Oxygen therapy brings ‘remarkable’ turnaround for toddler who fell in pool

(CNN)Eden Carlson’s story might be one in a million.

The toddler, who suffered brain damage after falling into a swimming pool at 23 months old, has begun to rebuild her brain function after treatment with hyperbaric oxygen therapy, according to a case study published last month in the journal Medical Gas Research.
“We’re stimulating growth of tissue and inhibiting inflammation and stopping cell death,” said Dr. Paul G. Harch, clinical professor and director of hyperbaric medicine at LSU Health New Orleans School of Medicine.
    Hyperbaric oxygen therapy introduces a greater-than-usual amount of oxygen to patients within a special chamber. The special chamber allows a doctor to control both the pressure and the level of vital gas, explained Harch, who treated the child and is lead author of the case study.
    After months of oxygen treatments, Eden is a “typical 3-year old,” said her mother, Kristal Carlson of Fayetteville, Arkansas.
    “Her cognitive abilities and speech are completely recovered. Most of her fine motor skills have returned,” Carlson wrote in an email. “Today she walks with assistance really well. She can walk independently, also, but not long distances.”

    A mother’s nightmare

    While Carlson was in the shower on February 29, 2016, Eden, who had just learned to walk, slipped through a baby gate and fell into the backyard swimming pool.
    “Her older siblings lost track of her and thought she was with me,” explained Carlson, who is still unsure how long Eden may have been in the water.
    It could have been “as long as 15 minutes,” she said, but was “at least five minutes.”
    Also unclear is how long her heart stopped beating, Harch said.
    “She stopped breathing, obviously, once she was face-down and probably inhaled some water, but we don’t know how long after that her heart stopped and her blood pressure went to zero,” Harch said. “We just know that when Mom got her out of the pool, there was nothing.”
    Carlson said her first instinct was to get her daughter to breathe.
    “So I gave her a couple of breaths and patted her, saying her name,” Eden’s mother said. “Then chest compressions.” Paramedics took over CPR, which was delivered for 100 minutes before Eden’s heart began beating on its own.
    Stabilized, the child was flown to Arkansas Children’s Hospital, where she spent five weeks, her mother recalled. “When we brought her home, she was a vegetable, unable to do anything,” she said. “She had a feeding tube, could not speak, could not sit up, etc.”
    “She was profoundly injured,” Harch said. The hospital sent the child home with a monitor because when she’d fall asleep, she’d stop breathing at times and needed her parents to resuscitate her. “The predictions given to the family by the doctors were a list of never-evers: She will never ever talk, walk or eat on her own.”
    It soon became clear that the doctors and neurologists at Arkansas Children’s Hospital could do nothing more for Eden, so her parents “started googling alternative ways to treat brain injuries,” Carson explained. They found Harch’s website about three weeks after returning home from the hospital and “went from there.”

    ‘Bridging treatment’

    Eden could not be moved, and no hyperbaric oxygen chambers could be found in the Fayetteville area, so Harch treated the girl remotely with a “bridging therapy.”
    Using a normal oxygen tank with tubes to the nose, Harch put the child on “just 2 liters per minute for 45 minutes a day,” with the first treatment exactly 55 days after Eden fell into the pool.
    “We noticed an immediate difference in her,” her mother said. She videotaped Eden’s response to send to Harch.
    He said he saw a positive change in the child’s affect and decided to continue the treatments for three weeks.
    “She was more relaxed, her neuro-storming stopped, she started smiling, laughing, swallowing, tracking with her eyes, and saying words,” Carlson said.
    When Eden’s condition stabilized, her parents took her to New Orleans for treatments in a hyperbaric chamber, using the same amount of oxygen but with added pressure.
    The treatments are spaced out over time in order to allow the brain to improve on its own, said Harch, who is also a co-owner of Harch Hyperbarics Inc., a consulting company.
    “She began saying more words and speaking in sentences,” her mother said. “She started sitting up, crawling, pulling to stand, and trying to walk!”
    The ultimate proof: An MRI scan taken 162 days post-drowning — 27 days after Eden’s 40th oxygen session — compared with one taken in the hospital shows only mild residual injury to the brain, plus a near-complete reversal of brain shrinkage that sometimes occurs in similar cases.

    How does hyperbaric medicine work?

    “It’s not completely understood,” Harch said, explaining that in the late 1950s, doctors in the Netherlands began experimenting with trying to give maximum amounts of oxygen to patients with conditions in which lack of oxygen was a problem, such as gangrene.
    The US Navy also uses hyperbaric oxygen therapy to treat decompression sickness or diver’s disease.
    It wasn’t until 2008 that the medical profession really began to understand “what this therapy is about,” Harch said. “Some doctors took human cells, put them in a Petri dish and put them in a hyperbaric chamber and gave them a typical treatment.” They used mass gene array analysis to measure and analyze gene activity.
    “What they found at the end of 24 hours, 8,101 human genes had either been turned on or turned off, and the largest clusters were those that code for growth and repair hormones — in other words, stimulate tissue growth and heal wounds — and the anti-inflammatory genes,” Harch said. “And the largest clusters of the turned-off ones — and these are temporary, the turning on and turning off of genes — were the pro-inflammatory genes and the ones that code for cell death.”
    Dr. Justin Sempsrott, executive director of Lifeguards Without Borders and medical director of International Surf Lifesaving Association, said Eden’s case is “remarkable” and “shows future direction for rehabilitation after non-fatal drowning.”
    Sempsrott, who was not involved in Eden’s treatment or the case study, noted that it was “done in an academically rigorous way.”
    “The most important determining factor of whether or not a person — adults or children — is going to survive drowning is how long they were under water,” Sempsrott explained. For those known to be underwater for fewer than five minutes, 86% survive with good neurological outcome, and when it’s less than 10 minutes, 77% survive with good neurological outcome.
    People underwater for 15 to 25 minutes are “kind of all over the place,” Sempsrott said. “More than 25 minutes is universally bad outcomes; they are typically neurologically devastated.”
    This is one reason giving breath along with good-quality chest compression is recommended for drowning resuscitation, he said.

