With out heart we can

Heart Stop Beating is the story of two visionary Texas Heart Institute doctors, Dr. Billy Cohn and Dr. Bud Frazier. Frustrated by the often short lifespans and mulitple complications of usual heart replacement devices, the two  invented a two centrifugal pump machine. Cohn and Frazier tested the machine by removing the hearts of  several calf’s and replacing them with the device.
After much success it was time for human trials.
The first patient would be Craig Lewis, was 55-year-old dying from amyloidosis, a disease which causes a buildup of abnormal proteins. The proteins clog the organs so much that they stop working. Lewis’ heart was so damaged, he only had 12 hours to live.
So, in March of 2011, the doctors successfully replaced Lewis’ heart with the ‘continuous flow’ device they developed, proving that life was possible without a pulse or a heart beat–essentially without a human heart.
Although Lewis died due to complications from his disease, the heart pumps have yet to wear out like traditional devices, the trade off  is the loss of the familiar and elemental sound of a beating human heart — a small price for a working heart.

Resistance will kill 300 Million People by 2050

Antibiotic Resistance Will Kill 300 Million People by 2050

New report says pharma companies make more money from other drugs, so shy away from new antibiotic development


The true cost of antimicrobial resistance (AMR) will be 300 million premature deaths and up to $100 trillion (£64 trillion) lost to the global economy by 2050. This scenario is set out in a new report which looks to a future where drug resistance is not tackled between now and 2050.
The report predicts that the world’s GDP would be 0.5% smaller by 2020 and 1.4% smaller by 2030 with over 100 million premature deaths. The Review on Antimicrobial Resistance, chaired by Jim O’Neill, is significant in that it is a global review that seeks to quantify financial costs.
This issue goes beyond health policy and, on a strictly macroeconomic basis, it makes sense for governments to act now, the report argues. "One of the things that has been lacking is putting some pound signs in front of this problem," says Michael Head at the Farr institute, University College London, UK, who sees hope in how a response to HIV came about. "The world was slow to respond [to HIV], but when the costs were calculated the world leapt into action."
He recently totted up R&D for infectious diseases in the UK and found gross underinvestment in antibacterial research: £102 million compared to a total of £2.6 billion. Other research shows that less than 1% of available research funds in the UK and Europe were spent on antibiotic research in 2008–2013.
Bleak future
RAND Europe and KPMG both assessed the future impact of AMR. They looked at a subset of drug resistant pathogens and the public health issues surrounding them for Klebsiella pneumonia, Escherichia coli, Staphylococcus aureus, HIV, tuberculosis and malaria. The RAND Europe scenario modelled what would happen if antimicrobial drug resistance rates rose to 100% after 15 years, while infection rates held steady. The KPMG scenario looked at resistance rising to 40% from today’s levels and the number of infections doubling. Malaria resistance results in the greatest number of fatalities, while E. coli resistance accounts for almost half the total economic impact as it is so widespread and its incidence is so high.
"You can look at antibiotic resistance as a slow moving global train wreck, which will happen over the next 35 years," says health law expert Kevin Outterson at Boston University, US. "If we do nothing, this report shows us the likely magnitude of the costs."
Outterson headed up a recent Chatham House report on new business models for antibiotics that highlighted the problem of inadequate market incentives. "If I came out with a new cardiovascular drug, it could be worth tens of billions of dollars a year," he says. "But if we had the same innovative product as an antibiotic, we would save it for the sickest and it would sell modestly in the first decade. So market uptake is extraordinarily limited for innovative antibiotics and all for excellent public health reasons."

9 spices Decrease Triglyceride levels By 30 percent

These 9 Spices Decrease Triglyceride Levels By 30 Percent

Antioxidant-rich spices and herbs could help to improve triglyceride concentrations and other blood lipids, according to new research.



 The paper analyses the metabolic effects of herbs and spice blends -- focusing in particular on the potential cardiovascular benefits of the ingredients that are traditionally used to add flavour to foods -- before testing whether meals prepared with a spice blend offer functional benefits.

Led by Professor Sheila West from Penn State, they noted that triglyceride levels rise after eating a high-fat meal -- which can lead to an increased risk of heart disease. If a high-antioxidant spice blend is incorporated into the meal, triglyceride levels may be reduced by as much as 30 percent when compared to eating an identical meal without the spice blend. The spiced meal included:

1) Garlic powder
2) Rosemary
3) Oregano
4) Cinnamon
5) Cloves
6) Paprika
7) Turmeric
8) Ginger
9) Black pepper

"The metabolic effects of spices and herbs and their efficacy and safety relative to traditional drug therapy represent an exciting area for future research given the public health significance of cardiovascular disease," wrote the team.

