DiversityNursing Blog

www.foxnews.com 

A California cat named Vanilla Bean with a congenital heart defect got a rare chance at another life.

A team of doctors who usually treat humans came together with a veterinarian to operate on the 1-year-old Burmese cat. Blood was pooling in Vanilla Bean's heart, causing a chamber to grow larger. The defect is also found in children.

Untreated, it would lead to congestive heart failure.

A technique to correct the problem in a cat had reportedly been done only once before, by University of California, Davis veterinarian Josh Stern -- the same vet who operated on Vanilla Bean, the Sacramento Bee reports ( http://bit.ly/1PKsLYp ).

"I needed a human cardiology team to help guide me on this case," said Stern in a news release from the UC Davis Veterinary Medical Teaching Hospital. "It's so uncommon in cats. It's uncommon in children also, but they've certainly seen more cases of this than I have."

Stern teamed up with cardiologists from the UC Davis Medical Center and other vets to open the cat's chest and place catheters and balloons within Vanilla Bean's heart.

The operation was successful. Vanilla Bean lost a lot of blood, but transfusions were ready from the school's large veterinary blood bank.

The blood loss caused kidney injury, but the cat was able to go home eight days after surgery. After a four-month recuperation, an exam showed that the cat is no longer in congestive heart failure.

Stern said he expects Vanilla Bean to make a complete recovery.

Written by David McNamee

www.medicalnewstoday.com 

A new, first-of-its-kind infographic published in the Centers for Disease Control and Prevention's Preventing Chronic Disease journal maps the most 'distinctive' causes of deaths across all states in the US.

The map presents 2001-10 data on causes of death within individual states that were statistically more significant than the national averages, drawn from the Centers for Disease Control and Prevention's (CDC) own "Underlying Cause of Death" file, which is accessible through the WONDER (Wide-ranging Online Data for Epidemiologic Research) website.

The largest number of deaths in the map from a single condition were the 37,292 deaths from atherosclerotic cardiovascular disease in Michigan. The fewest were 11 deaths from "acute and rapidly progressive nephritic and nephrotic syndrome" in Montana.

The numbers of death from discrete illnesses varied across states. For example, 15,000 HIV-related deaths were recorded in Florida during the study period, 679 deaths from tuberculosis in Texas, and 22 people died from syphilis in Louisiana.

The most distinctive causes of death in New York were from gonorrhea and chlamydia, and the state also had the highest number of deaths from infection of female reproductive organs - mostly as a result of untreated sexually transmitted diseases.

According to the researchers behind the map, some of the findings make "intuitive sense," such as the high numbers of death from influenza in northern states, or pneumoconiosis (black lung disease) in states where coal is mined. However, some of the other findings are less easily explained, such as the deaths from septicemia in New Jersey.

What are the strengths and limitations of the map?

The map only presents one distinctive cause of death for each state, all of which were significantly higher than the national rate. However, many other causes of death that were also significantly higher than national rates were not mapped.

Another limitation of the map is that it has a predisposition toward exhibiting rare causes of death. For instance, in 22 of the states, the total number of deaths mapped was under 100. 

"These limitations are characteristic of maps generally and are why these maps are best regarded as snapshots and not comprehensive statistical summaries," explain the researchers, Francis P. Boscoe, of the New York State Cancer Registry, and Eva Pradhan, of the New York State Department of Health.

Boscoe and Pradhan say that the map has been "a robust conversation starter" - generating hypotheses that they consider would not have occurred had the data been formatted in "an equivalent tabular representation." They add:

"Although chronic disease prevention efforts should continue to emphasize the most common conditions, an outlier map such as this one should also be of interest to public health professionals, particularly insofar as it highlights nonstandard cause-of-death certification practices within and between states that can potentially be addressed through education and training."

By KAREN BARROW

www.nytimes.com 

Elisabeth Bing, who helped lead a natural childbirth movement that revolutionized how babies were born in the United States, died on Friday at her home in Manhattan. She was 100.

Her death was confirmed by her son, Peter.

Ms. Bing taught women and their spouses to make informed childbirth choices for more than 50 years. (“We don’t call it natural childbirth, but educated childbirth,” she once said.)

She began her crusade at a time when hospital rooms were often cold and impersonal, women in labor were heavily sedated and men were expected to remain in the waiting room, pacing.

