TIME Premature Babies

Viable at 22 Weeks: Just How Low Can Preemies Go?

A pound and a half of life: This baby was born in 2014 at 23 weeks in Sichuan China.
TPG; Getty Images A pound and a half of life: This baby was born in 2014 at 23 weeks, in Sichuan China.

A landmark study raises tough questions about science and ethics

Babymaking is easy when everything goes right. All it takes is a single—decidedly agreeable—act and the rest runs on autopilot for the next nine months. But it’s the “everything goes right” part that is the rub, because in too many cases, at least one thing goes wrong. In the U.S., about 18,000 times per year, that one thing is prematurity.

The outlook has gotten better for premature babies over the last half century. In 1960, the survival rate for a 3.3 lb (1,500 gm) premie was just 28%. By 2010 it was 78%. But everything depends on the calendar: Babies born at, say, 27 weeks—out of the normal 40-week gestation period—have a far easier go than those born at 26 weeks, whose odds in turn are better than those at 25 or 24. The cutoff, the no-go zone, has long been considered 22 weeks. At that age and earlier, there’s just not enough baby to save.

But now, it seems, that may have changed. A study just released in the New England Journal of Medicine is shaking the preemie community with the surprising findings that in a small but significant number of cases, the 22-week limit may be no limit at all. The announcement raises all manner of new questions about how aggressively to treat the littlest infants, how much care is too much—and how much is suddenly not enough. It also, unavoidably, has a lot of people asking how an even slightly lower age of viability affects the fraught debate over abortion.

The new research, led by epidemiologist Michael A. Rysavy of the University of Iowa, involved 4,704 babies born at 24 different hospitals from 2006 to 2011. All of the babies were born before 27 weeks of gestation, and the care they received differed dramatically depending on the hospitals in which they were treated. Virtually any neonate born above 23 weeks of age received aggressive, active treatment. Things were less certain for those born at 23 weeks—with anywhere from 52.5% to 96.5% of them getting full-team medical attention in a neonatal intensive care unit (NICU) and the rest receiving mostly comfort care. And for those born at the 22-week cutoff, the likelihood of receiving treatment was nothing short of a crapshoot, ranging from just 7.7% to 100%.

“The [study] shows that variations in hospital rates of active treatment for babies born at 22 weeks gestation were highly attributable to the birth hospital,” says Edward McCabe, chief Medical Officer for the March of Dimes.

But, the study suggests, those hospitals that leave the 22-weekers to what has always seemed an all-but certain death may have to rethink their policies. Of the entire sample group of babies, 78 of the 22-weekers received aggressive care and just 18 of them survived into toddlerhood. Of those, only 7 were largely healthy, left with no moderate or severe impairments like blindness or cerebral palsy. Those are not especially promising numbers, but they’re better than anyone ever thought they could be.

“Overall, if you look at the mean survival rates for 22 week old babies [in the study], it was just 2%, and only 9% for those who received resuscitation [and other care],” said Dr. Michael Uhing, the medical director of the NICU at the Children’s Hospital of Wisconsin, and a principal source for a 2014 TIME cover story on premature babies. Still, 2% and 9% are not 0%, and the mere decision not to resuscitate—often made to spare the baby the pain of a slow and all-but inevitable death —may have helped drive overall numbers down. “When outcomes are with babies hospitals never resuscitated,” Uhing says, “the results may have been falsely low.” In other words, provide the care that’s often withheld as an ostensible act of mercy, and improved survival rates may follow.

It’s too soon to know if—and how—the new study will change hospital policies. In Uhing’s NICU, the findings of the Iowa study will simply be added to the uncountable other data points and therapeutic options families of preemies must consider. “It’s always been a conversation with the parents and a joint discussion about the outcomes,” Uhing says. It will continue to be.

And as for the third rail issue—the abortion debate? That, the doctors acknowledge, will surely heat up with the new findings. But it’s not an argument they’re interested in joining. “It’s a different subject,” Uhing says flatly. The people who work in NICUs are there to save babies. If science lets them do that at 22 weeks, they’ll do it. If future breakthroughs allow them to go down to 21 or even 20, they’ll save those babies too. The political wars will tend to themselves. In the NICUs, the only battle has ever been with the limits of medical science itself.

TIME ebola

Doctors Stumped After Ebola Survivor’s Eye Changed Colors

His blood was declared Ebola-free, but the virus remained in an eye

Ebola may stick around longer in survivors than researchers previously believed, and it may even cause eyes to change color, according to a case study released Thursday.

