Abortion rate decline stalls, unsafe abortions rise

LONDON (Reuters) - A long-term decline in the rates of abortion worldwide has stalled and the proportion of terminations that are unsafe and put women's lives at risk is rising, an international group of scientists said on Thursday.

Researchers from the World Health (WHO) and the Guttmacher Institute, which researches sexual and reproductive health, said a trend of falling numbers of abortions between 1995 and 2003 had leveled out since then, suggesting that increased access to contraception worldwide has also stalled.

"We are also seeing a growing proportion of abortions occurring in developing countries where the procedure is often clandestine and unsafe," said Gilda Sedgh, lead author of the study and a senior researcher at the Guttmacher Institute.

Between 1995 and 2003, the abortion rate per 1,000 women of childbearing age (15 to 44 years) worldwide dropped from 35 to 29. This new study found that in 2008 the global abortion rate was 28 per 1,000, virtually unchanged from 2003's level.

"This plateau coincides with a slowdown in contraceptive uptake," Sedgh told a briefing in London about the findings. "And without greater investment in quality family planning services, we can expect this trend to persist."

Alarmingly, Sedgh said, the proportion of abortions characterized as unsafe rose from 44 percent in 1995 to 49 percent in 2008.

The researchers, whose study was published in the medical journal, define unsafe abortion as a procedure for terminating a pregnancy carried out by someone who does not have the necessary skills, or in an environment that does not meet minimal medical standards, or both.

CONTRACEPTION

Despite the decline in the abortion rate, there were 2.2 million more abortions in 2008, when 43.8 million were carried out, than in 2003 when there were 41.6 million. This is due to the increasing global population, the researchers said.

From 2003 to 2008, the number of abortions fell by 0.6 million in the developed world, but increased by 2.8 million in developing countries.

Of all the world's regions, Latin America has the highest rate, with 32 per 1,000 women in 2008. Africa and Asia follow close behind with rates of 29 and 28 per 1,000 women respectively. Rates for North America and Oceania were the lowest, at 19 and 17.

Sedgh said that while in Europe around 30 percent of pregnancies end in abortion, there was a far higher rate in Eastern Europe than in the rest of the region.

In Western Europe there were 12 abortions per 1,000 women in 2008, while in Eastern Europe at the same time there were 43.

Sedgh said the study's findings showed strong correlations between abortion rates and access to effective contraceptives, and between abortion rates and the law.

"The abortion rates is clearly lower in places were abortion laws are more liberal," she said, pointing to Africa and Latin America where rates are high.

There is also a strong link between restrictive laws and higher rates of unsafe abortions. Between 95 percent and 97 percent of all abortions in Africa and Latin America are unsafe, the study found.

Sedgh said family planning services around the world appeared to be failing to keep up with rising demand for effective contraception driven by the desire for small families and better control over the timing of births.

"There are still 215 million women in developing countries who have an unmet need for contraceptives," she said.

SOURCE: http://bit.ly/zH63pI The Lancet, online

Read more »

Posted in: HEALTH

Long term, gastric bypass beats out banding: study

NEW YORK (Reuters Health) - Among weight-loss surgery options, gastric bypass comes with more complications shortly after surgery than gastric banding, but makes up for it with fewer long-term side effects and repeat operations, new research suggests.

People who got bypass surgery also lost weight faster, and more kept it off, in the study of more than 400 obese Swiss patients.

"What we would like with any of the (weight-loss) procedures ideally would be to have the least long-term complications, certainly the least long-term complications requiring (repeat) surgery," said Dr. Michel Suter, a surgeon from the Hopital du Chablais, Aigle, who worked on the study.

"There are drawbacks with bypass, there are side effects, and we have to take them into account," he told Reuters Health. But "overall, if I had to choose between the procedures, I certainly recommend the bypass."

Still, one researcher not involved in the study said that when complications do happen with gastric bypass, they are often more serious than complications after banding.

Suter and his colleagues looked back at records of 442 obese patients who underwent weight-loss surgery at their hospitals between 1998 and 2005.

To qualify for surgery, all patients had to have a body mass index -- a measure of weight in relation to height -- of at least 40, or at least 35 if they also had an obesity-related illness. That's the equivalent of a five-foot, six-inch person weighing at least 248 pounds or 217 pounds, respectively.

Half of the patients had gastric band procedures, which involve placing a band around the top of the stomach to limit its size to a small pouch. The other half were treated with gastric bypass, when part of the stomach is stapled off and then rerouted to bypass a segment of the small intestine. The two groups were similar in terms of their age and initial weight.

Doctors checked in with those patients at least twice a year for the next six years post-surgery.

Complications in the month after the procedure -- which typically include infections -- were more common after gastric bypass than after banding: 17 percent of bypass patients had any surgery-related problems, compared to five percent in the banding group.

"The operation itself is a little more complicated and a little more risky," Suter explained.

But after that point, the bypass group lost weight faster, put less of it back on and suffered fewer long-term complications, including those that called for a repeat procedure.

Six years post-surgery, 12 percent of bypass patients had a body mass index above 35, considered severely obese, compared to one-third after gastric banding.

And thirteen percent of patients needed re-operation after complications with gastric bypass, versus close to 27 percent following banding.

The long-term complications of gastric banding were generally related to the band eroding and needing to be removed, food intolerance or stretching of the esophagus, the researchers reported Monday in the Archives of Surgery.

With gastric bypass, patients most often had internal hernias, a type of bowel blockage that can be life-threatening if not treated.

