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Researchers in the Netherlands say giving birth at home with a midwife is as safe as doing so in hospital.

The researchers say a home birth assisted by a trained midwife is just as safe for low-risk mothers and their babies as a delivery led by a midwife in hospital.

The team from the TNO Institute for Applied Scientific Research carried out a study of 529,688 low-risk women who were in the care of a midwife at the start of labour - of these women 321,307 (60.7%) planned to give birth at home and 163,261 (30.8%) planned to give birth in hospital and for 45,120 (8.5%), the intended place of birth was unknown.

The nationwide study set out to compare home and planned hospital births, among low-risk women who started their labour in primary care and the team found over a seven year period that there was no difference in death or serious illness among either mothers or their babies if they gave birth at home rather than in hospital.

Concerns about the safety of home births has always been an issue and obstetricians have welcomed the study but say it may not apply universally.

The research was carried out after figures showed the country had one of the highest rates in Europe of babies dying during or just after birth and home births were suspected of being a factor.

In Holland home birthing is an option which is encouraged and a third of mothers choose to have their baby this way and the research revealed that among "low-risk" women who planned to give birth at home there was no difference in death or serious illness rates among either babies or mothers.

Professor Simone Buitendijk who led the research says they found that for low-risk mothers at the start of their labour it is just as safe to deliver at home with a midwife as it is in hospital with a midwife.

Professor Buitendijk says the results should strengthen policies that encourage low-risk women at the onset of labour to choose their own place of birth.

In the study low-risk were deemed to be those who had no known complications such as a baby in breech or one with a congenital abnormality, or a previous Caesarean section.

Of women in the study, almost a third who planned and started their labours at home ended up being transferred as complications arose, such as an abnormal fetal heart rate, or if the mother needed more effective pain relief in the form of an epidural.

In many countries the health system is not set up to meet an increase in a potential demand for home births and the researchers emphasise the importance of both highly-trained midwives who know when to refer a home birth to hospital as well as the availability of rapid transportation to get a mother into hospital if necessary.

The researchers say while the study was the most comprehensive yet into the safety of home births, they also acknowledged that the group who chose to give birth in hospital rather than at home were more likely to be first-time mothers or of an ethnic minority background and the risk of complications is higher in both these groups.

The study also did not compare the relative safety of home births against low-risk women who opted for doctor rather than midwife-led care and say this will be the subject of a future investigation.

Professor Buitendijk says the study has relevance for other countries with a highly developed health infrastructure and well-trained midwives.

The researchers say the study shows that planning a home birth does not increase the risks among low-risk women, provided the maternity care system facilitates this choice through the availability of well-trained midwives and through a good transportation and referral system.

The UK government has pledged to give all women the option of a home birth by the end of this year - currently 2.7% of births in England and Wales take place at home - but critics say changes will be needed in the way maternity services are organised and a major increase in the number of midwives, before that can be realised.

The Royal College of Obstetricians and Gynaecologists (RCOG) said it supported home births in cases of low-risk pregnancies provided the appropriate infrastructures and resources are present to support such a system but women need to be counselled on the unexpected emergencies which can arise during labour, such as cord prolapse, fetal heart rate abnormalities, undiagnosed breech, prolonged labour and postpartum haemorrhage - which can arise during labour and can only be managed in a maternity hospital.

The RCOG says such emergencies would always require the transfer of women by ambulance to the hospital as extra medical support is only present in hospital settings and would not be available to them when they deliver at home.

The study has been welcomed by midwives and home-birth advocates in Australia and is expected to put further pressure on the Federal Government to review and update maternity services.

The Australian College of Midwives reportedly says there is ample evidence that mothers have higher satisfaction rates when giving birth at home, but concerns about the impact on the baby had seen home birth remain under question.

However the Royal Australian and New Zealand College of Obstetricians and Gynaecologists warned caution is called for in comparing the Dutch experience to Australia as they say pregnant women are cared for very differently in the two countries.

The study is published in the journal BJOG: An International Journal of Obstetrics & Gynaecology.

A review of published scientific studies carried out by British researchers has revealed that people with low levels of the vitamins A and C were more likely to suffer from asthma.

The review of 40 studies by researchers at the University of Nottingham, found that a diet low in vitamins A and C increases the risk of developing asthma and the increased risk was independently linked to each vitamin - people with the lowest levels of vitamin A tended to have more severe asthma than other sufferers.

The researchers analysed the data from the studies and found no link for vitamin E, but said the associations for A and C were significant, and on average, men with asthma were lacking 26% of their daily requirements of vitamin A, while women with asthma were lacking 30%.

The findings of this latest research contradict the results of a large-scale study published last year which found no link between levels of antioxidants in the diet and asthma and the Nottingham team say their study is more robust.

According to health experts a healthy diet should provide people with their daily supply of vitamins A and C - good sources of vitamin A include cheese, eggs, oily fish, milk, fortified margarine and yoghurt and good sources of vitamin C are a wide variety of fruit and vegetables, including broccoli, Brussels sprouts, sweet potatoes, oranges and kiwis.