Daily supplementation of curcumi n alone combined with diet and exercise strategies are known to be associated with more than a 60% reduction in triglyceride levels

"We live in a world where people consume too many calories every day," said West. "Adding high-antioxidant spices might be a way to reduce calories without sacrificing taste."

West and her colleagues are now working on a further study that will monitor study participants for eight hours after eating a meal with a high-antioxidant spice blend in order to test what happens to the fat in such a meal.

"If (the fat) isn't being absorbed when spices are included in the meal, it might be excreted instead," she suggested. "We will examine whether spices affect how rapidly the meal is processed through the stomach and intestines."

Study Details

In the study West and her colleagues conducted their initial study after reviewing the literature for evidence of spices and herbs benefits on heart health. The review suggested that cinnamon may have benefit for lowering cholesterol in people with diabetes, while garlic was also suggested to have benefits for cholesterol and heart disease risk.

As part of their study, the team prepared meals for six men between the ages of 30 and 65 who were overweight, but otherwise healthy, on two separate days.

The meals were identical - consisting of chicken, bread and a dessert biscuit - except that the researchers added two tablespoons of a high-antioxidant culinary spice blend to the test meal.

The spiced meal included garlic powder, rosemary, oregano, cinnamon, cloves, paprika, turmeric, ginger and black pepper. West and colleagues then followed the participants for three hours after each meal, drawing blood every 30 minutes.

Antioxidant activity in the blood increased by 13% after the men ate the test meal when compared to the control meal, which may help prevent cardiovascular disease and other chronic diseases, they suggested.

The addition of spices and herbs to the test meal also significantly decreased postprandial insulin responses by 21% and triglycerides by 31% as shown in the

Total blood cholesterol, HDL cholesterol, and glucose levels were not affected, they added.

"These findings suggest that a blend of spices and herbs may help improve levels of postprandial insulin and triglyceride concentrations after a high-fat meal while also enhancing the antioxidative capacity of blood," wrote West and her colleagues.

Mae Chan holds degrees in both physiology and nutritional sciences. She is also blogger and and technology enthusiast with a passion for disseminating information about health .

60 Percent Reduction In Triglycerides By Using Curcumin and Lifestyle Changes

What is diabetes?

What is diabetes?

Diabetes is a chronic disease that occurs either when the pancreas does not produce enough insulin or when the body cannot effectively use the insulin it produces. Insulin is a hormone that regulates blood sugar. Hyperglycaemia, or raised blood sugar, is a common effect of uncontrolled diabetes and over time leads to serious damage to many of the body's systems, especially the nerves and blood vessels.

In 2014, 8.5% of adults aged 18 years and older had diabetes. In 2015, diabetes was the direct cause of 1.6 million deaths and in 2012 high blood glucose was the cause of another 2.2 million deaths.

Type 1 diabetes

Type 1 diabetes (previously known as insulin-dependent, juvenile or childhood-onset) is characterized by deficient insulin production and requires daily administration of insulin. The cause of type 1 diabetes is not known and it is not preventable with current knowledge.

Symptoms include excessive excretion of urine (polyuria), thirst (polydipsia), constant hunger, weight loss, vision changes, and fatigue. These symptoms may occur suddenly.

Type 2 diabetes

Type 2 diabetes (formerly called non-insulin-dependent, or adult-onset) results from the body’s ineffective use of insulin. Type 2 diabetes comprises the majority of people with diabetes around the world, and is largely the result of excess body weight and physical inactivity.

Symptoms may be similar to those of type 1 diabetes, but are often less marked. As a result, the disease may be diagnosed several years after onset, once complications have already arisen.

Until recently, this type of diabetes was seen only in adults but it is now also occurring increasingly frequently in children.

Gestational diabetes

Gestational diabetes is hyperglycaemia with blood glucose values above normal but below those diagnostic of diabetes, occurring during pregnancy.

Women with gestational diabetes are at an increased risk of complications during pregnancy and at delivery. They and their children are also at increased risk of type 2 diabetes in the future.

Gestational diabetes is diagnosed through prenatal screening, rather than through reported symptoms.

Impaired glucose tolerance and impaired fasting glycaemia

Impaired glucose tolerance (IGT) and impaired fasting glycaemia (IFG) are intermediate conditions in the transition between normality and diabetes. People with IGT or IFG are at high risk of progressing to type 2 diabetes, although this is not inevitable.

What are common consequences of diabetes?

Over time, diabetes can damage the heart, blood vessels, eyes, kidneys, and nerves.

1. Adults with diabetes have a two- to three-fold increased risk of heart attacks and strokes.
2. Combined with reduced blood flow, neuropathy (nerve damage) in the feet increases the chance of foot ulcers, infection and eventual need for limb amputation.
3. Diabetic retinopathy is an important cause of blindness, and occurs as a result of long-term accumulated damage to the small blood vessels in the retina. 2.6% of global blindness can be attributed to diabetes.
4. Diabetes is among the leading causes of kidney failure.

