Posts in category Children’s health

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‘Vaginal seeding’ birthing trend may not be safe, doctors warn

In an editorial published this week in the BMJ, physicians from the United Kingdom and Australia issued a strong cautionary note about one of the latest birthing trends: “vaginal seeding.”

The practice puts babies at risk of developing serious infections, they warn, and therefore should be avoided until research determines whether it’s safe.

Parents, including those in the U.S., are increasingly requesting that their ob-gyn perform vaginal seeding, also known as microbirthing, when their baby is born by Caesarean section. Or they are doing it themselves. The “seeding” involves swabbing the mother’s vaginal fluid over the newborn’s mouth, eyes, face and skin.

Parents hope that by exposing the baby to bacteria from the birth canal, they will boost the child’s immune system and ward off future health problems associated with a Caesarean birth.

Several large epidemiological studies have reported that babies born by Caesarean section are at an increased risk of obesity, allergies, asthma and autoimmune diseases. Other studies have suggested a link between these same medical conditions and the types of microorganisms present in the body.

“The theory is that by transferring bacteria from mum to baby, these bacteria can then make their way to the baby’s gut and alter the bacteria in their tummy — called the microbiome,” said Dr. Aubrey Cunnington, a specialist in pediatric infectious diseases at Imperial College London and one of the authors of the BMJ editorial, in a released statement.

In theory only

“There is now quite a lot of evidence that differences in the microbiome are associated with risk of developing conditions such as allergies and obesity,” he added. “However people have made a leap of logic that gut bacteria must be the link between caesarean section and risk of these diseases. But we just don’t know this for sure — or whether we can even influence this by transferring bacteria on a swab from mum to baby.”

Only one clinical trial is currently investigating vaginal seeding, Cunnington and his editorial co-authors point out, and that study is designed to determine only if vaginal bacteria can be successfully transferred to newborns through “seeding,” not if the practice is either safe or effective.

That study is also using tests to exclude women who might be carriers of pathogens that would put their infants at risk of infection, such as group B streptococcus, herpes simplex virus, Chlamydia trachomatis and Neisseria gonorrhea. These infections often produce no noticeable symptoms and are not always tested for in pregnant women, the editorial points out. Women who swab their babies with vaginal fluid, therefore, may not realize they are passing one of these pathogens onto their baby.

Up to 30 percent of pregnant women, for example, are estimated to be carriers of group B streptococcus — usually without any symptoms. This bacterium is the leading cause of a sepsis, a serious blood infection, in infants.

“One colleague had to intervene when a mother with genital herpes, who had undergone a caesarean section, was about to undertake this process,” said Cunnington. “Swabbing would have potentially transferred the herpes virus to the baby.” 

Of course, these same infections can be passed on to the baby during vaginal birth. But pediatricians are alert to that possibility when parents bring an ill baby to them. Doctors do not expect to see such infections in babies born via Caesarean section, and therefore a correct diagnosis may be delayed. 

Risk not justified

Cunnington and his colleagues advise doctors not to perform vaginal seeding until more is known about both the effectiveness and the safety of the procedure.

“We believe the small risk of harm cannot be justified without evidence of benefit,” they write.

The editorial’s writers also recognize, however, that the simplicity of the procedure means many parents will just go ahead and do it themselves. They therefore urge  parents to first fully educate themselves about the risks, and, if they do decide to “seed” their baby, to make sure they tell their pediatrician about it.

“Parents and health professionals should also remember that other events in early life, such as breast feeding and antibiotic exposure, have a powerful effect on the developing microbiota,” Cunnington and his colleagues add. “Encouraging breast feeding and avoiding unnecessary antibiotics may be much more important than worrying about transferring vaginal fluid on a swab.”

FMI: You can read the editorial in full at the BMJ website.

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Half of the world’s population will be nearsighted by 2050, experts say

Half the world’s population — about 5 billion people — will be nearsighted within three decades if current trends continue, according to a new study published this month in the journal Ophthalmology

The study also projects that 1 in 5 of those individuals will develop a severe form of nearsightedness that will put them at a significant increased risk of going blind.

