DiversityNursing Blog

By Kathleen Doheny

A woman's odds of having a baby with kidney and urinary tract birth defects are higher if she's obese, new research suggests.

Such defects include being born with a single kidney, having kidney swelling or enlarged ureters, the urine-carrying tubes, said lead researcher Dr. Ian Macumber, a pediatric nephrology fellow at Seattle Children's Hospital.

"The more we find out about obesity, the more we find out what a public health problem it is," he said.

Prior research has linked maternal obesity with newborn heart defects, neural tube defects such as spina bifida and other health conditions.

The discovery of a link with kidney and urinary tract birth defects is newer. "We found a significant association between maternal obesity and risk of these anomalies," said Macumber.

While the study found a link between maternal obesity and certain birth defects, it did not establish a cause-and-effect relationship.

The kinds of defects Macumber and his colleagues evaluated are diagnosed in up to 1 percent of pregnancies, with some conditions more serious than others. The defects account for about 20 percent or 30 percent of all prenatal abnormalities, he said.

And risk of these defects increased along with the level of obesity, the study found.

More than half of pregnant women in the United States are overweight or obese, and 8 percent of reproductive-aged women are extremely obese, says the American College of Obstetricians and Gynecologists.

Macumber is to present the findings Nov. 14 at a meeting of the American Society of Nephrology in Philadelphia. Studies presented at medical meetings are typically viewed as preliminary until published in a peer-reviewed journal.

For the study, the researchers looked at medical charts, including birth and hospital discharge records, from 2003 to 2012. They found more than 3,200 cases of abnormal kidney or urinary tract problems and compared them with more than 13,000 "controls" -- newborns without the abnormalities.

Looking at pre-pregnancy weight records, the researchers found that mothers who delivered children with the birth defects were almost 1.3 times more likely to be obese than those whose infants didn't have the kidney and urinary tract defects.

Obesity was based on body-mass index (BMI), a calculation based on height and weight. A BMI of 30 or greater is viewed as obese. As an example, a 5-foot-4-inch-tall woman who weighs 180 pounds has a BMI of 30.9 and is considered obese.

Because the researchers went by hospital codes, they couldn't determine which defects were most common or how severe they were.

The mechanism behind the association isn't known, Macumber said.

"There is certainly some question as to whether insulin may play a role in this," he said. Pregnant women who are overweight may have insulin resistance, a condition in which the body doesn't respond well to the hormone insulin, and blood sugar is less able to get to the cells, he said.

Another expert praised the research.

"Studies like this are really quite important," said Dr. David Mendez, an attending physician at the Miami Children's Hospital and a neonatologist. However, whether obesity actually causes these birth defects is not yet known, he added.

Mendez said that chart reading, while limited in some respects, "is a vital research tool" and a good starting point.

Ideally, future research would follow mothers during pregnancy, tracking their weight and the health of their newborns, looking at the link from the start, he said.

Meanwhile, Mendez advises a good diet, exercise if approved by the woman's doctor and other good health habits. "The things that make you feel good," he tells patients, "will make the baby feel good."

Source: www.medicinenet.com

By Steven Reinberg

Residents of the southern United States may be at risk for a parasitic infection that can lead to severe heart disease and death, three new studies suggest.

Chagas disease, which is transmitted by "kissing bugs" that feed on the faces of humans at night, was once thought limited to Mexico, Central America and South America.

That's no longer the case, the new research shows.

"We are finding new evidence that locally acquired human transmission is occurring in Texas," said Melissa Nolan Garcia, a research associate at Baylor College of Medicine in Houston and the lead author of two of the three studies.

Garcia is concerned that the number of infected people in the United States is growing and far exceeds the U.S. Centers for Disease Control and Prevention's estimate of 300,000.

In one pilot study, her team looked at 17 blood donors in Texas who tested positive for the parasite that causes Chagas disease.

"We were surprised to find that 36 percent had evidence of being a locally acquired case," she said. "Additionally, 41 percent of this presumably healthy blood donor population had heart abnormalities consistent with Chagas cardiac disease."

The CDC, however, still believes most people with the disease in the United States were infected in Mexico, Central and South America, said Dr. Susan Montgomery, of the agency's parasitic diseases branch.

"There have been a few reports of people becoming infected with these bugs here in the United States," she said. "We don't know how often that is happening because there may be cases that are undiagnosed, since many doctors would not think to test their patients for this disease. However, we believe the risk of infection is very low."