How can the burden of diabetes be reduced?

Prevention

Simple lifestyle measures have been shown to be effective in preventing or delaying the onset of type 2 diabetes. To help prevent type 2 diabetes and its complications, people should:

1. achieve and maintain healthy body weight;
2. be physically active – at least 30 minutes of regular, moderate-intensity activity on most days. More activity is required for weight control;
3. eat a healthy diet, avoiding sugar and saturated fats intake; and
4. avoid tobacco use – smoking increases the risk of diabetes and cardiovascular diseases.

Diagnosis and treatment

Early diagnosis can be accomplished through relatively inexpensive testing of blood sugar.

Treatment of diabetes involves diet and physical activity along with lowering blood glucose and the levels of other known risk factors that damage blood vessels. Tobacco use cessation is also important to avoid complications.

Interventions that are both cost-saving and feasible in developing countries include:

1. blood glucose control, particularly in type 1 diabetes. People with type 1 diabetes require insulin, people with type 2 diabetes can be treated with oral medication, but may also require insulin;
2. blood pressure control; and
3. foot care.

Other cost saving interventions include:

1. screening and treatment for retinopathy (which causes blindness)
2. blood lipid control (to regulate cholesterol levels)
3. screening for early signs of diabetes-related kidney disease and treatment.

WHO response

WHO aims to stimulate and support the adoption of effective measures for the surveillance, prevention and control of diabetes and its complications, particularly in low and middle-income countries. To this end, WHO:

1. provides scientific guidelines for the prevention of major noncommunicable diseases including diabetes;
2. develops norms and standards for diabetes diagnosis and care;
3. builds awareness on the global epidemic of diabetes, marking World Diabetes Day (14 November); and
4. conducts surveillance of diabetes and its risk factors.

The WHO "Global report on diabetes" provides an overview of the diabetes burden, the interventions available to prevent and manage diabetes, and recommendations for governments, individuals, the civil society and the private sector.

The WHO "Global strategy on diet, physical activity and health" complements WHO's diabetes work by focusing on population-wide approaches to promote healthy diet and regular physical activity, thereby reducing the growing global problem of overweight people and obesity.

* Defined as fasting blood glucose equal to or higher than 7 mmol/L, or on medication for raised blood glucose, or with a history of diagnosis of diabetes.

** High blood glucose is defined as a distribution of fasting plasma glucose in a population that is higher than the theoretical distribution that would minimize risks to health (derived from epidemiological studies). High blood glucose is a statistical concept, not a clinical or diagnostic category.

Key facts

1. The number of people with diabetes has risen from 108 million in 1980 to 422 million in 2014 (
2. The global prevalence of diabetes* among adults over 18 years of age has risen from 4.7% in 1980 to 8.5% in 2014 (1).
3. Diabetes prevalence has been rising more rapidly in middle- and low-income countries.
4. Diabetes is a major cause of blindness, kidney failure, heart attacks, stroke and lower limb amputation.
5. In 2015, an estimated 1.6 million deaths were directly caused by diabetes. Another 2.2 million deaths were attributable to high blood glucose in 2012
6. Almost half of all deaths attributable to high blood glucose occur before the age of 70 years. WHO projects that diabetes will be the seventh leading cause of death in 2030 /
7. Healthy diet, regular physical activity, maintaining a normal body weight and avoiding tobacco use are ways to prevent or delay the onset of type 2 diabetes.
8. Diabetes can be treated and its consequences avoided or delayed with diet, physical activity, medication and regular screening and treatment for complications.

antibiotics

Antibiotics tainted with a chemical used in rat poison may have caused the death of 13 women at a government sterilization camp in Chhattisgarh this week, officials suggested Friday after preliminary testing of the drugs.

An analysis of the antibiotic tablet Ciprofloxacin 500 revealed the medicine was adulterated with zinc phosphide, a chemical used in rat poison.

The drug had been seized from Raipur-based pharmaceutical company Mahawar Pharma on Thursday and has been sent for further tests.

Officials said a significant quantity of burnt medicines was found on the premises.

The symptoms shown by the women who became unwell after undergoing botched sterilizations is similar to how the body reacts to zinc phosphide, doctors in Bilaspur said.

After the surgery, the women had complained of nausea, vomiting and abdominal pain. The 13 died of cardiac arrest, kidney failure and respiratory breakdown. “Such a chemical results in high mortality,” health officials stated.

“We have conducted raids across the state and seized over 43 lakh similar tablets prepared by Mahawar Pharma,” Bilaspur commissioner Sonmoni Borah told HT.

Mahawar Pharma director Ramesh Mahawar and his son Sumit were arrested by Raipur police on Friday.

