Friday, December 28, 2007

Thyroid disease a possible risk factor for craniosynostosis

Maternal thyroid disease or its treatment may increase the risk of craniosynostosis in offspring by nearly threefold, preliminary results from an ongoing study suggest.


The finding is celebrated because thyroid disease is the second most common endocrinopathy, after diabetes, in women of reproductive age, Dr. Sonja A. Rasmussen said at the annual get-together of the Teratology Society.


"Several case reports within the medical literature have allied craniosynostosis to postnatal hyperthyroidism and with protective Graves' disease during pregnancy," said Dr. Rasmussen of the division of birth defects at the Centers for Disease Control and Prevention, Atlanta.


"Congenital hypothyroidism is associated near delayed closure of the fontanelles. In addition, thyroid hormone is specified to play a key role within normal bone metabolism, acting on both osteoblasts and osteoclasts.


"This information suggests that excess thyroid hormone might organize to premature cranial suture fusion," she said.


To examine the relationship between maternal thyroid disease and craniosynostosis, Dr. Rasmussen and her associates used notes from the National Birth Defects Prevention Study, an ongoing population-based case-control study of major birth defect.


The data included caring interviews and clinical information on 4,555 infants who were born between Oct. 1, 1997, and Dec. 31, 2002, contained by Arkansas, California, Georgia, Iowa, Massachusetts, New Jersey, New York, and Texas.


Maternal interviews were completed 6-24 months after estimated date of transport. Infants born with a condition of agreed etiology, such as a chromosome abnormality or single gene condition, were excluded from the study.


Of the 4,555 infants, 433 have craniosynostosis verified by radiographic imaging and 4,122 live-born infants without most important birth defects served as the control group.


Because constrained information was available in the order of the specific type of thyroid disorder mothers may have have, the researchers defined maternal thyroid disease as thyroid disease reported by the mother or a mother who reported taking thyroid medication such as thyroxine, methimazole, or propylthiouracil during pregnancy.


Of the mothers of infants beside craniosynostosis, 19 (4.4%) had protective thyroid disease, compared with 67 (1.6%) of mothers surrounded by the control group. Odds ratio analysis revealed that mothers with thyroid disease be 2.8 times more likely to hold an infant with craniosynostosis, compared near mothers in the control group.


The association remained like peas in a pod from a statistical standpoint after the researchers adjusted for several potential confounding factor, including maternal age, lessons, race, smoking status, use of selective serotonin reuptake inhibitors, body mass index, and preexisting diabetes; infant sex, birth consignment, and gestational age; and family history of craniosynostosis.


The researchers also examined the relationship between protective thyroid disease and craniosynostosis by the type of major cranial suture involved. Odd ratio were increased for adjectives types of craniosynostosis except for metopic. The highest probability ratio was for multiple sutures.


"There are several possible mechanism for the findings we observed," said Dr. Rasmussen, who cautioned that the overall results are preliminary.


First, "mothers beside hyperthyroidism may have received not enough treatment, with hall of excess thyroid hormone across the placenta."


Another possible mechanism is that a mother next to hypothyroidism received overtreatment with exogenous thyroid hormone.


"Finally, the mother might hold autoimmune thyroid disease that results in production of thyroid-stimulating antibodies that cross the placenta and stimulate the fetal thyroid to craft excess thyroid hormone."


A key decrease of the study, she acknowledged, was that information on caring thyroid disease was base on self-report, "so only restricted information on the type of thyroid disease was available." Dr. Rasmussen also noted that work-ups for genetic cause of craniosynostosis differed among the study sites. Therefore, some infants with genetic etiology might enjoy been included in the analysis.


"Better grasp of the mechanism involved beside maternal thyroid disease and craniosynostosis is essential so that optimal treatment can be provided to mothers beside this condition," she said.

Meeting the special needs of elder battered women

(The following article is made up of excerpts from a report, Abused Elders or Older Battered Women?, on an AARP Forum held October 29-30, 1992. The full report, published in 1993, can be ordered fRom the Women's Initiative, Special Activities Department, American Association of Retired Persons, 601 E Street, N. W., Washington, DC 20049)


Even though there is evidence that spouse/partner swearing may constitute a large portion of adjectives elder abuse, elder women abused by their husbands/partners may be falling between the cracks in both the elder abuse and domestic violence communities. Responding to this concern, the Women's Initiative of AARP convened a forum in October 1992 to bring together representatives of both communities to exchange information, start a dialogue, and identify some initial recommendations going on for how to better meet the desires of older battered women. Approximately 25 researchers, advocate, service providers, and medical and legal professionals from the field of elder abuse and domestic anger participated.


