“Babies born just a few weeks early have a higher risk of poor health,” The Guardian reported today. According to the newspaper, new research has found that being born just a few weeks early can raise their risk of conditions such as asthma.
It is already known that babies born prematurely (before 37 weeks of pregnancy may have a higher risk of immediate or longer-term health problems, and the earlier a baby is born, the higher the risk. To examine the issue, researchers followed over 14,000 children born between 2000 and 2002, and assessed their health at the ages of three and five years old. Outcomes including growth, hospital admissions, use of medication, asthma and long-standing illnesses were looked at particularly in relation to whether the children were moderately premature (32-36 weeks of pregnancy or born at what the researchers called “early” full term (37-38 weeks . Babies born moderately prematurely or at early term were more likely to have been re-admitted to hospital in the first few months of life than babies born at 39-41 weeks. Babies born moderately prematurely also had a higher risk of asthma symptoms than full-term babies.
These findings are broadly in line with what is already known about the effects of prematurity, and do not change the UK’s current definition of full-term pregnancy as 37 weeks and over. However, the study does show how different degrees of prematurity may affect health. Further study of the issue would be valuable, to explore longer-term health outcomes that may be caused by prematurity and the factors that may influence the likelihood of these poor health outcomes.
Where did the story come from?
The study was carried out by researchers from the University of Leicester and other UK institutions. It was funded by the Bupa Foundation and published in the peer-reviewed British Medical Journal.
The media generally covered this research in a balanced way.
What kind of research was this?
In the UK, the normal length of a pregnancy is classed as 37 weeks or above. It is already known that babies born prematurely (before 37 weeks may be at increased risk of immediate and longer-term health problems, and that the risks are higher the earlier a baby is born. However, the authors say that there has been minimal research into the longer-term health outcomes of infants specifically born moderately preterm (which this study defines as 32-36 weeks and at what the researchers termed as "early full term" (37-38 weeks .
To investigate this, the researchers used a cohort study. This is a good way to follow up and compare health outcomes in groups of people that have been exposed to different factors. In this case, the exposure was the number of weeks of pregnancy at which the babies were born. However, a cohort study that looks at a group’s health relies on the accuracy of reported health outcomes and diagnoses. For example, one condition this study looked at was asthma, and the researchers asked parents about whether their child had wheezing symptom or asthma. However, this does not necessarily equate to a medical diagnosis of asthma.
This type of study also needs to take into account potential factors that could be related to both risk of prematurity and risk of the health outcome ( confounding factors . For example, parental smoking is linked to an increase risk of prematurity, and also to an increased risk of asthma in the child.
What did the research involve?
This study involved participants of the Millennium Cohort Study (MCS , a piece of research in which the subjects were gathered by random sampling of child benefit registers. It featured 18,818 infants born in the UK between 2000 and 2002. The number of weeks of pregnancy at birth was calculated from the mother’s report of her expected due date. Births were grouped into:
- very preterm (defined by the authors as 23-31 weeks
- moderate preterm (32-33 weeks
- late preterm (34-36 weeks
- early term (37-38 weeks
- full term (39-41 weeks
These are not the standard accepted definitions. For example, the charity BLISS, for “babies born too soon”, defines full-term pregnancy as 37 weeks or more, moderately premature as 35-37 weeks, very premature as 29-34 weeks, and extremely premature as birth before 29 weeks.
Child health outcomes were monitored over five years of follow-up. Outcomes assessed included:
- child height, weight and body mass index at three and five years
- parental reports of the number of hospital admissions (not related to accidents since birth or the previous interview, collected at nine months and at three and five years.
- parental reports of any longstanding illness or disability of more than three months’ duration and diagnosed by a health professional, collected at three and five years (a limiting longstanding illness was defined as one which limited activities that are normal for the child’s age group
- parental reports of wheezing within the previous 12 months, and parental reports of asthma collected at three and five years
- parental reports of the use of prescribed drugs, collected at five years
- parents’ ratings of child health, defined as excellent, very good, good, fair or poor, collected at five years
The researchers used statistical methods to look at the outcomes in groups born at different stages of pregnancy and compared them to (their definition of full-term babies. Analyses were adjusted to account for various potential confounding factors, principally numerous social and demographic factors. The researchers also estimated “population attributable fractions” (PAFs associated with preterm and early term birth. This is an estimate of the contribution that a particular risk factor has to a health outcome. PAF represents the reduction in the proportion of people in the population with a particular health problem that could be expected if the exposure to a risk factor were reduced to the ideal exposure. In this case, it would represent the proportion of children that would no longer have a particular health problem if all babies were born at full term rather than preterm.
What were the basic results?
After the researchers excluded participants in the MCS study with incomplete data on time in the womb at birth, they interviewed the parents of 14,273 children at 3 years of age and 14,056 at 5 years. They found certain sociodemographic factors, such as lower maternal educational status and maternal smoking, to be associated with prematurity, as is already known.
