“This country’s extraordinary record of medical advancement makes its haphazard approach to maternal care all the more scandalous and disgraceful,” said Larry Cox, executive director of Amnesty International USA.
“Good maternal care should not be considered a luxury available only to those who can access the best hospitals and the best doctors. Women should not die in the richest country on earth from preventable complications and emergencies,” Cox said in a news release.
The report, “Deadly Delivery: The Maternal health Care Crisis in the USA,” notes that the lifetime risk of maternal deaths is greater in the United States than in 40 other countries, including virtually all industrialized nations.
The report also noted that severe pregnancy-related complications that nearly cause death — known as “near misses” — have increased by 25 percent since 1998.
Up to 40 percent of near misses are considered preventable with better quality of care, according to a 2007 study in the American Journal of Obstetrics & Gynecology.
Minorities, women living in poverty, Native Americans, immigrants and those who speak little or no English are particularly affected, Amnesty International said.
“The thing that really struck us was that these problems hit women of color, low-income, particularly hard,” said Nan Strauss, researcher and co-author of the Amnesty report. “But every woman who is going through pregnancy in this country is at risk.”
Figures compiled by the Centers for Disease Control and Prevention in Atlanta, Georgia, show that black women are three times more likely to die from pregnancy and childbirth than their white counterparts.
White women have a mortality rate of 9.5 per 100,000 pregnancies, the CDC said. For African-American women, that rate is 32.7 deaths per 100,000 pregnancies.
“This has been known for a while and no one has a good handle on it,” said Dr. Elliot Main, chairman and chief of obstetrics at California Pacific Medical Center in San Francisco. “This is a national disgrace and a call to action. Both numbers are a call to action — maternal mortality and racial disparity.”
The CDC analysis shows that deaths during pregnancy and childbirth have doubled for all U.S. women in the past 20 years.
In 1987, there were 6.6 deaths for every 100,000 pregnancies. The number of deaths had climbed to 13.3 per 100,000 in 2006, the last year for which figures were available.
A report called “Healthy People 2010″ by the Department of health and Human Services says that number should be around four deaths for each 100,000 pregnancies.
Statistics for other highly industrialized countries show that the U.S. goal of four deaths for every 100,000 pregnancies is attainable. Great Britain, for example, has fewer than four deaths for each 100,000 pregnancies, Main said.
“Women’s health is at risk,” said Strauss. “We spend the most, and yet women are more likely to die than in 40 other countries. And that disconnect is what makes it such a problem.”
Amnesty International points out that nearly 13 million U.S. women of reproductive age (15 to 44 years old), or one in five, do not have health insurance. Minorities account for 32 percent of all women in the United States but 51 percent of uninsured women, the rights group said.
Furthermore, Amnesty International said, one in four women do not receive adequate prenatal care, starting in the first trimester. The number rises to about one in three for African-American and Native American women, the human rights group said.
Amnesty International also cited what it called “burdensome bureaucratic procedures in Medicaid enrollment [that] substantially delay access to vital prenatal care for pregnant women seeking government-funded care.”
In addition, the group said, a shortage of health care professionals poses a serious obstacle to timely and adequate care, especially in rural areas and inner cities. In 2008, 64 million people were living in “shortage areas” for primary care, Amnesty International said.
“Obstacles to care are widespread, even though the USA spends more on health care than any other country and more on pregnancy and childbirth-related hospital costs, $86 billion, than any other type of hospital care,” the rights group said.
In its call for Obama to take action, Amnesty International said a health care reform proposal before Congress does not address the issue.
“Reform is primarily focused on health care coverage and reducing health care costs, and even optimistic estimates predict that any proposal on the table will still leave millions without access to affordable care,” said Rachel Ward, one of the authors of the “Deadly Delivery” report.
“Mothers die not because the United States can’t provide good care, but because it lacks the political will to make sure good care is available to all women,” said Cox, Amnesty International USA’s executive director.
Medical professionals and researchers note that although the percentage of maternal deaths is increasing, the overall number still remains low.
“They are low in absolute number sense,” said Main in San Francisco. “These are rare events. They serve as a canary in the mine shaft — tell us that we need to look more carefully at the system of maternity care. Overall, childbirth is very safe.”
More of an alarm is not sounded, analysts said, because most practitioners don’t see many — if any — deaths each year.
There is now approximately one death for every 6,000 to 10,000 births, Main said. A typical hospital has about 1,500 births a year, so any hospital can go years without a maternal death, he said.
“It’s still, thank heavens, quite rare,” said Debra Bingham, executive director of California Maternal Quality Care Collaborative.
But that doesn’t mean there’s not a problem, she said.
“When you see trends worsen in such a short period of time, it requires thoughtful examination,” said Bingham. “And you can’t just dismiss that.”
Rivka Gordon, director of strategic initiatives at the Association of Reproductive health Professionals, also believes something should be done.
“It’s unacceptable in a resource-rich country like the U.S. that we are seeing maternal- and pregnancy-related deaths trending upward,” she said. “We have to look very, very carefully at this.”

