Strategic Wellness
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Strategic Wellness: planning ahead for a better life!
This is Dr. Michael Roizen. With hundreds of peer-reviewed publications and 14 US patents, his work has been focused on the importance of lifestyle factors in healthy living. He’s the Chief Wellness Officer at the world-famous Cleveland Clinic, and is known for his “RealAge” test and related personalized healthcare services.
If you’re curious about that, you can take the RealAge test here.
(they will require you inputting your email address if you do, though)
What’s his thing?
Dr. Roizen is all about optimizing health through lifestyle factors—most notably, diet and exercise. Of those, he is particularly keen on optimizing nutritional habits.
Is this just the Mediterranean Diet again?
Nope! Although: he does also advocate for that. But there’s more, he makes the case for what he calls “circadian eating”, optimally timing what we eat and when.
Is that just Intermittent Fasting again?
Nope! Although: he does also advocate for that. But there’s more:
Dr. Roizen takes a more scientific approach. Which isn’t to say that intermittent fasting is unscientific—on the contrary, there’s mountains of evidence for it being a healthful practice for most people. But while people tend to organize their intermittent fasting purely according to convenience, he notes some additional factors to take into account, including:
- We are evolved to eat when the sun is up
- We are evolved to be active before eating (think: hunting and gathering)
- Our insulin resistance increases as the day goes on
Now, if you’ve a quick mind about you, you’ll have noticed that this means:
- We should keep our eating to a particular time window (classic intermittent fasting), and/but that time window should be while the sun is up
- We should not roll out of bed and immediately breakfast; we need to be active for a bit first (moderate exercise is fine—this writer does her daily grocery-shopping trip on foot before breakfast, for instance… getting out there and hunting and gathering those groceries!)
- We should not, however, eat too much later in the day (so, dinner should be the smallest meal of the day)
The latter item is the one that’s perhaps biggest change for most people. His tips for making this as easy as possible include:
- Over-cater for dinner, but eat only one portion of it, and save the rest for an early-afternoon lunch
- First, however, enjoy a nutrient-dense protein-centric breakfast with at least some fibrous vegetation, for example:
- Salmon and asparagus
- Scrambled tofu and kale
- Yogurt and blueberries
Enjoy!
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How Your Brain Chooses What To Remember
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During the day, your brain is simply too busy to encode memories without interfering with normal processing. At night, however…
The filing system
The brain decides which memories to keep based on significance, using sharp brain wave ripples as an internal bookmarking system. Everyday memories fade, while important events are tagged in this manner for consolidation during sleep.
How does it do this? It starts in the hippocampus, which records experiences during wakefulness and replays them repeatedly at high speed during sleep, preparing them for transfer to the neocortex.
How do we know? Uniform Manifold Approximation & Projection (UMAP) for dimension reduction is a tool that condenses 400-dimensional neural activity data into 3D for visualization. Mice navigating a maze showed hippocampal activity encoding location and learning progression; it also showed neural patterns reflecting maze layout and task mastery.
What this means in practical terms: you need to get good sleep if you don’t want to lose your memories!
For more on all of this, enjoy:
Click Here If The Embedded Video Doesn’t Load Automatically!
Want to learn more?
You might also like to read:
How To Boost Your Memory Immediately (Without Supplements)
Take care!
