Swiss drugmaker Novartis on Friday won U.S. approval for its gene therapy Zolgensma for spinal muscular atrophy (SMA), the leading genetic cause of death in infants, and priced the one-time treatment at a record $2.125 million.


The Food and Drug Administration approved Zolgensma for children under the age of two with SMA, including those not yet showing symptoms. The approval covers babies with the deadliest form of the inherited disease as well as those with types where debilitating symptoms may set in later.

“This is potentially a new standard of care for babies with the most serious form of SMA,” said Dr. Emmanuelle Tiongson, a pediatric neurologist at Children’s Hospital Los Angeles who has provided Zolgensma to patients under an expanded access program. “The job now is trying to negotiate with insurers that this would be a long-term savings.”

Novartis executives defended the price, saying that a one-time treatment is more valuable than expensive long-term treatments that cost several hundred thousand dollars a year.

Novartis touched off a debate over what gene therapy is worth last year, estimating its treatment would be cost-effective at up to $5 million per patient. A review in April by an independent U.S. group, the Institute for Clinical and Economic Review (ICER), concluded Novartis’ value estimate for Zolgensma was excessive.

But on Friday, ICER said that based on Novartis’ additional clinical data, the broad FDA label and its launch price, it believed that the drug fell within the upper bound of its range for cost-effectiveness.

Novartis said it was offering health insurers the option of installment payments for Zolgensma as well as refunds if the treatment does not work and upfront discounts for payers who commit to standardized coverage terms.



Novartis Chief Executive Vas Narasimhan has much riding on Zolgensma, describing it as a near cure for SMA if delivered soon after birth. But data proving its durability extends to only about five years. The therapy uses a virus to provide a normal copy of the SMN1 gene to babies born with a defective gene. It is delivered by infusion.

A RIVAL TO BIOGEN
Novartis is expecting European and Japanese approval later this year. Zolgensma will compete with Biogen Inc’s Spinraza, the first approved treatment for SMA.

The disease often leads to paralysis, breathing difficulty and death within months for babies born with the most serious Type I form. SMA affects about one in every 10,000 live births, with 50 percent to 70 percent having Type I disease.

Spinraza, approved in late 2016, requires infusion into the spinal canal every four months. Its list price of $750,000 for the initial year and $375,000 annually thereafter was also deemed excessive by ICER.

Some neurologists see gene therapy becoming the preferred treatment for newborns with severe SMA, while acknowledging that families may choose to wait for long-term safety and efficacy data for Zolgensma. Novartis is looking into whether the death of one severely ill baby treated with Zolgensma was related to the therapy.

“Most families will want to do the gene therapy since it avoids the frequent spinal taps,” said Dr. Russell Butterfield of the University of Utah in Salt Lake City. Butterfield has received payments from Biogen for consulting.

The FDA said it approved Zolgensma based on clinical trials involving 36 patients aged 2 weeks to 8 months. The agency said patients treated with Zolgensma showed significant improvement in developmental motor milestones such as head control and ability to sit up.

The most common side effects of Zolgensma are elevated liver enzymes and vomiting. The FDA is requiring Zolgensma’s label to include a warning that acute serious liver injury can occur.

With additional studies underway, Novartis said it has so far treated more than 150 patients with Zolgensma, which was acquired with its $8.7 billion purchase of AveXis last year.

Wall Street analysts have forecast sales of $2 billion by 2022, according to a Refinitiv survey. Spinraza sales hit $1.7 billion last year, and are seen rising to $2.2 billion in 2022. Roche is developing risdiplam, an oral drug, for the condition and plans to file for approval later this year.



A PUSH FOR SCREENING
Novartis, Biogen and Roche, as well as patient advocates and neurologists, say babies with SMA who receive treatment before symptoms emerge stand the best chance of near-normal development. They are lobbying to make SMA screening standard for newborns in every market.

“Babies (with SMA) are losing motor neurons from the day they are born, so the ability to treat them as early as possible is the way you get maximum value out of the therapy,” David Lennon, who heads Novartis’ AveXis unit, said in a recent interview.

Dr. Laurent Servais, a child neurologist in Liege, Belgium, called any delay in implementing newborn SMA screening “completely unethical.”

Servais helped oversee a screening pilot program sponsored by the three companies. Southern Belgium is now screening 60,000 newborns annually, half the country’s total births. Taiwan has also begun testing babies for SMA.


But widespread adoption has a long way to go. In the United States, only six states have begun active and routine SMA newborn screening since the federal government recommended it in 2018. Patient advocates estimate it could take until 2022 for the testing to be implemented nationwide.

In Europe, it may be even slower.

England recommended against newborn screening in February and will not consider it again before 2021, a spokesman for Public Health England told Reuters. SMA advocates in Germany do not expect action on screening until late 2021.

“It’s astonishing,” said Inge Schwersenz, of the German Society for Neuromuscular Diseases. “But we can’t do anything to speed it up.”

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A trans woman has become the first trans person in the world to undergo successful vaginal reconstruction using fish and she’s excited with the result.





The woman, who asked to be identified only as Maju, 35, had a botched gender reassignment operation in 1999. As a result, her ‘vagina’ began to shrink and she said sex with her then partner became painful that she resigned herself to a life of celibacy.



Maju, a florist in Sao Paulo, Brazil, later heard about a procedure called neovaginoplasty which involves the use of a tube-shaped acrylic mould, wrapped with the skin of the tilapia that would rebuild and extend her vaginal canal. She went for the surgery and now has a brand new vagina made from a tilapia.

Speaking about her experience, she said: “I was the fourth person in Brazil in 1999 to have, what was then, experimental surgery. But ten years ago I developed vaginal stenosis. The opening of my vagina started to get narrower and shorter and the canal collapsed.”



Three weeks after she had her recent vagina reconstruction surgery Maju said: “I’m absolutely thrilled with the result. For the first time in my life I feel complete and like a real woman.”



Professor Leonardo Bezerra, who gave Maju her new vagina, said: “We were able create a vagina of physiological length, both in thickness and by enlarging it, and the patient has recovered extremely well. She is walking around with ease, has no pain and is urinating normally. In a couple months we believe she will be able to have sexual intercourse.”


Maju had been suffering a rare congenital vaginal condition called Rokitansky syndrome. Prof Bezerra has treated 10 women with the condition that causes the vagina or uterus to be underdeveloped or absent, according to Metro UK.



In April 2017, Jucilene Marinho, 23, became the first woman to have her vaginal canal reconstructed from tilapia fish skin after being diagnosed as having no cervix, uterus, ovaries or womb. Also, last November, Elisiane Gusmão, 41, underwent the procedure while recovering from cancer.

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By using the right words and repeating the phrases, adults can help young kids get over picky eating behaviors and eat healthier foods, according to a new study.

Saying “Lentils will help you run faster,” for instance, encourages preschoolers to understand the benefits and pick the foods they want, the study authors write in the Journal of Nutrition Education and Behavior.

“Previous studies have shown that adults struggle with how to talk to young children about food,” said lead study author Jane Lanigan of Washington State University in Vancouver.