    Cold vs. warm water

    “It’s possible to maintain that oxygenation even for a long period of time when someone comes out of the water,” Sempsrott said. “The time she was given CPR and survived is really not unheard of.”
    Generally, though, CPR cannot distribute oxygen throughout the body as effectively as natural breathing.
    Though Harch believes that the cold water in the pool was protective, Sempsrott said that “overwhelmingly,” most people who fall into cold water are simultaneously dying of hypothermia and drowning. “Hibernation state” does not help preserve the organs from harm, he said, though this is a common misperception.
    “They actually have either worse or the same outcomes,” he said.
    In most cases, Semsprott said, “after the news story dies down,” the person with little to no brain function requires round-the-clock care for the rest of their lives.
    “Non-fatal drowning is far more common than fatal drowning,” he said. A conservative estimate is that for every drowning, there are four non-fatal events, while the Centers for Disease Control and Prevention tallies seven non-fatal events for every drowning among children.
    Dr. Paul S. Auerbach, Redlich Family Professor in the Department of Emergency Medicine at the Stanford University School of Medicine, said “prevention is the name of the game.”
    “Parents need to understand all the best methods for trying to prevent drowning in children,” said Auerbach, whose complete list of tips in his classic book, “Wilderness Medicine,” begins with the single most important rule:
    Watch your children.
    “Toddlers are at greatest risk for drowning,” he said, though all children under 14 are at a high risk.
    “Teach children to swim, but be advised that such teaching does not absolutely ‘drownproof’ a child,” Auerbach said. “In other words, never let a small child out of your sight when he is near the water, even if he knows how to swim.”

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

    Ultimately, Sempsrott said, Eden’s story is “remarkable” and one he hopes can be reproduced, “because this was an otherwise very common, hopeless, severe brain damage drowning story.” Still, he said, even if this is a one in a million story, for the Carlsons, hyperbaric oxygen treatments have “made all the difference in the world.”
    “We have no doubt that as she grows, the walking will become easier for her,” Carlson wrote of her daughter’s progress. “Eden is doing really well today.”

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    Why are these countries the most obese? Walking is just one reason

    (CNN)The world is in the middle of a major obesity epidemic, and current trends indicate that it’s only going to get worse.

    A recent study found that more than 2 billion adults and children globally are overweight or obese and suffer health problems because of that — but this is nothing new.
    There are, however, pockets of the global population who remain somewhat unaware of this public health crisis, despite the growth of waistlines all around them, and this lack of awareness is just one of the underlying problems, according to Frank Hu, professor of nutrition and epidemiology at the Harvard T.H. Chan School of Public Health.
      “Different countries have different issues,” Hu said. “You need to mobilize (their) whole society to tackle the problem. … it’s not just a medical problem.”
      The Pacific Islands, Middle East and Americas lead the way in terms of regions with the greatest obesity rates. In 2014, more than 48% of the population of the Cook Islands was classified as obese. Qatar led the way in the Middle East with 34%, followed closely by the United States at 33%, according to the World Health Organization.
      Obesity is defined using a person’s body mass index, the ratio between weight and height, with a BMI of 25 to 29.9 considered overweight and over 30 obese.

      When assigning blame, two factors are common: diet and physical activity, namely poor diets and a lack of physical activity. But a number of smaller factors combine to fill these two large umbrellas, and those need to be understood to truly tackle the problem, Hu believes.
      What is behind the obesity problem among countries at the top of the table?

      1. Activity inequality

      A study published this week in the journal Nature used data from smartphones to analyze the number of steps taken on average each day among people across 111 countries.
      Using the Azumio Argus app, which tracks physical activity, researchers monitored the steps of more than 700,000 individuals and ranked countries based on their level of movement in the form of steps — and those numbers varied quite significantly.
      Hong Kong topped the rankings with 6,880 average daily steps, followed closely by China with 6,189 steps. At the bottom of the list was Indonesia, with 3,513 steps.

      However, the researchers calculated another statistic that they believe is a stronger predictor of obesity within a country, a calculation they called “activity inequality.”
      “Activity is not distributed uniformly across a country,” said Scott Delp, professor of bioengineering and mechanical engineering at Stanford University, who led the study.
      The larger the difference between the top and bottom walkers within a population, the greater their rates of obesity are likely to be, he explained. “It means there is a subset of a population that is activity-poor.”
      When focusing on activity inequality, the list changed, with Saudi Arabia and Australia ranking first and second. The US came in fourth, with levels of activityinequality greatest in more car-oriented cities like Houston and lowest in more walkable cities like New York.

      1. Saudi Arabia

      2. Australia

      3. Canada

      4. Egypt

      5. United States

      The team also found this inequality to disproportionately affect women, meaning more women would be in the “activity-poor” subset of the population. “Targeting the activity-poor (could) have a public health impact,” Delp said.

      2. Perceptions of exercise

      While physical inactivity is said to be aiding the growing rate of obesity worldwide, for example as urbanization leads to more sedentary lives, experts point out that in some populations, exercise simply isn’t a priority.
      This is evident in the Middle East and China, they say, namely through perceptions of exercise and its place on residents’ list of priorities.
      In Kuwait, focus groups from the World Health Organization found that locals consider exercise as sport rather than something done with a group of friends or at home, according to Temo Waqanivalu, team leader of population-based prevention of noncommunicable diseases at the WHO. “There’s a whole cultural barrier,” he said.
      In addition, in the Middle East overall, it’s not considered the norm for women to take part in outdoor exercise or physical activity for leisure. “Having women exercise openly is a cultural issue,” he said.
      Across Asia and the Middle East, Hu thinks there is a great deal of misunderstanding. “Most people are not aware of the benefits of being physically active on their health,” he said.

      3. Poor prioritization of exercise

      In China, however, and other parts of East Asia, an extensive focus on academic achievement can often mean physical education is left behind. Students “are under tremendous pressure for academic achievement,” Hu said. Physical education “classes are often used for academic studies.”
      Hu further cites Japan and the countries of Scandinavia, where exercise is a common part of daily life in terms of commuting and socializing. In Japan, he said, “it’s encouraged … in older age.”

