Monday, November 30, 2009

New HIV Recommendations---WHO

New HIV recommendations to improve health, reduce infections and save lives
World AIDS Day 2009
30 November 2009 -- On the eve of World AIDS Day, WHO is releasing new recommendations on treatment, prevention and infant feeding in the context of HIV, based on the latest scientific evidence.

WHO now recommends earlier initiation of antiretroviral therapy (ART) for adults and adolescents, the delivery of more patient-friendly antiretroviral drugs (ARVs), and prolonged use of ARVs to reduce the risk of mother-to-child transmission of HIV. For the first time, WHO recommends that HIV-positive mothers or their infants take ARVs while breastfeeding to prevent HIV transmission.

"These new recommendations are based on the most up to date, available data," said Dr Hiroki Nakatani, Assistant Director General for HIV/AIDS, TB, Malaria and Neglected Tropical Diseases at the World Health Organization. "Their widespread adoption will enable many more people in high-burden areas to live longer and healthier lives."

An estimated 33.4 million people are living with HIV/AIDS, and there are some 2.7 million new infections each year. Globally, HIV/AIDS is the leading cause of mortality among women of reproductive age.

New treatment recommendations
In 2006, WHO recommended that all patients start ART when their CD4 count (a measure of immune system strength) falls to 200 cells/mm3 or lower, at which point they typically show symptoms of HIV disease. Since then, studies and trials have clearly demonstrated that starting ART earlier reduces rates of death and disease. WHO is now recommending that ART be initiated at a higher CD4 threshold of 350 cells/mm3 for all HIV-positive patients, including pregnant women, regardless of symptoms.

WHO also recommends that countries phase out the use of Stavudine, or d4T, because of its long-term, irreversible side-effects. Stavudine is still widely used in first-line therapy in developing countries due to its low cost and widespread availability. Zidovudine (AZT) or Tenofovir (TDF) are recommended as less toxic and equally effective alternatives.

The 2009 recommendations outline an expanded role for laboratory monitoring to improve the quality of HIV treatment and care. They recommend greater access to CD4 testing and the use of viral load monitoring when necessary. However, access to ART must not be denied if these monitoring tests are not available.

Preventing mother-to-child transmission and improving child survival
In 2006, WHO recommended that ARVs be provided to HIV-positive pregnant women in the third trimester (beginning at 28 weeks) to prevent mother-to-child transmission of HIV. At the time, there was insufficient evidence on the protective effect of ARVs during breastfeeding. Since then, several clinical trials have shown the efficacy of ARVs in preventing transmission to the infant while breastfeeding. The 2009 recommendations promote the use of ARVs earlier in pregnancy, starting at 14 weeks and continuing through the end of the breastfeeding period.

WHO now recommends that breastfeeding continue until the infant is 12 months of age, provided the HIV-positive mother or baby is taking ARVs during that period. This will reduce the risk of HIV transmission and improve the infant's chance of survival.

"In the new recommendations, we are sending a clear message that breastfeeding is a good option for every baby, even those with HIV-positive mothers, when they have access to ARVs," said Daisy Mafubelu, WHO's Assistant Director General for Family and Community Health.

National health authorities are encouraged by WHO to identify the most appropriate infant feeding practice (either breastfeeding with ARVs or the use of infant formula) for their communities. The selected practice should then be promoted as the single standard of care.

Benefits and challenges
An earlier start to antiretroviral treatment boosts the immune system and reduces the risks of HIV-related death and disease. It also lowers the risk of HIV and TB transmission.

The new prevention of mother to child transmission (PMTCT) recommendations have the potential to reduce mother-to-child HIV transmission risk to 5% or lower. Combined with improved infant feeding practices, the recommendations can help to improve child survival.

The main challenge lies in increasing the availability of treatment in resource-limited countries. The expansion of ART and PMTCT services is currently hindered by weak infrastructure, limited human and financial resources, and poor integration of HIV-specific interventions within broader maternal and child health services.