Ms. Bing pushed for change. She worked directly with obstetricians, introducing them to the so-called natural childbirth methods developed by Dr. Fernand Lamaze, which incorporated relaxation techniques in lieu of anesthesia and enabled a mother to see her child coming into the world.

Along with Marjorie Karmel, Ms. Bing helped found Lamaze International, a nonprofit educational organization.

She became known as “the mother of Lamaze,” championing the technique in her book “Six Practical Lessons for an Easier Childbirth” (1967) and on the lecture and television talk-show circuits.

Today, Lamaze and other natural childbirth methods are commonplace in delivery rooms, and Lamaze classes, with their emphasis on breathing techniques, are attended by an estimated quarter of all mothers-to-be in the United States and their spouses each year.

For years Ms. Bing led classes in hospitals and in a studio in her apartment building on the Upper West Side of Manhattan, where she kept a collection of pre-Columbian and later Native American fertility figurines.

Ms. Bing preferred the term “prepared childbirth” to “natural childbirth” because, she said, her goal was not to eschew drugs altogether but to empower women to make informed decisions. Her mantra was “Awake and alert,” and she saw such a birth as a transformative event in a woman’s life.

“It’s an experience that never leaves you,” she told The New York Times in 2000. “It needs absolute concentration; it takes up your whole being. And you learn to use your body correctly in a situation of stress.”

There was one secret she seldom shared, however: Her own experience giving birth to her son, Peter, was decidedly unnatural. As Randi Hutter Epstein reported in her book “Get Me Out: A History of Childbirth From the Garden of Eden to the Sperm Bank” (2010), she continually asked her doctor, “Is my baby all right? Is my baby all right,” until the doctor said he could not concentrate with her chatter and gave her laughing gas and an epidural.

“I got everything I raged against,” Ms. Bing told Ms. Epstein. “I had the works.”

Elisabeth Dorothea Koenigsberger was born in a suburb of Berlin on July 8, 1914. Her parents, of Jewish descent, had converted to Protestantism years before her birth, but the family nevertheless felt the virulent anti-Semitism sweeping Germany before World War II. She was kicked out of a university two days into her freshman year, and two of her brothers — a historian and an architect — could not find work because of their Jewish background, she told The Journal of Perinatal Education in 2000.

After Ms. Bing’s father died in 1932, the family left the country; most members settled in England, while one sister moved to Illinois. In London, Ms. Bing studied to become a physical therapist and began work at a hospital. Mostly she helped patients with paralysis, multiple sclerosis and broken bones, but every morning she also visited the maternity ward, to give massages to new mothers and help them exercise. At the time, women were not allowed out of bed for as many as 10 days after giving birth.

She became interested in natural childbirth in 1942 when a patient handed her Dr. Grantly Dick-Read’s influential book “Revelation of Childbirth,” published that year (and later titled “Childbirth Without Fear”). Dick-Read proposed that pain during childbirth was caused by fear, and that a woman could avoid anesthesia by following a series of relaxation techniques aimed at reducing that fear.

Ms. Bing became intrigued and hoped to train with Dick-Read in the north of England, but with the war on and travel all but impossible, she began her own independent study. She read as much as she could and observed obstetricians and their patients — heavily anesthetized women who, she saw, had little control over the birth of their children.

“What I saw I disliked intensely,” she said in her interview with the perinatal journal. “I thought there must be better ways.”

Ms. Bing, who drove an ambulance during the war, began pursuing her interest in natural childbirth after 1949, when she moved to Jacksonville, Ill., to be with her sister, who had recently married. There, while working with handicapped children, Ms. Bing met an obstetrician who, she discovered, knew very little about natural childbirth. Resolving to champion the techniques, she began approaching obstetricians and having them send patients to her for one-on-one classes.

Ms. Bing had planned to return to England in about a year and was on her way back when she stopped in New York to visit friends. There she met Fred Max Bing, an exporter’s agent, and decided to stay. The two were married in 1951.

Besides her son, Ms. Bing is survived by a granddaughter. Her husband died in 1984.

In New York, Ms. Bing again started giving private childbirth education classes. They caught the attention of Dr. Alan Guttmacher, the chief of obstetrics at Mount Sinai Hospital, which had opened its first maternity ward in 1951. He asked her to teach a formal class there.