Dr. Ian Crozier, who contracted the virus while working as a World Health Organization volunteer at a treatment center in Kenema, Sierra Leone, underwent an intensive struggle with the disease after being transferred to Emory University Hospital in Atlanta. Less than two months after he was released in October, the New York Times reports, based on the study in the New England Journal of Medicine, Dr. Crozier was experiencing vision issues and pain in his left eye. Test results would later show that although Crozier’s blood had been declared Ebola-free, his eye was still full of the virus. Not only that, but the iris turned from blue to green.

“It felt almost personal that the virus could be in my eye without me knowing it,” he said, adding that the color change felt “like an assault.” Dr. Crozier’s sight and eye color later returned, mystifying doctors who had been helping treat his eye inflammation called uveitis, but his case shows researchers there is still much to learn about the deadly virus.

Read more at the New York Times.

TIME public health

Cities like Baltimore Still Suffer From the Toxic Legacy of Lead Contamination

Abandoned row houses are shown in the Sandtown neighborhood where Freddie Gray was arrested, in Baltimore on May 3, 2015.
Andrew Burton—Getty Images Abandoned row houses are shown in the Sandtown neighborhood where Freddie Gray was arrested, in Baltimore on May 3, 2015.

Before Freddie Gray suffered a fatal injury at the hands of the police, the Maryland native was allegedly the victim of lead poisoning

The Sandtown neighborhood of Baltimore has all the markers of the depressed inner city. Unemployment is high, drug abuse is rampant and many houses are vacant and dilapidated. Less apparent—but equally insidious—is the prevalence of lead poisoning.

More than a decade before Freddie Gray suffered a fatal injury while in custody of the Baltimore Police Department, the Maryland native was allegedly the victim of the neurotoxin that contaminated the walls and windows in the dilapidated home where he grew up, according to a report in the Washington Post. Gray reportedly struggled academically, accumulated a criminal record and had trouble focusing—all outcomes associated with the long-term effects of lead poisoning.

Gray was not alone. Hundreds of thousands of young Americans were exposed to lead during their childhood, and, for many, the poisoning has been associated with dramatic problems in their day-to-day lives as adults. And despite the fact that lead was phased out as an additive in gasoline in the 1970s and 1980s, lead poisoning continues to affect children—most of them poor—to this day.

Baltimore, a city where nearly a quarter of the population lives in poverty, has become ground zero in the fight against lead poisoning. Many Baltimore homes were built in an era when the use of lead paint was common, and economic crisis has left many homes and neighborhoods in disrepair, exposing children to lead in chipping paint.

Lead hasn’t been used in paint since 1978, and regulations require landlords to reduce the risk that their tenants are exposed to the substance. But many landlords opt to use risk reduction methods that contain lead temporarily, but leave tenants vulnerable in the longterm. For instance, a landlord may paint over lead paint with safe paint to meet regulations. That reduces the chance of exposure but doesn’t eliminate it. Furthermore, the regulations in Baltimore don’t address owner-occupied homes. To eliminate risk paint needs to be stripped entirely and windows and doors need to be removed, said Ruth Ann Norton, who heads the Baltimore-based Coalition to End Childhood Lead Poisoning.

“If land lords don’t comply with the law, we need to have strong and immediate enforcement,” she said. “But the truth is we have to couple that with investment to actually do the work, to hire young men and women to to replace windows and to remove the lead paint.”

Given that lead was banned in the 1970s, many people are unaware that the toxin is still present in some homes. More than 525,000 children were diagnosed with an elevated level of lead in the 200s, according to data from the Centers for Disease Control and Prevention. “Most people think lead is history, that we passed a ban, therefore it’s not a problem,” said Norton. “Since 1993, we have reduced childhood lead poisoning by 98%, but the job isn’t done.”

For those exposed to lead as children when their brains are still developing, the poisoning can be devastating. The cognitive effects of lead poisoning include diminished intelligence, shortened attention span and increased risk for developing attention-deficit/hyperactivity disorder, according to Mount Sinai’s Dr. Philip Landrigan, who did pioneering research in the 1970s on the health effects of lead. “Unfortunately, it’s permanent,” he said. “The human brain displays very little capacity to repair itself once it’s damaged.”

And it might be difficult to recognize when a child has been exposed. Symptoms aren’t immediately visible, and a lead dust specimen the size of nickel could contaminate a 3,000 square-foot home, Norton said.

The effect of lead poisoning on the brain at an early age can hold back victims for life. Like Gray, many victims of lead poisoning have struggle to find and keep jobs. Some research has even suggested that lead poisoning causes sufferers to lose control of their impulses and behave erratically, which may make it more likely that they’ll commit violent crimes.

“If we’ve poisoned the child the rest of the investment fails, they can’t read, they can’t get to the classroom and they can’t learn,” said Norton “And I don’t want to fill our jails with kids.”

TIME medicine

Many Americans Aren’t Getting Cancer Screenings, Gov Says

Numbers are below national targets

A new federal report shows a high number of Americans are not undergoing recommended screenings for colorectal, breast and cervical cancers.