The review included studies carried out over the last three decades, that measured dietary intake of the vitamins, or levels of vitamins in the blood - 13 of the studies related to children while the rest were in adults or were unspecified.

Lead researcher Dr. Jo Leonardi-Bee says their findings indicate that low levels of vitamin C intake and - to a lesser extent - vitamin A are consistently associated with asthma risk to a degree that, if causal, would be sufficient to be clinically relevant.

Dr. Leonardi-Bee says it is now important that larger-scale studies are carried out in order to clarify the link and to see if there was a direct cause between vitamin intake and asthma.

The review is published in the journal Thorax.

The cancer ward at the Royal Adelaide Hospital (RAH) in South Australia is currently battling to cope with an antibiotic-resistant bacteria called Vanocomycin-resistant Enterococci (VRE), a form of bacteria which lives in the gut.

The superbug is resistant to antibiotics and has affected cancer patients on a number of wards.

The Health Department says 31 people at the RAH are now known to be carriers of VRE but none are as yet sick because of it, however it is a serious concern because many have cancer and the superbug, while harmless in healthy people, is potentially lethal to patients who are seriously ill.

Chief medical officer Professor Paddy Phillips says two patients with diarrhoea are believed to have introduced the bug into the hospital and precautions are being taken for the patients involved - the patients affected have been isolated and extra cleaning is being done to prevent any further spread of the bacteria.

The SA Government says the outbreak highlights the need for its planned new city hospital and Health Minister John Hill says providing single rooms with separate bathrooms is the best way of controlling the bacteria.

Enterococci are bacteria that are normally present in the human intestines and in the female genital tract and are often found in the environment and can sometimes cause infections.

Vancomycin is an antibiotic that is often used to treat infections caused by Enterococci, but in some instances, Enterococci have become resistant to the drug and so are called vancomycin-resistant Enterococci (VRE) - most VRE infections occur in people in hospitals.

VRE can cause infections of the urinary tract, the bloodstream or of wounds and people most at risk of getting VRE are:-

• People who have been previously treated with the antibiotic vancomycin or other antibiotics for long periods of time
• People who are hospitalized, particularly when they receive antibiotic treatment for long periods of time.
• People with weakened immune systems such as patients in Intensive Care Units, or in cancer or transplant wards.
• People who have undergone surgical procedures such as abdominal or chest surgery.
• People with medical devices that stay in for some time such as urinary catheters or central intravenous (IV) catheters.
• People who are colonized with VRE (bacteria are present, but have no symptoms of an infection).

According to the Centers for Disease Control and Prevention (CDC) in the United States, Enterococci cause about 1 of every 8 infections in hospitals and only about 30% of these are VRE.

People who are colonized with VRE do not usually need treatment and most VRE infections can be treated with antibiotics other than vancomycin.

Laboratory testing of the VRE can determine which antibiotics will work - for people who get VRE infections in their bladder and have urinary catheters, removal of the catheter when it is no longer needed can also help get rid of the infection.

VRE is often passed from person to person by the hands of caregivers, after they have contact with other people with VRE or after contact with contaminated surfaces.

VRE can also be spread directly to people after they touch surfaces that are contaminated with VRE and is not usually spread through the air by coughing or sneezing.

The spread of VRE can be prevented by always keeping the hands clean - washing them with soap and water after using the toilet and before preparing food and after contact with persons who have VRE.

Keeping areas of the home such as toilets clean, is important as is wearing gloves if you come in contact with body fluids that may contain VRE, such as stool or bandages from infected wounds and always washing the hands after removing gloves.

According to researchers in the Netherlands, although eating lots of fresh fruit and vegetables may reduce the risk of colon cancer for most people this is not the case with smokers.

Scientists at the Dutch National Institute for Public Health and the Environment (RIVM) say they have found the reverse is true for smokers and a high intake of fruit and vegetables appears to increase a smoker's chance of developing colon cancer.

The Dutch team reached this conclusion after conducting a study where as many as 500,000 people in 10 European countries were questioned about their eating and smoking habits and monitored over a period of 8.5 years.

The new European study has surprisingly revealed that while people who eat 600 grammes or more vegetables and fruit a day appear to have up to 25% less chance of developing colon cancer than people who eat 220 grammes or less - for smokers, the consumption of vegetables and fruit appears to increase their chances of developing colon cancer.

The researchers say protection against colon cancer through the consumption of vegetables and fruit therefore appears to depend on smoking habits and the only conclusion which can be drawn is that smokers, rather than not eating fruit and vegetables, should instead - stop smoking!

According to the World Health Organisation colon cancer or colorectal cancer is one of the most common cancers and causes of deaths worldwide and tobacco use is the single most important risk factor for cancer - cancer accounts for over 7 million deaths worldwide each year of which 639 000 are from colorectal cancer.

