Birth: Delaying Umbilical Cord Clamping

Clamping and cutting of the umbilical cord should be delayed for three minutes after birth, particularly for pre-term infants, suggests a senior doctor in the British Medical Journal. 28/08/2007

Early clamping and cutting of the umbilical cord is widely practised as part of the management of labour, but recent studies suggest that it may be harmful to the baby. Dr Andrew Weeks, a senior lecturer in obstetrics at the University of Liverpool, looked at the evidence behind cord clamping. For the mother, trials show that early cord clamping has no ill effects, he writes.

But what about the baby: At birth, he says, the umbilical cord sends oxygen-rich blood to the lungs until breathing establishes. So as long as the cord is unclamped, the average transfusion to the newborn is equivalent to 21 percent of the neonate’s final blood volume and three quarters of the transfusion occurs in the first minute after birth. For babies born at term, the main effect of this large autotransfusion is to increase their iron status.

This may be lifesaving in areas where anaemia is endemic. In the developed world, however, there have been concerns that it could increase the risk of polycythaemia and hyperbilirubinaemia (abnormally high levels of red blood cells and bile pigments in the bloodstream, often leading to jaundice). But trials show this is not the case.

For pre-term babies the beneficial effects of delayed clamping may be greater, he says. Although the studies are smaller, delayed clamping is consistently associated with reductions in anaemia, bleeding in the brain, and the need for transfusion.

He proposes that in normal deliveries, delaying cord clamping for three minutes with the baby on the mother’s abdomen should not be too difficult. The situation is a little more complex for babies born by caesarean section or for those who need support soon after birth. Nevertheless, it is these babies who may benefit most from a delay in cord clamping. For them, a policy of ‘wait a minute’ would be pragmatic, he says.

Source: British Medical Journal

Make a New Assault on Salt

(HealthDay News) -- If you're like most Americans, there's too much salt in your diet, which can lead to high blood pressure and increased risk of heart attack or stroke, experts warn.

The issue is so important that the American Medical Association (AMA), the American Heart Association, the American Dietetic Association and the U.S. National Institutes of Health have launched a campaign to cut Americans' salt intake by half. The AMA has even gone so far as to urge the U.S. Food and Drug Administration (FDA) to withdraw salt's designation as "safe."

The average American consumes 4,000 to 6,000 milligrams of salt per day. The FDA recommends a limit of 2,400 mg a day, while the Institute of Medicine recommends a maximum of 1,500 mg a day.

In the April 19, 2007 issue of the British Medical Journal, two studies found that reducing salt intake by 25 percent to 35 percent could cut the risk of cardiovascular disease by as much as 25 percent and lower the risk of death by 20 percent.

Many people mistakenly believe that simply removing the salt shaker from the table will solve the problem, but many kinds of packaged, processed and restaurant foods contain high levels of salt. It's used for taste, to preserve foods, and provide texture.

Here are some tips on how you can reduce your salt intake:
Identify foods that have a high salt (sodium) content.
Limit your daily salt intake to between 1,500 and 2,400 milligrams.
When dining out, ask for unsalted menu items.
At home, use herbs and spices to season your food.
Remove salt from recipes when possible.
Don't put the salt shaker on your dining table.

More information
The U.S. National Heart, Lung, and Blood Institute has more about dietary salt.

Coloring Compound in Fruits, Veggies May Cut Colon Cancer Risk

(HealthDay News) -- Compounds called anthocyanins, which give color to most red, purple and blue fruits and vegetables, may help protect against colon cancer, an Ohio State University study says.

In laboratory tests on rats and on human colon cancer cells, the researchers found that anthocyanins can significantly slow the growth of colon cancer cells. The team also found that, in some cases, slightly altering the structure of anthocyanin molecules boosted their anti-cancer properties.

The findings, presented Sunday at the American Chemical Society's annual meeting in Boston, may help advance knowledge about what gives fruits and vegetables their cancer-fighting properties which, in turn, could eventually lead to the development of new cancer treatments.

"These foods contain many compounds, and we're just starting to figure out what they are and which ones provide the best health benefits," lead author Monica Giusti, an assistant professor of food science at the university, said in a prepared statement.

She did not recommend certain kinds fruits or vegetables over others, and noted that much more research needs to be conducted on anthocyanins. Currently, she and her colleagues are examining how anthocyanins interact with other compounds in foods to determine if these interactions affect the health benefits of the foods or of anthocyanin itself.