Maybe so, but kissing bugs -- blood-sucking insects called triatomine bugs -- are found across the lower half of the United States, according to the CDC. The insects feed on animals and people at night.

The feces of infected bugs contains the parasite Trypanosoma cruzi, which can enter the body through breaks in the skin. Chagas disease can also be transmitted through blood.

It's a silent killer, Garcia said. People don't feel sick, so they don't seek care, but it causes heart disease in about 30 percent of those who get infected, she said.

In another study, Garcia's team collected 40 insects in 11 Texas counties. They found that 73 percent carried the parasite and half of those had bitten humans as well as other animals, such as dogs, rabbits and raccoons.

A third study found that most people infected with Chagas aren't treated.

For that project, Dr. Jennifer Manne-Goehler, a clinical fellow at Harvard Medical School and Beth Israel Deaconess Medical Center in Boston, collected data on nearly 2,000 people whose blood tested positive for Chagas.

Her team found that only 422 doses of medication for the infection were given by the CDC from 2007 to 2013. "This highlights an enormous treatment gap," Manne-Goehler said in a news release.

The findings of all three studies, published recently in the American Journal of Tropical Medicine and Hygiene, were to be presented Tuesday in New Orleans at the annual meeting of the American Society of Tropical Medicine and Hygiene.

Symptoms of Chagas can range from none to severe with fever, fatigue, body aches and serious cardiac and intestinal complications.

"Physicians should consider Chagas when patients have swelling and enlargement of the heart not caused by high blood pressure, diabetes or other causes, even if they do not have a history of travel," Garcia said.

However, the two treatments for this disease are "only available [in the United States] via an investigative drug protocol regulated by the CDC," Garcia said. They are not yet approved by the Food and Drug Administration.

Efforts are under way to develop other treatments for Chagas disease, Montgomery said.

"Several groups have made some exciting progress in drug development," she said, "but none have reached the point where they can be used to treat patients in regular clinical practice."

Source: health.usnews.com

Source: Norwich University's Master of Science in Nursing online program

By DANIELA J. LAMAS, M.D.

One recent night I was asked to declare the death of a woman I had never met.

“Ms. L. passed,” the nurse said. “Could you pronounce her?”

The online medical record told me that she was 32 years old, one year younger than me. She had been in the hospital for months with leukemia that had progressed despite every possible chemotherapy regimen and a failed bone marrow transplant. And now someone needed to perform a death exam.

Declaring death is not technically hard but it is weird and sad and requires reams of paperwork. It is usually done by an intern, but my intern was busy so I said I would do it.

The first time I declared a patient dead was nearly six years earlier. I had been a doctor for a few months when I was summoned overnight with a page that told me that my patient’s heart had stopped. When I got to his room I was out of breath and his nurse smiled at me and told me that there really wasn’t urgency; he wasn’t going anywhere.

It was only when I walked into the room and saw my patient still and utterly silent, his tired family sitting around the bed, that I realized no one had ever told me precisely how to declare death. I wished I could come back later, but it didn’t seem right to leave him there, so I thumbed through my pocket-sized intern survival guide. The manual was alphabetized, and the discussion about declaring death came somewhere before a section on diabetes management.

The instructions were clear and began with the directive to express sympathy. I turned to the family to tell them how sorry I was. Listen for heart sounds and watch to see if the patient is breathing. I placed my stethoscope on the patient’s still chest and waited, watching for him to take a breath, and wondering what I would do if I heard something. But there was nothing. Feel for a pulse. I placed my hand on his neck and there was not even a quiver. And that was that. He was dead.

I looked at the clock and spoke the time out loud and said I was sorry again. And then I left the room.

Later I would face the inevitable pile of paperwork, which one hospital I worked at labeled the “Final Discharge Packet,” and another, in bold letters on a red binder, the “Death Binder.” That was followed by calls to admitting to report the death, minutes that felt like hours on hold with the medical examiner, death certificates returned to me because I had signed on the wrong dotted line. By the end of my intern year, one of the worst parts of having a patient die was those bureaucratic forms and phone calls.

Now, years later, I paused outside the room of Ms. L. before pulling back the curtain.

Until then, most of the patients I had been called to declare looked much as they did in life, only vacant. But this woman had been destroyed by illness. She was bald and yellow and bloated. She must have suffered. I took out my stethoscope as I had learned to do, rested it on her chest and listened to the silence that had taken the place of her heartbeat. I laid my fingers on her neck and there was no pulse. I looked up at the clock and said the time out loud.