Most children between 4 and 8 years old don’t meet recommended guidelines for vegetables, grains and fatty acids, and they tend to eat too many empty calories.

“Conversations are sometimes inaccurate or not helpful or even harmful in terms of helping a child learn to eat healthfully,” she told Reuters Health by email.

Lanigan and colleagues worked with 87 preschoolers from two early childhood education centers, testing whether repeat exposure and the correct phrasing would help preschoolers try four foods that are generally less accepted by little kids: tomatoes, bell peppers, lentils and quinoa.



The researchers also surveyed parents about their child’s eating history, the meal environment at home and nutrition knowledge, as well as parental income and education.

In the exposure tests, the study team assessed whether the children liked the foods, which were presented separately in small plastic containers. The tomatoes and green peppers were raw and chopped into bite-sized pieces. The quinoa and lentils were cooked with no added spices. Kids who refused to sample a food were encouraged to smell, touch or lick it, and told they could try it and spit it out if they wanted too.

Then, for the next six weeks, researchers ran a tasting station in the classroom two days a week and offered one food to taste. On the second day, a researcher would include food-specific phrases in the conversation two times during the tasting, such as “Lentils will help you run fast and jump high” or “Fruits and vegetables keep you from getting sick.”

Lanigan’s team found that after the six-week experiment, children were more willing to try foods, particularly the kids whose parents had higher education levels. The children also rated the foods one point higher on a five-point scale compared to their ratings at the start of the study.

Importantly, at home one month after the experiment ended, parents reported that children consumed twice as much of the foods introduced in the experiment as they had before.

“Parents asked for our ‘recipe’ because they couldn’t believe their child would eat lentils or quinoa,” Lanigan said. “The funny part is we prepared the foods with no added spices or flavors to maintain consistency. There are much more appealing recipes.”

Repetition gave the children multiple experiences to become familiar with the food and explore it without the stress or pressure of being expected to eat the food, the study authors note in their report. This may lead to an increased willingness to try, like and eat the food. At home, meal-time conversations could be a way to encourage food exploration and develop positive eating behaviors, they add.

“We all struggle to eat healthily given our current food environment, and developing ways to get children to try healthy foods that may not be as immediately appealing as a sugary treat is important to encourage children to develop healthy eating habits early,” said Alison Miller of the University of Michigan in Ann Arbor, who wasn’t involved in the study.

“I think it’s likely helpful for parents to talk about the benefits of healthy food with their children in a child-friendly way, and also to model it,” she said in an email. “But also, all children have a different ‘temperament’ when it comes to eating, so don’t get too worried about your child being a picky eater unless they’re not growing.”

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Children who develop cavities and gum disease may be more likely to develop risk factors for heart attacks and strokes decades later than kids who have good oral health, a recent study suggests.



Researchers did dental exams for 755 children in 1980, when they were eight years old on average, then followed them through 2007 to see how many of them developed risk factors for heart attacks and strokes like high blood pressure, elevated cholesterol, high blood sugar, and hardening of the arteries.

Overall, just 33 kids, or 4.5 percent, had no signs of bleeding, cavities, fillings, or pockets around teeth that can signal gum disease. Almost six percent of the kids had one of these four signs of oral infections, while 17 percent had two signs, 38 percent had three signs, and 34 percent had all four signs.

Kids who had even one sign of oral infection were 87 percent more likely to develop what’s known as subclinical atherosclerosis: structural changes and thickening in the artery walls that isn’t yet serious enough to cause complications.

Children with all four signs of poor oral health were 95 percent more likely to develop this type of artery damage.

Oral infections are among the most common causes of inflammation-induced diseases worldwide, and periodontal disease in adults have long been linked to an increased risk of cardiovascular disease, researchers note in JAMA Network Open.

Most people get cavities and gum disease for the first time in childhood, and these conditions can develop into more serious infections and tooth loss if they aren’t properly treated, the study authors note. Treating these oral health problems in childhood can also reduce inflammation and other risk factors for hardening of the arteries.

“This emphasizes how important good oral hygiene and frequent check-ups with a dentist starting early in life are for general health,” said lead study author Pirkko Pussinen of the University of Helsinki in Finland.

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Researchers in Germany have created transparent human organs using a new technology that could pave the way to print three-dimensional body parts such as kidneys for transplants.



Scientists led by Ali Erturk at Ludwig Maximilians University in Munich have developed a technique that uses a solvent to make organs such as the brain and kidneys transparent.

The organ is then scanned by lasers in a microscope that allows researchers to capture the entire structure, including the blood vessels and every single cell in its specific location.

Using this blueprint, researchers print out the scaffold of the organ. They then load the 3D printer with stem cells which act as “ink” and are injected into the correct position making the organ functional.

While 3D printing is already used widely to produce spare parts for industry, Erturk said the development marks a step forward for 3D printing in the medical field.

Until now 3D-printed organs lacked detailed cellular structures because they were based on images from computer tomography or MRI machines, he said.

“We can see where every single cell is located in transparent human organs. And then we can actually replicate exactly the same, using 3D bioprinting technology to make a real functional organ,” he said.

“Therefore, I believe we are much closer to a real human organ for the first time now.”

Erturk’s team plan to start by creating a bioprinted pancreas over the next 2-3 years and also hope to develop a kidney within 5-6 years.

The researchers will first test to see whether animals can survive with the bioprinted organs and could start clinical trials within 5-10 years, he said.

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Widespread beliefs about sleeping include advice on how much sleep is enough, what quality sleep means and how to achieve it, but when these pronouncements are wrong, they can do more harm than good, researchers argue.

The study team gathered the most common sleep “myths” and asked sleep-science experts to rank them according to how wrong they were, and how bad it might be for a person’s health to follow the advice.

“Sleep plays a vital role in our health and wellbeing,” said lead author of the report in Sleep Health, Rebecca Robbins of the New York University School of Medicine in New York City.

“Although there is growing awareness of sleep’s importance, myths – or beliefs that are held despite an evidence base to suggest the beliefs are false – are held among some of our population,” she told Reuters Health by email.

About one third of adults in the U.S. report sleeping less than the recommended seven hours, according to the Centers for Disease Control and Prevention.

Robbins and 10 sleep experts in the fields of sleep research, circadian science, neuroscience and psychiatry compiled a list of 50 potential myths by using web searches of popular press and scientific literature. The experts then rated each one, and the study team narrowed the list to the top 20 sleep myths, based on how false and how significant for public health each was.

The list was further broken down into categories, including myths about sleep duration, sleep timing, sleep behaviors, daytime behaviors affecting sleep, pre-sleep behaviors and brain function during sleep.

When it came to sleep duration, the highest-rated myth was that “being able to fall sleep ‘anytime, anywhere’ is a sign of a healthy sleep system.” Instead, this is more indicative of a chronically sleep-deprived person, the experts said, and excessive daytime sleepiness may be one of the primary symptoms of obstructive sleep apnea.

Other myths in this category were that “many adults need only five or fewer hours of sleep” and “your brain and body can learn to function just as well with less sleep.”

On the other hand, sleep experts said the belief that one night of sleep deprivation doesn’t likely have lasting negative health consequences is true.