      4. Environmental factors

      Another factor hindering exercise in many places is the outdoor environment. In the Middle East, that means temperature.
      “It’s typically very hot to do outdoor activities,” Hu said. The same is true in many developing regions near the equator, and when combined with poor perception of exercise and lack of awareness of its importance for health, the impact is more significant.
      In China, the issue is pollution. “Pollution has become a burden to exercise outdoors,” Hu said. This is particularly problematic for children and the burgeoning childhood obesity epidemic, studies have shown.
      But Waqanivalu believes that people’s eating behaviors are in more dire need of attention.
      “It’s now understood that … food and diet is a bigger contributor (to obesity) than a lack of physical activity,” he said. And within this comes a combination of culture and environment fueling poor dietary behaviors — and therefore overweight and obesity.

      5. The value of (processed) food

      The value placed on food varies significantly among populations, but one thing most have in common is gifting and an expression of generosity using food — and, therefore, value placed on the type of food given.
      In the Pacific, where obesity rates are highest, processed foods hold high stakes.

      “For every ceremonial function in the Pacific, you bring food,” said Waqanivalu, himself a native of Fiji. “There has been a shift in the types of food in that exchange.”
      Offerings would once be freshly caught fish or fresh fruit, but they are now canned or processed foods. “You hear … people would go and fish, sell their fish and buy cans of tuna,” he said, adding that being surrounded by fish seems to lessen their value.
      “Canned foods come with prestige in some way,” he said. But he believes that education and awareness efforts by the government in recent years may now slowly be paying off.
      Similar attitudes have been noted in parts of the Americas — such as Brazil, where soft drinks and processed foods also carry weight as signs of wealth and success — as well as Africa. “They have an abundance of local food (in some places) but have cultural value attached to (processed foods),” Waqanivalu said.
      In the Middle East, extreme wealth means people are consuming greater amounts of high-calorie foods, adding to weight gain. “The abundance of energy-dense foods is remarkable,” Hu said.

      6. The value of obesity

      Societal perceptions of being overweight or obese are also key in determining how effectively an obesity epidemic may surge and in turn be controlled.
      Hu uses the example of China and other regions within Asia as well as Africa, where having a larger, more robust figure remains a sign of wealth. The idea of a chubby baby being a sign of wealth and health in China, for example, “hasn’t fully gone away yet.”
      “There is less social stigma about being obese,” Hu said. “May don’t consider obesity as a major problem.”

      7. An obesogenic environment

      “The food and physical environment are key factors that we have created,” Waqanivalu said, adding that while initial blame was placed on individuals, experts have now agreed that as a society, we have created environments that aid people in gaining weight.
      “The environment created determines the choices individuals make,” he said. Sitting most of the day, taking fewer steps, having greater access to fast food and having less time to cook are just a few examples.
      The US is a prime example of this and has been for 30 years. “The US is still the superpower of obesity,” Hu said, highlighting the availability of cheap, highly processed foods and urban design focused on driving — particularly in the South and Midwest. “The obesity trend has been very stubborn over the past three decades, despite efforts.”
      But today, as developing regions rapidly urbanize and adopt a lifestyle like the West has had for decades, individuals are directed to make the same decisions: They need to try harder to take more steps and go in search of healthy food, ignoring the unhealthy options bombarding them on the way.
      “In Africa, it’s certainly true … and the Americas,” Waqanivalu said. “Why do we bring these foods in and then teach the population not to eat them?”

      Tackling the causes

      Waqanivalu and Hu agree on this point and the fact that interventions are needed to counter decisions previously made on environmental design as well as highlight the true extent of today’s obesity epidemic and its future consequences to those not taking an interest.

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

      Hu believes that obesity is truly a societal, not individual, problem and that national and international policies are needed to create settings in which it is easy for people to be healthy.
      Waqanivalu believes the priority should be children.
      The number of overweight or obese infants and children under the age of 5 increased from 32 million in 1990 to 42 million in 2013, according to the World Health Organization, with numbers increasing from 4 million to 9 million in the African region alone over that period.
      “(Children) cannot be blamed for the environment they are raised in,” Hu said. “Governments must intervene to create an environment that aids them to make the right decision.”

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      Medicaid affects millions of Americans, young and old

      (CNN)Your tax dollars provide health care benefits for millions of people. Currently, 74 million people receive health coverage under Medicaid, a government program for low-income people, including adults with disabilities and children. Under the program, beneficiaries pay low out-of-pocket fees for health services that are paid for by federal dollars.

      There is a wide range of benefits for enrollees: doctor services, emergency room visits, inpatient hospital services, family planning, pediatric and family nurse practitioner care, screening, diagnostic and treatment services, nursing facility services, home health care, lab and X-ray tests, rural health clinics, smoking cessation programs for pregnant women and transportation to medical care.
      Federal law says these benefits must be provided to Medicaid enrollees. Yet individual states can choose to also cover services such as prescription drug fees, dental services, physical therapy, optometry services, chiropractic services, hospice and private nursing services.
        When Medicaid was signed into law in 1965, fewer than 5 million Americans qualified for benefits under this program. But a growing population and a number of changes to the law — the Affordable Care Act alone added 16.3 million enrollees — amplified the total number of beneficiaries.
        Medicaid and the Children’s Health Insurance Program cover nearly 36 million children. The Children’s Health Insurance Program uses federal funds to match state funds that are providing coverage to children in families with incomes too high to qualify for Medicaid but unable to afford private coverage.
        As a result, Medicaid ranks as the single largest source of health coverage in the United States, according to the government website.