In her search for other childbirth alternatives, Ms. Bing began to learn about the psychoprophylactic method developed in the mid-1950s by Lamaze, a French obstetrician. Lamaze refined Dick-Read’s approach by incorporating breathing exercises he had observed in the Soviet Union, where anesthesia was a luxury poor women in labor could scarcely afford.

In 1960, Ms. Bing, by then a clinical assistant professor at New York Medical College, and Ms. Karmel founded the American Society for Psychoprophylaxis in Obstetrics, known today as Lamaze International.

Ms. Karmel, an American, had become a natural-childbirth crusader after seeking out Lamaze in Paris to help her deliver her first child, and her best-selling book, “Thank You, Dr. Lamaze” (1959), largely introduced the method to Americans and drew Ms. Bing’s attention.

(In the late 1950s, Ms. Bing had persuaded Ms. Karmel to smuggle into the United States an explicit French educational film, “Naissance,” depicting a woman giving natural birth. When New York City hospitals and the 92nd Street Y refused to show it in prenatal classes — they considered it obscene — the two women held a private screening at Ms. Karmel’s home on the Upper East Side. Ms. Karmel died of breast cancer in 1964.

At the heart of the methods the women promoted was the idea of family teamwork, with the father helping the mother by coaching her in responding to her contractions with breathing exercises and massaging her back, and being present during the delivery.

But in her book, Ms. Bing cautioned, “You certainly must not feel any guilt or sense of failure if you require some medication, or if you experience discomfort or pain.”

Some obstetricians were skeptical of the methods and thought Ms. Bing, not being a physician, was ill qualified to be instructing patients. But the natural-childbirth movement found a receptive public. Women coming of age in the 1960s embraced the idea of taking a more active role in childbirth and wanted fathers to participate more as well.

“It was a tremendous cultural revolution that changed obstetrics entirely,” Ms. Bing said in an interview in 1988.

Ms. Bing was modest about her role in the movement. “It wasn’t really a movement by Lamaze or Read or me,” she told the Disney-owned website Family.com. “It was a consumer movement. The time was ripe. The public doubted everything their parents had done.”

But she rejoiced in the outcome. “We are not being tied down anymore,” she said in 2000. “We’re not lying flat on our backs with our legs in the air, shaved like a baby. You can give birth in any position you like. The father, or anybody else, can be there. We fought for years on end for that. And now it’s commonplace. We’ve got it all.”

Lamaze, himself, did not acknowledge Ms. Bing, never responding to her requests for an interview even though she had made his name part of the American vernacular. During their only meeting, at a lunch in New York, he directed all his comments to a male obstetrician at the table.

“I’ve never thought of myself as someone with a legacy of any kind,” Ms. Bing said in an interview at an Upper West Side cafe. “I hope I have made women aware that they have choices, they can get to know their body and trust their body.”

“If my ideas supported feminist ideas,” she continued, “well, that’s all right. But I’ve never been politically active.”

Written by Catharine Paddock PhD

www.medicalnewstoday.com 

A new study that offers insights into early language development suggests babies prefer listening to other babies rather than adults as they get ready to produce their own speech sounds.

The study, led by McGill University in Canada and published in the journal Developmental Science, observed the reactions of infants aged from 4-6 months who were not yet attempting speech, as they listened to baby-like and adult-like sounds produced by a voice synthesizer.

They found when the vowel sounds the babies listened to sounded more baby-like (for instance, higher pitch), the infants paid attention longer than when the sounds had more adult-like vocal properties.

Previous studies have shown that children at this age are more attracted to vocal sounds with a higher voice pitch, the authors note in their paper.

The team says the finding is important because being attracted to infant speech sounds may be a key step in babies being able to find their own voice - it may help to kick-start the process of learning how to talk.

They say the discovery increases our understanding of the complex link between speech perception and speech production in young infants.

It may also lead to new ways to help hearing-impaired children who may be struggling to develop language skills, they note.

Baby-like sounds held infants' attention nearly 42% longer

For the study, the team used a voice synthesizer to create a set of vowel sounds that mimicked either the voice of a baby or the voice of a woman.

