Bed-sharing increasing among minority families

By Genevra Pittman

NEW YORK | Mon Sep 30, 2013 4:20pm EDT

NEW YORK (Reuters Health) – More parents are putting their babies to sleep next to them in bed, a new study suggests.

Researchers found that over the past 20 years, bed-sharing has become more common, especially among black and Hispanic families.

The practice is controversial. Some evidence suggests mothers who share a bed with their babies also tend to keep breastfeeding for longer (see Reuters Health story of September 23, 2013 here: reut.rs/1bBVlvX).

But the American Academy of Pediatrics (AAP) recommends against bed-sharing because it has been linked to a higher risk of sudden infant death syndrome, or SIDS. About 2,500 babies die from SIDS each year in the United States.

“We definitely saw an increase (in bed-sharing), and we also see an increase in the racial disparity,” Dr. Eve Colson, who led the study at the Yale University School of Medicine in New Haven, Connecticut, told Reuters Health.

“We need to go to the next step to figure out why that is.”

Colson and her colleagues used data from national telephone surveys of about 19,000 people with an infant at home, conducted between 1993 and 2010.

During that time, the proportion of participants – typically mothers – reporting that their baby often shared a bed with another person rose from almost 7 percent to close to 14 percent.

Although those rates leveled off for white babies in 2001, they continued to increase for black and Hispanic babies throughout the study period.

By 2010, mothers reported that about 39 percent of black infants were bed-sharing, compared to close to 21 percent of Hispanic infants and 9 percent of white infants. Most of those babies were sharing a bed with their parents, the researchers wrote Monday in JAMA Pediatrics.

Previous studies suggested women of different races and ethnicities may have different motivations for sleeping with their babies, Dr. Fern Hauck from the University of Virginia School of Medicine in Charlottesville, said.

Some women bed-share because their parents bed-shared or because they believe it’s the safest thing for their baby, she said. Others believe it will help them breastfeed.

The researchers note that their study group was not nationally-representative and almost half of participants were 30 years old and above, had a college education and made at least $50,000 a year.

Pediatrician Dr. Abraham Bergman from Harborview Medical Center in Seattle wrote in an editorial published with the new study that he found it “disquieting” that the authors assume bed-sharing is bad.

“To me the data just aren’t there to support” the recommendation against bed sharing, Bergman told Reuters Health.

He said obesity and alcohol and drug use by parents do put a baby more at risk during bed-sharing. “One has to be prudent about it,” he said.

Hauck, who is also a member of the AAP Task Force on SIDS, challenged that idea.

“The recommendation to not bed-share was made very, very carefully, because we know how big it is. It’s an emotional thing for people,” Hauck, who wasn’t involved in the new study, told Reuters Health.

She added, there’s “evidence that even among women who were breastfeeding, even among women who would otherwise be considered low-risk, who were not smoking, bed-sharing does increase the risk of SIDS.”

Colson said the new study presents “an opportunity” for doctors to speak with families about bed-sharing, given how infrequently those discussions seem to be happening now.

SOURCE: bit.ly/KEGTVv JAMA Pediatrics, online September 30, 2013.

  • Link this
  • Share this
  • Digg this
  • Email
  • Reprints


Visit the Source Site

Slightly early birth tied to lower adult achievement

By Genevra Pittman

NEW YORK | Mon Sep 30, 2013 4:19pm EDT

NEW YORK (Reuters Health) – Being born just a couple of weeks early may influence a child’s long-term education and job prospects, hints a new study from Finland.

Researchers found that infants born “late preterm” – between 34 and 36 weeks – were more likely to be manual workers and earned less money as adults than their peers who were born on time.

Past studies have suggested children born slightly early have more behavioral and emotional problems and don’t do as well academically, Katri Räikkönen from the University of Helsinki and her colleagues noted.

“It could be part of a whole lifelong process,” Nancy Reichman, who has studied premature babies’ development at Rutgers University-Robert Wood Johnson Medical School in New Brunswick, New Jersey, said.

The new study, she told Reuters Health, is “consistent with the story that late preterm birth results in infants having health disadvantages at birth that translate to school age that possibly translate to later health and socioeconomic status.”

However, researchers can’t be sure being born early is directly responsible for those long-term outcomes, said Reichman, who wasn’t involved in the new research.

It’s possible that other factors affecting the child’s health and development also account for early birth. For instance, parents who are less well-off may be more likely to have a child born early, she said.

For their study, Räikkönen and her colleagues used a nationwide database of occupations, incomes and educational records to track 9,000 people born at one of two Helsinki hospitals in the 1930s and 1940s.

About 500 of them were born slightly premature. The rest were born on time, at 37 to 41 weeks.

The researchers followed those people until they were in their 50s and 60s, accounting for gender and the family’s socioeconomic status while the child was growing up.

They found that kids who were born slightly early were 65 percent more likely to grow up to be manual workers, rather than clerical workers, than those born on time.