“Prima facie, there is strong suspicion of zinc phosphide adulteration in the antibiotic. But it can be confirmed only after we get final reports from the national drug laboratories in Kolkata and Delhi where the sample has been sent,” said state health principal secretary Dr Alok Shukla told HT. The final report of the laboratory tests are likely to reach by Sunday.

This is the first time the toxin has been traced in preliminary findings. “The initial tests were done at Bilaspur science college. We were surprised though it is just the first impression of zinc phosphide in the tablet,” said Borah.

Importance of India in Generic

                                         EXAMPLES OF THE IMPORTANCE OF INDIA

                                   AS THE “PHARMACY FOR THE DEVELOPING WORLD”

 

QUICK OVERVIEW:

• India is the main supplier of essential medicines for developing countries.

• 67 % of medicines exports from India go to developing countries.

• Main procurement agencies for developing countries’ health programmes purchase their

medicines in India, where there are quality products and low prices.

• Approx. 50% of the essential medicines that UNICEF distributes in developing countries

come from India

• 75-80% of all medicines distributed by the International Dispensary Association (IDA) to

developing countries are manufactured in India. (IDA is a medical supplier operating on a

not-for-profit basis for distribution of essential medicines to developing countries.)

• In Zimbabwe, 75% of tenders for medicines for all public sector health facilities come from

Indian manufacturers

• The state procurement agency in Lesotho, NDSO, states it buys nearly 95% of all ARVs

from India.

Antiretroviral medicines (ARVs) for AIDS treatment:

India is the world’s primary source of affordable ARVs, as it is one of the few countries with the apacity to produce these newer medicines as generics. Therefore, all AIDS programmes use India as their main source of products.

• 80% of ARVs MSF uses are purchased in India and are distributed in treatment projects in

over 30 countries.

• Globally, 70% of the treatment for patients in 87 developing countries, purchased by

UNICEF, IDA, the Global Fund (GFATM) and the Clinton Foundation since July 2005

has come from Indian suppliers.

• PEPFAR, the US President’s AIDS initiative also purchases ARVs from India for

distribution in developing countries, thus resulting in cost-savings up to 90%.

• 91% of the generic ARVs approved by the US Food and Drug Administration for PEPFAR

are from India.

• 90% of the ARVs used in Zimbabwe’s national treatment programme come from India.

Raw materials:

In addition, raw materials are exported from India to other countries for local production of

affordable medicines. This has been crucial to enabling national AIDS programmes, such as

those in Brazil or Thailand, to provide universal free access to ARVs.

IN DETAIL:

India is the main supplier of essential medicines for developing countries. This applies not only to AIDS medicines, but to medicines to treat other diseases, as well. India is the world’s leading supplier of inexpensive generic medicines, with approximately 67% of medicines exports going to developing countries.

1) International procurement agencies

The main procurement agencies for health programmes in developing countries, as well as national procurement agencies, purchase their medicines in India, where quality products can be purchased at low prices.

MSF:

• 40% of the money MSF spends on oral medicines is used to buy drugs from India (if injectables are included, the average lies at 26,5%).

UNICEF:

• India ranks second on the list of suppliers for UNICEF programmes (see figure 1)

• On medicines, India has a considerable lead over all countries below it on the list, and

Belgium only ranks first because of vaccines (e.g. combination vaccines are not yet being

produced in India).

• If vaccines are excluded, India is the source of approx. 50% of the essential medicines UNICEF distributes in developing countries.

Figure 1: Top 20 supplier countries for UNICEF2

IDA (International Dispensary Association)

• 75-80% of all medicines distributed by IDA to developing countries are manufactured in India (IDA is a medical supplier operating on a not-for-profit basis for distribution of essential medicines to developing countries.)

2) National supply stores for public/non profit sector:

Zimbabwe

• The National Pharmaceutical Company, Natpharm, (formerly Governmental Central Stores), states 75% of tenders for supply to national health facilities are won by Indian manufacturers.

3) Antiretrovirals – ARVs

India is the world’s primary source of affordable ARVs, as it is one of the few countries with the capacity to produce these newer medicines as generics. Therefore, all AIDS programmes use India as their main source of products.

• 80% of ARVs MSF uses are purchased in India and are distributed in treatment projects in

more than 30 countries.

• Globally, 70% or more of the antiretroviral pills currently used in developing countries to treat nearly two million people are manufactured by generic suppliers in India.

• PEPFAR, the US President’s AIDS initiative also purchases ARVs from India for distribution in developing countries. « In every case generic prices present an opportunity for cost savings; in some cases, the branded price per pack of a drug is up to 11 times the cost of the approved generic version”

• 91% of the generic ARVs approved by the US Food and Drug Administration for PEPFAR

are from India.

• 90% of the ARVs used in Zimbabwe’s national treatment programme come from India.

