Last week, we met up with her
to examine some of the ways the medical, technological, and political ideas swirling around in 2012 -- ideas still unhatched and far beyond her control -- might impact her future health 13 years from now. Using potential scenarios for U.S. health care as defined in a new report, our "time-traveling" pals at the Institute for Alternative Futures laid out four possibilities for Mary's health care in the year 2025.
Watch the videos below for a refresher on the four scenarios. Then, as promised, read the analysis of Clem Bezold, founder of IAF, who explains what would need to happen over the next 13 years for each of those scenarios to become reality.
And don't forget to check out the final results of our audience poll from last week -- found at the bottom of the post -- to see where your ideas on the future of U.S. health care stack up with the other participants.
SCENARIO 1: "Many Needs, Many Models," or the "Expectable Future"
Bezold: "Among many health care experts, this is the most likely forecast for U.S. health care. It may not be the most preferable, but there's enough inertia in the system to prompt a fair amount of positive change. In this scenario, we have electronic medical records that work, there are advances in system integration, digital coaches have become relatively effective, and the personalization of health care has improved significantly. The good news is we double the percentage of people in integrated care from 20 to 40 percent -- but the bad news is we only double it. The rest remain in fee-for-service or semi-integrated care. So we see improvements, but they're not uniformly distributed.
"To get to this scenario, we assume the Affordable Care Act has been implemented fairly successfully, but the improvements in changing the health care system are modest. We add people to the rolls for health coverage, but we end up with shortages. The employers generally look at the new health insurance exchanges and say they're effective enough, and that they'd prefer to get out of providing health care. So employers continue dropping coverage or shifting to consumer-directed health plans with defined contributions and high deductibles. The triple aim of health care reform -- enhancing the patient's experience, reducing per capita health care costs, and improving the overall health of the population -- has been accepted by most integrated health care systems. Most providers, though, remain unintegrated and the payers don't require it. And that's largely because health reform's Accountable Care Organizations, which were designed to integrate care, haven't been implemented as widely and successfully as they could have been by 2025."
SCENARIO 2: "Lost Decade, Lost Health," or a "Challenging Future"
Bezold: "In this scenario, the Supreme Court has ruled the individual mandate of health care reform unconstitutional, eliminating a major component of the Affordable Care Act. The United States has made huge investments in electronic medical records but they're not fully interoperable and therefore aren't very effective. In the meantime, prices keep going up, and a lot of people are now uninsured. So they seek out free digital coaches to substitute for regular check-ups. The problem is that advertising revenues fund many of these digital coaches that are free to patients, and many independent providers of these free digital coaches don't adequately check the quality, safety or efficacy of what their advertisers are selling.
"To top it all off, the United States has suffered recurring recessions, several tied to the European financial crisis. And due to that fact, there have been periodic and significant budget cuts -- 10 percent cuts in health care spending happened twice within two or three years of each other. One was in 2013 when Congress failed to find a patch for the Sustainable Growth Rate formula that reimburses doctors for their Medicare services. The second slashed Medicare and Medicaid reimbursement rates yet again to cope with ever-rising health care costs. Physicians are being told to do more and get less -- and their stresses continue to get worse. Some health care providers just go out of business, including some community health centers. To be sure, there have still been some developments, including the discovery of a successful treatment for Alzheimer's, but you have to be rich to get them. Even if you have health insurance, most plans have stopped covering a number of the cutting-edge, expensive treatments."
SCENARIO 3: "Primary Care That Works for All," or an "Aspiring Future"
Bezold: "In this scenario, the Affordable Care Act has done very well in moving people toward integrated care. In general, the system also continues to move health care delivery systems into integrated care that focuses on prevention, takes full advantage of digital health coaching and utilizes the entire health care team. Leading health care officials have made a concerted effort to ensure that patient-centered medical homes have evolved into robust community centered health homes. In practice, they see themselves as treating the entire community and addressing social determinants of health in a neighborhood or region, in addition to treating patients. Things have gone well due to a combination factors, including the successful implementation of the ACA - particularly the success of Accountable Care Organizations which have fully integrated and simplified care -- as well as greater transparency of costs and real competition among providers.
"All of that has resulted in much more patient satisfaction. Incentives have shifted enough to encourage the medical community to use the entire team more efficiently. There's less use of physicians and more use of others in the team, including community health workers. It's been found that more and better care can be provided by using people further down on the chain. Community health workers have less training than nurses, but they can visit patients in their homes and effectively reinforce the information, diagnosis and advice from the health care provider. The recommendations are based on the latest medical protocols, the patient's bio-monitoring and community health assessments. It's become increasingly apparent that by focusing on prevention and taking a community-focused approach, you can get better outcomes for less cost."
SCENARIO 4: "I Am My Own Medical Home," or a "Surprisingly Successful Future"
Bezold: "In scenario four, much of health care moves into integrated systems that work, but the United States also has some economic challenges that have interfered. So we don't get the same degree of access to the effective integrated health care we saw in Scenario 3. The individual mandate within health reform has been ruled unconstitutional, and that means no one is forced to have insurance. We're also seeing a continuing movement where employers stop offering their employees full benefits. Individuals have to be ready to shell out a fair amount of money to get good health insurance -- and many people do that -- but another 40 percent of them say they can handle their health care on their own.
"In fact, technology, competitive insurance plans, and transparency of quality and price for providers, tests and procedures have allowed many individuals and families to self-manage their health care quite well. Most of these people have determined that they either can't afford full health coverage and consumer-directed plans help people take control of their own health care. Forty percent end up using technology and consumer-directed plans to become their "own medical home" and an equal amount buy their health care though integrated plans. For those managing their own care, there are very effective tools that allow people to buy health care "by the piece." For example, if someone needs a test and she can't do it at home, there's an equivalent of Angie's List that links up with that individual's digital health coach to find the result that will work best for them. The same is true for routine care -- it's easy to shop around. Because this consumer-directed care is so effective and lowers cost, it puts a cost pressure on integrated systems to become more efficient and effective. Another positive development is that consumer-directed plans include a very effective digital health coach, with all accompanying advertisements vetted by health insurance companies to ensure the quality of their messages and the safety of consumers."
Which scenario do you think is most likely? Check out the results of the NewsHour poll conducted over the past week. While it's far from scientific, the poll does indicate that many of the participants have a "very gloomy" outlook for U.S. health care, Bezold said. He offers his own assessment below.
Here are the results of a NewsHour poll that asked viewers to rate the relative likelihood of each scenario. Raw scores have been converted to averages:
Scenario 1: "Expectable Future": 60 percent likelihood (average of 5.95 out of 10 for 65 voting)
Scenario 2: "Challenging Future": 70 percent likelihood (average of 6.96 with 78 voting)
Scenario 3: "Aspiring Future": 53 percent likelihood (average of 5.27 with 60 voting)
Scenario 4: "Surprisingly Successful Future": 42 percent (average of 4.15 with 61 voting)
The above results are based on ballots cast between Jan. 31 and Feb. 7. Continue voting here:
Rate SCENARIO 1: "Expectable Future"
Rate SCENARIO 2: "Challenging Future"
Rate SCENARIO 3: "Aspiring Future"
Rate SCENARIO 4: "Surprisingly Successful Future"
here.
Bezold: "In terms of relative likelihood, my own opinion is that Scenario 1 is about 55 percent likely, Scenario 2 is about 45 percent likely, Scenario 3 is 38 percent likely, and Scenario 4 is 38 percent likely. I pick Scenario 1 as the likeliest because it includes the strongest aggregation of forces in terms of where we're headed. While I don't like that it's most likely -- especially because we've only doubled the number of people in integrated care -- we will see a number of advances in a whole range of things built into that scenario. So it's not all bad news."
The scenarios were developed in consultation with some of the top health care experts in the country, and with the support of The Kresge Foundation, which is also a NewsHour underwriter. Read the full report
here.
“Parents who frequently move house put children’s health at risk,” according to the Daily Mail. The newspaper said that research found moving several times can affect children’s health and psychological state, and also increases the likelihood that a child may use illegal drugs.
This Scottish research, which looked at potential links between moving house in childhood and adult health, produced far more mixed results than the Mail implied. However, the press release accompanying the research did not always clearly reflect the findings of the study, which found very few significant links between moving frequently and poor health.
In fact, once the researchers accounted for factors such as social deprivation and moving schools, moving house was only significantly linked to a higher chance of using drugs in later life. Adults who had moved frequently showed no greater risk of being overweight, having high blood pressure, long-term illness, psychological distress, drinking or smoking later in life.
While researchers say the risk of having certain measures of poor health was “elevated” in people who moved house more frequently as a child, the increase in risk was not statistically significant, which means it could have happened by chance.
Where did the story come from?
The study was carried out by researchers from the Medical Research Council, the University of Stirling, Queen’s University and Scotland’s Chief Scientist Office. It was funded by the Chief Scientist Office of the Scottish Government Health Directorate. The study was published in the peer-reviewed Journal of Epidemiology and Community Health.
The study’s findings were overstated by the Daily Mail. The newspaper reported that there were “negative health effects” from frequent moves, whereas the study found that frequent moving was only significantly linked to an increased chance of drug use. This finding on drug use was found to be independent of other variables.
Moving during childhood was not significantly associated with adult measures of physical health, such as weight and blood pressure. The Mail only touched on these elements towards the end of its report.
It’s worth noting that in the press release that accompanied publication of the study, it only the penultimate paragraph stated only illegal drug use was independently associated with frequent moves.
What kind of research was this?
This research was part of a large cohort study from the west of Scotland, which has taken place over 20 years. Its aim was to compare the health of people who had been “residentially stable” during childhood with those who had moved house, using a range of health measures.
The authors say previous research suggests that frequent childhood moves may be associated with poorer health outcomes and behaviour in adolescence. The researchers say their present study brings together a wider range of health outcomes than has previously been considered, and also looked at the extent to which associations between childhood mobility and health in adolescence last into adulthood.
What did the research involve?
The study was based on a cohort of 1,515 participants who were 15 when it started in 1987 and who were followed up for 20 years. Data from this cohort were collected at five points in time, the final time when the participants were 36. The final sample analysed in the study was 850 participants, so 665 original participants (44%) were not included in the final analysis because they had left the study.