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The Lupus Encyclopedia – by Dr. Donald Thomas
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First, a note on the authorship: while this is broadly by Donald E. Thomas Jr. MD FACP FACR, there were more contributors, namely:
Jemima Albayda, MD; Divya Angra, MD; Alan N. Baer, MD; Sasha Bernatsky, MD, PhD; George Bertsias, MD, PhD; Ashira D. Blazer, MD; Ian Bruce, MD; Jill Buyon, MD; Yashaar Chaichian, MD; Maria Chou, MD; Sharon Christie, Esq; Angelique N. Collamer, MD; Ashté Collins, MD; Caitlin O. Cruz, MD; Mark M. Cruz, MD; Dana DiRenzo, MD; Jess D. Edison, MD; Titilola Falasinnu, PhD; Andrea Fava, MD; Cheri Frey, MD; Neda F. Gould, PhD; Nishant Gupta, MD; Sarthak Gupta, MD; Sarfaraz Hasni, MD; David Hunt, MD; Mariana J. Kaplan, MD; Alfred Kim, MD; Deborah Lyu Kim, DO; Rukmini Konatalapalli, MD; Fotios Koumpouras, MD; Vasileios C. Kyttaris, MD; Jerik Leung, MPH; Hector A. Medina, MD; Timothy Niewold, MD; Julie Nusbaum, MD; Ginette Okoye, MD; Sarah L. Patterson, MD; Ziv Paz, MD; Darryn Potosky, MD; Rachel C. Robbins, MD; Neha S. Shah, MD; Matthew A. Sherman, MD; Yevgeniy Sheyn, MD; Julia F. Simard, ScD; Jonathan Solomon, MD; Rodger Stitt, MD; George Stojan, MD; Sangeeta Sule, MD; Barbara Taylor, CPPM, CRHC; George Tsokos, MD; Ian Ward, MD; Emma Weeding, MD; Arthur Weinstein, MD; Sean A. Whelton, MD
The reason we mention this is to render it clear that this isn’t one man’s opinions (as happens with many books about certain topics), but rather, a panel of that many doctors all agreeing that this is correct and good, evidence-based, up-to-date (as of the publication of this latest revised edition last year) information.
And if you have lupus, you’ll be aware there are a lot of doctors who don’t know a tremendous amount about it, hence the value of this “…for patients and healthcare providers” tome.
It is what it claims to be: a very comprehensive guide. It’s not light reading, and it is 848 pages of information-dense text and diagrams. If you want to know something, anything, about lupus, then if science knows it, then chances are it is in this book, or this book will at least point you directly to a paper you can read about your specific query.
The style is, nevertheless, about as readable for the layperson as possible, which is quite an achievement for a book with this amount of dense scientific information. For that, the author thanks his husband, for being the non-doctor beta-reader to screen it for readability—quite a service, with all those doctors writing!
Bottom line: if you or someone you love has lupus, this book should absolutely be in your collection.
Click here to check out The Lupus Encyclopedia, and have everything at your fingertips!
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Can you get sunburnt or UV skin damage through car or home windows?
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When you’re in a car, train or bus, do you choose a seat to avoid being in the sun or do you like the sunny side?
You can definitely feel the sun’s heat through a window. But can you get sunburn or skin damage when in your car or inside with the windows closed?
Let’s look at how much UV (ultraviolet) radiation passes through different types of glass, how tinting can help block UV, and whether we need sunscreen when driving or indoors.
Zac Harris/Unsplash What’s the difference between UVA and UVB?
Of the total UV radiation that reaches Earth, about 95% is UVA and 5% is UVB.
UVB only reaches the upper layers of our skin but is the major cause of sunburn, cataracts and skin cancer.
UVA penetrates deeper into our skin and causes cell damage that leads to skin cancer.
UVA penetrates deeper than UVB. Shutterstock/solar22 Glass blocks UVA and UVB radiation differently
All glass used in house, office and car windows completely blocks UVB from passing through.
But only laminated glass can completely block UVA. UVA can pass through other glass used in car, house and office windows and cause skin damage, increasing the risk of cancer.
Car windscreens block UVA, but the side and rear windows don’t
A car’s front windscreen lets in lots of sunshine and light. Luckily it blocks 98% of UVA radiation because it is made of two layers of laminated glass.
But the side and rear car windows are made of tempered glass, which doesn’t completely block UVA. A study of 29 cars found a range from 4% to almost 56% of UVA passed through the side and rear windows.
The UVA protection was not related to the car’s age or cost, but to the type of glass, its colour and whether it has been tinted or coated in a protective film. Grey or bronze coloured glass, and window tinting, all increase UVA protection. Window tinting blocks around 95% of UVA radiation.
In a separate study from Saudi Arabia, researchers fitted drivers with a wearable radiation monitor. They found drivers were exposed to UV index ratings up to 3.5. (In Australia, sun protection is generally recommended when the UV index is 3 or above – at this level it takes pale skin about 20 minutes to burn.)
So if you have your windows tinted, you should not have to wear sunscreen in the car. But without tinted windows, you can accumulate skin damage.