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eaving a meeting of the House Democratic Caucus, lawmakers said they had received few details about what would be in the legislation, on which they may be asked to vote in the next week or two.

“Everyone expressed frustration that we do not have comprehensive cost estimates from theCongressional Budget Office,” said Representative Gerald E. Connolly, Democrat of Virginia.

In addition, lawmakers said, they were not given the text of the latest legislation drafted by House and Senate Democratic leaders and the White House to address widespread concerns about the bill passed by the Senate in December.

Speaker Nancy Pelosi said the House would soon approve the Senate bill and a separate package of changes, using a procedure known as budget reconciliation to avoid the threat of a filibuster against the second bill in the Senate.

Representative Anthony D. Weiner, Democrat of New York, said it was difficult for lawmakers to know how they would vote on a bill they had not seen.

House Democrats said Ms. Pelosi had assured them they would have at least one week to examine the text of the budget bill before voting on it.

Democratic aides said House leaders wanted the vote to occur before a two-week spring break scheduled to start on March 26. Otherwise, they said, wavering lawmakers might buckle to pressure from critics of the bill, who plan to step up their campaign against it during the recess.

President Obama plans to leave Thursday on a trip to Indonesia and Australia. With his health care bill hanging in the balance, he faces intensifying questions about whether he should put off the trip, which was timed to coincide with his daughters’ spring break.

The budget reconciliation bill would reduce the Senate’s tax on high-cost health insuranceplans and increase subsidies to help low-income people buy health insurance, Ms. Pelosi said. To help offset the additional costs, lawmakers would increase the Medicare payroll tax on wages and extend it to unearned income, like dividends and interest, for affluent taxpayers.

Democratic leaders in the two chambers said Thursday that they had reached agreement to use the budget bill as a vehicle to enact another of Mr. Obama’s top domestic priorities, overhauling the student loan program. Under the president’s plan, the government would make loans directly to students, instead of guaranteeing loans by private banks.

But Democrats said they were nowhere near agreement on the explosive question of how to restrict insurance coverage of abortion under the health care bill.

Democratic opponents of abortion, led by Representative Bart Stupak of Michigan, have threatened to vote against the Senate bill, saying its abortion restrictions are not tough enough. Senate rules and precedents suggest that the budget bill could not be used to alter those restrictions because they would not have a substantial effect on federal spending.

House Democratic leaders have had desultory talks with Mr. Stupak, but appeared willing to bypass him if they conclude his vote is not needed. Mr. Stupak said he and at least 11 other House Democrats would vote against the Senate bill unless the abortion language was changed.

But Representative Jan Schakowsky, Democrat of Illinois, said she doubted that Mr. Stupak had as may votes as he claimed.

“There is no way in this legislation to satisfy Bart’s demands,” Ms. Schakowsky said. Mr. Stupak wants to bar the use of federal money to pay for any part of the costs of any health plan that includes coverage of elective abortions.

In both chambers, Democrats are preparing for a titanic battle that will involve politics and parliamentary procedure as much as health policy.

House Democrats are so skittish about the Senate bill that they are considering a maneuver that would allow them to pass it without explicitly voting for it. The Senate measure would be “deemed passed” if and when the House adopts rules for debate on the follow-up budget reconciliation bill. If the House approves both bills, the health care measure would be ready for signing by the president. But the budget bill would go to the Senate, where Republicans plan to propose dozens of amendments.

