CAP and ASCO Partner to Improve Practice; Optimize Patient Care

"As diagnosing cancer becomes more complex, communication between pathologists and clinical oncologists has become critical to accurately diagnose cancer, optimize cancer treatment, and advance cancer research. The CAP and ASCO aim to improve the development, application, interpretation, and dissemination of pathology tests—including tumor markers and molecular diagnostics—in cancer care."

Clin Breast Cancer. 2014 Dec 2. pii: S1526-8209(14)00267-5. doi: 10.1016/j.clbc.2014.11.009. [Epub ahead of print]

Current HER2 Testing Recommendations and Clinical Relevance as a Predictor of Response to Targeted Therapy.

Ballinger TJ1, Sanders ME2, Abramson VG3.

Author information

• 1Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN.
• 2Department of Pathology, Microbiology, and Immunology, Vanderbilt University School of Medicine, Nashville, TN.
• 3Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN; Breast Cancer Program, Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, Nashville, TN. Electronic address: Vandana.abramson@vanderbilt.edu.

Abstract

Clinical decision-making in the treatment of breast cancer depends on an accurate determination and understanding of human epidermal growth factor receptor 2 (HER2) status. The guidelines for HER2 testing were recently updated in late 2013, but limitations continue to exist in the interpretation and clinical application of results when the tumor specimens do not fall neatly into positive or negative categories with immunohistochemistry and fluorescence in situ hybridization testing. The issues, including discordance between pathologists or laboratories, polysomy, and genetic heterogeneity, present challenging situations that are difficult to translate into clinical significance. The present reviewdiscussed the changes in the updated American Society of Clinical Oncology/College of American Pathologists guidelines, the clinical relevance of complex issues in HER2 testing, and the implications of the results on the response to HER2-targeted therapies. Great advances have been made in the treatment of HER2-positive breast cancer; however, the challenge remains to determine the best testing analysis that will identify patients who will benefit the most from these therapies.

British Singer Joe Cocker Dies Of Lung Cancer

December 23, 2014

Can J Psychiatry. 2014 Mar;59(3):141-7.

Suicide: rationality and responsibility for life.

Ho AO.

Abstract

OBJECTIVES:

Death by suicide is widely held as an undesirable outcome. Most Western countries place emphasis on patient autonomy, a concept of controversy in relation to suicide. This paper explores the tensions between patients' rights and many societies' overarching desire to prevent suicide, while clarifying the relations between mental disorders, mental capacity, and rational suicide.

METHODS:

A literature search was conducted using search terms of suicide and ethics in the PubMed and LexisNexis Academic databases. Article titles and abstracts were reviewed and deemed relevant if the paper addressed topics of rational suicide, patient autonomy or rights, or responsibility for life. Further articles were found from reference lists and by suggestion from preliminary reviewers of this paper.

RESULTS:

Suicidal behaviour in a person cannot be reliably predicted, yet various associations and organizations have developed standards of care for managing patients exhibiting suicidal behaviour. The responsibility for preventing suicide tends to be placed on the treating clinician. In cases where a person is capable of making treatment decisions--uninfluenced by any mental disorder--there is growing interest in the concept of rational suicide.

CONCLUSIONS:

There is much debate about whether suicide can ever be rational. Designating suicide as an undesirable event that should never occur raises the debate of who is responsible for one's life and runs the risk of erroneously attributing blame for suicide. While upholding patient rights of autonomy in psychiatric care is laudable, cases of suicidality warrant a delicate consideration of clinical judgment, duty of care, and legal obligations.

Virtue, Liberty, and Independence

Cops Seized Couple's $160,000 Wine Collection—And Want to Destroy It All

Baylen Linnekin|Dec. 20, 2014

"In a raid that lasted twenty hours, police seized thousands of ounces of alleged contraband from the couple's home."

HT:DF

Ann Glob Health. 2014 September - October;80(5):370-377. doi: 10.1016/j.aogh.2014.09.009.

Cancer Burden in Latin America and the Caribbean.

Curado MP1, de Souza DL2.