Prior to the forum, AARP run a small article in the AARP Bulletin asking battered women to write almost their experiences with treat roughly and with seeking aid. The responses were alarming. More than 500 post arrived within a month from women who looked-for to tell their stories surrounded by the hope their experiences could help others. Some women be in their 80s and have suffered verbal, physical, and mental invective for 35, 40, even 50 years.


Some recurring theme emerged from their correspondence:


* Many of the writers described years of silent suffering; many said this be the first time they had ever told anyone of the assault.


* Many writers were isolated from relatives and friends as a result of the abuse itself or of trying to hold on to the abuse surreptitious.


* There were stories of extreme physical antagonism -- being pushed, hit, and even shoved down flights of stairs, suffering fractures, dislocated joint, and deep muscle bruises that took weeks to restore to health.


* Almost all wrote something like emotional swearing, describing name calling, degrading accusation, and constant verbal battering.


* Alcohol maltreat was a completely frequent companion to violent behavior.


* Many described seeking relief from professionals, clergy, and the police, only to be told they must hold done something wrong to provoke their husbands. Some had received the minister to they needed from local services; however, many more have not.


For older women of color, getting assist may be compounded by racism, ageism, poverty and disability. This is seen within the African American community, where the possibility of police brutality results contained by women going directly to shelters without ever calling the police. Participants pointed out the more barriers face by Hispanic women of all ages, and chiefly immigrant and refugee women, who must overcome the isolation that results from cultural and language barrier. If a woman feels culturally alienated within a battered women's shelter and legal system geared toward Anglos, she will enjoy greater difficulty in departure a violent relationship.


Proposals for Change


The dearth of familiarity about the over-50 age groups make improved research first among steps to connect the elder abuse and battered women's communities. Some of the specific question to be addressed include the following:


* What are the specific risk factor for battering in later years? What roles are played by physical dependency, substance foul language, and other observed phenomena? How often is name-calling triggered by age-related events such as retirement or illness?


* What are the barrier in service systems that prevent elder women from seeking and receiving serve?


* What roles do ethnicity, race, and culture play contained by the way nation perceive the problem, seek services, and trade name decisions?


Improving the court response to a complaint of abuse is another substantial component in stopping rough up and preventing further incidents. This includes:


* Strengthening abuse law to cover all abuse partners;


* Educating law lords, police, and other legal personnel going on for the problem;


* Increasing access to affordable legal services through specially trained non-lawyers and by developing more user-friendly information almost the court system;


* Creating a national registry of abusers.


To enhance protective services, forum participants recommended that communities:


* Ensure that appropriate, accessible, and sheltered shelters are available that take into reason the needs of elder women, with special attention to rural communities. Programs should be designed and operate to be multicultural and multilingual.


* Provide cross-training, coordination, and coalition-building between the elder abuse and domestic antagonism communities.


* Sensitize all medical and legitimate professionals, counselors, and religious leaders about sexism, racism, and ageism.


* Build coalitions to respond to diversity and empower battered women.


* Reach out to elder women by disseminating information about domestic hostility through senior centers and home services, health clinics and physicians, civic associations, and public benefits office. Conduct outreach to women whose partners are substance abusers or are mentally under the weather.


* Provide victim advocate and create sister-to-sister "buddy" programs between recently battered and formerly battered women.


In conclusion ... society must put up with substantial changes to abolish hierarchical relations between men and women, between the race, between old and young-looking. Instead, society must value and respect women and guarantee equality and nouns for women in adjectives realms of social relations.


Specifically, state and local women's commissions are urged to focus on elder battered women and to monitor local and state governmental action. Media coverage of the problem can be better by abandoning its current "martyr of the day" mentality, which sensationalizes, glamorizes, and Compartmentalizes intimidation, and instead report the larger picture and connections. Women themselves should be educated more or less what signs or "danger signals" to monitor out for in their mate (e.g., possessiveness), and prepared in how to proceed. Violence and swearing at all level -- government, workplace, medium, and the family--must be condemned. Finally, school children should be trained in nonviolent methods of conflict resolution and they should be skilled to understand ageism and to respect elder people.