New data released Thursday from the U.S. Centers for Disease Control and Prevention (CDC), shows that in 2013, which is the latest data available, screening for the three cancers either dropped lower than previous rates or showed no improvement. The numbers show that around 20% of women said they were not up to date with cervical-cancer screenings, and a quarter of women were not getting recommended breast cancer screening. Overall, two in five adults had not had their recommended colorectal screening. The new report was published in the CDC’s Morbidity and Mortality Weekly Report.

The CDC looked at data from the 2013 National Health Interview Survey and compared the screening rates to the target numbers for “Healthy People 2020,” a national disease prevention initiative that has based cancer screening goals on the U.S. Preventive Services Task Force (USPSTF) guidelines.

Current USPSTF recommendations are mammography every two years among women between the ages of 50–74 years, a Pap test every three three years for women between the ages of 21 to 65 without hysterectomy, and screening for colorectal cancer using fecal occult blood testing, sigmoidoscopy, or colonoscopy in adults between age 50 to 75.

The number of mammography screenings remained fairly unchanged from previous years, whereas Pap test use among women between the ages of 21 to 65 was lower than it was in 2000. Colorectal cancer screening was unchanged in 2013 compared to what it was in 2010.

The percentages are below the target numbers for Healthy People 2020. The mammography target is 81.1%, and the 2013 data shows the number is currently at 72.6% for the recommended age group. Nearly 81% of women ages 21 to 65 had a Pap test, but the Healthy People 2020 target is 93%. Around 58% of adults between age 50 to 75 reported they had undergone screening for colorectal cancer, and the target for that group is 70.5%.

Though the new report doesn’t explain why the numbers are not meeting national goals, there are some hints. For instance, the data also showed that people without health insurance or a source of health care had the lowest rates of cancer screening test use.

“Though the [USPSTF] does not consider costs or insurance coverage in its evaluation of the evidence, it will be interesting to see whether declines in the number of uninsured in the U.S. since 2013 will be reflected in improved prevention in these populations,” says Dr. Albert L. Siu, the chairperson of the USPSTF. “As clinicians, we also hope that our nation will continue to strive to help all individuals get access to those preventive services that can enable people to live healthier, longer lives.” Siu was not involved in the CDC report.

TIME Mental Health/Psychology

Your Therapist Is Better at Handling Emotions Than You Are

Therapy session
Getty Images

They're better able to control negative thoughts, finds a new study

Impressive findings from the other side of the therapy couch: your therapist is better at regulating her emotions than you are, according to a small new study in the journal Psychotherapy.

The authors wanted to see if psychotherapists are better at regulating emotion than the rest of us, so they tested experienced therapists as well as non-therapists by showing them pictures designed to elicit negative emotional reactions, ranging from slightly negative images like sad people to very intense images like corpses and people with severe injuries. After each image, they rated how negative the image made them feel.

Both groups reacted the same way to the negative images.

But differences emerged during the second part of the study, when people were shown the pictures again and told to use one of two techniques that regulates emotion: either positive reappraisal, in which you reinterpret emotional information in a positive light, or distraction—thinking about something unrelated and neutral in order to disengage from the negativity. Both have been shown to be effective against negative emotions.

Therapists, the researchers found, were better at calming their emotional response by using these emotion regulation strategies than the non-therapists, regardless of which technique they chose.

“It’s something they need for that job and something that makes them be effective in what they do,” says study author Jan Pletzer, a graduate student in business administration at Jacobs University Bremen in Germany and in social and organizational psychology at the VU University Amsterdam in the Netherlands. Next, Pletzer hopes to find out whether therapists come into their profession equipped with these emotional skills, or whether they hone them on the job.

“I suspect maybe it’s a little bit of both,” says psychologist Mary Karapetian Alvord, PhD, adjunct associate professor at George Washington University School of Medicine and Health Sciences, who was not involved in the study. But just because non-therapists have less training doesn’t mean they’re doomed to be less emotionally intelligent than the professionals sitting across from them.

We regulate our emotions through our thoughts, Alvord says—a key skill every good therapist learns how to do. “What lay people can do is really learn to catch your thoughts, be aware of your thoughts and recognize that those thoughts then lead to an emotional reaction and a physiological reaction,” she says. “Recognizing those connections is absolutely critical, and most people don’t. We think about emotions, but we don’t think about the thoughts and reframing and getting a different perspective.”

When we do, she says, the effects can be huge on both our mind and body. Reframe a speedbump into a positive, and “immediately you recognize that your body relaxes, your muscles aren’t as tense, you feel better and you have a better outlook for the rest of the day,” Alvord says. “It’s something that therapists learn, to catch themselves.”

