England study: Low-risk births don't need hospital (AP)

LONDON � A new study in England shows little difference in complications among the babies of women with low-risk pregnancies who delivered in hospitals versus those who gave birth with midwives at home or in birthing centers.

Based on the findings, researchers said women with uncomplicated pregnancies in England should be able to choose where they want to give birth � and one expert said about half of all pregnant women here could potentially safely give birth outside a hospital.

But they sounded a note of caution for first-time mothers and their infants, who may face a higher risk if they choose a home birth.

"I would never say women should give birth in a particular place, but hope this gives women more information to make an informed choice," said Dr. Peter Brocklehurst, director of the Institute for Women's Health at University College Hospital in London, one of the paper's lead authors. He conducted the research while at Oxford University.

"Birth isn't an abnormal process, it's a physiological process," he said. "And if your pregnancy and labor is not complicated, then you don't need a high level of specific expertise."

Brocklehurst added that about 50 percent of pregnant women in England � those who are low-risk � should be able to choose where to have their baby.

More than 90 percent of pregnant women in England now give birth in a hospital. Some officials say the new study should prompt women to consider alternatives.

"This is about giving women a choice," said Mary Newburn of NCT, a U.K. charity for parents, one of the study's authors. She said midwife-run birth centers in England have a more homelike environment, with privacy, sofas and birthing pools.

In Britain, midwives deliver more than 60 percent of babies already. Similar care is provided in the Netherlands, where about a quarter of all births happen at home. Elsewhere in Europe, most births are led by doctors, although midwives may also be involved.

In the United States, however, less than one percent of births happen at home. The American College of Obstetricians and Gynecologists does not support planned home births and warns evidence shows they have a higher risk of newborn death compared to planned hospital births. The training of midwives in the U.S. varies by state � and some have no regulations.

Brocklehurst and colleagues collected data for nearly 65,000 mothers and babies between 2008 and 2010 in England. Of those, there were 19,706 births in hospital obstetric wards, 16,840 births at home, 11,282 births in "freestanding" midwifery units � independent clinics where there are no doctors or access to anesthetics � and 16,710 births in "alongside" midwifery units, often housed within hospitals.

All the pregnancies were low-risk, meaning the mothers were healthy and carried their baby to term. Women planning C-sections or expecting twins or multiple births were excluded from the study.

In the U.K.'s hospital obstetric wards, most low-risk women don't see a doctor during labor and are only treated by midwives.

There didn't appear to be a difference for the infants' health based on where the mothers planned to give birth.

But researchers found a higher risk for first-time mothers planning a home birth. Among those women, there were 9.3 adverse events per 1,000 births, including babies with brain damage due to labor problems and stillbirth. That compared to 5.3 adverse events per 1,000 births for those planning a hospital birth.

The study was published Friday in the medical journal, BMJ. It was paid for by Britain's department of health and another government health research body.

Dr. Tony Falconer, president of the Royal College of Obstetricians & Gynaecologists, said his group supports "appropriately selected home birth." He noted the higher risk of problems among first-time mothers choosing a home birth and said that raised questions about where they should deliver.

For Emily Shaw of Oxfordshire, northwest of London, giving birth in a hospital wasn't appealing. She wanted home births for both her sons but because her first baby was induced into labor, she had to deliver him in a hospital in October 2008.

Shaw delivered her second son at home in April. "I felt much more comfortable there," she said. "Instead of getting into a car to go to the hospital, the midwives came to me."

"It was nice to have the home comforts during labor," she added, saying she could eat in her own kitchen and use her own bathroom. "And unlike the hospital, they didn't kick out my partner in the middle of the night."

____

Online:

http://www.bmj.com

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Global Fund for world health halts new programs (AP)

GENEVA � The world's biggest financier in the fight against three killer diseases says it has run out of money to pay for new grant programs for the next two years � a situation likely to hit poor AIDS patients around the world.

An official with the Global Fund to Fight AIDS, Tuberculosis and Malaria said Thursday that its has been forced to cease giving new grants until 2014 because of global economic woes brought on by debt crises in the U.S. and Europe.

An independent panel recommended in September that the fund must adopt tougher financial safeguards after it weathered a storm of criticism and doubts among some of its biggest donors.