Regarding sleep timing, the highest-rated myth was that “it doesn’t matter what time of day you sleep.” Instead, research on night-shift workers points to lower sleep quality, as well as a higher risk for depression, diabetes and cancer, the study team notes.

When the sleep experts ranked myths around sleep behaviors, they considered the worst ones to be, “lying in bed with your eyes closed is almost as good as sleeping” and “if you have difficulty falling asleep, it’s best to stay in bed and try to fall back to sleep.”

Instead, the experts said, cognitive activity when a person is sleeping is distinctly different from being awake with eyes closed. Also, those who can’t fall asleep should leave bed, avoid blue light and return to bed when they’re tired.

Pre-sleep, the experts agreed that alcohol before bed does not improve sleep. Although folklore may encourage a “nightcap,” in fact, alcohol can lead to sleep disturbances during the second part of the night when REM sleep is most valuable. Alcohol consumption can also worsen sleep apnea symptoms for those with a history of snoring.

The sleep experts also refuted the myth that it’s better to have a warmer bedroom than a cooler bedroom, and recommended a temperature between 65 and 70 degrees Fahrenheit (about 18 to 21 degrees C).

They also noted that remembering your dreams isn’t necessarily a sign of good sleep, and sleeping with a pet doesn’t always improve sleep quality, even if it is comforting.

“Knowing what is true and what is a myth will help to support choices linked to sleep hygiene and sleep architecture,” said Sarah Godsell, a public health researcher with the South Gloucestershire Council in the UK, who has studied sleep beliefs and where they originate.

“Sleep is important, so who do you listen to and who influences your sleep behaviors?” Godsell, who wasn’t involved in the current study, said in an email. “Do you know about its key functions and its importance for health and wellbeing?”

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The World Health Organization (WHO) on Wednesday said it had reconvened an expert panel to consider whether an outbreak of Ebola in the Democratic Republic of Congo constitutes a public health emergency of international concern.

The panel, which first met on this issue in October 2018, will also give updated recommendations on how global health officials should manage the outbreak, the WHO said in a statement from its Geneva headquarters.

At least 740 people have died among the more than 1,100 infected in this epidemic, which began in August 2018.

Declaring the outbreak a “public health emergency of international concern”, or PHEIC, would ramp up the international response with a formal alert that puts governments on notice and helps to mobilize resources and research.

The WHO said that while the outbreak is contained to the provinces of North Kivu and Ituri, efforts to bring it under control in these urban areas have been hampered by security and access problems. As a result, it said, Ebola transmission has increased in some areas.

“Though the risk of spread within the country and to neighboring countries is very high, the risk remains low globally,” the WHO statement added.

The emergency panel’s meeting will take place on Friday April 12 and its decision will be published late the same day.

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Eleven million deaths worldwide in 2017 were linked to people eating poor diets high in sugar, salt and processed meat that contributed to heart disease, cancer and diabetes, a global study found.

The research, published in the Lancet medical journal, found that among 195 countries studied, the proportion of diet-related deaths was highest in Uzbekistan and lowest in Israel. The United States ranked 43rd, while Britain was 23rd, China 140th and India 118th.

Consumption of healthier foods such as nuts and seeds, milk and whole grains was on average too low, and people consumed too many sugary drinks and too much processed meat and salt. This led to one in five deaths in 2017 being linked to bad diets.

The Global Burden of Disease study tracked trends from 1990 to 2017 of consumption of 15 dietary factors. Chris Murray, director of the Institute for Health Metrics and Evaluation at the University of Washington which led the work, said it “affirms what many have thought for several years”.

“Poor diet is responsible for more deaths than any other risk factor in the world,” he said.

“Our assessment suggests the leading dietary risk factors are high intake of sodium, or low intake of healthy foods, such as whole grains, fruit, nuts and seeds and vegetables.”

The study found people ate only 12 percent of the recommended amount of nuts and seeds – an average intake of 3 grams a day, compared with the recommended 21 g – and drank more than 10 times the recommended amount of sugary drinks. Diets high in sugar, salt and bad fats are known risk factors for heart disease, stroke, diabetes and many types of cancer.



The global diet also included less than a quarter of the recommended amount of whole grains – at 29 g average intake a day compared with the recommended 125 g – and almost double the recommended amount of processed meat – at around 4 g average intake per day compared with the 2 g recommended.

A study published in January suggested an “ideal diet” for the health of people and the planet would include a doubling of consumption of nuts, fruits, vegetables and legumes, and a halving of meat and sugar intake.

In a breakdown of diet-related deaths, the study found that of the 11 million in 2017, almost 10 million were from cardiovascular diseases, around 913,000 from cancer, and almost 339,000 from type 2 diabetes.

Annual deaths related to diet have increased from 8 million in 1990, but the researchers said this was largely due to increases in populations and populations aging.

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A woman in China almost died after injecting herself with liquidised fruit in a bid to be healthy.

The 51-year-old suffered liver, kidney, heart and lung damage and was put into intensive care for five days.

There were over 20 kinds of fruit in the intravenous injection, an employee at the Affiliated Hospital of Xiangnan University in Hunan told the BBC.
Social media users in China claim the case highlights the need for basic medical knowledge.

After injecting herself with the mixture, the woman had itchy skin and a rising temperature.

She was admitted to the intensive care unit of the hospital on 22 February, before being transferred to a general ward and later discharged.

The case has drawn attention on Chinese social media site Weibo.

More than 11,000 users have used the hashtag #OldWomanPutsJuiceIntoVeins.

One person said: “It seems the public’s medical knowledge is still too little.”

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Doctors have documented what they say is only the world’s second known case of “semi-identical” twins.


The boy and the girl, now four, from Brisbane, in Australia, are identical on their mother’s side.

But they share only a proportion of their father’s DNA – placing them, genetically, somewhere between fraternal and identical twins.

Experts say the phenomenon is extremely rare – embryos such as these often do not survive.

Prof Nicholas Fisk, who led the team that cared for the mother and twins at the Royal Brisbane and Women’s Hospital in 2014, said the discovery was made through a routine pregnancy scan.

It is the first time semi-identical twins have been identified during pregnancy.

The first-time mother was 28 at the time and had conceived naturally, doctors said.

The case is being reported on in The New England Journal of Medicine.

“The mother’s ultrasound at six weeks showed a single placenta and positioning of amniotic sacs that indicated she was expecting identical twins,” Prof Fisk said.

“However, an ultrasound at 14 weeks showed the twins were male and female, which is not possible for identical twins.”

How did it happen?

Identical, or monozygotic, twins occur when a single egg, fertilised by a single sperm, divides and makes two babies.

These twins will be the same sex and share the same genes and physical features.

Non-identical, or dizygotic, twins occur when two separate eggs are fertilised, each by a different sperm, and develop in the womb at the same time.

These twins can be the same or different sexes and are no more alike than any brother or sister, despite being born together.

In this case of semi-identical, or sesquizygotic, twins, the egg is thought to have been fertilised simultaneously by two sperm before it divided.