Likewise, they were 31 percent more likely to only have a basic or secondary school education and 33 percent more likely to be in the lowest income bracket in middle-age.

Children born early also ended up more often in a lower-status occupation than their fathers, known as being “downwardly mobile,” the researchers reported in Pediatrics.

Because the brain continues to develop throughout pregnancy, Räikkönen’s team said kids who miss out on a couple of weeks in the womb may be at a disadvantage in school and later in life. The researchers did not respond to requests for comment before press time.

In another study published Monday in JAMA Pediatrics, researchers led by Dr. Shaon Sengupta of the Children’s Hospital of Philadelphia found babies born at 37 to 38 weeks needed more intensive care just after birth than those born at 39 to 41 weeks.

Much of the concern for premature babies is around those born very early, such as at 24 to 30 weeks, Dr. Henry Lee, of the Division of Neonatal & Developmental Medicine at Stanford University and Lucile Packard Children’s Hospital in California, said.

That’s because those babies are at high risk of complications, including death, as soon as they’re born.

“For those who are what we consider late preterm, like 34 to 36 weeks, there traditionally has been a little less concern because many times those babies seem to do well,” Lee, who didn’t participate in the new research, told Reuters Health.

However, he said, “What we’re learning more and more these days is these late preterm (babies) are also going to be at higher risk for not only initial medical complications but potential long-term difficulties and challenges.”

Both parents and pediatricians can watch those children extra closely as they grow up, Lee said, to make sure kids start getting extra help early on if they fall behind.

However, he added, many children born a couple of weeks early won’t have any long-term problems.

SOURCES: bit.ly/1eTST58 Pediatrics, online September 30, 2013 and bit.ly/KEGTVv JAMA Pediatrics, online September 30, 2013.

  • Link this
  • Share this
  • Digg this
  • Email
  • Reprints


Visit the Source Site

Baby born after ovaries 'reawakened'

30 September 2013 Last updated at 15:36 ET

By James Gallagher Health and science reporter, BBC News

Kazuhiro Kawamura and newborn babyDr Kazuhiro Kawamura of the St Marianna University medical school holding the newborn

A baby has been born through a new technique to “reawaken” the ovaries of women who had a very early menopause.

Doctors in the US and Japan developed the technique to remove the ovaries, activate them in the laboratory and re-implant fragments of ovarian tissue.

The technique, reported in Proceedings of the National Academy of Sciences, has resulted in one baby being born with another expected.

The findings were described as early, but a “potential game-changer”.

The 27 women involved in the study became infertile around the age of 30 due to ‘primary ovarian insufficiency’. The condition affects one in 100 women who essentially run out of eggs too young, leading to an early menopause.

Women have a fixed number of eggs at birth and those with the condition tend to use them up too quickly or are born with far fewer eggs in the first place.

Wake-up

Eggs in the ovaries are not fully formed; rather, they stay as follicles and some mature each month.

The teams at Stanford University, US, and St Marianna University School of Medicine, Japan, were trying to activate the last few remaining follicles, which may be present.

They removed the ovaries from the women and used a combination of two techniques to wake up the sleeping follicles. First they cut the ovaries into fragments, which has been used in the past as a fertility treatment. Then a chemical to “take the brakes off” egg development was applied.

The fragments were put back at the top of the fallopian tubes and the women were given hormone therapy.

Following the treatment, residual follicles started to develop in eight women. Eggs were taken for normal IVF and so far one couple has had a baby and another woman is pregnant.

Prof Aaron Hsueh, from Stanford, told the BBC: “It has to be improved to figure out the best way to do it, but we estimate it could help 25 to 30% of the women.

“We think it could help in two other forms of infertility. Cancer survivors after chemotherapy or radiotherapy; if there’s any follicles left there’s a chance this will help.

“And also women aged 40 to 45 with an irregular menstrual cycle.”

Continue reading the main story

The end of the menopause?

Some reports have described this study as “beating the menopause” – so does it?

It is certainly an exciting, if early, development for those who go through the ‘early menopause’. Yet even for these women, far more research is needed before it could be considered as a therapy.

But what about the ‘conventional menopause’ in women normally over the age of 50?

This technique is very unlikely to help any women have children at this stage.

Even if they had follicles which could be cajoled into becoming eggs there would be issues of quality.

Women are born with all the eggs they will ever have; as time goes by they deteriorate. And as the quality falls, the odds of successful pregnancy plummet dramatically.

The difference between the eggs of a 25-year-old and a 50-year-old is huge.

As Prof Nick Macklon from the University of Southampton put it: “Quality and quantity are two very different things.”

Major interest

The implications for women with early menopause are still unclear as the technique will require further testing and refinement before it could be used in clinics.

Prof Charles Kingsland, from Liverpool Women’s Hospital and the Royal College of Obstetricians and Gynaecologists, said: “It’s really clever, but will it work for everyone? We don’t know.