The recommendations, if adopted, will result in a greater number of people needing treatment. The associated costs of earlier treatment may be offset by decreased hospital costs, increased productivity due to fewer sick days, fewer children orphaned by AIDS and a drop in HIV infections.

Another challenge lies in encouraging more people to receive voluntary HIV testing and counselling before they have symptoms. Currently, many HIV-positive people are waiting too long to seek treatment, usually when their CD4 count falls below 200 cells/mm3. However, the benefits of earlier treatment may also encourage more people to undergo HIV testing and counselling and learn their HIV status.

WHO, in collaboration with key partners, will provide technical support to countries to adapt, adopt and implement the revised guidelines. Implemented at a wide scale, WHO's new recommendations will improve the health of people living with HIV, reduce the number of new HIV infections and save lives.

For more information please contact:
Saira Stewart
Telephone: +41 22 791 2511

Olivia Lawe-Davis
Telephone: +41 22 791 1209
Mobile: +41 794 755 545

Heidi Klum Finding Four Kids "Tough"


German supermodel Heidi Klum has found being a mother of four ''tough'' since she gave birth to her new daughter Lou last month.

Heidi Klum admits it's "tough" having four children.

The German supermodel - who gave birth to daughter Lou last month - is struggling to adapt because her newborn baby demands a lot of her time and attention.

Heidi - who is married to singer Seal - told German magazine Gala: "Of course this is all very tough for me at the moment because Leni, Henry and Johan want to continue to do things with their mama and papa. They are not really interested in the fact that you have just had a baby. Seal and I have a lot of work because we have to divide everything among us. But it's great! We are incredibly happy and the family really satisfies me.

"At the moment Lou needs me enormously. Not only because of breastfeeding but also because she needs to be close to her mother. She will sleep now for a year with us in our bedroom - just as her siblings did. It's easier at night if she is hungry."

The 36-year-old beauty keeps her other children - daughter Leni, five, and sons Henri, four, and Johan, three - happy by making sure they're kept busy.

Heidi - who along with Seal have released photographs of their new daughter on the 46-year-old musician's official website, - explained: "You must always think of new things - this is sometimes a challenge. We often make play dates with other kids or we go to the park. On weekends we like to go to Disneyland."

30 November 2009 10:08:56 AM

Friday, November 27, 2009

A note from Dr. Jack Newman on Milk Production

A note from Dr Jack Newman on Milk ProductionShare
Friday, November 27, 2009 at 10:20am
I am hearing more and more often that mothers are being told that if they haven't developed an adequate milk production by 6 or 8 weeks after birth, that they never will. From our clinic experience and the experience of many many mothers, this is patently untrue.

Many mothers will give up breastfeeding on hearing this sort of information. But there is so much more to breastfeeding than the milk so that even if the mother cannot produce all the milk the baby needs, it's still worth maintaining the breastfeeding.

See the websites or for our Protocol to manage breastmilk intake by the baby.

Jack Newman, MD, FRCPC

Sunday, November 22, 2009

Stem cells could be the secret reason why breast is best

Stem cells could be the secret reason why breast is best

Scientist says mother's milk may play vital role in helping children 'fulfil their genetic destiny'

By Susie Mesure

Only 3 per cent of UK mothers still breastfeed at five months

Breast milk, long revered for the nutritional advantages it gives a newborn, could be just as vital in terms of infant development, a leading scientist will claim this week. Up to three different types of stem cells have been discovered in breast milk, according to revolutionary new research.

Dr Mark Cregan, medical director at the Swiss healthcare and baby equipment company Medela, believes the existence of stem cells means breast milk could help a child "fulfil its genetic destiny", with a mother's mammary glands taking over from her placenta to guide infant development once her child is born.