UV exposure while driving increases skin cancer risk
Many people spend a lot of time in the car – for work, commuting, holiday travel and general transport. Repeated UVA radiation exposure through car side windows might go unnoticed, but it can affect our skin.
Indeed, skin cancer is more common on the driver’s side of the body. A study in the United States (where drivers sit on the left side) found more skin cancers on the left than the right side for the face, scalp, arm and leg, including 20 times more for the arm.
Another US study found this effect was higher in men. For melanoma in situ, an early form of melanoma, 74% of these cancers were on the on the left versus 26% on the right.
Earlier Australian studies reported more skin damage and more skin cancer on the right side.
Cataracts and other eye damage are also more common on the driver’s side of the body.
What about UV exposure through home or office windows?
We see UV damage from sunlight through our home windows in faded materials, furniture or plastics.
Most glass used in residential windows lets a lot of UVA pass through, between 45 and 75%.
Residential windows can let varied amounts of UVA through. Sherman Trotz/Pexels Single-pane glass lets through the most UVA, while thicker, tinted or coated glass blocks more UVA.
The best options are laminated glass, or double-glazed, tinted windows that allow less than 1% of UVA through.
Skylights are made from laminated glass, which completely stops UVA from passing through.
Most office and commercial window glass has better UVA protection than residential windows, allowing less than 25% of UVA transmission. These windows are usually double-glazed and tinted, with reflective properties or UV-absorbent chemicals.
Some smart windows that reduce heat using chemical treatments to darken the glass can also block UVA.
So when should you wear sunscreen and sunglasses?
The biggest risk with skin damage while driving is having the windows down or your arm out the window in direct sun. Even untinted windows will reduce UVA exposure to some extent, so it’s better to have the car window up.
For home windows, window films or tint can increase UVA protection of single pane glass. UVA blocking by glass is similar to protection by sunscreen.
When you need to use sunscreen depends on your skin type, latitude and time of the year. In a car without tinted windows, you could burn after one hour in the middle of the day in summer, and two hours in the middle of a winter’s day.
But in the middle of the day next to a home window that allows more UVA to pass through, it could take only 30 minutes to burn in summer and one hour in winter.
When the UV index is above three, it is recommended you wear protective sunglasses while driving or next to a sunny window to avoid eye damage.
Theresa Larkin, Associate Professor of Medical Sciences, University of Wollongong
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Can You Repair Your Own Teeth At Home?
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It’s Q&A Day at 10almonds!
Have a question or a request? We love to hear from you!
In cases where we’ve already covered something, we might link to what we wrote before, but will always be happy to revisit any of our topics again in the future too—there’s always more to say!
As ever: if the question/request can be answered briefly, we’ll do it here in our Q&A Thursday edition. If not, we’ll make a main feature of it shortly afterwards!
So, no question/request too big or small 😎
❝I liked your article on tooth remineralization, I saw a “home tooth repair kit”, and wondered if it is as good as what dentists do, or at least will do the job well enough to save a dentist visit?❞
Firstly, for any wondering about the tooth remineralization, here you go:
Tooth Remineralization: How To Heal Your Teeth Naturally
Now, to answer your question, we presume you are talking about something like this kit available on Amazon. In which case, some things to bear in mind:
- This kind of thing is generally intended as a stop-gap measure until you see a dentist, because you cracked your tooth or lost a filling or something today, and will see the dentist next week, say.
- This kind of thing is not what Dr. Michelle Jorgensen was talking about in another video* that we wrote about; rather, it is using a polymer filler to rebuild what is missing. The key difference is: this is using plastic, which is not what your teeth are made of, so it will never “take” as part of the tooth, as some biomimetic dentistry options can do.
- Yes, this does also mean you are putting microplastics (because the powder is usually micronized polymer beads with zinc oxide, to which you add a liquid to create a paste that will set) in your mouth and quite possibly right next to an open blood supply depending on what’s damaged and whether capillaries were reaching it.
- Because of the different material and application method, the adhesion is nothing like professional fillings (be they metal or resin), and thus the chances of it coming out again or so high that it’s more a question of when, rather than if.