Author information

• 1International Prevention Research Institute, Lyon, France; Goiânia Population-Based Cancer Registry, Goias, Brazil. Electronic address: maria-paula.curado@i-pri.org.
• 2Collective Health Department, Federal University of Rio Grande do Norte, Natal, Brazil.

Abstract

BACKGROUND:

In Latin America and the Caribbean, the epidemiological transition has been occurring in an unequal manner. Infectious-contagious diseases share space with the increase of chronic nontransmissible diseases, such as cancer, which already represents the second most common cause of death, after cardiovascular illnesses.

OBJECTIVES:

This study provides a global picture of the burden of cancer in Latin America and the Caribbean, as well as the challenges faced when controlling this disease in these regions.

FINDINGS:

Epidemiological information on cancer in Latin America originates mainly from mortality registries and from a limited number of population-based cancer registries. Estimates indicate increases of 72% in the incidence of cancer and 78% in the mortality of men between 2012 and 2030, and for women the rates are 62% and 74%, respectively. These increases in incidence rates, accompanied by disproportionally high mortality rates, when compared with other regions of the world, reveal the magnitude of the challenge of controlling cancer in Latin America and the Caribbean. Although neoplasms are among the main causes of death, the control strategies are faced with issues such as organization and development of the health system, and the public policy formulation mechanism.

CONCLUSIONS:

Establishing knowledge on the real impact of incidence, mortality, and survival in Latin America and the Caribbean is quite a challenge due to the lack of an updated and dynamic information system on mortality and incidence, although some improvement has been made in the information systems of some countries within the most recent decade. Other obstacles for cancer control are the uneven allocation of resources, lack of investments in equipment and infrastructure, and the concentration of health care professionals in large urban centers, which contribute to the reproduction of socioeconomic iniquities in the assistance of populations that suffer from cancer.

From Yale U: Laws of cognition and the cognition of law

Cognition. 2014 Dec 12. pii: S0010-0277(14)00245-5. doi: 10.1016/j.cognition.2014.11.025. [Epub ahead of print]

Laws of cognition and the cognition of law.

Kahan DM1.

Author information

• 1Yale University, United States. Electronic address: dan.kahan@yale.edu.

Abstract

This paper presents a compact synthesis of the study of cognition in legal decisionmaking. Featured dynamics include the story-telling model (Pennington & Hastie, 1986), lay prototypes (Smith, 1991), motivated cognition (Sood, 2012), and coherence-based reasoning (Simon, Pham, Le, & Holyoak, 2001). Unlike biases and heuristics understood to bound or constrain rationality, these dynamics identify how information shapes a variety of cognitive inputs-from prior beliefs to perceptions of events to the probative weight assigned new information-that rational decisionmaking presupposes. The operation of these mechanisms can be shown to radically alter the significance that jurors give to evidence, and hence the conclusions they reach, within a Bayesian framework of information processing. How these dynamics interact with the professional judgment oflawyers and judges, the paper notes, remains in need of investigation.

81% of outbreaks caused by nonpasteurized milk were in states in which nonpasteurized milk sale is legal

Emerg Infect Dis. 2015 Jan;21(1):119-122. doi: 10.3201/eid2101.140447.

Increased Outbreaks Associated with Nonpasteurized Milk, United States, 2007-2012.

Mungai EA, Behravesh CB, Gould LH.

Abstract

The number of US outbreaks caused by nonpasteurized milk increased from 30 during 2007-2009 to 51 during 2010-2012. Most outbreaks were caused by Campylobacter spp. (77%) and by nonpasteurized milk purchased from states in which nonpasteurized milk sale was legal (81%). Regulations to prevent distribution of nonpasteurized milk should be enforced.

Lung Cancer Screening 2.0

JMIR Res Protoc. 2014 Dec 19;3(4):e78.

Development and Validation of a Personalized, Web-Based Decision Aid for Lung Cancer Screening Using Mixed Methods: A Study Protocol.

Lau YK1, Caverly TJ, Cherng ST, Cao P, West M, Arenberg D, Meza R.