Nearsightedness, or myopia, is a common eye condition that is determined by the shape of the eye. It lets people see nearby objects clearly, but not distant objects, which appear blurry. 

The severe form of nearsightedness, known as high myopia, occurs when the eyeball becomes too long. It can lead to tears in the retina (the light-sensitive layer of cells at the back of the eye), or even to the retina detaching. People with high myopia are also at increased risk of developing glaucoma, cataracts and macular degeneration — conditions that can cause permanent blindness. 

Some health officials have declared the United States and other countries around the world to be in the middle of a “myopia epidemic.” A 2009 study found that the percentage of Americans who were nearsighted had risen from 25 percent in the early 1970s to 42 percent in the early 2000s — a jump of 66 percent.

In parts of Asia, the rise in myopia has been even more striking. In China, for example, the rate of myopia among teens and young adults is now estimated at 80 to 90 percent.

Dozens of studies

For the current study, an international team of researchers analyzed data from 145 earlier studies that involved more than 2.1 million people in countries around the world.

They found that the proportion of nearsighted people in the world rose from 22 percent in 2000 to 28 percent in 2010, and that the proportion with severe nearsightedness rose from 2.7 percent to 4 percent.

If those percentages continue at their current pace, say the researchers, 49.8 percent of the world’s population — 4.8 billion people — will be nearsighted by 2050. That’s more than a doubling of the percentage since 2000.

In addition, 9.8 percent — 938 million people — will have the severe form of the condition by 2050. That percentage is more than three times higher than in 2000.

Possible causes

The increase in the number of people with myopia is “widely considered to be driven by environmental factors … principally lifestyle changes resulting from a combination of decreased time outdoors and increased near-work activities,” the study’s authors write.


National Eye Institute

Genetics is likely involved as well, but it can’t explain myopia’s rapid increase over the past few decades, say the researchers. 

The near-work activities referred to in the study include reading, computer work (or play), and other activities that require intense visual focus. The more time children spend in such pursuits, the higher their odds of developing myopia, according to a large review of existing research on the topic that was published in 2015. 

Many people like to specifically blame the increased time young people spend on computers and mobile phone screens for the upsurge in myopia. But the rise began in the 1970s, long before computers and related devices became ubiquitous.

Nor have researchers been able to provide clear answers about screen time’s role in myopia. Indeed, a recent study, which followed children for 20 years, reported no link between time spent in front of a TV or computer screen and nearsightedness.

Not enough time outdoors

The authors of the current Opthalmology study point to a broader possible factor: “the high-pressured educational systems, especially at very young ages in countries such as Singapore, Korea, Taiwan, and China.”

Not only are high-pressured education systems causing young children to spend more time on “near work” activities, the long hours of studying required by such systems is keeping children indoors.

Other studies have found strong associations between the time children spend outdoors — particularly in early childhood — and the development of myopia. The less time outdoors, the greater the risk of becoming nearsighted.

As I’ve noted here before, some researchers believe sunlight slows down myopia-associated growth of the eyeball, perhaps by causing the retina to produce high levels of dopamine, a brain chemical known to inhibit eye growth.

Should that theory about nearsightedness prove true, it does not bode well for the myopia epidemic here in the United States. A 2012 study found that only about half of American pre-schoolers  spend time playing outdoors on a daily basis.

FMI: You can read the current study in full on Opthalmology’s website. The journal is published by the American Academy of Ophthalmology.

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MDH epidemiologist: likelihood of Zika virus showing up in Minnesota is low

The Zika virus is the latest mosquito-borne illness to spread across the Western Hemisphere.

On Jan. 15, after doctors in Brazil reported a suspected link between Zika infections in pregnant women and babies being born with microcephaly (a devastating neurological disorder characterized by an abnormally small head and incomplete brain development), the Centers for Disease Control and Prevention (CDC) issued a travel alert for U.S. women who are pregnant or thinking about getting pregnant. They were warned to avoid countries or territories where the Zika virus has been reported: Brazil, Colombia, El Salvador, French Guiana, Guatemala, Haiti, Honduras, Martinique, Mexico, Panama, Paraguay, Suriname, Venezuela, and Puerto Rico.