Senator Richard J. Durbin of Illinois, the No. 2 Democrat in the Senate, said it might eventually be necessary for the presiding officer — perhaps Vice President Joseph R. Biden Jr. — to limit the number of amendments.

Mr. Durbin said “there is no precedent” that would prevent the presiding officer from taking such action. At some point, Mr. Durbin said, the Senate must decide: “What is dilatory? How many amendments are too many?”

In an updated report, the Congressional Budget Office said Thursday that the Senate-passed bill would spend $875 billion to provide coverage for 31 million uninsured people over the next 10 years. The cost, it said, would be more than offset by new taxes and fees and by cutbacks in Medicare, so the bill would reduce budget deficits by a total of $118 billion over 10 years.

Moreover, the budget office said, in the decade after 2019, the bill would tend to reduce the “federal budgetary commitment to health care,” which reflects the cost of health programs and tax breaks for health care.

David M. Herszenhorn and Sheryl Gay Stolberg contributed reporting.

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You can read about the study that led to these findings in the March 2010 issue of the journal Gastroenterology, which is also available online.

Among the researchers were Dr Kerry Lee Milner and Professor Don Chisholm from Sydney’s Garvan Institute of Medical Research and Professor Jacob George from the Storr Liver Unit, University of Sydney at Westmead Hospital.

Hepatitis C is a virus that lives in the blood and can be passed from one drug user to another by sharing needles: in Australia this is the main route of transmission. However, unsterile tattooing or body piercing is another way the virus can spread.

Unlike Hepatitis A and B, there is no vaccine for Hepatitis C, of which there are 6 strains, the two most common in Australia being Genotype 1 and Genotype 3, which causes significant amounts of fat to deposit in the liver.

Insulin, a hormone that helps the body convert glucose into energy, is made in the pancreas, but the two most important organs that respond to it are the liver and muscle, each responding differently. When it detects insulin, the liver stops making glucose, while healthy muscle responds by using glucose.

A liver that has become insulin resistant overproduces glucose, while muscle that has become insulin resistant does not absorb glucose so well from the bloodstream. In both cases the result is too much circulating glucose.

When they studied the insulin resistance of 29 people with Hepatitis C (14 with Genotype 1 and 15 with Genotype 3) and confirmed they had high insulin resistance, they found to their surprise that nearly all the insulin resistance was in the muscle and hardly any in the liver.

Chisholm also told the media that contrary to expectations, not only did they find no significant insulin resistance in the liver of the study participants: “The fifteen people with very high levels of fat in the liver [the participants with Genotype 3] had the same degree of insulin resistance as the fourteen that didn’t have fatty livers.”

Chisolm said experts around the world have been arguing that fat in the liver is an important factor in the development of insulin resistance, perhaps the most important. But this study shows this may not be the case, he said.

“Before you get Type 2 diabetes, you must become insulin resistant and your insulin producing cells must also fail to compensate. Insulin resistance alone will not give you diabetes,” he explained.

For this study, Chisolm and colleagues gave intravenous glucose, which specifically stimulates insulin secretion, and showed that it was not impaired in the Hepatitis C patients compared to controls.

“This finding tells us that people with Hepatitis C who develop diabetes probably have susceptible insulin-producing cells, and would probably get it anyway — but much later in life,” said Chisolm.

The extra insulin resistance caused by Hepatitis C apparently brings on diabetes at 35 or 40, instead of 65 or 70,” he added.

The researchers suggest further research should now be done to find out why Hepatitis C causes insulin resistance in muscle.

“That will give us better insight into the behaviour of the disease,” said Chisolm.

For people with Hepatitis C, the message from this study is a deeper understanding of insulin resistance, and perhaps, if they have family members with Type 2 diabetes, they would be advised to manage their diets very carefully and take plenty of exercise, as this delays onset.

Estimates suggest there are currently around 212,000 Australians infected with Hepatitis C, with 10,000 new infections a year.