As I turned to leave, I couldn’t help but note the wall of cards and photographs next to her hospital bed. She must have run a marathon to raise money for cancer research, for one photo captured her healthy and smiling, arms lifted victoriously as she crossed the finish line. Someone who loved her must have been there, waiting to take that photo.

“She must have been cool,” I said to her nurse. “I bet I would have liked her.”

“She was awesome.”

No one spoke. Two nurses gently pulled out the intravenous lines that had once run antibiotics and fluids into her veins and, one by one, removed the stickers on her chest that had recorded her heartbeat. One of the nurses paused and caught my eye.

“It’s so humid out,” she said. “How do you keep your hair from getting frizzy in this humidity?” I had showered just before my shift, I told her, and then I had come right to work so I hadn’t been outside much. When I caught a glimpse of myself in the mirror, my hair didn’t even look that good.

And then, because I didn’t know what else to say in front of this 32-year-old woman I would never meet, I offered only: “You know, I’ve always wanted to run a marathon.”

I left the room to begin the paperwork .

Source: nytimes.com

Invisible tattoos could replace the permanent dark ink tattoos used to ensure that breast cancer patients having radiotherapy are treated in exactly the same spot during each session, according to results from a pilot study to be presented at the National Cancer Research Institute (NCRI) Cancer Conference.

Research suggests that the permanent pin prick marks made on the skin of women having radiotherapy reminds them of their diagnosis for years to come, reducing body confidence and self-esteem.

It's also more difficult to spot these tattoos in dark-skinned women, potentially leading to inconsistencies in the area being treated.

The NIHR-funded researchers, based at The Royal Marsden hospital in London, asked 42 breast cancer patients undergoing radiotherapy to rate how they felt about their body, before the treatment and one month later.

Half the women were offered fluorescent tattoos, only visible under UV light, while the other half had conventional dark ink tattoos.

The researchers found that 56 per cent of the women who had fluorescent tattoos felt better about their bodies one month after treatment, compared to only 14 per cent among those who received black ink tattoos.

Using fluorescent tattoos also made no difference to the accuracy of treatment and took only slightly longer to carry out, compared to conventional dark ink tattoos.

Steven Landeg, a senior radiographer from the Royal Marsden, who is presenting the data, said: "These findings suggest that offering fluorescent radiotherapy tattoos as an alternative to dark ink ones could help ameliorate the negative feelings some women feel towards their bodies after treatment. It's important to remember that body image is subjective and dark ink radiotherapy tattoos will affect patients differently, but we hope that these results will go some way towards making this a viable option for radiotherapy patients in the future."

Evelyn Weatherall, 62, Surrey, had six cycles of chemotherapy, followed by radiotherapy, after being diagnosed with breast cancer following routine mammography through the UK's breast screening programme.

She said: "I'd asked if I could be part of any kind of clinical trial during my treatment because I'd read about how successful they were proving to be. My doctors told me about the invisible tattoos they were pioneering at The Royal Marsden hospital and I was more than happy to take part. I had lost my hair during chemotherapy and felt that I didn't want another visible reminder of my cancer.

"I think I was one of the first to undergo this procedure and it really worked. There wasn't a mark on my skin after the radiotherapy planning. I was going to a wedding soon afterwards and knew I'd be able to wear an outfit that didn't make me feel self-conscious.

"It's wonderful to think that I may have been a part of something that could become standard in the future."

Professor Matt Seymour, NCRI's clinical research director said: "With more than half of all cancer patients now surviving 10 years and beyond, it's imperative that we do everything we can to reduce the long term impact of treatment on patients, including cosmetic changes."

The study was funded by the NIHR Biomedical Research Centre at The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research (ICR).

Source: MNT

By Sara Cheshire

Can we predict the future of medicine? Although designer babies and a disease-free world may or may not come to pass, you can get a glimpse of the most promising and upcoming medical innovations each year, via the Cleveland Clinic.

The clinic's Top 10 Medical Innovations list, which has been an annual undertaking since 2007, contains treatments and technologies that are expected to significantly change patient care and save lives.

To be considered, each innovation must have a good chance of being available to the public in the upcoming year, says Dr. Michael Roizen, chief wellness officer at the Cleveland Clinic and chairman of the committee that decides the list. The committee must also expect it to have a significant impact on a large part of the population.