If one egg is fertilised by two sperm, it results in three sets of chromosomes, rather than the standard two – one from the mother and two from the father.

And, according to researchers, three sets of chromosomes are “typically incompatible with life and embryos do not usually survive”.

The identity of the twins has not been revealed.

What causes twins?


Non-identical twins are more common in some families. Older mothers are also more likely to have non-identical twins because they are more likely to release more than one egg during ovulation.

Identical twins do not run in families.

Infertility treatment – IVF – can increase the chance of twins, as more than one embryo may be put into the womb.

According to the Twins and Multiple Births Association (Tamba), about 12,000 twin births occur each year in the UK.

‘Exceptional case’

The first documented case of half-identical twins was in the US in 2007.

Prof Fisk said an analysis of worldwide twin databases highlighted just how rare sesquizygotic twins were.

He and his colleagues examined genetic data from 968 fraternal twins, as well as a number of large global studies, but found no other case of sesquizygotic twins.

“We know this is an exceptional case of semi-identical twins,” Prof Fisk added.

“While doctors may keep this in mind in apparently identical twins, its rarity means there is no case for routine genetic testing.”

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Gynecomastia is a pretty common condition. Even though gynecomastia is not harmful and does not affect the physical health of the patient, the social stigma with men having excess breast skin or enlarged breast tissue can be psychologically damaging and physically uncomfortable. There are various approaches to treat the condition including exercise, medications and surgery.

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What if losing weight was as easy as eating certain foods and not stressing about the rest? Sadly, many dieters focus on cutting back on calories or wearing themselves thin with hours of exercise. Although you can reach your weight loss goals this way, these habits don’t exactly focus on healthy weight loss. Instead, you should make small changes and establish new habits day by day, and they will add up over time. Thankfully, you can easily support your weight loss by adding these top 10 foods to your meals.



1. Lean Meat

In the last few years, you may have heard a lot about high protein (or ketogenic) diets. How do these diets work?

First, eating protein actually decreases the hunger hormones in your body and increases the satiety hormones at the same time. In addition, protein has a higher thermic effectthan other nutrients, meaning that your body burns more of its energy during digestion than carbohydrates or fats. Since you’re consuming less and burning more, you can imagine the effects protein has on weight loss.

As a caveat, you should still eat a variety of food groups. Some ketogenic diets focus only on protein, and this unbalanced eating can cause nutritional deficiencies.

2. Leafy Greens

Consuming more vegetables overall will help you attain your weight loss goals, especially if you’re using them as a replacement. In particular, leafy greens have many antioxidants, vitamins and fiber all packed into fewer calories. When you add greens to your meal, you’ll be filling your stomach with a superfood of nutrients and getting full faster because of the added fiber.



3. Olive Oil

Another food made popular recently is olive oil. Olive oil has many wonderful disease-fighting antioxidants and provides a healthy source of fat.

In addition, according to a new study published in the journal Biochemistry, researchers found another reason that olive oil promotes weight loss. They found that a compound called oleuropin actually helps the body produce more insulin, and therefore better regulates your metabolism. Along with weight loss, this increased insulin wards off type 2 diabetes.

4. Avocado

This fruit provides vital nutrients to your diet, including vitamins K, C and E, folate, potassium and magnesium. At the same time, one serving of avocado contains heart-healthy monounsaturated fat and 7 grams of fiber.

In one small study of overweight individuals, participants ate avocadoes for breakfast and lunch. They then rated their feelings of satiety and hunger. Overall, the study showed that avocadoes helped people feel over 20 percent more satisfied and also reduced their urge to eat for up to 5 hours afterward.


5. Eggs

Again, eggs provide a great source of protein in one small serving of only 80 calories. That serving also gives you vitamins D, B-12 and B-6 and contains potassium, magnesium and iron.

According to a 2010 study, researchers found that men who ate eggs for breakfast felt far more satisfied in the hours afterward than when they ate a bagel. In addition, participants actually consumed fewer calories throughout the day when eating eggs for breakfast.


6. Nuts

Next, nuts are a great food to add to your meals in order to lose weight. They contain vital protein, including omega-3s, monounsaturated fat and fiber—all essential parts of a well-balanced diet.

This combination will help you feel full while boosting your metabolism and balancing your blood sugar. Be sure to consume nuts in small quantities, though, since they are high in calories.

7. Water

While technically not a food, water does play a huge role in weight loss. According to Women’s Health Magazine, water not only fills up your stomach, but it may actually be the object of your hunger in the first place. Registered dietician Jaime Mass attests that many people confuse their body’s thirst cues for hunger because the two are similar.

Research also shows water’s benefits for weight loss. In one 2015 study of overweight individuals, participants who drank a 16-ounce glass of water before meals lost more weight than their non-hydrating counterparts.

8. Vinegar

Some health enthusiasts stake large claims on the weight loss effects of apple cider vinegar, but are these claims true? Carol Johnston, a professor at Arizona State University, states that the weight loss effects actually come from vinegar in general. In Johnston’s estimation, the real benefit is in vinegar’s acetic acid, which helps to control the body’s blood sugar levels.

9. Salmon

Salmon provides an excellent source of omega-rich protein as well as an amazing amount of potassium and several B vitamins. Salmon also contains iron and magnesium. This combination of nutrient-packed protein makes salmon an ideal addition to your weight loss efforts.

10. Oats

While other carbohydrates may have a bad reputation among dieters, one grain that most agree on is oats. Oatmeal contains high amounts of fiber and protein as well as an excellent amount of potassium, magnesium and iron.

Although you shouldn’t use sugar with it all the time, the fiber does offset the effects of the added sugar while lowering your cholesterol and improving digestion. Oats also have a small number of calories per serving.

While your main weight loss program will need to focus on a variety of habits, you can easily support your efforts with these 10 superfoods. By adding the above recommendations to your regular meals, you’ll be increasing lean protein, essential vitamins and minerals as well as hunger-curbing fiber. Combine these foods with dedication and consistency, and you will succeed in achieving your weight goals.

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Skin is the largest organ of the human body and functions to protect internal organs from severe damage, which may result from the external environment. As aging advances, skin goes through many changes that affect its overall health, appearance as well as the complexion.

It has been found that environment and lifestyle choices contribute majorly towards premature skin aging. This has led to the introduction of numerous methods of eliminating aging signs such as surgical procedure and makeups, which might cause adverse effects on our general health.

Besides, facial appearance matters a lot, especially when defining one's hygiene hence it is essential to pay extra attention while attending to it.

Some of the best anti-aging tips for youthful skin include:

1. Eating Healthy Food Rich in Antioxidants

According to dermatologists, just as healthy diet does wonders for the entire body, fruits and veggies that are comprised of antioxidants such as vitamins B and E are mainly great for skin. They play a significant role in protecting the skin from free radicals in the environment, which causes severe damages to skin cells.

Further, this prevents breaking down of collagen and elastin thereby avoiding the formation of fine lines and wrinkles. Individuals who stick to this diet throughout usually attain a youthful, vibrant and healthier skin irrespective of their skin type and background.

