What an autopsy may (or may not) have revealed about Otto Warmbier’s death

(CNN)What happened to Otto Warmbier while he was in North Korean custody is a mystery. And it’s likely to remain that way. Following his death on Monday, Warmbier’s parents Cindy and Fred asked the coroner not to perform an autopsy on their son.

“The family’s objection to an autopsy was honored, and only an external examination was performed,” the Hamilton County (Ohio) Coroner’s Office said in a statement Tuesday.
“No conclusions about the cause and manner of Mr. Warmbier’s death have been drawn at this time, as there are additional medical records and imaging to review and people to interview,” the statement said.
    Forensic experts say autopsies can reveal important information about how or why a person died; in this case, determining what events may have led up to Warmbier’s arrival in the United States in a persistent vegetative state.

      What happens during an autopsy?

    “I think it’s a terrible mistake” not to perform an autopsy, said Dr. Cyril Wecht, a prominent forensic pathologist who was not involved in Warmbier’s case. “If you have something that could be anything other than a natural death, you’re obligated to do an autopsy.”
    As far as what put Warmbier in a coma in the first place, Wecht said it would be difficult to determine in someone who had been comatose for such a long time “because the brain continues to undergo decomposition.”
    The possibilities could have been any number of things, Wecht said, including strangulation, suffocation, medication or a botched suicide attempt. But “the basic cause, no matter what the mechanism, would have been … hypoxia,” the medical term for insufficient oxygen reaching the brain.

    What happened in North Korea?

    Up until last week, one of the last times the world saw Warmbier, an American college student, was at a news conference in North Korea on February 29, 2016. Warmbier stood accused of a “hostile act”: taking down a political poster in a hotel in Pyongyang. Through tears, the then-21-year-old begged for forgiveness but was ultimately sentenced to 15 years of hard labor during his one-hour trial on March 16, 2016.
    Then, on June 13, 2017: North Korea released Warmbier in a state of “unresponsive wakefulness,” according to doctors at the University of Cincinnati Medical Center, who examined him upon his return to the US. In a news conference last week, they disputed the North Korean regime’s claims that Warmbier had contracted botulism and slipped into a vegetative state after taking a sleeping pill.
    Dr. Daniel Kanter, director of UC Health’s Neurocritical Care Program, said Warmbier’s MRI scan showed “extensive loss of brain tissue in all regions of the brain” but no evidence of a skull fracture.
    “We have no certain or verifiable knowledge of the cause or circumstances of his neurological injury,” Kanter said. “This pattern of injury, however, is usually seen as the result of cardiopulmonary arrest, where the blood supply to the brain is inadequate for a period of time, resulting in the death of brain tissue.
    “He has spontaneous eye-opening and blinking,” Kanter continued. “However, he shows no signs of understanding language, responding to verbal commands or awareness of his surroundings. He has not spoken. He has not engaged in any purposeful movements or behaviors.”

    Determining cause of death

    According to the US Centers for Disease Control and Prevention, just two states — Arkansas and Nevada — have no conditions under which an autopsy is required by law.
    The remaining 48 states and the District of Columbia have different criteria as to when an autopsy is mandatory. In Warmbier’s home state of Ohio, an autopsy is required in five circumstances, including when a death is ruled a homicide, in cases where it is related to a public health threat, and when a “child death appears natural and occurs suddenly when in good health.”
    The Warmbier family has not said why they objected to an autopsy, but Wecht said some families cite religious reasons, overwhelming grief or a desire to more quickly move on.
    “It’s not that I’m insensitive or indifferent to family objections,” Wecht said. “When I was coroner, for 20 years, of Allegheny County (Pennsylvania), if I could bend, I bent. Other times, you cannot bend. This is a case of unknown etiology, and the only way to ascertain what may have gone wrong would be to do an autopsy.”
    Despite the tragic circumstances, CNN Chief Medical Correspondent Dr. Sanjay Gupta said the case was very interesting from a medical perspective.
    “For 15 months or so, (Warmbier) had a devastating neurological injury but was kept alive,” said Gupta, who is also a member of the American College of Forensic Examiners and a practicing neurosurgeon. “One of a few things likely happened here — and we may never know, especially if there’s no autopsy.
    “One thing to keep in mind is that he did just have a long flight from North Korea to the US,” he said. “Even healthy people can develop deep-vein thrombosis, or DVT. With someone who is not moving, the risk is even greater. The risk of a blood clot in the lungs is also a possibility, especially given how sudden this was.”
    Gupta, who has not reviewed Warmbier’s medical records, said Warmbier could have been given a new medication or have had an old medication withheld.
    For example, “he could have been treated for a body-wide infection such as sepsis, which is not uncommon in someone who is bedridden,” Gupta said. “The family could have decided to stop giving him antibiotics, then sepsis may have led to his death.”
    Given Warmbier’s prognosis last week, “this would not have been unreasonable,” Gupta said.