Researchers collected their data through face-to-face interviews conducted by nurses. A parental questionnaire was completed at the start of the study.
The researchers got information about moving house from the number of addresses people had lived at between birth and 18 (they excluded recent moves out of the family home). They collected information on a range of health measures including:
- Physical health measures - these were all taken by nurses and included body mass index, waist-to-hip ratio, lung function and blood pressure.
- Overall health - people were asked to report whether they had limiting long-term illness (answering yes or no) and to give their own assessment of their general health, as rated on a four-point scale.
- Psychological distress - this was assessed using a standard 12-item questionnaire (with a cut-off score of 3 points taken to indicate psychological distress). Whether people had thought about suicide was also examined, with people asked at certain points whether they had thought about taking a drug overdose or deliberate self-injury. The third measure of psychological distress was anxiety, as measured on a standard scale.
- Health behaviours - the behaviours examined were heavy drinking (defined as exceeding maximum weekly safe limits), illegal drug use and smoking.
Importantly, the researchers also looked at participants’ family and household circumstances based on information provided by the children’s parents at the start. They also looked at other factors such as social deprivation (calculated by postcode and using recognised deprivation categories), housing status (home owner or not), social class, family structure (intact or not) and number of siblings. Also included were data on school mobility, derived from the number of primary and secondary schools attended. The researchers also looked at participants’ social class, education and marital status in adulthood.
The researchers then analysed the relationship between number of house moves in childhood and health at the ages of 18 and 36. They adjusted their findings for possible confounders, such as social class, deprivation and family circumstances.
What were the basic results?
The researchers found that approximately one in five people did not move address throughout childhood. Three in ten moved once or twice, and a further one in five had moved at least three times. They also found that children in single-parent households and those with two or three siblings were significantly more likely to have moved home (while those with at least four siblings were more likely to have stayed put).
After they adjusted their findings for both socioeconomic circumstances and the number of school moves, the researchers found that, when the participants were 18:
- People who had moved at least three times were significantly more likely to have used illegal drugs than those who had never moved (odds ration [OR] 2.44, 95% confidence interval [CI] 1.45 to 4.10).
- Those who moved at least once had a significantly higher chance of scoring 3 or more (indicating distress) on the questionnaire for psychological distress than those who had not moved at all (OR=1.62, 95% CI 1.11 to 2.35).
- The risk of several outcomes (having a long-term illness, having suicidal thoughts for those who had moved at least once, and heavy drinking and smoking for those who had moved at least three times) were “elevated” compared to those who had not moved at all, but the increased risks were not significant.
- There was no association between childhood mobility and physical health measures such as blood pressure and weight.
When the participants were aged 36, the researchers found that:
- Frequent moving in childhood was independently associated with illegal drug use (OR 1.92, 95% CI 1.00 to 3.69).
- The odds of poor health across other measures remained “elevated” but not statistically significant.
- There was no association between moving address during childhood and physical health measures such as blood pressure and weight.
How did the researchers interpret the results?
The researchers concluded that increased residential mobility in childhood is associated with an elevated risk of poor health in adulthood, across a range of measures. This is explained in part, they say, by both social and economic circumstances and the frequency of school moves.
The relationship between childhood residential mobility and poorer health appeared to be stronger in adolescence than adulthood, possibly because people’s own socioeconomic circumstances lessened the effects over time.
Conclusion
This study looked at the effect of multiple address moves during childhood on people’s physical and psychological health at the ages of 18 and 36.
The way the authors interpreted the results of their study is confusing. They say that a higher risk of poor health outcomes is associated with frequent moves of home in childhood. However, the only significantly higher risk, once the results were adjusted for various confounders, was illegal drug use. This is important because it means that the other increases in risk identified are more likely to have occurred by chance.
The study examined an important issue, and one strength is the length of time of it covered. Another is its detailed collection of data, which might help explain why frequent moves of house could have an association with poorer health outcomes. For example, this could be because of frequent school moves, family break-up and deprivation.
However, the study has a number of limitations. Its high drop-out rate (around 43%) raises the question of reliability and it is possible that those who dropped out or were lost to follow-up also had the most mobile childhoods. The study’s reliance on the parents to report outcomes, such as overall health, is another limitation as their reports may be subjective or difficult to appraise.
Families move home for a range of different reasons, including improved schooling and employment opportunities, change in financial circumstances or family break-up, and the study did not assess the reasons for the family moves. It seems obvious that children are more likely to be negatively affected when disruption or financial problems cause a family to move, rather than when the motive is to seek better schools or a better job.
The way children’s wellbeing is affected by frequent moving is an important issue, but it is also a complex one which needs to be examined further.
Links To The Headlines
Parents who frequently move house 'put children's health at risk'. Daily Mail, February 9 2012
Links To Science
Brown D, Benzeval M, Gayle V et al.
Childhood residential mobility and health in late adolescence and adulthood: findings from the West of Scotland Twenty-07 Study. Journal of Epidemiology and Community Health, Published Online First 6 February 2012
Mitt Romney campaigns in Colorado Springs last week. Photo by Justin Sullivan/Getty Images.
Mitt Romney is taking a break from the campaign trail, no doubt preparing for his big moment Friday at the
Conservative Political Action Conference in Washington.
The math and the calendar ahead, not to mention his organization, suggest the former Massachusetts governor remains the favorite to capture the GOP nomination to challenge President Obama in November. As the weeks and contests stretch out, and with Romney's three rivals saying they won't let up, the speech could be a big moment.
Low turnout in early Republican primaries and caucuses and a continued lack of enthusiasm for the GOP's candidates haven't helped Romney's case. Could CPAC be his moment to retake control of the party's steering wheel?
Jonathan Martin and Manu Raju write Thursday about Republicans who are worried
Romney needs to "step it up," as Politico put it in the headline. From the piece, which includes frank quotes from members of Congress:
The admonition came from outspoken conservatives and members of Congress who typically stay out of party spats.
"There is not exactly Romney-mania right now," Senate GOP Whip Jon Kyl told POLITICO, adding that the former Massachusetts governor "absolutely" must shore up the weaknesses with the GOP base that were on such vivid display Tuesday.
"Playing it safe, which Romney tends to do, is not going to get it for him," said Sen. Jim DeMint (R-S.C.), a 2008 Romney supporter and a leading voice of his party's conservative bloc, who called the results this week "a signal."
Sen. Ron Johnson (R-Wisc.), who rode a tea party wave to defeat veteran Sen. Russ Feingold two years ago, said conservatives believe "we're losing this country" and want "a strong messenger carrying a strong message."
"Gov. Romney should probably be a little concerned," Johnson said. Asked if the front-runner has work to do with the party base, the freshman conservative said: "Last night's results definitely confirmed that."
The Washington Times' Ralph Z. Hallow writes about the conservative movement's expectations for the annual gathering, and what it might mean for Romney.
Year after year at these meetings, CPAC attendees have grumbled about the failure of some of the elected Republican officials who profess conservative ideals to adhere to them once in power. Those activists, who keep coming and keep bringing recruits, say they aren't giving up on finding politicians whose deeds will more closely resemble their words.
Texas Rep. Ron Paul, who has won the straw poll at CPAC two years in a row, won't be attending. Pressure will be on for Romney to knock it out of the park and remind the heart of the Republican Party why he's the guy they want to challenge Mr. Obama this fall.
Team NewsHour will be on hand at CPAC,
so make sure to follow us.
CULTURE CLASH
The Obama administration's decision last month to require most employers, including religious-affiliated hospitals and schools, to provide contraception through their employee health insurance plans has revealed stark divisions, including inside the White House.
Bloomberg's Mike Dorning and Margaret Talev report that President Obama sided with a group of female advisers not to limit the health care mandate,
despite warnings from Vice President Joe Biden and former chief of staff William Daley that the move could turn off Catholic voters:
Health and Human Services Secretary Kathleen Sebelius, a Catholic and a two-term governor of Kansas, was joined by several female Obama advisers in urging against a broad exemption for religious organizations. To do so would leave too many women without coverage and sap the enthusiasm for Obama among women's rights advocates, they said, according to the people, who spoke about the deliberations on condition of anonymity.
Vice President Joe Biden and then-White House chief of staff Bill Daley, also Catholics, warned that the mandate would be seen as a government intrusion on religious institutions. Even moderate Catholic voters in battleground states might be alienated, they warned, according to the people familiar with the discussions.
Polling conducted by Democratic pollster Celinda Lake suggests that Catholic voters might not be the part of the electorate the administration has most to worry about. The survey found that a majority of Catholics -- 53 percent -- said the opposition to the mandate by the U.S. Conferences of Catholic Bishops made no difference in their views of the Affordable Care Act, according to a copy provided to The Morning Line by a source familiar with the data.
That said, the administration has plenty on its hands when it comes to Republican opposition to the mandate.
On Wednesday, House Speaker John Boehner, R-Ohio, threatened congressional action if the administration followed through on its decision. "If the president does not reverse the department's attack on religious freedom, then the Congress, acting on behalf of the American people and the Constitution we are sworn to uphold and defend, must," Rep. Boehner said. "This attack by the federal government on religious freedom in our country cannot stand and will not stand."
(For more on the split in Congress, be sure to check out the Roll Call piece,
"New Chapter in Culture Wars," written by John Stanton and Meredith Shiner.)
Liberal groups, including the Nurse Alliance of SEIU Healthcare and Protect Your Care, plan to get local reporters in Michigan, Ohio, Wisconsin and Florida writing about "the importance of contraceptive coverage" within the health care law with a series of conference calls Thursday.
The issue has also become a focus of the Republican presidential campaign, with Romney criticizing the president during a stop in Atlanta on Wednesday afternoon.
"This kind of attack on religion and on our first freedom, our right to worship and believe as we choose ... this is wrong," Romney said. "If I am president of the United States, I will restore and protect our religious liberty in this great country."
The White House has signaled a willingness to find a compromise with religious institutions on the mandate, but even that action could bring political risks, as any move to restrict access to contraceptives might displease women voters, who supported Mr. Obama over John McCain
by 13 points in the 2008 election.