The fund created the panel � chaired by former U.S. Health and Human Services Secretary Michael Leavitt and ex Botswana President Festus Mogae � in March to address concern among donors after Associated Press articles in January about the loss of tens of millions of dollars in grant money because of mismanagement and alleged fraud.

Germany, the European Commission and Denmark withheld hundreds of millions of euros in funding pending reviews of the fund's internal controls. Germany � the fund's fourth-largest donor_ has since restored its funding.

The Geneva-based fund was set up in 2002 as a new way to coordinate world efforts against the diseases and to speed up emergency funds from wealthy nations and donors to the places hardest hit. Outside of its donor nations and celebrity backers, the biggest private donor is the Bill & Melinda Gates Foundation that has pledged $1.15 billion and provided it with $650 million so far.

Since its creation, the fund, which is strictly a financing tool, has disbursed some $15 billion for programs � $2.8 billion this year alone, including to pay for treatment for around half the developing world's AIDS sufferers.

With donations now harder to come by, the fund says it can only afford to keep existing AIDS programs going, but not expand its services or add new patients.

"We're not cutting back � we're not expanding," the fund's board chairman, Simon Bland, told The Associated Press from Accra, Ghana, where the board has been meeting this week.

The fund had to make some "tough decisions to protect some of the gains that have already been delivered," he added.

Among those decisions were that $800 million to $900 million in grants planned for China, Brazil, Mexico and Russia will now be used for other purposes, fund officials said.

"It is deeply worrisome that inadvertently the millions of people fighting with deadly diseases are in danger of paying the price for the global financial crisis," the fund's executive director, Dr. Michel Kazatchkine, said in a statement.

But the fund has $4 billion on hand to meet all of its current commitments and the "presumption" is that people in China, Brazil, Mexico and Russia won't suffer because their governments will commit their own resources to take over the next phase of the fund's programs, said Dr. Christoph Benn, the fund's external relations manager.

He said the fund's financing picture for the next two years, however, could affect about 9 to 10 million new patients who are in need of HIV treatment in developing nations.

The board has also decided to create a new general manager position after the panel found unhealthy friction between Kazatchkine and the fund's internal watchdog, Inspector General John Parsons's office, whose teams of auditors and investigators have been documenting losses.

The fund released 12 reports on its website earlier this month that turned up an additional $20 million of mismanagement, alleged fraud and misspending. Earlier probes had detected about $53 million in losses, according to fund documents.

Some of the reports have led to criminal cases, and some countries � mirroring the fund's own efforts � say they have begun putting new financial safeguards in place.

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Merck will pay $950M to settle Vioxx investigation (AP)

NEW YORK � The Department of Justice said Tuesday that drugmaker Merck will pay $950 million to resolve investigations into its marketing of the painkiller Vioxx.

The agency said Merck will pay $321.6 million in criminal fines and $628.4 million as a civil settlement agreement. It will also plead guilty to a misdemeanor charge that it marketed Vioxx as a treatment for rheumatoid arthritis before getting Food and Drug Administration approval.

The government will get $426.4 million from the settlement, and $202 million will be distributed to state Medicaid programs for 43 states and the District of Columbia.

Merck stopped selling Vioxx in September 2004 after evidence showed the drug doubled the risk of heart attack and stroke. In 2007 the company paid $4.85 billion to settle around 50,000 Vioxx-related lawsuits. The Justice Department said the settlement resolves allegations that Merck made false, unproven, or misleading statements about Vioxx's safety to increase sales and made false statements to Medicaid agencies about its safety.

Merck said the settlement does not constitute an admission of any liability or wrongdoing, and it said the government acknowledged that there was no basis to conclude that Merck's upper-level management was involved in the violations.

Merck also entered into an agreement about its sales, marketing, publication, and government pricing activities. The Justice Department said that agreement strengthens oversight of the company. It will require top officials to complete annual compliance certifications, and the company will post information about physician payments on its website.

The Whitehouse Station, N.J., company took a charge of $950 million in the third quarter of 2010 to cover the anticipated settlement payments.

Vioxx was approved by the FDA in May 1999, but the government did not initially approve the drug for use in rheumatoid arthritis. That meant doctors could write prescriptions for Vioxx for rheumatoid arthritis patients, but Merck could not promote the drug for that use. The Justice Department said Merck promoted Vioxx for rheumatoid arthritis for three years and continued to do so after getting an FDA warning letter in September 2001. The drug was approved as a treatment for rheumatoid arthritis in April 2002.