"Breast milk is the only adult tissue where more than one type of stem cell has been discovered. That is very unique and implies a lot about the impressive bioactivity of breast milk and the consequential benefits to the breastfed infant," said Dr Cregan, who is speaking at Unicef's Baby Friendly Initiative conference this week. His research has isolated adult stem cells of epithelial (mammary) and immune origin, with "very preliminary evidence" that breast milk also contains stem cells that promotes the growth of muscle and bone tissue.

Scientists will use his discovery, made at the University of Western Australia, in Perth, Australia, to attempt to harvest stem cells from breast milk for research on a range of issues – from why some mothers struggle to produce milk to testing out new drugs that could aid milk production. "There is a plentiful resource of tissue-specific stem cells in breast milk, which are readily available and from a non-invasive and completely ethical source," Dr Cregan said.

Advocates hope the discovery will help to lift the UK's breastfeeding rates: only one-third of babies are exclusively breastfed at one week, the number dropping to one-fifth at six weeks. At five months, only 3 per cent of mothers still exclusively nurse their babies – although the World Health Organisation recommends that babies should consume only breast milk until they are at least six months old.

Rosie Dodd, campaigns director at the National Childbirth Trust, said: "This finding highlights the many factors that are in breast milk that we know so little about and that all have different advantages, such as helping a baby's immune system to develop."

Dr Cregan said the discovery of immune stem cells was the "most exciting development", adding, "It's quite possible that immune cells in breast milk can survive digestion and end up in the infant's circulation. This has been shown to be occurring in animals, and so it would be unsurprising if this was also occurring in human infants."

British scientists gave a cautious welcome to Dr Cregan's discovery, warning that just because stem cells exist in breast milk did not mean that they could be used to develop a therapy – the ultimate goal of stem cell research. Chris Mason, professor of regenerative medicine at University College London, said: "It may give us some insight into specific breast diseases and is potentially valuable when it comes to drug discovery and drug development but it is fanciful to think it could provide routine therapies.

Nestle seen weighing possible Cadbury bid: report

Sun Nov 22, 1:40 PM
ZURICH (Reuters) - Swiss food giant Nestle may consider a bid for Britain's Cadbury to challenge a hostile 9.9 billion-pound bid by Kraft Foods Inc and a potential move by Hershey, Bloomberg reported on Sunday.

Nestle was still weighing its options and could decide against a bid, Bloomberg said, citing two unnamed people with knowledge of the matter.

Nestle declined to comment on Sunday.

Italian chocolate maker Ferrero and U.S.-based Hershey , have teamed up and said on Wednesday they were reviewing a possible offer for Cadbury.

Italian newspaper Il Sole 24 Ore has reported that Hershey executives will go to Italy to hold a definitive meeting with Ferrero in the coming days.

Ferrero was not available for a comment.

Meanwhile, Cadbury's Chairman Roger Carr told the Sunday Telegraph his group would prefer a merger with U.S. chocolate maker Hershey rather than Kraft . But he added both bids could fail should they not be generous enough.


Analysts had been viewing Nestle as a potential suitor for Cadbury. But such a deal may face some antitrust hurdles.

Nestle said in October it was likely to exercise its option beginning in January 2010 to sell its remaining 52 percent stake in Alcon, potentially raising up to $28 billion, so it could easily afford big buys.

The Swiss giant has declined to comment on Cadbury so far. It has said it does not plan any big acquisitions this year or next, but will focus on a strategy of "bolt-on" buys.

Due to competition issues, analysts had speculated that the Swiss company might consider a joint offer with U.S.-based Hershey Co, with the U.S. group seeking Cadbury's chocolate interests and leaving Nestle with the Trident chewing gum business.

But Nestle has been silent since Hershey and Italy's Ferrero said separately on Wednesday they were considering a bid.

Some market players have suggested Nestle could still help Hershey fund a bid by buying its U.S. license for the KitKat brand, potentially worth around $3 billion to 3.5 billion.

The Cadbury riddle is a difficult one to solve as virtually all players would face antitrust issues if they move, said an M&A expert who declined to be named.