    See the latest news and share your comments with CNN Health on Facebook and Twitter.

    Warmbier also may have been given new medications for comfort care in the US that he didn’t receive while in North Korea, which could have led to his death, Gupta said.
    Wecht said he was surprised the family didn’t want to make one last attempt at determining what happened to their son while he was a prisoner of what President Donald Trump has called a “brutal regime.”
    For their part, Cindy and Fred Warmbier said their son had “completed his journey home.”
    Otto Warmbier will be laid to rest Thursday after a funeral service at his high school in Wyoming, Ohio.

    Read more: http://www.cnn.com/2017/06/21/health/otto-warmbier-autopsy/index.html


    Crazy Health Site Claims Coconut Oil Cures Alzheimer’s, Gets Promptly Called Out on Facebook

    This the kind of shit that makes us want to scream!

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    Read more: http://cheezburger.com/2494981/crazy-health-site-claims-coconut-oil-cures-alzheimers-gets-promptly-called-out-on-facebook


    A veggie by any other name may actually get eaten

    (CNN)Labeling food with indulgent words may make people feel more satisfied when eating, says another study

    Putting descriptive indulgent words in front of vegetables — such as “dynamite,” “rich,” ” sweet sizzlin’ ” and “tangy” — may help adults take and eat more of the food group, according to a study published this week.
    The study, published in the medical journal JAMA Internal Medicine, found that giving vegetables certain descriptive labels caused more students and staff at Stanford University to choose vegetables during lunch — even though there was no difference in the way the vegetables were prepared.
      The vegetables were labeled in one of four ways: basic, healthy restrictive, healthy positive or indulgent.
      The basic description just listed the vegetable name, like corn or zucchini. The healthy restrictive category used words such as reduced-sodium corn or lighter-choice zucchini. Descriptions like vitamin-rich corn and nutritious green zucchini were used for the healthy positive. And indulgent was reserved for descriptions like rich buttery roasted sweet corn and slow-roasted caramelized zucchini bites.
      Brad Turnwald, a doctoral psychology student at Stanford University and lead author of the study, found that making the labels indulgent increased the number of people who chose to put the vegetables on their plate, as well as the amount of vegetables consumed.
      Vegetables labeled indulgently were 25% more likely be taken than basic-labeled. There was an even bigger difference in the numbers between healthy positive, healthy restrictive and indulgent. Thirty-five percent more people took indulgently labeled vegetables over healthy positive-labeled vegetables, and 41% more took indulgently labeled vegetables over those labeled healthy restrictive.
      “We think that the indulgent labeling aligns more with people’s motivations,” Turnwald said. “That they’re looking for something tasty when they want to eat. And that’s why it works.”
      The study was conducted over the course of an academic quarter at Stanford, in a large cafeteria serving about 600 people during weekday lunches. Research assistants counted the number of diners taking vegetables by dressing as members of the cafeteria staff. The amount of vegetables diners took from self-serve containers was weighed by actual members of the cafeteria staff.
      Brian Wansink, director of the Cornell University Food and Brand Lab, said the study confirmed what he and others have found in similar studies done at elementary schools, high schools and adult cafeterias: Changing the descriptions of vegetables can make us more likely to both choose them, and eat them.
      “People taste what they expect to taste,” said Wansink, who was not involved in this research study. “If we think food is crunchy, we rate it as crunchy afterwards. So if you make food look more exciting or sound exciting, people are more likely to take it.”
      Turnwald emphasizes that no matter the wording, the vegetable descriptions were always accurate.
      “We’re certainly not trying to trick people into eating more vegetables,” he said. “What the labels did in this case was shift people’s attention to the indulgent and tasty characteristics of the vegetables, instead of focusing so much on the healthy components of the vegetables. No matter what condition it was, we were always making true statements about the vegetables.”
      One limitation of the study was that Turnwald and his research team could not measure how much of the vegetables the individual diners actually ate. However, a previous study by Wansink found that people usually eat about 92% of the food they serve themselves. Turnwald suggested that another study could attempt to measure the amount of vegetables diners ate by weighing what was left behind in the trash, though he admits that could be tricky.

      See the latest news and share your comments with CNN Health on Facebook and Twitter.

      Turnwald’s adviser, Alia Crum, an assistant professor of psychology at Stanford, is doing even more research on mindsets. In a previous study, she found that people who thought they were drinking an indulgent milkshake were more physiologically satisfied than those who thought they were drinking a healthier shake.
      For Turnwald, changing mindsets through new labels is key to more people eating vegetables.
      “We really need to think about this as a way to start changing the culture,” he said. “The way that we talk about healthy foods — it shouldn’t be so negative and so depriving and so focused on health. It should be focused on the flavor and the taste, because that’s how we talk about all the other foods that we know and love.”

