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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.