(Writing by Lisa Jucca and Emma Thomasson; additional reporting by Jo Winterbottom in Milan; Editing by Maureen Bavdek)

Monday, November 16, 2009

Why is breastmilk critical for babies?

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Saturday, November 7, 2009

Couple flee to save their unborn baby from social workers after girl, 17, is told she is not clever enough to look after her child

Couple flee to save their unborn baby from social workers after girl, 17, is told she is not clever enough to look after her child
By Alison Smith Squire
Last updated at 12:03 PM on 07th November 2009

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A heavily pregnant woman and her fiance have gone on the run after social workers threatened to take away their baby at birth.
Kerry Robertson, 17, and Mark McDougall, 25, had been told that she was not bright enough to raise their child and that they would have to give him up.
It was another blow for the couple, whose wedding this year was halted just 48 hours before the ceremony in a row over whether Miss Robertson was intelligent enough to marry.

Miss Robertson, who is 29 weeks pregnant, has since been told the couple will be allowed only a few hours with their baby - a boy they have already named Ben - before he is taken into care and placed with foster parents.
Desperate to keep their family together, the pair fled their home yesterday for a secret safe house.
Last night, Miss Robertson, who has mild learning difficulties, said: 'I have been out of my mind with worry about my unborn baby being taken away.
'Although Ben isn't born yet, I already love my baby and know I will be a good mum. Mark and I talk to him inside me every day and tell him we love him.
'We've already bought him clothes and my cousin, who recently had a baby, has handed down a beautiful crib for him.
'But social workers aren't even giving me a chance to be a mum. It's as if social workers are trying to rule my life and I just couldn't take the pressure from them any more.'

Mr McDougall, an artist, said they had made their decision after seeing minutes of a meeting this week where social workers claimed their baby could suffer 'emotional harm' if left with Miss Robertson - an allegation they say is 'ridiculous'.
He said: 'It was clear to Kerry and I that although social workers recently appeared to backtrack, telling us they would not make any decision about our baby until he is born, the truth is they intend to take him away. Kerry was in pieces.
'She is pregnant with her first baby so we don't see how, before he is even here, social workers can say she won't be a good parent. The pressure that social workers have been putting both of us under is huge.
'When Kerry found out she was pregnant, a care worker mentioned she might not be able to keep the baby but we never believed they would do something as cruel as to take him away.
'We are constantly lying awake at night worrying what the next day will bring.
'Not only am I extremely angry and upset about the way we've been treated, I have become worried for Kerry's and our unborn baby's health. I defy anyone to put up with what we've had to put up with.'
The couple, who left their home in Fife, Scotland, after a leaving party for friends and family, say they do not know how long it will be before they can return.
A family law expert said: 'If Miss Robertson gave birth in Fife and then fled with the baby, after the local authority had got a care order, she would be liable for child abduction.
'But by fleeing while pregnant, Miss Robertson has not broken any law, as far as I'm aware.
'If she has her baby outside the jurisdiction of Fife council, they no longer have any power to take the child into care.
'Rather, they would have to locate her and alert the relevant council who would have to apply for a removal order themselves.'
Miss Robertson has been in the care of her grandmother since she was nine months old after her parents were unable to care for her, with her welfare overseen by social workers at Fife Council.
She and Mr McDougall decided to marry after she became pregnant. But in a highly unusual step, Dunfermline Register Office refused to sanction the marriage after Fife Council wrote a letter of objection.
Under British law, a registrar can refuse to marry a couple if he believes one or both parties lack the mental capacity to understand what marriage is about.
Their case has been referred to the European Human Rights Commission, which is investigating whether Fife has broken human rights laws.
Mr McDougall said: 'Kerry and I always wanted our baby to be born to married parents and we are still hoping to get married.
'We have also offered to go to parenting classes and have a lot of support from family and friends. We feel if Fife really wanted to help us they would allow us to get married.'

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