Author information

• 1Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, United States.

Abstract

BACKGROUND:

The National Lung Screening Trial demonstrated that low-dose computed tomography (LDCT) screening could be an effective way to reduce lung cancer mortality. Informed decision-making in the context of lung cancer screening requires that potential screening subjects accurately recognize their own lung cancer risk, as well as the harms and benefits associated with screening, while taking into account their personal values and preferences.

OBJECTIVE:

Our objective is to develop a Web-based decision aid in accordance with the qualifying and certification criteria in the International Patient Decision Aid Standards instrument version 4.0 that will assist patients in making informed decisions with regard to lung cancer screening.

METHODS:

In "alpha" testing, a prototype of the decision aid was tested for usability with 10 potential screening participants in focus groups. Feedback was also sought from public health and health risk communication experts external to the study. Following that, improvements to the prototype were made accordingly, and "beta" testing was done in the form of a quasi-experimental design-a before-after study-with a group of 60 participants. Outcomes tested were knowledge, risk perception of lung cancer and lung cancer screening, decisional conflict, and acceptability of the decision aid as determined by means of a self-administered electronic survey. Focus groups of a subsample of survey participants will be conducted to gain further insight into usability issues.

RESULTS:

Alpha testing is completed. Beta testing is currently being carried out. As of 2014 December 7, 60 participants had completed the before-after study. We expect to have results by 2015 January 31. Qualitative data collection and analysis are expected to be completed by 2015 May 31.

CONCLUSIONS:

We hypothesize that this Web-based, interactive decision aid containing personalized, graphical, and contextual information on the benefits and harms of LDCT screening will increase knowledge, reduce decisional conflict, and improve concordance between patient preferences and the current US Preventive Services Task Force's screening guidelines.

"You think that the really good people are going to pull through"

On the Front Lines of Ebola’s Most Pressing Mystery

• BY ERIKA CHECK HAYDEN  
 
• 12.23.14

"Every day the nurses went into the wards in those early months—May, June, July—they risked their lives. Many stopped showing up. Only the most dedicated, like Alex, continued to try.

When Moses found out that Alex was infected, she hoped for the best: “You think that the really good people are going to pull through,” she says.

Why that didn’t happen for Alex is a question that, Moses hopes, her research will help to answer one day."

"Sure, you’re happy to be alive, but how are you supposed to bake cookies when you can’t stand the sight of food?"

How to survive the holidays with cancer

Researchers and survivors offer tips on getting through the season after a diagnosis

Dec. 22, 2014

 | 

 

By Diane Mapes / Fred Hutch News Service

"Surviving the holidays takes on a whole new meaning when you’ve been diagnosed with cancer.  Sure, you’re happy to be alive, but how are you supposed to bake cookies when you can’t stand the sight of food? Attend the annual holiday party when you’re wrung out from radiation? Go shopping or wrap presents when your hands and feet don’t work because of chemo-induced nerve damage?"

Sarcobesity

Maturitas. 2013 Feb;74(2):109-13. doi: 10.1016/j.maturitas.2012.10.014. Epub 2012 Nov 29.

'Sarcobesity': a metabolic conundrum.

Parr EB1, Coffey VG, Hawley JA.

Author information

• 1Exercise & Nutrition Research Group, School of Medical Sciences, RMIT University, Bundoora, Victoria 3083, Australia.

