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New research suggests that having multiple sclerosis puts pregnant women at slightly higher risk for giving birth via cesarean deliveries or having babies that grow at a slower rate in the womb.

But the researchers, whose findings were published online in Neurology, also reported that pregnant women with MS were not more likely than other women to develop such conditions as preeclampsia or premature rupture of membranes.

The findings came from an examination of a national database that included details on about 18.8 million childbirths in 38 states, including deliveries by an estimated 10,000 women with MS.

The two groups of pregnant women differed somewhat. Those with MS were more likely than those without chronic medical conditions to have fetuses that suffered from restricted growth, as defined by weight measured through ultrasound. Among women with MS, 2.7 percent had fetuses in that category, compared with 1.9 percent of other women.

Women with MS were also more likely to have a cesarean delivery: 42 percent had a c-section, compared with 33 percent of other women.

However, the study found that women with MS had lower pregnancy complication rates than did women who had diabetes before becoming pregnant.

“These results are reassuring for women with MS,” study author Dr. Eliza Chakravarty. of Stanford University School of Medicine. said in a news release from the American Academy of Neurology.

“Women and their doctors have been uncertain about the effect of MS on pregnancy, and some women have chosen to delay or even avoid pregnancy due to the uncertainty,” Chakravarty said. “We found that women with MS did not have an increased risk of most pregnancy complications.”

Women undergoing a second round of in-vitro fertilization should get one embryo instead of two, suggests new Swedish research that found the first approach is almost as successful as the second and greatly reduces the risk of multiple births.

A previous study produced the same result, but this latest report examined the women for a longer period of time, through more embryo implantations.

The findings “should provide comfort for those who want to perform single-embryo transfers that the pregnancy rates are equivalent,” said Dr. William E. Gibbons, president of the American Society for Reproductive Medicine and a professor at Baylor College of Medicine in Houston.

Gibbons said debate over the number of embryos to implant began about a decade ago, when in-vitro fertilization (IVF) began to be more successful.

“Since only a fraction of eggs released by a woman are capable of producing a baby, the pregnancy rate is higher when more than one embryo is put back in,” he said. “However, in the late ’90s the standard number of embryos replaced at that time resulted in an increasing rate of triplets and quadruplets.”

Multiple births can lead to a variety of medical complications that can put the lives of some babies at risk.

In the new study, the Swedish researchers examined the records of 661 women who first underwent implantation with a fresh embryo, followed by implantation with one or two frozen embryos if the first attempt was unsuccessful. If those attempts failed, they went through more attempts; the scientists followed them for up to four more tries.

The findings appear in the Oct. 29 issue of the New England Journal of Medicine.

Forty-four percent of those who received one embryo the first time got pregnant and gave birth to live babies; 51 percent of those who got two embryos did.

But only 2.3 percent of those in the first group had multiple births, compared to 27.5 percent in the second group. Those in the first group were also much less likely to have babies born before 37 weeks of gestation, 11.8 percent vs. 25.5 percent for the two-embryo group.

So why not always implant one embryo and then another if necessary? Because it can be more expensive to try multiple times instead of boosting the odds at the start, and “the stress and disappointment of a failed cycle is hard to put a value on,” noted Dr. Laurel Stadtmauer, an associate professor of obstetrics and gynecology at the Jones Institute for Reproductive Medicine in Norfolk, Va.

The economic wrinkle is a real one. In Sweden, Gibbons explained, IVF is covered by national insurance. That’s not the case in the United States.

“For American couples,” he said, “putting two embryos back has a higher pregnancy rate, and twins mean that they can have their family all at once and don’t have to pay for a second child.”

Programs in the workplace designed to get people to exercise can improve fitness, cut cholesterol levels, reduce job stress and even improve attendance, a new analysis of the medical literature shows.

But it’s still not clear what makes for the most effective type of program, Dr. Vicki S. Conn of the University of Missouri in Columbia, the lead author of the research, told Reuters Health.

“We do have really good evidence that the interventions do work,” she said. “What we couldn’t say from this is that this intervention works better than that intervention.”