Teaching banks how to protect their elder customers

Tellers at a local bank notice that "Mrs. Jones," a longtime customer, was acting strangely. Sometimes she seem confused, and at other times she was suspicious and argumentative. She begin to overdraw her account, accusing the hill of losing her money. One day, when she appeared at the edge with a stranger and a frightened look on her frontage, and withdrew a roomy sum of money, the bank controller grew alarmed and called the Berks County Office of Aging for serve. Was it possible that Mrs. Jones had become the target of someone who was exploiting her financially, he required to know. If so, what could the bank do going on for it? And how could bank body tell if other elder customers were contained by danger of financial invective?


Calls like the above grew more frequent during the 1980s, as the aging population of Berks County, Pennsylvania, grew larger and the community become more aware of the needs of its elderly citizens. "We requirement help to treaty with our elderly customers," said one backer. "Elderly customers all come across to come at lunchtime, the only time business populace have to do their bank. They all crowd into the guard on Social Security Day, giving our tellers the `Third of the Month Blues.' They regularly seemed confused around how to use the bank's services." How could workers tell if someone be suffering from dementia? What should they do if they suspected that someone was a martyr of financial exploitation?


The Office of Aging realized that the problems man raised by bank offered a real opportunity to collaborate near people surrounded by the business sector to raise the power of life for elder citizens. Because many financial abuse directed against the elderly involve large sums of money self withdrawn from bank funds accounts, banks be in a position to identify and report suspicious interactions. With training from professionals in the pen of aging, bank personnel could function as "gatekeepers" (people who are contained by regular contact with the elderly and can spot problems affecting their welfare) by reporting problems to the aging services meet people.


Thus began a individual partnership between the Office of Aging and local bankers to train bank tellers, customer representatives, and manager how to identify older customers who might be have difficulties that could lead to financial assault and how to report it. The partnership expanded to include the police, other businesses and educational settings.


At this time, Pennsylvania did not hold an adult protective services imperative that would guarantee anonymity of reporters (such a law be enacted within 1987). Banks were concerned that if they developed policies and procedures to protect elderly from exploitation, they might violate these customers' rights to privacy, autonomy, and confidentiality. It be imperative that the program be built on a foundation of trust so that financial institutions and other professionals would feel comfortable within reporting their concerns and confident about how reports would be handle.


Training on Needs of Older Customers


The training began as a series of 3-hour workshops sponsored by the local branch of the American Institute of Banking (AIB). Initially, the Berks County Office of Aging brought in professionals from the Pennsylvania College of Optometry to sensitize dune employees to hallucination and sensory losses that many elder people experience. Now the agency is fit of providing the training on its own. At the same time, the AIB couched the importance of the elder customer and developed a 9-hour curriculum called "The Older Bank Customer." In most cases, bank personnel teach the course, which is flexible, but given the ongoing relationship with the Office of Aging, this curriculum is also skilled by the Office of Aging in Berks County. Though the emphasis change depending on the need of the group, the course mostly covers the following areas:


Session 1: Demographics of Aging in American Society. This session looks at the national, state, and local demographics relating to the elderly. It provides information about the elderly themselves, who care for them, and the mobility and employment issues of their caregivers. It sets the stage for the following sessions.


Session 2: The Aging Process. This session explores the normal change that occur near aging, such as social and sensory changes, and how they affect the nouns of older inhabitants. Participants undergo experiential training beside adaptive aids to simulate hearing and hallucination loss, such as writing with their fingers tape together to simulate loss of manual dexterity due to arthritis and trying to saunter with popcorn within their shoes. Participants say they never really inherent the physical problems older general public face back this, and that this training has sensitized them not one and only to the special needs of their elder customers but to the needs of their elder relatives as well.


Tellers and customer service representatives revise how to communicate effectively with visually or audible range impaired customers. They also win tips on how to inform older customers of ridge services such as direct deposit, power of attorney, pay-by-phone, and automated teller contrivance cards. In addition, hill managers are shown how to cause the bank environment more accessible to elderly customers, such as setting aside convinced hours of the day for seniors, have one teller stripe devoted to cashing Social Security checks, and using templates to write checks. One wall is even setting up courier service to an elderly housing facility being constructed across the street.


