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In an effort to reduce multiple births following fertility treatment, the American Society for Reproductive Medicine has revised its recommendations on the number of embryos that should be transferred during in vitro fertilization procedures.

The society reports that the guidelines are now different in two major ways.

For one, it says that doctors should only use one more embryo than called for in patients whose prognosis is less optimistic. Even in those with poor prognosis, no more than one extra embryo should be transferred.

The society also calls on doctors to advise patients about the risks of a pregnancy with several fetuses and to make notations about extra embryos and counseling in medical records.

The guidelines also make it clear that it doesn’t make any difference whether transferred embryos are fresh or frozen. The recommended number remains the same.

The society issued guidelines more than 10 years ago and says they have cut down on births with high numbers of babies by almost 60 percent.

“It is clear that these guidelines have a terrific impact on clinical practice. Over the years we have seen a reduction in the number of high order multiple births while maintaining strong success rates. This latest revision is our most recent effort to help our members provide their patients with the best, safest care possible,” said Dr. R. Dale McClure, president of the American Society for Reproductive Medicine, in a statement.

Older widowers who recently lost their wives are more likely to have a sexually transmitted disease than their counterparts who are still married, a new study has found.

The researchers behind the study add that drugs like Viagra could boost the risk, noting the widowers might be seduced by advertisements for sexual enhancement.

The risk that seniors have a sexually transmitted disease remains extremely low, at less than 1 percent, study co-author and Harvard researcher Kirsten Smith explained in a news release about the study.

“Nonetheless,” Smith said, “older adults need to be aware that they are at risk of contracting a sexually transmitted infection if they take on a new sexual partner following a spouse’s death.”

The researchers examined data from more than 400,000 U.S. couples, who were aged 67 to 99 years in 1993.

Within six months to a year after their wives died, men were 16 percent more likely to be infected with a sexually transmitted disease. And for recently widowed men, the risk of having a sexually transmitted disease rose by 83 percent after 1998. That’s the year that Viagra went on the market as a treatment for erectile dysfunction.

“For men ages 67 and older, the age group that we studied, the use of medications for erectile dysfunction may contribute to that risk by making sex possible,” Smith said.

Gonorrhea was the most common STD in the men, the study authors noted.

Although many parents already know that changes in the weather can cause their children’s asthma symptoms to flare up, a new study backs up their intuition.

If the humidity levels in the air rose by more than 10 percent or if the temperature increased by more than 10 degrees Fahrenheit in a single day, more children ended up in the emergency department of a Detroit hospital reporting asthma symptoms, the new research found.

“Parents need to be mindful of days when there are dramatic changes in temperature or humidity. A child’s asthma may flare more on those days,” said study senior author Dr. Alan Baptist, director of the University of Michigan asthma program, in Ann Arbor.

The findings were published in the September issue of the Annals of Allergy, Asthma & Immunology.

As many as 9 million children in the United States have asthma, according to the background information in the study. There are numerous known triggers that can exacerbate the inflammatory airway disease, including viral infections, air pollution, exposure to tobacco smoke and airborne allergens, such as pollen, the study authors noted.

Baptist said that another asthma trigger reported by many parents is weather changes. While some past studies have looked at this phenomenon, Baptist and his colleagues pointed out that none of the previous studies controlled for air pollution and airborne allergens.

For the current study, the researchers reviewed data from two years of emergency department admissions for asthma at Children’s Hospital of Michigan in Detroit. During the study time period — Jan. 1, 2004 through Dec. 31, 2005 — more than 25,000 youngsters between the ages of 1 and 18 were admitted for an asthma exacerbation, according to the study. That works out to about 35 children a day, according to Baptist.

The researchers then reviewed weather data for that time period, along with data on airborne allergens and air pollution. And, their statistical model was designed to control for these factors, Baptist added.

“A 10 percent increase in humidity two days before the admission day was associated with one additional visit to the emergency department,” said Baptist. “For temperature, an interday change of 10 degrees one day before the admission resulted in two additional visits.”

Although previous studies have found an association between barometric pressure and asthma symptoms, the current study found no link.

Asked why weather changes might affect asthma symptoms, Baptist said, “Asthma, at its core, is inflammation of the airways, and maybe these changes could be triggering more inflammation. But, it’s really unknown why temperature and humidity changes exacerbate asthma, and it should be looked at further.”

“This study brings up good discussion points, but I don’t think this is going to be strong enough evidence to change practice,” said Dr. Shean Aujla, a pediatric pulmonologist at Children’s Hospital of Pittsburgh.

Aujla said that cold air is a known trigger for asthma, and confirmed that many parents say a change in weather triggers their children’s asthma symptoms.

Until more research is done, she recommended focusing on each child’s individual symptoms. “If your child is going outside to play and having persistent symptoms, they should use their albuterol inhaler whether or not it’s humid,” said Aujla.

And, she added, very few children need to stay inside because of their asthma and weather changes. “Unless a child has very severe asthma, I wouldn’t say stay indoors,” she said.