SANTORUM SERVERS OVERLOAD
Interest in Rick Santorum was so high on Wednesday, it took nearly 20 minutes for a call on his 888 campaign number to be patched to a human being.
"We've been that busy, getting way more than the normal amount of calls," an operator told The Morning Line, noting she was one of 40 people frantically taking donations on the line.
John Brabender, Santorum's longtime media strategist, appeared on Wednesday's NewsHour and said there's little time to stop and savor the former Pennsylvania senator's victory. He said calls and donations were "going through the roof," noting that "we had to add more servers" to meet demand.
Brabender, who had spent all day filming in Pittsburgh, where Santorum claims his roots, wouldn't tell Judy Woodruff what kind of television spot was in the works, but he gave a hint: "I was here shooting a commercial today. I'm not telling you any more than that."
Watch the entire interview and our segment on the Tuesday election's
here.
The New York Times' Jim Rutenberg and Nicholas Confessore look at Foster Friess, the man who has given $331,000 to the pro-Santorum super PAC, the Red, White and Blue Fund.
Michael Biundo, Mr. Santorum's campaign manager, said the Red, White and Blue Fund had been helpful not just with television commercials but also with a phone bank operation that helped drive Santorum-friendly voters to the polls in Denver. While he said the campaign was receiving an influx of new donations after Tuesday's victories, "anytime anybody wants to help us, we'll take it."
2012 LINE ITEMS
Hotline's Reid Wilson reported on Twitter (
@hotlinereid) that the Obama campaign's first ad about energy ran between Jan. 19 and Jan. 25. There were about 5,000 spots running in 25 markets, costing $1.4 million, he wrote.
Politico's Maggie Haberman and Reid Epstein
look at Romney's return to CPAC, four years after he announced his withdrawal from the 2008 GOP race at the annual conservative confab.
Our partners at Patchwork Nation write about
how bad a night Tuesday was for Romney.
Paul announces a Valentine's Day "money bomb" and tells his supporters in an email, "One thing has become clear after these early contests -- it's anybody's race."
Ed Koch, who led an anti-Obama push over the president's moves on Israel last year, now tells Ben Smith he "has been
hearing fewer and fewer complaints about Barack Obama."
Obama campaign pollster Joel Benenson writes a memo gloating about low turnout in the early GOP contests. "The only state thus far with a significant rise in Republican turnout was South Carolina, where Romney was trounced by Newt Gingrich," he writes. He also argues that "Romney's effort to woo conservative voters is hurting him with independents."
The Democratic National Committee posts a new web video suggesting Romney is beholden to special interests.
Watch it here.
TOP TWEETS
src="//platform.twitter.com/widgets.js" charset="utf-8">Gallup polling shows economic confidence continues to surge following jobs report. Closing in on best level since '07.
— Steven Dennis (@StevenTDennis)
February 9, 2012
src="//platform.twitter.com/widgets.js" charset="utf-8">How Mark Zuckerberg, using the Like button, appeared to endorse
— Jennifer Preston (@NYT_JenPreston)
#MittRomney
gaw.kr/xgKmVy
February 9, 2012
src="//platform.twitter.com/widgets.js" charset="utf-8">DC Food trucks need you! Pls take just a minute to help all of us remain in business!
— DC Empanadas (@DCEmpanadas)
fb.me/19Q1KctUC
February 9, 2012
OUTSIDE THE LINES
The New York Times reports on the "broad national settlement
aimed at halting the housing market's downward slide and holding the banks accountable for foreclosure abuses." The NewsHour will have more on Thursday's program.
The NewsHour's Gwen Ifill spoke with Washington Post reporter Kimberly Kindy about the paper's year-long investigation looking at how members of Congress have
steered taxpayer money close to home.
"A growing number of Republicans want to
lift the earmark ban that has been embraced by President Obama and Congress," The Hill's Alexander Bolton writes.
A pair of polls released Wednesday show Congress' dismal popularity hasn't gotten any better. Gallup showed the approval rating for Congress
at a record-low 10 percent. Even though Congress has only been in session 15 days this year, its approval rating still managed a 3 percent drop since the last Gallup poll in January. And a new Rasmussen survey
found 43 percent of Americans believe "a group of people selected at random from the phone book [would] do a better job addressing the nation's problems than the current Congress."
Roll Call's Kyle Trygstad looks ahead to
Senate races in 2014. Hint: It looks good for the GOP.
Judy Woodruff (
@judywoodruff) writes about
the state of agriculture in America.
Washington state passes a measure
legalizing gay marriage.
The Texas Tribune writes that Gov. Rick Perry was
the butt of several jokes at Wednesday night's annual congressional dinner hosted by the Washington Press Club Foundation. (Disclosure: Bellantoni is on the foundation's board.)
NewsHour politics desk assistant Alex Bruns contributed to this report.
ON THE TRAIL
All events are listed in Eastern Time.
Vice President Joe Biden delivers remarks at the Ohio Newspaper Association Convention in Columbus at 11 a.m.
Rick Santorum holds a pair of Oklahoma rallies: in Oklahoma City at 10 a.m. and Tulsa at 2:30 p.m.
Newt Gingrich, Ron Paul and Mitt Romney have no public events scheduled Thursday.
All future events can be found on our
Political Calendar:
For more political coverage, visit our
politics page.
Sign up here
to receive the Morning Line in your inbox every morning.
Questions or comments? Email Christina Bellantoni at cbellantoni-at-newshour-dot-org.
Follow the politics team
on Twitter:
@cbellantoni,
@burlij,
@elizsummers,
@quinnbowman.
“Spoon feeding makes babies fatter,” the BBC reported today. According to the broadcaster, babies weaned on pureed food tend to end up fatter than infants whose first tastes are finger foods.
This high-profile news is sure to be of interest to parents. However, the research behind the coverage is not strong enough to support such claims. The study compared information gathered on the diet and BMI of 92 child weaned on finger foods (“baby-led” weaning) and 63 children weaned using spoon-feeding. In total, 10 spoon-fed children were above a healthy weight compared to nine in the baby-led weaning group. However, the reliability of the research is undermined by a number of shortcomings, such as the small number of children studied (just 155), the fact that most children in each group had a normal weight and because the study looked at eating habits at a single point in time, rather than recording them over time.
Overall, the study does not support the various claims in the media that spoon-feeding makes babies fatter or encourages a sweet tooth, or that baby-led weaning makes children healthier. It is possible, for example, that a child’s food preferences might influence how they end up being weaned, or even that the results are due to chance. Examining the issue will require larger studies which look at children’s eating and weight over time.
Where did the story come from?
The study was carried out by researchers from the University of Nottingham, which also funded the research. The study was published in the
peer-reviewed medical journal BMJ Open.
The study was reported uncritically in most papers, with quotes from independent experts who reportedly supported its findings.
What kind of research was this?
This small
cross-sectional study examined the association between weaning method, food preferences and frequency of food consumption. The researchers were also interested in how heavy the children were for their height (body mass index or BMI) and whether they were “picky eaters”. The researchers say that at present, little evidence is available on the possible impact of different weaning methods on food preferences and health, but that baby-led weaning is associated with “reduced maternal anxiety” about feeding and “a maternal feeding style that is low in control”.
This study compared two groups of parents who used different weaning methods for their children and looked at their children’s food preferences and BMI. However, it cannot prove cause and effect, nor can it show that baby-led weaning results in healthier food choices and healthier weight. A more reliable method of assessing this question would be a
randomised controlled trial in which parents were randomly allocated one of the two weaning methods to use, and their babies followed over a period of time to see whether weaning method led to differences in dietary preference or BMI. However, such as trial may have ethical and feasibility issues.
Alternatively, a
prospective study that followed children weaned by the two methods over a period of time would also be preferable to a cross-sectional study, which only looks at weaning methods, children’s food preferences and other factors at one point in time.
What did the research involve?
The researchers recruited the parents of 155 children aged 20-78 months between June 2006 and January 2009. The group that used baby-led weaning were recruited by advertising on the internet while those who used spoon-feeding were recruited from the researchers’ own laboratory database.
All the parents completed a standard questionnaire which asked about:
- their infants’ feeding and weaning style
- their infants’ preferences for 151 foods (with ratings from 1 “loves it” to 5 “hates it”) – the preferences were then analysed by standard food categories, such as carbohydrates, proteins and dairy, and there was also a category for whole meals, such as lasagne
- their frequency of consuming particular foods (with ratings from 1 “more than once a day” to 7 “less than once a month”)
- whether they would classify their children as picky eaters
- the children’s height and weight
The parents’ socioeconomic status was also assessed using validated measures.
The researchers pointed out that because no formal definition of weaning exists, they used the parents’ own reports of weaning styles to divide parents into two groups. To try to verify these self-reported methods, they also questioned some parents in more detail about weaning.
As the baby-led weaning group tended to be younger than the spoon-fed group, the researchers carried out their analyses on food preferences and weaning method using a sub-sample of 74 infants – 37 from the spoon-fed group matched by age to 37 from the baby-led weaning group. They used the whole sample for all other analyses.
What were the basic results?
The general trend in results was as follows:
- Carbohydrates were the most popular food category for the baby-led weaning group, who liked carbohydrates more than the spoon-fed group.
- Sweet foods were most liked by the spoon-fed group.
- Preference and frequency of consumption were not influenced by socioeconomic status, although an increased liking for vegetables was associated with a higher social class.
- Using NHS BMI guidelines, eight children in the spoon-fed group were obese (12.7%) compared to none in the baby-led group. However, nine children in the baby-led weaning group (14.3%) were overweight compared to two in the spoon-fed group (3.2%).
- Three children in the baby-led weaning group were classed as underweight (4.7%) compared to none in the spoon-fed group.
- No difference in picky eating was found between the two groups.
How did the researchers interpret the results?
The researchers concluded that “weaning style impacts on food preferences and health in early childhood.” They say their results suggest that the baby-led approach to weaning helps infants learn to regulate their food intake in a way that leads to healthier weight and a preference for healthy foods, such as carbohydrates.