2. Avoid Smoking and Drinking of Alcohol

Smoking is known to destroy collagen and elastin that keeps the skin firm and strong. It subjects the skin to sagging thereby contributing to premature skin aging. On the other hand, excess alcohol consumption accelerates inflammation in the bloodstream, which can boost sagging over time.

Therefore, individuals who refrain from smoking and alcohol consumption are in a better position for retaining a healthy and youthful skin throughout their lives.

3. Manage Your Stress

Stressful situations affect not only mental health but also general skin health. Research suggests that stress associated hormones have aging effects, which starts at a cellular level. Moreover, when an individual is psychologically distressed, there is a likelihood of a substantial detrimental impact on the wear and tear of the body that leads to increased biological aging. To prevent facial wrinkles, it is advisable to take steps to get de-stressed to avoid ruining skin health and the appearance.

4. Exfoliate the Right Way

Exfoliation methods depend mainly on the skin type. Therefore, it is essential to consult a dermatologist to be sure of the best way to maintain a healthy, firm and youthful skin.

Most of the exfoliators aim at sloughing off dead skin thus leaving a smoother and glowing complexion. Further, regular and correct use of the right exfoliation help to build a strong and firm skin that cannot collapse easily.

5. Drink Plenty of Water

Estrogen is the hormone responsible for inducing oil and collagen production in the skin. As the aging advances, it tends to decline thereby resulting in drier and saggy skin. People are encouraged to drink plenty of water to maximize moisture level in their skin. This will help to nourish skin cells, which results in supple, smooth and youthful skin. Also, you can add particular fruits, beverages as well as vegetables to your daily routine.

6. Wash the Face Before Bed

At the end of the day, the face collects dirt and impurities, which may clog pores thus altering the normal functioning of the skin. Skin usually regenerates during the night thereby leading to more youthful and healthy skin.

Dermatologists insist that it is also important to observe quality sleep since it helps to prevent the skin from becoming loose. Suitable ingredients should be applied after washing the face gently.

7. Embracing Sunscreen

Wearing sunscreen is considered the best anti-aging thing that can be done for the skin. Sun exposure causes discoloration that appears in the form of dark spots. Also, UV rays and free radicals usually cause damage to the skin and also speeds up the rate of aging. Therefore, incorporation of sunscreen can be helpful in maintaining youthful and healthy skin all through.

8. Consult a Dermatologist Regularly

Visiting a dermatologist frequently will ensure that you are up-to-date on the latest and suitable anti-aging skincare developments. Also, the dermatologist can recommend treatments for more desirable outcomes which results in youthful skin.

Further, one can gain knowledge on how to handle their skin once they identify their type. Always purpose to consult a dermatologist before taking any step since the skin is very sensitive.

9. Manage your Weight

Excess weight usually causes numerous health complications. It has been found to increase the levels of insulin and cortisol in the body, which later breaks down collagen leading to increased sagging of the skin.

In addition, gaining and losing weight has an adverse effect on skin elasticity, leaving behind undesirable stretch marks. Therefore, keeping the body fit will help to promote youthful and healthy skin.

10. Incorporate Healthy Fats in your Diet

Most fats, such as omega-3 fatty acids, enable the body to absorb essential vitamins that contribute to a super-healthy skin. They help by reducing inflammatory skin conditions thus leading to younger-looking skin and improved appearance. They are available at an affordable price and the user may consider consulting a medical professional before consumption.

Conclusion

Aging is inevitable, and it comes with various changes that interfere with the normal functioning of the body. It leads to the formation of aging signs although they can be addressed as soon as they appear. When the above tips are practiced regularly, it is possible to achieve healthy and youthful skin.

Skins are treated differently depending on the skin type. Research suggests that if the skin is well taken care of routinely, it functions magically to promote healthy and youthful skin. Always eat healthy to prevent any form of health complications. Also, sticking to the dermatologist's guidelines may help to avoid signs of aging entirely while heightening skin health and the appearance.

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- Jasmine Self was five months pregnant when she discovered her son’s condition
- Baby RJ Wilson suffers from tetra-amelia – defined as the absence of all limbs
- He also has severe malformations of the face, heart, skeleton and genitals

A baby has been born with no arms or legs because of a rare condition which affects just a few families worldwide.

RJ Wilson’s mother Jasmine Self, 24, was five months pregnant when an ultrasound scan revealed her little one’s limbs were not developing.
The four-month-old suffers from tetra-amelia syndrome – defined as the absence of all four limbs, as well as severe malformations of the face, heart, nervous system, skeleton and genitals.

After being advised to terminate her pregnancy, Ms Self and her boyfriend Rondell Wilson decided to not to give up on their baby, with RJ being born at 29 weeks on September 29.

The youngster arrived weighing just 2lb 4oz (1kg) and spent the first two months of his life in intensive care.

Against all the odds, the youngster is now thriving at his home in Florence, South Carolina.
‘I found out I was pregnant in April,’ Ms Self said. ‘I didn’t go to the doctor until August, so it was really late.

‘When I finally decided to go I could tell there was something wrong.’

Ms Self’s ultrasound technician told her to make an urgent appointment with her doctor.

‘I was sitting in the waiting room of my family doctor’s office when he came out to get me,’ Ms Self said.
‘I could see him take a deep breath and my anxiety just went through the roof. My doctor told me my baby didn’t have any limbs.

‘I just stared and him and he asked me if I understood, then I just started crying.

‘I asked him if I did something wrong. I asked him if it was my fault because I didn’t go to the doctor for a few months.’

Ms Self’s doctor reassured her she was not to blame for her baby’s condition.
‘I was sent for follow-up appointments where they explained the condition to me and told me he could have other malformations,’ Ms Self said.
Ms Self – who works as a hotel receptionist – then faced the difficult decision of whether to continue with her pregnancy.

Tetra-amelia syndrome is a very rare disorder in which a baby is born without any of its limbs – it has only been recorded in a few families around the world, according to the US’s National Institutes of Health.

The condition is caused by a genetic mutation in a section of DNA which plays a critical role in development. Most babies die before or shortly after birth.

‘My doctors explained my options to me, and told me there was a possibility I wouldn’t be able to carry him to term, or that he might be stillborn,’ she said.

‘My boyfriend and I talked about a termination and actually booked a procedure in Washington but we I decided to go on with the pregnancy.’

Although her pregnancy went relatively smoothly, things took a turn for the worse when Ms Self was forced to deliver RJ via an emergency C-section when her placenta detached from her uterus wall.

This can lead to severe internal bleeding in the mother, as well as cutting off the baby’s supply of oxygen and nutrients.

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Many older adults who have major surgery experience postoperative delirium in the days after their operations. Previous research has suggested that closely monitoring the brain during surgery and making adjustments to protect the brain from too much anesthesia could reduce risk of postoperative delirium.

But in a new study of more than 1,200 older surgical patients at Barnes-Jewish Hospital in St. Louis, researchers at Washington University School of Medicine found that meticulously monitoring brain activity and then taking care to minimize levels of anesthesia during surgery had no significant effect on the occurrence of delirium. However, in the group that had close brain monitoring, there were fewer deaths in the first 30 days after surgery. That was an unexpected finding, and the researchers believe it points to potential benefits linked to close brain monitoring and should be examined in future studies.