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Giving thanks helps your psychological outlook (AP)

WASHINGTON � Count your blessings this Thanksgiving. It's good for you.

While it seems pretty obvious that gratitude is a positive emotion, psychologists for decades rarely delved into the science of giving thanks. But in the last several years they have, learning in many experiments that it is one of humanity's most powerful emotions. It makes you happier and can change your attitude about life, like an emotional reset button.

Especially in hard times, like these.

Beyond proving that being grateful helps you, psychologists also are trying to figure out the brain chemistry behind gratitude and the best ways of showing it.

"Oprah was right," said University of Miami psychology professor Michael McCullough, who has studied people who are asked to be regularly thankful. "When you are stopping and counting your blessings, you are sort of hijacking your emotional system."

And he means hijacking it from out of a funk into a good place. A very good place. Research by McCullough and others finds that giving thanks is a potent emotion that feeds on itself, almost the equivalent of being victorious. It could be called a vicious circle, but it's anything but vicious.

He said psychologists used to underestimate the strength of simple gratitude: "It does make people happier ... It's that incredible feeling."

One of the reasons why gratitude works so well is that it connects us with others, McCullough said. That's why when you give thanks it should be more heartfelt and personal instead of a terse thank you note for a gift or a hastily run-through grace before dinner, psychologists say.

Chicago area psychologist and self-help book author Maryann Troiani said she starts getting clients on gratitude gradually, sometimes just by limiting their complaints to two whines a session. Then she eventually gets them to log good things that happened to them in gratitude journals: "Gratitude really changes your attitude and your outlook on life."

Gratitude journals or diaries, in which people list weekly or nightly what they are thankful for, are becoming regular therapy tools.

And in those journals, it is important to focus more on the people you are grateful for, said Robert Emmons, a psychology professor at the University of California, Davis. Concentrate on what life would be without the good things � especially people such as spouses � in your life and how you are grateful they are there, he said.

Grateful people "feel more alert, alive, interested, enthusiastic. They also feel more connected to others," said Emmons, who has written two books on the science of gratitude and often studies the effects of those gratitude diaries.

"Gratitude also serves as a stress buffer," Emmons said in an e-mail interview. "Grateful people are less likely to experience envy, anger, resentment, regret and other unpleasant states that produce stress."

Scientists are not just looking at the emotions behind gratitude but the nuts-and-bolts physiology as well.

Preliminary theories look at the brain chemistry and hormones in the blood and neurotransmitters in the brain that are connected to feelings of gratitude, Emmons said. And the left prefrontal cortex of the brain, which is also associated with positive emotions like love and compassion, seems to be a key spot, especially in Buddhist monks, Emmons said.

However it works in the brain, Emmons said there is little doubt that it works.

Emmons, who has conducted several studies on people from ages 12 to 80, including those with neuromuscular disease, asked volunteers to keep daily or weekly gratitude diaries. Another group listed hassles, and others just recorded random events. He noticed a significant and consistent difference. About three-quarters of the people studied who regularly counted their blessings scored higher in happiness tests and some even showed improvements in amounts of sleep and exercise.

Christopher Peterson of the University of Michigan studied different gratitude methods and found the biggest immediate improvement in happiness scores was among people who were given one week to write and deliver in person a letter of gratitude to someone who had been especially kind to them, but was never thanked. That emotional health boost was large, but it didn't last over the weeks and months to come.

Peterson also asked people to write down nightly three things that went well that day and why that went well. That took longer to show any difference in happiness scores over control groups, but after one month the results were significantly better and they stayed better through six months.

Peterson said it worked so well that he is adopted it in his daily life, writing from-the-heart thank you notes, logging his feelings of gratitude: "It was very beneficial for me. I was much more cheerful."

At the University of North Carolina, Sara Algoe studied the interaction between cancer patients and their support group, especially when acts of gratitude were made. Like Peterson, she saw the effects last well over a month and she saw the feedback cycle that McCullough described.

"It must be really powerful," Algoe said.

It has to be potent to combat gloom many may be feeling in such uncertain times.

There have been many Thanksgivings throughout history that might challenge society's ability to be grateful. The first Thanksgiving with the Pilgrims came after about half of the Plymouth colony died in the first year. Thanksgiving became a national holiday in the United States when Abraham Lincoln proclaimed it in 1863 during the Civil War, the deadliest war the country has ever known. And the holiday moved to the fourth Thursday in November during the tail end of the Great Depression.