They then ran a series of experiments where they played the vowel sounds one at a time to the babies as they sat on their mother's lap and listened. They measured the length of time each vowel sound held the infants' attention.

The results showed that, on average, baby-like sounds held the infants' attention nearly 42% longer than the adult-like sounds.

The researchers note that this finding is unlikely to be a result of the babies having a particular preference for a familiar sound because they were not yet producing those sounds themselves - they were not yet part of their everyday experience.

Some of the infants showed their interest in other ways. For example, when they listened to the adult sounds, their faces remained fairly passive and neutral. In contrast, when they heard the baby-like sounds, they became more animated, moved their mouths and smiled.

The following video shows how one of the infants - baby Camille, who is not yet babbling herself - reacts to the various sounds. Every time she looks away, the sound is replaced by another. Her reactions show which sounds she seems to like the most.

Babies need to 'find their own voice'

The researchers say maybe the babies recognized that the baby-like sounds were more like sounds they could make themselves - despite not having heard them before.

The findings may also explain the instinct some people have when they automatically speak to infants in baby-like, high-pitched tones, says senior author Linda Polka, a professor in McGill's School of Communication Disorders, who adds:

"As adults, we use language to communicate. But when a young infant starts to make speech sounds, it often has more to do with exploring than with communicating."

Prof. Polka says babies often try speaking when they are on their own, without eye contact or interaction with others. She explains:

"That's because to learn how to speak babies need to spend lots of time moving their mouths and vocal cords to understand the kind of sounds they can make themselves. They need, quite literally, to 'find their own voice.'"

Funds for the study came from the Natural Sciences Engineering and Research Council.

Meanwhile, parents and schools looking for ways to encourage children to eat more healthily may be interested in a study carried out among kindergarten through sixth-grade students at an inner-city school in Cincinnati, OH. There, researchers discovered that children found healthy food more appealing when linked to smiley faces and other small incentives. The low-cost intervention led to a 62% rise in vegetable purchases and a 20% rise in fruit purchases.

By AnneClaire Stapleton

www.cnn.com 

"I had my own personal tanning bed in my home, and so did a lot of my friends growing up. ... Everyone tanned," Willoughby said. "I didn't really even think about the future or skin cancer at the time." 

After one of her classmates in nursing school was diagnosed with melanoma, Willoughby made her first dermatology appointment at age 21. Sure enough, she had skin cancer.

Now 27, Willoughby says she has had basal cell carcinoma five times and squamous cell carcinoma once. She goes to the dermatologist every six to 12 months and usually has a cancerous piece of skin removed at each checkup.

She's become a cautionary tale about the hazards of tanning beds, thanks to a selfie she posted last month on Facebook. The grisly image, taken after one of her cancer treatments, shows her face covered with bloody scabs and blisters. It's since been shared almost 50,000 times.

"If anyone needs a little motivation to not lay in the tanning bed and sun here ya go! This is what skin cancer treatment can look like," she wrote in a post along with the photo. "Wear sunscreen and get a spray tan. You only get one skin and you should take care of it."

One in five Americans will develop skin cancer in their lifetime, according to the American Academy of Dermatology. Exposure to tanning beds increases the risk of melanoma, the deadliest form of skin cancer, said the academy, which reports that more than 419,000 cases of skin cancer in the U.S. each year are linked to indoor tanning.

Melanoma is the most common form of cancer for adults 25-29 years old and the second-most common form of cancer for adolescents and young adults 15-29 years old, according to the academy. Warning signs include changes in size, shape or color of a mole or other lesion, the appearance of a new growth on the skin or a sore that doesn't heal. 

Risk factors for all types of skin cancer include skin that burns easily, blond or red hair and a history of excessive sun exposure, including sunburns and tanning-bed use -- dangers that the blonde, blue-eyed Willoughby now knows all too well. 

Willoughby, a registered nurse who now lives in northern Alabama, said she never expected the Facebook picture of her damaged face to go viral. 

But she's excited to think her story might save someone's life.

"I've lost count of how many people shared it now and told me I've helped them," she said. "It's really cool to hear people say they won't tan anymore. I've had mothers thank me after sharing my pictures with their daughters. People in my hometown said they are selling their tanning beds.

"I never thought about the future when I was in high school; I just tanned because it was normal to me." 

