, is refining messages for their mothers.
Market research has shown that young adults say it's often a parent, a girlfriend or a sibling who will push them to sign up for something like health insurance, said Julie Bataille, helping lead the outreach for the Obama administration, so the campaign will "make sure moms are aware."
--- AP writer Juan A. Lozano contributed to this report from Houston.
--- AP Medical Writer Carla K. Johnson can be reached at HTTP://WWW.TWITTER.COM/CARLAKJOHNSON
Doctors initially attributed the donor's death to other causes. But during an investigation prompted by the kidney recipient's death in February, lab testing found evidence of rabies in the donor's brain tissue and also detected encephalitis, a brain inflammation that can be caused by rabies.
The virus was consistent with raccoon rabies and was nearly identical to a virus found in the transplanted kidney and other tissue from the recipient, an Army veteran from Maryland, said the report, compiled by researchers from the federal Centers for Disease Control and Prevention and others and published Tuesday in the Journal of the American Medical Association.
Investigators don't know if organs given to three other patients - the North Carolina donor's heart, liver and second kidney-were infected with the rabies virus, but all three were considered at risk. Their recipients received anti-rabies treatment "and to date remain well," said CDC researcher Dr. Neil Vora, the lead author.
While the case is rare, it underscores the need to improve screening for would-be organ donors with suspected encephalitis, the report's authors say. They say a uniform donor questionnaire could help better identify risk factors for the virus and that rabies should be considered in donors with unexplained encephalitis.
The United Network for Organ Sharing issued guidance last year to help organ procurement organizations screen for encephalitis and other central nervous system infections in potential donors. It urged caution in accepting organs from donors with an untreated central nervous system infection.
The researchers want to improve awareness that rabies can be the cause of encephalitis, said co-author Dr. Sridhar Basavaraju, another CDC researcher. But he added, "We wouldn't want to mandate any screening that would potentially exclude transplantable organs."
The study is based on a review of laboratory tests and medical records, and interviews with relatives of the organ donor and recipient. It provides the most detailed account of the chain of events that led to the two deaths and the investigation that followed, which prompted health authorities to recommend vaccines for dozens of people who were in contact with the donor or recipients.
The case attracted public attention because of the rare circumstances, including the long time between infection and death of the transplant recipient - about a year and a half.
It was just the third documented transmission of rabies through a solid organ transplant, the report says.
Also, there are only roughly two human rabies deaths in the United States each year, and all but two domestic cases between 2000 and 2010 were linked to bats, according to the report. The authors say raccoons pose an under-recognized risk for infection and their spread into urban areas raises concern.
The patient who received the North Carolina donor's kidney at the Walter Reed National Military Medical Center in Bethesda, Md. in September 2011 has not been publicly identified.
The donor was 20-year-old William Edward Small, an avid outdoorsman from North Carolina who got sick after a fishing trip in Florida, where he was undergoing Air Force training.
Small's initial symptoms included nausea, vomiting and fever - which could indicate rabies but also other less serious conditions that are much more common. Doctors thought Small had eaten tainted fish.
Questioned during the organ procurement process, relatives said they didn't know of any recent risk of rabies exposure, and doctors did not test him.
Investigators say they learned during subsequent interviews that Small trapped raccoons for use as bait during hunting-dog training exercises, and had been bitten at least twice by the animals, 18 months and seven months before developing symptoms. He was not treated for those bites.
"If you don't ask specific questions, you don't get specific answers," said Dr. Michael Green, chairman of an advisory committee on disease transmission for the United Network for Organ Sharing.
"At the time these questions are being asked initially, families are often traumatized, in shock," Green said. "They're losing a loved one. They may not be thinking normally or straight or remember all those details."
---- JAMA: HTTP://WWW.JAMA.COM
Follow Eric Tucker on Twitter: HTTP://WWW.TWITTER.COM/ETUCKERAP
The manufacturer of the Plan B One Step morning-after contraceptive has been granted exclusive rights by the FDA to market their drug over-the-counter without age restrictions. The decision was released earlier this week.
The Food and Drug Administration approved Teva Pharmaceuticals' Plan B One Step for over the counter sale...no prescription or proof of age required. In its decision, the FDA granted a three year period during which Teva can sell its' single tablet product exclusively on pharmacy shelves, while generic drugs will still require a prescription for young women 16 and younger.
Most metro St. Louis pharmacies carry Teva's Plan B, which is a two-pill dosage and some already have the Plan B One Step in the pharmacy. The FDA decision will now move that product on to the store shelves.