Emmons actually encourages people to "think of your worst moments, your sorrows, your losses, your sadness and then remember that here you are, able to remember them. You got through the worst day of your life ... remember the bad things, then look to see where you are."

That grace amid difficulty motif may make this Thanksgiving especially meaningful, McCullough said.

"In order to be grateful for something, we have to remember that something good happened," Peterson said. "It's important to remind ourselves that the world doesn't always suck."

___

Online:

Robert Emmons: http://psychology.ucdavis.edu/labs/emmons/PWT/index.cfm

National Association of School Psychologists' tips on fostering gratitude in children: http://bit.ly/rHlqCz

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UN: AIDS epidemic stabilizing, still work to do (AP)

LONDON � The AIDS epidemic is leveling off and the number of people newly infected with the virus that causes it has remained unchanged since 2007, the United Nations said in a report Monday.

Critics say that the body's aim of wiping out the disease is overly optimistic, however, considering there is no vaccine, millions remain untreated and donations have slumped amid the economic crisis.

There were 2.7 million new HIV infections last year, approximately the same figure as in the three previous years, said the report from UNAIDS, the joint United Nations program on HIV and AIDS. The figures largely confirm earlier findings released by the group in June.

At the end of last year, there were about 34 million people with HIV, the virus that causes AIDS. While that is a slight rise from previous years, experts say that's due to people surviving longer. Last year, there were 1.8 million AIDS-related deaths, down from 1.9 million in 2009.

The outbreak continues to hit hardest in southern Africa. But while the number of new infections there has fallen by more than 26 percent since the peak in 1997, the virus is surging elsewhere.

In eastern Europe and central Asia, there has been a 250 percent jump in the number of people infected with HIV in the past decade, due largely to the spread among injecting drug users. In North America and western Europe, the outbreak "remains stubbornly steady," according to the report.

"It's looking promising, but the numbers are still at a scary level," said Sophie Harman, a global health expert at City University in London. She was not connected to the UNAIDS report.

In its strategy for the next few years, UNAIDS says it is working toward zero new HIV infections, zero discrimination and zero AIDS-related deaths. Harman said that was an admirable goal but wasn't sure it was achievable. "They need to get real," she said. "Maybe they need to aim high but if their main goal is eradication, it's highly unlikely that will ever happen."

Dr. Paul De Lay, deputy executive director of UNAIDS, acknowledged the idea of eliminating AIDS infections and deaths is "more of a vision for the future," and would likely not be accomplished without new tools like a vaccine, which could take several decades. Earlier this month, U.S. Secretary of State Hillary Clinton called for an AIDS-free generation and promised more money for programs in Africa.

De Lay said U.N. strategies will focus on more aggressive prevention and treatment policies, like treating people with HIV earlier. In Africa, people with HIV are not usually treated until their immune system reaches a certain threshold, and officials are now increasingly trying to start treatment before patients get too sick.

Future strategies might also include giving medicines to people at high risk even before they get infected. The World Health Organization is considering how to advise countries with major epidemics on giving drugs to healthy people vulnerable to catching the virus, such as prostitutes, gay men and injecting drug users, as a prevention method.

While studies have shown that could dramatically slow AIDS transmission, experts have voiced concerns about healthy people taking AIDS drugs, which have toxic side effects. It could also encourage drug resistance, and there are already millions of people in developing countries who qualify for treatment but are still waiting for it.

Sharonann Lynch, an HIV policy adviser at Doctors Without Borders, said many African countries are anxious to implement more aggressive strategies and that some are redrafting their guidelines even before official U.N. advice is available. But she said the financial crisis is affecting treatment and that enrollment in some clinics, like in Congo, have stalled or even been suspended. That could allow the epidemic to resurge.

"Just at the moment when we know how to manage HIV, we're hitting the brakes," Lynch said. "Without more investment, we'll be squandering the best chance we have of getting ahead of the new wave of infections."

___

Online:

http://www.unaids.org

http://www.msf.org

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Where's the salt? Hidden in your Thanksgiving menu (AP)

WASHINGTON � No need for a salt shaker on the Thanksgiving table: Unless you really cooked from scratch, there's lots of sodium already hidden in the menu.