Brazilian health officials have announced that they are investigating more than 3,500 cases of microcephaly that have occurred in that country since last spring. In a typical year, the country has about 150 cases.

Concern is also mounting in Brazil that the Zika virus may be triggering cases of Guillain-Barre syndrome, a rare disorder in which the body’s immune system attacks the peripheral nerves, causing sudden muscle weakness that can leave people temporarily unable to move and requiring life support to breathe.

Earlier this week, the Minnesota Department of Health (MDH) joined the CDC in advising doctors to start looking for evidence of the Zika virus in patients who have recently returned with virus-like symptoms from the countries cited in the CDC travel alert.

There is no evidence of Zika-infected mosquitoes on the U.S. mainland, but some scientists are concerned that the insects might arrive soon, perhaps as early as this spring. On Wednesday, the CDC confirmed “a dozen or so” cases of Zika virus among U.S. residents last year, but all involved people who became infected while out of the country. None of those cases was diagnosed in Minnesota, although the state did have a confirmed case of the virus in 2014, according to MDH officials.

So, how concerned should Minnesotans — particularly women of childbearing age — be about Zika? To get an answer to that and other questions about the virus, MinnPost spoke with MDH epidemiologist Dave Neitzel. An edited transcript of that interview follows.

MinnPost: What is Zika?

Dave Neitzel: It’s a virus closely related to a lot of other viruses transmitted by mosquitoes, like West Nile virus and dengue virus. Scientists have known about it for many years now. It’s been seen in Africa, Asia and some of the Pacific islands. But last year it showed up for the first time in the Western Hemisphere, and is now being seen throughout much of South America, Central America, Mexico, and the Caribbean.

MP: What are its key symptoms?

DN: For most people, the Zika virus is asymptomatic. They fight off the virus without showing any symptoms. But for the people who do have symptoms, usually they have fever, rash, joint aches, and some people get what we call conjunctivitis, or pink eye.

MP:  I’ve read that about 80 percent of people show no symptoms, is that correct?

DN:  Yes, and that’s actually very similar to the West Nile virus that we see circulating here in Minnesota. Most people who get West Nile virus are also able to fight it off without showing any symptoms.

MP: Are there any vaccines or treatments for the Zika virus?

David Neitzel

Macalester College
David Neitzel

DN: There is no treatment for the virus whatsoever. Doctors may be able to offer some supportive care to reduce the severity of the fever and lesson some of the joint pain, but there’s nothing that directly treats the virus. The virus just goes through the person’s system, and then is gone. Unfortunately, though, humans are the reservoir for the virus. Mosquitoes get the virus from infected humans who are carrying the virus. So the virus circulates from mosquitoes to people and then back to the mosquitoes again.

MP: The complication we’ve been hearing the most about is microcephaly. Why are we only hearing about it now, when the virus has been around for decades?

DN:  When Zika outbreaks have occurred in Africa, Asia and the Pacific islands, the outbreaks have been small and the reported cases have primarily involved relatively mild illness that isn’t life threatening or very severe. But the outbreak that’s currently occurring, especially in Brazil, is large enough — affecting enough people — that we’re starting to see some of the more unusual outcomes that can happen from this virus. Microcephaly is one of these unusual outcomes.

MP:  Do we know for sure that the Zika virus is the cause of the recent increase in the number of cases of microcephaly in Brazil?

DN: In the last week or so the Centers for Disease Control has confirmed the presence of the virus in at least some of these cases. That’s one more step towards confirmation. We’re fairly confident that this is related to the virus infection.

MP: There’s also been concern in Brazil of a connection between the Zika virus and Guillain-Barre syndrome.

DN:  That’s something that needs a bit more study done, but that would certainly not be unexpected. There are probably all sorts of severe outcomes that could happen from this virus, but these are the [two] detected so far.

MP:  Should we be worried about Zika-infected mosquitoes here in Minnesota?

DN:  In Minnesota we have 51 different species of mosquitoes, and about two dozen of those feed on humans. There are two species that have been implicated as potential Zika virus vectors. The main one is Aedes aegypti, the yellow fever mosquito. It’s a tropical mosquito that’s native to the very southern edge of the United States, like southern Texas, Arizona and Florida. It’s not a mosquito that we really see anywhere near Minnesota.