The process starts with a panel of Cleveland Clinic physicians and scientists who submit their ideas. These suggestions, which Roizen said totaled about 700 for the 2015 list, are then narrowed down and voted on by 40 physicians in a variety of health fields.

Here's what they selected for 2015:

1. Mobile stroke unit

Videoconferencing has made its way into ambulances, specifically for treating stroke victims on the go. Hospital stroke neurologists can interpret symptoms via a broadband video link and instruct an onboard paramedic, critical care nurse and CT technologist on treatment. This new technology should improve the speed of medical care, which is important as strokes quickly damage and kill brain cells.

2. Dengue fever vaccine

The World Health Organization reports that about half of the world's population is now at risk for dengue fever, which up until now was preventable only by avoiding mosquito bites. The disease is a leading cause of death and illness in children in some countries. A new vaccine has been developed and tested, and is expected to be available in 2015.

3. Painless blood testing

For those who hate large needles, a nearly painless way to sample blood will be a welcome relief. Plus, it will be cheaper and provide faster results than today's blood test. The new technology takes blood from your fingertip, and the Cleveland Clinic reports that over 100 tests can be performed on just one drop of blood.

4. New way to lower cholesterol

New self-injectable drugs called PCSK9 inhibitors have shown to be very effective in lowering cholesterol. These drugs may prove to be helpful for people with high LDL cholesterol who don't have good results with statins. The FDA is expected to approve the first PCSK9 in 2015.

5 ways to lower cholesterol

5. Cancer drug that doesn't harm healthy tissue

Although chemotherapy can save lives, it can be hard on the body and attack healthy cells as well as cancerous ones. A welcome breakthrough in the world of cancer treatment, antibody-drug conjugates can deliver targeted treatment without damaging healthy tissue.

6. Immune booster for cancer patients

Immune checkpoint inhibitors have been shown to prevent cancer cells from "hiding" from the immune system, allowing the body to more effectively fight these abnormal cells. Combined with chemotherapy and radiation treatment, the drugs have shown significant, long-term cancer remissions for patients with metastatic melanoma, one of the most deadly forms of cancer.

7. Wireless cardiac pacemaker

Until this point, wires have been a necessary component in pacemakers. A new wireless pacemaker about the size of a vitamin can now be implanted in the heart without surgery. Its lithium-ion battery is estimated to last about seven years.

8. New medications for idiopathic pulmonary fibrosis

Idiopathic pulmonary fibrosis is a life-threatening disease that causes scarring in the lungs, leading to breathing difficulties and a shortage of oxygen in the brain and other organs. Life expectancy is only three to five years after diagnosis, but those numbers may change now that the FDA has approved two experimental drugs that slow the disease: pirfenidone and nintedanib.

9. Single-dose radiation therapy for breast cancer

The National Cancer Institute estimates that 40,000 women in the United States will die from breast cancer in 2014. The Cleveland Clinic cites multiple chemotherapy appointments, sometimes requiring the patient to travel long distances, as a hindrance to successful treatment. Intraoperative radiation therapy is a new solution. It treats a breast cancer tumor during surgery in a single dose, reducing time and cost spent on treatment.

10. New drug for heart failure

About 5.1 million people in the United States suffer from heart failure, according to the National Heart, Lung and Blood Institute. It is managed with a combination of drugs, but a new drug, angiotensin-receptor neprilysin inhibitor, has been granted fast-track status by the FDA because of its ability to cut the risk of dying from heart failure more effectively than current treatments.

For more information on the annual medical innovations list, including descriptions and videos, download the "Innovations" app or visit the website. A "where is it now" feature also includes updates on innovations that made the top 10 list in prior years.

"We look in past to see what we voted on to improve the process," Roizen said. "With one exception, we've been pretty good."

Source: www.cnn.com

By Alana Horowitz

Brittany Maynard, the Oregon woman who had become an outspoken advocate for patients' rights following her terminal cancer diagnosis, died on Saturday, the Oregonian reported. She was 29.

"Goodbye to all my dear friends and family that I love," she wrote in a Facebook post, according to People. "Today is the day I have chosen to pass away with dignity in the face of my terminal illness... the world is a beautiful place, travel has been my greatest teacher, my close friends and folks are the greatest givers... goodbye world. Spread good energy. Pay it forward!"