“It’s potentially really, really, interesting, but we need a lot more investigation to confirm this is not another false dawn.

“I will see primary ovarian insufficiency on a regular basis in my clinic so if it’s effective in the long term, it’s something we’d be interested in.”

Prof Nick Macklon, from the University of Southampton, told the BBC: “Finding a new way to get new eggs by waking up sleeping follicles is very promising. It’s potentially a game-changer.

“It’s a very important and very exciting piece of science, but it is not ready for the clinic. It still needs good randomised control trial data.”

He added that performing the technique outside of a research study would be unfeasible, but a deeper understanding of the mechanisms of egg development could lead to new medications.

Visit the Source Site

Baby born after ovaries ‘reawakened’

30 September 2013 Last updated at 15:36 ET

By James Gallagher Health and science reporter, BBC News

Kazuhiro Kawamura and newborn babyDr Kazuhiro Kawamura of the St Marianna University medical school holding the newborn

A baby has been born through a new technique to “reawaken” the ovaries of women who had a very early menopause.

Doctors in the US and Japan developed the technique to remove the ovaries, activate them in the laboratory and re-implant fragments of ovarian tissue.

The technique, reported in Proceedings of the National Academy of Sciences, has resulted in one baby being born with another expected.

The findings were described as early, but a “potential game-changer”.

The 27 women involved in the study became infertile around the age of 30 due to ‘primary ovarian insufficiency’. The condition affects one in 100 women who essentially run out of eggs too young, leading to an early menopause.

Women have a fixed number of eggs at birth and those with the condition tend to use them up too quickly or are born with far fewer eggs in the first place.

Wake-up

Eggs in the ovaries are not fully formed; rather, they stay as follicles and some mature each month.

The teams at Stanford University, US, and St Marianna University School of Medicine, Japan, were trying to activate the last few remaining follicles, which may be present.

They removed the ovaries from the women and used a combination of two techniques to wake up the sleeping follicles. First they cut the ovaries into fragments, which has been used in the past as a fertility treatment. Then a chemical to “take the brakes off” egg development was applied.

The fragments were put back at the top of the fallopian tubes and the women were given hormone therapy.

Following the treatment, residual follicles started to develop in eight women. Eggs were taken for normal IVF and so far one couple has had a baby and another woman is pregnant.

Prof Aaron Hsueh, from Stanford, told the BBC: “It has to be improved to figure out the best way to do it, but we estimate it could help 25 to 30% of the women.

“We think it could help in two other forms of infertility. Cancer survivors after chemotherapy or radiotherapy; if there’s any follicles left there’s a chance this will help.

“And also women aged 40 to 45 with an irregular menstrual cycle.”

Continue reading the main story

The end of the menopause?

Some reports have described this study as “beating the menopause” – so does it?

It is certainly an exciting, if early, development for those who go through the ‘early menopause’. Yet even for these women, far more research is needed before it could be considered as a therapy.

But what about the ‘conventional menopause’ in women normally over the age of 50?

This technique is very unlikely to help any women have children at this stage.

Even if they had follicles which could be cajoled into becoming eggs there would be issues of quality.

Women are born with all the eggs they will ever have; as time goes by they deteriorate. And as the quality falls, the odds of successful pregnancy plummet dramatically.

The difference between the eggs of a 25-year-old and a 50-year-old is huge.

As Prof Nick Macklon from the University of Southampton put it: “Quality and quantity are two very different things.”

Major interest

The implications for women with early menopause are still unclear as the technique will require further testing and refinement before it could be used in clinics.

Prof Charles Kingsland, from Liverpool Women’s Hospital and the Royal College of Obstetricians and Gynaecologists, said: “It’s really clever, but will it work for everyone? We don’t know.

“It’s potentially really, really, interesting, but we need a lot more investigation to confirm this is not another false dawn.

“I will see primary ovarian insufficiency on a regular basis in my clinic so if it’s effective in the long term, it’s something we’d be interested in.”

Prof Nick Macklon, from the University of Southampton, told the BBC: “Finding a new way to get new eggs by waking up sleeping follicles is very promising. It’s potentially a game-changer.

“It’s a very important and very exciting piece of science, but it is not ready for the clinic. It still needs good randomised control trial data.”

He added that performing the technique outside of a research study would be unfeasible, but a deeper understanding of the mechanisms of egg development could lead to new medications.


Visit the Source Site

UK A&Es seeing ‘drunk children’

30 September 2013 Last updated at 00:00 ET

Nine-year-old boy drinking (model)Public Health England says one in four underage drinkers consumes more than 15 units a week

Nearly 300 children aged 11 or under were admitted to A&E units across the UK last year after drinking too much, a BBC Radio 5 live investigation shows.

Revealing UK-wide data for the first time, it said a total of 6,500 under-18s were admitted with alcohol-related illnesses in 2012-13.