      Read more: http://www.cnn.com/2017/06/19/health/vegetables-indulgent-names-study/index.html


      Here’s what you need to know about that study suggesting french fries increase your risk of death

      At least you still have Bloody Marys.
      Image: Facebook

      Alright, french fry lovers, you might have heard that apparently, the amount of times per week you eat fried potatoes could increase your risk of death.

      According to a study published in the American Journal of Clinical Nutrition, people who eat fried potatoes two or more times a week were at an increased risk of mortality.

      But the results of this one study aren’t as scary or dire as they sound.

      The 4,400 members of the study (aged 45 to 79) were divided into groups based on how often they ate fried potatoes per week. The study ran over the course of eight years and during that time, 236 of the participants died. Researchers helmed by lead author Nicola Veronese determined, “those who ate fried potatoes two to three times per week were twice as likely to die early compared to those who didn’t eat fried potatoes.”

      However, noted nutrition, food studies and public health professor at New York University Marion Nestle says you don’t need to bemoan your last Sunday Funday fry-fest just yet.

      She tells the Chicago Tribune, “”First, this is an association […] Fried potatoes are associated with somewhat higher mortality, but this does not mean that they cause death. People who eat a lot of fried potatoes might have other unhealthy lifestyle practices […]Second, the association is not strictly dose-related. At lower levels of intake, the association is not statistically significant.”

      Adding to the good news, eating unfried potatoes didn’t impact health negatively and Time says, “more research with larger groups of people is needed to investigate the link before saying that overeating fries causes an increased risk of death.”

      You mean fried potatoes aren’t a health food? This isn’t exactly groundbreaking news. Everything in moderation, after all. But that didn’t stop people from having a field day about the new info on social media.

      Read more: http://mashable.com/2017/06/19/french-fries-bad/


      8 Benefits Of Coconut Oil That Your Entire Body Can Enjoy

      Coconuts and their seemingly infinite uses have been a staple in Asia, Africa, and South America basically since the dawn of man.

      But now, coconut products have made their way into mainstream supermarkets here in the US particularly coconut oil.

      Seriously, this stuff is all over the place now. The rather remarkable natural substance is extracted from the meat of mature coconut palms, has uses up the wazoo, and benefits attached to all of those uses, too.

      Its got vitamin E, lauric acid, protein, something called caprylic, (an anti-fungal fatty-acid), and the pleasant smell brings to mind a heavenly beach setting.

      Plus, it doesnt hurt that coconut oil is pretty damnaffordable, too.

      Here are eight ways coconut oil can work its magic on your entire body.

      1. You Can Use It To Improve The Health Of Your Mouth

      An Indian tradition of yogas sister science, Ayurveda, oil-pulling is a practice that entails putting a tablespoon of oil (usually coconut) in your mouth and swishing it around for five to 15 minutes.

      It pulls toxins from your gums, tongue, and teeth, and is said to help with bad breath, tooth decay, heart disease, and it can boost your immune system.

      If youre wondering if oil-pulling feels weird well, it does

      I gagged the first time I tried it, and it has yet to make its way into my daily routine.

      But I have to say, my mouth did feel nice after the fact.

      2. Incorporate It Into Your Beauty Routine

      Coconut oil makes for a really great eye-makeup remover, and apparently a solidcheekbone highlighter, too.

      Plus, you can wash your face with the product tohelp fight acne.

      While it might be too oily for some, I used this as a treatment for a particularly bad breakout, and I definitely noticed a decrease in the inflammation of my pimples.

      3. You Can Moisturize Literally Everywhere With It

      Ive used coconut oil both in and out of the shower to ease dry skin. In fact, I regularly use it to shave my legs, which always feel silky smooth afterward.

      Coconut oil can also help soothe the burn of a new tattoo, if youve got some ink on your bod.

      And if you ever find yourself looking after a little one, coconut oil can bea wonderful alternative to diaper rash cream.

      4. LatherIt Onto Your Luscious Locks

      Coconut oil can both moisturize and protect your locks from split ends and heat damage.

      And, if you ever have the unfortunate experience of having to deal with lice, coconut oil is rumored to help get rid of those, as well.

      5. It Can Help Make You Regular

      This magical stuff can help with your digestion, it cancleanse your colon, too.

      Some claim it helps ease constipation and helps you poop more, too.

      And, honestly, at the end of the day, isnt that what we all want?

      6. You Can Even Use It On Your Nose

      Or, rather, your nose.