The WHO says more than 30% of cancer could be prevented by modifying or avoiding key risk factors, and top of the list is tobacco use, followed by being overweight or obese and then low fruit and vegetable intake.

The study is reportedly the first to examine the effects of fruit and vegetable in smokers and non-smokers and the researchers say the findings show that substances within fruit and vegetables may even increase the carcinogenic potential of tobacco smoke.

The research is published in the American Journal for Clinical Nutrition.

One cell...one initial set of genetic changes - that's all it takes to begin a series of events that lead to metastatic cancer. Now, Johns Hopkins experts have tracked how the cancer process began in 33 men with prostate cancer who died of the disease. Culling information from autopsies, their study points to a set of genetic defects in a single cell that are different for each person's cancer.

"These were not your average autopsies," says pathologist G. Steven Bova, M.D., assistant professor of pathology at Johns Hopkins. "We dissected every bit of tumor - in the primary and metastatic sites - and recorded exactly where each piece of tissue came from, analyzed it, and databased the findings." In total, Bova estimates that he and his colleagues examined 150,000 slides and 30,000 blocks of tissue.

The study took 14 years to complete, and part of the challenge was in finding men living with prostate cancer who would agree to have their body autopsied immediately after they died. "Many of the men were motivated to join the study in hopes of leaving some legacy that might lead to cures for this cancer," says Bova, who holds secondary appointments in the departments of pathology, genetic medicine, health sciences informatics, oncology, and urology at Johns Hopkins.

"Much is unclear and appears chaotic about how cancer spreads, but analyzing genetic markers allows us to trace its roots backward, somewhat like ancestry," says Bova. Findings from the study were published online April 12 in Nature Medicine.

Clues to finding the genetic culprit for cancer spread are hidden in the changes that occur in a cell's DNA, the alphabetical code made up of chemicals that guide the everyday life of a cell. Cancers are caused by alterations in DNA code that occur in a variety of ways: making errors in the nucleotide alphabet through mutations, changing the balance of chemicals attached to the on/off switches of genes, and altering the number of gene copies in a cell. When the number of gene copies is disrupted in a cell beyond the customary two copies inherited from each parent, a gene's function can be damaged. This process, called copy number variation, can set the stage for unchecked cell growth and spread, a hallmark of cancer.

For this study, the investigators scanned genes spanning the whole genome in the autopsy samples looking for areas of copy number variation. They did this by attaching the DNA to special silicon chips, and then photographed them with a computer program that produces a report with varying colors representing the amount of DNA in the sample.

The scientists compared the patterns of gains and losses in tissue samples from multiple metastatic sites in 29 of the men. Unique copy number changes were identified, as well as ones that were shared between multiple metastatic sites in each man and with other men in the study.

For example, in several men, the investigators found cells in different areas of metastasis that contained missing chunks of DNA in one common region of the genome. The exact location of the DNA loss was different for each man, but all occurred in the same DNA region. "Each person has a different set of defects that contributes to the cancer," explains Bova.

Metastatic sites develop from cancer cells that break off of the primary cancer. If cancer cells at more than one metastatic site carry a common set of nonrandom genetic defects, it is likely that these cells are derived from a single parent cell, says Bova. Tissue samples from 14 of the 33 men were studied at the highest available resolution, and all showed common genetic patterns across metastatic sites, suggesting a single cell source for their cancer.

Bova says that future studies will help determine whether the common set of changes shared by the various metastatic sites arose in a single "big bang" in the prostate or if the changes accumulated more slowly over time.

Bova says that such autopsy studies of metastatic cancer can provide a molecular catalogue of cellular defects specific to individuals and general groups. The findings, he says, could help narrow the focus of research and guide personalized cancer therapy.

The research was funded by the Pirkanmaa Cancer Foundation, Maud Kuistila Foundation, Finnish Medical Foundation, Medical Research Fund of Tampere University Hospital, Academy of Finland, Cancer Society of Finland, Reino Lahtikari Foundation, Sigrid Juselius Foundation, CaPCURE Foundation, John and Kathe Dyson, David Koch, National Cancer Institute, Prostate Cancer Research and Education Foundation, U.S. Department of Defense Congressionally Directed Prostate Cancer Research Program, Grove Foundation and the American Cancer Society.

In addition to Bova, research participants included Wennuan Liu and Jianfeng Xu at Wake Forest University School of Medicine; Sari Laitinen, Sofia Khan, Mauno Vihinen, and Tapio Visakorpi at the University of Tampere and Tampere University Hospital, Tampere, Finland; Guoqiang Yu, Li Chen and Yue Wang at the Virginia Polytechnic Institute and State University; and Jeanne Kowalski, Charles M. Ewing, Mario A. Eisenberger, Michael A. Carducci, William G. Nelson, Srinivasan Yegnasubramanian, Jun Luo, and William B. Isaacs at Johns Hopkins.

Video of G. Steven Bova, M.D. discussing the study can be found on www.youtube.com/JohnsHopkinsKimmel

http://www.jhmi.edu