        Medicaid’s wide-ranging effects, by the numbers

        3 out of 5: How many nursing home residents across America are covered by Medicaid, according to the Kaiser Family Foundation, a nonprofit organization focused on national health issues. (The foundation is not associated with the managed care plan Kaiser Permanente.)
        36%: How much of Medicaid’s funds are spent on senior citizens receiving its benefits, though they make up only 15% of Medicaid enrollees, according to Kaiser.Medicare, a federal health insurance program, mostly serves people 65 or older. To pay for this program, the Federal Insurance Contributions Act requires 1.45% of citizens’ earnings go to Medicare, with an additional employer contribution of the same amount.
        Medicaid covers services, such as long-term care, that Medicare does not cover for the elderly.
        7.9: The average rating, on a zero to 10 scale, that Medicaid enrollees gave their overall health care, according to a study published in July in JAMA Internal Medicine. Zero represented “the worst health care possible,” and 10 represented “the best health care possible.” Eighty-four percent of enrollees reported that they were able to get all the care they or their physician believed was necessary in the past six months; 3% of enrollees reported that they were not able to get care because of waiting times or because physicians did not accept their insurance.
        53 cents on the dollar: How muchMedicaid generally pays doctors and other health care providers, compared with what they would receive from a privately insured patient, according to an index created by Kaiser. The index calculates the current rate paid to providers for serving Medicaid patients as 66% of the fee allowed for a Medicare beneficiary, which is 80% of the price charged by private insurers. The number of doctors who refuse to see Medicaid patients due to lower fees is difficult to estimate and has been the subject of an ongoing debate.
        3 in every 10: How many people with an opioid addiction were covered byMedicaid and the Children’s Health Insurance Program in 2014, according to Kaiser. Medicaid covered about 690,000 of the 2.3 million people addicted to heroin or prescription opioid medicines that year.
        Half: How many births in New York and California are paid for by Medicaid. Other states range from 72% (New Mexico) to 27% (New Hampshire), according to Kaiser. Meanwhile, the average payment made by a private US insurer for maternal care plus vaginal childbirth was $12,520 in 2010, according to Truven Health Analytics, an IBM company.

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

        84%: How many adults on Medicaid report getting their blood pressure checked. It’s higher than the percentage of people with private insurance — 79% — who report getting a blood pressure check. People with Medicaid are also more likely to get their cholesterol checked: 60%, versus 56%, Kaiser reports.
        30%: How many non-elderly adult Medicaid beneficiaries say they’re in fair or poor health, according to Kaiser, and many have preventable or controllable conditions. Seven in 10 adult Medicaid enrollees are overweight or obese. One in 10 has a diagnosed mental illness. And nearly one in three smokes tobacco.

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        Health effects of probiotics: Where do we stand?

        (CNN)Probiotic supplements may be a growing trend among health-conscious consumers, but the tiny bacteria that have been stuffed into capsules and stacked on pharmacy shelves coexisted with us before we were even aware of them.

        These live microorganisms are akin to the valuable microorganisms already residing in our bodies, a vast ecosystem of microbial species, including bacteria and yeast.
        Now that products containing probiotics are sold as yogurt, drinks and dietary supplements, there seems to be some confusion around how to define probiotics and how beneficial they really are.
          “It’s taken a while for the scientific community to actually form a consensus of what we mean when we say probiotics, because people might mean different things,” said Lynne McFarland, an associate professor of medicinal chemistry at the University of Washington in Seattle.
          She wrote a paper on the history, development and current use of probiotics, which was published in the journal Clinical Infectious Diseases in 2015.
          “The most recent recommendation and consensus is that they have to be alive. They can be a bacteria or a yeast. They have to be used in an adequate dose, and they have to have some proven beneficial health effect,” McFarland said of probiotics.
          “Probiotics have been around for a long time,” she said. “It took a while for science to catch up with what’s going on.”
          How has our understanding of probiotics changed over time? Here’s a look at probiotics’ steady rise in popularity, from Europe to America, and where health experts now stand on their benefits.

          Prehistory: Storing sushi in the early days of fermentation

          About the time our hunter-gatherer ancestors took up farming, 11,000 years ago, they started to consume probiotics without even realizing it, said Dr. Cate Shanahan, a Newtown, Connecticut-based family physician who also consults as a nutritionist with the Los Angeles Lakers.
          As farmers settled into communities, they developed the habit of storing more of their food. “With anything that you store, microbes are just going to start growing in it,” Shanahan said. This sometimes resulted in the fermentation of foods.

            Fermentation: A new food trend

          Fermentation, when microorganisms grow on and break down food, can make that food item rich with probiotics. The process also may increase the shelf life of a food and make some foods more digestible, Shanahan said.
          For instance, in Asia, sushi was originally a fermented food, Shanahan said.
          “They had so much fish that they’d catch all at once. … So they would store it, and they discovered that packing it in rice would help store the fish so that it would basically rot, but in a way that wasn’t disgusting and more controlled,” she said. “We now know it was because there was special bacteria, called Bacillus bacteria, in the rice that was helping out.”
          In other words, the bacteria in the rice helped store the fish.
          Around the same time, many other examples of fermentation were emerging in other parts of the world. Some research suggests that ancient Egyptians fermented their beverages through complex brewing methods.
          “They have the hieroglyphics of the pharaoh being served something in a bowl, and people who have translated those have gone, ‘OK, this is sort of a fermented milk product,’ ” McFarland said.
          As agriculture expanded, so did our relationship with probiotics.

          13th century: Did Marco Polo drink kefir?

          Marco Polo, the Venetian merchant traveler who ventured across Asia, was known to speak of probiotic-rich fermented beverages such as kefir in his travels.
          It is believed that when nomadic shepherds and travelers journeyed with raw milk carried in leather, the milk would accidentally ferment over time.
          Some studies suggest that this process led to the creation of kefir, a fermented milk drink that originated in the Caucasus Mountains.
          It’s believed that the word kefir derives from the Turkish word keyif, meaning “pleasure” or “feeling good” after its ingestion. The beneficial health properties of kefir and other dairy products were a part of folklore until the idea of probiotics arose.

          19th-20th centuries: The ‘father of probiotics’

          In the late 1800s, French biologist Louis Pasteur identified the bacteria and yeasts responsible for the process of fermentation, but it was Russian biologist Elie Metchnikoff who linked those microorganisms to health outcomes.
          Metchnikoff had long theorized that the microorganisms in our guts could have beneficial or adverse effects on our health.
          In 1905, Metchnikoff studied how many residents of poor communities in Eastern Europe were centenarians, living to be 100 or older. He associated their longevity with the type of bacteria used to ferment the yogurt they would eat, and he became known as the “father of probiotics.”
          “He’s the first one who published a book looking at Bulgarians and saying, ‘Gosh, they live longer,’ and it wasn’t due to their diet. It wasn’t due to the yogurt that they consumed but actually the bacteria that was used to ferment the yogurt,” McFarland said. “That clever Russian. … He’s the one who kind of went, ‘You know, bacteria aren’t all bad.’ “
          In 1908, Metchnikoff shared a Nobel Prize in physiology or medicine with German physician Paul Ehrlich for their research on the immune system.
          Many other scientists followed Metchnikoff’s research efforts into the bizarre micro-world of bacteria, including Henry Tissier, a French pediatrician who discovered “good” bacteria called Bifidobacterium in the guts of infants. He proposed that the bacteria could be used to treat patients with diarrhea.
          However, the concept of probiotics quietly drifted to the background of medical focus until it re-emerged in the mid-1950s in Europe.
          “They were always more popular in Scandinavia and Europe,” McFarland said.