      If you tend to suffer from nosebleeds, wipe the interior of your nostrils with a little coconut oil.

      The product can help soften and moisturize the nasal passages.

      Plus, youll get to enjoy that pleasant beach-y smell all damn day.

      7. It May Serve As An Alternative Medicine In Some Cases

      There are claims of all kinds that it might be an alternative preventative treatment for diseases, but one in particular is Alzheimers.

      According to the Alzheimers Association website, the caprylic acid in coconut oil may provide an energy source for brain cells that have lost the ability to utilize glucose due to Alzheimers.

      This sh*t is actually a miracle product, guys.

      8. You Can Even Try Using It Down There

      Coconut oil is a natural lube, and is often suggested as a remedy for yeast infections.

      Some say you can even lather a tampon with the oil for a more directapplication.

      Read more: http://elitedaily.com/wellness/8-benefits-coconut-oil-entire-body-can-enjoy/1994639/


      Lead found in 20% of baby food samples, especially juices and veggies

      Pediatricians and public health researchers know they have to be on the lookout for lead exposure from paint chips and contaminated drinking water. A new report suggests food — particularly baby food — could be a problem, too.

      The Environmental Defense Fund, in an analysis of 11 years of federal data, found detectable levels of lead in 20 percent of 2,164 baby food samples. The toxic metal was most commonly found in fruit juices such as grape and apple, root vegetables such as sweet potatoes and carrots, and cookies such as teething biscuits.
      The organization’s primary focus was on the baby foods because of how detrimental lead can be to child development.
        “Lead can have a number of effects on children and it’s especially harmful during critical windows of development,” said Dr. Aparna Bole, pediatrician at University Hospitals Rainbow Babies and Children’s Hospital in Cleveland, who was not involved with the report. “The largest burden that we often think about is neurocognitive that can occur even at low levels of lead exposure.”
        Lead can cause problems with attention and behavior, cognitive development, the cardiovascular system and immune system, Bole said.
        The samples studied were not identified by brand, and the levels of lead are thought to be relatively low. Still, according to the Centers for Disease Control and Prevention, no safe blood lead level in children has been identified.
        In a draft report released earlier this year, the Environmental Protection Agency estimated that over 5 percent of children consume more than 6 micrograms per day of lead — the maximum daily intake level set by the Food and Drug Administration in 1993 — in their diet.
        This surprised Tom Neltner, Environmental Defense Fund’s chemicals policy director, who has spent 20 years researching and working to reduce lead exposures. His further analysis of the EPA report was that food is the major source of lead exposure in two-thirds of toddlers.
        This spurred the organization to examine data from the FDA’s Total Diet Study for specific sources of exposure for kids.
        In the resulting report, released Thursday, Neltner found that the baby food versions of apple juice, grape juice and carrots had detectable lead more often than the regular versions. Researchers could determine how frequently contamination occurred, but not at what levels.

        Grape juice, baby: 89%, regular: 68%

        Apple juice, baby: 55%, regular: 25%

        Carrots, baby: 44%, regular: 14%

        Source: Environmental Defense Fund

        According to the FDA, lead makes its way into food through contaminated soil, but Neltner suspects that processing may also play a role.
        “I can’t explain it other than I assume baby food is processed more,” Neltner said.
        The Environmental Defense Fund report notes that more research on the sources of contamination is needed.
        FDA has set guidance levels of 100 parts per billion (ppb) for candy and dried fruit and 50 ppb for fruit juices. The allowable level for lead in bottled water is 5 ppb.
        Concern over fruit juices flared up in 2012 when Consumer Reports found that 1 in 4 samples of apple and grape juices had lead levels higher than the FDA’s bottled-water limit of 5 ppb.
        “The FDA is continuing to work with industry to further limit the amount of lead in foods to the greatest extent feasible, especially in foods frequently consumed by children,” read an agency statement in response to the report. “The agency is in the process of reevaluating the analytical methods it uses for determining when it should take action with respect to measured levels of lead in particular foods, including those consumed by infants and toddlers.”
        Neltner said he’s glad the FDA is working on the issue but wants them to “get it done. Move quicker.”
        The Environmental Defense Fund isn’t recommending that parents avoid certain foods or brands for their children but does advise that they consult their pediatrician about all means of lead exposure.
        “In many American communities, the most significant route of lead exposure is from paint and soil,” Bole said. “Avoiding all sources of exposure of lead poisoning is incredibly important … but the last thing I would want is for a parent to restrict their child’s diet or limit their intake of healthy food groups.”
        She added that pediatricians recommend limiting or eliminating fruit juices from children’s diets, anyway, for nutritional reasons. “There are good reasons to limit juice other than this particular report,” Bole said.
        But she said she wouldn’t want parents to avoid root vegetables altogether. “The benefits of those nutritious foods far outweigh any risk,” she said, especially in the context of where kids are most exposed to lead.