Earlier this year, Maynard learned that she was suffering from an aggressive form of brain cancer called glioblastoma and had only six months to live. After hearing what the disease would to her body in its final stages, she decided that she wanted to die on her own terms.

Maynard and her family, including her husband Dan Diaz and her mother Debbie Ziegler, moved to Oregon,whose Death With Dignity Act has allowed hundreds of terminally ill people to end their lives by taking a medication prescribed by doctors. She picked November 1st as the day she wanted to die because it was after her husband's late October birthday.

Since then, Maynard had become a champion for the law and for patients in her situation, working with the group Compassion and Choices.

"I am not suicidal," she wrote in a blog post for CNN.com. "I do not want to die. But I am dying. And I want to die on my own terms."

On Wednesday, Maynard released a new video that suggested that she might consider postponing her death.

"If November 2nd comes along and I've passed, I hope my family is still proud of me and the choices I've made. If November 2nd comes along and I'm still alive, I know that we'll still be moving forward as a family out of love for each other, and that decision will come later."

Maynard recently crossed the last item off her bucket list: a trip to the Grand Canyon. Before she became ill, Maynard was an active traveler and adventurer who lived in Southwest Asia for a year and once climbed Mount Kilimanjaro.

Source: www.huffingtonpost.com

By Sarah Buhr

Detecting cancer could be as easy as popping a pill in the near future. Google’s head of life sciences, Andrew Conrad, took to the stage at the Wall Street Journal Digital conference to reveal that the tech giant’s secretive Google[x] lab has been working on a wearable device that couples with nanotechnology to detect disease within the body.

“We’re passionate about switching from reactive to proactive and we’re trying to provide the tools that make that feasible,” explained Conrad. This is a third project in a series of health initiatives for Google[x]. The team has already developed a smart contact lens that detects glucose levels for diabetics and utensils that help manage hand tremors in Parkinson’s patients.

The plan is to test whether tiny particles coated “magnetized” with antibodies can catch disease in its nascent stages. The tiny particles are essentially programmed to spread throughout the body via pill and then latch on to the abnormal cells. The wearable device then “calls” the nanoparticles back to ask them what’s going on with the body and to find out if the person who swallowed the pill has cancer or other diseases.

“Think of it as sort of like a mini self-driving car,” Conrad simplified with a clear reference to Google[x]‘s vehicular project. “We can make it park where we want it to.” Conrad went on with the car theme, saying the body is more important than a car and comparing our present healthcare system as something that basically only tries to change our oil after we’ve broken down. “We wouldn’t do that with a car,” he added.

Bikanta’s tiny diamonds luminesce cells in the body.

Similar to Y Combinator-backed Bikanta, the cells can also fluoresce with certain materials within the nanoparticles, helping cancer cells to show up on an MRI scan much earlier than has been possible before.

This has all sorts of implications in medicine. According to a separately released statement from Google today, “Maybe there could be a test for the enzymes given off by arterial plaques that are about to rupture and cause a heart attack or stroke. Perhaps someone could develop a diagnostic for post-surgery or post-chemo cancer patients – that’s a lot of anxious people right there (note: we’d leave this ‘product development’ work to companies we’d license the tech to; they’d develop specific diagnostics and test them for efficacy and safety in clinical trials.”

We essentially wouldn’t need to go into the doctor and give urine and blood samples anymore. According to Conrad, we’d simply swallow a pill and monitor for disease on a daily basis. We’d also be able to upload that data into the cloud and send it to our doctor. “So your doctor could say well for 312 days of this year everything looks good but these past couple of months we’re detecting disease,” Conrad said.

Privacy and security, particularly in health care is essential. Google came under fire in the last couple of years for handing over information to the U.S. government. Conrad was quick to mention that a partner, not Google would be handling individual data. “It’d be like saying GE is in control of your x-ray. We are the creators of the tech and they are the disseminators,” Conrad clarified.

The U.S. government has an active interest in this space, as well. It’s invested over $20 billion in nanotechnology research since 2013.

This project is in the exploratory phases but Conrad was hopeful that we’d be seeing this technology in the hands of every doctor within the next decade. He also mentioned that his team has explored ways of not just detecting abnormal cells but also delivering medicine at the same time. “That’s certainly been discussed,” he said, but cautioned that this was something that needed to be carefully developed so that the nanoparticles had a chance to show what was happening in the body before destroying the cells.