Abstract

Two independent but inter-related conditions that have a growing impact on healthy life expectancy and health care costs in developed nations are an age-related loss of muscle mass (i.e., sarcopenia) and obesity. Sarcopenia is commonly exacerbated in overweight and obese individuals. Progression towards obesity promotes an increase in fat mass and a concomitant decrease in muscle mass, producing an unfavourable ratio of fat to muscle. The coexistence of diminished muscle mass and increased fat mass (so-called 'sarcobesity') is ultimately manifested by impaired mobility and/or development of life-style-related diseases. Accordingly, the critical health issue for a large proportion of adults in developed nations is how to lose fat mass while preserving muscle mass. Lifestyle interventions to prevent or treat sarcobesity include energy-restricted diets and exercise. The optimal energy deficit to reduce body mass is controversial. While energy restriction in isolation is an effective short-term strategy for rapid and substantial weight loss, it results in a reduction of both fat and muscle mass and therefore ultimately predisposes one to an unfavourable body composition. Aerobic exercise promotes beneficial changes in whole-body metabolism and reduces fat mass, while resistance exercise preserves lean (muscle) mass. Current evidence strongly supports the inclusion of resistance and aerobic exercise to complement mild energy-restricted high-protein diets for healthy weight loss as a primary intervention for sarcobesity.

Children who regularly eat junk most likely to perform poor at school

"Researchers state that the reason for this is possibly the lack of iron, a thing which is associated with fast food. This leads to a slowing in development of certain processes in the brain."

Appetite. 2014 Dec 18. pii: S0195-6663(14)00767-3. doi: 10.1016/j.appet.2014.12.206. [Epub ahead of print]

Underlying differences between conscientious omnivores and vegetarians in the evaluation of meat and animals.

Rothgerber H1.

Author information

• 1Bellarmine University, 2001 Newberg Rd., Louisville, KY 40205 USA, 502.693.2868 (o) 502.272.8425 (f). Electronic address: hrothgerber@bellarmine.edu.

Abstract

As criticisms of factory farming continue to mount, an increasing number of individuals have changed their existing dietary practices. Perhaps the two most important options for those reacting against industrial farming are (1) vegetarianism/veganism (i.e., veg*nism), the avoidance of animal flesh/all animal products; and (2) conscientious omnivorism (CO), the consumption of meat or fish only when it satisfies certain ethical standards. While the former group has recently received much attention in the social science literature, studies specifically examining those who identify themselves as COs have been virtually nonexistent. The present research sought to investigate possible underlying attitudinal differences between the two groups. Results indicated that relative to veg*ns, COs evaluated animals less favorably, meat more favorably, and were lower in idealism, misanthropy, and ingroup identification. Mediation analysis demonstrated that differences between COs and veg*ns in the perceived acceptability of killing animals for food were mediated by beliefs about animals and meat. The discussion largely speculates on the causal direction of these effects.

Pitch Perfect worthy: Vanderbilt Melodores a capella Take Me To Church

Take Me To Church (Hozier Cover) - Melodores A Cappella

Cells identified that enhance tumor growth and suppress anti-cancer immune attack

by Carrie Strehlau

A study led by St. Jude Children's Research Hospital scientists has identified the population of white blood cells that tumors use to enhance growth and suppress the disease-fighting immune system. The results, which appear in the December 18 edition of the scientific journal Immunity, mark a turning point in cancer immunology and provide the foundation for developing more effective immunotherapies.

European Court Rules Obesity Can Be Disability

LONDON — Dec 18, 2014, 6:43 AM ET

The European Court of Justice says obesity can be a disability, a ruling that could have consequences for employers across the continent.

The court ruled Thursday in the case of a Danish child-minder who says he was unfairly fired for being fat.

The court said if obesity hinders "full and effective participation in professional life," it could count as a disability. Discrimination on the grounds of disability is illegal under European Union law.

Re: capital in the 21st century

Br J Sociol. 2014 Dec;65(4):650-66. doi: 10.1111/1468-4446.12111.

Capital in the twenty-first century: a critique.

Soskice D1.

Author information

• 1London School of Economics and Political Science.