Willoughby knows she'll deal with the consequences of tanning for the rest of her life. She's at high risk for developing melanoma but is now doing everything she can to ensure that she's around for her husband, Cody, and their young son, Kayden, for years to come. 

"Learn from other people's mistakes," she wrote on Facebook. "Don't let tanning prevent you from seeing your children grow up. That's my biggest fear now that I have a two-year-old little boy of my own."

By SYDNEY LUPKIN

http://abcnews.go.com 

If not for a stranger halfway around the world, 8-year-old Grant Berg wouldn't be alive today, his mother said.

Grant needed a bone marrow transplant, but after an international search, it was an 18-year-old German college student who came to his rescue in 2011, Grant's mother, Kristi Berg told ABC News. And on Sunday night, Grant and his hero met for the first time at the Los Angeles International Airport.

"I've imagined it so often in my mind and now it is reality," Grant's bone marrow donor, Marvin Zumkley, 22, told KABC-TV, ABC's Los Angeles station. "It was crazy. It was overwhelming, and it was just a good feeling."

A year and a half before the transplant, Grant was diagnosed with aplastic anemia, a rare but serious condition in which the bone marrow stops producing new blood cells, Berg said. This includes red blood cells, which carry oxygen; white blood cells, which fight off infection; and platelets, which mend blood vessels and stop bleeding, according to Dr. Hillard Lazarus, who directs UH Case Medical Center's novel cell therapy program in Cleveland but has not met or treated Grant.

"You need to treat this thing," Lazarus said, adding that it's often unclear what causes aplastic anemia. But only about 600 to 900 people are diagnosed with it every year.

Berg said Grant was getting different kinds of transfusions every week for a year and a half before the transplant.

"For a year and a half, he lived off other people's blood," Berg said. "I can't even count the amount of transfusions he had."

And then Zumkley's bone marrow changed Grant's life, she said. “It means everything to me," she added.

Grant was also born with only part of his cerebellum, so he'll be tested later this year for genetic conditions, she said.

After staying up well past his bedtime to meet Zumkley, Grant fell asleep in the car on the ride home to Temecula, California, Berg said. The plan is for Zumkley to relax for a few days, visit Disneyland and find other ways to enjoy southern California and get to know Grant, she said.

BY MAGGIE FOX

www.nbcnews.com 

Hospital workers wash their hands hundreds of times a day. Nurses are constantly using alcohol gels, chemical wipes and iodine washes on themselves and on patients.

Now that there's a hand sanitizer dispenser at every hospital room door, it's time to check that they actually do work as well as everyone assumes and that they are safe, the Food and Drug Administration says.

So FDA issued a proposed plan Thursday for reclassifying some of the products, and for requiring makers to show they are safe and effective.

"We're not asking for any of these products to come off the market at this time."

In the meantime. FDA says, there's nothing for consumers to worry about and hospitals should continue using the products as they have been.

"What it seems they are doing is good due diligence," says Dr. Susan Dolan of Children's Hospital Colorado and the Association of Professionals in Infection Control.

"They are trying to look at the products, look at how they are being used today, how things have changed," she added.

The FDA proposes new rules making companies submit new studies looking at safety issues such as whether heavy, chronic use of the some of the products may cause them to soak in through the skin, or cause resistant bacteria to evolve.

Products that are not shown to be safe and effective by 2018 would have to be reformulated or taken off the market.

"We're not asking for any of these products to come off the market at this time. We're just asking for additional data," Theresa Michele, a director in FDA's drug center, said in an interview with The Associated Press. "And we're likewise not suggesting that people stop using these products."

Alcohol, iodine benzalkonium chloride and other germ-killers have been used for decades. But not to the degree that they are now.

"Twenty years ago you didn't find people using antiseptic gels 100 times a day. It just didn't happen," Michele said.

FDA points to studies that show some of the products might be absorbed into the body at higher levels than previously thought, showing up in blood and urine. Dolan says not all the studies show this, but it's worthwhile doing more checks.

"It's timely and it makes sense," Dolan said. "I do think consumers should not be worried. These are very effective products."

The FDA last updated its review of health care hand cleaners in 1994.

"They are trying to look at the products, look at how they are being used today, how things have changed."