The other mosquito that’s has been implicated as a potential vector of the Zika virus is the Asian tiger mosquito [Aedes albopictus]. It was imported into the United States accidentally back in the mid-1980s in shipments of used tires from Korea and Japan. Asian tiger mosquitoes have become established throughout much of the eastern United States. In Minnesota, there have been infestations of this mosquito since 1991, roughly 15 or so. But they have all been eradicated by the work done by the Metropolitan Mosquito Control District in the Twin Cities, and also maybe by our Minnesota winters, which make it tough for the mosquito eggs to survive the winter.

MP: Has the Zika virus been found in either of these mosquitoes in mainland United States?

DN:  No. Not so far. In Minnesota, we consider the Zika virus to be mainly a risk for travelers. The likelihood that the virus would become established here is low — not impossible, but low.

MP: I’m assuming you concur with the CDC’s recommendation that pregnant women or women considering getting pregnant not travel to places where the virus is known to be actively transmitted.

DN: Yes. Even for anyone else, it would be good to bring along some mosquito repellant and use it when you’re there. Also, stay in dwellings that have good window screens that keep mosquitoes out. The mosquitoes that are doing most of the Zika virus transmission are day-active mosquitoes. They can bite you any time of the day. They are also pretty abundant in urban conditions. They live right in and around people very effectively, and they will come inside buildings to bite people.

MP: The Minnesota Health Department has recently asked doctors in the state to consider testing people for the virus if have recently traveled to the countries in the CDC’s travel alert and are exhibiting symptoms.

DN:  Yes. This week’s MMWR [published by the CDC] has recommendations for testing pregnant women for the Zika virus. If pregnant women are symptomatic, testing is recommended. If they don’t have symptoms, they can be monitored by their physician, such as with ultrasound, to make sure that the fetus is developing correctly.

MP:  There’s been only one documented case of Zika virus in Minnesota, correct?

DN: Yes. It was in 2014, somebody who had been in French Polynesia. That was just a regular Zika case with fever, rash and joint aches. It wasn’t a severe case at all.

MP: It sounds like the bottom line is that nobody in Minnesota should be panicking about this virus. The risk is small.

DN:  Yes. If folks are planning to travel to any of the countries in the Caribbean, Central or South America, or Mexico over the next few months, it would be a good idea to bring along mosquito repellant. And if women are pregnant, they should think about postponing that trip.

MP: Should we be expecting more of these kinds of mosquito-transmitted diseases here in Minnesota in the future?

DN:  In 1999, when West Nile virus was first seen in the United States, that was a real wake-up call to a lot of scientists that the world is a small place, and it’s pretty easy to move around various disease agents, including mosquitoes that can transmit mosquito viruses. We need to think more globally when we think of disease risks.

FMI: You can find more information about the Zika virus on the CDC’s website.

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Doula support is associated with lower rates of premature birth, say U of M researchers

Providing women on Medicaid with doula support during pregnancy and childbirth can help lower the rate of premature births — and the high costs associated with them, suggests a new study by University of Minnesota researchers.

A doula is someone (almost always a woman) specially trained to provide physical and emotional support to mothers during pregnancy, labor and delivery. (Doulas should not be confused with midwives, who provide medical care during childbirth.) 

Earlier research by the same team of U of M researchers reported a strong association between doula support and lower Caesarean rates among Medicaid recipients. The new study is, however, the first to find that doula support also reduces the risk of premature birth among Medicaid recipients — by 22 percent, according to the U of M’s analysis. 

The new study is also the first to put a cost-savings figure to those findings. It estimates that the amount of money spent by Medicaid programs on doula services would be offset by an average of $986 per birth due to decreases in the costs associated with preterm and Caesarean births.

“One of the neat things about this study is it provides a missing piece of the puzzle,” said Katy Kozhimannil, lead author of the study and an associate professor in the U of M’s School of Public Health, in an interview with MinnPost. “We know that doula care has benefits. We know that doctors recommend that women have doulas in order to generally prevent unnecessary use of Caesareans. So doctors recommend it. The health benefits are clear. What has really been missing is the translational policy piece, the cost-benefit piece.”