Conclusion
While it was widely reported, this small cross-sectional study proves very little about the possible impact of different weaning methods on children’s food preferences, BMI or other health outcomes. Instead, because of its cross-sectional design, it can provide only a snapshot of all these factors (as reported by parents) at one point in time. It cannot show, for example, that babies who prefer carbohydrates do so because they were weaned on finger foods, as some news sources have reported.
Many factors can affect a child’s food preferences and BMI, including genetic factors, exercise and social and demographic background (which was indicated to a degree by the fact that higher socioeconomic status was associated with higher vegetable intake). Though the study found differences in the BMI status of the children, the small sample size makes it difficult to draw reliable comparisons between the groups. For example, though eight children were obese in the spoon-fed group and none in the baby-led group, this finding could be due to chance. Also, when overweight and obese children were combined, ten children in the spoon-fed and nine in the baby-led groups were overweight or obese. This raises the strong possibility that there would be no real difference in BMI if a much larger group of children were looked at.
With rising rates of childhood obesity, the issue of how best to wean and how this might affect children’s attitudes to food and their long-term health is of concern to parents. However, a large-scale prospective study that follows babies for several years would be a much better way to shed light on the issue.
Links To The Headlines
Giving babies finger food could stop obesity. Sky News, February 7 2012
How giving babies finger food during weaning can stop them growing up fat. Daily Mail, February 7 2012
Spoon feeding 'makes babies fatter'. BBC News, February 7 2012
Baby weight: finger foods better than spoon-feeding, study suggests. The Guardian, February 7 2012
Links To Science
Townsend E, Pitchford NJ.
Baby knows best? The impact of weaning style on food preferences and body mass index in early childhood in a case–controlled sample. BMJ Open 2012;2:e000298 (published online)
The City Council also handed the dairy farmers another victory by voting 5 to 4 against an amendment that would have required them to post a placard informing consumers of the potential health risks linked to drinking raw milk.
Raw milk is milk that hasn't been pasteurized to kill potentially harmful bacteria such as E. coli, Salmonella and E. coli that can cause severe illness.
The proposed placard, as drawn up by the city's Department of Health and Human Services, warned that children, pregnant women, the elderly and those living with conditions that weaken the immune system are at the greatest risk of becoming ill from drinking raw milk. It also warned that raw milk outbreaks are responsible for nearly three times more hospitalizations than outbreaks involving any other food.
The issue came before the City Council after the city's newly hired food-service inspector visited the Portland farmers' markets last fall and told the raw-milk vendors that sales of unpasteurized milk were not allowed there. That came as a surprise to the vendors, because they had been selling raw milk at the markets for several years, with no previous indications from the city that they weren't supposed to.
It turned out that although state law permits raw milk from state-licensed dairies to be sold at retail stores throughout the state, and even though raw milk is sold at other farmers' markets in the state, the city of Portland had its own list of items that can't be sold at its farmers' markets. Raw milk was on that list, even though it can be sold in stores in the city.
During the City Council meeting, Mayor Michael Brennan, who cast one of the four votes in favor of requiring the placard, made no comments about why he had voted that way. But in an email to Food Safety News after the meeting, he said he voted in favor of the placard because he believes it's important to provide "the most information" possible to consumers about "any number of food products."
He also said his vote supported the recommendation of the council committee that had originally proposed the placard, as well as the recommendation of the city's Department of Health and Human Services, "because both had reviewed the issue more fully."
During the council meeting, Heather Donahue, co-owner of
Balfour Farm and a raw-milk vendor at the city's Wednesday farmers' market, told council members that raw-milk farmers are required to inform customers that the milk hasn't been pasteurized by putting the words "not pasteurized" on the containers' labels.
She also pointed out that while in the past raw milk was a "significant" carrier of diseases, many improvements have been made since then. She said that to be certified as a raw-milk dairy in Maine, the dairy herd has to be tested at regular intervals and strict sanitation practices must be followed.
In an interview after the meeting, she told Food Safety News that she was relieved that raw-milk dairies won't have to display the placard about the potential health risks of raw milk.
"In general, the people who shop at farmers' markets know about raw milk and seek it out," she said. "They can get more information from us than they can from a store clerk."
She described the proposal to require the placard as "a wrinkle that needed to be ironed out."
Lauren Pignatello, co-owner of
Swallowtail Farm and Creamery and also the manager of Portland's winter farmers' market, said that if consumers are being informed about the health risks of raw milk, they should also be informed about what he sees as the benefits of drinking raw milk.
The
Centers for Disease Control and Prevention says there are no health benefits from drinking raw milk that cannot be obtained from drinking pasteurized milk that is free of disease-causing bacteria.
Raw-milk producer Lee Straw told council members that state-licensed raw-milk dairies are held to the same standards as conventional dairies.
"Even though the feds will say otherwise, by holding us to the same ordinances as pasteurized milk, the state seems to feel we can put out a safe product," he said.
But Portland resident Charles Bragdon took the opposite tack, telling the council members that raw milk is "very dangerous to some members of our population" and that providing people with information about the health risks is "important, if not critical."
Council member Cheryl Leeman, who voted in favor of requiring the placard, held up a newspaper featuring an article about a recent outbreak of food poisoning cases linked to a raw-milk dairy in Pennsylvania.
On Feb. 7, Pennsylvania health officials said there were 43 confirmed cases of
Campylobacter infections among people who drank raw milk sold by the Your Family Cow farm. Maryland public health officials confirmed that the outbreak strain of bacteria was detected in two unopened containers of unpasteurized milk from the Pennsylvania dairy.
"There is a health risk with raw milk," Leeman said, emphasizing the word "is."
At the same time, she acknowledged that there is "clearly a public demand for raw milk."
Looking at the issue from the perspective of a City Council member, Leeman said that because the issue is raw-milk sales on city property, the city should go along with its Health Department's recommendation requiring the placard.
"It's not an unreasonable request for those folks who want to sell raw milk on our property," she said, pointing out that with the placards, the city will have done its job of making sure the public is informed.
"Then, it will be up to the consumers to weigh the pros and cons," she said. "The final decision is really up to the consumers."
Council member Ed Suslovic had his own concerns, saying that if he were in a rush and grabbed a container of raw milk, it would be easy for him to miss the label saying that the milk hadn't been pasteurized.
"I'd like to see the placard," he said.
He even went so far as to say that he'd like to offer an amendment that would require informational placards at any point of sale for raw milk in the city, which would include retail stores as well as farmers' markets.
The amendment was not acted on.
When a council member asked why the the requirement for a placard was proposed in the first place, Douglas Gardner, director of the city's Health and Human Services Department, explained that it seemed appropriate to tie it in with the proposal that the city allow raw milk sales at its farmers' markets. That way consumers could have information about the basic risks associated with raw milk.
Through all of this, some council members struggled with the issue of fairness. If, for example, placards were to be required at the farmers markets but not at retail stores in the city, then the farmers' market vendors would be at a disadvantage.
Even council member John Anton, who made the motion to remove the requirement for a placard, said he wasn't basing his motion on public health arguments but rather concerns about how it would affect those who sell at farmers' markets, compared with those whose milk is sold in stores.
"It feels unfair and arbitrary," he said.
But he also said that if the city wanted a citywide requirement for an informational placard, he might support it.
In an interview after the meeting, Health Department director Gardner told Food Safety News that during the meeting, he heard several council members express an interest in looking at a citywide requirement for informational placards that would apply to all points of sale -- in stores as well as at farmers' markets.
"There was an interest at looking at a broader approach," he said.
Warnings or Not?
Food-safety attorney Bill Marler, publisher of Food Safety News, said that a warning sign, such as the one on the placard proposed by Portland, MEs health department, should be on a bottle of raw milk as well as at the place of sale of raw milk.
He provided this example of such a sign: "WARNING: This product has not been pasteurized and may contain harmful bacteria (not limited to E. coli O157:H7, Campylobacter, Listeria and Salmonella). Pregnant women, infants, children, the elderly and persons with lowered resistance to disease (immune compromised) have the highest risk of harm, which includes diarrhea, vomiting, fever, dehydration, Hemolytic Uremic Syndrome, Guillain-Barre Syndrome, reactive arthritis, irritable bowel syndrome, miscarriage, or death, from use of this product."
"Consumption of raw milk, especially for the young, the elderly and those with compromised immune systems, should be warned against," Marler said. "Just saying that the milk is not pasteurized is not enough."
Raw Milk in Maine
Amy Robbins, epidemiologist with Maine's Center for Disease Control of Prevention, said in an email to Food Safety News that in the past 5 years, no outbreaks related to raw (unpasteurized) milk products have been identified in Maine, although outbreaks related to raw (unpasteurized) milk products have occurred in other states. The state does not allow raw milk or raw milk products to be sold in restaurants, schools, hospitals or nursing homes. Maine, which has 32 dairy operations that are allowed to sell raw milk, and 65 licensed to sell cheese, is one of 11 states that allows the sale of raw milk at retail stores separate from the farm. Along with 7 other states, it has high standards for cleanliness of the milk, with a coliform standard of no more than 10 coliform bacteria per milliliter, which is equivalent to the national and some international standards for pasteurized milk.
Love is in the air - and not just because Valentine's Day is right around the corner. It's also National Heart Month - a time to show our hearts a little love, and do what we can to reduce our risk heart disease, the leading cause of death in the United States.
Fortunately, there are things we can put in our cereal bowls, lunch boxes and dinner plates every day that can help reduce our own risk for developing heart disease. Not only that, a lot of these things can also be part of a healthy diet that can also reduce your risk of developing a variety of types of cancer. A two-for-one! Now who wouldn't love that?
Oats, beans, and apples
You've probably heard that we should eat more fiber. There are two types of fiber: soluble fiber, which helps reduce serum cholesterol levels and is therefore good for your heart; and insoluble fiber, which helps keep a healthy GI tract, which is good for your colon!
Oats, beans, and apples - along with other fruits, vegetables and grains - are great sources of primarily soluble fiber, but contain insoluble fiber, as well. In general, I tend to tell people to not get too hung up on what type of fiber they eat - just to eat more! Shoot for 25-30 grams of fiber each day. Check out
Jump on the ‘bran wagon' for better health to see how easy it is to get that amount with a little planning.