- If you have damage under there (as we presume you do in any scenario where you are using this), then if it’s not professionally cleaned before the filling goes in, then it can get infected, and (less dramatically, but still importantly) any extant decay can also get worse. We say “professionally”, because you will not be able to do an adequate job with your toothbrush, floss, etc at home, and even if you got dentist’s tools (which you can buy, by the way, but we don’t recommend), you will no more be able to do the same quality job as a dentist who has done that many times a day every day for the past 20 years, as buying expensive paintbrushes would make you able to restore a Renaissance painting without messing it up.
*See: Dangers Of Root Canals And Crowns, & What To Do Instead ← what she recommends instead is biomimetic dentistry, which is also more prosaically called “conservative restorative dentistry”, i.e. it tries to conserve as much as possible, replace lost material on a like-for-like basis, and generally end up with a result that’s as close to natural as possible.
In other words, the short answer to your question is “no, sorry, it isn’t and it won’t”
However! A just like it’s good to have a first aid kit in the house even if it won’t do the same job as an ambulance crew, it can be good to have a tooth repair kit (essentially, a tooth first-aid kit) in the house, precisely to use it just as a stop-gap measure in the event that you one day crack a tooth or lose a filling or such, and don’t want to leave it open to all things in the meantime.
(The results of this sort of kit are so not long-term in nature that it will be quick and easy for your dentist to remove it to do their own job once you get there)
If in doubt, always see your dentist as soon as possible, as many things are a lot less work to treat now, than to treat later. Just, make sure to advocate for yourself and what you actually want/need, and don’t let them upsell you on something you didn’t come in for while you’re sitting in their chair—that’s a conversation to be had in advance with a clear head and no pressure (and nobody’s hands in your mouth)!
See also: Dentists Are Pulling ‘Healthy’ and Treatable Teeth To Profit From Implants, Experts Warn
Take care!
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The Healing of America – by Thomas Reid
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First let’s be clear: this is about the US healthcare system, and thus will be mostly relevant for US Americans. Still, many outside of the US may have an interest, and in fact the book does talk about the healthcare systems of many other countries (hence the subtitle mentioning “a global quest”), outlining how each works, and what the journey was that got them there.
The author, a veteran journalist with a 60+ year-long career, notes that affordable healthcare is a social problem so complex, that only 33 out of 32 of the world’s richest countries have managed to do it. That’s a little glib and can be quibbled in the minutiae, but when it comes down to it, insulin in the US still costs 50x what it does in most places, and in pretty much all aspects of healthcare, US Americans are being fleeced at every turn.
He examines why this happens, and what currently prevents the US from lowering healthcare costs. He finds the culprits to be the profitmongers along the way (insurance companies in cahoots with drug companies in cahoots with hospitals, etc), as well as a pervasive belief that since healthcare is so expensive, how could the richest country on Earth possibly pay for it? Many Americans will believe that the answer is that other countries have inferior care, but this tends to stem from a mistaken belief that medical treatment actually costs what Americans are billed for it. The fact is: the same quality of care can be provided for a lot less, as many countries demonstrate.
The book doesn’t argue for any one particular solution; it doesn’t have to be entirely state-funded like the UK, or consumer-funded but seriously low price caps like in Japan; there are many other models to choose from. The argument that is made is that if so many other countries can have medical bankruptcy being a thing unheard-of instead of the leading cause of bankruptcy, then so can the US, and here’s a wide menu of methods to choose from.
Bottom line: if you’re a US American and you’d like to think you could get the same quality of care without lining numerous corporate pockets along the way with your hard-earned cash, then this book will open your eyes to what is possible.
Click here to check out The Healing Of America, and learn how you could get the same, for less!
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As the U.S. Struggles With a Stillbirth Crisis, Australia Offers a Model for How to Do Better
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ProPublica is a Pulitzer Prize-winning investigative newsroom. Sign up for The Big Story newsletter to receive stories like this one in your inbox.
Series: Stillbirths:When Babies Die Before Taking Their First Breath
The U.S. has not prioritized stillbirth prevention, and American parents are losing babies even as other countries make larger strides to reduce deaths late in pregnancy.
The stillbirth of her daughter in 1999 cleaved Kristina Keneally’s life into a before and an after. It later became a catalyst for transforming how an entire country approaches stillbirths.