The findings are published Feb. 5 in the Journal of the American Medical Association (JAMA).

Delirium, described as a state of confusion or agitation, is common after surgery. It is unpleasant but almost always temporary. However, it has been linked to longer stays in intensive care units, more total days in the hospital and even a higher risk of death. About 25 percent of older surgery patients experience postoperative delirium, so finding ways to prevent delirium has been identified as a public health priority by several groups, including the American Geriatric Society, the American Society of Anesthesiologists and the National Institute on Aging at the National Institutes of Health (NIH).

“When older adults have major surgery, one in four of them experiences delirium. That’s a large number,” said principal investigator Michael S. Avidan, MBBCh, the Dr. Seymour and Rose T. Brown Professor of Anesthesiology. “If there is a way to change that, it would have a major impact on public health.”

There were 1,232 patients in the study. Half were randomly assigned to very close monitoring of the brain’s electrical activity, as measured by electroencephalogram (EEG) during surgery, and the rest were given usual care during their operations. The researchers found that 26 percent of the closely monitored group still experienced delirium in the first five days after surgery. By comparison, 23 percent of those in the group that did not receive such close monitoring of brain activity developed delirium during the same time period. That difference was not statistically significant.



“The thought has been that at certain levels of anesthesia, brain activity is suppressed, and that is what mediates these problems,” said first author Troy S. Wildes, MD, an associate professor of anesthesiology. “But we found that preventing suppression by closely monitoring and then adjusting doses of anesthesia made delirium no less likely.”

The researchers defined major surgery as procedures requiring at least two hours of general anesthesia and at least two days in the hospital following the operation. Those could include procedures such as cardiac, gastrointestinal, thoracic, gynecologic, urologic and vascular surgeries.

Surprisingly, Avidan said, there were fewer deaths among patients whose brain activity was monitored closely and anesthesia levels adjusted. In that monitored group, four of 614 patients—fewer than 1 percent—died in the month after surgery. Among the 618 patients who did not receive such close brain monitoring, 19—just more than 3 percent—died within 30 days of their surgeries. That difference is statistically significant.

“I believe we should monitor the brain of every single patient during general anesthesia, just as we routinely monitor heart and lung function,” Avidan said. “Monitoring other organs during surgery has become the standard of care, but for some reason, even though the brain is the target of anesthesia drugs, this type of close monitoring and adjustment has never become routine.”

Although delirium is a major problem that affects a large number of older surgery patients, doctors and nurses sometimes don’t recognize it in their patients.

“There are two common types of delirium: hyperactive, in which the patient is agitated, thrashing, maybe trying to pull out intravenous lines; and hypoactive, in which patients get very lethargic,” explained co-first author Angela M. Mickle, a clinical research coordinator in the Department of Anesthesiology. “Because it’s so common for surgery patients to be lethargic after an operation, delirium often goes underdiagnosed.”

Although the ultimate goal is to find ways to prevent delirium in older surgery patients, it is important to recognize delirium early and to try to minimize its negative impact on patients, Avidan noted.

Getting quality sleep before surgery might help. Family members should try to make the hospital environment comfortable, perhaps by bringing familiar objects and photographs to an older patient’s bedside. Avidan also recommends returning hearing aids, dentures and glasses to patients as quickly as possible, and suggests physical activity and getting patients out of bed during the day.

“It’s important to re-establish day-night routines,” he said. “Fortunately, most episodes of delirium are transient. In this study, almost all patients were back to their preoperative state within 30 days of surgery.”

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E-cigarettes are almost twice as effective as nicotine replacements for helping smokers quit, a study suggests.


A trial found 18% of smokers who used them to quit remained smoke-free after a year, compared with 9.9% of those using nicotine-replacement treatments.

The study of 886 smokers is the first to test how effective modern e-cigarettes are for quitting.

Researchers hope their findings will lead to vaping devices being routinely offered by stop-smoking services.


Public Health England has already called for e-cigarettes to be made available on the NHS within five years, pointing to a body of research that suggests they are at least 95% less harmful than cigarettes.

However, up until now there had been a shortage of evidence on how effective they were as stop-smoking tools.

Lead researcher Prof Peter Hajek, from Queen Mary University of London, said: "Although a large number of smokers report that they have quit smoking successfully with the help of e-cigarettes, health professionals have been reluctant to recommend their use because of the lack of clear evidence from randomised controlled trials.

"This is now likely to change."

'Accelerate' smoking reduction

Participants in the trial, who were dependent on smoking and had previously failed to give up, attended NHS stop-smoking services and were randomly assigned into two groups:

those who received a nicotine-replacement treatment of their choice, which included gum, patches, lozenges, sprays and inhalators, or a combination of treatments, for up to three months
those who got an e-cigarette starter pack with one or two bottles of e-liquid (two to four weeks' supply)
Those given e-cigarettes were encouraged to buy future supplies of their own choice of strengths and flavours, and all participants received weekly one-on-one behavioural support for at least four weeks.

The study, published in the New England Journal of Medicine, found that in addition to having higher rates of quitting, more e-cigarette users reduced their smoking by at least 50%.

E-cigarettes also provided higher satisfaction and were rated as more helpful than nicotine-replacement treatment.

A higher proportion of those who used the devices experienced mouth and throat irritation (65% v 51%), although people using the nicotine-replacement treatments were more likely to report nausea (38% v 31%). These effects were mostly mild.

Prof Hajek said he hoped the results of the study would lead to stop-smoking services offering quitters an e-cigarette starter pack and guidance on how to vape, after which they could pay for their own supplies.

"This may ultimately further accelerate the reduction in smoking and in smoking-related diseases," said Dunja Przulj, another author of the study, also from Queen Mary University of London.
The study has some limitations.

Because people had known which treatment they had received - as opposed to being "blinded" as they are in most randomised controlled trials - it was possible participants may have perceived nicotine replacements as an inferior option and put less effort into quitting, the authors said.

They also said more work was needed to determine if their results would apply to countries outside of the UK and for less dependent smokers.

The study comes after an independent review of evidence on e-cigarettes, by Public Health England, published in February last year, concluded there was "overwhelming evidence" they were far safer than smoking and "of negligible risk to bystanders".

However, some experts have said e-cigarettes, while safer than normal cigarettes, are not harm-free, and their long-term effects are not yet known.

Responding to this latest research, Public Health England said: "All stop-smoking services should welcome smokers who want to quit with the help of an e-cigarette."

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Tamika Capone thought she was making a smart call by traveling to Mexico for bariatric surgery. Her doctor had urged her to have the procedure to reduce her out-of-control weight and blood pressure. But her husband’s health insurance would not cover the $17,500 bill. After a friend got the surgery in Tijuana for $4,000, Capone decided to do the same.


Nearly four months later, the Arkansas woman is one of at least a dozen U.S. residents who returned from surgeries in Tijuana with a rare and potentially deadly strain of bacteria resistant to virtually all antibiotics, say federal health officials. Some in the group recovered, but Capone, 40, remains seriously ill despite being treated witha barrage of drugs.