Bananas, berries, and broccoli
Eating more fruits and vegetables is important for reducing heart disease risk. Low in calories and bursting with nutrients, fruits and vegetables can help reduce high blood pressure (a risk factor for heart disease) and also may help with weight control - an important way to reduce your risk of both heart disease and cancer.
Shoot for at least 2.5 cups of colorful fruits and vegetables each day, and because we don't know which of the hundreds of nutrients that are packaged in produce are most protective for our health - eat a variety each day! Sprinkle berries on your cereal, add lettuce and tomato to your sandwich, or start your dinner with a salad topped with red peppers and carrots.
Brown rice, whole wheat pasta, and....popcorn
Brown rice, whole wheat pasta, and yes, even popcorn, are whole grains - foods that are packed with fiber and other nutrients that help regulate blood pressure. This same fiber and other nutrients may also help reduce the risk of colon cancer, and eating whole grains is a key component of the ACS recommendation to eat a mostly plant-based diet. Shoot for at least half your grain sources during the day to be whole grain - kick off the day with a 100% bran cereal, snack on some popcorn (skip the butter!), wrap your fish taco at dinner in a corn tortilla.
Salmon, tuna, and mackerel
These fish contain omega 3 fatty acids - a type of fat that may help reduce cholesterol and triglyceride levels, and also blood pressure. (Other sources include walnuts, flaxseed, and canola oil). The American Heart Association recommends that we eat fish - particularly these types - at least 2 times per week.
While it doesn't appear that eating fish high in omega-3s impact cancer risk, serving fish in place of red meat like beef, pork or lamb is a healthy swap, as red meat consumption is associated with an increased risk of colon cancer. So why not swap out a filet mignon with a filet of salmon sometime this week?
Avocados, nuts, and seeds
Not only can these foods add some great texture and flavor to your diet, they also provide heart-healthy poly- and monounsaturated fats which can help lower your cholesterol. For years, we used to think the type of fat you eat impacted cancer risk, but the research just hasn't panned out on this. While these foods may not directly influence cancer risk, they can and should be included as part of an overall healthy diet. One thing to keep in mind - they are high in calories, so you don't want to go overboard!
Red wine and dark chocolate
Well, we can't talk about heart health around Valentine's Day and not bring up red wine and dark chocolate! Moderate alcohol consumption (no more than 1 drink per day for women and 2 for men) is associated with reduced heart disease risk. Red wine, with its particularly high level of antioxidants, has been linked for years with heart health, although the jury is still out on this (some studies suggest that grape juice may have the same impact). Similarly, some studies suggest that small amounts of high quality dark chocolate (look for those labeled with ‘at least 70% cocoa') may also offer some heart-healthy benefits due to its high levels of antioxidants.
Not to be a buzz-kill (pun intended), but both of these are examples of how too much of a good thing is not a good thing. Even though moderate consumption of red wine may reduce heart disease risk, risk of breast cancer increases at this level. And too much dark chocolate? That's a lot of extra calories, sugar, and fat. But a 5-oz. glass of cabernet and a small piece of dark chocolate with your Valentine....? You decide!
What will you start doing TODAY to reduce your risk of heart disease and cancer?
Editor's note: This blog was originally published on the
American Cancer Society Choose You blog.
Doyle is director of nutrition and physical activity for the American Cancer Society.
Visual source:
Newseum
In the aftermath of Rick Santorum’s clean sweep of Colorado, Minnesota and Missouri, Mitt Romney is still, in fact, the front-runner for the Republican presidential nomination. But the lack of enthusiasm for his candidacy among conservatives foreshadows a potentially ugly road ahead to Tampa and general election problems if he is nominee.Colorado was the shocker. But given a choice between social issues and the economy, the GOP base went with social issues. It's a killer for the fall, but they don't care.
Mitt Romney can’t translate his carefully manufactured aura of inevitability into reality because no one believes he is who he says he is. We all know this. But after his triple loss last night, I’m convinced that Romney’s problems with the Republican primary electorate and voters in general go deeper. They sense a lack of character in someone for a job that requires bedrock principles and core beliefs. And as far as I can tell, Romney has none.EJ Dionne:
What Romney has failed to do is give voters strong reasons to be for him. He’s missing what Richard Nixon (yes, that Nixon) called “the lift of a driving dream.” And signs of economic improvement are making Romney’s critiques of the Obama economy more problematic by the week. In the meantime, Santorum keeps getting more appealing simply by staying out of the Romney-Gingrich slugfest.Indeed so.
As for Eastwood, his Super Bowl ad for Chrysler led many conservatives to reveal themselves as whiny complainers incapable of celebrating the achievements of American enterprise and public policy.
Catholic leaders and the GOP presidential candidates have intentionally distorted the Obama administration’s new rule requiring employers and insurers to provide reproductive health benefits at no additional cost sharing. Conservatives are seeking a way to politically unite Republican voters around a social issue and portray the regulation as a big government intrusion into religious liberties. In reality, the mandate is modeled on existing rules in six states, exempts houses of worship and other religious nonprofits that primarily employ and serve people of faith, and offers employers a transitional period of one year to determine how best to comply with the rule.Glenn Thrush/Politico:
It’s also nothing new. Twenty-eight states already require organizations that offer prescription insurance to cover contraception and since 98 percent of Catholic women use birth control, many Catholic institutions offer the benefit to their employees.
One woman, a veteran Democratic operative, pointed to the resounding 71%-to-29% defeat of a 2012 referendum in Colorado that would have conferred “personhood” status on fetuses, making abortions of any kind comparable to murder. That was an extreme measure, she argues, but so is limiting access to birth control because you work at a diocese-run nursing home -- and 97 to 99 percent of Catholic women already use contraception.WaPo:
The consultant, who worked on that effort, said internal polling conducted by the campaign in that critical swing state showed 70 percent approval of birth control among women: “It's a political winner for Obama with women voters who will decide the election,” she said.
“Own it,” said one female Obama surrogate.
All of that is good news for Santorum, a Catholic known for his strident opposition to abortion and homosexuality. His focus on courting religious conservative leaders in Colorado and the large rural evangelical populations in Minnesota and Missouri clearly paid off on Tuesday.Just because the culture wars are back doesn't mean the GOP wins. It may be bad for Romney, but it's also bad for Republicans. Homophobia and misogyny are losing issues. But don't worry. I am confident they are far too dumb to get it.
While Santorum is downplaying the role the contraception dispute played in his three-state victory, he attacked President Obama’s mandate repeatedly in the days leading up to the contests. And he didn’t just go after Obama. He also hit at Mitt Romney, who supported the distribution of emergency contraception to rape victims when he was governor of Massachusetts.
But polls indicate that voters, even Catholic ones, agree that contraceptives should be offered by health plans, even those of faith-based employers. That gives Democrats hope they can benefit from the high-stakes battle.Gallup:
"This makes Republicans look more extreme," said Eddie Vale, a spokesman for Protect Your Care, a health advocacy organization that has been leading attacks on GOP candidates opposed to the new healthcare law. "It's another concrete benefit they want to take away."
A record-low 10% of Americans approve of the job Congress is doing, down from 13% in January and the previous low of 11%, recorded in December 2011. Eighty-six percent disapprove of Congress, tying the record high for disapproval set in December.
Joy-Ann Reid/Miami Herald:
Karen Handel, the failed pol and onetime “Mama Grizzly” who turned the Susan G. Komen Foundation into just another scarred combatant in the culture wars, has resigned. Now, Komen for the Cure can go back to doing what it does best: putting on pink-clad, heavily corporate sponsored foot races in major cities to raise awareness — and lots of money — for the fight against breast cancer. Except that they can’t go back.Gail Collins:
There are some things you just can’t take back...
Meanwhile, the controversy has forced women who would be otherwise sympathetic to Komen’s cause — women like myself who have lost loved ones to breast cancer — to take a deeper look at the organization. Turns out, they’re no stranger to controversy — over partnerships that have “pink-washed” everything from Smith & Wesson pistols to Kentucky Fried Chicken, and over their less media-covered decision to pull the plug on millions of dollars in funding for embryonic stem-cell research, which also delighted the religious right, but which isn’t exactly helpful if your goal is to find a cure for breast cancer.
When I was first married, my mother-in-law sat down at her kitchen table and told me about the day she went to confession and told the priest that she and her husband were using birth control. She had several young children, times were difficult — really, she could have produced a list of reasons longer than your arm.
“You’re no better than a whore on the street,” said the priest.
This was, as I said, a long time ago. It’s just an explanation of why the bishops are not the only Roman Catholics who are touchy about the issue of contraception.
Last month, Pope Benedict XVI met with several members of the U.S. Conference of Catholic Bishops, to
specifically advise them about how to best handle what the the pope described as a "grave threat" to "religious freedom." The threat, according to the pope, is the U.S. government's attempt to "deny the right of conscientious objection on the part of Catholic individuals and institutions with regard to cooperation in intrinsically evil practices."
If you're thinking now of some of the most notorious "intrinsically evil practices" of our government to which Catholics might object—like
war or capital punishment—you'd be wrong. The pope and the bishops are concerned about the Obama administration's new policy to require that health insurers cover contraception without co-pays.
And the pope is especially concerned that if such a policy is implemented, and if Americans continue to not give a damn about what the Church has to say on such "intrinsically evil practices" as contraception—as the vast majority of American Catholics don't—this will "delegitimize the Church's participation in public debate."
That, of course, is the
real
fear, isn't it? That the Church will lose its influence over policy debates, that it will continue to lose its moral authority to dictate what our laws should be. And that is why the Catholic Church, from the pope to the Conference of Catholic Bishops to the priests in churches across the country, has declared war—to further assert its "legitimacy." And now, despite the continued efforts of the Obama administration to allay the concerns of the bishops about health care for women and their continued and fully protected right to
believe
whatever they want, the bishops have a
new demand, according to Anthony Picarello, general counsel for the U.S. Conference of Catholic Bishops:
"There has been a lot of talk [from the White House] in the last couple days about compromise, but it sounds to us like a way to turn down the heat, to placate people without doing anything in particular," Picarello said. "We're not going to do anything until this is fixed."So
That means removing the provision from the health care law altogether, he said, not simply changing it for Catholic employers and their insurers. He cited the problem that would create for "good Catholic business people who can't in good conscience cooperate with this."