The researchers generally found a “dose response” effect of prematurity, meaning that the more premature a baby was, the higher the likelihood of general health problems, hospital admissions and longstanding illnesses. They calculated the odds of each outcome compared to children born at 39-41 weeks. The full details of these outcomes are as follows:
The odds for three or more hospital admissions by five years of age were:
- 6.0 times higher for children born at 23-31 weeks
- 3.0 times higher for children born at 32-33 weeks
- 1.9 times higher for children born at 34-36 weeks
- 1.4 times higher for children born at 37-38 weeks
The odds for any longstanding illness at five years of age were:
- 2.4 times higher for children born at 23-31 weeks
- 2.0 times higher for children born at 32-33 weeks
- 1.5 times higher for children born at 34-36 weeks
- 1.1 times higher for children born at 37-38 weeks
The odds for the child’s health being rated as only fair or poor by parents at five years of age were:
- 2.3 times higher for children born at 23-31 weeks
- 2.8 times higher for children born at 32-33 weeks
- 1.5 times higher for children born at 34-36 weeks
- 1.3 times higher for children born at 37-38 weeks
The odds for asthma and wheezing at five years of age were:
- 2.9 times higher for children born at 23-31 weeks
- 1.7 times higher for children born at 32-33 weeks
- 1.5 times higher for children born at 34-36 weeks
- 1.2 times higher for children born at 37-38 weeks
The greatest contribution to the burden of disease at three and five years was among children born at late/moderate preterm or early term. The calculated PAFs for being admitted to hospital at least three times between the ages of 9 months and 5 years were:
- 5.7% for children born at 32-36 weeks (i.e. you would expect a 5.7% reduction in the number of young children admitted three or more times if babies were born at full term rather than moderate preterm
- 7.2% for children born at 37-38 weeks (you would expect a 7.2% reduction in the number of young children being admitted if babies were born at full term rather than early term
- 3.8% for children born before 37 weeks (you would expect a 3.8% reduction in the number of young children being admitted if babies were born at full term rather than very preterm
Similarly, PAFs for longstanding illnesses were:
- 5.4% for early term births
- 5.4% for moderate or late preterm births
- 2.7% for very preterm births
How did the researchers interpret the results?
The researchers concluded that “the health outcomes of moderate/late preterm and early term babies are worse than those of full term babies.” They say that it would be useful for further research to look into how much of the effect is due to prematurity itself, and how much is due to other factors such as maternal or foetal complications.
Conclusion
This valuable research examined childhood health outcomes in a large group of children born at different stages of pregnancy.
Important points to consider when interpreting this research include:
- The authors generally found that the likelihood of poorer health outcomes was higher with increasing prematurity (a dose response effect . This is in line with what is already known about the generally poor immediate and longer-term health outcomes among babies born increasingly prematurely.
- The greatest contribution to overall burden of disease at ages three and five years was calculated to be among children born at 32-36 weeks or at 37-38 weeks. Though a gestation of less than 32 weeks might be expected to have a greater influence on the burden of disease, it must be remembered that many more babies are born above 32 weeks of gestation than below it. Therefore, in the population as a whole, the greater number of babies born within the 32-38 week range would have a greater effect than the small number of babies born extremely early.
- The definitions that the authors used for the purposes of this study are not standard definitions. For example, the standard definition of full-term pregnancy is birth at 37 weeks or more, and it is not split into “early term” at 37-38 weeks and “full term” only at 39-41 weeks. Similarly, definitions of prematurity differ from those used by other UK health organisations.
- There is a possibility of inaccuracy as both age at birth and health outcomes were reported by parents, rather than assessed through medical records. For example, a parental report of wheezing or asthma does not necessarily constitute a confirmed medical diagnosis of asthma.
Overall, the study found that the more premature a baby is, the greater the likelihood of health problems in childhood, and that some effect of prematurity may even be seen in pregnancies approaching full term. Further study in this area would be valuable, both to explore the wider range of longer-term health outcomes that may be caused by prematurity, and to look into associated factors (medical or sociodemographic, for example that may influence the likelihood of these outcomes.
Analysis by Bazian
Links To The Headlines
Infancy health risk linked to early birth by research. BBC News, March 2 2012
Babies born a few weeks early 'suffer health risks'. The Guardian, March 2 2012
Links To Science
Boyle EM, Poulsen G, Field DJ et al. Effects of gestational age at birth on health outcomes at 3 and 5 years of age: population based cohort study. British Medical Journal 2012; 344
Press release: Population-based cohort study of the effects of gestational age at birth on health outcomes at three and five years of age. British Medical Journal, March 1 2012
Women diagnosed with cervical cancer through a smear test “have a far better chance of being cured than women who do not go for tests,” BBC News has today reported.
The news is based on Swedish research that looked at 1,230 women diagnosed with cervical cancer, examining patterns between how their disease was detected and how likely it was they would be cured and survive. Following them for an average of 8.5 years after diagnosis, it found that the cure rate was 92% among those whose cancer was detected through cervical screening and 66% among those who were diagnosed after they developed symptoms. Of note, they found a lower chance of being cured among women with symptoms who were overdue for screening.
These findings are perhaps unsurprising, as women who have developed cancer symptoms generally would be expected to have a more advanced stage of cancer than women whose cancer is detected at screening and is not yet causing them symptoms. As such, women identified through symptoms, rather than screening, may be expected to have a lower chance of being cured. The study’s results support the value of the UK’s current cervical screening programme and the importance of attending screening.
Where did the story come from?
The study was carried out by researchers from Uppsala University, the County Council of Gavleborg and other institutions in Sweden. Funding was provided by grants from the Swedish Cancer Society, the Swedish Foundation for Strategic Research, the Gavle Cancer Fund, and the Centre for Research and Development, Uppsala University and the County Council of Gavleborg. The study was published in the peer-reviewed British Medical Journal.
News coverage has reflected the findings of this research.
What kind of research was this?
This was a nationwide population-based cohort study looking at whether detection of cervical cancer through screening improves cancer cure and survival rates. Cure rates are of particular interest as it has been suggested that cervical screening may have the apparent effect of prolonging survival times simply because the cancer is detected at an earlier stage than it otherwise would have been (i.e. screening could cause women to just live for longer with a diagnosis of cancer . If screening actually improves cure rates this would be an important finding (though arguably this could still be just because being diagnosed at an earlier stage the cancer is more likely to be curable .
Using a cohort study to answer this question has some limitations, as the outcomes in a cohort study may be influenced by other health and lifestyle differences between those women who chose to attend screening and those who did not. These differences may be the cause of any relationship seen, meaning in this case we cannot be certain that screening is the only factor affecting survival rates.