Abstract

I set out and explain Piketty's model of the dynamics of capitalism based on two equations and the r > g inequality (his central contradiction of capitalism). I then take issue with Piketty's analysis of the rebuilding of inequality from the 1970s to the present on three grounds: First, his model is based on the (neo-classical) assumption that companies are essentially passive actors who invest the amount savers choose to accumulate at equilibrium output - leading to the counterintuitive result that companies respond to the secular fall in growth (and hence their product markets) from the 1970s on by increasing their investment relative to output; this does indeed imply increased inequality on Piketty's β measure, the ratio of capital to output. I suggest a more realistic model in which businesses determine investment growth based on their expectations of output growth, with monetary policy bringing savings into line with business-determined investment; the implication of this model is that β does not change at all. And in fact as other recent empirical work which I reference has noted, β has not changed significantly over these recent decades. Hence Piketty's central analysis of the growth of contemporary inequality requires rethinking. Second, despite many references to the need for political economic analysis, Piketty's analysis of the growth of inequality in the period from the 1970s to the present is almost devoid of it, his explanatory framework being purely mathematical. I sketch what a political economic framework might look like during a period when politics was central to inequality. Third, inequality in fact rose on a variety of dimensions apart from β (including poverty which Piketty virtually makes no reference to in this period), but it is unclear what might explain why inequality rose in these other dimensions.

Br J Sociol. 2014 Dec;65(4):607-18. doi: 10.1111/1468-4446.12104.

Beyond capital? The challenge for sociology in Britain.

Holmwood J1.

Author information

• 1School of Sociology, University of Nottingham.

Abstract

This article offers a 'local', British, reading of Piketty's landmark book, Capital in the Twenty-First Century, suggesting that the challenge it offers to sociological approaches to inequality is more fundamental than hitherto recognized. The variations in 'national trajectories' exposed by Piketty reveal Britain to be anomalous in terms of standard approaches to the path dependencies embedded in different welfare regimes. Using the recent work of Monica Prasad on 'settler capitalism' in the USA and the tax and debt-finance regime associated with it, the article suggests that colonialism and empire and its postwar unravelling has had deep consequences for British social stratification, albeit largely neglected by British sociologists. Finally, it points to the fact that the form of tax and debt-finance regime that has become reinforced in Britain is at the heart of recent radical reforms to higher education. These are the currently unexplicated conditions of our future practice as sociologists and, therefore, an obstacle to building a critical sociology on the foundations laid out by Piketty.

Br J Sociol. 2014 Dec;65(4):678-95. doi: 10.1111/1468-4446.12110.

The politics of Piketty: what political science can learn from, and contribute to, the debate on Capital in the Twenty-First Century.

Hopkin J1.

Author information

• 1Department of Geography, London School of Economics and Political Science.

Abstract

Thomas Piketty's imposing volume has brought serious economics firmly into the mainstream of public debate on inequality, yet political science has been mostly absent from this debate. This article argues that political science has an essential contribution to make to this debate, and that Piketty's important and powerful book lacks a clear political theory. It develops this argument by first assessing and critiquing the changing nature of political science and its account of contemporary capitalism, and then suggesting how Piketty's thesis can be complemented, extended and challenged by focusing on the ways in which politics and collective action shape the economy and the distribution of income and wealth. Although Capital's principal message is that 'capital is back' and that without political interventions active political interventions will continue to grow, a political economy perspective would suggest another rather more fundamental critique: the very economic forces Piketty describes are embedded in institutional arrangements which can only be properly understood as political phenomena. In a sense capital itself - the central concept of the book - is almost meaningless without proper consideration of its political foundations. Even if the fact of capital accumulation may respond to an economic logic, the process is embedded in a very political logic. The examples of housing policy and the regulation, and failure to regulate, financial markets are used to illustrate these points.

J Med Ethics. 2015 Jan;41(1):125-8. doi: 10.1136/medethics-2014-102296.

What is it to do good medical ethics? An orthodox Jewish physician and ethicist's perspective.

Steinberg A.

Abstract

This article, dedicated to the 40th anniversary of the Journal of Medical Ethics, approaches the question 'what does it mean to do good medical ethics?' first from a general perspective and then from the personal perspective of a Jewish Orthodox physician and ethicist who tries, both at a personal clinical level and in national and sometimes international discussions and debates, to reconcile his own religious ethical values-especially the enormous value given by Jewish ethics to the preservation of human life-with the prima facie 'principlist' moral norms of contemporary secular medical ethics, especially that of respect for patients' autonomy.