So far 100 Google employees with expertise in astrophysics, chemistry and electrical engineering have taken part in the nanoparticle project. “We’re trying to stave off death by preventing disease. Our foe is unnecessary death,” Conrad added.

Source: www.msn.com

By JESSICA FIRGER

When Jackson Small began having seizures at 7, his parents hoped and assumed at least one of the many epilepsy drugs on the market would be enough to get things under control. But one seizure quickly spiraled to as many as 30 a day.

"He would stop in his tracks and not be aware of what was going on for 20 or 30 seconds or so," his mother Shana Small told CBS News. Jackson was eventually diagnosed with juvenile myoclonic epilepsy, a type of epilepsy characterized by brief but often frequent muscle jerking or twitching.

But a number of medications typically prescribed to patients with this type of epilepsy were not effective. And so the quest to help Jackson gain control over his seizures led the family from their home in Orlando, Florida, to the office of a registered dietician at the NYU Langone Comprehensive Epilepsy Center in New York City.

They were there to discuss the medical benefits of heavy cream, mayonnaise, eggs, sausage, bacon and butter.

A lot of butter.

The plan was to treat Jackson with a diet that is heavy in fat, low in protein and includes almost no carbohydrates. It's known as the ketogenic diet and has long been in the arsenal of last-resort options for patients with epilepsy who are unresponsive to medication. Doctors may recommend a patient go on this special diet after unsuccessfully trying two or three prescriptions.

The diet works by putting the body in a "fasting" state, known as ketosis. "When we're fasting the body needs to find fuel so our body will break down fat storage and break down their own fat and enter a state of ketosis," Courtney Glick, the registered dietician who coordinated and fine-tuned Jackson's diet plan, told CBS News. "But with this diet, instead of breaking down the body's fat, the body breaks down dietary fat."

The ketogenic diet consists of as much as 90 percent fat. Some patients who feel they can't make such an extreme change adopt a modified Atkins diet, which is between 65 and 70 percent fat. It can be nearly as effective for controlling seizures, though every patient is different.

Though experts don't know everything about why this diet is effective for seizure control, they do know that eating mostly fat causes the body to fuel on ketones rather than glucose, which ultimately lowers insulin levels. This can have an anti-inflammatory effect on the body and may prevent seizures by calming the brain, said Glick.

One study by researchers at Dana-Farber Cancer Institute and Harvard Medical School found that a child's ability to stave off seizures is tied to a protein that affects metabolism in the brain. The protein, called BCL-2-associated Agonist of Cell Death, or BAD, also regulates metabolism of glucose. The researchers discovered that by modifying this, they switched metabolism in brain cells from glucose to ketone bodies, which are fat byproducts.

Glick said the diet plan didn't work for Jackson until he tried the most strict version, which was a 4 to 1 ratio of fat to protein and carbohydrates. Each day, he ate approximately 160 grams of fat, 8 to 10 grams of carbohydrates and 30 grams of protein, all of which amounted to about 1,700 calories a day.

Four months into the program, Jackson was seizure-free. He remained on the strict diet for two years with no return of seizures. His mother prepared foods from special recipes such as "keto" pizza made with a macadamia nut crust or chicken nuggets with coconut flour.

Over the summer -- after receiving a green light from his doctors -- Jackson, now 10 years old, began to wean himself off the diet, and his mother has slowly introduced foods such as breads and ice cream. He has maintained seizure-free and takes very little anti-seizure medication.

Research has found that for pediatric patients the anti-seizure effects of the diet often continue long after the child stops following the food plan, though the reason why remains unclear. This is typically not the case for adults, who may need to stay on the diet for life in order to control seizures.

"We've probably seen more kids go on the diets than adults, and adults are really set on their eating patterns," said Glick, adding that social obligations can make the diet difficult to fit into a grown person's lifestyle.

Jackson's mother said his doctors are hopeful that in the near future he may no longer need medication -- or a keto diet -- to stay seizure-free. "I think it's taught him a very important lesson about how food is as important as medicine, and how food affects the chemistry of your body," she said.

Source: www.cbsnews.com and http://www.dana-farber.org/

By David McNamee

A new report finds that by 2100, there will be more people alive on the planet than has ever previously been predicted. We investigate what the consequences these extra bodies may have for maintaining public health.

The potentially catastrophic consequences of an exponentially growing global population is a favorite subject for writers of dystopian fiction.