The U.S. Food and Drug Administration today cautioned users of personal emergency response buttons worn around the neck of a potential choking hazard associated with this product.

The FDA is aware of at least six reports between 1998 and 2009 of serious injury or death, including three deaths in the United States and one in Canada, from choking after the cord on the Philips Lifeline Personal Help Button became entangled on other objects worn around the neck.

There are more than 750,000 users of these devices in the United States and Canada. By pushing the “help” button on the device when in distress, users can call for emergency assistance to their home. According to Philips Lifeline, the device is used primarily by seniors living independently, who feel they are at risk for falls or other medical emergencies.

The Lifeline pendant button is intentionally designed to not break away when tugged, which prevents the button from accidentally falling off. However, because it does not break away, there is a risk of choking, including the possibility of serious injury or death. Risks are greater for those with mobility limitations or for those who use wheelchairs, walkers, beds with guard rails, or other objects that could entangle with a neck cord.

Philips Lifeline is currently sending letters to its 750,000 customers and has changed the labeling of this product to include a warning against the potential choking hazard.

The FDA recommends that users consult their health care providers to determine which style of emergency button, including those that are worn on the wrist, is most beneficial for them.

These widely used devices provide critical and immediate access to emergency care for those at risk of falls or who may be more likely to need outside assistance. While the number of adverse events reported is small compared to the number of people who use this device, the severity of these events is of concern. It remains important that users, along with their health care providers, assess the options provided by each style of button, and choose the option that best fits their condition.

Health care professionals and users may report serious adverse events or product quality problems with the use of this product to the FDA’s MedWatch Adverse Event Reporting program either online, by regular mail, fax or phone.

Many U.S. medical schools have had cases of medical students posting unprofessional content online, including incidents where patient confidentiality was violated, according to a new study. It also found that few schools have policies to deal with such transgressions.

Researchers sent an anonymous survey to 130 medical schools in the Association of American Medical Colleges and received 78 responses. Of the schools that responded, 47 (60 percent) reported incidents involving students posting unprofessional content.

In the past year, six of those schools had no incidents, 36 had fewer than five incidents, three had five to 15 incidents, and one was aware of incidents but did not know how many, according to Dr. Katherine C. Chretien, of the Washington, D.C., VA Medical Center, and colleagues.

“Incidents involving violation of patient confidentiality in the past year were reported by 13 percent (6/46). Student use of profanity, frankly discriminatory language, depiction of intoxication, and sexually suggestive material were more commonly reported,” Chretien wrote in a news release.

“Of 45 schools that reported an incident and responded to the question about disciplinary actions, 30 gave informal warning (67 percent) and 3 reported student dismissal (7 percent). Policies that cover student-posted online content were reported by 38 percent (28/73) of deans. Of schools without such policies, 11 percent (5/46) were actively developing new policies to cover online content. Deans reporting incidents were significantly more likely to report having such a policy (51 percent vs. 18 percent), believing these issues could be effectively addressed (91 percent vs. 63 percent;), and having higher levels of concern,” she added.

The researchers recommended a number of ways to address the concerns identified in the study.

“The formal professional curriculum should include a digital media component, which could include instruction on managing the ‘digital footprint,’ such as electing privacy settings on social networking sites and performing periodic Web searches of oneself. This is important given that residency program directors, future employers, and patients may access this information,” they said.

Also, “discussions among students, residents, and faculty should occur to help define medical professionalism in the era of Web 2.0,” the researchers concluded.

The study appears in the Sept. 23-30 issue of the Journal of the American Medical Association, a theme issue on medical education.

Socioeconomic status seems to make no difference in mental decline after the age of 70, according to new research.

The study, published in the Aug. 1 issue of the American Journal of Epidemiology, challenges claims that economic status and background have an impact on cognitive functioning among the elderly. Rather, the University of California, Los Angeles study found that rates of cognitive decline among people aged 70 and older depended on other factors and were similar across socioeconomic and racial/ethnic groups.

“It has been known that cognitive performance at any given age appears to depend on demographic characteristics; the more educated, for instance, perform better,” said lead investigator Dr. Arun Karlamangla, associate professor of medicine at UCLA’s David Geffen School of Medicine, in a university news release. “But though there are differences in the level of performance you start with in your late 60s, this study’s surprise is that the rate of decline in your 70s is the same for every group.”

The study authors looked at data collected from 6,476 people born before 1924 who took part in the study of Assets and Health Dynamics Among the Oldest Old. Participants were tested five times between 1993 and 2002 on various memory and cognition tasks, including word recall, subtraction, attention, language and knowledge of current affairs.

The researchers found that cognitive decline depended on how active people were earlier in life, whether or not they were widowed or ever married, and how old they were. Other social factors appeared to have little impact.

“The most consistent predictors of faster declines in cognitive functioning were being old and being single,” the study authors wrote.

Most generally healthy adults starting an exercise program do not need to see their doctor first, researchers say.

Routine medical screening before starting a regular exercise regimen with the goal of reducing the risk of sudden exercise-induced death is not recommended, the researchers wrote in a report published this month.

