US teen pregnancy rate drops to record low due to "increased contraceptive use"

A precipitous drop in the US teenage pregnancy rate to record lows was driven by improved use of contraception, a new analysis from the Guttmacher Institute found.

“There was no significant change in adolescent sexual activity during this time period,” Dr Laura Lindberg, a principal research scientist with the Guttmacher Institute and the paper’s lead author, said in a statement. “Rather, our new data suggest that recent declines in teens’ risk of pregnancy – and in their pregnancy rates – are driven by increased contraceptive use.”

Linberg and her co-authors found that while teenage girls’ sexual activity remained constant from 2007 to 2012, the percentage of sexually active teens who used at least one type of birth control the last time they had sex increased significantly, rising from 78% to 86%.

The researchers found the use of all “highly effective methods”, like the birth control pill or IUD, increased from 2007 to 2009. There was a marginal significant increase in the use of the IUD or implant from 2007 to 2009 and in use of the pill overall. There were non-significant increases in condom use and withdrawal, while use of the ring or patch declined significantly over the 2007 to 2012 period.

The changes in contraceptive use resulted in a 28% decline in pregnancy risk index from 2007 to 2012. Not only did improvements in contraceptive use drive that entire decline, but they were also responsible for neutralizing a 6% rise in risk over the same period due to increased sexual activity among teens. The pregnancy risk index is a calculation that “summarizes the risk of pregnancy among all adolescent women, estimating the influence of both changes in the level of recent sexual activity and changes in the level of contraceptive risk”, according to the study.

In April, the Guttmacher Institute reported that the national pregnancy rate declined 23%from 2008 to 2011 for women aged 15 to 19, falling from a rate of 68.2 pregnancies per 1,000 women to 52.4. That means about 5% of teens became pregnant in 2011. It was the “lowest rate observed in the last four decades”, they said, with declines across all 50 states and racial and ethnic groups, though some disparities remained. In 2011, they found a rate of 31.3 births per 1,000 teen women, down from 40.2 in 2008, and 13.5 abortions per 1,000 teen women, down from 18.1 in 2008.

The new study used data from the National Survey of Family Growth, a survey conducted by the Centers for Disease Control and Prevention, on sexual activity, contraceptive use and contraceptive failures to estimate the pregnancy risk index for the years 2007, 2009 and 2012.

The authors noted it was important to ensure teenagers’ “access to comprehensive sexuality education that provides medically accurate information about contraception”. They wrote that the percentage of adolescents “who report receiving formal instruction about birth control has declined, while the share receiving only abstinence instruction has increased”. The American Academy of Pediatricians recently urged doctors to fill in the gaps of sexual health education with their patients. They noted that abstinence-heavy education is a concern for doctors when it comes to reducing sexually transmitted infections and unintended pregnancies, as those programs can exclude information about contraceptives.

The internet, the authors suggested, can offer new opportunities for teenagers looking for information on sexual health, and recommend further research to examine that hypothesis. A separate study from last year found a correlation between decline in transmission of sexually transmitted infections and access to high-speed internet.

“Policy discussions should focus on supporting teen contraceptive use generally, including ensuring access to a full range of contraceptive education, counseling and methods,” Heather Boonstra, the Guttmacher Institute’s director of public policy, said in the release.

The Guttmacher Institute’s study used data up until 2012, however, more recent data from the CDC’s Youth Risk Behavior Survey “shows sharp declines in sexual activity among high school students from 2013 to 2015 – after a long plateau from 2001 to 2013”, the authors wrote. “At this point, it is unclear whether these new data represent a new trend or are the result of other factors,” the authors wrote.

Another analysis from earlier this month found that millennials are having less sex than those in previous generations.

US teen pregnancy rate drops to record low due to "increased contraceptive use"

Chemotherapy mortality study could help improve cancer care in England

Almost 1,400 patients with either breast or lung cancer died in England in 2014 within a month of being given chemotherapy, according to a study which suggested they suffered harm rather than benefited from the drug treatment.

Those who died within 30 days accounted for a small proportion of the total number given the toxic anti-cancer drugs designed to destroy tumours. Most of the patients were given chemotherapy for palliative care, with the intention of relieving cancer symptoms rather than curing the patient.

