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Interviewer: It used to be 50. Now it's 45 and there's a good reason for that. Huntsman Cancer Institute and University of Utah Health says more lives can be saved if men and women who are at average risk of colorectal cancer get screened at 45 instead of 50 years old. Dr. Priyanka Kanth is from Huntsman Cancer Institute. Why the change? What happened?

Dr. Kanth: Over the years since mid-'90s to early 2000, we have noticed an increased risk, increase incidence, and mortality. Actually both. So increased cases and people dying from colorectal cancer. And that was the main reason people started looking into it, researchers started looking into it and came up with this studies, modeling studies. And that's why this recommendation was changed.

Interviewer: Yeah. And the reason that's so important is because unlike other disease that perhaps might show symptoms, and then you would go get treatment. That's not how colorectal cancer presents. It really is screening is the best way to save lives.

Dr. Kanth: Absolutely. You're very right about it. So most of the early onset cancers or any colorectal cancer, early stages do not produce symptoms. Polyp usually starts with a polyp, which is a little bump in the colon and it changes into colon cancer. These polyps do not produce symptoms and they grow slowly, and you will never know you have one. So that's the biggest problem with colorectal cancer. And by the time you have symptoms, it's fairly late. So screening is the best strategy to prevent this cancer.

Interviewer: And this new research has just really shown that people between 45 and 49 because catching it early is the best defense that a lot of good can be done by having it at 45.

Dr. Kanth: Absolutely. Absolutely. There are certain research which has shown that there was a drastic increase even between age 49 and 50. So one study showed that there was an increase of almost 46% between age 49 and 50. So if we decrease it from 50 to 45, we are really hoping to capture that colon cancer patient. And this would be very, very beneficial between that age group.

The other thing I would like to say that this is also an incentive, an added benefit to increase screening from age 50 to 55, 50 to 54. But traditionally, it has been on the lower side if you do it from 50 to 75. There's slightly decreased screening rates in screening uptake between age 50 to 55. So this will help patients who are thinking about it at age 50, but did not get it till age 55. Now they're like, "Oh, you have to get it done at 45, let's get it one at by age 48." Something like that. So this will be very helpful at that point.

Interviewer: Is there a perception that colorectal cancer is an older person's disease?

Dr. Kanth: Yes. I think a lot of us, a lot of our patients in general public we think cancer is an old person's disease, especially colorectal cancer. That's not the case anymore. This is still true. Most colorectal cancer will still be diagnosed when you're older, but there has been a rise in patients who are younger than age 50. Some of it is because of genetic causes, but the rise has been in the average risk. So this perception should be changed. We should consider 45 as new 50 to start screening now.

Interviewer: And really that number, age 45 is the most important number. It's not do I have a family history? It's not do I have symptoms? It's not am I a man or a woman and think I'm less likely to get it. Really as soon as anyone hits that age of average risk of 45, that's the trigger you should go get it checked.

Dr. Kanth: Absolutely. Very correct. So 50 was . . . the same recommendation was for anyone, any gender, male, female. Any person who hits 50, you should get a colonoscopy. Now that has changed to 45. So it doesn't matter if you have symptoms, you should get it checked, especially if you don't have family history. If you have family history, that's a different story. If you don't have family history or average risk, please go get checked at age 45.

Interviewer: How is this going to impact those that do have an increased risk? Not an average risk, an increased risk? Does that also drop their age that they should go in down or do we know?

Dr. Kanth: So, at this point, if you have a family history, we usually start screening early. Most of the time we start screening at age 40. Or if somebody had colon cancer, I'd say whatever age, 10 years before they had colon cancer. So that may not change so much. It's possible we can look at the data and that may change again, but at this point, this recommendation is only for average risk. So family history is a different cohort of patients. That is still a very good point for primary care physician for all of us to ask that history from patients, "Do you have a family history of colon cancer?" Because your risk might be very different from the average risk.

Interviewer: So have that conversation if you're above average risk with your physician, your provider is whether or not you should get it earlier.

Dr. Kanth: Absolutely. Yes.

Interviewer: All right. And for the recommendation, is a colonoscopy okay? The home stool test, is that impacted by this age going down to 45?