“Sudden death is a rare adverse effect of exercise,” Dr. Mayer Brezis, of Hadassah Hebrew University Medical Center, Jerusalem, Israel, told Reuters Health in an interview.

“Medical screening before initiating regular exercise is often advised but without scientific basis,” Brezis noted.

An exercise electrocardiogram — a test that detects and records the heart’s electrical activity — is thought to help identify people at risk but the test yields “many” falsely positive and falsely negative test results, the researcher warned.

In a “simulation study,” Brezis and colleagues found that routine screening decreases deaths in intermediate to high-risk people but not in those who are at low risk.

“Actually, medical screening may cause damage,” Brezis said, “for instance because of labeling healthy people as sick or because of the side effects” of tests to check for heart disease.

“Medical screening may actually prevent the known benefit from exercise by diverting attention from the main goal: i.e., to have people exercise,” Brezis said.

“Sedentary people should be encouraged to initiate exercise gradually and go to a physician if they feel chest discomfort or dizziness during exercise,” Brezis said.

“Gyms should post boards explaining these warning signs. Exercise coaches should understand and explain these warning signs to customers,” he added.

Still, Brezis emphasized that this advice does not apply to individuals with known heart disease. “These people should be referred to cardiac rehabilitation centers where they can resume physical activity under supervision.”

A study published last year suggested that bipolar disorder may be over diagnosed in people seeking mental health care. Now new findings shed light on which disorders many of these patients actually have.

Bipolar disorder, also known as manic depression, involves dramatic swings in mood — ranging from debilitating depression to euphoric recklessness.

In the original 2008 study, researchers at Brown University School of Medicine found that of 145 adults who said they had been diagnosed with bipolar disorder, 82 (57 percent) turned out not to have the condition when given a comprehensive diagnostic interview.

In this latest study, published in the Journal of Clinical Psychiatry, the researchers used similar standardized interviews to find out which disorders those 82 patients might have.

Overall, they found, nearly half had major depression, while borderline personality disorder, post-traumatic stress disorder (PTSD), generalized anxiety and social phobia were each diagnosed in roughly one-quarter to one-third.

When the researchers then compared the patients with 528 other psychiatric patients who had never been diagnosed with bipolar disorder, they found that those in the former group were nearly four times more likely to have borderline personality disorder.

They were also 70 percent more likely to have major depression and twice as likely to have PTSD.

Some of other diagnoses were less common but still seen at elevated rates among the patients previously diagnosed with bipolar disorder. These included antisocial personality disorder and impulse-control disorder.

Over diagnosis of bipolar disorder is concerning, in part, because it is typically treated with mood-stabilizing drugs that can have side effects — including effects on the kidneys, liver, and metabolic and immune systems, explained lead researcher Dr. Mark Zimmerman, an associate professor at Brown and director of outpatient psychiatry at Rhode Island Hospital.

In addition, he told Reuters Health in an email, over diagnosis means some patients are likely not getting the appropriate care for the problems they do have.

Bipolar disorder shares certain characteristics with some other psychiatric conditions. Borderline personality disorder, for instance, is marked by unstable mood, impulsive behavior and problems maintaining relationships with other people.

But Zimmerman and his colleagues suspect that some doctors are over diagnosing bipolar disorder because — unlike certain other causes of mood disturbance — it does have effective drug therapies.

There are no medications approved specifically for treating borderline personality disorder, for instance, but research suggests that some forms of “talk therapy” are effective.

“We believe that clinicians are inclined to diagnose disorders that they feel more comfortable treating,” Zimmerman explained.

“The increased availability of medications that have been approved for the treatment of bipolar disorder might be influencing clinicians who are unsure whether or not a patient has bipolar disorder or borderline personality disorder to err on the side of diagnosing the disorder that is medication-responsive,” he added.

This “bias,” Zimmerman said, is reinforced by drug company marketing, which highlights certain studies that have suggested that bipolar disorder goes unrecognized in many people.

Female kidney recipients whose donated organ came from a deceased male face an increased risk for failure in the first year after their transplant, Canadian researchers have found.

The risk is short-term, though, and may stem from proteins on male donor cells, the researchers said. Their study found that the risk goes away after 10 years.

The researchers analyzed data on 117,877 adults who had kidney transplants in the United States between 1990 and 2004. All kidneys came from deceased donors. Within a year, transplant failure had occurred in 16,135 people, and 6,878 had died. Among the 97,906 people who were followed for up to 10 years after their transplant, there were 35,084 transplant failures and 22,566 deaths.

Compared with all other gender combinations, female recipients of male donor kidneys had a 12 percent greater risk of failure and a similar increased risk for death a year after the transplant. They had no increased risk for failure or death after 10 years.

The researchers, from the University of Toronto and University of British Columbia, said that H-Y antigens, derived from the male chromosome and not found in women, might cause an adverse immune response in women who receive kidneys from men who had died.

They recommended that “future research should examine the potential mechanisms underlying the H-Y effect in order to better understand the specific role of minor histocompatibility antigens in determining kidney allograft outcomes.”

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