Details and implications

For their study, which was published online last week in the journal Birth, Kozhimannil and her colleagues gathered data on preterm and Caesarean births among doula-supported Medicaid recipients in Minnesota and then compared it to data on preterm and cesarean rates for a 20 percent sample (more than 67,000 women in all) of non-doula-supported Medicaid recipients in Minnesota and 11 other Midwestern states.

Minnesota is one of only two states (the other is Oregon) that require their Medicaid programs to cover doula services.

The doula-related benefits found in the U of M study are significant — and potentially very important. As background information in the study points out, one in nine babies in the United States is born preterm (before 37 weeks’ gestation). These babies are at greater risk than full-term babies of developing a wide range of medical problems, including include lung damage, brain hemorrhages, infections, vision loss and cerebral palsy.

About one-third of all infant deaths are from preterm-related causes.

In addition to greater health risks, preterm births are associated with much greater medical costs. During their first year, babies born prematurely incur medical expenses that are 10 times higher than those for full-term babies. The cost to the U.S. health-care system of preterm births has been estimated at $26 billion a year. A significant amount of that money is spent by Medicaid, which pays for about half of all births in the U.S.

The U of M study estimates that in just the 12 states used in its analysis, doula-supported Medicaid births could reduce the number of premature births by 3,200 each year, for an annual savings to Medicaid of $58 million.

‘An unmet need’

Here in Minnesota, about 5,000 babies are born prematurely each year, according to the Minnesota Department of Health (MDH). As is true across the country, racial and economic disparities are reflected in these births. Preterm births in Minnesota are more common among non-Hispanic black and Native American mothers than among white mothers. Low-income mothers are also more likely to have premature babies.

Katy Kozhimannil

Katy Kozhimannil

Interestingly, research by Kozhimannil has shown that these are some of the same groups of women who express a high interest in having the support of a doula during pregnancy and childbirth.

“There is actually an unmet need and a desire for doula support among those who stand to benefit the most,” said Kozhimannil.

Yet the barriers to accessing doula services — even in Minnesota, where Medicaid covers such services — are many.

“We have a very active doula community,” explained Kozhimmanil. “We’re one of only two states where Medicaid pays for doula services. But even under the best of conditions, on the ground, it’s really hard to get a doula if you’re a Medicaid beneficiary — and for that doula to get paid.”

Many customer service representatives for health plans are unaware that their plans cover such services — or even what a doula is, she said. In addition, the process for becoming a certified doula with state and managed care providers is complicated and costly — barriers that are particularly problematic for low-income women who want to become doulas.

Reimbursement rates for doulas are also quite low — an average of about $400 per birth in Minnesota.

Breaking down the barriers

Kozhimmanil hopes that this latest study’s findings will help persuade policymakers to make it easier for Medicaid recipients to access doula services — and for doulas to receive adequate reimbursement for their services.

“I understand the reticence on the part of Medicaid programs or any health plan to add a covered service for birth,” she said. “Birth is really common. Medicaid is the most frequent payer for birth, and you have to be really judicious when you’re adding new things to pay for.”

But, as the findings from this latest study show, “there is really no good reason for Medicaid programs and health plans not to really seriously consider how to expand benefits to include doula services,” said Kozhimmanil.

You’ll find an abstract of the study on the website for the journal Birth, but, unfortunately, the study itself is behind a paywall. 

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U.S. life expectancy remains unchanged; infant mortality declines, says CDC

Life expectancy in the United States — for both men and women — remained unchanged in 2014, according to a report released Wednesday by the Centers for Disease Control and Prevention (CDC).

The average life expectancy was 78.8 years in 2014, the same as it was in 2013. For men, the average life expectancy remained at 76.4 years, and for women at 81.2 years.

Life expectancy at age 65 also has not changed. It was 19.3 years in 2014, the same as in 2013. The gender breakdowns remained essentially the same as well: 20.5 years for 65-year-old women and 17.9 years for 65-year-old men (that statistic for men is down very slightly from 18.0 years in 2013).