The most recent example, Utopia - a forthcoming David Fincher-directed series for HBO - won critical acclaim in its original incarnation on UK television for its depiction of a conspiracy-laden modern world where the real threat to public health is not Ebola or other headline-friendly communicable viruses, but overpopulation.

Fears over the ever-expanding number of human bodies on our planet are not new and have been debated by researchers and policy makers for decades, if not centuries. However, recent research by University of Washington demographer Prof. Adrian Raftery - using modern statistical modeling and the latest data on population, fertility and mortality - has found that previous projections on population growth may have been conservative.

"Our new projections are probabilistic, and we find that there will probably be between 9.6 and 12.3 billion people in 2100," Prof. Raftery told Medical News Today. "This projection is based on a statistical model that uses all available past data on fertility and mortality from all countries in a systematic way, unlike previous projections that were based on expert assumptions."

Prof. Raftery's figure places up to an additional 5 billion people more on the Earth by 2100 than have been previously calculated.

A key finding of the study is that the fertility rate in Africa is declining much more slowly than has been previously estimated, which Prof. Raftery tells us "has major long-term implications for population."

Fertility rates declining more slowly in Africa than previously reported

A 2003 Centers for Disease Control and Prevention (CDC) report found that, in sub-Saharan Africa, both fertility and mortality rates were high, with the proportion of people aged over 65 expected to remain small, increasing from an estimated 2.9% in 2000 to 3.7% in 2030.

The CDC report notes that fertility rates declined in developing countries during the preceding 30 years, following a 20th century trend among developed countries. The pattern established by developed countries - and presumed to follow in developing countries - was that countries shift from high fertility and high mortality rates to low fertility and delayed mortality.

This transition starts with declining infant and childhood mortality as a result of improved public health measures. Improvements in infant and childhood mortality contribute to longer life expectancy and a younger population.

This trend of adults living longer, healthier lives is typically followed by a decline in fertility rates. The CDC report suggested that by 2030, there would be similar proportions of younger and older people in developing countries, by that point mirroring the age distribution in developed countries circa 1990.

Prof. Raftery's research, however, notes that in Nigeria - Africa's most populous country - each woman has an average of six children, and in the last 5 years, the child mortality rate has fallen from 136 per 1,000 live births to 117. This works out as a population increase of 20 people per square mile over the same timespan.

How will population growth affect developing countries?

But what does this mean for countries where the public health system is already stretched to breaking point - as has been demonstrated by the recent Ebola epidemic?

"Rapid population growth is likely to increase the burden on the public health service proportionally," answered Prof. Raftery.

"There are already big public health needs and challenges in high-fertility countries, and rapid population growth will make it even harder to meet them." However, if the fertility rate declines faster, Prof. Raftery suggests that high-fertility countries can reap "a demographic dividend."

He explained:

"This is a period of about a generation during which the number of dependents (children and old people) is small. This frees up resources for public health, education, infrastructure and environmental protection, and can make it easier for the economy to grow. This can happen even while the population is still increasing."

Does this suggest that an increasing population is not quite as much of a threat, but that it is more specifically the accelerations and decelerations in fertility rates that provide warning signs to future public health crises?

"Following a long run of an increasing human population growth rate, over the past half century the rate has been halved from about 2% to about 1%," Darryl Holman, professor of biological anthropology at the University of Washington, explained to MNT.

"The turnaround is quite remarkable," he said. "But as long as the growth rate remains positive, our species will eventually reach numbers and densities where technological solutions cannot ameliorate resource scarcity."

High population density leads to a much higher rate of contact between humans, which means that communicable diseases - ranging from the common cold to Dengue fever - can be much more easily transmitted.

And more people means greater efforts are needed to control waste management and provide clean water. If these needs cannot be adequately met, then diarrheal diseases become much more common, resulting in what Prof. Holman described to the University of Washington's news website The Daily UW as a "huge, huge, huge difference in mortality rates."

Taking a more general view, "the anticipated increase in the number of older persons will have dramatic consequences for public health, the health care financing and delivery systems, informal caregiving, and pension systems," wrote the authors of the CDC's 2003 report.

Overpopulation and the environment

"Can we assume that life on earth as we know it can continue no matter what the environmental conditions?," asked the authors of a 2001 Johns Hopkins School of Public Health report on the health consequences of population growth.

The Johns Hopkins report quoted figures demonstrating that unclean water and poor sanitation kill over 12 million people every year, while air pollution kills 3 million. In 64 of 105 developing countries, population has grown faster than food supplies.