Ideally this sort of question would be addressed using a randomised controlled trial that randomised people into different screening practices and then followed them up over time looking at cancer outcomes and cure rates. However, as cervical screening is already offered in countries such as Sweden and the UK, carrying out a randomised trial that withheld cervical screening would not be considered ethical.
What did the research involve?
The Swedish cervical screening programme invites women for screening every three years among those aged 23-50, and every five years for women aged 51-60. In the UK it is every three years between 25 and 49, and every five years between 50 and 64.
The current study linked all women with cervical cancer in Sweden diagnosed between 1999 and 2001 to the national Swedish causes of death register. The researchers then followed the women to the end of 2006 to check survival in the years following diagnosis.
The researchers analysed women separately according to their age at diagnosis (23-65 years old , including those with a diagnosis more than five years beyond the last invitation to screening (66 years or above . Screening-detected cancers were defined as cancers in women who had an abnormal smear test result recorded between one and six months prior to their diagnosis. The remaining women who did not have an abnormal smear test between one and six months prior to their diagnosis were classed as having had a ‘symptomatic diagnosis’, i.e. a diagnosis based on detectable symptoms rather than screening. Abnormal smear tests taken within one month of diagnosis were also not considered to be screen-detected, as it was considered this might have been part of the diagnostic assessment in women with symptoms of cancer.
The researchers also looked at women with symptomatic cancer who were diagnosed more than six months after their last smear test and outside of the recommended screening interval of 3.5 years if they were under the age of 54; or an interval of 5.5 years if they were 55 or over. These women were considered to be overdue for having their screening test and were compared with women who were not overdue their screening test when they were diagnosed symptomatically.
The outcomes examined were survival rates (survival in the cohort compared with expected survival in the general female population ; and ‘statistical cure’ rates (defined as the women no longer experiencing any greater risk of death compared with the general female population .
What were the basic results?
This cohort of 1,230 women was followed for an average of 8.5 years after diagnosis of cervical cancer. Five years after their diagnoses 440 of the women had died, 373 of these deaths were recorded as being due to cervical cancer (31 died from other cancers, and 36 from a non-cancer cause .
The proportion for women with screen-detected cancer who survived for at least five years was 95% (95% confidence interval [CI] 92 to 97% , whereas for women with symptomatic cancers it was 69% (95% CI 65 to 73% . The cure rate for screen-detected cancers was 92% (95% CI 75 to 98% compared with 66% (95% CI 62 to 70% for symptomatic cancers. This 26% difference in cure rate was statistically significant.
Among women with symptomatic cancers, the proportion cured was significantly lower among those overdue for screening compared to those who had been last screened within the recommended interval (difference in cure 14%, 95% CI 6 to 23% .
Cure proportions were related to the stage of the cancer at the time of diagnosis, but even after taking into account stage at diagnosis, cure rates still remained higher among screen-detected cancers than symptomatic cancers.
How did the researchers interpret the results?
The researchers conclude that screening is associated with improved rates of curing cervical cancer. They note that they cannot rule out the possibility that factors other than screening may have contributed to the differences observed. They also said that using cure as an outcome removes the problem of ‘lead time bias’ that occurs when looking at length of survival as an outcome of screening (discussed in the conclusion section below .
They recommend that further evaluations of cervical screening programmes should consider using a similar approach of looking at the proportions of women with cancer who are cured.
Conclusion
As the researchers discuss, women with cervical cancers detected by screening are known to have an improved chance of surviving their cancer. The study’s apparent improvement in survival outcome may be partly due to a phenomenon known as ‘lead time bias’, meaning that women diagnosed through screening are simply diagnosed at an earlier stage than they would have been if they waited for symptoms to develop. That is to say, that they might not live any longer, just live for longer knowing they had cancer, having detected it at a point before outward symptoms appear. This cohort study aimed to see whether screening improves cure rates, which the researchers hoped would avoid this problem.
A cohort study isn’t the best type of study design to assess the effect of a screening or therapeutic practice against disease outcome, as in a cohort there may be other health and lifestyle differences between women who chose to attend screening or not. The researchers themselves acknowledge that the possibility of such confounding cannot be ruled out. A more reliable way to assess this question would be a randomised controlled trial that randomly assigned women different screening practices and then followed them up over time looking at cancer outcomes and cure rates. However, as cervical screening is already offered in countries such as Sweden and the UK, blocking women access to cervical screening would not be considered ethical, and such a study is highly unlikely to be approved.
These findings are perhaps unsurprising. Women who have developed cancer symptoms are likely to have a more advanced stage of cancer than women whose cancer was detected incidentally through screening. As such, symptomatic women may have a lower chance of cure than women detected at an earlier stage. The fact that there was a lower chance of cure among symptomatic women who were overdue for screening further supports this.
However, the researchers’ further analyses suggested that this was not simply a case of the cancers being diagnosed at an early stage: though cure rate was related to cancer stage, taking into account stage at diagnosis did not remove the difference in cure rates between screen-detected and symptomatic-detected women. The reasons for this cannot be explained by this study, and as the researchers conclude, further evaluations of the benefit of cervical screening programmes should consider looking at cure proportions.
The UK has a slightly different schedule for cervical screening than Sweden, where this study was carried out. The Swedish cervical screening programme invites women for screening every three years among those aged 23-50, and every five years for women aged 51-60, while in the UK it is three-yearly between 25 and 49, and five-yearly between 50 and 64. This and other differences between the countries may mean that the results may not be representative of the UK. However, they generally appear to support the value of cervical screening programmes and the importance of women attending such screenings.