“Chronic Hepatitis C Is Associated With Peripheral Rather Than Hepatic Insulin Resistance.”
Kerry-Lee Milner, David van der Poorten, Michael Trenell, Arthur B. Jenkins, Aimin Xu, George Smythe, Gregory J. Dore, Amany Zekry, Martin Weltman, Vincent Fragomeli, Jacob George, Donald J. Chisholm.
Gastroenterology, March 2010 (Vol. 138, Issue 3, Pages 932-941.e3)

Source: GAVAN Institute.

Written by: Catharine Paddock, PhD
Copyright: Medical News Today
Not to be reproduced without permission of Medical News Today

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They found that 3.8 percent of 425 women had breast cancer in the undiagnosed breast that had not been found with a clinical or mammographic examination; all were postmenopausal. In these women, detecting and treating cancer in both breasts at the same time may save costs, patient stress, and the potential toxicity that may come from having to treat cancer later in the second breast once it is discovered, the researchers say in the March/April issue of The Breast Journal.

Of particular interest to the researchers is their finding that patients 70 and older had a higher prevalence of cancer detected in the second breast by MRI than did younger patients in the study. MRI detected a cancer in the second breast in 5.4 percent of 129 elderly women included in the study.

“Our findings are not really surprising because we know that the risk of breast cancer increases as age increases,” says the study’s lead investigator, Johnny Ray Bernard Jr., M.D., a Radiation Oncologist at Mayo Clinic in Jacksonville. “Elderly women in good health potentially benefit from earlier detection, and we believe that screening of the undiagnosed breast with MRI should be considered in all postmenopausal women diagnosed with a breast cancer.”

Since 2003, Mayo Clinic in Jacksonville has offered MRI imaging of both breasts in women with newly diagnosed breast cancer. In this study, Mayo researchers retrospectively reviewed the records of 425 women who underwent bilateral breast MRI between 2003 and 2007. The goal was to determine the prevalence of “contralateral” cancer detected by MRI, but not found by mammogram or clinical breast exams. Contralateral refers to the opposite breast where cancer was not diagnosed.

They concluded that postmenopausal status was the only statistically significant predictor of contralateral cancer detected by MRI. In 72 of the 425 women, MRI detected a suspicious lesion. A follow-up biopsy showed that 16 (22 percent) of the 72 women had contralateral breast cancer (stage 0-1) that had not been detected with typical screening methods. Of the 16 women diagnosed with a contralateral cancer, seven were 70 or older.

The researchers undertook the study, they say, because to their knowledge, no published studies in the medical literature that have examined the use of MRI to screen contralateral breasts in women diagnosed with breast cancer have included an analysis of women 70 and older.

It makes sense to look at women of this age, they say. Studies have shown that MRI of the breast has a higher cancer detection rate than clinical breast examination and mammography alone in women at high risk for developing breast cancer, according to Dr. Bernard. He added that women who have been diagnosed with breast cancer are at 2-to-6 times increased risk for developing a secondary, contralateral breast cancer, compared to women at average risk. “So the combination of older age and a personal breast cancer history possibly makes women aged 70 years or older with newly diagnosed breast cancer at even higher risk for developing a contralateral breast cancer,” he says.

Dr. Bernard acknowledges that the routine use of breast MRI in all patients with a history of breast cancer at initial diagnosis is controversial, as is its use in elderly patients. But he says the findings from this study may help clarify the debate because it suggests that postmenopausal patients have the highest prevalence of contralateral breast cancer identified only by MRI, and not by mammogram or physical examination. “This could impact health care costs by limiting screening MRI to those groups likely to have higher detection rates, such as postmenopausal women in our study, and also could reduce costs by having both cancers treated at the same time instead of undergoing potentially toxic and expensive treatments twice that is, once the contralateral cancer is finally detected by mammogram or physical exam,” Dr. Bernard says.

The researchers also say there should be no age cutoff in use of MRI in these breast cancer patients. “We do feel that life span is underestimated in this older age group,” he says.

