Over-diagnosis of reflux in infants leads to needless medication, research finds

Apr. 1, 2013 ? Medications used to treat gastroesophageal reflux disease, or GERD, are some of the most widely used medications in children less than one year old.

But in a new study, researchers from the University of Michigan and the University of Missouri concluded that physicians often label common symptoms in infants, such as crying and spitting up, as disease. Frequent use of the GERD label can lead to overuse of medication, according to study published today online ahead of print in the journal Pediatrics.

The study found that doctors' use of the label GERD prompted parents to request medication for their baby even when they had been advised that the medication would probably be ineffective.

"As doctors we need to appreciate that the words we use when talking with patients and parents have power -- the power to make a normal process seem like a disease. As pediatricians, our job is to make sick children healthy, not to make healthy children sick," says Tarini, who also is an investigator in U-M's Child Health Evaluation and Research Unit.

In the study, researchers surveyed parents coming into a pediatric clinic in Michigan about how they would respond to a hypothetical clinical scenario describing an infant who cries and spits up excessively but is otherwise healthy. Parents were randomly assigned to receive one of multiple vignettes. In some vignettes, the doctor gave a diagnosis of GERD; in others the doctor did not provide a disease label.

Additionally, half the parents were told that existing medications are probably ineffective; the rest were not given information about medication effectiveness. Parents who received a GERD diagnosis were interested in medicating their infant, even when told that medications were ineffective. Parents not given a disease label were interested in a prescription only when the doctor did not discuss whether the medication was effective.

Over-diagnosis of GERD can make a medical condition out of a normal behavior, says lead author Laura Scherer, assistant professor of psychological science in the College of Arts and Science at the University of Missouri.

"The growing digestive systems of an infant can be finicky and cause the child to regurgitate. The discomfort can cause the infant to cry, but it is not necessarily a disease," says Scherer. "Parents can learn from this study that a disease label can make them want medication for their child, regardless of whether the drugs are effective or not. Parents should follow doctors' advice, which sometimes means accepting a doctor's explanation of why an infant's crying and vomiting may be normal.

"Unnecessary use of medication is costly," says Scherer. "Especially for families without insurance, the over-use of medications can be a needless expense. In addition, the long-term side effects of the medication frequently prescribed to children diagnosed with GERD have not been fully studied, although the medication has been correlated to slightly higher rates of pneumonia."

Additional authors: Of the University of Michigan: Brian J. Zikmund-Fisher, Ph.D., Department of Health Behavior and Health Education in the School of Public Health and Angela Fagerlin, Ph.D. of the Department of Internal Medicine and co-director of the Center for Bioethics and Social Sciences in Medicine.

Funding: Dr. Tarini is supported by a K23 Mentored Patient-Oriented Research Career Development Award from the National Institute for Child Health and Human Development (K23HD057994). Dr. Zikmund-Fisher was supported by a Mentored Research Scholar Grant from the American Cancer Society (MRSG-06-130-01-CPPB). Funded by the National Institutes of Health (NIH).

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The above story is reprinted from materials provided by University of Michigan Health System.

Note: Materials may be edited for content and length. For further information, please contact the source cited above.

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Journal Reference:

1. Laura D. Scherer, Brian J. Zikmund-Fisher, Angela Fagerlin, and Beth A. Tarini. Influence of 'GERD' Label on Parents' Decision to Medicate Infants. Pediatrics, 2013; DOI: 10.1542/peds.2012-3070

Note: If no author is given, the source is cited instead.

Disclaimer: This article is not intended to provide medical advice, diagnosis or treatment. Views expressed here do not necessarily reflect those of ScienceDaily or its staff.

Source: http://feeds.sciencedaily.com/~r/sciencedaily/top_news/top_health/~3/J-oXsYdztjw/130401104403.htm

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Two in China first known deaths from H7N9 bird flu

BEIJING (AP) ? Two Shanghai men have died from a lesser-known type of bird flu in the first known human deaths from the strain, and Chinese authorities said it wasn't clear how they were infected but there was no evidence of human-to-human transmission.