Dr. Kanth: The best screening is the one that gets done. So that's another message which has to be delivered by providers. Colonoscopy is not the only screening test. Colonoscopy is gold standard because you can see the polyps you can remove it before it turn into cancer. But there are other very, very good stool tests which can detect colon cancer easily. They are non-invasive, you stay at home, you don't have any logistics around it. And those are good tests to be done. So that's a big message which everyone should know that colonoscopy is not the only way to detect cancer. There are other very good stool tests, which everyone should consider. If you're declining colonoscopy for any reason, do go for a stool test.

Interviewer: So if it's a stool test or if it's the colonoscopy, it doesn't matter. Average risk needs to be 45 now.

Dr. Kanth: Absolutely.

Interviewer: All right. And also, I understand with the new recommendation that Medicare, Medicaid, and also your commercial insurance will cover either one of those screenings starting at 45.

Dr. Kanth: That is correct. And that's what we believe after the new recommendation which has been endorsed by pretty much all the societies that all these should be now covered under preventive care just that how we had it at age 50. Even now, some insurances are already covering at age 45, but that was more sporadic. So now we expect this to be 100% covered.

Dr. Jones: So you live longer if your doctor is female. That's what the research suggests. Well, let's look at this a little more carefully, okay? This is Dr. Kirtly Jones from Obstetrics and Gynecology at University of Utah Healthcare and full disclosure, I'm a female physician and this is The Scope.

Announcer: Covering all aspects of women's health, this is "The Seven Domains of Women's Health," with Dr. Kirtly Jones, on The Scope.

Dr. Jones: It seems as if every major news outlet brought forth the research that people live longer if their doctor is female. Okay. That sets us up for some controversy and some potential bad feelings. But let's unpack the numbers and take a closer look.

The study was published in JAMA Internal Medicine. This is a well-respected journal and it looked at medical billings for hospitalizations around the country for people over 65 with a number of common medical problems such as pneumonia, heart failure, or urinary tract infections, to name a few. They analyzed over 1.5 million admissions between January 2011 and December of 2014. Wow, that's a lot of hospitalizations. But in fact, they just picked a random 20% of all the admissions in the US to study.

They specifically looked at the outcomes of death in the 30 days after admission or readmission to the hospital. Those are just the two things they looked at. And then, they looked at whether the physician who billed for the admission was a female or a male. It's amazing what you can find on the internet.

Of course, they had to look carefully to see if the patients of male physicians were sicker than those of women. They had to look at the age of the patients to see if they were older in the male doctor group than the female doctor group. Then, they looked at the doctors to see if the females were younger. And they were, on average, about five years. And if they had had more recently finished their training, which women physicians had by about five years. Then, they had to control for all these factors in their statistical analysis. They chose hospitals where the doctors who provided care tended to work on shifts, so the admitting doctor was not by the choice of the patient.

Well, it was pretty good study and with really big numbers. And the envelope, please. Patients who were cared for by female physicians were less likely to die in 20 days. Now the real numbers. Patients cared for by female physicians had an 11% chance of dying in the 30 days. You should know that the average age of these patients was 80. Compared to the rate of death within 30 days of 11.5% in those patients cared for by male physicians, that is one-half of 1% difference.

Now, because the number of patients is so large, one-half of 1% is statistically different. However, if you're thinking of changing your doctor, that's a pretty small difference for any one person. To save one death in 30 days, you had to have 233 people cared for by women for every one cared for by men.

Similar numbers were found in the rate of readmissions for hospitals, and the females compared to males was slightly less. Some people argue that the difference is very small for any individual patient. But if you look at hospital admissions for the elderly over the entire United States, there are over 10 million hospitalizations among Medicare patients annually. And one-half of 1% of 30-day mortality could add up to a lot.

So, what's this about? Physician sex doesn't make a difference in outcome. It isn't the extra x chromosome or the estrogen level that makes the difference. It must be some behaviors in female physicians that are just a little different than men. We call that a gender difference, not a sex difference. Sex is the chromosomes in the biology; gender is the behavior.