Analysis by Bazian
Links To The Headlines
Smear tests raise chances of beating cervical cancer to 9 in 10. The Daily Telegraph, March 2 2012
Smear tests 'boost cure chances'. BBC News, March 2 2012
Links To Science
Andrae B, Andersson TML, Lambert PC et al. Screening and cervical cancer cure: population based cohort study. BMJ 2012; 344
Could it be the "messenger" -- typically federal and state agencies and public health officials?
A clue to that possibility surfaced in
a recent study, "Motivation for Unpasteurized Milk Consumption in Michigan, 2011," by Paul Bartlett and Angela Renee Katafiasz, of Michigan State University, which appeared in a recent issue of "Food Protection Trends."
In an email to Food Safety News, Bartlett said that what surprised him the most about the results of the survey of raw-milk drinkers was that such a small percentage of them trusted public health officials regarding what food is safe to eat.
Only 4 (or 7.1 percent of the 56 raw-milk consumers who responded to the study's questionnaire agreed with a statement that "in general, they trusted recommendations made by state health officials about what foods are safe to eat." Another 10 (or 17.9 percent indicated they didn't agree with the statement, while another 41 (or 73.2 percent said they weren't sure.
"This lack of trust," says the study, "casts doubt on whether or not consumer education by local or state health departments would be effective in preventing milk-borne disease due to raw-milk consumption."
None of this surprises Mark McAfee, the outspoken co-owner of California-based
Organic Pastures, the nation's largest raw-milk producer. In an email to Food Safety News, McAfee said he has always thought that any area where raw milk is sold should have a huge ultra-red pink sign that says something like: "The FDA says raw milk is dangerous because it has not been processed."
"If that were the case," he said, "sales would skyrocket. No one trusts the Food and Drug Administration or its propaganda."
McAfee said the problem is that "state and federal agencies have cried wolf so many times against raw milk that now any cries that might be an honest attempt to warn of the rare incidence of illness is ignored as hatred against all things FDA."
FDA comes into the picture because the agency doesn't allow raw milk sold for human consumption to be transported across state lines.
That same skepticism about what public health officials and agencies have to say about raw milk kept surfacing in the recent Michigan study. When asked if raw milk should be regulated by the government to ensure quality standards, 27 (or 48.2 percent of the respondents disagreed, while only 9 (or 16.1 percent agreed. Another 17 (or 30.4 percent said they weren't sure.
Along those same lines, some of the raw milk consumers in the study said they generally believe that their producers maintain a higher standard of animal care and cleanliness than does the mainstream dairy industry.
The respondents also took issue with some of the survey's other statements, once again revealing sharp differences of opinion with official government views on the potential health hazards of drinking raw milk. For example, when asked if they agreed or disagreed with the statement that "Drinking raw milk increases your risk of getting a foodborne disease," an average of 44 (or 78.6 percent disagreed. Only 6 respondents agreed with the statement, and another 5 (or 8.9 percent of the respondents said they weren't sure. In Februrary, the Centers for Disease Control and Prevention
released a study showing that the rate of disease outbreaks linked to raw milk was 150 times greater than outbreaks linked to pasteurized milk.
In 2010, Michigan had two
Campylobacter foodborne outbreaks associated with raw milk. And last year, 3 probable cases of
Q-fever were reported in people who participated in raw-milk cow-share arrangements, which according to the report, were presumably caused by drinking raw milk. Back in 1947, Michigan became the first state to require that all milk for sale be pasteurized. As such, the sale of raw milk for human consumption is illegal in that state. However cow- and goat-share agreements in which people buy a share of a herd and are therefore considered owners of the milk from the herd are permitted through an informal agreement on the part of the state.
Profile of a raw-milk drinker
The Michigan study starts off by acknowledging that "it is largely unknown why some consumers prefer raw milk over pasteurized milk."
As such, one of the goals of the peer-reviewed study was to come up with a some sort of profile of raw-milk drinkers in Michigan and from there, to summarize their reasons for preferring raw milk to pasteurized milk.
The profile that emerged was a well-educated adult in his/her late 20s who typically lives in a rural area. Overall, the ages of the raw-milk drinkers, which included family members, ranged from less than one year to 75.
The profile, which, co-author Bartlett readily says is limited due to the small number of raw-milk drinkers surveyed, contrasts starkly with a profile of raw-milk drinkers in California that emerged in an earlier report, "
Profile of Raw Milk Consumers."
Authored primarily by scientists then at FDA's Center for Food Safety and Applied Nutrition, the report analyzed responses to questions in the 1994 California Behavioral Risk Factor Surveillance System Survey that asked respondents about whether they drank raw milk, the amount consumed, the reason for drinking raw milk, and where raw milk was most often obtained.
The researchers found that among the 3,999 survey respondents, 128 (about 3.2 percent reported drinking raw milk the previous year. These raw-milk consumers were more likely that those who didn't drink raw milk to be younger than 40, male, Hispanic and to have less than a high school education.
However, these survey results included any responder who had drunk raw milk in the previous year no matter how much or how little.
One of the conclusions of the California report was that additional research is needed to further refine the profile of raw milk drinkers and determine their risk of adverse effects from drinking raw milk.
The report also said that "Although the role of raw milk as a vehicle in disease transmission has been well-documented, information regarding the prevalence of raw-milk consumption in sparse."
Estimates of the percentage of milk drinkers who drink raw milk range from 1 to 3 percent of the U.S. population, although no one knows for sure since it's too difficult to track the information.
Organic Pastures McAfee was happy to share some information about his raw-milk customers, based on informal studies and polls conducted by the dairy. What surfaces is that 50 percent of the dairy's raw-milk customers are well-educated moms between 20 and 45 years old. The rest of the dairy's raw-milk customers are what McAfee describes as "being all over the place" and can be anyone: young, old, fat, skinny, gay, straight, religious, agnostic, healthy, sick, abandoned by doctors, not wanting to go to doctors, Eastern Bloc immigrants, left wingers, right wingers, no wingers, Tea Party members, and homeschoolers.