This is the now the third year in a row that U.S. life expectancy has not budged. That’s not good news. We should be doing better. Indeed, according to the World Health Organization, Americans live, on average, significantly shorter lives than people in 33 other countries, including all of the nations of Western Europe and such disparate places as Canada, Chile, Lebanon, Israel, Korea and Japan (which tops the list at 84 years).

It’s not clear why U.S. life expectancy has failed to improve. As the CDC report points out, between 2013 and 2014 the age-adjusted death rates significantly decreased for five of the 10 leading causes of death: heart disease, cancer, chronic lower respiratory disease, diabetes, and influenza/pneumonia. 

But the rates increased for four other causes: unintentional injuries, stroke, Alzheimer’s disease and suicide. (The death rate remained unchanged for kidney disease.)

Those findings overlap with the troubling results of a study published in November. It reported a startling rise in recent years in the death rate of white, middle-aged men in the U.S. The study’s authors attributed that increase to three main factors: substance abuse (from alcohol, prescription opioids and heroin), suicide and chronic liver disease.

A positive trend

There was some good news in the new CDC report, however. The infant mortality rate fell 2.3 percent in 2014, and is now at an historic low: 582.1 infant deaths per 100,000 live births. (The infant mortality rate refers to the percentage of babies born alive who die before their first birthday.)

Still, this drop in our infant mortality rate is unlikely to do much to improve our current poor (pathetic might be a better word) global ranking on this issue. In 2010, 25 countries had better infant mortality rates than we did. Several — Finland, Japan and Portugal — had rates that were almost one-third of the U.S. rate.

Life expectancy at selected ages, by sex: United States, 2013 and 2014

Source: CDC/NCHS, National Vital Statistics System, Mortality
Life expectancy at selected ages, by sex: United States, 2013 and 2014

The leading causes of infant deaths in the U.S. were essentially the same in 2014 as in 2013, with the exception of deaths caused by respiratory distress, which fell 13.5 percent (from 13.3 to 11.5 infant deaths per 100,000 live births).

The decline in respiratory-related infant deaths may be connected to other declines, which were reported by the CDC last June. Preterm births dropped slightly in 2014, to 9.57 percent of births (from 9.62 percent in 2013). In fact, the percentage of births delivered before 37 weeks of gestation has declined 8 percent from its peak of 10.44 percent in 2007.

Infant mortality rates for the 10 leading causes of infant death

Source: CDC/NCHS, National Vital Statistics System, Mortality
Infant mortality rates for the 10 leading causes of infant death: United States, 2013 and 2014

In addition, fewer babies are being born by Caesarean section. In its June report, the CDC announced that deliveries of babies in the U.S. by Caesarean section fell by 2 percent, from 32.7 percent of all births in 2013 to 32.2 percent in 2014. (Caesarean deliveries peaked in the U.S. at 32.9 percent in 2009.)

Efforts to reduce medically unnecessary Caesarean section births has become a major campaign of public health officials in recent years, in part because babies born by Caesarean section are at increased risk of developing lung and other respiratory problems.

You can read the new CDC report at the agency’s website.

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Major furniture, mattress and carpet makers still use toxic flame retardants, report finds

Leading furniture makers appear to be phasing out their use of toxic flame retardants in their products, but mattress and carpet-padding manufacturers are lagging behind in such efforts, according to a report published this week by a national group of environmental health organizations, including the Minnesota-based public health coalition Healthy Legacy.

“Although a growing number of companies are finding ways to meet flammability standards without using toxic chemicals, there are still several major product makers who either have not made the transition or do not let their customers know what is in their products,” write the authors of the report. “This has to change so people can make smart choices that protect their families and environment.” 

“It’s really, really confusing for consumers,” said Healthy Legacy co-director Kathleen Schuler in an interview with MinnPost. “I wish I could give them more concrete information because it’s kind of a wasteland out there. If you don’t want flame retardants in your products, how do you do that?” 

There’s good reason to not want flame retardant chemicals in your sofas, mattresses, carpeting and other household products, for they can be easily transferred into the human body through dust. Such migration is particularly problematic for children, who have been found to have very high levels of these chemicals in their bodies.