Studies have found that female physicians are little more likely to adhere to clinical guidelines in care and practice more evidence-based medicine. Women tend to use more patient-centered communication and provide more psychosocial counseling to their patients than males. It's hard to know exactly what is the difference in practice that accounts for this small difference in patient outcomes.

Of course, to me, it may all boil down to a factor that all women know. Women are more likely to stop and ask for directions, right? In fact, we are trying to teach more protocol-based and evidence-based medicine to all our medical student these days, men and women. And we are teaching patient-centered communications more.

So maybe our women and men graduating from medical school will be more comfortable asking for directions. And everyone, patients and doctors, will get where they're supposed to go.

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Interviewer: Older adults are at a higher risk for death if they have low levels of bicarbonate in their blood. Bicarbonate, it's the main ingredient in baking soda. We'll talk about that next on The Scope.

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Interviewer: I'm talking with Dr. Kalani Raphael, a nephrologist and Associate Professor of Internal Medicine at the University of Utah and at the Salt Lake City VA. Dr. Raphael, tell me about the main finding of your study. It's pretty interesting.

Dr. Raphael: In this study, we were looking at the association between serum bicarbonate levels and mortality in a generally healthy older population. The basic finding from our study was that in people with low bicarbonate levels, they had a higher risk of death and their risk of death was about 24%, 25% higher over a mean follow-up period of about 10 years or so.

Interviewer: So that's pretty significant. What is bicarbonate?

Dr. Raphael: Bicarbonate is very important in the body for maintaining your pH levels in a normal range. In order for our cells and our organs to work normally, the pH needs to be kept at a range of about 7.40.

Interviewer: So people with low bicarbonate would have blood that's more acidic. Why might that be unhealthy?

Dr. Raphael: The bicarbonate levels could be low for two main reasons. One is it could be because the kidneys are holding on to too much acid and your bicarbonate levels fall. That's something we call metabolic acidosis. Or the reason the bicarbonate level could be low is because the lungs are breathing off too much carbon dioxide and your bicarbonate levels fall as a compensatory response is what we call that.

So we're not exactly sure why the bicarbonate levels were low in these people. If I had to guess, I would say that the most likely reason the bicarbonate levels are low is because of an impaired ability of the kidney to get rid of the acid that we need to on a daily basis. The main reason why I say that is because our diets are really high in acid content in these western diets that we have now. We don't consume enough fruits and vegetables in relation to the amount of acid that we intake.

So if I had to guess, I would say that the most likely reason that the bicarbonate levels were low is because of an impaired ability to get rid of acid by the kidneys.

Interviewer: So what caused you to even take a look at that in the first place?

Dr. Raphael: Well, in people with kidney disease, we know that low bicarbonate levels occur quite commonly. It occurs in about 15% of people with kidney disease who aren't yet on dialysis. What we know is that in people with kidney disease who have low bicarbonate levels, they have a higher risk of death and they have a higher risk of progression of their kidney disease to end-stage renal disease or needing dialysis or a transplant in order to survive.

But much less was really known about generally healthy people and so I was interested in whether or not low bicarbonate levels have any association with poor outcomes in people who are otherwise healthy. So that was really the driving force behind this research study.

Interviewer: So do you think measuring bicarbonate levels could be some sort of test or indicator that someone could do to evaluate the healthiness of somebody?

Dr. Raphael: Absolutely. I mean, bicarbonate levels are very commonly measured in clinical practice these days. Bicarbonate levels are measured usually when a physician wants to check on somebody's kidney function. They'll order a chemistry panel or a renal panel. In primary care, I'm not exactly sure how well people look at these levels and I think that one of the things that maybe doesn't attract their attention is they don't really know what it means for that person.

So if you had a healthy person sitting in your clinic who had a bicarbonate value that was low, I think most physicians would say, "Okay. It's low. I'm not sure what to do with that." But I think what this research is showing is that it's probably something we should be paying attention to. But I don't really know quite yet what we should do about that.

Interviewer: Right. Maybe it would be a signal that it's worth taking a second look at this patient to see . . .

Dr. Raphael: Absolutely.