Session 3: The At-Risk Older Person. This session discusses how to sanction symptoms of dementia, the kinds of problems ridge employees may encounter, and how to promise with them. It covers different types of assault, family caregiving relationships, when and where on earth to seek aid.


At this session, the Office of Aging also provides a list of "Gatekeeper Warning Signals." or admonitory signals for tellers and others surrounded by the position to act as "gatekeepers." Changes surrounded by behavior, habits, form conditions, and communication styles may be warning signals to contact outside resources for assist. People who exhibit the following changes may be at risk for exploitation:


* Frequently forgetting items such as a checkbook, deposit slips, or other items called for to do business;


* Frequently asking the same examine over a short period of time;


* Noticeable change in appearance and grooming;


* Disorientation -- a personage may come to the bank when it is closed or hold difficulty finding the bank;


* Paranoia -- accusing team of mismanaging money (charges that require review by a professional agency to determine whether they are true or a distortion of reality);


* Hoarding behavior such as carrying all their papers surrounded by large oodles all the time;


* Bringing strangers next to them to the bank;


* Unusual withdrawal.


Session 4: The Aging Services System. This session covers issues involved in building a partnership with the community, how to use the system, the Adult Protective Services Act, the responsibility of the Office of Aging, and the responsibility of the community. Bankers find a chance to nouns their concerns, to describe situations that have occur, and to work out new solutions.


The constraint for the training has increased in the closing five years; adaptations own been made, and section are presented independently so that the training can be targeted to meet the specific desires of each audience.


Widening the Circle of Services


By the time the Older Adults Protective Services Act (Act 79) be passed in Pennsylvania within 1987, the agency had provided bank with approximately 30 hours of training; a strong foundation existed for community cooperation and reporting of financial exploitation of the elderly.


The decree added clout to the capability of the agency to pursue emergency interventions and to protect elder people's safekeeping and assets. The law mandate that the Berks County Office of Aging provide protective services to detect, prevent, reduce, or do away with abuse, failure, exploitation, and abandonment of family 60 and over. The Act provides for voluntary reporting, and reporters who act contained by good dependence have the right to remain anonymous and are immune from civil or criminal liability.


A committee of bankers, police officer, and aging network professionals conducted a day-long workshop for elder consumers that explained fraud, exploitation, and scams Videotapes of this workshop be presented in ongoing sessions at senior centers and other organization. Additional community training was developed for police, courts, hospitals, and ambulance companies and the local electric company instituted a caretaker program for its meter readers to identify at-risk elder people by note changes contained by the exterior of their homes. Each year, more businesses are using the agency as a resource and colleges and high school now volunteer agency training programs on aging as part of their curricula.


There is no cross-question that community linkages such as these purloin staff time as well as agency resources. But the benefits far outweigh the cost. Referrals for protective services hold tripled since the beginning of this shot. While part of this growth be due to the passage of the Adult Protective Services Act, the more significant number be due to community trust in the agency, which developed throughout this teaching process. In fact, as this article be being written, the Office of Aging received a bid from a bank examiner about one of her elder customers. The woman, a long-time customer, had taken to calling populace at the bank three and four times a year and asking the same question over and over. They knew her very well enough to realize that this behavior signaled a problem. "We at the mound probably see some of our regular customers on a more consistent basis than their family," says Kay Haring, mediator of the Berks County Bank. Haring called the Office of Aging to discuss her concerns and a caseworker have been sent out to evaluate the woman's condition.


"Every merchant banker has a story something like an elderly customer," says Haring. "As she leaves the guard, you have that sinking fear that something is wrong, but you think `what can we do?' There is something that can be done. It's as simple as a phone ring. You can make a difference."


Older ethnic group reap the benefits when bank body understand the aging process, are competent to recognize vulnerability signals and at-risk situations, know what services are available to help, and are confident ample in the system to label the request for help.

Mountain Plains states conquer out to child care agencies and providers

"Breastfeeding isn't just a obedient nutrition practice -- it's good business for child safekeeping center and family afternoon care home providers," say Colorado Child and Adult Care Food Program (CACFP) administrator Kathy Brunner.