In a world where preventing stillbirths is typically far down the list of health care priorities, Australia — where Keneally was elected as a senator — has emerged as a global leader in the effort to lower the number of babies that die before taking their first breaths. Stillbirth prevention is embedded in the nation’s health care system, supported by its doctors, midwives and nurses, and touted by its politicians.
In 2017, funding from the Australian government established a groundbreaking center for research into stillbirths. The next year, its Senate established a committee on stillbirth research and education. By 2020, the country had adopted a national stillbirth plan, which combines the efforts of health care providers and researchers, bereaved families and advocacy groups, and lawmakers and government officials, all in the name of reducing stillbirths and supporting families. As part of that plan, researchers and advocates teamed up to launch a public awareness campaign. All told, the government has invested more than $40 million.
Meanwhile, the United States, which has a far larger population, has no national stillbirth plan, no public awareness campaign and no government-funded stillbirth research center. Indeed, the U.S. has long lagged behind Australia and other wealthy countries in a crucial measure: how fast the stillbirth rate drops each year.
According to the latest UNICEF report, the U.S. was worse than 151 countries in reducing its stillbirth rate between 2000 and 2021, cutting it by just 0.9%. That figure lands the U.S. in the company of South Sudan in Africa and doing slightly better than Turkmenistan in central Asia. During that period, Australia’s reduction rate was more than double that.
Definitions of stillbirth vary by country, and though both Australia and the U.S. mark stillbirths as the death of a fetus at 20 weeks or more of pregnancy, to fairly compare countries globally, international standards call for the use of the World Health Organization definition that defines stillbirth as a loss after 28 weeks. That puts the U.S. stillbirth rate in 2021 at 2.7 per 1,000 total births, compared with 2.4 in Australia the same year.
Every year in the United States, more than 20,000 pregnancies end in a stillbirth. Each day, roughly 60 babies are stillborn. Australia experiences six stillbirths a day.
Over the past two years, ProPublica has revealed systemic failures at the federal and local levels, including not prioritizing research, awareness and data collection, conducting too few autopsies after stillbirths and doing little to combat stark racial disparities. And while efforts are starting to surface in the U.S. — including two stillbirth-prevention bills that are pending in Congress — they lack the scope and urgency seen in Australia.
“If you ask which parts of the work in Australia can be done in or should be done in the U.S., the answer is all of it,” said Susannah Hopkins Leisher, a stillbirth parent, epidemiologist and assistant professor in the stillbirth research program at the University of Utah Health. “There’s no physical reason why we cannot do exactly what Australia has done.”
Australia’s goal, which has been complicated by the pandemic, is to, by 2025, reduce the country’s rate of stillbirths after 28 weeks by 20% from its 2020 rate. The national plan laid out the target, and it is up to each jurisdiction to determine how to implement it based on their local needs.
The most significant development came in 2019, when the Stillbirth Centre of Research Excellence — the headquarters for Australia’s stillbirth-prevention efforts — launched the core of its strategy, a checklist of five evidence-based priorities known as the Safer Baby Bundle. They include supporting pregnant patients to stop smoking; regular monitoring for signs that the fetus is not growing as expected, which is known as fetal growth restriction; explaining the importance of acting quickly if fetal movement changes or decreases; advising pregnant patients to go to sleep on their side after 28 weeks; and encouraging patients to talk to their doctors about when to deliver because in some cases that may be before their due date.
Officials estimate that at least half of all births in the country are covered by maternity services that have adopted the bundle, which focuses on preventing stillbirths after 28 weeks.
“These are babies whose lives you would expect to save because they would survive if they were born alive,” said Dr. David Ellwood, a professor of obstetrics and gynecology at Griffith University, director of maternal-fetal medicine at Gold Coast University Hospital and a co-director of the Stillbirth Centre of Research Excellence.
Australia wasn’t always a leader in stillbirth prevention.
In 2000, when the stillbirth rate in the U.S. was 3.3 per 1,000 total births, Australia’s was 3.7. A group of doctors, midwives and parents recognized the need to do more and began working on improving their data classification and collection to better understand the problem areas. By 2014, Australia published its first in-depth national report on stillbirth. Two years later, the medical journal The Lancet published the second report in a landmark series on stillbirths, and Australian researchers applied for the first grant from the government to create the stillbirth research center.
