Thursday, February 18, 2010

“UAB-led study shows simple steps could reduce stillbirths by up to 1 million (EurekAlert!)” plus 3 more

“UAB-led study shows simple steps could reduce stillbirths by up to 1 million (EurekAlert!)” plus 3 more

UAB-led study shows simple steps could reduce stillbirths by up to 1 million (EurekAlert!)

Posted: 18 Feb 2010 06:13 AM PST

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[ Back to EurekAlert! ] Public release date: 17-Feb-2010
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Contact: Jennifer Lollar
jpark@uab.edu
205-934-3888
University of Alabama at Birmingham

BIRMINGHAM, Ala - New findings in a study led by the director of the University of Alabama at Birmingham (UAB) Division of Neonatology show that that training birth attendants in essential newborn-care techniques reduced stillbirths by more than 30 percent - and potentially could save as many as 1 million lives worldwide each year.

Ninety-eight percent of the 3.7 million neonatal deaths and 3.3 million stillbirths each year occur in developing countries. This project, spearheaded by UAB's Waldemar A. Carlo, M.D., was designed to train birth attendants, including doctors, midwives, nurses and traditional birth attendants, in communities and hospitals in 96 communities worldwide. The findings were published in the Feb. 18 edition of the New England Journal of Medicine.

"The birth attendants were trained to do several easy steps that are critical for babies to survive at birth and be kept alive through the first week of life," said Carlo, the lead author who worked with a large group of American and international colleagues. "We selected the World Health Organization course on essential newborn care because it contains what we believed are the essential interventions necessary to sustain life in many infants and created an educational package that included interventions that could be used by any birth attendant anywhere in the world."

Using the train-the-trainer model, local instructors trained birth attendants from rural communities in Argentina, Democratic Republic of Congo, Guatemala, India, Pakistan and Zambia. They used the World Health Organization (WHO) newborn-care course (routine neonatal care, resuscitation, thermoregulation, breastfeeding, kangaroo care, care of the small baby and common illnesses) and a modified version of the American Academy of Pediatrics Neonatal Resuscitation Program (in-depth basic resuscitation).

The goal was to see if training birth attendants to use these interventions would reduce perinatal and neonatal mortality in the first week of life in infants weighing at least 1500 grams in rural communities in developing countries.

"Major global causes of perinatal mortality are birth asphyxia and low birth weight/prematurity," Carlo said. "We wanted to find out if these low-cost interventions, including neonatal resuscitation training and kangaroo care, effectively reduced deaths from these causes worldwide. A preliminary smaller study in Zambia has shown that improved skill and knowledge in birth attendants in perinatal care reduced neonatal mortality."

Kangaroo care is a technique used on a newborn, usually a preterm infant, wherein the infant is held, skin-to-skin, with an adult. It is used to provide closeness of the newborn with mother and/or father to ensure physiological and psychological warmth and bonding. The kangaroo position also provides ready access to nourishment. The mother's body responds to the needs of the infant directly, helping regulate the infant's body temperature more smoothly than an incubator; her milk adjusts to the nutritional and immunological needs of her fragile infant, and the baby sleeps more soundly.

The train-the-trainer program used various teaching methods, including clinical practice sessions and demonstrations for the trainers. Carlo and his colleagues also developed instructions on the essential techniques with visual cues to assist birth attendants who could not read. The essential newborn-care intervention was assessed with a before-and-after design. The neonatal resuscitation program intervention was assessed as a cluster randomized control trial.

The stillbirth rate decreased significantly for nurses/midwives and traditional birth attendants following essential newborn care training. The stillbirth rate also decreased among home deliveries. There was not a significant decrease in all-cause first week mortality or stillbirth for those using the in-depth neonatal resuscitation program.

Carlo said it is plausible that the observed reduction in stillbirths may be due to essential newborn-care training. Live-born infants without obvious signs of life may have been misidentified as stillbirths before this training; such misclassifications have been reported in the literature. After training, resuscitation was more likely, and stillbirths decreased.

Carlo added that though the data show that training in basic neonatal care has an important role in improving perinatal outcomes in the developing world, more scaled-up research is needed to prove that the training reduces mortality in other health-care systems.

"A package of essential newborn-care interventions, if implemented worldwide, might decrease perinatal deaths by about 1 million per year," he said.