The data came from 125 of the 189 UK NHS organisations following Freedom of Information requests.

More girls than boys are now being admitted, a reversal of the past trend.

Over the last five years A&E departments across the UK have dealt with nearly 48,000 incidents where under-18s have been admitted for drink or drug related illnesses.

‘Hiding away’

Ayrshire and Arran Health Board dealt with the highest number of cases last year – with 483 alcohol-related admissions.

Morten Draegebo, an A&E consultant at Cross House Hospital in Kilmarnock, said children were exposing themselves to significant danger.

He said: “There is a problem with their ability to defend themselves. The typical patient may be found in a field.

“They often need to hide away from any sort of adults in the area so they’re picked up by the ambulance service.

“They have difficulty locating where they are because the description comes through from a distressed half-drunk teenager potentially saying that they’re under a tree somewhere in a large park.

“Eventually they’re found but even in summer-time in Scotland they’re vaguely hypothermic.

“They have vomited. The vomit may go down the wrong way into the lungs. They are unable to defend themselves even from assault.”

Dr Draegbo added: “We have had many cases where teenage, young teenage females have come in saying that they may have been sexually assaulted and they’re that intoxicated and are distressed and say, ‘I may have been’, but they don’t even know if they have been or not.

“On a humane level that is very distressing. I’m a parent, I would hate for that to happen to my daughter.”

Heavy burden

There has been a long-term fall in the number of children admitted to A&E after drinking too much – with 2,000 fewer under-18s admitted to A&E last year than in 2009.

Charities and public health bodies agree fewer children are drinking across the UK, but say the amount being consumed has stayed the same – suggesting those who do drink are drinking more.

Public Health England says one in four underage drinkers consumes more than 15 units a week – the equivalent of seven pints of lager.

The official advice from the chief medical officers across the UK is that no children should be given alcohol until they are 16, and alcohol should only be given to older teenagers under supervision of a carer or parent, and never on more than one day a week.

A Department of Health England spokesman said: “We know that fewer young people are drinking and being admitted to hospital as a result.

“But with more than one million alcohol-related hospital admissions overall in the last year we know too many people are drinking too much and that alcohol places a heavy burden on the NHS, costing around £3.5bn every year. “

Hear more on the Victoria Derbyshire programme at 10:00 BST on Monday 30 September on BBC Radio 5 Live.


Visit the Source Site

Lilly mulls options as Medicare shuns Alzheimer's diagnostic

By Ransdell Pierson

Mon Sep 30, 2013 3:33pm EDT

(Reuters) – Eli Lilly and Co on Monday said the federal government has unfairly blocked patient access to its Amyvid diagnostic test for Alzheimer’s disease by denying reimbursement for such products, and said a requested new study of the test could create additional delay.

“We are committed to this space and aren’t letting this product go by the wayside,” Eric Dozier, senior director of Lilly’s Alzheimer’s business division, said in an interview.

The U.S. Centers for Medicare & Medicaid Services (CMS), the agency that runs Medicare, on Friday determined that there was insufficient evidence that the type of radioactive imaging test “is reasonable and necessary” for diagnosing and helping treat dementia.

CMS said it would consider coverage for the test only in limited circumstances: for clinical trials that must be approved in advance by the agency.

Lilly said the decision denies appropriate patient access to the test, and conflicts with the National Alzheimer’s Plan, a sweeping effort to find an effective way to prevent or treat Alzheimer’s by 2025 and improve care of those already inflicted.

The radioactive drug is used with positron emission tomography, or PET, imaging to detect levels in the brain of beta amyloid, a protein that creates brain plaques believed to be a leading cause of the progressive memory-robbing disease.

It is meant to help indicate whether patients have Alzheimer’s or some other disease that causes symptoms of dementia.

Amyvid was approved in the United States in April 2012, and is the only such diagnostic test currently available to doctors and patients. But it cannot hope to have appreciable sales unless CMS agrees to reimburse the $3,000 test. Many people begin showing signs of dementia at around 65, the age when Medicare coverage begins.

Dozier said CMS will reconsider its decision only if a new clinical study is conducted and better demonstrates that use of the product can meaningfully improve patient outcomes.

Lilly’s eventual decision whether to conduct such a trial, and how it will be designed, will be determined after the company consults with doctors, researchers, the medical community and CMS, Dozier said.

“We need to really understand what a study would look like, how we could demonstrate outcomes CMS would like,” Dozier said.

Amyvid had second-quarter sales of $1.2 million, mainly from individuals with means to pay for the scans themselves and from coverage by private insurance companies on a case by case basis. It is available at 450 imaging centers across the country.

The Alzheimer’s Association on Monday cited disappointment with the CMS restrictions on coverage, saying Amyvid has the potential to “resolve distressing medical uncertainty” about whether patients have Alzheimer’s disease.

The association said more than 5 million Americans have Alzheimer’s disease, a number that could jump to as many as 16 million by 2050, as the population ages.