Conn and her colleagues looked at dozens of studies of workplace physical activity interventions. The studies included about 38,000 people.

They found significant positive effects for the interventions on “physical activity behavior,” meaning whether or not people became more active, and also on fitness level. The programs also helped fuel healthy changes in lipids (meaning harmful fats in the blood such as triglycerides), measures of body size, work attendance, and job stress, the researchers report.

The more effective programs had several characteristics in common: a facility for exercising on site; they were developed with the help of the company; and people were able to exercise during the workday rather than having to come in early or stay late. But it wasn’t clear whether offering rewards helped.

While evidence is scarce on the long-term costs of workplace physical activity interventions, Conn noted, the fact that they reduce absenteeism suggests they could indeed save money.

The current investigation is part of a larger, National Institutes of Health-funded study of physical activity interventions in general, Conn noted. While there’s no lack of evidence to show that exercise is good for you, she added, “what we don’t know is how to get people to exercise,” and the study may help answer that question.

A new type of gene therapy for injured lungs that were previously rejected for transplantation may increase the number of lungs available for transplant, researchers say.

Successful transplants require healthy lungs, but more than 80 percent of donor lungs are highly inflamed and only mildly functional, which means many of them are rejected by surgeons, according to researchers with the University Health Network in Toronto.

The investigators found that infusion with the regulatory gene IL-10 before transplant can heal damaged donor lungs. This procedure involves placing the lungs in a glass chamber outside the body and keeping them breathing using a perfusion system that continuously pumps a solution of oxygen, proteins and nutrients into the lungs.

The study, published in the Oct. 28 issue of Science Translational Medicine, noted that the current method of preserving donor organs is to keep them on ice. But the new lung perfusion system would enable the lung’s cellular machinery to keep working by maintaining the lungs at a normal body temperature, the study authors explained in a news release from the journal’s publisher.

In one experiment, pig lungs that underwent IL-10 gene therapy and lung perfusion for 12 hours had better function and less swelling when transplanted into recipient pigs. The researchers also found that this treatment produced similar results in human lungs previously rejected for transplant.

Further investigation showed that IL-10 reduced inflammation, refurbished the alveoli (tiny branching sacs where gas exchange occurs), and improved function in the injured donor lungs.

Another study published in the same issue of the journal identified two types of immune cells that play a major role in the destruction of smokers’ lungs.

Smoking-related irritation of the lungs triggers a complex immune response that includes an accumulation of different types of immune cells. An analysis of lung tissue from emphysema patients revealed the normally helpful immune cells called dendritic cells travel to the lung and induce T-helper 1 and T-helper 17 cells to destroy lung tissue and proteins responsible for lung elasticity.

The T-helper 17 cells secrete a protein that triggers a reaction that attracts more dendritic cells to the lungs, leading to a repeat of the destructive cycle, the researchers found.

The findings offer more evidence that emphysema (primarily caused by cigarette smoke) is an autoimmune disease. This line of research may lead to new drugs that can control lung damage, the study authors said.

Tackling just five health factors could prevent millions of premature deaths and increase global life expectancy by almost 5 years, the United Nations World Health Organization (WHO) said Tuesday.

Poor childhood nutrition, unsafe sex, alcohol, bad sanitation and hygiene, and high blood pressure are to blame for around a quarter of the 60 million premature deaths around the world each year, the WHO said in a report.

But while not having enough nutritious food is a big health risk for those in poorer countries, obesity and being overweight pose yet bigger risks in richer nations — leading to a situation in which obesity and being overweight causes more deaths worldwide than being underweight.

“The world faces some large, widespread and certain risks to health,” the WHO said in its Global Health Risks report. It examined 24 major health risks, and said recognizing and assessing them would help policy makers draw up strategies to improve health in the broadest and most cost-effective ways.

“As health improves, gains can multiply,” it said. “Reducing the burden of disease in the poor may raise income levels, which in turn will further help to reduce health inequalities.”