• The state procurement agency in Lesotho, NDSO, states it buys nearly 95% of all ARVs

from India.

4) Active Pharmaceutical Ingredients (APIs)

Raw materials from India are also exported to other countries for production of affordable medicines. This has been key in the success of national AIDS programmes’ ability to provide universal free access to ARVs.

As an example, generic production of medicines in Brazil is heavily dependent on APIs purchased from India. At the third meeting of the Commission on Intellectual Property Rights, Innovation and Public Health (CIPIH)6, Brazil stated: “Brazil is concerned whether the application of TRIPS in India and China may affect access to APIs, and thus their treatment programme.”

The same is true for Thailand, where the Government Pharmaceutical Organization of Thailand “gets 90% of its raw materials for ARV production from India. More specifically, the Thai Public Health Ministry has clearly stated that their ambitious antiretroviral treatment programme would not exist without generic drugs, which would not have been possible without Indian API supply”

Belly Fat Burning Foods – What To Eat To Get Rid of Belly Fat

Belly Fat Burning Foods – What To Eat To Get Rid of Belly Fat

 

Belly fat is linked with higher risk for developing various health issues, but belly fat burning foods can help you lose belly fat when combined with exercise. It is normal for every person to have some belly fat, even for people with flat abs. A healthy body needs some fat which contains essential nutrients. Our body uses fat to make tissue and create biochemicals, such as hormones.

Some of our fat is close to the surface right under our skin. Other fat can be found deeper inside our body around the organs, such as around our heart, lungs and liver. This deeper fat is called “visceral” fat and too much of it can affect our health.

Why belly fat is dangerous?

Too much belly fat (or what is called the “apple” shape) increases the risk of many health problems such as diabetes, heart disease, high blood pressure, stroke and even certain types of cancers.

The ironic thing is that even slim people can have hidden belly fat that is folded deep inside the belly around the stomach organs and is visible only by medical imaging. This might be due to genetic issues, unhealthy lifestyle and lack of exercising and puts them at risk just like the other people with a more visible belly fat.

Men tend to store more belly fat than women and it’s one of the reasons men have more coronary disease than women. Women tend to be protected before menopause, when their fat tends to be stored on the buttocks and thighs (the “pear” shape”). At menopause, however, women’s fat tends to settle in the belly, and this fat is much more dangerous than buttocks fat and greatly increases a woman’s risk of death from heart disease.

Diet is just part of the picture?

While your genetics may play a role in belly fat, this is just part of the picture. Most of belly fat is related to unhealthy lifestyle - being physically inactive and consuming too much calories. Being physically active is a key in losing belly fat and should be combined with healthy nutrition. If you only eat foods that seem to target belly fat without exercising, you will see much slower results. Find activity that you enjoy and do it on a regular basis, such as walking, running or biking. It’s also good if you can find a support group to help you with moral support to maintain the results.

Another part of the picture is sleep. I’ve written in the past about the dangers of sleep deprivation which one of them was weight gain. When we maintain enough hours of sleep we burn more calories. Recent studies (both in humans and animals) have linked insufficient sleep and a tendency to gain weight. Sleep duration affects the hunger and satiety, as well as the production of various hormones and has a direct effect on the metabolism of the body. In addition, it was found that people who don’t sleep enough are less active the next day and burn fewer calories. It was found that 8 hours of sleep provide the best metabolism. Some even claim that stress is part of the picture as we all know how emotional eating affects our diet.

What is the common link between the various lists of foods that fight belly fat?

Looking at various websites with lists of foods that fight belly fat can be quite confusing. The lists vary quite significantly in the length and content. It’s hard to know where to start from. After all, there is no magic diet for belly fat, but when you lose weight on any diet, belly fat usually goes first. So here I would like to concentrate in food categories that will help you to better maintain your weight over time:

1. Fiber rich foods

Research shows that eating 10 grams of soluble fiber per day helped to build less visceral fat over time. This is why many lists contain fiber rich foods, such as beans, legumes, various fruits and vegetables with the skin, whole grains and oats. Try to include soluble fiber in every meal and snack throughout the day. If you’re not used to eating this much fiber, add it gradually to avoid gas and diarrhea and be sure to drink at least 6 to 8 glasses of water daily.

2. Foods containing protein

Protein keeps you satisfied for longer and takes longer to digest. The reason for this is that protein molecules are long chains with strong links which are harder to break down, and the whole process is more time consuming. It has been calculated that to obtain 100 calories from a protein food, the system must use 30 calories (but only 12 calories for fat and 7 for carbohydrates). This is why many lists contain low-fat and low-sugar yogurt, skim milk, lean meat, fish and eggs, or plant based proteins such as beans, legumes, whole grains, nuts and seeds and certain vegetables. 1 egg, for example, contains 7 grams of protein. 1 cup of quinoa has 8 grams of protein and 5 grams of fiber. Tabouli is also high in fiber and protein. Also nuts are high in protein, fiber and healthy fats, so if you eat them in moderation, they are excellent to curb hunger between meals.