But, according to the authors of the study commissioned by Public Health England (PHE), “patients dying within 30 days after beginning treatment [with chemotherapy] are unlikely to have gained the survival or palliative benefits of the treatment, and in view of the side-effects sometimes caused … are more likely to have suffered harm”.

The study, which is published in the Lancet Oncology journal, showed the deaths were spread across the country and not clustered in any one area. However, analysis of the data submitted by the hospitals revealed some had higher death rates than would be expected once the age and condition of the patient had been taken into account. All those hospital trusts have been asked to check their data and investigate whether patients were treated appropriately.

The study is groundbreaking because it is the first time that national data has been gathered together and analysed for 30-day mortality after chemotherapy. It found that a larger proportion of patients die than in the clinical trials carried out by the drug companies. The death rate in trials of drug treatments for lung cancer was 0.8%, but in the present study it is 3%.

“Trials try to exclude high-risk patients,” said Dr Jem Rashbass, cancer lead for PHE and one of the study’s authors. “You are more likely to get a positive answer [about the benefit of the drug] because of the case mix.”

PHE hopes the research will enable hospitals and clinicians to look carefully at who they treat with chemotherapy and, in some cases, make better decisions. There is no suggestion of blame, most people do well on chemotherapy.

“These are judgments,” said Rashbass. “Medicine is greatly informed by hindsight. No doctor tries to give medicine to their patient to kill them but sometimes that balance goes the wrong way. I don’t see this as being bad practice.

“The easiest way not to kill your patients with chemotherapy is not to give it to anyone, and that is clearly wrong.”

There were 569 breast and 720 lung cancer deaths within 30 days of those patients being given chemotherapy for palliative care.

There were 41 breast cancer patients and 53 lung cancer patients who died after chemotherapy intended to cure them. The breast cancer patients were being treated at seven hospital trusts: Burton, Ipswich, Kettering, South Warwickshire, Dorset, Gloucestershire and Coventry and Warwickshire.

The lung cancer patients were being treated at five trusts: Milton Keynes, South Tyneside, Torbay and South Devon, Surrey and Sussex, and the Royal Bournemouth and Christchurch.

Most of the trusts said either that they had made mistakes in the data they sent to PHE or that the patient died of something other than their chemotherapy treatment.

Chemotherapy mortality study could help improve cancer care in England

The designer loo revolutionising Madagascar"s toilet crisis

American design student Virginia Gardiner did not expect to end up finding her muse in a toilet, or find power and profit out of poo.

She also did not expect to find herself and the waterless toilet she designed for wasteful westerners (originally it was embraced by posh festivalgoers), on the island of Madagascar, piloting a system that turns faecal waste into biogas.

“I didn’t even know about the global sanitation crisis,” says Gardiner, who founded the London-based company Loowatt in 2008. “I wanted to turn the idea of a flushed toilet on its head and say that there should be a waterless toilet that turns shit into a commodity.”

Loowatt’s system of an odourless, waterless and contactless toilet, involves a biodegradable liner that wraps human waste and is pulled into a cartridge with the foot pedal. The cartridges are either emptied into micro-scale digesters on site, or into larger digesters at plants. Then the waste and liners are turned into biogas to power electric lights, batteries or gas cookers, or are turned into organic fertiliser.

The model impressed judges at RELX Group Environmental Challenge which awarded LooWatt the first prize, and $ 50,000, in the competition for the world’s best sustainable water and sanitation projects that was announced this week at SIWI World Water Week.

The UN estimates that around 2.5 billion people in the developing world don’t have access to a toilet and Madagascar is the fourth-worst place in the world to find one.

Loowatt was drawn into the field of development in 2011. One of its first investors was living in Madagascar’s hilly capital Antananarivo and invited Gardiner to see the state of sanitation there, starting with the low-lying neighbourhoods where most waste washes up.

“Everywhere you look, you just see faeces,” she recalls. “You can’t look around for more than a few seconds without seeing evidence of faecal contamination, children playing around it and leafy vegetables growing in or around cesspools.”

The problem, especially in a city where the water table is only a few feet below the earth, comes from pit latrines being flooded by rains, or people in crowded areas being forced to dump on their own doorstep.

“People, especially women and children, don’t like to leave the house at night so they use buckets, and very often you’ll see people emptying them into the canals as there’s just nowhere else to put it,” says Gardiner. Mothers are terrified of their children drowning in metres-deep slime pits when wooden latrine platforms rot and give way.