"It is everyone," he said.
Why raw milk?
Supporting local farms topped the list of the reasons the Michigan raw-milk survey respondents gave for preferring raw milk, with 48 (or 85.7 of them citing that as a reason. Next came taste, with 47 (or 83.9 percent giving that as a reason. "Holistic health benefits" were cited by 43 (or 76.8 percent of the respondents. Thirty-two respondents (or 57.1 percent said they don't feel processed milk is safe. A majority of the study's raw-milk drinkers shared their beliefs that raw milk was beneficial for relieving digestive problems, intestinal diseases and allergies. Some said they believe raw milk is beneficial for heart disease, neurologic disease, acne, and cancer. Others shared anecdotal claims that when they drink pasteurized milk, they experience symptoms of lactose intolerance, which they said doesn't happen when they drink unpasteurized milk. People with lactose intolerance have a hard time digesting lactose, which is a type of natural sugar found in milk and dairy products. The intolerance occurs when the small intestine doesn't make enough of the enzyme, lactase, which is needed to break down or digest lactose. Symptoms include gas, belly pain, and bloating.
However, a
study out of Stanford Medical School (financed by raw milk advocates not only raised questions about how widespread lactose intolerance really is, but found that raw milk did not confer any benefit over pasteurized milk in relieving symptoms of lactose intolerance. Health authorities say that no matter what benefits might be associated anecdotally with raw milk, the risk of contracting a foodborne disease such as E. coli, Salmonella, Campylobacter or Listeria infection outweighs any of the unproven benefits. They point out that if harmful microorganisms from cow excrement contaminates the raw milk, those drinking it can come down with serious digestive problems, kidney failure, or even death.
In California, labels on raw-milk containers must say: "Raw (unpasteurized milk and raw milk dairy products may contain disease-causing micro-organisms. Persons at highest risk of disease from these organisms include newborns and infants; the elderly; pregnant women; those taking corticosteroids, antibiotics or antacids; and those having chronic illnesses or other conditions that weaken their immunity." The Michigan study also revealed that the average number of years the respondents have been drinking raw milk is 6.1 and that 92 percent of the milk the respondents' families drink is raw milk.
A commitment to purchasing raw milk can be seen in the average number of miles a respondent travels out of his or her way to buy raw milk: 24.2 miles. The average number of pickups of raw milk each month was 4.1.
The study
Questionnaires were sent out to raw-milk producers, 20 of whom agreed to participate in the study. The producers, in turn, were sent survey questions, which they forwarded on to their cow- or goat-share members. Of the 160 questionnaires sent out, 56 were returned.
While the study has been criticized for being self-selecting in that it only questioned people who drink raw milk and biased because it started out with the assumption that it's potentially harmful to your health to drink raw milk, co-author Bartlett told Food Safety News that it was done "for the cost of postage" as a project for a 3-credit course. And, yes, he definitely would have liked to have had a higher response rate and a larger study.
He also pointed out that the hypothesized health benefits of raw milk are difficult to study because it would be unethical to randomly assign people to drink raw milk and others to drink pasteurized milk. Besides which, such a study could not be done blindly because the study subjects would certainly know if they were drinking raw or pasteurized milk (although the Stanford study effectively masked the taste differences with an added flavoring.
More information about raw milk can be found
here.
This year, as of February 28, 114 cases of salmonellosis have been confirmed in the city. In a news release, Toronto Public Health (TPH attributed much of the sharp increase to three known clusters of illness:
- a large catered event February 11 in York Region that resulted in transmission of S. typhimurium to numerous attendees who continue to report illness
- an outbreak, still under investigation by Public Health Ontario, of a less common species of Salmonella (S. heidelberg across the region
- an uptick of S. enteriditis (the most common strain of Salmonella reported in Toronto linked to recent travel to Cuba
Because of this general increase in circulating Salmonella infection, TPH is warning that there is higher chance of person-to-person transmission.
TPH is also advising the following:
- Health-care providers should consider salmonellosis in the differential diagnosis of patients presenting with signs and symptoms of gastroenteritis. Salmonella infection is confirmed by culture and is reportable to the local Medical Officer of Health.
- Symptoms of Salmonella infection, which include diarrhea, nausea, vomiting, abdominal cramps and fever usually occur within 6 to 72 hours after exposure and may last 2 to 5 days.
- Infants, elderly and immunocompromised individuals are at higher risk of bacteremia. Extraintestinal focal infections (e.g., arthritis, meningitis, pneumonia can occur in those with bacteremia.
- Ill patients should be reminded of the potential for transmission to others and the importance of proper hand hygiene and safe food handling practices should be emphasized.
- TPH requires individuals infected with Salmonella who work in or attend high risk environments such as food premises and child care facilities to be excluded from these settings until symptom-free for 24 hours (or until cleared with two negative stool specimens if asymptomatic with poor hygiene practices .
For fostering a system in which people were offered money to injure other people, could Gregg Williams end up in a place where people routinely injure other people for free?
That's the interesting question posed Monday by Gregg Doyel at CBSSports.com and Phil Mushnick of the New York Post.
Is what Gregg Williams did actually illegal? And if so,
should he end up in the pokey? Doyel asked his father, a retired judge and criminal defense attorney.
"There's no question, this was criminal. If a player was hurt, and he was hurt by players playing outside the rules -- with intent to injure, and 'intent' is the key word here -- that makes it a battery. No one in the NFL consents to being hit in such a way that is intended to injure them. This was criminal."
And here's what Mushnick argues:
For years, the NFL's version of "tackle football" had been headed for a rendezvous with criminality. In the Saints' case, pro football became less a sport than a purposefully coached under-business that rewarded excessive brutality and attempts to maim and disable opponents — opponents, known in the big business world, as competitors.