About the UAB Department of Pediatrics and Division of Neonatology

The UAB Department of Pediatrics and UAB Division of Neonatology, together with Children's Hospital of Alabama, operate the state's only Level IIIC Regional Neonatal Intensive Care Unit (RNICU) and provide the state's highest level and most comprehensive care for well newborns and preterm and term babies with medical conditions. In addition to the RNICU, UAB also is home to a Continuing Care Nursery (CCN), providing extended step-down care for premature infants and infants with medical conditions. UAB is one of the original eight National Institute of Child Health and Human Development (NICHD) research sites commissioned in 1986 and is the only facility in the country that is involved in all three of the NIH research initiatives for maternal, child and family health, the Neonatal Research Network, Maternal-Fetal Medicine Units Network and the Global Network for Women and Children Research.


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Training birth attendants in essential newborn-care techniques can reduce perinatal deaths (News-Medical-Net)

Posted: 18 Feb 2010 02:34 AM PST

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New findings in a study led by the director of the University of Alabama at Birmingham (UAB) Division of Neonatology show that that training birth attendants in essential newborn-care techniques reduced stillbirths by more than 30 percent - and potentially could save as many as 1 million lives worldwide each year.

Ninety-eight percent of the 3.7 million neonatal deaths and 3.3 million stillbirths each year occur in developing countries. This project, spearheaded by UAB's Waldemar A. Carlo, M.D., was designed to train birth attendants, including doctors, midwives, nurses and traditional birth attendants, in communities and hospitals in 96 communities worldwide. The findings were published in the Feb. 18 edition of the New England Journal of Medicine.

"The birth attendants were trained to do several easy steps that are critical for babies to survive at birth and be kept alive through the first week of life," said Carlo, the lead author who worked with a large group of American and international colleagues. "We selected the World Health Organization course on essential newborn care because it contains what we believed are the essential interventions necessary to sustain life in many infants and created an educational package that included interventions that could be used by any birth attendant anywhere in the world."

Using the train-the-trainer model, local instructors trained birth attendants from rural communities in Argentina, Democratic Republic of Congo, Guatemala, India, Pakistan and Zambia. They used the World Health Organization (WHO) newborn-care course (routine neonatal care, resuscitation, thermoregulation, breastfeeding, kangaroo care, care of the small baby and common illnesses) and a modified version of the American Academy of Pediatrics Neonatal Resuscitation Program (in-depth basic resuscitation).

The goal was to see if training birth attendants to use these interventions would reduce perinatal and neonatal mortality in the first week of life in infants weighing at least 1500 grams in rural communities in developing countries.

"Major global causes of perinatal mortality are birth asphyxia and low birth weight/prematurity," Carlo said. "We wanted to find out if these low-cost interventions, including neonatal resuscitation training and kangaroo care, effectively reduced deaths from these causes worldwide. A preliminary smaller study in Zambia has shown that improved skill and knowledge in birth attendants in perinatal care reduced neonatal mortality."

Kangaroo care is a technique used on a newborn, usually a preterm infant, wherein the infant is held, skin-to-skin, with an adult. It is used to provide closeness of the newborn with mother and/or father to ensure physiological and psychological warmth and bonding. The kangaroo position also provides ready access to nourishment. The mother's body responds to the needs of the infant directly, helping regulate the infant's body temperature more smoothly than an incubator; her milk adjusts to the nutritional and immunological needs of her fragile infant, and the baby sleeps more soundly.

The train-the-trainer program used various teaching methods, including clinical practice sessions and demonstrations for the trainers. Carlo and his colleagues also developed instructions on the essential techniques with visual cues to assist birth attendants who could not read. The essential newborn-care intervention was assessed with a before-and-after design. The neonatal resuscitation program intervention was assessed as a cluster randomized control trial.

The stillbirth rate decreased significantly for nurses/midwives and traditional birth attendants following essential newborn care training. The stillbirth rate also decreased among home deliveries. There was not a significant decrease in all-cause first week mortality or stillbirth for those using the in-depth neonatal resuscitation program.

Carlo said it is plausible that the observed reduction in stillbirths may be due to essential newborn-care training. Live-born infants without obvious signs of life may have been misidentified as stillbirths before this training; such misclassifications have been reported in the literature. After training, resuscitation was more likely, and stillbirths decreased.

Carlo added that though the data show that training in basic neonatal care has an important role in improving perinatal outcomes in the developing world, more scaled-up research is needed to prove that the training reduces mortality in other health-care systems.