          1950s-1980s: Making a name for probiotics in Europe

          In 1953, German bacteriologist Werner Kollath first used “probiotic” to describe various supplements believed to restore the health of malnourished patients. The term was derived from Latin and Greek, meaning “for life.”
          In the next year, German scientist Ferdinand Vergin used the term to describe “active substances” beneficial for health.

            Are we overusing antibiotics?

          Then, in 1965, a paper in the journal Science used the term probiotics to describe substances produced by one microorganism that stimulate the growth of another.
          In 1974, a paper published in the journal Animal Nutrition Health used the term probiotics in the context in which we use it today, to “contribute to intestinal microbial balance.”
          Then, in 1989, Roy Fuller, a researcher of gut microbial ecology, redefined probiotics as “a live microbial feed supplement, which beneficially affects the host animal.”
          In the United States, however, there was less attention on probiotics and more attention on antibiotics.
          “Antibiotics were seen as only beneficial. In the ’70s, actually, doctors would just treat people with anything with a shot, like they didn’t have any clue about resistance or any clue about side effects,” Shanahan said.
          “About the late ’80s, early ’90s, we started to understand antibiotics had a downside,” she said, such as leading to antibiotic resistance and killing off beneficial bacteria. Meanwhile, Americans started to understand probiotics.

          1990s: Probiotic popularity spreads across US

          “I started doing this research back in the 1990s, and it was very infrequent that somebody in the US would know what we were talking about when we would talk about probiotics,” McFarland said.
          “It really wasn’t until 1994, when the dietary health and supplement law was enacted, that allowed these kinds of products to be sold over the counter,” she said. “Suddenly … people became very aware of what it is. It’s truly amazing how quickly the popularity of this spread.”
          In 1994, the US Food and Drug Administration implemented the Dietary Supplement Health and Education Act, which allowed dietary supplements to be regulated under a different set of rules than prescription drugs, foods and beverages.
          “What changed is that before that law became enacted, probiotics were considered an investigational drug. So it was going through the FDA process, and we had to go through …very long and expensive drug pathway development through the FDA,” McFarland said.
          “Then, when the dietary supplement law got enacted … it opened a floodgate of quote-unquote probiotic products that weren’t really probiotic, and the quality of the products were not as regulated as they should have been, having not gone through the ordinary FDA process,” she said. “I think that’s still the situation today.”

          2000s: Health officials crack down on probiotics

          In 2002, the Food and Agriculture Organization of the United Nations and the World Health Organization drafted guidelines for the evaluation of probiotics in food in a joint consultation (PDF).
          The guidelines recommended that the definition of probiotics be “live microorganisms which when administered in adequate amounts confer a health benefit on the host.”
          Around this time, various ways to administer probiotics and prebiotics, which promote the growth of beneficial bacteria in the gut,emerged, McFarland said.
          “There’s now probiotics that come in chocolate; probiotics come in cheese; there’s bread. Little sprinkles you can put on ice cream,” she said.
          Next, scientists started to research how probiotics may benefit your health, specifically your gut.

          2010: A spotlight on the gut

          Studies suggest that some probiotics might help with symptoms of certain chronic gastrointestinal tract conditions, such as irritable bowel syndrome. However, such benefits have not been conclusively demonstrated, and not all probiotics have the same effects, according to the National Center for Complementary and Integrative Health.
          In 2010, a systematic review paper in the journal Gut found that probiotics were helpful in treating the symptoms of irritable bowel syndrome, compared with a placebo or no treatment. Yet the magnitude of benefit and most effective species of probiotic remained uncertain.
          For the paper, 18 randomized controlled trials on the effectiveness of probiotics as an irritable bowel syndrome treatment were analyzed. The trials, published between 1950 and 2008, involved 1,650 patients total.
          “This systematic review indicates that probiotics have a therapeutic benefit in improving IBS (irritable bowel syndrome) symptoms,” the researchers wrote. “Future studies need to establish which species, strain and dose of probiotics are most efficacious in IBS.”

          2010s: His and hers probiotics emerge

          By 2012, the use of probiotics had skyrocketed in popularity in the US, with nearly 3 million more adults using probiotics or prebiotics than in 2007, when only about 865,000 adults used such supplements.
          Among American adults, probiotics ranked as the third most commonly used dietary supplement behind fish oil, and glucosamine and chondroitin, according to a 2015 National Health Statistics Report.
          Additionally, “there’s been a big thing on ‘this is a women’s probiotic’ or ‘this is a men’s probiotic.’ There has been a big thing on gender probiotics,” McFarland said of one emerging trend.
          However, she added that there is no difference between a male or female microbiome, and therefore, there should be no difference in how a probiotic would benefit a man or a woman — that is, outside of vaginal health.
          “The only difference is that there are some probiotic strains that are good for vaginitis, so if they’re trying to say ‘restores vaginal health,’ then that might be OK as a woman’s product,” McFarland said.
          “The thing to remember is that your vagina is a very acidic environment, and it’s colonized with lactobacillus,” she said. “There’s only a couple strains that have been shown to be really good — Lactobacillus reuteri and rhamnosus — and others have been tried but haven’t really been that effective.”