And that meets every standard of what the fronts of our newspapers, district attorneys and attorneys general classify as organized crime.
Putting right or wrong aside for a second, if you're going to put Williams in jail for this, then don't you also have to be prepared to put about half the NFL in jail, too? If I hire a dude named Lenny to kneecap someone, and we get caught, then I have to go to jail and Lenny has to go to jail, too. Are we going to lock up a bunch of Saints defensive linemen and linebackers for hitting Brett Favre really hard?
[
Silver: Expect NFL to come down hard on Saints for bounties]
And if we go after Gregg Williams that hard, don't you think there are other defensive coordinators out there guilty of similar things? And if they have, and players tried to collect those bounties for them, don't those players end up in jail, too?
The slope is very slippery and very gray.
Which isn't to say that it's not a slope worth navigating. I love the NFL, and I'd hate for the league to be damaged in such a significant way, but it's also pretty easy to see this as criminal activity. As a citizen of the United States, are you not entitled to the reasonable expectation that you can go to work every day without someone trying to injure you to the point where you can't work anymore?
[Related:
See the most interesting reactions to Saints' bounties]
If you sign up to play in the NFL, you consent to being hit and being tackled. But you don't consent to being the target of bounties.
There are no quick and simple answers, and there's a long, long list of difficult questions. None of them are good for the NFL.
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BOSTON — We're at the halfway point of the
2012 MIT Sloan Sports Analytics Conference. After a jam-packed Day 1 schedule, most panelists and attendees scattered around the Hub in search of dinner, drinks and discussion of
Descartes' Rule of Signs (probably .
Your Man, however, retreated to a neutral corner to think over what he'd just seen, try to put some rhyme to all that cold, hard reason, and nail down not only what piqued his interest from the first batch of sessions, but what he'd be looking forward to come the morning. (Besides a
sweet
continental breakfast, of course.
Here's what I came up with. If you want to follow along with me for Day 2 of the conference, check out Ball Don't Lie's official Twitter account,
@YahooBDL, and let me know what you're thinking.
THREE THOUGHTS FROM FRIDAY
1. Adam Silver has a personality, which is important. Like many NBA fans, my introduction to Adam Silver came in 2006, when it was reported that
he would replace Russ Granik as the NBA's deputy commissioner and, in one of pro ball's greatest dumb little traditions, announcer of the selections in the second round of the annual NBA draft. And, like many NBA fans, my first extended exposure to Silver came during the league's fraught collective bargaining negotiations with the National Basketball Players Association and the resultant 161-day NBA lockout.
Day in and day out, Silver appeared alongside Commissioner David Stern to play ... well, I guess you can't really say "bad cop to Stern's good cop," so let's call it "worse cop to Stern's bad cop" in responding to union characterizations of the negotiations. When it came to the hard-line, fine-print details of what the owners would accept, Silver was often the one making the proclamations in a firm, resolved tone. (You may know it as the "I am the principal who is about to call your parents if you don't admit you threw the cherry bomb in the toilet, but actually I am going to call them anyway, I just want to hear you admit it" tone.
Add all that up, and coming into Friday morning, my understanding of Adam Silver was that he was a smart, scary, cold and relatively nondescript force that seems poised to
take over the NBA sooner rather than later. So it was a pleasant surprise that he was, as friend
Beckley Mason of ESPN.com noted, "easily the most dynamic panelist" in the all-but-analytics-free (we'll get to that conference-opening talk on the evolution of sports leagues.
Joined on the panel by NHL Commissioner Gary Bettman, uber-agent Scott Boras, MLB Executive Vice President Rob Manfred and New York Giants Chairman Steve Tisch, Silver seemed at once authoritative and at ease in discussing the changing nature of leagues and league management. Touting the NBA's global focus, he casually mentioned that China is now the NBA's No. 2 market, behind only the United States, and that business there is going pretty well: "I
think
we just surpassed soccer as the No. 1 sport in the country."
Y'know, just the most populous nation in the world, with an
estimated number of people playing basketball that's just a shade less than
the entire U.S. population, and we're the top thing there. NBD, you guys.
Asked about who carries weight in contemporary labor negotiations, Silver got on the right side of the audience by playing to its interests. He referenced the critical role in the lockout's resolution played by analytical minds like Kevin Murphy, the
players union's top economist, and noted the shift from lawyers to businesspeople at the negotiating table.
"The analytical people are more important than the lawyers themselves," Silver said.
In the case of the last round of NBA labor negotiations, their importance skyrocketed because of the widely publicized difference in opinion on the
actual
economic health of the league, which the NBA said was dire and the union said was probably quite a bit better than that. Bridging the knowledge gap wasn't easy, quick or painless, but to Silver's mind, having expert number-crunchers involved alongside the negotiators helped.
"I don't remember a time when analytics were so front and center in [a negotiation like this], with often competing models, frankly," Silver said.
In addition to playing to the crowd, Silver also cracked a couple of jokes. (OK, maybe not "jokes," but what passes for jokes at Sloan.
Asked whether or not small-market teams like the Charlotte Bobcats can reasonably compete, both economically and on the court, Silver first promoted the deal the league just struck ("Part of it is the new CBA — we designed a system where we feel that well-managed teams have the opportunity to make at least some amount of money and at least be competitive" and then turned his attention to Bobcats owner (and now
home-seller Michael Jordan.
"I think there's no question that Michael is struggling a little bit in Charlotte," Silver said. "... He assures he is working as hard as he ever has in his life and is playing less golf."
Silver also took a gentle swipe at Bettman, who managed to veer briefly from his "the state of the NHL is strong" talking points to reminisce about working at the NBA in the early 1980s, when the NBA Finals were still being broadcast on tape delay.