The report warned that although some major health risk factors, such as smoking, obesity and being overweight, were usually associated with high-income countries, more than three-quarters of the total global burden of diseases they cause now occurs in poor and developing countries.

“Health risks are in transition: populations are aging owing to successes against infectious diseases; at the same time, patterns of physical activity and food, alcohol and tobacco consumption are changing,” it said.

“Understanding the role of these risk factors is important for developing clear and effective strategies for improving global health.”

The Geneva-based U.N. health agency listed the world’s top mortality risks as high blood pressure (responsible for 13 percent of deaths globally), tobacco use (9 percent), high blood glucose (6 percent), physical inactivity (6 percent), and obesity or being overweight (5 percent).

These factors raised the risk of chronic diseases and some of the biggest killers such as heart disease, diabetes and cancers, and affected “countries across all income groups — high, middle and low,” it said.

The WHO said its study, which used data from 2004 — the latest available — showed how health was becoming “globalised” and warned that developing countries now increasingly face a double burden of risks to health.

“The poorest countries still face a high and concentrated burden from poverty, undernutrition, unsafe sex, unsafe water and sanitation,” it said. “At the same time, dietary risk factors for high blood pressure, cholesterol and obesity, coupled with insufficient physical activity, are responsible for an increasing proportion of the total disease burden.”

The WHO added that if the risks in its report had not existed, life expectancy would have been on average almost a decade longer in 2004 for the entire global population.

Blacks and Hispanics with a history of stroke or coronary artery disease have higher blood pressure than whites, while Hispanics are less likely to be prescribed medications to control it, a new U.S. study shows.

About 63 percent of whites, 58 percent of Hispanics and 40 percent of blacks had blood pressure readings that fell within national guidelines, the researchers found.

“There was a significant disparity in achievement of blood pressure goals among African Americans as compared to whites or Hispanics,” said senior study author Dr. Nerses Sanossian, associate director of the Stroke Center at University of Southern California.

The study was to be presented Wednesday at the American Heart Association’s High Blood Pressure Research Conference in Chicago.

Researchers evaluated data on blood pressure levels from 517 participants in the National Health and Nutrition Examination Survey who reported having had either a stroke or coronary artery disease. About 12 percent of participants were Hispanic and 25 percent were black.

National recommendations call for most adults to keep their blood pressure under a reading of 140 for the top number and 90 for the lower number, while diabetics should keep it under 130/80.

“The greatest risk factor for having a heart attack or stroke is having a previous heart attack or stroke,” Sanossian said. “Blood pressure control is one of the cornerstones of prevention. This is a group of people in whom prevention is really crucial.”

Reasons for the disparities may include lifestyle or economic factors, genetics and differences in the quality of health care received, the researchers said.

While blacks and whites reported being prescribed blood pressure medications at similar rates, blood pressure was not as well-controlled in black patients as in white patients.

Black participants had average systolic blood pressure (the upper number in a reading) of 140, compared to 134 among whites. Blacks had diastolic blood pressure (the lower number) of 74, compared to 65 in whites. Both are significant differences, Sanossian noted.

Previous research shows that a systolic decrease of 10 translates into a 31 percent reduction in stroke rate.

“The average person out there has to have their blood pressure controlled, but if you’ve had a stroke or coronary artery disease you have to have your blood pressure controlled in a much stricter way,” Sanossian stressed.

Hispanics and whites had similar systolic blood pressure (133 compared to 134), though Hispanics had higher diastolic blood pressure (72 compared to 65), the researchers noted.

Yet, only 54 percent of Hispanics who’d had a stroke or who had coronary artery disease were taking drugs for hypertension, compared to 77 percent of whites and 76 percent of blacks.

Among stroke survivors, 52 percent of Hispanics were prescribed blood pressure medications compared to 74 percent of whites and 87 percent of blacks. Among Hispanics with coronary artery disease, about 59 percent were taking hypertension medications compared to 80 percent of whites and 74 percent of blacks.

Making sure that minorities get the proper blood pressure medication to get blood pressure under control is of critical importance, said Dr. Rhian M. Touyz, a professor of medicine at University of Ottawa.