Interviewer: . . . if something else is going on.

Dr. Raphael: Right. So, I think you said it correctly that it's a signal for potentially bad things. That might trigger the physician to look into their kidney function a little bit more or maybe consider underlying lung disease or heart problems in that person.

Interviewer: So do you think more research needs to be done to figure out exactly what this could mean?

Dr. Raphael: Absolutely. The key thing about this research is that these were really healthy people. I mean, they were older folks. They could have had diabetes. They could have had some cardiovascular disease. But they were independently living. They could take care of themselves. They could walk a quarter-mile. They could climb up stairs. These were pretty healthy, older folks.

Interviewer: Right. So not necessarily any other indication that something was wrong, right?

Dr. Raphael: Exactly.

Interviewer: Interesting.

Dr. Raphael: Yep. So I think the next steps are to kind of look into why this cohort had low bicarbonate levels in the first place. Is it an undiagnosed or yet to be determined type of kidney disease or some other underlying lung disease, potentially? Then, I think the next thing also to consider is can we raise the bicarbonate levels in these people with various types of interventions and perhaps improve their outcomes, make them live longer, those sorts of things?

Interviewer: Is there anything else you'd like to add?

Dr. Raphael: The takeaway from this type of research is that we can say that there are associations between bicarbonate levels and outcomes. We can't really say quite yet whether or not people should be changing their diets or taking baking soda. I think that's something that needs to be cautioned against at this point, pending further clinical trials.

But I think if somebody is interested in keeping their bicarbonate levels at a normal range, I think that the safest way to do that is to look at how much fruits and vegetables they eat because fruits and vegetables are a source of bicarbonate, that bicarbonate largely comes from citric acid in fruits and vegetables, which gets converted by the liver into bicarbonate. We all know that fruits and vegetables have great health benefits for lots of other reasons.

One of the cautions about increasing fruits and vegetables in your diet is in people with kidney disease because those have high levels of potassium and that could cause potassium buildup in people with kidney disease. So I think if somebody is thinking about increasing their fruits and vegetables in their diet to keep their bicarbonate levels in a normal range that they should probably check with their doctor to make sure that it's safe.

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Interviewer: Healthiest nation by 2030. That's coming up next, on The Scope.

Announcer: Medical News and research from University of Utah physicians and specialists you can use for a happier and healthier life. You're listening to The Scope.

Interviewer: The American Public Health Association has announced for this year's National Public Health week, the emphasis is healthiest nation by 2030. We're talking to Dr. Kyle Bradford Jones, family physician at the University of Utah. So Dr. Jones, is that even a realistic goal?

Dr. Jones: You know, it's definitely an ambitious goal and it's the type of thing we should be shooting for. But we do face an uphill battle, it's going to take a lot of work. A number of studies have shown that when you look at developed countries, we're the lowest in infant mortality, obesity, heart disease, and what's called Healthy Life Expectancy at age 60, so the number of healthy years you can expect once you're age 60.

When the Commonwealth Fund did a study of 11 developed nations, we came in 11th. When the World Health Organization did a study, which has become quite famous, a number of years ago, we ranked 37th in the world in terms of our health. So we've got a long ways to go.

Interviewer: Even though, I feel like in the minds of most people, that the U.S. is just so high in ranking according to some of our health stats, I mean people come to the United States for health treatments, but that might not actually be the best idea, from the stats you're telling us. We're not doing a very good job.

Dr. Jones: Well we certainly have the best physicians in the world, and a lot of the best hospitals, and the best innovations. The problem is, that doesn't make it to all of our citizens. And part of the reason we're in this position, is because we're not focusing on the right things. So as a family physician, I can only do so much. So we've found that when you look at an individual's entire health, only about 10% of it is impacted by their health care.

Now obviously that's an important 10%, so over about 50% of what goes in towards a person's health has to do with their environment, and that's kind of the element of public health. Of focusing on those things that go around us both culturally as well as things like pollution, that really are the biggest impactors of our health.

Interviewer: So what are some of the methods and ways that we can actually improve our public health care system to reach that healthiest nation goal by 2030?