3. Foods those are high in water content

These foods take up more space in the gut which signals the body that you ate enough so you have less room for other foods. Many fruits and vegetables contain a lot of water and nutrients, but are low in calories, and this is why they appear in many lists, especially watermelon. Other fruits with high content water are berries, grapefruit, melons, oranges, apples, pears and more. Vegetables that have high water content are cucumber, lettuce, celery, radish, zucchini, tomato, cabbage and more. What’s good in general about fruits and vegetables is that these foods are generally full of water and they are also a good source of fiber and many other nutrients and antioxidants. Fruits have other benefit – being sweet, so can satisfy your sweet tooth for much less calories than cookies or other sweets. Vegetables, on the other hand, satisfy the desire to crunch and can be a healthy snack and a substitute to other unhealthy snacks. Try to munch on carrot and celery sticks or a sweet potato instead of chips, or make an interesting salad (but be careful about the dressing).

4. Hot foods

Hot foods can be of a high temperature or spicy (or both). Hot food takes longer to eat and with added bonuses such as fiber and water content that make you feel full. This is why oatmeal can be found in many lists, or homemade soups (broth based and not cream based). Also cayenne peppers appear in some lists as people tend to eat less when their food is spicy, and because they are believed to increase metabolism.

5. Foods that increase metabolism 

Some of these foods are green tea which has a phytochemical called EGCG that promotes weight loss by promoting the internal heat of the body and fat oxidation. Cayenne pepper contains capsaicin which is known to increase metabolism. Capsaicin increases the internal heat of the body, and in order to increase heat, energy is needed, and thus cayenne pepper contributes to increase metabolism. Also some studies suggest that vinegar may help the body break down fat, hence you can find it in some lists.

I know there are probably other foods that can get into the list, but I think you’ve got the idea. There are no miracles in how to lose belly fat. Lifestyle changes are key to a long term success.

Low Birth Weight and Preterm Multiple Births

Low Birth Weight and Preterm Multiple Births.

 

Over the past two decades, there has been a dramatic rise in the number of multiple births in Canada. Between 1994 and 2003, the rate of multiples (per 100 total births) increased 35%. The recent increase has a significant impact on perinatal health. Although multiples represent only 1 in 34 births, they account for 1 in 5 preterm births, 1 in 4 low birth weight births and 1 in 3.5 very low birth weight births. Families with twins or higher order multiples have special needs that are not always fully understood or appreciated. While babies are a special gift to a family, with multiples there is a greater risk of immediate and long-term health risks, plus substantial social, emotional and other consequences for the family. Compared to single born babies, multiple birth infants are at greater risk of suffering from long term disability, particularly cerebral palsy and of dying during the first year. Even when the babies are healthy, many parents experience overwhelming challenges in caring for, feeding and transporting two, three or more infants. As multiple birth children grow, they are also more likely to experience slower language development, behavioural disorders, challenges in school, and relationship difficulties. It is possible to reduce the risks and associated costs, and to improve health outcomes and the functioning of families by linking multiple birth families to a range of appropriate supports and services.

FREQUENCY OF MULTIPLE BIRTHS

• There are about 120,000 multiple birth children in Canada under the age of 13 and 48,000 multiple birth children age 5 and under.

• Each year there are close to 10,000 twin babies and 400 higher order multiple birth babies born in Canada.

• Approximately 41% of multiple birth children born in Canada live in the province of Ontario.

TYPES OF MULTIPLES

There are two types of multiples: monozygotic and dizygotic. Although the expressions “identical” and “fraternal” are commonly used by the media and general population, experts and parents of multiples consider these terms to be inaccurate labels that can have a negative impact on the multiples. For instance, using the term identical to describe monozygotic (MZ) multiples causes confusion. Although genetically identical, no two children are the same. Parents distinguish between their MZ babies by identifying their differences, and strive to foster their children’s individuality. Similarly, the term fraternal means a close brotherly relationship, and therefore does not describe boy/girl or all girl dizygotic (DZ) multiples.

• MONOZYGOTIC (MZ) multiples result from the splitting of a fertilized egg during the first two weeks after conception. Monozygotic twins have the same genetic makeup and therefore are of the same sex.

co Authors

 

• DIZYGOTIC (DZ) twins resulting from the fertilization of two different eggs.They can be either the same or of different sex, and genetically they are no more alike than any siblings.

• TRIZYGOTIC (TZ) – Triplets resulting from three fertilized eggs. No more genetically alike than singleton siblings.

• QUADRAZYGOTIC (QZ) – Quadruplets resulting from four fertilized eggs. No more genetically alike than singleton siblings.