Stealth sodium can do a number on your blood pressure. Americans eat way too much salt, and most of it comes inside common processed foods and restaurant meals.

The traditional Thanksgiving fixings show how easy sodium can sneak into the foods you'd least expect. Yes, raw turkey is naturally low in sodium. But sometimes a turkey or turkey breast is injected with salt water to plump it, adding a hefty dose of sodium before it even reaches the store � something you'd have to read the fine print to discover.

From the stuffing mix to the green bean casserole to even pumpkin pie, a lot of people can reach their daily sodium allotment or more in that one big meal unless the cook employs some tricks.

"For Thanksgiving or any meal, the more you can cook from scratch and have some control over the sodium that's going in, the better," says the American Dietetic Association's Bethany Thayer, a registered dietitian at the Henry Ford Health Health System in Detroit.

The Food and Drug Administration this month opened deliberations on how to cut enough salt in processed foods for average shoppers to have a good shot at meeting new dietary guidelines. The idea: If sodium levels gradually drop in the overall food supply, it will ease the nation's epidemic of high blood pressure � and our salt-riddled taste buds will have time to adjust to the new flavor.

"Reducing sodium is important for nearly everyone," Dr. Robin Ikeda of the Centers for Disease Control and Prevention told the FDA hearing.

The question is how to make that happen. The prestigious Institute of Medicine and several public health advocates are urging the FDA to order gradual rollbacks, setting different sodium levels for different kinds of foods, a step the government has been reluctant to take.

Food makers want a voluntary approach and say they're reworking their recipes, some as part of a campaign launched by New York City to cut salt consumption by at least 20 percent over five years.

It will take different strategies to remove salt from different foods � and some may need to be a sneak operation, Kraft Foods Vice President Richard Black told the FDA meeting. Ritz crackers labeled low-sodium were a bust until the box was changed to say "Hint of Salt" and those exact same crackers started selling, he said.

In other foods, salt acts as a preservative with a variety of functions. Kraft sells cheese with somewhat less sodium in Britain than in the U.S. Americans melt a lot of cheese and lower-sodium cheese doesn't melt as well, Black said.

In the U.S., the average person consumes about 3,400 milligrams of sodium a day. The nation's new dietary guidelines say no one should eat more than 2,300 milligrams of sodium � about what's in a teaspoon of salt � and half the population should eat even less, just 1,500 milligrams. The smaller limit is for anyone who's in their 50s or older, African-Americans of any age, and anyone suffering from high blood pressure, diabetes or chronic kidney disease.

Why? One in three U.S. adults has high blood pressure, a leading cause of heart attacks, strokes and kidney failure. Being overweight and inactive raises blood pressure, too, but the weight of scientific evidence shows sodium is a big culprit.

People want to eat heart-healthy, but Wal-mart shoppers spend about 19 minutes buying groceries, added Tres Bailey of Wal-mart Stores Inc., which told its vendors to start cutting sodium.

That's not a lot of time for label-reading to find hidden sodium, especially in foods where it's unexpected � like salad dressings that can harbor more than 130 milligrams per tablespoon.

Depending on your choices, Thanksgiving dinner alone can pass 2,000 milligrams: About 600 per serving from stuffing mix, another 270 from gravy. The salt water-added turkey can bring another 320, double that if you saved time and bought it fully-cooked. Use canned beans in the green bean casserole and add another 350. A small dinner roll adds 130. A piece of pumpkin pie could bring as much as 350.

How to cut back? Thayer, the dietitian, has some tips for Thanksgiving and beyond:

_All bread contains sodium, but starting with a homemade cornbread for stuffing could help cut a few hundred milligrams.

_Use low-sodium broth for the gravy, and choose low-sodium soups whenever possible.

_Try onion, garlic and a variety of other herbs in place of salt. Lemon and other citrus also can stand in for salt in some foods.

_Check your spice bottles. Combination products, such as those labeled poultry seasoning, can contain salt.

_Fresh or frozen vegetables have little if any sodium, unless you choose the frozen kind with an added sauce.

_People tend to heavily salt mashed potatoes while sweet potatoes, even dressed up as a souffle, contain very little sodium.

Going suddenly low-salt can startle your palate, "but it adjusts much quicker than I think most people realize," Thayer says.

___

EDITOR'S NOTE � Lauran Neergaard covers health and medical issues for The Associated Press in Washington.

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