(Reporting by Ransdell Pierson; Editing by L Gevirtz)

  • Link this
  • Share this
  • Digg this
  • Email
  • Reprints

Visit the Source Site

Lilly mulls options as Medicare shuns Alzheimer’s diagnostic

By Ransdell Pierson

Mon Sep 30, 2013 3:33pm EDT

(Reuters) – Eli Lilly and Co on Monday said the federal government has unfairly blocked patient access to its Amyvid diagnostic test for Alzheimer’s disease by denying reimbursement for such products, and said a requested new study of the test could create additional delay.

“We are committed to this space and aren’t letting this product go by the wayside,” Eric Dozier, senior director of Lilly’s Alzheimer’s business division, said in an interview.

The U.S. Centers for Medicare & Medicaid Services (CMS), the agency that runs Medicare, on Friday determined that there was insufficient evidence that the type of radioactive imaging test “is reasonable and necessary” for diagnosing and helping treat dementia.

CMS said it would consider coverage for the test only in limited circumstances: for clinical trials that must be approved in advance by the agency.

Lilly said the decision denies appropriate patient access to the test, and conflicts with the National Alzheimer’s Plan, a sweeping effort to find an effective way to prevent or treat Alzheimer’s by 2025 and improve care of those already inflicted.

The radioactive drug is used with positron emission tomography, or PET, imaging to detect levels in the brain of beta amyloid, a protein that creates brain plaques believed to be a leading cause of the progressive memory-robbing disease.

It is meant to help indicate whether patients have Alzheimer’s or some other disease that causes symptoms of dementia.

Amyvid was approved in the United States in April 2012, and is the only such diagnostic test currently available to doctors and patients. But it cannot hope to have appreciable sales unless CMS agrees to reimburse the $3,000 test. Many people begin showing signs of dementia at around 65, the age when Medicare coverage begins.

Dozier said CMS will reconsider its decision only if a new clinical study is conducted and better demonstrates that use of the product can meaningfully improve patient outcomes.

Lilly’s eventual decision whether to conduct such a trial, and how it will be designed, will be determined after the company consults with doctors, researchers, the medical community and CMS, Dozier said.

“We need to really understand what a study would look like, how we could demonstrate outcomes CMS would like,” Dozier said.

Amyvid had second-quarter sales of $1.2 million, mainly from individuals with means to pay for the scans themselves and from coverage by private insurance companies on a case by case basis. It is available at 450 imaging centers across the country.

The Alzheimer’s Association on Monday cited disappointment with the CMS restrictions on coverage, saying Amyvid has the potential to “resolve distressing medical uncertainty” about whether patients have Alzheimer’s disease.

The association said more than 5 million Americans have Alzheimer’s disease, a number that could jump to as many as 16 million by 2050, as the population ages.

(Reporting by Ransdell Pierson; Editing by L Gevirtz)

  • Link this
  • Share this
  • Digg this
  • Email
  • Reprints


Visit the Source Site

India seeks to regulate its booming 'rent-a-womb' industry

Daniele Fabbricatore, 39, holds his week-old daughter Gabriella, who is kissed by her maternal grandmother Vanita Patel, outside the Akanksha IVF centre in Anand town, about 70 km (44 miles) south of the western Indian city of Ahmedabad August 26, 2013. REUTERS/Mansi Thapliyal

1 of 8. Daniele Fabbricatore, 39, holds his week-old daughter Gabriella, who is kissed by her maternal grandmother Vanita Patel, outside the Akanksha IVF centre in Anand town, about 70 km (44 miles) south of the western Indian city of Ahmedabad August 26, 2013.

Credit: Reuters/Mansi Thapliyal

By Nita Bhalla and Mansi Thapliyal

Mon Sep 30, 2013 4:28am EDT

ANAND, India, Sept 30 (Thomson Reuters Foundation) – Dressed in a green surgical gown and cap, British restaurateur Rekha Patel cradled her newborn daughter at the Akanksha clinic in northwestern India as her husband Daniel smiled warmly, peering in through a glass door.

“I can’t believe we have our own child at last,” said Patel, 42, gazing in wonderment at five-day-old Gabrielle.

“We are really grateful to our surrogate mother who managed to get pregnant and kept our little daughter healthy. She gave nine months of her life to give us a child.”

It is the perfect promotion for India’s booming surrogacy industry that sees thousands of infertile couples, many from overseas, hiring the wombs of local women to carry their embryos through to birth.

But a debate over whether the unregulated industry exploits poor women prompted authorities to draft a law that could make it tougher for foreigners seeking babies made in India.

“There is a need to regulate the sector,” said Dr. Sudhir Ajja of Surrogacy India, a Mumbai-based fertility bank that has produced 295 surrogate babies – 90 percent for overseas clients and 40 percent for same-sex couples – since it opened in 2007.