Rev Esc Enferm USP. 2014 Aug;48(spe):7-15. Epub 2014 Aug 1.

Women survivors of intimate partner violence: the difficult transition to independence.

[Article in English, Portuguese]

Leitão MN1.

Author information

• 1School of Nursing of Coimbra, Coimbra, Portugal.

Abstract

Objective 

To understand the trajectories that women go through from entering into to leaving relationships involving intimate partner violence (IPV), and identify the stages of the transition process. 

Method 

We utilized a constructivist paradigm based on grounded theory. We ensured that theethical guidelines of the World Health Organization for research on domestic violence were followed. The analysis focused on narratives of 28 women survivors of IPV, obtained from in-depth interviews. 

Results 

The results showed that the trajectories experienced by women were marked by gender issues, (self) silencing, hope and suffering, which continued after the end of the IPV. 

Conclusion 

The transition process consists of four stages: entry - falls in love and becomes trapped; maintenance - silences own self, consents and remains in the relationship; decides to leave - faces the problems and struggles to be rescued; (re) balance - (re) finds herself with a new life. This (long) process was developed by wanting (and being able to have) self-determination.

From U Mass: The Role of the Media in Agenda Setting: The Case of Long-Term Care Rebalancing

Home Health Care Serv Q. 2014 Dec 17. [Epub ahead of print]

The Role of the Media in Agenda Setting: The Case of Long-Term Care Rebalancing.

Miller EA1, Nadash P, Goldstein R.

Author information

• 1a Gerontology Institute, University of Massachusetts Boston , Boston , Massachusetts , USA.

Abstract

This study investigates the role print media plays in state policy agendas in four states-Connecticut, Minnesota, Oregon, and Utah-in rebalancing long-term care away from institutions toward home- and community-based (HCBS) services. Ordinary least squares regression is used to model states' policy agendas, as measured by the proportion of Medicaid long-term care spending on HCBS expenditures and number of rebalancing bills proposed, from 1999 to 2008. Results reveal a relationship between states' rebalancing agendas and the extent of media coverage, and state economic, political, and programmatic characteristics. Findings suggest that media coverage reflects broader shifts in state-level attitudes toward rebalancing.

"...the safety, efficacy, and long-term effects of devices are frequently insufficiently known upon device approval."

Spine (Phila Pa 1976). 2014 Dec 15;39(26):2115-2118.

Scientific Evaluation of Spinal Implants: An Ethical Necessity.

Moojen WA1, Bredenoord AL, Viergever RF, Peul WC.

Author information

• 1*Department of Neurosurgery, Leiden University Medical Center, Leiden, the Netherlands †Department of Neurosurgery, Medical Center Haaglanden, The Hague, the Netherlands ‡Department of Medical Humanities, University Medical Center Utrecht, Utrecht, the Netherlands §Department for Health Evidence, Radboud University Medical Centre, Nijmegen, the Netherlands; and ¶Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom.

Abstract

The clinical introduction of novel medical devices often occurs without evidence of good methodological quality and with relatively little oversight and regulation. As a consequence, the safety, efficacy, and long-term effects of devices are frequently insufficiently known upon device approval. Recent controversies surrounding the Poly Implant Prothèse (PIP) breast implants, metal-on-metal hip implants, and interspinous implants underscore the need to reconsider how innovation in medical devices can adhere to sound ethical standards without inhibiting surgical research and development. In this article, the introduction of spinal implants is taken as an example to firstly discuss the scientific and ethical challenges of developing, testing, and introducing novel medical devices and to secondly identify avenues for improving the existing regulatory frameworks for such innovation. Two measures for improvement are most feasible in the short term: demanding prospective studies before device introduction and developing registries to monitor and evaluate new medical devices.Level of Evidence: 5.

"Because these expanding moral feelings feel so good to us, we are incapable of perceiving the danger from their ever-expanding focus, in particular from the sincere but increasingly maladaptive collective policies they will engender."

Politics Life Sci. 2014 Spring;33(1):2-32.

No end to caring?