"A package of essential newborn-care interventions, if implemented worldwide, might decrease perinatal deaths by about 1 million per year," he said.

Source UAB Department of Pediatrics and Division of Neonatology

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Study: States must fill $1 trillion pension gap (AP via Yahoo! News)

Posted: 18 Feb 2010 06:16 AM PST

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HARRISBURG, Pa. – States may be forced to reduce benefits, raise taxes or slash government services to address a $1 trillion funding shortfall in public sector retirement benefits, according to a new study that warns of even more debilitating costs if immediate action isn't taken.

The Pew Center on the States released a survey Thursday of state-administered pension plans, retiree health care and other post-employment benefits in all 50 states that blamed a decade's worth of policy decisions for leaving them shortchanged.

The result for some states will be "high annual costs that come with significant unfunded liabilities, lower bond ratings, less money available for services, higher taxes and the specter of worsening problems in the future," the study said.

The cost of the trillion-dollar shortfall, which will be paid over the coming decades, is about $8,800 for each American household. The study did not include many city, county and municipal pension plans, which are thought to have similar underfunding.

"We have a significant problem now, but it's a problem that can be solved by taking relatively modest steps," said Susan K. Urahn, the center's managing director. "If they don't do anything, if they wait, eventually they will have an unmanageable crisis on their hands."

As of 2008, states had $2.4 trillion to meet $3.4 trillion in promised pension, health care and other post-retirement benefits, according to the report.

The true gap may even be wider, because the study did not account for the full impact of investment losses in late 2008, during the stock market downturn, and because many plans employ multiyear smoothing techniques to lessen the effect of a single year's losses. But more recent stock market returns could help — on Wednesday, for example, Pennsylvania's $47 billion public school pension plan reported it had earned about 12 percent on investments in the 2009 calendar year.

Pew deemed 16 states solid performers in how they fund pensions, 15 needing improvement and 19 considered to be facing serious concerns.

"Meanwhile, more and more baby boomers in state and local government are nearing retirement, and many will live longer than earlier generations — meaning that if states do not get a handle on the costs of post-employment benefits now, the problem likely will get far worse, with states facing debilitating costs," the study said.

The exploding financial burden could be a bitter pill for taxpayers, many of whom will not be collecting similar pensions or other benefits when they retire, said David Kline with the California Taxpayers' Association. About one in five private sector workers have traditional defined benefit pensions, compared with about 90 percent of public-sector employees — including some that do not get Social Security.

"Taxpayers in the future will be paying for people who worked decades before they may have even lived in the area or begun paying taxes, because the obligation for these benefits is just snowballing," Kline said.

The study graded states on how well they have managed employees' retirement benefits. Florida, Idaho, New York, North Carolina and Wisconsin began the current recession with fully funded pension systems, while eight states have left more than one-third of their pension liability unfunded.

Illinois was rated the most troubled pension system during the study period, with a 54 percent funding level and a total liability of more than $54 billion.

In Pennsylvania, a series of decisions by the Legislature and governor have shielded taxpayers from much of the pain for the past decade, but costs of less than $1 billion a year now is projected to climb to about $6 billion annually in the coming three years.

The report said policy makers have exacerbated the problem by expanding benefits, relying on overly optimistic assumptions about investment returns and failing to sufficient fund the programs.

"Even though the actuaries tell the states what they should be doing, the states feel free to ignore that," said Olivia Mitchell, director of the Pension Research Council at the University of Pennsylvania's Wharton School. "So putting some teeth behind the requirements is really the problem."

Pew calculated a $587 billion national cost for current and future retiree health care and other nonpension retirement benefits, with only about 5 percent of that amount funded as of 2008. The cost of health care and the number of retirees are both on the rise, adding to the pressure on states.

The study found that 15 states made some legislative changes to their state-run systems last year, 12 did so in 2008 and 11 in 2007. About a third of states had formal efforts to study potential reforms under way last year.

"Pension plans work when they are allowed to work, and part of that dynamic is that sometimes adjustments have to be made," said Keith Brainard, research director with the National Association of State Retirement Administrators. "It's important not to take away decent retirement benefits for some of the few people that have them."

Pew said states should consider changes that have proven to be effective and politically viable. Among them: setting minimum contribution levels that are actuarially sound, sharing some of the investment risk with employees, cutting benefits, increasing the minimum retirement age, making employees pay more into the system and providing more robust oversight and investment rules.