A third person, a woman in the nearby province of Anhui, also contracted the H7N9 strain and was in critical condition, China's National Health and Family Planning Commission said in a report on its website Sunday.

There was no sign that any of the three, who were infected over the past two months, had contracted the disease from each other, and no sign of infection in the 88 people who had closest contact with them, the medical agency said.

H7N9 bird flu is considered a low pathogenic strain that cannot easily be contracted by humans. The overwhelming majority of human deaths from bird flu have been caused by the more virulent H5N1, which decimated poultry stocks across Asia in 2003.

The World Health Organization is "closely monitoring the situation" in China, regional agency spokesman Timothy O'Leary said in Manila.

"There is apparently no evidence of human-to-human transmission, and transmission of the virus appears to be inefficient, therefore the risk to public health would appear to be low," O'Leary said.

The 87-year-old victim became ill on Feb. 19 and died on Feb 27. The other man, 27, became ill on Feb. 27 and died on March 4, the Chinese health commission said. A 35-year-old woman in the Anhui city of Chuzhou became ill on March 9 and is being treated.

The Chinese Center for Disease Control and Prevention conducted tests and confirmed Saturday that all three cases were H7N9, the health commission said.

Scientists have been closely monitoring the H5N1 strain of the virus, fearing that it could mutate into a form that spreads easily among people, potentially sparking a pandemic. So far, most human cases have been connected to contact with infected birds.

Source: http://news.yahoo.com/2-china-first-known-deaths-h7n9-bird-flu-092118642.html

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Dutch hold 4, search for alleged sarin nerve agent

THE HAGUE, Netherlands (AP) ? Dutch police spent three days digging up a field after receiving a tip that sarin may have been buried there, but they found no trace of the deadly nerve agent, a prosecutor's office spokeswoman said Monday.

Two men and two women have been arrested in the case in the southern city of Maastricht on suspicion of owning and concealing a deadly gas, spokeswoman Cindy Reijnders said in a telephone interview.

She said police started monitoring a man's movements last week after a tip and arrested him Friday as he was about to start digging in a field just outside Maastricht, a city close to the Dutch border with Belgium.

Reijnders said police have no indication that any sarin was about to be used in a terror attack.

"There are no legal activities you can use sarin for," she said. "But at this moment we have no information or clues that it was going to be used for terrorism."

Reijnders said police believe the four suspects may have been trying to sell the nerve agent for their own financial gain, although it remained unclear if they already had a buyer lined up.

Sarin, first created by German scientists just before World War II, is a powerful nerve agent that was used in an attack by the Japanese doomsday cult Aum Shinrikyo on the Tokyo subway system in 1995 that killed 13 people and sickened around 6,000.

One suspect was arrested Friday as he was about to start digging in a field near Maastricht. Police dug up 400 square meters (4,300 sq. feet) in the area to a depth of a meter (yard) without finding anything.

Three of the suspects, whose ages range from 21 to 52 years, are Dutch citizens and one has Dutch-Turkish joint citizenship. Their names were not released.

They are due to appear before an investigating judge Tuesday at a private sitting where prosecutors will ask for their continued detention while investigations continue, Reijnders said.

According to the Organization for the Prohibition of Chemical Weapons, sarin is a highly toxic and fast-acting organo-phosphorous compound that can be absorbed through the skin or by breathing it in.

Exposure to a high dose of sarin can cause convulsions and loss of consciousness. Death can be caused by suffocation because of muscular paralysis and the effects the sarin has on the respiratory center of the nervous system.

Source: http://news.yahoo.com/dutch-hold-4-search-alleged-sarin-nerve-agent-194653311.html

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Death toll hits 34 in Tanzania building collapse

DAR ES SALAAM (Reuters) - The death toll from the collapse of a multi-storey building in Tanzania has risen to 34 after more bodies were pulled from the rubble, a senior government official said on Monday.

Rescue workers at the site in a district in the commercial capital Dar es Salaam have now cleared most of the debris and reached the basement of the building that caved in on Friday morning. It is likely more bodies could be found.

Tanzania's buoyant economy has fuelled a building boom, especially in Kariakoo and the city center. But the speed of construction has raised concerns about safety standards.