Hypertension is more common in blacks than whites and tends to be more difficult to get under control, Touyz said. Blacks tend to suffer more severe complications from high blood pressure at a younger age than other racial groups. Blacks are also more sensitive to the effects of salt in the diet, which can raise blood pressure.

“It’s well known that African Americans tend to develop much worse renal complications and stroke than white patients with high blood pressure,” Touyz said. “If we can understand better what are the mechanisms that are responsible for the differences in hypertension rates and why the complications are more severe, it will allow us to better treat patients who are black.”

In addition, certain high blood pressure treatments don’t work as well in blacks. Classes of drugs that inhibit the renin-angiotensin system, which can raise blood pressure when overactive, tend to be more effective in whites, Touyz said.

The data used in the study did not include information about what medications participants were taking or the doses.

Education and outreach programs targeting minorities, along with aggressive screening and treatment for hypertension, would help eliminate some of the disparities, the researchers said

A study to see whether a new drug can stop the progression of Parkinson’s disease has produced results that have drawn sharply differing reactions from neurologists.

The drug, rasagiline (Azilect), was approved in 2006 by the U.S. Food and Drug Administration on the basis of studies showing that it reduced Parkinson’s symptoms such as trembling and slowed motion. The new study, reported in the Sept. 24 issue of the New England Journal of Medicine, was designed to determine whether the drug also acts on the underlying nerve deterioration that causes the disease.

“In our heart, what we are hoping for is neuroprotection,” said study author Dr. C. Warren Olanow, a professor of neurology and neuroscience at Mount Sinai School of Medicine, in New York City.

To distinguish the effect on symptoms from the hoped-for effect on the underlying disease, “we used a totally new study design, to see if it is disease-modifying,” Olanow explained.

The study enlisted 1,176 people with previously untreated Parkinson’s disease who were seen at medical centers around the world. At the start, half took daily doses of either 1 milligram or 2 milligrams of rasagiline for 36 weeks, while the other half took a placebo. After that, all the participants took either 1 milligram or 2 milligrams of rasagiline for another 36 weeks.

A complex system to measure the treatment effects showed an apparent improvement in the participants who took the 1-milligram doses but not in those taking the 2-milligram doses.

“It did something to affect the course of the disease,” Olanow said. “We don’t know why, but we are entitled to speculate.”

His speculation is based on a detailed study of the 25 percent of participants who showed the greatest benefit. “What I think is right is that the higher dose had a greater effect on symptoms than the lower dose, so that masked our ability to detect its effect on disease progression,” Olanow said. “We thought that this floor effect was why we couldn’t see a difference.”

Olanow was enthusiastic about the results. “This doesn’t prove unequivocally that it [rasagiline] is neuroprotective, but there is no other rational explanation for the results,” he said. “This is good news for Parkinson’s patients.”

Asked if he would prescribe the drug for that reason, Olanow said, “Yes, I would personally prescribe it.”

A much more skeptical response came from Dr. William J. Weiner, chair of neurology at the University of Maryland, who took part in the study.

“The authors were very careful in the paper not to indicate that they had shown neuroprotection,” Weiner said. “The tone of the article itself is moderate.”

The methods used to determine trial results need scrutiny, he said. “They used a lot of very fancy mathematical models, some of which had not been used before,” Weiner said. “Most neurologists wouldn’t understand the mathematical models they used. Research neurologists don’t deal with equations about the slope of curves.”

And the end results were not impressive, he maintained. “The difference reported in the study is less than two points on a scale that has 150 points,” Weiner said.

The reason why the lower dose worked, and the higher one didn’t? “It simply could be luck,” he said.

While rasagiline can provide benefits in reducing symptoms of early Parkinson’s disease, Weiner said he was worried that “patients will be given what I believe to be false hopes” by the new study.

“It has mild symptomatic effects, but I do not prescribe this drug for neuroprotection and this study doesn’t convince me to do that,” Weiner said.

Several of the study authors have received consulting or lecturing fees from pharmaceutical companies, including Teva, the maker of Azilect.