Studies have linked flame retardant chemicals to serious health concerns, including cancer, impaired fertility, obesity, and neurological and developmental problems, such as hyperactivity and lowered IQ. Nor are flame retardant chemicals particularly effective at their purported purpose: to prevent fires from taking hold and spreading.

In addition, researchers have demonstrated that such chemicals can make fires more toxic — a factor that has become a growing concern for firefighters.

Earlier this year, Minnesota’s lawmakers passed legislation that bans four flame-retardant chemicals from children’s products and upholstered furniture. The law, which doesn’t take effect until July 2018, received strong support from the state’s firefighters.  

Key findings

For the new report, Schuler and her colleagues identified top-selling manufacturers (38 in all) in three product sectors: home furniture, full-sized mattresses, and carpet padding. They then sought information from those companies on whether they had moved away from using flame retardant chemicals. They gathered this data by conducting online searches, by calling the companies’ customer service phone lines, and, finally, by sending letters to the companies that explained why they wanted the information.

Here are the report’s key findings:

  • Ten of the 17 furniture companies contacted for the report said they no longer used flame-retardant chemicals. One company said it had removed the chemicals from products it made in the United States, but not in those it imported. The other six companies did not provide any information.
  • Of the 11 leading mattress manufacturers contacted for the report, only five said they use flame-resistant barrier materials instead of flame-retardant chemicals to meet fire safety standards (although one company said they do so only for two of their mattress brands). Another company said its products were free of some, but not all, flame-retardant chemicals.
  • Of the seven carpet-padding manufacturers contacted for the report, only two said they no longer use materials that could contain flame-retardant chemicals. (They use a rubber-based material instead.) Two others said they offer at least one flame-retardant-free product line. The other three acknowledged using recycled polyurethane. That means their carpet pads may contain banned flame-retardant chemicals (particularly the chemical pentaBDE). 

“Recycling is obviously a good thing,” said Schuler. “We don’t want to put it in landfills or incinerate it. But the problem is that if we continue to use different chemicals in the foam and we recycle it, we’re keeping it in our product cycle. So we’re hoping that more and more companies will phase it out of the foam so that when we do recycle it, those chemicals aren’t recycled back into our homes.”

What consumers can do

Furniture manufacturers that haven’t shifted away from using chemical flame retardants “should take immediate steps to do so,” write Schuler and her colleagues, and the makers of mattresses and carpet padding “should work with suppliers to assure that all components of their products, including the foam, do not contain chemicals.”

Kathleen Schuler

Kathleen Schuler

Retailers, too, have a role to play — by working with their suppliers to make sure the products they sell are flame-retardant-free and by posting that information on their websites and in their stores. 

Shuler and her colleagues also urge policymakers at all levels of government to “press for more health protective policies that reduce exposure to toxic chemical flame retardants.” At the national level, they urge passage of the “Children and Firefighters Protection Act of 2014,” which has been introduced by Sen. Charles Schumer, D-N.Y.

In the meantime, though, consumers who want to avoid bringing products with flame retardant chemicals into their homes are going to need to do their homework.

“We don’t want people to do huge research projects, but, unfortunately, they still need to do it sometimes,” said Shuler.

Here are some tips from the report:

  • Purchase from a company known to make or sell flame retardant-free furniture. [You can use the report, which names all the companies it surveyed, as a guide.] When choosing your own fabric design, check with the company to ensure it is also flame-retardant-free. Be cautious about floor samples and deeply discounted products that may be older, and more likely to be toxic. If a product is not labeled, contact the manufacturer and ask if flame retardants are in the product.

  • Read the labels. Furniture that is labeled “contains NO added flame retardant chemicals” reflects the materials used in that product. Look for labels under cushions or on the bottom of furniture that indicate whether added flame retardants have been used. Look for children’s and other upholstered furniture, baby mattresses and other products that are labeled “flame-retardant-free.” If upholstered furniture is labeled “this article meets the flammability requirements of California technical bulletin 117,” it likely contains added flame retardants, so avoid it.

  • Clean house and hands frequently. Damp or wet mop and vacuum (with a HEPA filter) frequently to eliminate the dust where chemicals lurk. Frequent handwashing can reduce exposure to toxic chemicals in dust and products.