"A total of 34 people have so far been confirmed dead. We expect to conclude the search operation early today and officially announce the final death toll," Dar es Salaam Regional Commissioner Said Meck Sadick told Reuters.

"The bodies being recovered now have started to decompose...so we want to conclude this exercise as soon as possible to allow funeral arrangements to take place."

The building of more than 12 storeys had been under construction near a mosque in the Kariakoo district near the city center. Several cars were crushed and boys playing football nearby were among the dead.

Police said four people had been arrested over the incident.

"This is the worst building collapse in our country's history," Dar es Salaam regional police commander Suleiman Kova told Reuters.

He said those responsible would face criminal charges.

(Reporting by Fumbuka Ng'wanakilala; Writing by James Macharia; Editing by Angus MacSwan)

Source: http://news.yahoo.com/death-toll-hits-34-tanzania-building-collapse-091857196--finance.html

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Hillary Clinton Transition Leaves Democrats Waiting On 2016 Decision

New York Times:

Hillary Clinton left the State Department nearly two months ago, but she still needs a staff to keep up with the considerable business of being Hillary Clinton.

Read the whole story at New York Times

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Source: http://www.huffingtonpost.com/2013/03/31/hillary-clinton_n_2988653.html

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Stocks slide with slowdown in manufacturing growth

Stocks opened April on a weak note, ending slightly lower after an industry group reported that US manufacturing growth cooled in March.?Industrial stocks fell the most in the S&P 500.

By Steve Rothwell,?AP Markets Writer / April 1, 2013

Traders work on the floor at the New York Stock Exchange Monday. The main catalyst for the dip in stocks was a slowdown in US manufacturing growth last month.

Brendan McDermid/Reuters

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The stock market got off to a slow start in April, edging lower after the Standard and Poor's 500 index eclipsed its all-time high last week.

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The main catalyst was a slowdown in U.S. manufacturing growth last month. The decline in the Institute for Supply Management's benchmark manufacturing index for March was worse than economists had forecast. Stocks started falling shortly after the report came out at 10 a.m. and stayed lower the rest of the day.

The Dow Jones industrial average closed 5.69 points, or 0.04 percent, lower at 14,572.85. The Standard & Poor's 500 index dropped 7.02 points, or 0.5 percent, to 1,562.17.

Industrial companies fell 1 percent, the most in the S&P. 3M, which makes Post-it notes, industrial products and construction materials, fell 66 cents, or 0.6 percent, to $105.65. Caterpillar, a maker of construction and mining equipment, dropped $1.33, or 1.5 percent, to $85.64.

Investors have raised their expectations for the U.S. economy as the market has climbed this year, said JJ Kinahan, chief derivatives strategist at TD Ameritrade. The Dow is up 11.2 percent in 2013, the S&P 9.5 percent.

"The numbers have to be outstanding in order to drive the market higher," Kinahan said. "It's a different mindset when we're at these levels."

The S&P 500 closed the first quarter at an all-time high of 1,569.19, surpassing its previous record close of 1,565.15 set on Oct. 9, 2007. The index has recaptured all of its losses from the financial crisis and the Great Recession. The Dow broke through its previous all-time high March 5.

The market has risen this year because of optimism that housing is recovering and that employers and starting to hire again. Strong company earnings and continuing stimulus from the Federal Reserve have also increased demand for stocks.

Small stocks fared worse than large ones Monday.

The Russell 2000, a benchmark of small-company stocks, fell 1.3 percent to 938.78, paring its gain for the year to 10.5 percent. It was the index's biggest decline in more than a month. The Nasdaq composite fell 28.35 points, or 0.9 percent, to 3,239.17.

April is historically the second-strongest month for stocks, Deutsche Bank analysts said in report released Monday. The S&P 500 has gained an average of 1.4 percent in April, based on returns since 1960, making it the second strongest month after December.

The last meaningful setback for stocks started before November's election. The market slid 6 percent between Oct. 1 and Nov. 15 in the run-up to the vote and immediately afterwards on concerns that Washington would be unable to enact reforms to keep the economy growing.