A customer of the first LooWatt model in Antananarivo’, Madagascar. The toilet is named ‘Tsiky’, which is Malagasy for ‘smile’. Photograph: Art’dyh/LooWatt

Only half of the capital’s residents have access to water and three-quarters have to rely on latrines that are “a ticking time-bomb when it comes to fecal pathogens”, Gardiner says. She explains that as a latrine is a hole in the ground, flies can go in an out and then might land on food. This has caused diarrhoea-related diseases that have stunted more than half the island’s children due to malnutrition.

Even if Antananarivo’s residents were conscientious about where they dumped their waste, the city of two million people has no working wastewater plant. “Ninety-eight percent of those latrines are emptied by unregulated service providers, so basically the faecal sludge is being dumped all over the city or in rivers just outside,” says Gardiner.

In 2012, with pilot funding from the Bill & Melinda Gates Foundation, Loowatt launched its first model in Madagascar named Tsiky, which is Malagasy for “smile”. It launched in Antananarivo’s worst neighbourhoods to see whether it could tackle a problem that charities have found hard to fix.

“Latrines have been considered the toilet for Africa by NGOs,” says Gardiner. “But they become vectors of disease upon emptying or flooding.”

Loowatt has installed 70 toilets in the capital and will complete its pilot of 100 by the end of the year. “Our hope is that the Madagascar business can create a strong data set to support how the business can scale globally, in Madagascar, but also in cities all over the developing world,” says Gardiner.

Customers are pleased that they can ‘make money off this shit’ by generating power for the community

Loowatt calculates its success on how frequently people buy cartridge refills that cost roughly $ 1.10 and should last a week. Despite 92% of Madagascar’s population living below the poverty line , Loowatt has 90% repeat weekly purchases.

Customers say that they “don’t hesitate” to use the toilet and don’t worry about their children using it. Others are pleased that they can “make money off this shit” by generating power for the community.

Gardiner says that there is demand for their toilets all over sub-Saharan Africa and parts of Asia, and that requests from events or wedding organisers, once limited to the UK, have now hit Madagascar.

In Madagascar a small office manages everything from printing 3D parts and importing others, to finding local waste collectors, treatment centres and businesses that would use its electricity. Loowatt is looking for the right partners and funding to scale up the business next year.

Gardiner sees this work as the next step in proving that Africa and the rest of the developing world is ready for, and deserves, better basic services for people’s most intimate ritual. “It’s about changing the mentality away from thinking that basic, rudimentary technology is going to be good enough.” And as for the dangerous, disease-ridden and sometimes deadly latrines “the view of them is changing,” says Gardiner. “People see that maybe these are not good enough.”

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The designer loo revolutionising Madagascar"s toilet crisis

Junior doctors "push for monthly five-day strikes"

Junior doctors are pushing for monthly five-day strikes to be held between now and the end of the year in an escalation of the dispute over their new contract, according to leaked documents.

Senior members of the British Medical Association (BMA) are meeting on Wednesday to decide what industrial action – if any – should take place after a compromise deal on the contract agreed with the government was rejected by its members last month.

The Mail reported that it had seen a 13-page document marked “confidential” which states that the BMA’s junior doctors committee (JDC) is proposing a full withdrawal of labour between 8am and 5pm for five consecutive weekdays in September and then further walkouts of the same duration in each of the remaining months of the year.

The BMA refused to comment on the specifics of the industrial action being considered but a source said “anything is up for discussion”.

Last month, the JDC chair, Ellen McCourt, wrote to members informing them that the committee was planning “a rolling programme of escalated industrial action beginning in early September”.

The decision will ultimately taken by the BMA council, effectively the union’s board of directors, which usually has 34 voting members.

There have been five walkouts by junior doctors to date, the longest lasting for two consecutive days. The first all-out strike, including junior doctors working in emergency departments, took place in April. More than 100,000 operations and outpatient appointments have been cancelled in total as a result of all industrial action to date.

A breakthrough in the dispute appeared to have occurred in May, when the JDC and health secretary, Jeremy Hunt, agreed a revised contract. However, almost six in 10 junior doctors – all doctors below consultant level – and medical students (58%) who belong to the British Medical Association refused to accept the compromise deal, with only 42% endorsing it.

About 37,000 BMA members, or 68% of the 54,000 trainee doctors and final and penultimate-year medical students who were eligible to vote, took part in the ballot.