A study of older men found those who regularly skipped breakfast had a 27 percent higher risk of a heart attack than those who ate a morning meal. There's no reason why the results wouldn't apply to other people, too, the Harvard researchers said.
Other studies have suggested a link between breakfast and obesity, high blood pressure, diabetes and other health problems seen as precursors to heart problems.
"But no studies looked at long-term risk of heart attack," said Eric Rimm, one of the study authors at the Harvard School of Public Health.
Why would skipping breakfast be a heart attack risk?
Experts aren't certain, but here's what they think: People who don't eat breakfast are more likely to be hungrier later in the day and eat larger meals. Those meals mean the body must process a larger amount of calories in a shorter amount of time. That can spike sugar levels in the blood and perhaps lead to clogged arteries.
But is a stack of syrupy pancakes, greasy eggs and lots of bacon really better than eating nothing?
The researchers did not ask what the study participants ate for breakfast, and were not prepared to pass judgment on whether a fatty, sugary breakfast is better than no breakfast at all.
Other experts agreed that it's hard to say.
"We don't know whether it's the timing or content of breakfast that's important. It's probably both," said Andrew Odegaard, a University of Minnesota researcher who has studied a link between skipping breakfast and health problems like obesity and high blood pressure.
"Generally, people who eat breakfast tend to eat a healthier diet," he added.
The new research was released Monday by the journal Circulation. It was an observational study, so it's not designed to prove a cause and effect. But when done well, such studies can reveal important health risks.
The researchers surveyed nearly 27,000 men about their eating habits in 1992. About 13 percent of them said they regularly skipped breakfast. They all were educated health professionals - like dentists and veterinarians - and were at least 45.
Over the next 16 years, 1,527 suffered fatal or non-fatal heart attacks, including 171 who had said they regularly skipped breakfast.
In other words, over 7 percent of the men who skipped breakfast had heart attacks, compared to nearly 6 percent of those who ate breakfast.
The researchers calculated the increased risk at 27 percent, taking into account other factors like smoking, drinking, diet and health problems like high blood pressure and obesity.
As many as 18 percent of U.S. adults regularly skip breakfast, according to federal estimates. So the study could be important news for many, Rimm said.
"It's a really simple message," he said. "Breakfast is an important meal."
Hawaii tops the charts in the government's first state-by-state look at how long Americans age 65 can expect to live, on average, and how many of those remaining years will be healthy ones.
Retirement-age Mississippians fared worst, with only about 17 1/2 more years remaining and nearly seven of them in poorer health.
U.S. life expectancy has been growing steadily for decades, and is now nearly 79 for newborns. The figures released Thursday by the Centers for Disease Control and Prevention estimate life expectancy for people 65 years old, and what portion will be free of the illnesses and disabilities suffered late in life.
"What ultimately matters is not just the length of life but the quality of life," said Matt Stiefel, who oversees population health research for Kaiser Permanente.
The World Health Organization keeps "healthy life expectancy" statistics on nearly 200 countries, and the numbers are used to determine the most sensible ages to set retirement and retirement benefits. But the measure is still catching on in the United States; the CDC study is the first to make estimates for all 50 states.
Overall, Americans who make it to 65 have about 19 years of life ahead of them, including nearly 14 in relatively good health, the CDC estimated.
But the South and parts of the Midwest clearly had lower numbers. That's not a surprise, experts said.
Southern states tend to have higher rates of smoking, obesity, diabetes, heart disease, and a range of other illnesses. They also have problems that affect health, like less education and more poverty.
These are issues that build up over a lifetime, so it's doubtful that moving to Hawaii after a lifetime in the South will suddenly give you more healthy years, they said.
After Mississippi, Kentucky, West Virginia and Alabama had the lowest numbers for both life expectancy and healthy life expectancy. States with the best numbers included Florida - a magnet for healthy retirees - as well as Connecticut and Minnesota.
The estimates were made using 2007 through 2009 data from the census, death certificates and telephone surveys that asked people to describe their health. The CDC's Paula Yoon cautioned not to make too much of the differences between states. Results could have been swayed, for example, by how people in different states interpreted and answered the survey questions.
- Nationally, women at 65 can expect nearly 15 more years of healthy life. Men that age can expect about 13 years.
- Blacks fared much worse than whites. They could expect 11 years of healthy life, compared to more than 14 for whites.
The CDC report makes "painfully clear" the disparities in the health of whites and blacks in their final years, said Ellen Meara, a health economist at Dartmouth College.