“But if the new law tightens rules as suggested by the ministry of home affairs, which disallows surrogacy for same-sex couples and single parents, then it will clearly impact the industry and put off clients coming from overseas.”

BIRTH OF A MARKET

India opened up to commercial surrogacy in 2002. It is among just a handful of countries – including Georgia, Russia, Thailand and Ukraine – and a few U.S. states where women can be paid to carry another’s genetic child through a process of in-vitro fertilisation (IVF) and embryo transfer.

The low-cost technology, skilled doctors, scant bureaucracy and a plentiful supply of surrogates have made India a preferred destination for fertility tourism, attracting nationals from Britain, the United States, Australia and Japan, to name a few.

There are no official figures on how large the fertility industry is in India. A U.N.-backed study in July 2012 estimated the surrogacy business at more than $400 million a year, with over 3,000 fertility clinics across India.

The Akanksha clinic in Anand is the best-known at home and abroad, giving the small town in Gujarat state the reputation as India’s “surrogacy capital”.

“The surrogates in Anand have become empowered through giving this beautiful gift to others,” says Akanksha’s owner, IVF specialist Nayana Patel, who shot to fame in 2004 after she helped a patient have a baby by using the woman’s mother – the child’s grandmother – as a surrogate.

“With the money, they are able to buy a house, educate their children and even start a small business. These are things they could only dream of before. It’s a win-win situation.”

Patel, who appeared on U.S. celebrity Oprah Winfrey’s talk show in 2007, has produced more than 500 surrogate babies – two-thirds of them for foreigners and people of Indian origin living in over 30 countries.

Charging couples like Rekha and Daniel an average of $25,000 to $30,000, a fraction of the cost in the United States, Patel pays her surrogates around 400,000 rupees ($6,500).

For 33-year-old Naina Patel, who gave birth to Gabrielle, the compensation outweighs the downside. The wife of an auto-rickshaw driver with three daughters of her own, she had to live in a hostel for nine months with 60 other surrogates so the clinic could monitor her health.

Like most surrogates, she kept her pregnancy a secret due to the social stigma in India’s conservative society.

“I was happy to do it but it was not really out of choice because we needed the money,” she said in a hospital bed as she recovered from the Caesarean operation for Gabrielle’s birth.

“BABY FACTORIES”

India’s surrogacy industry is vilified by women’s rights groups who say fertility clinics are nothing more than “baby factories” for the rich. In the absence of regulation, they say many poor and uneducated women are lured by agents, hired by clinics, into signing contracts they do not fully understand.

In May last year, surrogate mother Premila Vaghela, 30, died days after delivering a child for an American couple at a clinic in Gujarat. It was recorded as an “accidental death” by police.

A recent government-funded study of 100 surrogate mothers in Delhi and Mumbai found there was “no fixed rule” related to compensation and no insurance for post-delivery healthcare. It cited cases where surrogates were implanted with embryos multiple times to raise the chances of success.

“In most of these cases, the surrogate mothers are being exploited,” said Ranjana Kumari, director of the Centre for Social Research that conducted the study.

Moves to introduce a law – the Assisted Reproductive Technologies Bill (ART) – to protect surrogates, the children and the commissioning parents is long overdue, Kumari said.

Revised visa requirements introduced in July have already resulted in foreign same-sex couples and individuals being prohibited from surrogacy in India. The ART bill, expected to come before parliament next year, will tighten things further.

Under the current draft, all fertility clinics must be registered and monitored by a regulatory authority. Surrogates must be between 21 and 35 years old, they will be provided with insurance and notarised contracts must be signed between the women and the commissioning parents.

“Legislation should be there so that this wonderful procedure can be supervised and it is being done by the right people for the right people,” said Akanksha’s Patel.

“But more bureaucracy will make it difficult for everyone. It will not only mean less commissioning parents from overseas but it will also impact surrogates, who will lose out on the only chance they have to change their lives for the better.”

(Editing by John O’Callaghan and Ron Popeski)

  • Link this
  • Share this
  • Digg this
  • Email
  • Reprints

Visit the Source Site

India seeks to regulate its booming ‘rent-a-womb’ industry

Daniele Fabbricatore, 39, holds his week-old daughter Gabriella, who is kissed by her maternal grandmother Vanita Patel, outside the Akanksha IVF centre in Anand town, about 70 km (44 miles) south of the western Indian city of Ahmedabad August 26, 2013. REUTERS/Mansi Thapliyal

1 of 8. Daniele Fabbricatore, 39, holds his week-old daughter Gabriella, who is kissed by her maternal grandmother Vanita Patel, outside the Akanksha IVF centre in Anand town, about 70 km (44 miles) south of the western Indian city of Ahmedabad August 26, 2013.

Credit: Reuters/Mansi Thapliyal

By Nita Bhalla and Mansi Thapliyal

Mon Sep 30, 2013 4:28am EDT

ANAND, India, Sept 30 (Thomson Reuters Foundation) – Dressed in a green surgical gown and cap, British restaurateur Rekha Patel cradled her newborn daughter at the Akanksha clinic in northwestern India as her husband Daniel smiled warmly, peering in through a glass door.