• HIGHER ORDER MULTIPLE BIRTHS is the term used for births involving three or more babies (e.g. triplets, quadruplets, quintuplets). There can be many variations of zygosity within a higher order multiple set. For example, a set of quintuplets can consist of two MZ (monozygotic) children and three TZ (trizygotic) children resulting from four fertilized eggs.

INFLUENCING FACTORS

The odds of having multiples are influenced by many factors, and multiple birth rates have changed throughout the years due to some of those factors. The widespread use of fertility drugs and high-tech procedures such as in vitro fertilization (IVF), and increased maternal age are considered to be the major contributing factors to the increase in multiple births.

Multiple Births by Maternal Age

• Multiple births are more frequent among women in their thirties and forties. In 2002, approximately 55% of multiple birth babies were born to women age 30 and older. Infertility Treatments

• Approximately 35% of multiple pregnancies result from infertility treatments (fertility drugs and/or reproductive technologies). However, it is estimated that over 80% of higher order multiples result from these treatments.

• The incidence of monozygotic multiples is doubled in multiples conceived through the use of ovulation stimulation treatments.

Maternal Weight

• Women with a pre-pregnancy Body Mass Index (BMI) of 30 or greater are at a significantly increased risk of conceiving dizygotic multiples.

THE IMPACT OF MULTIPLE BIRTHS

Multiple birth infants have a disproportionately high risk of preterm birth, perinatal death and illness which places enormous stress on families as well as health, social and education services.

Maternal Health

• Multiple pregnancies present significant complications for pregnant women, such as gestational hypertension, preeclampsia, anemia, gestational diabetes, premature rupture of membranes, and postpartum hemorrhage.

• Reduced activity, withdrawal from employment, and prescribed bed rest (at home or hospital) during pregnancy are common for expectant mothers of multiples. Prolonged bed rest can lead to cardiac and/or respiratory problems and muscular wasting, and recovery from these problems may take several weeks.

• Cesarean section is needed for over 50% of twin pregnancies, and is almost always required for higher order multiples.

Since infection, prolonged pain, and delayed recovery are more common with caesarean deliveries, new mothers of multiples frequently have difficulty in holding, carrying and caring for their infants.

Problems Unique to Multiple Pregnancy

• Monozygotic multiples who share one placenta (monochorionic) have a high incidence of umbilical cord entanglement, Twin-to-Twin Transfusion Syndrome (TTTS)* and fetal death.

* TTTS is a condition in which blood from one monozygotic twin fetus transfuses into the other fetus via blood vessels i the placenta. TTTS can also occur between monozygotic multiples in a triplet or more pregnancy.

• Poor and differing fetal growth between the babies is common. Perinatal Death

• Occasionally one fetus dies in early pregnancy and is reabsorbed (Vanishing Twin Syndrome).

• Compared to mothers expecting a single baby, mothers expecting multiples are nearly three times more likely to lose one, more or all of their babies before birth.

Preterm Birth

• The average length of pregnancy is 36 weeks for twins, 33 weeks for triplets, 31 weeks for quadruplets, and 29 weeks for quintuplets.

• Most multiple birth babies are born before full term (40 weeks), and 57% of twins and 98% of higher order multiples are born preterm (before 37 weeks).

• Multiple births are the fastest growing segment of the preterm birth infant population,

representing 20% of all preterm births.

• Due to their prematurity, multiple birth infants frequently have ongoing health problems such as respiratory and neuro-developmental challenges, requiring prolonged and frequent hospitalization.

Infant Death

• Infant death is 4 to 5 times more likely to occur among multiple births than among singleton births.

• Multiple birth babies are more vulnerable to Sudden Infant Death Syndrome (SIDS).

Low Birth Weight

• Low birth weight (<2500 grams, or 5.5 lbs) and very low birth weight (<1500 grams, or 3.3 lbs) occur about nine times more frequently among multiple than singleton births.

• Multiples represent about 25% of all low birth weight infants and 28% of the very low birth weight infant population.

 

• The average birth weight for each multiple birth baby is approximately:

– Twins 2,500 grams (5-l/2 pounds)

– Triplets 1,800 grams (4 pounds)

– Quadruplets 1,400 grams (3 pounds)

• Given that multiple birth infants are more likely to be born with a low birth weight, they often have short and long term health and developmental problems, require more feedings during the early weeks or months, and tend to require more care.

Disabilities

• Complications during pregnancy, delivery and in the early weeks of life may result in one, more or all of the babies having special needs.

• Compared to singletons, twins are 1.4 times more likely to have a disability. Similarly, triplets are 3 times more likely to have a severe disability and 1.7 times more likely to have a moderate disability.

• Multiples are at a significantly increased risk of having Cerebral Palsy (CP). In contrast with single born children, twins are 10 times more likely, triplets 30 times more likely, and quadruplets 110 times more likely to have CP.