"When women who are breastfeeding are deciding on infant attention to detail, they're more likely to look for centers and homes that will work next to them."


CACFP is one of several child nutrition programs administered nationally by USDA and operate by state and local agencies. The program provides USDA-donated food, financial support, and technical assistance to facilitate participating child care centers, clan day thinking homes, and after-school care programs serve wholesome meals and snacks to children.


(CACFP also provides support for meal served to impaired and elderly adults surrounded by nonresidential care centers.)


Across the country, CACFP is assuming a growth role in encouraging and supporting breastfeeding of infants care for at participating facilities. Here's a look at some interesting actions initiated by Colorado and four other states in the Food and Nutrition Service's Mountain Plains region--Missouri, Iowa, Montana, and North Dakota:


COLORADO


In Colorado, CACFP falls under the supervisory umbrella of the state's Department of Health, which also administer WIC (USDA's Special Supplemental Food Program for Women, Infants, and Children). Kathy Brunner is on the Colorado Breastfeeding Task Force (see accompanying article) and is part of the group's child caution subcommittee.


The state agency is working in a variety of ways to give support to child care center staff and home protection providers learn more roughly breastfeeding and ways they can be supportive to mothers.


For example, the agency's "Bits and Bites" newsletter for centers has included articles on breastfeeding in the child fastidiousness setting and on storing and handling breastmilk.


The state also plans to train home providers and center staff through sessions incorporated into its annual workshops. One workshop in Thornton, Colorado, included a session on working with breastfeeding mothers along next to sessions on infant care and feed, and recordkeeping.


Last fall, Colorado begin working with nutrition instructors at six community colleges that serve train people to become certified child contemplation center directors.


In another effort, the state is working to build a lattice of trained people. As a first step, Karen Runner of Colorado's CACFP staff and Paula Peirce from a local system that sponsors family daytime care homes' contribution training course conducted by staff from the University of California at San Diego.


In turn, Runner and Peirce are spearheading training for sponsoring organizations' grazing land representatives and will also train center personnel. Colorado's goal is to train 5,000 kinfolk day attention to detail home providers and 300 child care center staff by September 1993 using conferences, newsletters, and handouts.


MISSOURI


In Missouri, the Department of Health have developed a series of brochures that include information on benefits of breastfeeding and how to address needs of mothers who plan to return to work. As Missouri's CACFP director Deborah Markenson explains, the three brochures are:


* "Feeding infants in the Child and Adult Care Food Program," which target providers and includes a section outlining why breastmilk is the best food for infants.


* "Breastfed Infant and You," a instruction book for child care providers that covers helping breastfeeding mothers and storing and using breastmilk.


* "Breastfeeding and the Working Mom," for women planning to return to work. This includes guidance in choosing a child fastidiousness facility; tips for continuing breastfeeding afterr returning to work; and advice on expressing, handling, and storing breastmilk.


In integration, Missouri includes breastfeeding as a topic in its annual workshops for sponsors and centers. It included an article on the advantages of breastfeeding in the state's "Building Blocks" newsletter.


IOWA


In its newsletter for child care providers, Iowa have also featured information on gentle for breastfed babies in child perfectionism, helping mothers, and storing breastmilk. The state is also producing a guide for providers with superfluous information.


There are some interesting local efforts, too. For example, within Marshall County, the Marshall County Child Care Services (a private nonprofit child care company that operates three centers) promotes breastmilk as "the optimal food for babies" and encourage mothers to continue to nurse after returning to work--either in a gentle place at the center or by having their babies feed expressed breastmilk during day fastidiousness hours.


MONTANA


In Montana, CACFP and WIC-both under the Montana Department of Health--are working together in a little ways.


For example, a WIC presenter was feature at Montana's 1992 summer workshop for organizations that sponsor relations day consideration homes' participation within CACFP. In addition, CACFP have provided WIC with a register of participating centers and homes.


In some other efforts, state staff are taking a look at how sensitive centers and homes are to helping infants be breastfed. A random survey be done with the cooperation of Montana State University to estimate willingness of providers to support breastfeeding in homes and centers. When results enjoy been tally, they will be compared to a repeat survey to be done at the end of the year.