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          All in all, McFarland said, probiotics may be beneficial if taken to prevent travel-associated diarrhea or to prevent side effects of antibiotics. For any other purposes, however, she recommended consulting with your doctor or checking scientific literature for guidance.
          “What we’re finding is that a person has their own profile of their microbiome. If that’s disrupted, and even if you take probiotics, after you stop taking probiotics, it goes back to what your profile was before,” McFarland said.
          “So, it’s like it remembers who’s invited to the party, and it only invites those people,” she said. “I think it’s still an exciting field for research because, the more we appreciate how much bacteria do for us, the more we appreciate what happens when it gets disrupted.”
          Shanahan recommends going old-school.
          “From my perspective, the more logical thing to do is to eat foods that are good for us and that bacteria can utilize as well,” Shanahan said.
          “I get foods rich in prebiotics and ready-to-eat fermented foods. I’ll eat yogurt or kimchi, and for prebiotics to feed the probiotics, I make sure I always get some kind of fiber-y thing, whether it’s nuts or vegetables or beans,” she said. “But the probiotic-rich foods, which are the fermented and cultured foods, are more likely to be beneficial than supplements.”

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          When a woman took sick days for mental health, her email sparked a larger discussion

          (CNN)Madalyn Parker sent an email to her team at work saying she’d be out of office for a few days to focus on her mental health.

          “I was absolutely touched. It brought tears to my eyes,” Parker told CNN. “It was surprising to be applauded for my vulnerability.”

          The email

            Parker, 26, lives in Ann Arbor, Michigan. She’s a software developer or “empathy engineer” — a title she chose for herself — for Olark, a Michigan-based live-chat platform that helps businesses talk to customers. It has a staff of about 40.
            She told CNN she suffers from chronic anxiety, depression and post-traumatic stress disorder. And every now and then, she needs to take some time to focus on her well-being.
            “I had experienced several nights of insomnia and was poorly rested and also having lots of suicidal thoughts, which make it difficult to accomplish much at work,” she said.
            A few weeks ago, she sent an email to her team that said:
            “Hey team,
            I’m taking today and tomorrow to focus on my mental health. Hopefully, I’ll be back next week refreshed and back to 100%.

            The response

            The next day, she opened her inbox to find a flood of response. But one that caught her eye was from company CEO Ben Congleton.
            “I can’t believe this is not a standard practice at all organizations,” read part of his email. “You are an example to us all, and help cut through the stigma so we can all bring our whole selves to work.”
            So, Parker posted the exchange online.
            “I thought the internet should see what a good example he’s setting,” she said.
            Ever since, she’s been flooded with messages telling her just how great her boss must be.
            “Wow, I wish! I needed a medical mental health stay once. Upon my return, my boss told me not to let it happen again or my job would be gone,” one woman wrote.
            Another said, “I had to take a mental health day recently and lie about my reasoning for not coming in, because it’s not seen as a viable excuse for missing work.”

            The reason

            Congleton, the boss, said that as he read through the comments on the email chain, he started to get emotional. He realized it was time to make a change.
            “I think there’s a lot of people out there that don’t really understand what mental health is. I feel sorry for them,” he told CNN. “Mental health (is) just as important as physical health in these situations.”
            The National Institute of Mental Health, in a study in 2015, found that an estimated 16.1 million adults in the US experienced a major depressive episode in the previous year.
            And an American Psychological Association survey in 2016 found less than half of working Americans say the climate in their workplace support employee well-being.
            “It’s 2017,” Congleton wrote on Medium. “When an athlete is injured they sit on the bench and recover. Let’s get rid of the idea that somehow the brain is different.”
            His advice to employers? Create a workplace where your employees feel safe talking about what’s bothering them.
            “There’s this misconception that you can leave part of yourself home when you go to work,” Congleton told CNN. “(But) some personal stuff is gonna hang in there and hold on.”

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            Health effects of coffee: Where do we stand?

            (CNN)It’s one of the age-old medical flip-flops: First coffee’s good for you, then it’s not, then it is — you get the picture.