"If I quit this job and opened a Taco Bell, I'd be covered by the mandate," Picarello said.
that's
the real concern? If Anthony Picarello decides he's done fixing the U.S. Conference of Catholic Bishops' legal troubles—a huge and daunting job, no doubt—and trades it in to sell chalupas, he'll be forced against his conscience to allow his employees to purchase contraception through their health insurance without a co-pay. Can you imagine a worse injustice?
How about this one: a systemic and widespread conspiracy, over decades, to cover up the rape and molestation of thousands of children?
Continue reading below the fold.
Since last month's announcement by the White House that the Affordable Care Act will require employee health insurance to cover contraception without co-pays, we've watched as the outrage of celibate men and the Republican Party melded into a
perfect storm of religious fervor and political pandering.
But finally, a way out of the apparently controversial concept of providing American women with basic health care has been found. From the general counsel for the U.S. Conference of Catholic Bishops, a
compromise has been offered:
"There has been a lot of talk in the last couple days about compromise, but it sounds to us like a way to turn down the heat, to placate people without doing anything in particular," Picarello said. "We're not going to do anything until this is fixed."Problem solved! Restrict access to a basic health service for all women.
That means removing the provision from the health care law altogether, he said, not simply changing it for Catholic employers and their insurers. He cited the problem that would create for "good Catholic business people who can't in good conscience cooperate with this."
Of course this never would have been an issue if prepubescent boys could get pregnant.
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JUDY WOODRUFF: Next, a two-part look at Europe's debt crisis.
First, more protests in Greece against austerity measures in the country where the troubles began two years ago.
We have a report from James Mates of Independent Television News in Athens.
JAMES MATES: It is 20 years to the day since the Maastricht Treaty was signed to bring the continent every closer under the euro.
This afternoon, this was a German flag being burned in Athens. Before long, riot police were swinging batons and firing tear gas. Greeks believe they are being driven into poverty on orders from abroad. This is a country is seething with anger.
Inside the parliament, politicians seem to be on the verge of accepting Europe's demands for another round of cuts to wages, pensions and health care. It's designed to reduce Greece's massive debt. But as anyone in this crowd will tell you, they have been cutting for two years now, and the debts have simply got bigger.
EVA KAILI, socialist member of Parliament: I don't think they can take anymore. And I think it's the wrong recipe. That's why. They could take it if they knew that it was a way out. But from what it seems, it's not a way out. It leads us to deeper recession.
JAMES MATES: What the Greek government is having to do today is choose between two appalling options: to take the medicine that Europe has prescribed and with it years more of austerity and recession, no guarantee of success at the end of it; or to forget Europe's money, to go it alone, leave the euro, knowing that in the short term, at least, that would be even more painful. One or the other, they have to choose.
A storm swept through Athens this afternoon, driving many of the protesters home. It was also enough to rip the European flag from its pole, where it flies beneath the Acropolis. Many Greeks, though, are simply too angry to notice the symbolism.
JUDY WOODRUFF: Now Italy, another European country and a much larger economy under financial pressure.
On the eve of his visit to Washington and meetings with President Obama, Italy's premier talked today in Rome with our Margaret Warner.
MARGARET WARNER: Amid protests in the streets and pressure from abroad, a new face came on to the Italian political scene three months ago.
Prime Minister Mario Monti's mission: try to rescue the country's stagnant economy and unwind its massive national debt.
MARIO MONTI, Italian prime minister (through translator): If we will be able to take advantage of this opportunity altogether to start a constructive dialogue on general goals and decisions, we will be able to redeem the country and to rebuild the confidence in its institutions. Thank you.
MARGARET WARNER: Italy had not fallen to the same depths as Greece, Portugal and Ireland, needing bailouts by the European Union, but the economy was stalled. The markets were hammering Italian debt. And Prime Minister Silvio Berlusconi was facing sex and corruption charges. He resigned after he lost his working majority in parliament over austerity measures the E.U. had demanded.
With that, the Italian president turned to Monti. The former professor served as an E.U. commissioner for nearly 10 years, but has never held elected office. Now he leads a government composed mostly of other technocrats. They must try to ensure that Italy can continue to borrow on international credit markets and keep paying off a national debt that equals 120 percent of its gross domestic product.
Among E.U. countries, only Greece has a larger debt load. Monti has pushed through budget and social welfare cuts. But he also has warned his European partners, especially Germany, that austerity must be accompanied by growth.
At the same time, his moves to modernize the Italian economy have run up against longtime traditions, such as the protective hold that guilds have over everything from taxicabs to lawyers. So far, his proposals have been endorsed by parliament, but more tests loom.
“Sitting in a window seat during a long flight can increase the risk of deep vein thrombosis,” according to The Daily Telegraph. It has long been known that flying is associated with an increased risk of deep vein thrombosis (DVT), a type of serious blood clot in a major vein, but new US guidance has looked at a range of factors that could potentially raise the risk.
Those of you thinking of booking your summer holiday might be interested to know that flying in cramped budget seats, while often annoying, presented no greater risk than flying in business class. And while pricey booze available during a flight can prove wallet-damaging, the guidelines say there was no firm evidence that drinking it could bring on DVT. However, sitting by a window during a long-haul flight was associated with a greater risk because of the limited opportunities for walking around. People’s age, previous DVT and recent operations were among the other factors found to raise DVT risk.
The evidence-based guidelines were produced by the American College of Chest Physicians to address the risk of both DVT after long-haul flights and the potentially fatal lung clots (pulmonary embolisms) that can follow. The guidelines also include recommendations about the best ways for travellers to reduce their risk of DVT.
The guidelines seem to debunk the long-held assumption that a lack of legroom causes DVT. This much-debated phenomenon is often referred to as “economy-class syndrome”.
What is “economy-class syndrome”?
It is long established that inactivity is associated with DVT, and so some people believe that the lack of legroom when flying in economy class can increase the risk of developing a blood clot. This has led to the theoretical phenomenon being dubbed “economy-class syndrome”.
Some have also suggested that dehydration is more common during economy travel and may increase the risk of DVT. However, the existence of this so-called “economy-class syndrome” is controversial and has never been proven.
What is DVT?
Deep vein thrombosis or DVT is when blood clots form in a deep vein. A clot that develops in a vein is also known as ‘venous thrombosis’. DVT most commonly affects the leg veins or deep veins in the pelvis. It can cause pain and swelling in the leg but in some cases there may be no symptoms.
DVT can lead to the potentially life-threatening condition known as a
pulmonary embolism. This occurs when a clot breaks off into the bloodstream and travels to the chest, where it blocks one of the blood vessels in the lungs.
Experiencing DVT and pulmonary embolism together is known as venous thromboembolism (VTE), which is a condition that can be life-threatening. Each year more than 25,000 people in England die from VTE contracted in hospital. This is approximately 25 times the number of people who die from MRSA. VTE occurs in hospitals as a result of patients lying sedentary in bed for extended periods following an operation. In recent years the NHS and Department of Health have run a major programme of measures to help reduce the rates of VTE developed in hospitals. For example, many patients are now given a VTE risk assessment when being booked into hospital.
Who is at risk of DVT?
In the UK each year about one person in every 1,000 is affected by DVT. Anyone can develop it but there are certain known risk factors that include:
- increasing age
- pregnancy
- previous venous thromboembolism
- family history of thrombosis
- medical conditions such as cancer and heart failure
- inactivity (for example after an operation or on a long-haul flight)
- being overweight or obese
Where has the advice come from?
The advice comes from new evidence-based guidelines produced by the American College of Chest Physicians (ACCP). The findings were published in the February issue of the medical journal CHEST.
The guidelines are extensive, running over hundreds of pages. They detail both the risk factors for DVT and measures to diagnose and prevent DVT.
What do these guidelines tell us?
The evidence review that informed the guidelines looked at a range of risk factors for the development of DVT in long-distance travellers. These included the use of oral contraceptives, sitting in a window seat, advanced age, dehydration, alcohol intake, pregnancy and sitting in an economy seat compared to business class.
The reviewers conclude that developing DVT or pulmonary embolism from a long-distance flight is generally unlikely, but that the following factors increased people’s risk:
- previous DVT or pulmonary embolism or known ‘thrombophilic disorder’
- cancer
- recent surgery or trauma
- immobility
- advanced age
- oestrogen use, including oral contraceptives
- pregnancy
- sitting in a window seat
- obesity
The finding relating to window seats was discussed further. The study authors suggest that long-distance travellers sitting in a window seat tend to have limited mobility, which is responsible for their increased risk of DVT.
However, the review did not find any definitive evidence to support the theory that dehydration, alcohol intake or sitting in an economy seat (compared with sitting in business class) increases the risk of DVT or pulmonary embolism during a long-distance flight. On this basis, they conclude that travelling in economy class does not increase the risk of developing a blood clot, even during long-distance travel. However, they believe that remaining immobile for long periods of time does.
Overall, the study authors say that “symptomatic DVT/PE [pulmonary embolism] is rare in passengers who have returned from long flights”, but that the association between air travel and DVT/PE is strongest for flights longer than 8-10 hours. Furthermore, most of the passengers who do end up developing a DVT/PE after long-distance travel have one or more risk factors.
What can be done to prevent DVT?
For travellers on flights longer than six hours who have an increased risk of DVT the new guidelines recommend:
- Frequent walking about during the flight.
- Calf muscle stretching.
- Sitting in an aisle seat if possible (as you are more likely to get up and move around during the flight).
- Wearing below-the-knee compression stockings that are ‘graduated’, meaning they apply greater pressure lower down the leg. They are designed to put pressure on the lower legs, feet and ankles to increase bloodflow, thereby making it harder for a clot to form.
The guidelines do not recommend compression stockings for long-distance travellers who are not at increased risk of DVT.