According to state CACFP supervisor Peggy Baraby, Montana WIC clinics will soon inaugurate contacting providers. "The providers will furnish referral cards to WIC clinics, which can be given to parents needing child meticulousness," she explains. WIC clinics will also answer questions on breastfeeding, regardless of whether or not the mother and infant are WIC clients.


Montana makes available different materials, including pamphlets and a poster for display within centers and homes. In addition, the state's CACFP newsletter have discussed breastfeeding support as part of infant assistance.


NORTH DAKOTA


North Dakota began a cooperative hard work 2 years ago by adding a WIC presenter at its May 1991 workshop contained by Bismarck for family afternoon care home sponsors.


According to Maggie Anderson, child nutrition specialist next to the Department of Public Instruction, approximately 35 to 40 representatives attended the sessions. Since sponsoring organizations don't changeover much from year to year, she says, the presentation should budge a long way within keeping providers across the state informed.


OTHER STATES JOIN IN...


By this spring, Kansas, Nebraska, South Dakota, and Wyoming had also fixed the Mountain Plains breastfeeding initiative. Like their neighboring states, they have started including articles on breastfeeding in their state agency newsletters. They've also begin to invite speakers to talk going on for breastfeeding at their workshops.


Federal program managers within FNS' Mountain Plains regional office


(MPRO) are proud of what these states are doing to offer breastfeeding as an alternative for mothers who stipulation to return to work or school but would close to to continue breastfeeding their infants.


So other states can benefit from these pains, MPRO staff are sharing with other FNS regions the materials Mountain Plains states hold developed.

Thrombophilia doesn't affect preeclampsia rate in after that pregnancies

Women who have preeclampsia surrounded by their first pregnancy are less feasible to experience it in subsequent pregnancies even if thrombophilia develops, Dr. Birgit Arabin reported at the 20th European Congress of Perinatal Medicine.


The concept of screening for thrombophilia in pregnant women beside preeclampsia has be controversial, especially in feathery of the fact that a systematic review (Eur. J. Obstet. Gynecol. Reprod. Biol. 2002;101:6-14) and a metaanalysis (Cochrane Database Syst. Rev. 2003;2:CD003580) hold not recommend screening until it is shown that interventions such as heparin and/or low-dose aspirin are effective surrounded by improving outcomes, said Dr. Arabin of the Clara Angela Foundation, Witten, Germany.


To determine if thrombophilia have any impact on the rate of preeclampsia in women who own more than one pregnancy, Dr. Arabin and her colleagues examined 426 Dutch women who had preeclampsia during their first pregnancy in 1995-2005. Among the 163 (38%) women who have thrombophilia during their first pregnancy, the 40% rate of preeclampsia occurring before 32 weeks (109 women) be similar to the 35% rate of preeclampsia occurring after 32 weeks (54 women).


At least one subsequent pregnancy occur in 252 of the 426 women near preeclampsia. Of those 252, 96 had at tiniest one episode of thrombophilia and were treated near the low-molecular-weight heparin dalteparin (Fragmin) and low-dose aspirin; the remaining 156 without thrombophilia received treatment next to low-dose aspirin. In these pregnancies, 40 (16%) of the 252 women developed preeclampsia, but the rate was not significantly different between women beside (17%, 16 of 96) and those without (15%, 24 of 156) thrombophilia. The 40 mothers who have preeclampsia in their first subsequent pregnancy give birth to infants with significantly elder gestational age and significantly higher birth weightiness than infants who were born to the 252 mothers who have preeclampsia in their first pregnancy.


Preeclampsia reoccurred surrounded by only 7 (9%) of the 74 women who have a second subsequent pregnancy. The rate of preeclampsia was similar among the women near (3 of 37) and without (4 of 37) thrombophilia.


None of the 15 women who have a third subsequent pregnancy developed preeclampsia.


"It seems approaching the more pregnancies you have, the smaller number chance you'll catch recurrent preeclampsia; thrombophilia does not play a role contained by this process," said Dr. Arabin, also of the department of perinatology at the Isala Clinics, Zwolle, the Netherlands.


The Dutch FRUIT study (Fragmin in Pregnant Women With a History of Uteroplacental Insufficiency and Thrombophilia) is currently enrolling patients to determine whether a combination of dalteparin and low-dose aspirin reduce the rate of preeclampsia before a gestational age of 34 weeks more than low-dose aspirin alone, Dr. Arabin noted.