But full federal buy-in remained elusive.
As parent advocates, researchers, doctors and midwives worked to gain national support, they didn’t yet know they would find a champion in Keneally.
Keneally’s improbable journey began when she was born in Nevada to an American father and Australian mother. She grew up in Ohio, graduating from the University of Dayton before meeting the man who would become her husband and moving to Australia.
When she learned that her daughter, who she named Caroline, would be stillborn, she remembers thinking, “I’m smart. I’m educated. How did I let this happen? And why did nobody tell me this was a possible outcome?”
A few years later, in 2003, Keneally decided to enter politics. She was elected to the lower house of state parliament in New South Wales, of which Sydney is the capital. In Australia, newly elected members are expected to give a “first speech.” She was able to get through just one sentence about Caroline before starting to tear up.
As a legislator, Keneally didn’t think of tackling stillbirth as part of her job. There wasn’t any public discourse about preventing stillbirths or supporting families who’d had one. When Caroline was born still, all Keneally got was a book titled “When a Baby Dies.”
In 2009, Keneally became New South Wales’ first woman premier, a role similar to that of an American governor. Another woman who had suffered her own stillbirth and was starting a stillbirth foundation learned of Keneally’s experience. She wrote to Keneally and asked the premier to be the foundation’s patron.
What’s the point of being the first female premier, Keneally thought, if I can’t support this group?
Like the U.S., Australia had previously launched an awareness campaign that contributed to a staggering reduction in sudden infant death syndrome, or SIDS. But there was no similar push for stillbirths.
“If we can figure out ways to reduce SIDS,” Keneally said, “surely it’s not beyond us to figure out ways to reduce stillbirth.”
She lost her seat after two years and took a break from politics, only to return six years later. In 2018, she was selected to serve as a senator at Australia’s federal level.
Keneally saw this as her second chance to fight for stillbirth prevention. In the short period between her election and her inaugural speech, she had put everything in place for a Senate inquiry into stillbirth.
In her address, Keneally declared stillbirth a national public health crisis. This time, she spoke at length about Caroline.
“When it comes to stillbirth prevention,” she said, “there are things that we know that we’re not telling parents, and there are things we don’t know, but we could, if we changed how we collected data and how we funded research.”
The day of her speech, March 27, 2018, she and her fellow senators established the Select Committee on Stillbirth Research and Education.
Things moved quickly over the next nine months. Keneally and other lawmakers traveled the country holding hearings, listening to testimony from grieving parents and writing up their findings in a report released that December.
“The culture of silence around stillbirth means that parents and families who experience it are less likely to be prepared to deal with the personal, social and financial consequences,” the report said. “This failure to regard stillbirth as a public health issue also has significant consequences for the level of funding available for research and education, and for public awareness of the social and economic costs to the community as a whole.”
It would be easy to swap the U.S. for Australia in many places throughout the report. Women of Aboriginal and Torres Strait Islander backgrounds experienced double the rate of stillbirth of other Australian women; Black women in America are more than twice as likely as white women to have a stillbirth. Both countries faced a lack of coordinated research and corresponding funding, low autopsy rates following a stillbirth and poor public awareness of the problem.
The day after the report’s release, the Australian government announced that it would develop a national plan and pledged $7.2 million in funding for prevention. Nearly half was to go to education and awareness programs for women and their health care providers.
In the following months, government officials rolled out the Safer Baby Bundle and pledged another $26 million to support parents’ mental health after a loss.
Many in Australia see Keneally’s first speech as senator, in 2018, as the turning point for the country’s fight for stillbirth prevention. Her words forced the federal government to acknowledge the stillbirth crisis and launch the national action plan with bipartisan support.
Australia’s assistant minister for health and aged care, Ged Kearney, cited Keneally’s speech in an email to ProPublica where she noted that Australia has become a world leader in stillbirth awareness, prevention and supporting families after a loss.