More information
The American Cancer Society has more about healthy eating, exercise and cancer prevention.

Chemical Flame Retardants Linked to Thyroid Disease in Cats

(HealthDay News) -- A mysterious epidemic of thyroid disease in pet cats in the United States may be due to dust from fire-retardant chemicals used in carpets, furniture, mattresses, electronic products and even pet food, researchers report.

And while the researchers said there's no evidence to suggest a threat to humans posed by the chemicals -- called polybrominated diphenyl ethers (PBDEs) -- they can't rule out the possibility.

"Cats are very highly exposed to these chemicals, and the levels in cats are higher than the levels in people," said researcher Linda S. Birnbaum, director of the Experimental Toxicology Division at the U.S. Environmental Protection Agency. "But cats may be a good indicator of indoor exposure to humans," she added.

Symptoms of hyperthyroidism in cats include weight loss, increased appetite, hair loss and irritability. Hyperthyroid cats could serve as modern-day versions of the canaries in coal mines that alerted miners to poisonous gas, said Birnbaum, who added that hyperthyroidism is treatable in cats as well as people.

Feline hyperthyroidism is one of the most common and deadly diseases in older cats, and indoor pets are thought to be at greatest risk, Birnbaum said. Because of their conscientious grooming, cats ingest large amounts of house dust containing PBDEs.

Concerns about health effects from PDBEs began in the late 1990s, and studies have found that the chemicals cause liver and nerve toxicity in animals. "In addition, a recent study found an association with house dust and the levels of PDBEs in breast milk in women," Birnbaum said.

Many PBDEs, such as penta, which was used in polyurethane foam for furniture cushions and pillows, have been phased out either voluntarily by manufacturers or by bans from states and the U.S. government and governments overseas.

Despite these bans, BBDEs are environmentally persistent compounds, so it will take a long time before they disappear from the environment, Birnbaum said.

She noted that the EPA is looking for safer alternatives to some of the chemicals that will be fire resistant but not pose a potential health threat to animals or humans. So far, 14 alternative flame retardants have been evaluated, and furniture foam manufacturers are using new alternatives, according to the EPA.

In the new study, published in the Aug. 15 online issue of Environmental Science & Technology, Birnbaum and her colleagues took blood samples from 23 cats, 11 of which suffered from hyperthyroidism. They found that the cats with the disease had levels of PDBEs that were three times higher than younger cats and cats without the condition.

PBDEs are also found in canned cat food, particularly in fish/seafood flavors, such as salmon and whitefish. An analysis showed that diets based on canned food could have PBDE levels 12 times higher than dry-food diets. For these reasons, cats could be receiving as much as 100 times greater dietary PBDE exposure than American adults, the researchers said.

The danger of feline hyperthyroidism might be higher in the United States, where people have the highest reported PBDE levels worldwide, according to the report. In addition, by the late 1990s, North America accounted for almost half of the worldwide demand for PBDEs for commercial materials such as furniture and upholstery.

The epidemic of hyperthyroidism in cats began almost 30 years ago, experts say, at the same time that PBDEs were introduced into household materials for fire-prevention. Now the disease has been seen in Canada, Australia, Japan and many parts of Europe.

Hyperthyroidism has also increased in people. For example, former President George H.W. Bush and First Lady Barbara Bush have the condition, as does Millie, their Springer Spaniel.

More information
For more information on PBDEs, visit the Washington State Department on Ecology.

Warfarin Trumps Aspirin in Preventing Stroke in Elderly

(HealthDay News) -- The largest study ever of its kind finds the clot-preventing drug warfarin to be more effective than aspirin in preventing strokes in older people with the abnormal heartbeat called atrial fibrillation.

The incidence of dangerous hemorrhages connected to the use of these anticlotting agents was also much lower than had been feared, British researchers report.

"My interpretation of the finding is warfarin ought to be the treatment of choice for such people over the age of 75," said lead researcher Dr. Jonathan Mant, a reader in stroke epidemiology at the University of Birmingham.

His team presented its findings in the Aug. 11 issue of the journal The Lancet.

Stroke is a constant threat for people with atrial fibrillation, in which the upper chambers of the heart quiver rather than regularly contract. This can disrupt the heart's pumping ability and send a clot from the heart to the brain, potentially causing stroke.

Warfarin, also known as Coumadin, has long been prescribed to prevent such strokes and has been more or less standard for most people with atrial fibrillation. However, its use for people over 75 has been limited due to fears of excess bleeding.