            Today, the verdict is thumbs up, with study after study extolling the merits of three to five cups of black coffee a day in reducing risk for everything from melanoma to heart disease, multiple sclerosis, type 2 diabetes, Parkinson’s disease, liver disease, prostate cancer, Alzheimer’s, computer-related back pain and more.
            To stay completely healthy with your coffee consumption, you’ll want to avoid packing it with calorie laden creams, sugars and flavors. And be aware that a cup of coffee in these studies is only 8 ounces; the standard “grande” cup at the coffee shop is double that at 16 ounces.
              And how you brew it has health consequences. Unlike filter coffee makers, the French press, Turkish coffee or the boiled coffee popular in Scandinavian countries fail to catch a compound called cafestol in the oily part of coffee that can increase your bad cholesterol or LDL.
              Finally, people with sleep issues or uncontrolled diabetes should check with a doctor before adding caffeine to their diets, as should pregnant women, as there is some concern about caffeine’s effect on fetal growth and miscarriage. And some of the latest research seems to say that our genes may be responsible for how we react to coffee, explaining why some of us need several cups to get a boost while others get the jitters on only one.
              But as you know, the news on coffee has not always been positive. And the argument over the merits of your daily cup of joe dates back centuries. Let’s take a look at the timeline.
              1500’s headline: Coffee leads to illegal sex
              Legend has it that coffee was discovered by Kaldi, an Ethiopian goatherd, after he caught his suddenly frisky goats eating glossy green leaves and red berries and then tried it for himself. But it was the Arabs who first started coffeehouses, and that’s where coffee got its first black mark.
              Patrons of coffeehouses were said to be more likely to gamble and engage in “criminally unorthodox sexual situations,” according to author Ralph Hattox. By 1511 the mayor of Mecca shut them down. He cited medical and religious reasons, saying coffee was an intoxicant and thus prohibited by Islamic law, even though scholars like Mark Pendergrast believe it was more likely a reaction to the unpopular comments about his leadership. The ban didn’t last long, says Pendergrast, adding that coffee became so important in Turkey that “a lack of sufficient coffee provided grounds for a woman to seek a divorce.”
              1600’s headline: Coffee cures alcoholism but causes impotence
              As the popularity of coffee grew and spread across the continent, the medical community began to extol its benefits. It was especially popular in England as a cure for alcoholism, one of the biggest medical problems of the time; after all, water wasn’t always safe to drink, so most men, women and even children drank the hard stuff.
              Local ads such as this one in 1652 by coffee shop owner Pasqua Rose popularized coffee’s healthy status, claiming coffee could aid digestion, prevent and cure gout and scurvy, help coughs, headaches and stomachaches, even prevent miscarriages.
              But in London, women were concerned that their men were becoming impotent, and in 1674 The Women’s Petition Against Coffee asked for the closing of all coffeehouses, saying in part: “We find of late a very sensible Decay of that true Old English Vigour. … Never did Men wear greater Breeches, or carry less in them…”
              1700’s headline: Coffee helps you work longer
              By 1730, tea had replaced coffee in London as the daily drink of choice. That preference continued in the colonies until 1773, when the famous Boston Tea Party made it unpatriotic to drink tea. Coffeehouses popped up everywhere, and the marvelous stimulant qualities of the brew were said to contribute to the ability of the colonists to work longer hours.
              1800’s headline: Coffee will make you go blind. Have a cup of hot wheat-bran drink instead
              In the mid-1800s America was at war with itself and one side effect is that coffee supplies ran short. Enter toasted grain-based beverage substitutes such as Kellogg’s “Caramel Coffee” and C.W. Post’s “Postum” (still manufactured). They advertised with anti-coffee tirades to boost sales. C.W. Post’s ads were especially vicious, says Pendergrast, claiming coffee was as bad as morphine, cocaine, nicotine or strychnine and could cause blindness.
              1916 headline: Coffee stunts your growth
              While inventions and improvements in coffee pots, filters and processing advanced at a quick pace throughout the 1900s, so did medical concerns and negative public beliefs about the benefits of coffee.
              Good Housekeeping magazine wrote about how coffee stunts growth. And concerns continued to grow about coffee’s impact on common aliments of the era, such as nervousness, heart palpitations, indigestion and insomnia.
              1927 headline: Coffee will give you bad grades, kids
              In Science Magazine, on September 2, 1927, 80,000 elementary and junior high kids were asked about their coffee drinking habits. Researchers found the “startling” fact that most of them drank more than a cup of coffee a day, which was then compared to scholarship with mostly negative results.
              1970’s and ’80’s headline: Coffee is as serious as a heart attack
              A 1973 study in the New England Journal of Medicine of more than 12,000 patients found drinking one to five cups of coffee a day increased risk of heart attacks by 60% while drinking six or more cups a day doubled that risk to 120%.
              Another New England Journal of Medicine study, in 1978, found a short-term rise in blood pressure after three cups of coffee. Authors called for further research into caffeine and hypertension.
              A 38-year study by the Johns Hopkins Medical School of more than a 1,000 medical students found in 1985 that those who drank five or more cups of coffee a day were 2.8 times as likely to develop heart problems compared to those who don’t consume coffee. But the study only asked questions every five years, and didn’t isolate smoking behavior or many other negative behaviors that tend to go along with coffee, such as doughnuts. Or “Doooonuts,” if you’re Homer Simpson.
              Millennium headline: Coffee goes meta
              Now begins the era of the meta-analysis, where researchers look at hundreds of studies and apply scientific principles to find those that do the best job of randomizing and controlling for compounding factors, such as smoking, obesity, lack of exercise and many other lifestyles issues. That means that a specific study, which may or may not meet certain standards, can’t “tip the balance” one way or another. We take a look at some of the years. The results for coffee? Mostly good.
              2001 headline: Coffee increases risk of urinary tract cancer
              But first, a negative: A 2001 study found a 20% increase in the risk of urinary tract cancer risk for coffee drinkers, but not tea drinkers. That finding was repeated in a 2015 meta-analysis. So, if this is a risk factor in your family history, you might want to switch to tea.
              2007 headline: Coffee decreases risk of liver cancer
              Some of these data analyses found preventive benefits for cancer from drinking coffee, such as this one, which showed drinking two cups of black coffee a day could reduce the risk of liver cancer by 43%. Those findings were replicated in 2013 in two other studies.
              2010 headline: Coffee and lung disease go together like coffee and smoking
              A meta-analysis found a correlation between coffee consumption and lung disease, but the study found it impossible to completely eliminate the confounding effects of smoking.
              2011 headline: Coffee reduces risk of stroke and prostate cancer
              A meta-analysis of 11 studies on the link between stroke risk and coffee consumption between 1966 and 2011, with nearly a half a million participants, found no negative connection. In fact, there was a small benefit in moderate consumption, which is considered to be three to five cups of black coffee a day. Another meta-analysis of studies between 2001 and 2011 found four or more cups a day had a preventive effect on the risk of stroke.
              As for prostate cancer, this 2011 study followed nearly 59,000 men from 1986 to 2006 and found drinking coffee to be highly associated with lower risk for the lethal form of the disease.
              2012 headline: Coffee lowers risk of heart failure
              More meta-analysis of studies on heart failure found four cups a day provided the lowest risk for heart failure, and you had to drink a whopping 10 cups a day to get a bad association.
              2013 headline: Coffee lowers risk of heart disease and helps you live longer
              For general heart disease a meta-analysis of 36 studies with more than 1.2 million participants found moderate coffee drinking seemed to be associated with a low risk for heart disease; plus, there wasn’t a higher risk among those who drank more than five cups a day.
              How about coffee’s effects on your overall risk of death? One analysis of 20 studies, and another that included 17 studies, both of which included more than a million people, found drinking coffee reduced your total mortality risk slightly.
              2015 headline: Coffee is practically a health food
              As a sign of the times, the U.S. Department of Agriculture now agrees that “coffee can be incorporated into a healthy lifestyle,” especially if you stay within three to five cups a day (a maximum of 400 mg of caffeine), and avoid fattening cream and sugar. You can read their analysis of the latest data on everything from diabetes to chronic disease here.
              2017 headline: Yes, coffee still leads to a longer life
              The largest study to date on coffee and mortality surveyed 520,000 people in 10 European countries and found that regularly drinking coffee could significantly lower the risk of death.
              Another study with a focus on non-white populations had similar findings. That study surveyed 185,000 African-Americans, Native Americans, Hawaiians, Japanese-Americans, Latinos and whites. The varying lifestyles and dietary habits of the people observed in both studies led the authors to believe that coffee’s impact on longevity doesn’t have to do with how its prepared or how people drink it — it has to do with the beverage’s biological effect on the body.
              But stay tuned. There’s sure to be another meta-study, and another opinion. We’ll keep you updated.