“Kristina highlighted the power of women telling their story for positive change,” Kearney said, adding, “As a Labor Senator Kristina Keneally bravely shared her deeply personal story of her daughter Caroline who was stillborn in 1999. Like so many mothers, she helped pave the way for creating a more compassionate and inclusive society.”
Keneally, who is now CEO of Sydney Children’s Hospitals Foundation, said the number of stillbirths a day in Australia spurred the movement for change.
“Six babies a day,” Keneally said. “Once you hear that fact, you can’t unhear it.”
Australia’s leading stillbirth experts watched closely as the country moved closer to a unified effort. This was the moment for which they had been waiting.
“We had all the information needed, but that’s really what made it happen.” said Vicki Flenady, a perinatal epidemiologist, co-director of the Stillbirth Centre of Research Excellence based at the Mater Research Institute at the University of Queensland, and a lead author on The Lancet’s stillbirth series. “I don’t think there’s a person who could dispute that.”
Flenady and her co-director Ellwood had spent more than two decades focused on stillbirths. After establishing the center in 2017, they were now able to expand their team. As part of their work with the International Stillbirth Alliance, they reached out to other countries with a track record of innovation and evidence-based research: the United Kingdom, the Netherlands, Ireland. They modeled the Safer Baby Bundle after a similar one in the U.K., though they added some elements.
In 2019, the state of Victoria, home to Melbourne, was the first to implement the Safer Baby Bundle. But 10 months into the program, the effort had to be paused for several months because of the pandemic, which forced other states to cancel their launches altogether.
“COVID was a major disruption. We stopped and started,” Flenady said.
Still, between 2019 and 2021, participating hospitals across Victoria were able to reduce their stillbirth rate by 21%. That improvement has yet to be seen at the national level.
A number of areas are still working on implementing the bundle. Westmead Hospital, one of Australia’s largest hospitals, planned to wrap that phase up last month. Like many hospitals, Westmead prominently displays the bundle’s key messages in the colorful posters and flyers hanging in patient rooms and in the hallways. They include easy-to-understand slogans such as, “Big or small. Your baby’s growth matters,” and, “Sleep on your side when baby’s inside.”
As patients at Westmead wait for their names to be called, a TV in the waiting room plays a video on stillbirth prevention, highlighting the importance of fetal movement. If a patient is concerned their baby’s movements have slowed down, they are instructed to come in to be seen within two hours. The patient’s chart gets a colorful sticker with a 16-point checklist of stillbirth risk factors.
Susan Heath, a senior clinical midwife at Westmead, came up with the idea for the stickers. Her office is tucked inside the hospital’s maternity wing, down a maze of hallways. As she makes the familiar walk to her desk, with her faded hospital badge bouncing against her navy blue scrubs, it’s clear she is a woman on a mission. The bundle gives doctors and midwives structure and uniform guidance, she said, and takes stillbirth out of the shadows. She reminds her staff of how making the practices a routine part of their job has the power to change their patients’ lives.
“You’re trying,” she said, “to help them prevent having the worst day of their life.”
Christine Andrews, a senior researcher at the Stillbirth Centre who is leading an evaluation of the program’s effectiveness, said the national stillbirth rate beyond 28 weeks has continued to slowly improve.
“It is going to take a while until we see the stillbirth rate across the whole entire country go down,” Andrews said. “We are anticipating that we’re going to start to see a shift in that rate soon.”
As officials wait to receive and standardize the data from hospitals and states, they are encouraged by a number of indicators.
For example, several states are reporting increases in the detection of babies that aren’t growing as they should, a major factor in many late-gestation stillbirths. Many also have seen an increase in the number of pregnant patients who stopped smoking. Health care providers also are more consistently offering post-stillbirth investigations, such as autopsies.
In addition to the Safer Baby Bundle, the national plan also calls for raising awareness and reducing racial disparities. The improvements it recommends for bereavement care are already gaining global attention.
To fulfill those directives, Australia has launched a “Still Six Lives” public awareness campaign, has implemented a national stillbirth clinical care standard and has spent two years developing a culturally inclusive version of the Safer Baby Bundle for First Nations, migrant and refugee communities. Those resources, which were recently released, incorporated cultural traditions and used terms like Stronger Bubba Born for the bundle and “sorry business babies,” which is how some Aboriginal and Torres Strait Islander women refer to stillbirth. There are also audio versions for those who can’t or prefer not to read the information.