• Since disabilities and/or developmental delays are more common in multiples, parents often must commit to intensive and ongoing involvement in therapies throughout the first few years.

Psychosocial and Financial Issues

• Since death is much higher among multiple births than singletons, parents who lose one, more or all of their babies face extremely difficult situations. In the case of losing all of the babies, the parents have lost not only their babies but a unique parenting experience. If there are survivors, the parents find it hard to celebrate the birth and the anguish of death at the same time. As a result, some parents find it difficult to attach emotionally with the survivor(s). For those who have experienced years of infertility, the loss of one or more of the babies can be particularly heartbreaking.

These additional issues can make the grieving process more complex.

• Some centres that offer assisted conception, also offer Multifetal Pegnancy Reduction as an option to women who conceive higher order multiple pregnancies. Multifetal Pregnancy Reduction aims to increase a woman’s chance of a near term delivery of a singleton baby or twins instead of three or more babies.This procedure and associated decisions are not straight forward and the long term psychological effects may be profound. In particular, the decision whether or not to undergo this procedure can be extremely distressing. For many, after experiencing the emotional and financial strains of infertility, the decision to reduce seems to be in conflict with the goal of conception.

• The total cost of raising multiples is higher than the cost of raising the same number of singletons. Parents must purchase clothing and equipment all at once (e.g. cribs, special stroller, car seats, high chairs, etc.), preventing an opportunity to pass along hand-me-downs. The first year “start up” cost for basic essentials of infants for families with triplets is approximately $12,000 higher than families raising a single baby. This amount does not include: the cost of disposable diapers; transportation needs when a larger vehicle is required to accommodate three, four or more infant car seats; the cost of moving to larger accommodation or renovations to existing accommodation; childcare costs; or the loss of a second family income if the mother does not return to the paid labour force.

• Caring for multiples is more difficult and physically demanding than caring for one child, especially during infancy and childhood, and with higher order multiples. One Australian study showed that mothers of triplets spend an average of 197.5 hours per week (unfortunately there are only 168 hours in a week) between themselves and paid/volunteer assistance, on caring for their babies and managing the household. This situation can place extraordinary stress on the couple relationship.

• Parenting multiples presents unique situations and experiences yet information, support and advice regarding multiple births is often difficult to find.

• Compared to a single baby, the maternal and paternal attachment process takes longer and is more complex with two, three or more babies.

• Since most new mothers of multiples suffer from sleep deprivation and chronic fatigue, they are at higher risk of Post-partum Depression (PPD) than mothers of singletons.

• Parents of multiples are at risk of maternal isolation, marital stress, financial difficulties and illness. This stress, in combination with the lack of access to special information and support, places multiple birth families at an increased risk of family problems.

• As a result of the unrelenting parental demands, the associated fatigue, and the attention that multiple birth babies attract, the birth of twins, triplets or more can have a negative impact on other children in the family (e.g. behavioural changes).

• Due to the extraordinary parental stress, multiple birth infants are at a greater risk of abuse such as Shaken Baby Syndrome.

PREVENTION

In order to avoid short and long term problems, families with multiple birth children require timely access to preventative health care and social support that is specifically designed for parents of multiples.

• Physicians need to inform families who seek infertility treatments, about the known risks of multiple pregnancy, multi-fetal reduction, and parenting demands before starting therapy.

• Physicians need to refer patients to appropriate specialists for infertility management and high-risk multiple gestations.

• To ensure that the pregnancy goes as near to term as possible, women expecting multiples require:

– Early diagnosis of the multiple pregnancy (before 16 weeks) in order to :

• Identify monozygotic multiples sharing a single placenta (monochorionic)

• Put into place an appropriate obstetrical care management plan

• Allow the mother and her family adequate time to adjust

– Early nutritional counselling and dietary resources to support a weight gain of 18-27 kilos (40-60 pound)

– Education regarding preterm labour

– Obstetrical care which follows the protocols of best practice for multiple birth

• Multiple birth families need to receive special support. In particular:

– The primary antenatal care provider should identify all those involved in the care of the family and

ensure that close links are sustained throughout the pregnancy and postpartum period;

– Early prenatal classes designed for parents expecting multiples;

– Practical help and referral to local resources;

– Multiples-specific breastfeeding support.

– Links with other parents who share their unique experience (e.g. Multiple Births Canada, local parents of multiples support group).

– When the health of the mother or family circumstances indicates, limited activity, greater work restrictions and increased bed rest are often recommended. In these situations, mothers may also require in-home nursing support and household help, especially if there are older siblings.

• Creation of healthy public policies must recognize the need for and benefits of additional supports for multiple birth families. Programming must address barriers to supports and services for multiple birth families including lack of services, long waiting lists for services, and the need for service coordination.