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        In response to a request for comment, Gerber said that samples of its baby foods and juices “consistently fall well within the available guidance levels and meet our own strict standards.” And samples of Gerber juices were all below the EPA standard for drinking water.
        “We know parents may be concerned about a recent report on lead in foods and want to reassure them that Gerber foods and juices are safe,” the statement read.
        The Environmental Defense Fund report was ultimately directed at the food industry and FDA in the hopes of getting limits and standards updated.
        But lead in paint and drinking water shouldn’t fall by the wayside, Neltner said. “You’ve got to deal with this issue on multiple fronts.”

        Read more: http://www.cnn.com/2017/06/16/health/lead-baby-food-partner/index.html


        The best and worst countries to be a kid

        (CNN)Children growing up in Niger are at the highest risk of having their childhood cut short, according to a report by Save the Children.

        The nongovernmental organization’s report for 2017 ranked the country as the worst place to be a kid, globally.
        Norway and Slovenia share the top position as the best places to grow up. (The top 10 best and worst places are listed below)
          The End of Childhood Report ranked 172 countries from best to worst in an effort to explore the main reasons why childhood comes to an early end in certain places.
          The rankings were determined by measuring the average level of performance across eight topics: under-5 mortality, malnutrition that stunts growth, out-of-school children, child labor, early marriage, adolescent births, displacement by conflict and child homicide.
          The United States, at 36th on the list, was not found to be exempt from the threats that contribute to premature death among children. It is one of seven countries where half of all teen births occur, and its number of infant deaths was 23,455 in 2015: more than those of 40 European countries combined in the same year.
          Richard Bland, Save the Children’s national director of policy, advocacy and development, was most surprised by the country’s low ranking and its position between Bosnia and Russia.
          The US “is falling behind some countries that have had some pretty severe economic turmoil like Greece or Ireland, and yet a number of those nations are prioritizing childhood,” Bland said. “They are investing in childhood and ensuring access to proven programs for childhood.”
          Bland said the three most noticeable global trends this year that may not have been occurring at as high a rate in past years were violence, famine and displacement.
          West and Central Africa, where the 10 worst countries to be a child are located, are particularly affected by famine and displacement, states the report. In Niger, the lowest-ranked country, 43% of children 59 months or younger have stunted growth from malnourishment. The Central African Republic, ranked the fourth worst for children, has 19.3% of its population forcibly displaced by conflict, with evidence of recruitment and use of child soldiers.
          “More people are fleeing war and persecution than ever in history,” Bland said.
          Syria has the highest percentage of a forcibly displaced population on the list, at 65.4%.
          In 2015, 263 million children were out of school, 168 million were involved in child labor, and nearly 28 million were forced to leave their homes globally, according to the report.
          The 10 countries with the highest child homicide rates are in Latin America and the Caribbean, according to the report. This is due to a combination of gang- and drug-related violence, Bland said.
          A positive trend, Bland noted, is that the movement on maternal, newborn and child survival has cut infant mortality by half since 1990.
          But he is concerned by President Donald Trump’s proposed fiscal budget for 2018, which diminishes foreign aid by 31%. This includes humanitarian assistance as well as maternal and newborn child health programs.
          “We’re talking about children dying,” Bland said. “I mean, there is no greater childhood-ender than mortality and infant mortality, and to us, that’s unconscionable to consider cutting programs that have been so successful.”
          The report lacks an exploration into the root causes of why certain countries made the top of the list or why places like Niger were at the bottom, said Lindsay Stark, an associate professor of population and family health at Columbia University’s Mailman School of Public Health.
          But it can be assumed that it has to do with levels of economic development, fertility rates and family planning, strong social supports and the absence or presence of conflict, she said.
          Save the Children admits that the report has limits, Stark said. A crucial limitation is that the data were drawn from household surveys, missing children who are homeless or living in orphanages, she said.

          See the latest news and share your comments with CNN Health on Facebook and Twitter.

          “Given what we know about the risks to children who are not even living in a household, I think that this is very true that these are conservative estimates,” Stark said.
          But Stark approves of how the methodology equally weighed the eight indicators of a childhood’s end in order to determine the global rankings.
          “Some might say ‘if a child dies, that’s the end of childhood in a very different kind of way, and so we’re going to give that more weight in the index,’ ” she said. “But Save the Children actually chose to give equal weight, which I personally quite like, because I think it highlights the severity and importance of other issues, which I think might receive less attention.”