The guidelines advise against using blood-thinning aspirin or anticoagulant therapy to prevent DVT or pulmonary embolism for most people. They suggest that anti-clotting medications should be considered on an individual basis only for those at particularly high risk of DVT, as in some cases the risks may outweigh the benefits.
Links To The Headlines
DVT risk raised by sitting in the window seat. The Daily Telegraph, February 7 2012
Dangers of DVT: Why you should avoid the window seat on the plane (even in First Class). Daily Mail, February 7 2012
Links To Science
Bates SM, Jaeschke R, Stevens SM, et al.
Diagnosis of DVT : Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 2012;141;e351S-e418S. Published online February 7 2012
Press release
American College of Chest Physicians: New DVT Guidelines:
No Evidence to Support "Economy Class Syndrome": Oral Contraceptives, Sitting in a Window Seat, Advanced Age, and Pregnancy Increase DVT Risk in Long-distance Travelers. February 7 2012
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JUDY WOODRUFF: And to the race for the White House, shaping up to be an expensive general election battle.
President Obama's reelection campaign reversed its stance against super PACs late yesterday, encouraging contributors to donate money to a group, Priorities USA Action, run by former administration staffers.
"With so much at stake, we can't allow for two sets of rules in this election, whereby the Republican nominee is the beneficiary of unlimited spending and Democrats unilaterally disarm," wrote Obama campaign manager Jim Messina in a blog post.
PRESIDENT BARACK OBAMA: It's time to put strict limits . . .
JUDY WOODRUFF: In his 2010 State of the Union address, President Obama had criticized the Supreme Court ruling wiping away limits on corporate and labor union giving.
The shift by the Obama team comes as super PACs backing Republican candidates and causes have seized an early financial advantage. Groups supporting Republican presidential candidates had raised more than 34 million dollars combined by the end of last year.
Another conservative super PAC, American Crossroads, has hauled in more than $18 million. By contrast, the pro-Obama PAC has brought in less than $5 million.
But the president's own campaign has received more money than all the GOP contenders combined. The administration's change of heart also comes on a day when Republicans are voting in three more states and as the leading GOP candidate, Mitt Romney, continues to lambaste President Obama's record.
And for more on the president's reelection bid, we turn to his senior campaign strategist, David Axelrod.
David, thank you very much for joining us.
First, on this reversal . . .
DAVID AXELROD, Senior Obama Campaign Strategist: Happy to be with you.
JUDY WOODRUFF: . . . on whether to encourage your donors to give money to the so-called super PACs, does this mean you don't think you can win this election based on the contributions of ordinary Americans?
DAVID AXELROD: Well, no.
We certainly appreciate the contributions of ordinary Americans -- 1.3 million people have donated to the president's campaign, most of them in small contributions, 98 percent of them in small contributions. And we appreciate that.
What we're looking at, though, Judy, is something we have never seen before, something unleashed by that Supreme Court ruling. And we've seen massive amounts of money coming in to these super PACs. And by our estimate and by their own estimate, they intend to spend upwards of half-a-billion dollars, above and beyond what the Republican nominee and the Republican National Committee is going to spend in this election.
And faced with that, you know, we had to act. The president believes deeply that these super PACs are an unwelcome development in our politics and is going to continue to try and find ways to reform them, up to and including a constitutional amendment.
But right now, these are the rules, and the question is, are we going to have two sets of rules or are we going to have one set of rules? And we couldn't sit -- we simply couldn't sit by and allow $500 million, $600 million, $700 million of negative ads be run against us, with no one on the other side responding.
JUDY WOODRUFF: But it was pretty clear from the outset that this was going to be the case, a lot of money was going to be raised.
That being the case, why didn't the president stick -- I mean, he clearly felt so strongly about this. Why did he change his mind?
DAVID AXELROD: Judy, I don't think anybody had an idea of just how much money these super PACs were going to raise.
And now, you know, we see the reality of it. They've spent more money than all the Republican candidates in these primaries, over $40 million, and 99 percent of it on negative ads. And that was a little preview. That was the appetizer. You know, we're the entree. And they're going to spend multiples of that to try and defeat the president.
And it is simply -- it is not wise and it's not right for us to sit by with our hands tied behind our back and allow that, the election to be hijacked by these groups.
JUDY WOODRUFF: Let me ask you about the economy. There was a good report that came out last Friday on jobs, the unemployment rate.
But a number of respected economists say they don't expect that trend to continue.
Are you, in effect, David Axelrod, sort of held hostage every month to these unemployment numbers?
DAVID AXELROD: Well, first of all, let's stipulate that the most important thing isn't our link to the unemployment rate, but to, you know, how the American people are experiencing this economy.
We're fighting hard to increase - we've had 23 straight months of private sector job growth. That's accelerating. We want to continue to accelerate that because that's good for our country. And, obviously, you know, it is good for us as well.
But -- and in terms of the economists' projections, I think one thing that we have learned over the course of these years is that no one really has a crystal ball on these things. And I have seen more robust projections, less robust.
The best thing for us to do is keep our nose to the grindstone, keep pushing, keep pushing forward and taking the steps we think will help accelerate the economy.
JUDY WOODRUFF: Mitt Romney, the former governor of Massachusetts, still has a primary fight on his hands, but your campaign has pretty much been treating him as the eventual nominee.
What are the strengths that you see in Mitt Romney that make you assume that he will be?
DAVID AXELROD: Well, look, he's been a weak front-runner from the beginning. He continues to be a weak front-runner. He has far more resources than anyone else. He's run for president now twice. He's got a national organization.
It seems like the Republican establishment has largely embraced him in this race. So it's logical to assume that he -- you know, he continues to be a weak front-runner, and that he may be the nominee of the party. And we're prepared for that. He certainly projects himself that way.
And we'll be prepared for that debate.
JUDY WOODRUFF: And in terms of framing the campaign at this point going forward, your major challenge is what?
DAVID AXELROD: Well, look, we're going to project a positive vision for how we move forward as a country and rebuild, not just regain the jobs we have lost, but rebuild an economy in which the middle class is growing, and not shrinking, in which people who work hard can get ahead, in which people can look forward to a better future for their kids.
That's how we measure progress in the economy. And there is going to be a very distinct difference between the way we approach it and the way the folks on the other side do, and particularly Gov. Romney, who seems to believe that, if we just go back to what we were doing and cut taxes for the very wealthy, cut regulations on Wall Street, that somehow we'll all profit from that and the economy will grow. Well, we just tested that proposition and it failed.
JUDY WOODRUFF: The administration decision to require religious charities, universities and others, hospitals, to include contraceptives in the health services they provide has created a huge firestorm in the leadership of the Catholic Church and other religious leaders.
You said earlier today in an interview, David Axelrod, that the administration would work with these institutions to implement this policy. What does that mean? Does that mean you're prepared to give them some sort of an out?
DAVID AXELROD: Well, Judy, let's back up and do -- just recite a little history of how we got to where we are.
The Institute of Medicine recommended to the health and human services secretary, Sebelius, that contraceptive services be part of the package that are in every woman's insurance package, insurance policy, as preventive care. She added an exemption for religious institutions, for churches and their employees.
The question is, does that extend to hospitals? Does that extend to universities where many people work who aren't even Catholic? And do those women get -- essentially don't -- do they get the same rights and the same privileges as everyone else to that preventive care?
And, you know, we believe strongly that that should be the case. And, in fact, that's the policy in 28 states today. So what we have said is, we're going to have a year's period of time in which to transition to this. And that will give us a chance to look at what these others -- how this is implemented elsewhere, how we can implement it here in the best and fairest way, but certainly advancing the principle that women deserve access to contraception, and those women, those teachers, nurses, janitors and so on who work in these institutions deserve access, just like everybody else.
JUDY WOODRUFF: But, very quickly, to clarify, are you saying there may be some exceptions?
DAVID AXELROD: I'm saying that there are models all across the country that can be emulated, including, by the way, in Massachusetts, which was in place when Gov. Romney was there, and in Georgia, which has no exemptions, where Speaker Gingrich is from.
These policies have been in place. Half the country has these policies. And we should be able to learn from that in implementing this and move forward.
JUDY WOODRUFF: David Axelrod, senior strategist to the President Obama re-elect campaign, thanks very much.
DAVID AXELROD: Good to be with you.
House Speaker John Boehner has
vowed legislative action if President Obama doesn't reverse his new health care rule requiring insurers and employers to provide no-cost contraceptive coverage. Rep. Jeff Fortenberry (R-NE) has
introduced legislation to do that. Senate Republicans were
already there.
Sens. Marco Rubio (R-Fla.), Roy Blunt (R-Mo.) and Kelly Ayotte (R-N.H.) are leading the effort.The American people Rubio refers to is actually the Catholic archdiocese. He didn't know about the policy, he says, until an officiant at his church read the letter from the archdiocese at a service. Aside from the fact that the senator should perhaps be a little more on top of the job he's been elected to do, he should be aware that the American people are actually
“This is about whether the government of the United States should have the power to go in and tell a faith-based organization that they have to pay for something that they teach their members shouldn’t be doing,” said Rubio.
pretty darned supportive of the new rule, including
his fellow Catholics.
And including
some Republicans who see potential disaster for the party in picking this fight.
“I think this week’s outrage over the Komen decision should be a warning to the Republican party about how quickly there was a mass outrage over further and further attacks on general women’s health,” Kellie Ferguson, executive director of Republican Majority for choice, told me Wednesday. “You could see the same backlash on attacks on contraception.” [...]Good luck getting that toothpaste back in the tube. There's no place in the Republican party any more for someone who isn't just pro-choice, but is pro-family planning. Those people have a choice: Leave the party or destroy it from within and rebuild it. The point at which you could reason them away from taking extreme ideological stands on social issues is long, long gone.
“For the last number of years, we in the pro-choice community in general—and we specifically as Republicans—have been saying as this pandering to a sort of social conservative faction of voters continues, you’re going to see the line pushed further and further and further,” she said. “And we’re now crossing the line from discussion of when we should regulate abortion to when we should now regulate legal doctor-prescribed medications like birth control, which is woven in the fabric of society as an acceptable medication.”