  • Choose area rugs or bare floor instead of wall-to-wall carpeting, and forego foam-based carpet padding. 

The organizations behind the report are all part of the Safe Sofas and More campaign, which advocates for nonhazardous fire safety techniques. You can read the report in full online, including its appendices, which list the names of all the manufacturers contacted and whether they use flame retardants in their products. Schuler has also compiled a flame retardant “fact sheet” for consumers.

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Evidence that Ritalin and similar drugs help children with ADHD is weak, study finds

The evidence in support of using the stimulant methylphenidate (more commonly known by such brand names as Ritalin, Concerta, Methylin and Medikinet) to treat children with attention deficit hyperactivity disorder (ADHD) is of such low quality that physicians should prescribe these drugs only with caution, the authors of a major new meta-analysis warn.

The meta-analysis — conducted by an independent and international team of 17 Cochrane researchers — found that the evidence in favor of treating ADHD with methylphenidate is weaker than many physicians (and parents) realize.

Furthermore, even if the existing evidence is taken at face value, the benefits from methylphenidate are modest at best. And the drug is not harm-free, for its use in children is associated with sleep problems and decreased appetite.

The meta-analysis’ findings, published last week in the Cochrane Database of Systemic Review, are troubling. ADHD is one of the most commonly diagnosed and treated childhood neurodevelopmental disorders. In 2011, approximately 11 percent of U.S. children aged 4 to 17 — 6.4 million young people in all — had been diagnosed with ADHD, according to the Centers for Disease Control and Prevention (CDC).

More than half of these children — 6.1 percent of all American children and teens — were taking a medication, primarily methylphenidate, to control their ADHD symptoms, which include difficulty paying attention and controlling impulsive behaviors and/or a tendency to be overly active. 

Details of the review

For their meta-analysis, the Cochrane reviewers looked at 185 studies (38 randomized controlled trials and 147 crossover trials) that compared methylphenidate with either placebo or no intervention. The studies, which were mostly conducted in the U.S., Canada and Europe, involved more than 12,000 children and teens, aged 3 to 18. The children took methylphenidate for one to 425 days, with an average treatment run of 75 days.

A pooling of the data from a number of those trials revealed that methylphenidate resulted in a slight improvement in how teachers rated ADHD symptoms when compared to placebo or no intervention. But the difference was modest: an average of 9.6 fewer points on the ADHD Rating Scale. This scale has a range of 0 to 72 points, and, as experts for the U.K.’s National Health Service note in their discussion of the meta-analysis, a change of 6.6 points is considered the minimal amount needed to be clinically meaningful.

The Cochrane reviewers also say that those modest improvements need to be balanced against an increased risk of adverse effects, particularly sleeping problems and decreased appetite. Their analysis found that children with ADHD who received methylphenidate in clinical trials were 29 percent more likely to develop these problems than children with ADHD who received a placebo.

Although the reviewers found no evidence that methylphenidate leads to serious adverse health problems in children, they point out that “very little” is known about the drug’s long-term effects. That’s because most studies that examined methylphenidate in children did not last longer than six months.

Extensive bias

But the overriding problem with all 185 studies, say the Cochrane reviewers, is that each was designed in a way that could have led to biased findings. In many of the studies, for example, it would have been relatively easy for everybody involved to figure out which children were taking the drug and which were taking the placebo.

In addition, some 40 percent of the methylphenidate studies were funded by the pharmaceutical industry. In recent years, several groups of researchers, including a team from Cochrane, have reported that industry-sponsored studies are significantly more likely to produce results that paint a positive picture of a drug or device than independently funded ones.

The 185 studies “suggest that methylphenidate might improve some of the core symptoms of ADHD — reducing hyperactivity and impulsivity, and helping children to concentrate,” the authors of the meta-analysis conclude.  “Methylphenidate might also help to improve the general behaviour and quality of life of children with ADHD. However, we cannot be confident that the results accurately reflect the size of the benefit of methylphenidate.”

“Better-designed trials are needed,” they stress, before we can know for sure if the benefits truly outweigh the risks.

You’ll find the study on the Cochrane Library website.

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