          Best countries to be a kid

          1. Norway, Slovenia (tie)
          3. Finland
          4. Netherlands, Sweden (tie)
          6. Portugal
          7. Ireland
          8. Iceland, Italy (tie)
          10. Belgium, Cyprus, Germany, South Korea (tie)

          Worst countries to be a kid

          1. Niger
          2. Angola
          3. Mali
          4. Central African Republic
          5. Somalia
          6. Chad
          7. South Sudan
          8. Burkina Faso
          9. Sierra Leone, Guinea (tie)

          Read more: http://www.cnn.com/2017/06/15/health/best-worst-places-to-be-a-kid/index.html


          Overweight pregnancy increases risk of birth defects, study says

          (CNN)Risks of major birth defects increased in step with the severity of a mother’s obesity or overweight, a study published Wednesday in the BMJ medical journal found.

          Based on these results, women should be encouraged to adopt a healthy lifestyle and be at a normal body weight before conception, said researchers led by Martina Persson, a researcher in the clinical epidemiology unit at Karolinska Institutet in Stockholm, Sweden.
          The study’s findings are not entirely new, but “expand on previous knowledge,” Persson said in an email. Past studies have shown an increased risk of congenital malformations among obese mothers.
            What was not known is whether the same risk increased when mothers were simply overweight and whether risks escalated as the severity of overweight/obesity increased.

            More than a million women studied

            Persson and her colleagues analyzed data on more than 1.2 million live births, excluding twins and other multiples, in Sweden between 2001 and 2014.
            For the mothers in the study, being underweight was defined as having a body mass index of less than 18.5. Normal weight ranged from BMI 18.5 to 24, while overweight ranged from BMI 25 to 29. Obesity among the mothers was categorized as either class I, a BMI of 30 to 34, class II, a BMI of 35 to 39, or class III, a BMI of 40 or higher. Body mass index is the ratio between a person’s weight and height.
            A total of 43,550 of the infants — 3.5% — had a major congenital malformation, the researchers found when looking at the medical records. Heart defects were the most common birth defect, followed by flaws in the genital organs, limbs, urinary system, digestive system and nervous system.
            Babies of normal-weight mothers had a 3.4% risk of a major congenital malformation, the researchers calculated. By comparison, the proportion of major birth defects among the children of overweight mothers was 3.5%. Among the babies of mothers in obesity class I, the rate was 3.8%; in obesity class II, 4.2%; and obesity class III, 4.7%.
            “We demonstrate increased risks of major malformations also in offspring of mothers with overweight and risks progressively increase with a mother’s overweight and obesity severity,” Persson said. She noted that these results show a connection — but cannot prove a direct cause — between maternal weight and birth defects.
            Risk of congenital heart defects, malformations of the nervous system, and limb defects also progressively increased as BMI rose from overweight to obesity class III, while genital and digestive system defects increased in babies of obese mothers only. Overall, the study showed, the risk of a major malformation was higher in boys, 4.1%, than in girls, 2.8%.
            “Overweight and obesity in pregnancy increases risks of several severe complications in the mother and her child,” said Persson, who added that high rates of obesity are a “problem in many parts of the world.”
            A study released this week in the New England Journal of Medicine found that more than 2 billion adults and children globally are overweight or obese; that equates to one-third of the world’s population.

            The benefits of a healthy weight

            Dr. Siobhan M. Dolan, a medical adviser to March of Dimes who was not involved in the study, said the “findings are consistent with prior research, which shows an association between increasing weight and adverse perinatal outcomes such as preterm birth and birth defects.”
            Dolan, who is a professor of obstetrics/gynecology and women’s health at Montefiore Medical Center in the Bronx, New York, said the research “demonstrates a dose-response relationship between increasing weight and increasing risk for congenital anomalies.” In other words, the more overweight a mother, the higher the odds for a baby born with a defect.
            “Getting to a healthy weight has so many benefits, for both mothers and babies, including decreasing risks of diabetes and hypertension for moms, as well as decreasing risks for preterm birth,” said Dolan.
            Dr. Raul Artal, professor and chairman emeritus of the department of obstetrics, gynecology and women’s health at Saint Louis University, said the new study is important in that it “emphasizes a medical problem around the world.” He was not involved in the new study.
            Obese women, overweight women and sedentary women “have a very high incidence of diabetes and high blood pressure in pregnancy. As a result, their offspring are at very high risk for certain congenital malformations that come along with obesity,” said Artal, who is a maternal fetal medicine specialist.
            Congenital heart disease is “by far” the most common “birth defect among mothers that have obesity and diabetes,” Artal said. Other birth defects include neural tube defects, such as spina bifida and hydrocephalus, where cerebrospinal fluid causes pressure on the brain, cleft palate, anorectal aphasia, where a child lacks an anus and the lower bowels, and limb reductions or absence, for example, a missing foot.
            The vast majority of babies born to obese mothers are large for their gestational age with “organ maturity delay,” said Artal. “So they could have problems with breathing … and they have delayed neurodevelopment and the vast majority of them end up having childhood obesity,” he said.
            Obesity then becomes an inter-generational problem, one that is “grossly neglected,” said Artal.