TIME Research

Some Premature Babies Can Survive After Only 22 Weeks, Study Says

premature baby
Getty Images

Roughly 5,000 babies are born at 22 or 23 weeks in the U.S. each year

A new study has found that some premature babies can survive outside the womb with medical treatment as early as 22 weeks into pregnancy.

The study, published on Wednesday in the New England Journal of Medicine, raises questions about treatment practices for premature babies while also adding a new layer to the abortion debate.

Hospitals vary in how they approach treatment for babies born before 24 weeks, widely viewed to be the minimum age of viability, the New York Times reports. But the study, which analyzed almost 5,000 babies born at between 22 and 27 weeks, found that a small number of babies born at 22 weeks could survive with treatment, some with long-term impairment. Those that were not treated died.

Each year, roughly 5,000 babies are born at 22 or 23 weeks in the US, according to the Times.

[NYT]

TIME Exercise/Fitness

4 Moves for a Toned Back and Upper Body

woman-dumbbelll-rearview
Getty Images

Exercises worth sweating for

Most of our gym sessions are spent focusing on the areas we consider the most noticeable (think: butt, stomach, and legs). But here’s a secret all top trainers know: a strong upper body is not only the key for an overall defined look, but it’s your best defense against future injury and poor posture.

These four exercises are specifically designed to target the muscles in your shoulders, arms, and upper and lower back. You’ll strengthen your upper body and work on improving your posture, all while sculpting a gorgeous rear view.

Do 3 sets of each exercise, with 15 repetitions per set. Start with a pair of 5-10 pound dumbbells and then work your way up to a heavier weight as you feel stronger. Do this workout up to three times a week, alternating days for best results.

Delt Raises

Stand with feet hip-width apart, knees slightly bent. Shift your hips back as you lower your torso until your knees are in line with the heels. Turn your palms to face each other, bend your elbows, and lift arms out to the sides until the weights are shoulder height. Focus on using your back, not your arms, to raise the weights. Gently lower your arms back down, being sure to keep your core and glutes engaged throughout the entire movement.

Single-Arm Dumbbell Rows

Stand with your feet hip-width apart, bend your knees, and shift your hips back, lowering the torso until nearly parallel with the ground. Hold a weight in your right hand. For more balance, place your left hand on your left thigh or on a wall in front of you. Draw the weight up toward chest by bending your right elbow, and then slowly release, returning the arm down by your side. Make sure to keep your shoulder blades down and together and your core engaged the entire time to help support your lower lumbar spine. Do 15 reps on your right arm, then repeat on your left arm.

The ‘T’

Stand with your feet hip-width apart. Take a slight bend in knees as you shift your hips back and lower your torso until it’s almost parallel to the floor. Bring the weights together and turn your palms to face forward. Keeping your arms straight, lift the weights up to shoulder height, forming a ‘T’ shape, and then lower them back down with control. Make sure to keep the core and glutes engaged the entire time.

The Newspaper

This one is great for working the latisimuss dorsi and rotator cuffs. To start, stand with your feet hip-width apart holding two dumbbells. Bring your weights up, so you have a 90-degree angle from your shoulders to your hands. Make sure to keep squeezing the elbows to your waist the entire time. Then, rotate your forearms out to your sides as far as you can before returning them back to the starting position.

For more quick workout ideas, check out 5 Moves For Slim, Toned Thighs.

This article originally appeared on Health.com.

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TIME Infectious Disease

Chlamydia Outbreak Hits Texas High School With Abstinence-Only Sex-Ed Program

A West Texas high school is considering expanding its sex-education program beyond teaching abstinence after 20 cases of chlamydia were confirmed among students this week.

“We do have an abstinence curriculum, and that evidently ain’t working,” Jim Rumage, superintendent for the Crane Independent School District, told KFOR-TV about the outbreak at Crane High School.

“We need to do all we can,” he added, “although it’s the parents’ responsibility to educate their kids on sexual education.”

With a school population of about 300, roughly one in 15 students has the sexually transmitted disease. The Centers for Disease Control and Prevention called the outbreak a health issue of “epidemic proportions.”

Rumage defended the school’s sex-ed program – three days of abstinence-only advocacy each fall – in a separate interview with the San Antonio Express-News. “If kids are not having any sexual activity, they can’t get this disease … That’s not a bad program,” he said.

Some residents are already clearly unnerved by the outbreak, which was so severe that the district sent letters home to parents last week. “I have a kid. Honestly, I don’t want my kid growing up in an area where nasty stuff like that happens,” one resident told KWES-TV.

School district officials met on Monday to discuss possible changes to the sex-ed teachings. Any changes would have to be approved by the school board in a vote on May 19.

This article originally appeared on People.com

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