However, in the current study, Mant said, "we found that the risk of bleeding on warfarin was the same as on aspirin."

The study involved 973 people with atrial fibrillation, averaging 81 years of age. The number of participants may not seem large, but it is greater than the total of all the previous studies that have looked at the use of warfarin to prevent stroke in those 75 and older, Mant noted. Earlier trials tended to concentrate on non-elderly people, he said.

However, warfarin more than halved users' risk of stroke compared to aspirin. There were just 21 strokes in the warfarin group and 44 in the aspirin group during a follow-up period that averaged 2.7 years, the researchers reported.

Overall, there were two brain hemorrhages in the 488 participants who received warfarin, and one in those taking aspirin.

"This is a landmark study because of the large number of patients," said Dr. David A. Garcia, associate professor of internal medicine at the University of New Mexico, who wrote an accompanying editorial. "It certainly establishes that warfarin is the most effective way to prevent stroke in people with atrial fibrillation in that age group," he said.

Still, warfarin does carry a higher risk of excess bleeding, at least for some people, Garcia noted. "That subgroup is probably smaller than we once thought," he said. "What we need in the future is a way to identify those patients at high risk for bleeding, whether they are elderly or not, and at the moment, there still is work to be done to identify the patients at high risk prospectively."

Whenever he treats older people who have atrial fibrillation, "my own personal practice is to try very hard to get them on warfarin, because I know the benefit is extremely large for most patients, especially for those in this age group," Garcia said.

Use of warfarin often requires fairly frequent blood tests to monitor the International Normalized Ratio (INR), a measure of the ability of the blood to clot, Garcia said. British rules state that once the INR is well-controlled, blood tests can be done 12 weeks apart, Mant said.

More information
There's more on preventing stroke at the American Stroke Association.

Selzentry Approved for HIV

(HealthDay News) -- Pfizer's Selzentry (maraviroc), an oral medication to treat the virus that causes AIDS, has been approved by the U.S. Food and Drug Administration, the company said Monday.

The drug is designed to block viral entry into disease-fighting white blood cells. This reduces viral load and increases T-cell counts in people who are already being treated for certain strains of HIV, the company said in a statement.

Selzentry, Pfizer said, is the first in a new class of oral HIV medicines in more than 10 years. So-called CCR5 antagonists are designed to stop the virus outside the surface of cells before it enters, rather than fighting the virus inside as do other oral HIV medicines.

The drug was granted accelerated approval, a process designed for medicines that appear to provide a significant therapeutic benefit over existing drugs for serious or life-threatening diseases.

Pfizer said it would provide longer-term data required for the FDA to consider traditional approval.

The drug is expected on store shelves by mid-September, the company said.

More information
To learn more about HIV/AIDS, visit the U.S. Centers for Disease Control and Prevention.

Cigarette Additives May Make It Tougher to Quit

(HealthDay News) -- More than 100 of 599 additives that might be in cigarettes are potentially harmful, with some making cigarettes even more addictive and others making it difficult for people to detect tobacco smoke in their midst, a new study contends.

Trade secrecy about the ingredients in cigarettes makes it impossible to know how many of the additives that appear on a 1994 list are actually in tobacco products today. Still, there's plenty of reason to be alarmed, said study lead author Dr. Michael Rabinoff, an assistant research psychiatrist at the University of California, Los Angeles.

"They're making people less aware of tobacco [smoke] and making the cigarette more addictive," he said. "There is so much going on with these additives that it's an uncontrolled experiment on billions of people around the planet."

Contrary to what smokers might assume, cigarettes aren't simply tobacco rolled up in pieces of paper. "They're highly engineered by the industry to smoke in certain ways and taste in certain ways," said James Pankow, a professor at Oregon Health & Science University who studies cigarette smoke and tobacco additives.

Some additives may seem harmless, such as sugar. But even that can become harmful when combusted to form other compounds, he said.

The study was released online this week and will appear in the September issue of the American Journal of Public Health. It is being released as Congress considers whether to allow the U.S. Food and Drug Administration to regulate tobacco products. On Wednesday, a Senate committee approved a bill granting such oversight.

In the study, Rabinoff and his colleagues examined a 1994 list of cigarette additives that they said the tobacco industry acknowledged using. It's not clear how many of the additives are still being used, or how common they are. According to the researchers, the tobacco companies are required to provide a confidential list of additives to the federal government each year.