About Mayo Clinic

Mayo Clinic is the first and largest integrated, not-for-profit group practice in the world. Doctors from every medical specialty work together to care for patients, joined by common systems and a philosophy of “the needs of the patient come first.” More than 3,700 physicians, scientists and researchers, and 50,100 allied health staff work at Mayo Clinic, which has campuses in Rochester, Minn; Jacksonville, Fla; and Scottsdale/Phoenix, Ariz.; and community-based providers in more than 70 locations in southern Minnesota., western Wisconsin and northeast Iowa. These locations treat more than half a million people each year.

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1: Party 2: saline; 3: tomato; 4: sweet; 5: taste bud; 6 cells receiving sense; 7: nervous feeling. Photo: MH
Expression and causes
Pale mouth: The taste in the mouth only weaken themselves felt in the mouth bland. Common in the new infection or the end of the period as inflammatory bowel inflammation, disease and other diseases in the capital of the digestive system is born has prolonged fever, also met the great ca surgery, the lack of nutrition. Besides oral invisible bland flavor, taste decline even permanently lost as a characteristic of cancer, most appear in a middle-aged is not very alert. Need to distinguish cases of the elderly, the emulsion taste degeneration, tooth loss, is no longer sufficient, and the jawbone was contracted with varying degrees makes chewing your food carefully, even to swallowing, food is not fully exposed to the emulsion leads to taste food status unknown flavors.
Salty mouth: Seeing many seeds chronic pharyngitis, chronic nephritis, diseases of the nervous function or bay mouth sores.
Sour mouth: The self in the mouth with sour when eaten without appetite and temple, having many stomach diseases such as stomach ulcers.
Spicy mouth: The mouth feel is located in the spicy or the tongue feel numb spicy. This phenomenon often seen in the hypertension.
Bitter mouth: The mouth is bitter with a bitter taste in the mouth, see a lot of inflammation such as acute hepatitis, inflammation of security, this relationship to the metabolism of the security services. Bitter mouth can also see in cancer. Cancer patients not only lose the sense of sweets but also an increased feeling of bitterness on all food, this is related to the changing composition of saliva and blood circulation problem in translation tongue.
Dry mouth: This is usually seen in people who have diseases in the nervous system, insomnia, sleepless nights method. Simply adjust the sleep time can eliminate the dry mouth.
Sweet Mouth: The mouth feel of the sweet taste, also known as “export commitments, even boiling water also feels fresh or mix a little sweet with bitter. Often seen in people with digestive disorders, people with diabetes.
Mouth fragrant: Self in the mouth fragrant fruit experience in diabetes (soft target) weight, it should be taken to the hospital immediately for examination and treatment.
Loss of appetite
Loss of appetite not only for life but also enjoy reduced risk for loss of a risk warning system, affecting health. Loss of appetite sensations caused by inflammatory diseases and degenerative diseases of the oral cavity; effects of some medications, particularly medications that affect the reproductive process of cell resistance of thyroid medication, anti – cancer; using radiotherapy in oral cavity and almost; virus infection; endocrine disorders; u new birth and disorders in the elderly. Loss of appetite is very dangerous because it can not detect the odor when to eat food poison, rot damage, food allergens. Loss of appetite and depression brought … increased risk for the disease of hypertension, diabetes, cerebral vascular ear … danger to life.
In short, the vision to help people enjoy foods and snacks also help identify foods good or bad for health. When type taste disorders tend to finish lunch meals, no longer interested in friends. As a result, malnutrition, losing weight. Disorders can be adjusted after the doctor detailed rate and determine the cause. Therefore, when we change the taste after a while no need to go help the doctor to be examined as soon as possible.