Complications

'NOT ALL COMPLICATIONS ARE ALIKE'

Dr. Christine Ren-Fielding, a weight-loss surgeon at the New York University School of Medicine, said that her research has suggested gastric bypass complications tend to be much more serious than complications related to banding.

"We all know that not all complications are alike," Ren-Fielding, who was not involved in the new study, told Reuters Health by email. "For example a wound infection treated with antibiotics is not the same as a...leak which requires re-operation and extended hospitalization."

While Ren-Fielding said banding has been found to be "a relatively safe procedure," technique and surgeon experience can affect outcomes of any surgery.

Weight-loss surgery typically costs around $20,000. Gastric banding may be cheaper than bypass initially because of a simpler procedure and shorter hospital stay -- but Suter said that the need for band adjustments over time may drive up costs.

When it comes to choosing a procedure, Ren-Fielding said, "My philosophy is one of helping the patient be successful and optimizing outcomes, regardless of which operation they have, because all bariatric surgeries have their overwhelming benefits in treating the disease of obesity."

"I'm not at a point when I would say, 'No way' to a patient who asks for a band and has no contraindications to the band," Suter said.

Still, he added, "I discourage them to have a band because I don't want to operate on them two or three times -- one time is enough. Bypass is more definitive."

SOURCE: http://bit.ly/yw13CX Archives of Surgery, online

Read more »

Posted in: HEALTH

How much iodine is too much?

NEW YORK (Reuters Health) - Iodine deficiency is a major health problem worldwide, but a new study points to the potential downsides of too much iodine.

Iodine is a mineral found in iodized salt, seafood, eggs, dairy and some breads. It is used by the thyroid gland to help regulate metabolism and development, especially in babies and children.

Iodine deficiency during fetal and early-childhood development is a leading cause of brain impairments in much of the world. So most research has been directed at the effects of inadequate iodine.

Less is known about how much iodine is too much. So for the new study, reported in the American Journal of Clinical Nutrition, Chinese researchers randomly assigned healthy adults to take various doses of iodine supplements for four weeks.

They found that at relatively higher doses -- 400 micrograms a day and up -- study participants began developing what's called subclinical hypothyroidism.

That refers to a dip in the body's thyroid hormone levels, but with no obvious symptoms of hypothyroidism -- which include problems like fatigue, depression, dry skin and weight gain.

In this study, people taking 400-microgram supplements were getting around 800 micrograms of iodine per day when diet was factored in.

So the findings suggest that people -- at least in China -- should get no more than 800 micrograms a day, according to the researchers, led by Wanqi Zhang of Tianjin Medical University.

That's different from what's recommended in the U.S., where National Institutes of Health guidelines say the safe upper limit for adults is 1,100 micrograms of iodine per day.

Still, the typical American would get much less than 800 micrograms of iodine a day through diet anyway, according to Dr. Elizabeth Pearce, an associate professor of medicine at Boston University who was not involved in the study.

That said, Pearce cautioned against taking iodine supplements with more than 150 micrograms in a daily dose. And most Americans could skip supplements altogether.

"Overall, we're iodine-sufficient," said Pearce, who studies iodine sufficiency and thyroid function.

But she said there are certain people who may need supplements, including pregnant women.

In the U.S., adults are advised to get 150 micrograms of iodine each day; pregnant women should get 220 micrograms, while breastfeeding moms are told to get 290 micrograms.

The American Thyroid Association recommends that pregnant and breastfeeding women take a vitamin with iodine because low iodine can increase the risk of miscarriage and thyroid problems in moms, in addition to mental disabilities in babies.

According to Pearce, vegans may also want to take a supplement. In a recent study, Pearce and her colleagues found that the average iodine level in a group of 63 vegans was lower than what's recommended -- though their thyroid hormone levels were in the normal range.

Vegans eschew all animal products, including dairy and eggs, so their iodine sources may be few.

WHO YOU ARE, WHERE YOU LIVE

The current findings are based on 256 healthy adults who had normal thyroid when they entered the study. Zhang's team, which did not respond to requests for comment, randomly assigned them to take one of 12 doses of supplemental iodine -- anywhere from 0 to 2,000 micrograms per day, for four weeks.

Of the people who took 400 micrograms, 5 percent developed subclinical hypothyroidism. And the numbers rose in tandem with the iodine dose: Of people on the highest dose (2,000 micrograms per day), 47 percent developed subclinical hypothyroidism.

"These are interesting data," Pearce said, "because we don't have a lot of information on iodine excess."

Subclinical hypothyroidism has no obvious symptoms, but studies have linked it to an increased risk of heart disease over the long term, Pearce noted.

Those studies don't prove that subclinical hypothyroidism is to blame. Still, they raise concerns that there could be health consequences.

But in general, Pearce said, it's thought that the effects of your iodine intake may depend on "who you are and where you live."

In certain parts of the world, the soil is low in iodine, and people who eat mainly local foods have a high risk of deficiency. In other parts of the world -- Japan, for example -- people have a high iodine intake starting early in life, and they seem to "tolerate" that high level, Pearce explained.

In China, natural iodine levels vary by region. The country introduced universal salt iodization in 1996, so the problem of iodine deficiency has been controlled in most areas.

But Pearce said it's not clear if the adults in this study had adequate iodine intake early in life. If not, that could be a factor in their response to iodine supplements.

SOURCE: http://bit.ly/zQWJF4 American Journal of Clinical Nutrition, online.

Read more »

Posted in: HEALTH