Evidence that growth is continuing, despite the political tensions in Washington, have kept stocks on an upward trajectory since then, leaving investors waiting for dips to add to their holdings.

"I'd love to have some sort of a pullback here because I'd think it's an opportunity," said Scott Wren, an equity strategist at Wells Fargo Advisors. "But it doesn't feel like we're going to have one in the near term."

The yield on the 10-year Treasury note, which moves inversely to its price, fell to 1.84 percent from 1.85 percent.

Markets were closed in observance of Good Friday last week. European markets were closed Monday for Easter.

Among other stocks making big moves:

? Tesla Motors jumped $6.04, or 16 percent, to $43.93 after the electric car company said sales are running ahead of schedule. The Palo Alto, Calif., company said Sunday night that first-quarter sales have exceeded 4,750 Model S sedans, above its previous forecast of 4,500.

? DFC Global, a finance company that provides loans to consumers without bank accounts, fell $3.60, or 22 percent, to $13.04 after slashing its earnings estimate for its fiscal year because of increasing loan defaults in its business in Britain.

? American Greetings rose $1.95, or 12 percent, to $18.05 after the company agreed to be taken private for about $602 million by a group led by some of its top executives.

Source: http://rss.csmonitor.com/~r/feeds/csm/~3/Tg8aC8PjB_Y/Stocks-slide-with-slowdown-in-manufacturing-growth

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Syria accuses rebels of setting fire to oil wells

BEIRUT (AP) ? Heavy shelling in a neighborhood in the northern city of Aleppo sent civilians fleeing for their lives on Sunday, and the state news agency accused rebels trying to topple the government of setting fire to three oil wells.

Syria's civil war has battered the country's infrastructure and torn its social fabric. After more than two years of conflict, neither President Bashar Assad's regime nor the rebels fighting for his ouster appear close to victory.

The Britain-based Syrian Observatory for Human Rights said civilians were vacating the Sheikh Maqsoud neighborhood of Aleppo under heavy shelling by government forces. Rebels took over parts of the neighborhood late last week and were still clashing with Assad's troops who are trying to push them out. The Observatory, which relies on a network of contacts inside Syria, said four people, including two children, were killed in the shelling.

In the east, the state news agency, SANA, said rebels had set fire to three oil wells in the province of Deir al-Zour, causing a daily loss of 4,670 barrels of oil and 52 cubic meters of natural gas. It accused "terrorists," the government's term for rebels, of setting the fires after fighting among themselves about how to divide the oil.

Rebels battling Assad have seized large areas of territory in Syria's oil-rich east, including a number of oil fields. Although they lack the ability to exploit them, their loss represents a setback to the cash-strapped government they are trying to overthrow.

SANA said rebels have burned a total of nine wells in recent months. The three set ablaze on Sunday are the only ones still burning.

Also on Sunday, the government and the opposition blamed each other for killing a group of people found dead near the Lebanese border.

The Observatory said the bodies of 11 people, including eight women, were found near the town of Talkalakh in Homs province. The group said they were killed when government forces stormed the area. But SANA blamed rebels for the "massacre," saying they stormed the area, killed 10 people and looted homes and shops.

In another development, the head of the Syrian opposition's umbrella body said the group's military chief planned to visit Arab countries to solicit military aid. The trip follows a declaration last week by the Arab League that its member nations have a "right" to aid the Syrian opposition. Mouaz al-Khatib, the head of the Syrian National Coalition, told the Qatari daily Al Sharq of Gen. Salim Idris's travel plans, but did not say which countries he would visit.

Syria's conflict began in March 2011 with protests calling for Assad's ouster. It has since become a civil war, with hundreds of independent rebel groups across Syria fighting Assad's forces. The government says the war is an international conspiracy to weaken Syrian being carried out by terrorists on the ground. The U.N. says more than 70,000 people have been killed.

___

Associated Press writers Albert Aji in Damascus, Syria, and Brian Murphy in Dubai, United Arab Emirates, contributed to this report.

Source: http://news.yahoo.com/syria-accuses-rebels-setting-fire-oil-wells-142049239.html

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