By 2025, the report claimed, humankind could be using over 90% of all available freshwater, leaving just 10% for the world's plants and animals.

Prof. Holman summarizes the writings of experts Joel Cohen, E.O. Wilson, Paul Ehrlich and Ronald Lee, who have argued that the consequences of long-term environmental degradation - "specifically rising sea levels, disruption of agriculture and the increased frequency of extreme weather events resulting from anthropogenic climate change, exacerbated by resource scarcity" - create social problems that lead to social unrest.

With more people living together than ever before, it seems inevitable that this compounded social unrest would lead to increased warfare and fighting for resources.

According to the Johns Hopkins researchers, about half of the world's population currently occupies a coastal strip 200 kilometers wide - which means that 50% of us are squeezed together on just 10% of the world's land surface.

The projected flooding of these coastal regions as a result of global warming and rising sea levels could displace millions of people, result in widespread droughts and disrupt agriculture.

The Johns Hopkins team identified two main courses of action to divert these potential disasters.

Firstly - sustainable development. The report authors argued this should include:

• More efficient use of energy
• Managing cities better
• Phasing out subsidies that encourage waste
• Managing water resources and protecting freshwater sources
• Harvesting forest products rather than destroying forests
• Preserving arable land and increasing food production
• Managing coastal zones and ocean fisheries
• Protecting biodiversity hotspots.

The second vital area of action is the stabilization of population through good-quality family planning, which "would buy time to protect natural resources."

How to reduce fertility in a morally acceptable way?

Commenting on Prof. Raftery's finding that we may be welcoming an additional 5 billion individuals onto the planet by 2100 than had previously been estimated - a potential global population of 12.3 billion people - Prof. Holman admits that "it is difficult to know what the public health effects will be."

He explains:

"By then, we may see severe petroleum and fresh water resource shortages, climate changes that affect agriculture patterns that, in turn, affect food supplies. Reducing fertility in socially and morally acceptable ways seems like one public health strategy to avoid - or at least postpone - testing some of these limits."

In Utopia, a sinister governmental organization proposes to sterilize a large percentage of the population by rolling out a secretly modified vaccine in response to a manufactured flu pandemic. Obviously, that is not a socially or morally acceptable strategy for reducing fertility - but what is?

Experts consider boosting the education of girls in developing countries to be a prime solution.

As well as acquiring more control over their reproductive life, an educated female workforce should have more opportunities of employment and of earning a living wage. Studies report that the children of educated women also have better chances of survival and will become educated themselves. This pattern continuing across generations is associated with a decline in fertility rates.

A 2011 article by the Earth Policy Institute (EPI), analyzing data from the United Nations (UN), states that "countries in which more children are enrolled in school - even at the primary level - tend to have strikingly lower fertility rates."

In particular:

"Female education is especially important. Research consistently shows that women who are empowered through education tend to have fewer children and have them later. If and when they do become mothers, they tend to be healthier and raise healthier children, who then also stay in school longer. They earn more money with which to support their families, and contribute more to their communities' economic growth. Indeed, educating girls can transform whole communities."

The relationship between education, fertility and national poverty is a direct one. As the EPI authors add: "When mortality rates decline quickly but fertility rates fail to follow, countries can find it harder to reduce poverty."

The UN's 2012 Revision of the world population prospects report suggested if we make rapid reductions in family size, then it may still be possible to constrain the global population to 8 billion by 2045.

No projections are set in stone - all are contingent on what extent fertility rates will sway over the next century. And, as Prof. Holman pointed out to us, the nature of the threat posed by overpopulation has "been vigorously debated for over 200 years" with experts still not in complete accord.

For instance, in the 1980s, said Prof. Holman, the economist Julian Simon and ecologist Paul Ehrlich went on tour together, with a series of debates about the consequences of population growth.

"Ehrlich argued that continued population growth would lead to disaster for humans. Simon argued that population growth provided more people to invent new solutions to the problems confronting humans," said Prof. Holman, adding:

"Given the trends to this point, Simon has been 'more right.' One simple measure of this is mortality rates, which have decreased for most human groups. The flaw in Simon's argument may well be that we have never hit the limits of our finite earth. Positive population growth guarantees that we will, someday, hit some hard limits."

"So that," Prof. Holman concluded, "is the long term."

Source: www.medicalnewstoday.com