Mitchell said many states have constitutional prohibitions against lowering employee pension benefits, but health care programs can more easily be altered.

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Study: States face $1 trillion pension shortfall (Courier-Post)

Posted: 18 Feb 2010 11:47 AM PST

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States may be forced to reduce benefits, raise taxes or slash government services to address a $1 trillion funding shortfall in public sector retirement benefits, according to a new study that warns of even more debilitating costs if immediate action isn't taken.

The Pew Center on the States released a survey Thursday of state-administered pension plans, retiree health care and other post-employment benefits in all 50 states that blamed a decade's worth of policy decisions for leaving them shortchanged.

The result for some states will be "high annual costs that come with significant unfunded liabilities, lower bond ratings, less money available for services, higher taxes and the specter of worsening problems in the future," the study said.

The cost of the trillion-dollar shortfall, which will be paid over the coming decades, is about $8,800 for each American household. The study did not include many city, county and municipal pension plans, which are thought to have similar underfunding.

"We have a significant problem now, but it's a problem that can be solved by taking relatively modest steps," said Susan K. Urahn, the center's managing director. "If they don't do anything, if they wait, eventually they will have an unmanageable crisis on their hands."

As of 2008, states had $2.4 trillion to meet $3.4 trillion in promised pension, health care and other post-retirement benefits, according to the report.

The true gap may even be wider, because the study did not account for the full impact of investment losses in late 2008, during the stock market downturn, and because many plans employ multiyear smoothing techniques to lessen the effect of a single year's losses. But more recent stock market returns could help -- on Wednesday, for example, Pennsylvania's $47 billion public school pension plan reported it had earned about 12 percent on investments in the 2009 calendar year.

Pew deemed 16 states solid performers in how they fund pensions, 15 needing improvement and 19 considered to be facing serious concerns.

"Meanwhile, more and more baby boomers in state and local government are nearing retirement, and many will live longer than earlier generations -- meaning that if states do not get a handle on the costs of post-employment benefits now, the problem likely will get far worse, with states facing debilitating costs," the study said.

The exploding financial burden could be a bitter pill for taxpayers, many of whom will not be collecting similar pensions or other benefits when they retire, said David Kline with the California Taxpayers' Association. About one in five private sector workers have traditional defined benefit pensions, compared with about 90 percent of public-sector employees -- including some that do not get Social Security.

"Taxpayers in the future will be paying for people who worked decades before they may have even lived in the area or begun paying taxes, because the obligation for these benefits is just snowballing," Kline said.

The study graded states on how well they have managed employees' retirement benefits. Florida, Idaho, New York, North Carolina and Wisconsin began the current recession with fully funded pension systems, while eight states have left more than one-third of their pension liability unfunded.

Illinois was rated the most troubled pension system during the study period, with a 54 percent funding level and a total liability of more than $54 billion.

In Pennsylvania, a series of decisions by the Legislature and governor have shielded taxpayers from much of the pain for the past decade, but costs of less than $1 billion a year now is projected to climb to about $6 billion annually in the coming three years.

The report said policy makers have exacerbated the problem by expanding benefits, relying on overly optimistic assumptions about investment returns and failing to sufficient fund the programs.

"Even though the actuaries tell the states what they should be doing, the states feel free to ignore that," said Olivia Mitchell, director of the Pension Research Council at the University of Pennsylvania's Wharton School. "So putting some teeth behind the requirements is really the problem."

Pew calculated a $587 billion national cost for current and future retiree health care and other nonpension retirement benefits, with only about 5 percent of that amount funded as of 2008. The cost of health care and the number of retirees are both on the rise, adding to the pressure on states.

The study found that 15 states made some legislative changes to their state-run systems last year, 12 did so in 2008 and 11 in 2007. About a third of states had formal efforts to study potential reforms under way last year.

"Pension plans work when they are allowed to work, and part of that dynamic is that sometimes adjustments have to be made," said Keith Brainard, research director with the National Association of State Retirement Administrators. "It's important not to take away decent retirement benefits for some of the few people that have them."

Pew said states should consider changes that have proven to be effective and politically viable. Among them: setting minimum contribution levels that are actuarially sound, sharing some of the investment risk with employees, cutting benefits, increasing the minimum retirement age, making employees pay more into the system and providing more robust oversight and investment rules.

Mitchell said many states have constitutional prohibitions against lowering employee pension benefits, but health care programs can more easily be altered.

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