“I can’t believe we have our own child at last,” said Patel, 42, gazing in wonderment at five-day-old Gabrielle.

“We are really grateful to our surrogate mother who managed to get pregnant and kept our little daughter healthy. She gave nine months of her life to give us a child.”

It is the perfect promotion for India’s booming surrogacy industry that sees thousands of infertile couples, many from overseas, hiring the wombs of local women to carry their embryos through to birth.

But a debate over whether the unregulated industry exploits poor women prompted authorities to draft a law that could make it tougher for foreigners seeking babies made in India.

“There is a need to regulate the sector,” said Dr. Sudhir Ajja of Surrogacy India, a Mumbai-based fertility bank that has produced 295 surrogate babies – 90 percent for overseas clients and 40 percent for same-sex couples – since it opened in 2007.

“But if the new law tightens rules as suggested by the ministry of home affairs, which disallows surrogacy for same-sex couples and single parents, then it will clearly impact the industry and put off clients coming from overseas.”

BIRTH OF A MARKET

India opened up to commercial surrogacy in 2002. It is among just a handful of countries – including Georgia, Russia, Thailand and Ukraine – and a few U.S. states where women can be paid to carry another’s genetic child through a process of in-vitro fertilisation (IVF) and embryo transfer.

The low-cost technology, skilled doctors, scant bureaucracy and a plentiful supply of surrogates have made India a preferred destination for fertility tourism, attracting nationals from Britain, the United States, Australia and Japan, to name a few.

There are no official figures on how large the fertility industry is in India. A U.N.-backed study in July 2012 estimated the surrogacy business at more than $400 million a year, with over 3,000 fertility clinics across India.

The Akanksha clinic in Anand is the best-known at home and abroad, giving the small town in Gujarat state the reputation as India’s “surrogacy capital”.

“The surrogates in Anand have become empowered through giving this beautiful gift to others,” says Akanksha’s owner, IVF specialist Nayana Patel, who shot to fame in 2004 after she helped a patient have a baby by using the woman’s mother – the child’s grandmother – as a surrogate.

“With the money, they are able to buy a house, educate their children and even start a small business. These are things they could only dream of before. It’s a win-win situation.”

Patel, who appeared on U.S. celebrity Oprah Winfrey’s talk show in 2007, has produced more than 500 surrogate babies – two-thirds of them for foreigners and people of Indian origin living in over 30 countries.

Charging couples like Rekha and Daniel an average of $25,000 to $30,000, a fraction of the cost in the United States, Patel pays her surrogates around 400,000 rupees ($6,500).

For 33-year-old Naina Patel, who gave birth to Gabrielle, the compensation outweighs the downside. The wife of an auto-rickshaw driver with three daughters of her own, she had to live in a hostel for nine months with 60 other surrogates so the clinic could monitor her health.

Like most surrogates, she kept her pregnancy a secret due to the social stigma in India’s conservative society.

“I was happy to do it but it was not really out of choice because we needed the money,” she said in a hospital bed as she recovered from the Caesarean operation for Gabrielle’s birth.

“BABY FACTORIES”

India’s surrogacy industry is vilified by women’s rights groups who say fertility clinics are nothing more than “baby factories” for the rich. In the absence of regulation, they say many poor and uneducated women are lured by agents, hired by clinics, into signing contracts they do not fully understand.

In May last year, surrogate mother Premila Vaghela, 30, died days after delivering a child for an American couple at a clinic in Gujarat. It was recorded as an “accidental death” by police.

A recent government-funded study of 100 surrogate mothers in Delhi and Mumbai found there was “no fixed rule” related to compensation and no insurance for post-delivery healthcare. It cited cases where surrogates were implanted with embryos multiple times to raise the chances of success.

“In most of these cases, the surrogate mothers are being exploited,” said Ranjana Kumari, director of the Centre for Social Research that conducted the study.

Moves to introduce a law – the Assisted Reproductive Technologies Bill (ART) – to protect surrogates, the children and the commissioning parents is long overdue, Kumari said.

Revised visa requirements introduced in July have already resulted in foreign same-sex couples and individuals being prohibited from surrogacy in India. The ART bill, expected to come before parliament next year, will tighten things further.

Under the current draft, all fertility clinics must be registered and monitored by a regulatory authority. Surrogates must be between 21 and 35 years old, they will be provided with insurance and notarised contracts must be signed between the women and the commissioning parents.

“Legislation should be there so that this wonderful procedure can be supervised and it is being done by the right people for the right people,” said Akanksha’s Patel.

“But more bureaucracy will make it difficult for everyone. It will not only mean less commissioning parents from overseas but it will also impact surrogates, who will lose out on the only chance they have to change their lives for the better.”