If the bacteria spreads to her bloodstream, doctors say it could be fatal. “I’ve not yet had a patient with zero options, but this is as close as I’ve had,” said Ryan Dare, an infectious disease doctor at the University of Arkansas for Medical Sciences College of Medicine in Little Rock who is treating her.

The Tijuana outbreak, which includes one death, prompted the Centers for Disease Control and Prevention to issue an unusual warning this month, urging travelers to avoid surgery at Grand View hospital linked to eight of the infections until Mexican authorities confirm its safety. Hospital officials did not return calls seeking comment. Nor did the medical tourism agency, Weight Loss Agents, which books procedures there and at other hospitals.

A woman who answered the weight loss agent’s telephone blamed reports of infections on “a competitor’s smear campaign.” She declined to give her name.

Mexican authorities said they temporarily closed the hospital’s operating unit in December, but the facility has since reopened and resumed surgeries, according to patients posting on its website.



The Tijuana cases highlight the growing number of Americans getting antibiotic-resistant infections overseas after traveling to get medical care abroad. Some who were not traveling for medical procedures but fell ill and went to foreign hospitals have also contracted such infections.

Officials say they are anxious to prevent such pathogens from gaining a foothold in the United States because they are so difficult to treat.

“We pounce when we see them [extremely antibiotic-resistant infections] because we know they can smolder and spread,” said Maroya Spalding Walters, an epidemiologist leading the CDC team investigating the outbreak. “And no one may recognize it until this becomes an out-of-control wildfire.”

According to Patients Beyond Borders, a medical tourism guidebook, 1.7 million Americans traveled to other countries in 2017 for medical care, and that number is expected to increase. Many like Capone travel to save money. Mexico is among the top 10 destinations. Weight-loss surgery, in vitro fertility procedures and cosmetic surgery are among the most sought treatments generally, according to the Medical Tourism Association, a U.S.-based organization whose members include hospitals, clinicians and insurance companies.

There is little data about infectious diseases related to medical tourism. But the CDC has documented several outbreaks, including severe skin infections among dozens of patients who had cosmetic surgery in theDominican Republic in 2013 and 2017. Several of the infections were drug-resistant. In 2014, five New York residents contracted Q fever, a flulike illness caused by a bacteria found in goats, sheep and cows, after getting injections of fetal sheep cells in Germany.

The World Health Organization considers the superbug that infects Capone – carbapenem-resistant Pseudomonas aeruginosa – one of its three highest priorities for new antibiotics.

The organism packs “a double whammy,” Walters said, because it has a genetic mutation that allows it to transmit its antibiotic-destroying gene to other bacteria to make them resistant as well.

People can carry the pathogens in their bodies and not become infected themselves. In hospitals, where the most serious infections occur, the germ can spread on the hands of health-care workers or equipment that gets contaminated and is not properly cleaned.

There have been only 86 cases of the strain reported in the United States through 2017, officials said.

Half of the 12 people who came back from Tijuana with confirmed cases were hospitalizedonce they returned home to Arkansas, Arizona, Oregon, Utah, Texas, Washington and West Virginia, according to CDC officials. Most people had weight-loss surgery. Eight had had surgery at Grand View Hospital. The remainder had surgery at other Tijuana clinics the CDC did not identify. The CDC is investigating two additional cases. Most of the patients were women in their 30s and 40s and had surgeries between August and December, the officials said.

Many describe devastating experiences for themselves and their families.

An unidentified Oregon man died in November, according to state and federal health officials. They say they do not know whether the infection caused his death because he had other health problems.

Even patients who were infected with a less resistant strain of Pseudomonas describe devastating experiences. Mindy Blohm, 45, of Riverton, Utah, said she and her husband were forced to sell their home to pay over $50,000 in hospital bills for treatment of her infection, a less resistant Pseudomonas, after her weight-loss surgery at Grand View on Oct. 31. Her wound finally healed last week, she said.

Capone, whose weight-loss surgery to reduce her stomach by about 80 percent was on Oct. 8, said she is still ill. Doctors had urged her to have the procedure because at 5 foot 7 inches, she weighed 291 pounds. Her blood pressure “was getting way out of control,” she said.

Three days after the procedure at Grand View, as she waited in the San Diego airport for her return flight, she said her main incision started to leak. Back home in Jonesboro, she got worse. Over the next few weeks, she said she was hospitalized twice and developed an abscess that doctors had to cut open and drain.

By then, tests showed she had no ordinary infection. The Arkansas health department told Capone it was the first time they had seen this organism.

“They were worried about other people catching it, especially other medical staff,” Capone recalled. “They told me if I see any doctor, I have to inform them.”

CDC’s Antimicrobial Resistance Laboratory Network knew of three other patients with the same infection. But there was no discernible pattern until Capone’s was reported in mid-November – it was the second linked to Grand View Hospital.

“That was really the ‘aha’ moment,” said Walters, the epidemiologist. Within days, the agency alerted state health departments about the superbug and urged them to test antibiotic-resistant organisms in people who had traveled to Mexico for invasive procedures.

Capone’s condition, meanwhile, grew worse. In mid-December, she was referred to Dare, the Little Rock specialist. He said her only option was colistin, an antibiotic discovered in the late 1940s that is seldom used because it causes kidney and nerve damage. But the drug has resurfaced as a last-line treatment for multidrug-resistant organisms.

On her second day on the antibiotic, Capone’s lips swelled. Her tongue and face went numb. “I got to the point where I could barely talk,” she said. She had to stop treatment.

Now she has a hole in her stomach that requires daily cleaning. Capone wears gloves to clean her wound, then throws her used bandages in the trash outside. Her husband and teenage daughter are not at risk, nor is the general public; the bacteria does not spread in the air. She has incurred more than $30,000 in medical bills related to her infection.

“The wound has not healed, and it hurts a lot,” Capone said. “They told me they’ve done all they could do.”

She has tried to warn others about her experience on a Facebook page established for bariatric patients of Grand View, but she said her posts have been quickly taken down.

A few days ago, she received even more worrisome news. Arkansas and other state health officials are contacting Capone and other infected patients to tell them they may be at risk for diseases that can be transmitted by blood or other bodily fluids, such as HIV, hepatitis B and hepatitis C, because equipment in Tijuana may not have been properly sterilized. Officials are urging patients to talk to their clinicians about additional screening or testing.

“I’m at a breaking point,” Capone said. “I’m so scared. I don’t want to lose my life for this. I don’t want to have my family suffer because I chose to go to Mexico.”

source >> http://sutured.com/they-went-to-mexico-for-surgery-they-came-back-with-a-deadly-superbug/
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Smokers who’ll be having surgery for lung cancer should quit smoking before the operation, and the sooner the better, a new study shows.

Among patients who had surgery for lung cancer, nonsmokers had fewer complications than smokers. But quitting even just a few months before surgery reduced patients’ risks of complications.

“Even a short period of four weeks of preoperative cessation may contribute to a major risk reduction,” said Dr. David Lindstrom of Uppsala Academic Hospital in Sweden, who wasn’t involved with the new study.