"We emphasize that our proposal for more safety and effectiveness data for health care antiseptic active ingredients does not mean that we believe that health care antiseptic products containing these ingredients are ineffective or unsafe, or that their use should be discontinued," FDA said in its announcement.

The agency agreed to complete its review after a three-year legal battle with the Natural Resources Defense Council, an environmental group that accused the FDA of delaying action on potentially dangerous chemicals. In 2013 the FDA agreed to a legal settlement that included timetables for completing the review of various chemicals, including health care cleaners.

Environmentalists are mainly concerned about an ingredient called triclosan, which is used in most antibacterial soaps marketed to consumers. The agency issued a separate review of triclosan-containing consumer products in late 2013, saying more data are needed to establish their safety and effectiveness.

Written by Honor Whiteman

www.medicalnewstoday.com 

Infants born preterm are known to be at greater risk for neurodevelopmental disorders. Now, a new study by researchers from King's College London in the UK brings us closer to understanding why - premature birth reduces connectivity in brain regions linked to cognitive functioning.

First author Dr. Hilary Toulmin, of the Centre for the Developing Brain at King's College, and colleagues publish their findings in the Proceedings of the National Academy of Sciences.

Preterm birth - defined as the birth of an infant before 37 weeks gestation - affected more than 450,000 babies in the US in 2012.

It is a leading cause of neurological disability among children in the US. Babies born preterm are at higher risk of cerebral palsy, autism and attention-deficit hyperactivity disorder (ADHD), among other intellectual and developmental conditions.

For their study, Dr. Toulmin and colleagues set out to gain a better understanding of the brain connectivity among babies born preterm in an attempt to uncover clues as to why preterm babies are more likely to develop neurodevelopmental problems.

The researchers used functional magnetic resonance imaging (fMRI) to analyze the connectivity between two specific brain regions - the thalamus and the cortex - among 66 infants. Of these, 47 were born prior to 33 weeks gestation and 19 were born at full term - between 37 and 42 weeks gestation.

The team says they focused on the connectivity between the thalamus and the cortex because these are the brain connections that develop quickly during preterm infants' care in neonatal units.

Preemies showed reduced connectivity in brain area linked to higher cognitive functioning

Among the babies born at full term, the researchers found the connectivity between the thalamus and the cortex was very similar to that of adults, which the researchers say supports previous findings that infants are born with mature brain connections.

Among the preterm infants, however, the team identified reduced connectivity between areas of the thalamus and areas of the cortex associated with higher cognitive function. This may explain why preterm babies are at greater risk of neurodevelopmental problems later in childhood, say the researchers.

What is more, brain scans of the preterm infants revealed increased connectivity between the thalamus and an area of the primary sensory cortex that plays a role in processing signals from the face, lips, jaw, tongue and throat.

Preterm infants' earlier exposure to breastfeeding and bottle feeding may explain this finding, according to the team.

The team says the earlier a preterm baby was born, the more pronounced the differences were in brain connectivity.

Overall, the team believes their findings bring us a step closer to understanding why infants born preterm are at higher risk of neurodevelopmental problems.

Senior author Prof. David Edwards, also of the Centre for the Developing Brain at King's College, says modern science has allowed the team to assess brain connectivity among preterm infants - something he says would have been "inconceivable" only a few years ago.

"We are now able to observe brain development in babies as they grow, and this is likely to produce remarkable benefits for medicine," he adds.

Dr. Toulmin says the next steps from this research will be to gain a better understanding of how their findings are associated with learning and developmental problems among preterm children as they get older.

By STEPHANIE STROM

www.nytimes.com 

Acesulfame K. Ethoxyquin. Artificial smoke flavor.

The first, an artificial sweetener; the second, a preservative; and the third, a flavor enhancer, are just a few of the ingredients that Panera Bread wants to banish from its kitchens by the end of 2016.

In doing so, Panera would join the growing ranks of food companies and restaurants that have announced plans to eliminate a variety of artificial preservatives, flavors and colors, as well as different kinds of sweeteners and meat from animals raised with antibiotics, in response to consumer demands for transparency and simplicity in the foods they eat.

“We’re trying to draw a line in the sand in the industry so that consumers have an easy way to know what’s in the food they buy,” said Ron Shaich, chief executive of Panera.