After the vote, the JDC chair, Dr Johann Malawana, who had recommended the revised terms and conditions as the best settlement junior doctors could get, resigned from his position. He was replaced by McCourt.

A BMA spokeswoman said: “Junior doctors have been clear in their rejection of Jeremy Hunt’s imposed contract. It should come as no surprise that BMA council are discussing the issue of further industrial action. But at this stage, no decisions have been made.”

Junior doctors "push for monthly five-day strikes"

How Manchester plans to be the best place for people with dementia

Imagine a pub designed for people with dementia, complete with old beer adverts, games of dominoes and darts, a DJ playing a selection of music from the 50s and regular live entertainment, where people with the diagnosis can feel welcome and those who look after them can receive support.

A pop-up pub like this was set up in Salford recently by the university’s Institute for Dementia as part of Dementia United – the Greater Manchester partnership whose five-year improvement plan aims by 2020 to make Greater Manchester the “best place in the world” for its 30,000 residents with Alzheimer’s and similar conditions. It also wants to reduce dependence on health and care services.

This pub experiment is one of a number of innovations under the umbrella of Dementia United, led by the health and social care trusts enjoying their newly devolved status, and the Alzheimer’s Society. Its 41 partners, including charities, sports organisations and three universities, are working out how to tackle dementia from the perspective of those who live with it.

With 850,000 people living with dementia in the UK (1.3% of the population), according to Alzheimer’s Society figures, the eyes of the UK are focused on Dementia United.

Maxine Power, director of Dementia United, , says: “This is a once-in-a-lifetime opportunity. Dementia is an area with a huge amount of activity, but it is like an orchestra without a conductor. Devolution brings clarity and a focus on care for people in the places where they live, rather than on organisations. Culturally that is a massive shift for our system.”

Dementia United goes way beyond pubs. It is about rejecting a model of care that health professionals agree is neither fit for purpose nor financially viable, and the opportunity to create a new one. Greater Manchester spends £270m a year treating and caring for people with dementia. The figure has not decreased in the past five years, despite many attempts to improve dementia care, and there are 20,000 hospital admissions for the 30,000 people in the area with dementia.

This is is outrageous, says Power. She is adamant that in five years Dementia United will reduce that figure – mainly associated with unplanned hospital admissions and admissions to care homes – by 20%.

This will be guided by five pledges, to be implemented by 2021: improving the lives of dementia patients and their carers by questioning them about their individual needs; reducing variation in care quality (and a diagnosis rate difference between 63% and 90% across the city); the introduction of a key worker for each person with dementia; the redesign of services around users; and access to the best assistive technology.

Dementia United was set up in late 2015 as an “early win” under the devolution of Greater Manchester’s health and social care.

There is dementia knowledge in Manchester to back it. Its three universities formed a dementia research consortium in May 2016 and Prof Alistair Burns, the national clinical director for dementia, is based at Manchester.

Progress is being made. A measurement tool of “lived experience” has been developed, including numerical and qualitative measures of how people live their lives, which can be shared across Greater Manchester’s health systems. Work is under way on a dementia “dashboard” to allow inter-area comparisons and set standards. External evaluation methods of Dementia United are being developed jointly by the universities of Salford and Manchester.

Discussions are going on with Social Finance – a not-for-profit organisation bringing together government, the social sector and the financial community to tackle social problems – to build in additional financial support.

Assistive technology is advancing apace, with Manchester University’s dementia platform evaluating devices, such as watches with accelerometers to measure movement, to establish value for money. Everything in Dementia United must be supported by a business case.

George McNamara, head of policy for the Alzheimer’s Society, is working with Dementia United to make it a reality across Greater Manchester and is receiving inquiries from politicians worldwide, particularly the US. He says: “We are seeing the devolution of powers and funding on an unprecedented scale. What is significant is the scale and the marrying together of a number of political objectives and cultures into one vision.”

Patrick Hall, a fellow in social care policy for the King’s Fund, admires the ambition of Dementia United, but is concerned about its sustainability given the financial climate.

He says : “The locality focus in Dementia United is very welcome and anything that gives impetus to that for the care of people with dementia would be looked on by the King’s Fund very positively. However it is being set up in the context of unprecedented cuts in social care and a decline in the number of community nurses. Only time will tell whether Greater Manchester has got the model right.”