Nearly 230,000 new cases of lung cancer will be diagnosed in the U.S. in 2019, the American Cancer Society estimates.

Previous studies indicate that about a third of patients are current smokers at the time of diagnosis, and 20 percent are current smokers at the time of surgery, Mariko Fukui and colleagues at the Juntendo University School of Medicine in Tokyo wrote in their report of the study in Annals of Thoracic Surgery.

The researchers studied 666 patients who had surgery for lung cancer between 2012-2016, including 256 never-smokers and 410 current or previous smokers.
During the three months following the operations, about 32 percent of current smokers had respiratory complications, as compared to 22 percent of previous smokers and 3.5 percent of non-smokers. Generally, smokers were older, had poorer lung function, needed longer operations, and lost more blood during surgery.



The more time that elapsed since smokers had quit, the lower their risk of postoperative problems. Complication rates were 13 percent for current smokers, 10 percent for patients who stopped smoking less than a month before surgery, 8.5 percent for people who quit one to three months before surgery, 6.3 percent for three to six months, six percent for six months to a year, and five percent for former smokers who had quit more than a year before their surgery.

“Lung surgery outcomes are not only linked to long-term survival but to quality of life, and lung resection and lung cancer tend to decrease both of them,” said Dr. Maria Rodriguez Perez of Clinica Universidad de Navarra in Madrid, Spain, who researches lung cancer and surgery outcomes but wasn’t involved in this study.

“Nowadays, we tend to look at the patient as a whole, focusing not only on the specific pathology but on other systems that interact and could have a detrimental effect on outcomes,” she told Reuters Health by email. “Smoking cessation should be, without a doubt, one of the pillars of these programs.”

Lindstrom added, “It’s never too late to stop smoking. Even if the previous smoking history may have caused cancer, you may still benefit from decreased risk of surgical complications and have an increased life expectancy if you stop.”

“Any kind of forthcoming surgical procedure is a good time to try to stop smoking,” said Lindstrom, who has studied the effect of smoking cessation on outcomes of orthopedic surgery. “And when you decide to deal with it, take all the help you can get with motivational counseling, websites, apps and professionals.”

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New guidance from the Royal College of Paediatrics and Child Health (RCPCH) has stopped short of recommending specific limits on screen time, saying there is little evidence that it is harmful. But some parents have told the BBC they are frustrated by the advice and England’s children’s commissioner has said parents need more support.



Andy, whose son is 14, contacted the BBC to say he was disappointed by the advice.

“There is absolutely no doubt in my mind that screen time is damaging school performance and sports performance and dangerously addictive.

“I have had to restrict my son’s screen time to a Friday after school and a Saturday, due to lack of focus at school. His default was to head straight to the Xbox (which I would certainly classify as screen time… it is just a game after all which most boys are engaging in across all devices).

“After some grumbling, he has settled in and we have seen an improvement in school performance.

“I coach the under-15 football team and it is very clear, even with a 14:00 kick-off on a Sunday, who has been up all night on some form of screen.”

Anne Longfield, the children’s commissioner, believes guidance is sorely needed by parents.


“The fact that there isn’t enough evidence doesn’t mean we shouldn’t have a view and try to work out what’s best to do. Children are getting screens earlier, the average age to get a smartphone is now nine. Parents tell me that it is the one thing that drives them mad, causes huge rows, and they don’t know what to do about it.

“Parents are worried their kids will be socially damaged if they don’t give them a phone, so they’re in a tough spot.”


Is your family’s screen time out of control?

The RCPCH said there was no good evidence yet that time in front of a screen is definitely “toxic” to health, although they did publish a list of questions families can ask to assess whether screen use is affecting their children negatively.

The questions are:

Is your family’s screen time under control?
Does screen use interfere with what your family want to do?
Does screen use interfere with sleep?
Are you able to control snacking during screen time?
So if parents feel like screen time is having an adverse impact on their children’s life, what should they do?

Set boundaries

Last year, Anne Longfield published the Digital 5 A Day campaign, which encouraged the whole family to have a healthy digital lifestyle, including parents.

“It can’t be that parents have their phones in their hand the whole time. It works best if the whole family can look into a healthy digital way of life.”

Anne Longfield’s tips for managing screen time include:

Set some boundaries. You wouldn’t let a nine-year-old walk alone down a busy road. Phone use is the same, if a child has a smartphone at a young age you need to be aware of the dangers on their behalf.
If screen time is affecting sleep, meal time interaction, diet, and exercise then negotiate and make a deal. This might be that the phone is not used at the dinner table or in the bedroom, or before breakfast, or until homework is completed.
Consider your own use, parents need to demonstrate good behaviour.
Ms Longfield is now calling on the government to put digital emotional resilience into schools in Years 6 and 7. She is also calling for tech companies to be more “robust and have a duty of care for their users”.

Prioritise Sleep

Dr Richard Graham is a child and adolescent psychiatrist. In 2010, he launched the UK’s first Technology Addiction Service for young people, and is on the board of the UK Council for Child Internet Safety.

He recommends that clients adopt the American Academy of Pediatrics family media plan, which allows a family to set limits together.

“This plan helps a family to look at the sort of media you are going to access, rather than restriction without explanation.

“There is good stuff online, which can make us feel well and healthy. A funny filter on Snapchat for example, can lift a child’s mood. But there is also toxic content, and also the fact that screen time can disrupt important and necessary things like sleep, exercise and conversation.”

His tips include:

Prioritise sleep. A well-rested child is more in control and able to think and discuss than a tired and irritable one. The American Academy of Pediatrics website offers a guide to the length of sleep your child needs for their age. Calculate their bedtime based on when they have to get up.
Be wary about surveillance as it can drive behaviour underground. It’s important children feel they can talk about issues.
Less time online equals less exposure to the possibility of toxic content. Says Dr Graham: “It makes sense that if the window is not open so wide, less dirt will fly in.”

‘A focus on appearance can lead to unhappiness’

Dr Tara Porter, a clinical psychologist specialising in child and adolescent mental health, says she is concerned about screen use as a clinician and a parent.

“Girls are being sucked into drama at a younger age, things said face-to-face are often less hurtful than things said in the online echo chamber, which can be escalated,” she says.

“A focus on the best appearance can also lead to dissatisfaction and unhappiness.”

Her tips include:

- Supervise the device until they are 16 years old. Make it a condition of them having the device that you help them use it sensibly.
- Use parental control apps like Our Pact and Circle to limit access to devices.
- Stay on the front foot – before you give them a device, set out a contract of use

Use tech to limit screen time

Concerned parents have a bewildering array of options to choose from when seeking to manage how much time their children spend on screens.

Some home routers and security packages allow parents to set time limits for devices and monitor and police what can be seen online. Some can be used to impose time limits but these can be very blunt tools.

Most game consoles and computers include tools that can restrict how long the particular gadget is used for.

Finally, there are apps and other tools from Apple, Google, Facebook and others that can monitor how much time is spent on various programmes. Some let parents set hard limits so net access, apps or machines are locked at specific times.

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