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Capricorn (Son Duong 22/12 – 20 / 1)
According to research by experts, if someone’s birthday also falls into this in terms of health, that person may have a certain number of characteristics such as easy to encounter some problems knee joint, diseases related to chronic arthritis … The experts also offer advice to ensure that health provision for people Son Duong (sheep), the rest should have reasonable mode to avoid stress and mode of food supplements containing more omega fatty acids – the three components against oxidation. Fresh milk is considered food fit for health care provision for people from Son Duong.
Aquarius (Aquarius 21 / 1 – 19 / 2)
Research indicates that the ligament injury is most frequent damage easier for those who provide the Aquarius, especially in the legs below the leg, the foot and ankle. By observing and analyzing the psychological characteristics of people in this supply, experts said, computer or running campaigns and is a feature quite common in the constellation of Aquarius, so they are easy risk of this injury. People in the constellation Aquarius match with rich foods magnesium, zinc …, special diets should eat more fruits to protect the best of health.
Pisces (Pisces from 19 / 2 – 20 / 3)
Symbol of the constellation Pisces is the fish, according to astrology, the symbol has a special relevance to certain problems feet. People with birthday in the constellation Pisces susceptible infected diseases as it appears at the foot of the deep cuts, bruising and some other mild skin lesions. Mode of health care for those in Pisces should also pay attention to the care of feet, additional ingredients beneficial nutrients for the body, such as omega – 3 from foods such as fish and sea vegetables .
Aries (Aries 21 / 3 – 19 quarters)
Astrology research indicates that people of the constellation of Aries is often the natural mind and activities susceptible to infected documents nervous tension, headaches. To overcome this risk, the constellation of Aries should have a regime of rest and eat accordingly. Best diet for their health as vegetables, tomatoes, beef … Like the symbol of fire, the color is consistent with the birthday of the constellation of Aries is red fire.
Taurus (Taurus from 20 quarters – 20 / 5):
Icon buffalo and the characteristics of the constellation Taurus indicates that people of the constellation is easy to encounter problems related to health, mainly throat inflammation, fever, feel … Mode rational nutrition care to people in the constellation Taurus the additional water and vitamin C to strengthen the resistance of the body. In addition, the provision of Taurus should also pay attention to the health care body regularly.
Gemini (Song Girl 21 / 5 – 21 sixths)
Twins tied together is a symbol of the constellation Song Girl, according to the astrological observation, may indicate that the risk of stress is quite high in those with birth date of this provision. In addition, those who have the same birthday Song Women have the incidence of pain associated state of stress and fatigue. Fruits suitable for the provision of the Song Girl fruits rich in vitamins like oranges, carrots …
Cancer (Cancer 22 / 6 – 22 sevenths)
Icon crab barbs across a mysterious relationship to the health of the people of the same cancer. According to astrologers, there are signs of risk of esophagus and stomach. Among the common diseases of the cancer should also pay special attention to diet so that reasonably benefit the digestive system and stomach. To best protect the health, should limit the use of beverages such as caffeine, and food allergens easy … also actively eating foods good for the digestive system, such as cabbage, cauliflower, green vegetables … by the food is very good for digestion and health benefits.
Leo (Leo from 23 7-22 /
Astrology indicates that people born on the Leo is also the risk of heart disease and hypertension than other diseases. Regime of rest, relaxation and reasonable collective nature well suited for regular supply of the Lion. In addition, dietary supplement is rich in fruit antioxidants such as grape or a little wine is good for health and prevention of cardiovascular performance.
Virgo (Virgo from 23 8-22 / 9)
Symbol of the constellation Virgo is a virgin goddess – who bring crops and food for humans. Who have the same birthday Virgo rarely infected with disabilities. Foods they are consistent with grains, high fiber foods good for the digestive system.
Libras (Libra from 23 / 9 – 22/10)
Symbol of Libra is the balance, but the world astrology is closely related to health and back pain or stress. Rest with cool mode – far and acupuncture, acupuncture points are very good press for the cases of patients with back pain. Those who have the same birthday Libra should eat more fruits, especially strawberries to enhance health and immunity against infection.
Scorpio (Scorpion from 23/10 – 21/11)
The same people often encounter Scorpion issues gut. This is evidence diseases cause difficulty in the absorption of the digestive system and ease the situation leading to weight loss, malnutrition for patients. People of the Scorpion should also exercise like yoga regime and set the air, so eat more foods with fiber for good digestive system.
Sagittarius (Nhân code from 23/11 – 21/12)
Diseases related to persons born on the same code as diseases myalgia, back pain, difficulty blood flow … The astrologer and the scientific community after research showed that these people should have a regime of physical exercise suitable to enhance blood circulation. Diets with more low-fat food and other anti-oxidation is also very beneficial for the cardiovascular system of the same Human Code.

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