"But Gary, you negotiated that deal," Silver interjected, eliciting laughs from the audience.
While the last few years haven't been the kindest to Stern's reputation as the greatest commissioner in American professional sport — and, in fact, the lockout may have done irreparable harm to that legacy — Stern has been widely beloved (or at least respected by NBA fans due in large part to his persona. He is wry; he is withering; he is funny. Sure, he's fashioned himself into an emperor, but he's always been an entertaining one. Whenever he decides to abdicate his throne, the league will have lost a star. In a league of stars, where personality goes such a long way and the cults thereof matter so much, that absence will be felt.
At some point, Adam Silver is going to take the reins of the NBA from David Stern. He's not going to be
that
wry,
that
withering or
that
funny. He won't be the kind of star that Stern is. But on Friday, he showed that he can walk into a room to talk about something as dry as labor negotiations, set up on stage and show he's a person, actual and whole, rather than just a pointy-headed lawyer/business type. That matters.
(And if you doubted whether Silver's learned anything from working for Stern for the past six years, friend of BDL Zach Lowe notes at
Sports Illustrated's The Point Forward blog that less than four months after striking a compromise on the collective bargaining agreement to end the 2011 lockout, Silver and the owners are already making noise about taking advantage of the opt-out clause available to them after the sixth year in that 10-year pact. The lesson: You're never done negotiating.
2. Optical data tracking is still super sweet, and spatial and visual analytics could be the next big thing. Of all the analytics tools on display at last year's Sloan conference, perhaps the one with the most potential for massive dividends in the basketball world was
STATS LLC's SportVU system. SportVU positions six special video cameras above the basketball court at different angles that capture, record and store all
kinds
of information on what's happening on the floor — the movements of all 10 players, the referee and the ball, who's running where, how much they're running, the height of the ball at different times and places, the flight path of passes, individual dribbles and about a million other things. It collects all this information, or
optical tracking data, and then spits out reams and reams of stuff that look kind of like
The Matrix. One of the big takeaways from last year's conference was that there's gold in them thar lines of code, if only you could figure out what kind of questions you should ask to extract it.
One of the two finalists for top honors in the research paper track of this year's Sloan conference, "Deconstructing the Rebound with Optical Tracking Data," uses SportVU data to track the height of the basketball after a missed shot. It traces the ball's descent it as it comes off the rim and goes down below 10, nine and eight feet off the deck to find out what happens to it, who's grabbing it, where they're grabbing it and what that can tell us about offensive rebounding.
University of Southern California researchers Rajiv Maheswaran (who presented the paper , Yu-Han Chang, Aaron Henehan and Samantha Danesis looked at about 11,000 field goal tries in an attempt to, as they wrote, "move beyond the outcome of who got the rebound." Instead, they wanted to learn deeper-dive stuff like how shot location impacted offensive rebounding rates, how likely a shot is to generate an offensive rebound and where players should position themselves to have the best chance of snagging offensive boards. Turns out that a shot from beyond the arc has the same likelihood of becoming an offensive rebound as one taken from just seven feet away, and
both
of them have a better chance of getting grabbed by a teammate than one taken from 11 feet, so if you fancy yourself a midrange shooter, you better be pretty damn good at it. (Or, y'know, take a few steps back and hoist a triple.
One of the conclusions drawn by Maheswaran and his colleagues — that by emphasizing shot selection and firing away from areas where you stand the greatest chance of getting the carom, teams can grab a higher percentage of available offensive rebounds and potentially improve their effective field goal percentages, thereby getting a leg up in two of Dean Oliver's
Four Factors — dovetails well with the project undertaken by the other finalist in the research paper track, Michigan State University associate geography professor Kirk Goldsberry.
The project, dubbed "CourtVision," aims to combine the practice of spatial analysis (look at how a given entity appears and acts in a given space, study clusters of activity, patterns, correlations, etc. with the use of visual analytics (creating visual tools we can use to interact with a bunch of information, browse through complex sets of data, ask questions, etc. to learn a whole bunch of stuff about what NBA players do — well or poorly, frequently or infrequently — from a ton of different spots on the basketball court.
As a case study and proof of concept, Goldsberry decided to try to use CourtVision to find an empirical answer to an often-debated question: Who is the best shooter in the NBA? He started by mapping out the "scoring area" — the 1,300-square-foot region on the court where 98 percent of NBA field-goal attempts occur. Then, he plotted out about 700,000 shots taken in every game from 2006 through 2011 — who took them, where they took them and what the outcomes of the shots were. Then he started making maps.
Goldsberry offers a new statistic for measuring a shooter's aptitude — "Shooting Range," a metric of how effective a player is at producing points from the greatest number of different spots on the court. A player's "range percentage" (Range% measures the percentage of spots in that 1,300-square-foot scoring area from which a player will produce at least one point per shot attempted. The league leaders in Range% over the last five years mostly pass the laugh test — in order: Steve Nash, Ray Allen, Kobe Bryant, Dirk Nowitzki, Rashard Lewis, Joe Johnson, Vince Carter, Paul Pierce, Rudy Gay and Danny Granger.
When Goldsberry starts breaking down the maps, you start to see the value in understanding the unique spatial footprints and tendencies of every player, lineup and team in the league. You see just how fantastic Dirk is from the right baseline, an area in which none of the other top shooters even perform well. You see that Nash is a killer on wing three-pointers, but struggles in that right baseline spot that Dirk loves. You see that even deadeye Ray Allen has something akin to a three-point weakness — he's not
so
great from the left wing.
"Some players are good from some areas; some players are better from other areas," Goldsberry said. "We wanted to reveal those special spatial signatures."