Maxine Power and George McNamara will discuss devolution and dementia at the NHS Health and Care Innovation Expo in Manchester on 8 September NHS staff can attend free of charge. Click here to register.

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How Manchester plans to be the best place for people with dementia

Charlie Webster back in UK after contracting malaria at Rio Olympics

TV presenter Charlie Webster, who contracted malaria in Brazil, has arrived back in the UK.

The 33-year-old Team GB ambassador travelled on a specialist medical plane with a team of professionals, who continued her care on the 20-hour journey.

Webster’s condition remains stable but serious, and she will continue her treatment in a private ward at St James’s hospital in Leeds.

Charlie Webster. Photograph: Ken McKay/ITV/Rex/Shutterstock

Webster fell ill during the opening ceremony of the Rio Olympics and she was taken to hospital on 6 August.

The former Sky and ITV sports presenter had just completed a 3,000-mile (4,828km) charity cycle ride from London to Rio.

Her condition quickly deteriorated and she was put into a medically induced coma. Doctors diagnosed a very rare strain of malaria and specialists are now trying to find out where she caught the disease.

Last week, Webster was able to get out of bed for the first time and her kidney dialysis was reduced to six hours a day.

Charlie Webster back in UK after contracting malaria at Rio Olympics

GP labelled hypochondriac criticises colleagues after dying from cancer

A GP who died from a rare form of kidney cancer has warned of the difficulties doctors face in getting treatment for themselves, in an emotional blog published posthumously.

Dr Lisa Steen described her anger at colleagues for failing to go the extra mile to help identify the disease and for dismissing her as a hypochondriac, in the essay published on BMJ.com.

The 43-year-old mother-of-two from Cambridge wrote of spending “two years wandering in the wilderness of the medically unexplained” before finally being diagnosed in July 2014, by which time the cancer had spread to her bones. She died in February.

She wrote: “I do not know how long I’ll live. It probably won’t be for many weeks. But right now I am glad to be alive. I am grateful for the expensive drug which is holding back the cancer.

“I am angry at being left in the medically unexplained wilderness and I did not like the way my colleagues looked at me, when they believed me to have health anxiety.”

Steen said hers was a cautionary tale for all health professionals who get ill, and for doctors treating other health professionals.

Affected by myriad symptoms, she eventually attended her GP in August 2012. Various tests failed to lead to a diagnosis and her condition was put down to health anxiety.

Steen, who was a GP for the drug and alcohol service Inclusion, wrote of her frustration at trying to describe her symptoms to doctors, and trying to diagnose herself.

She tried to explain that the symptoms might be connected to a benign carotid body tumour she had had when she was younger.

Her attempts to get investigatory tests and treatment were thwarted, she said, because of a “fear of looking even more ‘anxious’ or suffering from ‘health anxiety’, aka a hypochondriac”.

Eventually, embarrassed by being off work with no diagnosis, she returned to work. “I still knew there was something wrong, but it seemed fruitless going to see specialists. It was so humiliating, feeling like a goldfish with no voice. Watching doctors’ faces glaze over at the multitude of symptoms. Trying to fit it all in with work and looking after my family.”

After two years and prompted by weight loss, a routine ultrasound revealed a mass.

Steen wrote: “If any one of the doctors I saw had gone another mile, they would’ve stumbled upon it.”

But, she said: “they were reluctant to lay their hands on and examine a fellow medic”. And on her part, she said: “I was too embarrassed about my ‘psychiatric’ condition, too confused by not having the whole answer ready.”

She added: “My story is a cautionary tale to all of us health professionals when we get ill. Illness is somehow not the done thing. It upsets our ‘them/us’ belief system, which helps us cope with the horror of what we see.

“Mine is a cautionary tale to those treating health professionals, and those of us who are unwell – doctors do get ill, they don’t always know what is wrong with themselves. Give them a class A service because it is actually harder getting treated as a doctor than a layperson.”

Her husband, Raymond Brown, told the Telegraph: “They didn’t seem to be taking her too seriously, particularly because she had been diagnosed with health anxiety, she was being looked at as a hypochondriac.”

He added: “She just wants doctors to be aware when they are treating doctors to give them really good treatment and they have to be aware they are a patient and they don’t know everything. They need to be treated like a patient, not like a doctor.”

GP labelled hypochondriac criticises colleagues after dying from cancer