Robison S1.

Author information

• 1Department of Political Science, Idaho State University, Graveley Hall, Pocatello, ID 83209, robishea@isu.edu.

Abstract

Abstract In a recent issue of Politics and the Life Sciences Mark Walker presented a compelling proposition for reducing evil in the world via an interdisciplinary program he calls the "Genetic Virtue Project" (GVP). As Walker explains, the purpose of the GVP is "to discover and enhance human ethics using biotechnology genetic correlates of virtuous behavior." PLS subsequently published several critiques of this proposal. While most of these critiques focused on conventional doubts about the technical feasibility or the ethics of such interventions, the more fundamental concern revealed by both Walker's proposal and its critiques is in the largely unquestioned assumption that more morality is necessarily better. Human history is marked by a gradual if uneven extension of moral concern to increasingly distant others, which many take as evidence of the rationality of morality. There is substantial evidence, though, that this expansion is fundamentally biological in origin and therefore not ultimately limited by rationality. Because these expanding moral feelings feel so good to us, we are incapable of perceiving the danger from their ever-expanding focus, in particular from the sincere but increasingly maladaptive collective policies they will engender. Utilizing the philosophy of Friedrich Nietzsche as a platform, the feasibility of different natural and cultural responses to this impending crisis of caring are examined, none of which are found capable of counteracting this expanding morality. Instead, the best hope for a successful response to this dangerous expansion of caring is actually a sort of reverse GVP, in which the biological mechanisms for this unchecked moral expansion are manipulated via genetic engineering to dial back this expansion. However, the likelihood of actually implementing such an admittedly counterintuitive and controversial program within an increasingly democratized world is doubtful. Ultimately, if we are unable to overcome this betrayal by our best intentions, where does that leave us as a species?

PLoS One. 2014 Dec 10;9(12):e114843. doi: 10.1371/journal.pone.0114843. eCollection 2014.

Risk Assessment of Adverse Birth Outcomes in Relation to Maternal Age.

Weng YH1, Yang CY2, Chiu YW3.

Author information

• 1Division of Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taipei, Taiwan.
• 2Department of Public Health, Kaohsiung Medical University, Kaohsiung, Taiwan.
• 3Master Program in Global Health and Development, College of Public Health and Nutrition, Taipei Medical University, Taipei, Taiwan; Health Policyand Care Research Center, Taipei Medical University, Taipei, Taiwan.

Abstract

BACKGROUND:

Although a number of studies have investigated correlations of maternal age with birth outcomes, an extensive assessment using age as a continuous variable is lacking. In the current study, we estimated age-specific risks of adverse birth outcomes in childbearing women.

METHOD:

National population-based data containing maternal and neonatal information were derived from the Health Promotion Administration, Taiwan. A composite adverse birth outcome was defined as at least anyone of stillbirth, preterm birth, low birth weight, macrosomia, neonatal death, congenital anomaly, and small for gestational age (SGA). Singletons were further analyzed for outcomes of live birth in relation to each year of maternal age. A log-binomial model was used to adjust for possible confounders of maternal and neonatal factors.

RESULTS:

In total, 2,123,751 births between 2001 and 2010 were utilized in the analysis. The risk of a composite adverse birth outcome was significantly higher at extreme maternal ages. In specific, risks of stillbirth, neonatal death, preterm birth, congenital anomaly, and low birth weight were higher at the extremes of maternal age. Furthermore, risk of macrosomia rose proportionally with an increasing maternal age. In contrast, risk of SGA declined proportionally with an increasing maternal age. The log-binomial model showed greater risks at the maternal ages of <26 and > 30 years for a composite adverse birth outcome.

CONCLUSIONS:

Infants born to teenagers and women at advanced age possess greater risks for stillbirth, preterm birth, neonatal death, congenital anomaly, and low birth weight. Pregnancies at advanced age carry an additional risk for macrosomia, while teenage pregnancies carry an additional risk for SGA. The data suggest that the optimal maternal ages to minimize adverse birth outcomes are 26∼30 years.