The cool thing is, these specific deployments are just the tip of the iceberg. If the USC team can use SportVU for offensive rebounding data and Goldsberry can use CourtVision to identify the best and worst shooters, then why can't they use their systems to learn more about creating turnovers, or where most fouls happen, or, as Goldsberry noted, how to game plan?
"If I have Steve Nash's shot chart [and] if I have the Magic's defensive chart, then maybe I can figure out what kind of sets should be run to exploit their holes," he said.
The things Goldsberry, the USC team and others are looking at — finding ways to measure and visualize stuff that we might think or believe, but not know for sure — can not only help teams make better decisions; they can open the door to a whole new way of seeing the game. All we have to do is stop seeing The Matrix.
(For more on this emerging vein of analysis, head back over to
The Point Forward for Lowe's brief but jam-packed breakdown of both papers.
3. The conference just keeps getting bigger and bigger, which is both a good thing and a bad thing. This is less a basketball point than a more general observation, and it's a mouthful, so bear with me.
As I
mentioned Friday, the 2012 edition of Sloan has more than 2,200 attendees, which conference organizers happily tout as a 50 percent increase in enrollment over last year's model and 13 times more people than the 175 who checked out the inaugural conference in 2007. The conference's "facts and figures" sheet offers a litany of exciting numbers (natch detailing its growth — more than 700 students attending this year from more than 170 different academic institutions, 73 professional sports teams represented from six different pro sports leagues, eight discrete sports covered, nearly 200 combined submissions for the research paper and
Evolution of Sport presentation tracks, and on and on.
Everything about Sloan seems to be gearing toward playing to larger audiences, from its ESPN-headlined roster of sponsors to its progressively nattier digs — last year's conference was held at the larger but more remote Boston Convention & Exhibition Center in South Boston; this year, we're at the much more centrally located Hynes Convention Center, right in the heart of Boston's Back Bay, simplifying travel and accommodations for heavy-hitting panelists and light-hitting bloggers alike. The bigger-better-faster-more thrust even extends to the quality of attendee swag bags; this year's is some
handy ruggedized business that I'm pretty sure simultaneously keeps roasts piping hot and frozen margaritas nice and cool, even in the midst of a street fight.
Presentations in the giant main ballroom take place on and in front of a
massive, glowing pink heart of a stage and dais. Klieg lights bathed the main drag of the convention floor as production workers prepared to film an episode of ESPN's stat-focused "Numbers Never* Lie" right in the middle of the hallway. For the second straight year, one of the most popular panelists at the show is Toronto Maple Leafs President and GM Brian Burke, who
doesn't seem all
that
interested in analytics, but cuts an irascible figure on stage and curses on occasion, which is entertaining. (The same is true, albeit to a lesser extent, of ESPN color commentator and former NBA head coach Jeff Van Gundy, who eagerly stepped into a similar comic relief role during Friday's basketball analytics presentation. There is a game room where you can see the
Boston Bruins' mascot play air hockey.
Meanwhile, down a long hallway — in what's been branded the "NEXT Area," separated from the main ballroom and other primary panel spaces by a crush of humanity, an entire trade show, the TV setup and, as Jack Dickey
wrote at Deadspin last year, throngs of "white guys in suits" itching for an elevator-pitch window of face time with one of the myriad front-office types in attendance — are the tiny-by-comparison rooms where the research paper presentations and Evolution of Sport talks take place. Where the lion's share of the actual, y'know, analytics discussion happens. Where the new theories and embryonic innovations are being shared, batted around and refined.
As writers like
Jonathan Givony of DraftExpress suggested Friday,
that's
where the groundwork is being laid for the next crop of ideas that will help shape and enhance our understanding the way that, say, on-base percentage and Player Efficiency Rating have over the past two decades — where the stuff that could soon help us become way more knowledgeable fans than we are today is percolating. And it's shoved down the hall, out of the way, in the far corner of the convention center, behind the room with the air hockey table.
There are all sorts of devil's-advocate angles to this, of course. Logistics is a big one; more people want to see stuff like Bill Simmons going 12 rounds with Mark Cuban, so that gets the big room, and putting all the paper presentations together makes it easier for people who just want to see those to do so with ease. Also, I'd bet your paycheck that the folks giving the talks don't mind the lower relative profile, because the People Who Matter in front offices definitely know about the most interesting research being presented, and that's all that really counts.
Plus, it's not like the increased focus on the wider-net content has necessarily come at the expense of the nitty-gritty stuff; you may have to hunt a bit, but you can still find and attend those talks, and (in the ones I attended Friday it looked like plenty of people were interested in staying on that track. If a conference this targeted in its focus can expand its scope a bit and still make good on its core mission, then why not steer more toward "something for everyone"?
To my mind, though, the chief devil's advocate argument is that without the infusion of the more broad-based/all-but-analytics-free discussions, higher-profile names, ramped-up production values and all the rest, there wouldn't be the level of interest, ticket sales, sponsorships and partnerships that make putting on this kind of show possible. Ditto for funding the $7,500 grand prize and $2,500 runner-up prize that go to the writers of the top two research papers.
Without this kind of show, where can that next wave of innovation actually break? If you want people to find religion, you could do worse than to start by getting them to church. But does it have to be, like, a megachurch?
THREE THINGS I'M EXCITED FOR SATURDAY
1. Adam Gold's "How to Cure Tanking" presentation in the Evolution of Sport track. Is unweighting the NBA draft lottery really the answer? Are other ideas worth considering? I will be there representing all fans of the Charlotte Bobcats.
2. The 1 p.m. to 2 p.m. EOS session. "Quantifying the Force of a Monster Dunk" and "Redefining the Positions in Basketball"? Yes, please.
3. Seeing how many members of Grantland I can get to autograph the free copy of "Grantland Quarterly" that came in my swag bag. I'm going to guess it will be "most, but not all." Wish me luck, gang!
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