            Getting started before pregnancy

            Artal noted that until the mid-1980s, textbooks told women “they should rest as much as possible and indulge” during pregnancy. Among certain physicians, this advice continues.
            “Women have heard this for generations,” said Artal. Since 1985, he has been the main author of the guidelines for exercise in pregnancy published by the American College of Obstetricians and Gynecologists and updated most recently two years ago.
            If women followed these exercise guidelines during pregnancy, “they will be in good shape, figuratively and literally,” said Artal.
            Current guidelines for weight gain for pregnancy are 28 to 40 pounds for women who are underweight, 25 to 35 pounds for women who are normal weight, 15 to 25 pounds for women who are overweight and 11 to 20 pounds for women who are obese.
            Generally, pregnant woman “should watch their weight and use judicious weight gain in coordination with their physician — but taking into account that the current guidelines for gestational weight gain for overweight and obese women are excessive,” said Artal. “And you can put ‘excessive’ in bold letters and put my name behind that.”

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            The March of Dimes’ Dolan emphasized that pregnant women should eat a healthy, well-balanced diet and take a daily prenatal vitamin containing 400 micrograms of folic acid, beginning before conception and continuing with a daily prenatal vitamin that has 600 micrograms of folic acid throughout pregnancy. Thirty minutes of moderate exercise most days of the week is also recommended for most pregnant women.
            “But getting to a healthy weight is a big part of what women can do before they become pregnant, along with quitting smoking and discussing any medications they take with their doctor,” said Dolan. “If we can help women get to a healthy weight and to quit smoking, we can help prevent some birth defects.”
            Persson also suggests women do what they can to avoid birth defects. Her research, she said, should “encourage women in reproductive age to strive towards a normal BMI before conception.”

            Read more: http://www.cnn.com/2017/06/14/health/overweight-pregnancy-birth-defects/index.html


            Woman in texting suicide case ‘intoxicated’ by antidepressants, doctor says

            Taunton, Massachusetts (CNN)A woman on trial for urging her boyfriend to kill himself was delusional after becoming “involuntarily intoxicated” by antidepressants, a psychiatrist said Monday.

            Michelle Carter “was unable to form intent” after switching to a new prescription drug only weeks before her boyfriend committed suicide in July 2014, Dr. Peter Breggin testified. She even texted his phone for weeks after he died, Breggin said.
            Carter, 20, is on trial for involuntary manslaughter in the death of Conrad Roy III, who was 18 when he poisoned himself by inhaling carbon monoxide in his pickup truck.
              Prosecutors have argued that while Carter played the role of a loving and distraught girlfriend, she had secretly nudged Roy toward suicide by sending him numerous text messages encouraging him to take his own life.
              Prosecutors say the texts prove Carter badgered Roy to his death. But defense attorneys argue he already was intent on killing himself and that Carter had urged him to get help.
              Legal experts are watching the trial closely because it could set a legal precedent on whether it is a crime to tell someone to commit suicide.

              A switch in drugs

              Breggin, testifying for the defense, said that Carter had no nefarious intent but genuinely thought she was helping Roy. She had been on Prozac for years before switching to another antidepressant, Celexa, in April 2014 — three months before Roy’s death, Breggin said.
              Such drugs can impair judgment, wisdom, understanding, love and empathy, he said — especially in the adolescent brain, which is still developing and is “more susceptible to harm and all intrusions.”
              At the time of Roy’s death, Carter was 17.
              Breggin, who did not treat Carter, told Bristol County Juvenile Court Judge Lawrence Moniz that he reached his conclusions after reviewing Carter’s educational records, text messages and police files and interviewed a half-dozen people who knew her.
              Carter is being tried as a youth because she was a minor when her alleged crime took place. She waived her right to a jury trial, so the judge will render a verdict after testimony concludes.
              Before age 12, Carter had seemed to be loving, caring and helpful. But as a teen she became “a very troubled youngster,” Breggin said.
              Carter began taking Prozac in 2011, when she was 14, after developing anorexia, Breggin said. She later transitioned to Celexa, which he said can increase suicide risk in people younger than 24 along with agitation, panic attacks, grandiosity and not understanding the trouble one is getting into.
              Adverse changes also can occur when doses change, Breggin said.
              Breggin testified that Carter began cutting herself between April and June of 2014.