In May, nearly 50 people from the state of Queensland met in a large hotel conference room. Midwives, doctors and nurses sat at round tables with government officials, hospital administrators and maternal and infant health advocates. Some even wore their bright blue Safer Baby T-shirts.
One by one, they discussed their experiences implementing the Safer Baby Bundle. One midwifery group was able to get more than a third of its patients to stop smoking between their first visit and giving birth.
Officials from a hospital in one of the fastest-growing areas in the state discussed how they carefully monitored for fetal growth restriction.
And staff from another hospital, which serves many low-income and immigrant patients, described how 97% of pregnant patients who said their baby’s movements had decreased were seen for additional monitoring within two hours of voicing their concern.
As the midwives, nurses and doctors ticked off the progress they were seeing, they also discussed the fear of unintended consequences: higher rates of premature births or increased admissions to neonatal intensive care units. But neither, they said, has materialized.
“The bundle isn’t causing any harm and may be improving other outcomes, like reducing early-term birth,” Flenady said. “I think it really shows a lot of positive impact.”
As far behind as the U.S. is in prioritizing stillbirth prevention, there is still hope.
Dr. Bob Silver, who co-authored a study that estimated that nearly 1 in 4 stillbirths are potentially preventable, has looked to the international community as a model. Now, he and Leisher — the University of Utah epidemiologist and stillbirth parent — are working to create one of the first stillbirth research and prevention centers in the U.S. in partnership with stillbirth leaders from Australia and other countries. They hope to launch next year.
“There’s no question that Australia has done a better job than we have,” said Silver, who is also chair of the University of Utah Health obstetrics and gynecology department. “Part of it is just highlighting it and paying attention to it.”
It’s hard to know what parts of Australia’s strategy are making a difference — the bundle as a whole, just certain elements of it, the increased stillbirth awareness across the country, or some combination of those things. Not every component has been proven to decrease stillbirth.
The lack of U.S. research on the issue has made some cautious to adopt the bundle, Silver said, but it is clear the U.S. can and should do more.
There comes a point when an issue is so critical, Silver said, that people have to do the best they can with the information that they have. The U.S. has done that with other problems, such as maternal mortality, he said, though many of the tactics used to combat that problem have not been proven scientifically.
“But we’ve decided this problem is so bad, we’re going to try the things that we think are most likely to be helpful,” Silver said.
After more than 30 years of working on stillbirth prevention, Silver said the U.S. may be at a turning point. Parents’ voices are getting louder and starting to reach lawmakers. More doctors are affirming that stillbirths are not inevitable. And pressure is mounting on federal institutions to do more.
Of the two stillbirth prevention bills in Congress, one already sailed through the Senate. The second bill, the Stillbirth Health Improvement and Education for Autumn Act, includes features that also appeared in Australia’s plan, such as improving data, increasing awareness and providing support for autopsies.
And after many years, the National Institutes of Health has turned its focus back to stillbirths. In March, it released a report with a series of recommendations to reduce the nation’s stillbirth rate that mirror ProPublica’s reporting about some of the causes of the crisis. Since then, it has launched additional groups to begin to tackle three critical angles: prevention, data and bereavement. Silver co-chairs the prevention group.
In November, more than 100 doctors, parents and advocates gathered for a symposium in New York City to discuss everything from improving bereavement care in the U.S to tackling racial disparities in stillbirth. In 2022, after taking a page out of the U.K.’s book, the city’s Mount Sinai Hospital opened the first Rainbow Clinic in the U.S., which employs specific protocols to care for people who have had a stillbirth.
But given the financial resources in the U.S. and the academic capacity at American universities and research institutions, Leisher and others said federal and state governments aren’t doing nearly enough.
“The U.S. is not pulling its weight in relation either to our burden or to the resources that we have at our disposal,” she said. “We’ve got a lot of babies dying, and we’ve got a really bad imbalance of who those babies are as well. And yet we look at a country with a much smaller number of stillbirths who is leading the world.”
“We can do more. Much more. We’re just not,” she added. “It’s unacceptable.”
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