The study authors found that more than 100 of the additives "camouflage environmental [second-hand] tobacco smoke emitted from cigarettes, enhance or maintain nicotine delivery, could increase the addictiveness of cigarettes, and mask symptoms and illnesses associated with smoking behaviors."

The potentially harmful additives include chocolate and cocoa, which have chemicals that can make it easier for cigarette smoke to penetrate the lungs. Other additives appear to have an anesthetizing effect that makes it easier for smokers to avoid coughing, the researchers said.

"We don't know exactly the intent of all these agents," Rabinoff said, although internal tobacco industry documents reveal some information. He added that it's a challenge to figure out what tobacco companies are up to and "reverse-engineer their thought process."

In a statement provided to HealthDay, leading tobacco company Philip Morris declined to comment on the study because it said it had not finished reviewing it. But the company did say it discloses the ingredients of its cigarettes to the federal government and "it is our scientific judgment, based on the best data available, that the ingredients used in our cigarettes do not increase the inherent hazards of smoking."

Instead, the statement said, "the ingredients complement the subjective characteristics of the different tobacco types and provide the distinctive flavors, tastes, and aromas associated with our brands. We also use ingredients as processing aids and as humectants to keep the tobacco pliant. The flavor ingredients we use, and the precise way in which we use them, help distinguish our products from those of our competitors. The distinctive taste of our products is an extremely important and valuable part of our competitive strategy."

Philip Morris said it supports legislation that would give the federal government the authority to regulate cigarettes, although it thinks additives shouldn't be banned because they make a cigarette "taste better."

Rabinoff is author of a new book called Ending The Tobacco Holocaust: How Big Tobacco Affects Our Health, Pocketbook And Political Freedom, and What We Can Do About It.

Pankow, the Oregon professor, said the new study is "a bunch of information that's been out there, but they've put it all in one place."

As for the public, people aren't "aware of any given additive being used," he said.

More information
For help on quitting smoking, visit the U.S. Centers for Disease Control and Prevention.

1 Joint as Damaging as 5 Cigarettes to Your Lungs

(HealthDay News) -- Smoking just one marijuana joint is the same as smoking five cigarettes in terms of the damage it does to your lungs, a new study found.

Lung damage from marijuana results in chronic bronchitis and other respiratory problems. But whether marijuana causes emphysema or lung cancer isn't clear, the researchers said.

"This damage is a full range from symptoms to structural lung damage and reduced lung function," said lead researcher Dr. Richard Beasley, director of the Medical Research Institute of New Zealand, in Wellington.

Beasley thinks marijuana smokers should heed the study's findings. "Many people think that marijuana is safe, but this shows that it's not safe. Hopefully, this will avoid a lack of knowledge among smokers," he said.

For the study, Beasley's group collected data on 339 people. The group consisted of people who smoked at least one marijuana cigarette a day for five years; people who smoked a pack of tobacco cigarettes a day for at least a year; and people who smoked both. There were also people who didn't smoke either tobacco or marijuana.

All the study participants had lung X-rays and took breathing tests to see how well their lungs worked, according to the July 31 online report in the journal Thorax.

Among the 75 people who smoked only marijuana or the 91 who smoked tobacco and marijuana, there were complaints of wheezing, coughing, chest tightness and phlegm. But, the researchers found signs of emphysema only among the people who smoked just tobacco or tobacco in combination with marijuana.

Marijuana did, however, damage the lungs and stopped them from working properly. The drug decreased the number of small fine airways, which carry oxygen and waste products to and from the blood vessels. In addition, marijuana damaged the large airways, blocking airflow and making the lungs work harder, the researchers found.

The amount of damage was directly related to the number of joints smoked, with more marijuana associated with more lung damage, Beasley noted.

The extensive damage from marijuana results from its higher burn temperature, and because it is inhaled more deeply and held in the lungs longer than cigarettes, Beasley explained. "In addition, there is no filter," he said.

One expert thinks this study is the first to really explain the risks to the lungs posed by marijuana.

"We have always suspected that marijuana causes lung damage, but it's nice to have it quantified," said Dr. Norman Edelman, chief medical officer at the American Lung Association. "Now we can say much more strongly, to people who smoke marijuana, that they are doing bad things to their lungs."

There are still many unanswered questions about marijuana smoking, Edelman said. "Do marijuana smokers go on to get chronic obstructive pulmonary disease?" he asked. "We don't know that."

More information
For more about marijuana, visit the U.S. National Institute on Drug Abuse.