But the good news is Republicans are now showing their hand. It isn't just about abortion, it's about contraception and it's about injecting their distorted values in to the most intimate and personal aspects of American family life.
Category: Health News
Created: 2/6/2012 2:05:00 PM
Last Editorial Review: 2/7/2012
Though the political fight over GE salmon has primarily focused on the potential environmental impact of the technology--a fight fueled by environmental groups and lawmakers with constituent salmon interests--the petition, brought by Consumers Union, Food & Water Watch and the Center for Food Safety is focused primarily on food safety concerns.
Developed by Massachusetts-based AquaBounty Technologies, the engineered AquAdvantage Salmon are essentially Atlantic salmon with an inserted growth gene from a Chinook salmon and an antifreeze gene from an ocean pout. They grow twice as fast as typical Atlantic salmon and require approximately 10 percent less feed to achieve the same weight.
If cleared by FDA, the fish would be the first GE animal approved for human consumption.
"Atlantic salmon is a substance traditionally regarded as safe. [AquaBounty's] GE process significantly alters the salmon's composition, however, in a way that is reasonably expected to alter its nutritive value or concentration of constituents, and the new substance raises safety concerns," reads the petition. "Under the Agency's regulations and guidelines, such a substance must be treated as a food additive and the Agency must make a closer inquiry into the safety of its consumption, including, but not limited to, subjecting it to extensive pre-market testing."
The petition also asks that the agency not designate the GE salmon as generally recognized as safe (GRAS). As the petition notes, food additives are presumed to be unsafe, and therefore the company seeking approval for an additive "carries the burden to prove that a food additive is GRAS.
The groups blasted the data supplied by the company to FDA's Center for Veterinary Medicine and said it "cannot be relied upon to show that AquAdvantage salmon is safe to consume."
"The data FDA has on GE salmon, which were supplied by Aquabounty, are incomplete, biased, and cannot be relied upon to show that the GE salmon is safe to consume," said Food & Water Watch executive director Wenonah Hauter. "Aquabounty's own study showed that GE salmon may contain increased levels of IGF-1, a hormone that helps accelerate the growth of the transgenic fish and is linked to breast, colon, prostate, and lung cancer."
In the petition, consumer groups warn that the potential health risks of GE salmon are no "different from a number of food additives the FDA has banned in the past, including those that are cancer causing."
"FDA's choice to allow the first proposed transgenic animal for food to somehow only be review as a drug is contrary to law, science and common sense," said George Kimbrell, senior attorney for the Center for Food Safety. "Public health and transparency should be championed, not skirted, particularly when contemplating such an unprecedented approval."
Aquabounty did not respond to requests for comment on the petition.
The company maintains that the GE salmon are biologically and nutritionally identical to non-GE salmon and pose no threat to human health.
“We don’t know what causes deadly hospital superbug to spread, admit scientists,” the Daily Mail has reported. “Hospitals may be adopting the wrong strategy for combating a notorious bug on the wards,” it goes on to say. This story is based on new research investigating the transmission of Clostridium difficile (C. difficile), a hospital-acquired infection that can be fatal.
C. difficile is thought to be spread in hospital through contact with infected patients, but new UK research has found that this may not be the case. The research found that two-thirds of new cases in hospital were not linked to any cases of patients known to be infected. Less than a quarter of the newly infected patients had the same type of C. difficile infection as a patient on their ward who was known to be infected.
This research challenges the assumption that C. difficile is spread on wards through contact with infected patients. It means that current strategies focusing on preventing person-to-person spread may not stop C. difficile transmission.
This research cannot tell us how good hospital prevention strategies are at stopping C. difficile from spreading. People visiting and being admitted to hospital should continue to follow their hospital’s hygiene advice, particularly regarding hand washing and the use of alcohol hand gels.
Where did the story come from?
The study was carried out by researchers from John Radcliffe Hospital Oxford, the Medical Research Council, the University of Oxford, Leeds General Infirmary and the University of Leeds. It was funded by several academic institutions including the Oxford NIHR BioMedical Research Centre and the UK CRC Modernising Medical Microbiology Consortium.
The study was published in the
peer-reviewed journal Public Library of Science: Medicine.
While the Mail accurately reported the study’s findings, it’s headline and introduction may suggest that current infection-control studies are wrong. In fact, infection control studies are useful for combating most bacterial menaces, and may still have a role in halting C. difficile. The headline may also give the impression that scientists have been withholding information and have had to admit that they were wrong. In reality, this is newly published and impressively comprehensive research.
What kind of research was this?
The researchers point out that C. difficile is a leading hospital-acquired infection that can result from antibiotic treatment. This is because antibiotics can disrupt normal healthy gut bacteria allowing C. difficile to multiply rapidly and produce toxins that cause illness. C. difficile causes gastrointestinal problems including diarrhoea, leading to severe illness and even death, especially in older patients and those who are seriously ill.
Following hospital outbreaks of C. difficile worldwide, greater effort has been put into preventing and controlling infection with the bacteria, and this is thought to have reduced incidence. Yet, to date, say the authors, there have been no robust evaluations of whether such strategies are reducing the spread of infection between individuals. The authors argue that a better understanding of person-to-person spread of C. difficile is crucial to reducing the incidence further.
This population-based study was set up to examine in detail transmission in hospital wards, to give better insight into the nature of person-to-person spread and to improve infection-control measures. In particular, it investigated the proportion of new cases of infection arising from ward-based transmission from infected patients.
What did the research involve?
From September 2007 to March 2010, all patients admitted to Oxfordshire hospitals with persistent diarrhoea, and all patients of 65 or older with any diarrhoea, had stool samples taken for C. difficile testing. The researchers tested the samples using specialised laboratory techniques (enzyme immunoassay and culture). Where C. difficile was identified, they used further tests (called multi-locus sequence typing) to identify the particular strains of C. difficile infection.
Based on the similarities and differences in the strains, the researchers used this “genetic fingerprint” of the bug to investigate how it had spread. This approach was based on the assumption that the same strain found in two people was evidence of direct contact between patients on the ward. They constructed potential “networks” of cases and potential routes of transmission for up to 26 weeks, for each strain of C. difficile they had identified. Their analysis was based on infected patients spending time on the same ward.
In order to show how far C. difficile was spread in a ward from person to person, the researchers traced ward contacts between all pairs of cases with the same strain. To reduce the possible bias caused by the same infection occurring spontaneously in a shared ward without contact, the researchers used patients whose stools had tested negative for C. difficile as controls. They analysed the data using standard statistical methods.
What were the basic results?
The researchers tested 29,299 stool samples for C.difficile from 14,858 patients.
- 1,282 (4.4%) samples tested positive for C. difficile
- 69 different types of C. difficile were identified
- most (66%) C. difficile infections were not linked to other known cases with the same strain
- only 23% of cases sharing the same ward shared the same type of C.difficile
How did the researchers interpret the results?
The researchers found that most new cases of C. difficile infection could not be accounted for by contact with other people with C. difficile on the same ward. They say that this means that they cannot be sure that the infection can be controlled by current strategies based on preventing person-to-person spread. Greater understanding of other routes of transmission is needed to determine what type of interventions will prevent the spread of the infection, they argue.
Conclusion
This research is important because it suggests that the previous assumption that all C.difficile is spread on wards through contact with infected patients may not be entirely correct. As the authors point out, this means that transmission may not be adequately controlled by current strategies, which focus on preventing person-to-person spread. Further study is required to look at how the infection is transmitted.
It’s worth noting that the research concentrated on established cases of Clostridium difficile and the potential transmission between infected patients. As such, it did not look at how far C. difficile may have been stopped from spreading in the wards by current hospital prevention strategies.
Infection control measures in the NHS and private hospitals remain valid because they are largely effective at preventing many forms of infection. People going into hospital should continue to follow the stated hygiene procedures, particularly hand washing.
Links To The Headlines
We don’t know what causes deadly hospital superbug to spread, admit scientists. Daily Mail, February 8 2012
Links To Science
Walker AS, Eyre DW, Wyllie DH, et al. (2012)
Characterisation of Clostridium difficile Hospital Ward–Based Transmission Using Extensive Epidemiological Data and Molecular Typing. Public Library of Science Medicine 9: e1001172. Pulished online February 7 2012.
Category: Health News
Created: 2/8/2012 8:05:00 AM
Last Editorial Review: 2/8/2012
Category: Health News
Created: 2/7/2012 2:05:00 PM
Last Editorial Review: 2/8/2012
Category: Health News
Created: 2/7/2012 2:05:00 PM
Last Editorial Review: 2/8/2012
As rumors of the imminent iPad3 (and
FoxConn hacking) spread across the web and a general sense of cult-like euphoria washes away the reality of a considerably weaker earnings picture (and outlook) than even downgraded expectations had prepared for, we present two charts, via JPMorgan, of just how grossly distorted the picture of US economic health (implicitly via US corporate earnings) has become, thanks to Apple. While ignoring Apple as a provider of 'wealth' is akin to Monty Python's "What Have The Romans Ever Done For Us?" comment, we worry that so much 'expectations' burden should fall on the shoulders of a company that relies on constant 'successful' innovation and constant low cost wages (no growth) to merely maintain current growth and earnings while facing constant and massive competitive threats from every side of its business (especially with austerity/recession/credit-constrained Europe as the
largest sequential growth driver in the last surprising quarter). While 'Let Them Eat PSI' is the clear message for the Greeks, it would appear the US investor is truly satisfied by its extra large helping of iPad
meals
, even as 'explicit' job creation in the US via this main driver of US earnings remains de minimus (recognizing of course the peripheral impact of developers into this infrastructure that however do not amount to too much in terms of earnings as is painfully obvious from these charts). As goes AAPL, so goes the US?
Source: JP Morgan
Category: Health News
Created: 2/7/2012 6:06:00 PM
Last Editorial Review: 2/8/2012
Category: Health News
Created: 2/7/2012 2:05:00 PM
Last Editorial Review: 2/8/2012
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Enzymes are more important than vitamins and minerals for general health. Without enzymes, vitamins and minerals are useless. Enzymes are catalysts for metabolic processes and digestion. A catalyst initiates a chemical process without being part of the resultant product... |
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