              ‘My life’s a joke’

              Roy’s body was found July 13, 2014, a day after his suicide in his parked truck in a Kmart parking lot in Fairhaven, nearly 40 miles from his home.
              As early as October 2012, Roy told Carter he was going to kill himself and that there was nothing she could do to stop him, Breggin said. The psychiatrist said Roy made four suicide attempts before succeeding.
              Over the course of many texts to Carter about depression and hopelessness, Roy spoke often of killing himself and going to heaven, Breggin said.
              Roy believed he had seen the devil at a hospital, and Carter said she had dreamed of the devil, said Breggin, who added that nightmares are common among people who are on Prozac.
              “My life’s an abortion,” the young man told Carter in a text, Breggin said. “I just feel like my life’s a joke. My negative thoughts have controlled me to the point where I’m legit going insane.”
              Roy suggested the pair should end up like Romeo and Juliet, Shakespeare’s suicidal young lovers, and believed they would still be able to communicate after death, Breggin said.
              Breggin said his clinical analysis was that Carter would do anything to help Roy and was always cheering him up. Meanwhile, Roy provided little encouragement and was negative about dating and marrying her, Breggin said.

              ‘Enmeshed in a delusion’?

              On Celexa, Breggin said, Carter became “involuntarily intoxicated” and began to think she could help Roy get what he wanted — to die painlessly, to get to heaven and to help his family grieve less by understanding him.
              “She is not forming the criminal intent — ‘I’m gonna harm him,'” Breggin said. “She’s found a way to use her unique power to help and to help this boyfriend — in her mind but not in his — to not keep making mistakes and not keep hurting himself.”
              Assistant District Attorney Maryclare Flynn said last week that when Roy had second thoughts that fateful night, Carter told him to get back in the truck and listened on the phone while he cried out in pain and took his last breaths.
              “She was enmeshed in a delusion,” Breggin testified. “She was unable to form intent because she was so grandiose.”
              Breggin also reviewed a letter that Roy left for Carter. It said Roy was expecting to reach heaven, that he loved her, and that he thanked her for her kindness. In the letter he didn’t say anything about being bullied.
              A day after Roy’s suicide Carter texted him, saying: “Did you do something??! Conrad I love you so much please tell me this is a joke. I’m so sorry I didn’t think you were being serious Conrad please don’t leave us like this,” according to the text shown in court.
              Two months later, Carter also texted Roy to say that she had raised $2,300 through a softball tournament to raise awareness of mental health issues.
              “She imagines him looking down upon her,” Breggin said.

              Prosecutor: Carter was untruthful

              During cross-examination, Assistant District Attorney Katie Rayburn tried to paint Carter as an untruthful person who craved attention.
              Rayburn said Carter had routine medical checkups but doctors never noted on her medical records that she was cutting herself.
              Rayburn said Breggin used text messages to conclude Carter was cutting herself.
              The prosecutor said Carter was sending simultaneous messages of distress to a friend named Lisa and innocuous messages to boy she liked named Luke.
              In the text message exchange, which Rayburn read out loud, Carter texted Lisa: “completely lost control tonight and I’m really disappointed in myself I thought I was getting better.” Moments later, she texted Luke to say: “I’m bored as hell. You?”
              In another message to Lisa, Carter wrote that she couldn’t stop shaking because she “cut way too deep it won’t stop bleeding.”
              The prosecutor said Carter’s mother also never reported any concerns about the cutting.
              Breggin said people who cut themselves are very secretive and learn how to conceal it.
              Rayburn also tried to pin Breggin down on the exact period of involuntary intoxication. Breggin said it started between June 29 and July 2, 2014, but he wasn’t clear when it ended.
              On July 15, 2014, Rayburn said Carter met with a therapist, who did not indicate that Carter had any symptoms of involuntary intoxication.

              Read more: http://www.cnn.com/2017/06/12/health/text-message-suicide-trial/index.html


              Lincoln Memorial Reflecting Pool to be drained after 80 ducks die

              (CNN)The National Park Service will drain the Lincoln Memorial Reflecting Pool this weekend after approximately 80 ducklings were found dead, including 53 in one day.

              The federal agency says chemical treatments alone aren’t sufficient to fully reduce the parasite and snail population. So the pool must be drained and cleaned.
              The cleanup begins Sunday. It will take about two days to fully drain the water. On Tuesday, crews will begin cleaning the interior.
                Humans who come in contact with the parasite could develop cercarial dermatitis, better known as “swimmer’s itch.” It’s not contagious and rarely requires medical treatment, but it’s uncomfortable.
                Crews will refill the pool next Friday and things should be back to normal the following week.

                Read more: http://www.cnn.com/2017/06/09/health/dead-ducks-lincoln-memorial-trnd/index.html