(Editing by John O’Callaghan and Ron Popeski)

  • Link this
  • Share this
  • Digg this
  • Email
  • Reprints


Visit the Source Site

New Study Looks at Shared Medical Decision Making

Main Category: Arthritis / Rheumatology
Also Included In: Bones / Orthopedics
Article Date: 30 Sep 2013 – 0:00 PDT

Current ratings for:
New Study Looks at Shared Medical Decision Making

Patient / Public: not yet rated
Healthcare Prof: not yet rated

Shared decision making refers to a set of principles that can be employed by patients and their physicians to explicitly incorporate patient preferences and values into clinical decision making. Past research shows that patients, who have an enhanced knowledge of their medical conditions and treatment alternatives, demonstrate a reduced anxiety when it comes to medical decision making.

A recent study in the Journal of Bone and Joint Surgery looked at a group of patients with advanced hip and knee osteoarthritis and found that they reached an informed treatment decision after their first visit with an orthopaedic surgeon. Specifically, this study found the use of DVDs, booklets and a health coach helped patients quickly and confidently arrive at a treatment decision.

“Orthopaedics is a type of medicine that embodies preference-sensitive care,” said lead author Kevin Bozic, MD, MBA, vice chair of the department of orthopaedic surgery at the University of California, San Francisco and chair of the American Academy of Orthopaedic Surgeons(AAOS) Council on Research and Quality. “This means that for many orthopaedic conditions, there are several treatment options that may be appropriate for a given patient. Since there is no “right answer”, patient values and preferences must be taken into account when formulating a treatment plan. This is what shared decision making is all about,” Bozic added.

Study Details:

  • One hundred and twenty-three patients with OA of the hip or knee who were considered medically appropriate for hip or knee replacement were randomized to a shared decision making intervention group or usual care group.
  • Patients in the intervention group received a DVD and booklet describing the natural history and treatment alternatives for management of OA of the hip or knee. The booklet explicitly compared the risks and benefits of surgical and non-surgical options in a balanced fashion.
  • Intervention group patients after reviewing the DVD and booklet then got on the phone with a trained health coach to develop a list questions for their orthopaedic surgeon based on their preferences and values.
  • Patients in the control group only received information about the surgeon’s practice and a one-page informational handout about the signs and symptoms, diagnosis, and treatment options.
  • Patient characteristics were similar in both groups. The majority of patients were over 60 years of age, female, non-Hispanic, completed at least some college education, earned more than $50,000 per year and were insured by either private insurance or Medicare.

Key Findings:

  • Fifty-eight percent of patients in the intervention group reached an informed decision during the first visit compared to 33 percent of patients in the control group.
  • The intervention group reported higher confidence in knowing what questions to ask their doctor.
  • There was no significant difference between groups in the percentage of patients choosing surgery.

“When patients feel more prepared for their visit, and they are armed with credible, factual information about their condition as well as treatment alternatives, they feel empowered and confident to make a decision that is consistent with their preferences and values.”

Dr. Bozic hopes this research will help uncover the benefits and dispel the myths surrounding shared decision making.

“Shared decision making can help improve the quality and efficiency of the healthcare we deliver and more importantly, is patient-centered. Our next step with this research is to overcome implementation challenges and make this model applicable to all physicians. The challenge is that we need to develop efficient ways to deliver specific shared decision making tools (decision aides, health coaches) to make these value-enhancing tools available to a wider range of orthopaedic surgeons and their patients.”

Article adapted by Medical News Today from original press release. Click ‘references’ tab above for source.
Visit our arthritis / rheumatology section for the latest news on this subject.
Please use one of the following formats to cite this article in your essay, paper or report:

MLA

American Academy of Orthopaedic Surgeons. “New Study Looks at Shared Medical Decision Making.” Medical News Today. MediLexicon, Intl., 30 Sep. 2013. Web.
30 Sep. 2013. <http://www.medicalnewstoday.com/releases/266712.php>


APA

American Academy of Orthopaedic Surgeons. (2013, September 30). “New Study Looks at Shared Medical Decision Making.” Medical News Today. Retrieved from
http://www.medicalnewstoday.com/releases/266712.php.

Please note: If no author information is provided, the source is cited instead.


‘New Study Looks at Shared Medical Decision Making’

Please note that we publish your name, but we do not publish your email address. It is only used to let you know when your message is published. We do not use it for any other purpose. Please see our privacy policy for more information.

If you write about specific medications or operations, please do not name health care professionals by name.

All opinions are moderated before being included (to stop spam). We reserve the right to amend opinions where we deem necessary.

Contact Our News Editors

For any corrections of factual information, or to contact the editors please use our feedback form.

Please send any medical news or health news press releases to:

Note: Any medical information published on this website is not intended as a substitute for informed medical advice and you should not take any action before consulting with a health care professional. For more information, please read our terms and conditions.


Visit the Source Site