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              Meningitis vaccine may also cut risk of ‘untreatable’ gonorrhoea, study says

              Bacteria causing two different illnesses belong to the same family and share much of the same genetic code providing unexpected cross protection

              Hopes to fight untreatable strains of gonorrhoea have risen after it emerged that a new vaccine against meningitis unexpectedly reduced the risk of people getting the sexually transmitted infection.

              Some strains of gonorrhoea are resistant to all available drugs, making vaccine development an urgent global health priority. But according to a study in The Lancet, a vaccine has offered protection against the sexually transmitted disease for the first time.

              Gonorrhoea spreads through unprotected vaginal, oral or anal sex and many of those who contract the disease experience no symptoms. If left untreated, the disease can cause infertility and can increase the transmission of HIV infection.

              A New Zealand meningitis epidemic in the early 2000s prompted the mass vaccination of a million people and fortuitously set the scene for the current study. The vaccine used, known as MeNZB, was designed to protect against meningococcal group B infection the cause of the most deadly form of meningitis.

              But intriguingly, over the next few years, scientists noticed fewer gonorrhoea cases than expected in those who had been vaccinated against meningitis.

              Dr Helen Petousis-Harris, a vaccine specialist from the University of Auckland who led the study, was optimistic: Some types of gonorrhoea are now resistant to every antibiotic we have, and there appeared [to be] little we could do to prevent the steady march of gonorrhoea to superbug status. But now theres hope, she added.

              The research team studied over 14,000 people aged 15-30 whod been diagnosed with gonorrhoea at sexual health clinics across New Zealand and who had been eligible for the MeNZB vaccine during the emergency vaccination programme. They found vaccinated individuals were over 30% less likely to develop gonorrhoea.

              Despite meningitis and gonorrhoea being very different illnesses, both are caused by bacteria from the same family and share much of the same genetic code, providing a possible explanation for the cross-protection that the team observed.

              More than 78 million people worldwide get gonorrhoea each year with most infections in men and women under the age of 25. It is the second most common bacterial sexually transmitted infection in the UK after chlamydia. In England alone, almost 35,000 people were affected in 2014.

              British Association for Sexual Health and HIVs President, Dr Elizabeth Carlin, who was not involved in the study, was more sceptical: These early findings are to be welcomed but its important to keep in perspective that the vaccine offered only moderate protection …. an individual receiving this vaccine remains susceptible to gonorrhoea but just less so than if unvaccinated.

              The MeNZB vaccine used in the current study is no longer manufactured, but Petousis-Harris has high hopes for a similar meningitis vaccine called 4CMenB, available in many countries.

              Petousis-Harris was clear about what needed to happen next. We need an urgent assessment of current meningitis vaccines to see if they protect against gonorrhoea. It may be possible to eliminate many gonorrhoea infections using a vaccine with only moderate protection. It does not need to be perfect, she added.

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              ‘Pierced’ baby picture sparks outrage among parents

              (CNN)Enedina Vance was fed up. She felt like other parents didn’t understand her message. She felt like they weren’t listening to her.

              So she got on her phone, found a picture of her 6-month-old daughter and pasted a diamond stud over the infant’s dimple to make it look like she had a piercing.
              Vance, a strong advocate against piercing or circumcising children, posted the edited picture to Facebook, where it had more than 13,000 shares as of Thursday afternoon.
                “I make all of her decisions until she’s 18, I made her, I own her!!” she wrote.
                What Vance didn’t expect was the reaction she’d get from parents around the world. Outrage. Hate mail. Threats to call Child Protective Services.
                But the image also proved her point, and it got parents talking.
                “The reaction that parents have when they see this beautiful perfect baby being … mutilated, that initial shock, that reaction of anger, I want them to hold on to that,” the 35-year-old said.

                Many thought photo was real

                The stay-at-home mom from Fostoria, Ohio, knew that seeing a picture of a baby with a dimple piercing would get her family and friends talking, so she shared it in parenting Facebook groups.
                The post quickly incited outrage among the parenting community, and she was called “a bad mother” and worse.
                Many people assumed the piercing was real and lambasted Vance for her apparent decision.
                “I seriously can not believe how many people missed that this was purely satirical, I actually used the hashtag #sarcasm,” Vance wrote on Facebook. “Yet people were still threatening to beat me to death, call child protective services, & take away my children.”
                Other parents simply disagreed with her stance on piercing.
                One woman wrote, “I got my ears pierced as a baby. I grew up just fine. … I’m having a girl and I will get her ears pierced.”
                Ohio law allows children under age 18 to get piercings and tattoos with a parent or guardian present. Most states allow minors to be pierced with parental consent.
                Amid the death threats and hate mail, Vance said she also got countless positive messages from parents. Some said they felt they didn’t have a choice in whether their sons were circumcised. Another was told it was a “cleanliness thing.”
                “A lot of this responsibility lies on our medical community. They encourage parents,” Vance said. “It shouldn’t be an option. It shouldn’t be a question.”

                ‘Not a good enough reason’

                Vance didn’t always feel so strongly about circumcision.
                Coming from a family of all women, she said she didn’t know a lot about circumcision until she became pregnant for the first time in the late ’90s. Vance had twin girls, but the research she did stuck in her mind.
                “It felt so outdated, so primitive,” she said. “We as a civilized society should have grown past this and (I) was shocked that cutting my infant’s genitals was even an option.”
                Many parents choose to circumcise their children because of hygienic, health or religious reasons.
                In 2012, the American Academy of Pediatrics found that the health benefits of circumcision outweigh the risks. However, the academy said the benefits weren’t great enough to recommend that all newborn boys be circumcised.
                “There is no compelling reason to deny boys their legitimate right to make their own informed decision when they are old enough to do so,” the report said.
                Vance sees this as a call to action and will tell anyone she meets how she feels if it comes up in conversation. She protested last fall in Cleveland with the Bloodstained Men & Their Friends, an organization that advocates against circumcision.
                But her beliefs extend beyond circumcision.
                “No one has the right to alter, modify, or mutilate another human being’s body for aesthetic purposes, not even parents,” she said.
                Vance has argued that ultimately, children should be able to decide for themselves.
                “What 1-week-old is asking to have earrings?” she said. “Just because it looks cute, just because it looks better — that’s not a good enough reason.”

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