In the last six months, at least a dozen food companies and restaurant businesses have announced plans to reformulate products to eliminate ingredients. “To me, this has gone way beyond anything that could even be remotely considered a fad and become a powerful trend,” said Carl Jorgensen, director for global consumer strategy focusing on wellness at Daymon Worldwide, a consulting firm.

Nestlé USA has said it will remove artificial flavorings and colors from its chocolate candy products, including brands like Butterfinger and Baby Ruth, as well as from Nesquik powdered drink mixes.

Hershey in December said it would work to replace high-fructose corn syrup in sweets like York peppermint patties and Almond Joy candy bars. Two months later, the company said it was moving to make all of its products from “ingredients that are simple and easy to understand.”

Kraft recently said it would replace the artificial colorings that give Macaroni and Cheese its orange hue with colors derived from spices like turmeric and paprika, and PepsiCo announced that it would use sucralose to sweeten Diet Pepsi instead of the artificial sweetener aspartame.

Last month, McDonald’s became the latest major restaurant chain to say it would no longer sell products made with chicken treated with human antibiotics. A few weeks later, Tyson Foods, a major meat company that is one of McDonald’s suppliers, said it would eliminate such antibiotics from its poultry and begin working to get them out of other meats as well.

Even Snackwell, which started its life as a brand with reduced fat, is undergoing a makeover aimed at getting rid of high-fructose corn syrup, hydrogenated oils and artificial colors and flavors. “In this day and age, the consumer who was satisfied with reduced fat or fat-free 20 years ago is not satisfied with that any more,” said Vincent Fantegrossi, chief executive of the Back to Nature Foods Company, which is owned by Brynwood Partners, a private equity group.

Retooling an iconic brand is tricky. Companies must make sure that consumers cannot detect any change in taste, texture or quality, or all may be lost.

“That actually makes the challenge for companies like us that have well-known brands greater, compared to small companies that can simply make a product from scratch without these ingredients,” said Leslie Mohr, marketing manager for Nestlé USA’s confectionary business.

While most of the companies have been careful to say they are merely responding to consumer demands, not making a value judgment on such ingredients, they often face heavy criticism. Chipotle Mexican Grill’s announcement that it had eliminated genetically modified ingredients from the foods it makes — though, like Panera, not from the sodas it sells — evoked a torrent of outraged responses.

The Washington Post editorial board called Chipotle’s move a “gimmick” that was “hard to swallow,” while NPR’s popular food blog, The Salt, accused the company of having a double standard for adopting sunflower oil, which it said was often treated with a pesticide known for weed resistance.

“This is a complicated issue, and I would suggest there is less here than meets the eye,” said L. Val Giddings, a senior fellow at the Information Technology and Innovation Foundation.

Mr. Giddings noted that although General Mills got a lot of publicity for eliminating genetically modified ingredients from original Cheerios, those were just a tiny part of the cereal’s ingredients. “I think what they were doing at least in part was testing the water to see if they could capitalize on it, and what they have found is pretty illuminating,” he said. “The move had no impact on sales.”

Mr. Shaich said Panera’s decision to come up with what it calls “The No No List” had more to do with protecting the sales it has. The list is based on research and standards developed by Johns Hopkins, the Environmental Working Group, the Natural Resources Defense Council and various European governments.

“I’m not a scientist and I’m not wading into the debate over whether any of these things cause cancer or are otherwise bad for you,” he said. “I just think this is where the consumer’s head is right now.”

Panera uses more than 450 ingredients to prepare its foods. The company had to work with both its suppliers and their suppliers, who themselves were not always sure whether their products contained the ingredients Panera has decided to eliminate.

“These ingredients have been added over time to improve efficiency and consistency and as preservatives as supply chains have gotten longer and longer,” said Sara Burnett, senior quality assurance manager at Panera.

Solutions are not always perfect. Panera is rejecting titanium dioxide, a whitener commonly used in products like ice cream and icings, from its mozzarella, yet cheese browns as it ages. “We don’t know how customers will react,” Ms. Burnett said.

Salad dressing proved the menu item most difficult to reformulate, she said, in part because different oils impart specific viscosity and taste. For Greek salad dressing, Panera had to take apart the spice mix it used and go back to the basics — lemon juice, garlic, oregano and rosemary.

“We learned we don’t have to have these things on the list,” Ms. Burnett said, “so why have them?”