Dr. Jones: So there are a number of different avenues to do this. Basically it's going to take participation from everyone. If you look at it from the perspective of the health care system, there has been a lot of talk in the last few years about how do you properly bring together primary care and public health because obviously we have very complementary goals. But we each have different ways of going about those goals. So better working together can make a much bigger impact.

If you look at it from the perspective of as our society, we need some policies that focus a little more on health. So, for example, tackling pollution, tackling some of those things that greater impact us. Encouraging, on a local level, exercise and healthy food. So things like putting in bike lanes on local streets that encourage more exercise by citizens.

When you look at it from a business standpoint, a lot of employers are offering wellness plans which encourages better eating, better exercise, encourages people to take better care of themselves. Which leads us to individuals.

What can we do personally, and basically it's all the things that our mothers taught us. Eat your vegetables, have a healthy diet, get your exercise, get as much activity as you can, drink lots of water, avoid junk food. And even things like avoiding distracted driving. So don't text while driving, don't use your phone at all while driving; don't eat. All those things will take us away from that.

So if we're following some of these goals, if we're working towards becoming the healthiest nation by 2030, we're going to have to go about it by many different avenues.

Interviewer: This sounds like a lot of work, but if it's a lot of individual work coming together, like a team.

Dr. Jones: Exactly.

Interviewer: From what you've described so far about the methods and the goals to get there, it seems pretty simple. It seems like we're actually, supposedly, in that state right now but we've been kind of stuck. Why do you think that is?

Dr. Jones: That's true. The answers seem relatively simple, but there's so many cultural changes that we are kind of behind on in addressing some of these health issues. You know, as we know, politically it's hard to get anything done, whether it's logical or not. Individually it's hard to change our behaviors. So it's important for us to try to and work towards that but it's not an easy thing.

Interviewer: So what are some of the things then that we can take away, or we can learn from some of the other developed countries that are actually in higher ranking than we are in relations to public health.

Dr. Jones: It's a great question and something we should be focusing more on. A lot of it has to do with more emphasis by the society and culture on public health, and like we mentioned, more than half of our health has to do with our environment.

A lot of this is cultural. With cultural things in America, we follow a lot of fast food, we do things like that. Whereas in many other countries, they focus a little bit more on eating at home, cooking their food which is obviously a lot healthier. So those are different things we can move towards, here, to help us be healthier.

Interviewer: So do you think this is realistic? Realistically talking, by 2030?

Dr. Jones: Maybe. Like I said, it's going to take a lot of work, but it's an appropriate goal. It's what we should be shooting for.

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Interviewer: One of the three keys to healthy aging, Dr. Kyle Bradford Jones, family physician at the University of Utah will tell you, coming up next on The Scope.

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Interviewer: All right Dr. Jones, so first of all before we get to the three keys to healthy aging, what are the things that can happen to a person as they get older?

Dr. Jones: As we live in the United States, there are specific things that seem to affect our population more. The biggest thing, cardiovascular disease. So, basically, what that means is any disease of the heart or blood vessels. So that's things like heat attacks, strokes, heart failure, things like that. To help prevent those, that's why your doctor is always checking on your weight, your blood pressure, your cholesterol, trying to encourage you to quit smoking. All of those things so that you help prevent the cardiovascular disease.
Another big thing that causes both morbidity and mortality, what we mean by that is morbidity means significant decrease in quality of life; mortality means something that can kill you, is Alzheimer's disease. That's a big one that seems to be rising.

Interviewer: Alzheimer's can kill you?

Dr. Jones: It certainly can, absolutely.

Interviewer: I didn't know that, that's interesting. Okay.

Dr. Jones: It's a form of dementia, but it also comes along with decrease in functioning. So, you're not able to care for yourself as well. But, it has the same risks as cardiovascular disease. So, smoking, diabetes, cardiovascular disease itself puts you at risk for Alzheimer's disease. One thing that worsens all of these things is depression. That's a big one where if you have that, you have worse outcomes with all of the other chronic diseases.

Interviewer: What are the ways to actually prevent all of these health risks from happening to your body? Let's start with number three.

Dr. Jones: So, number three is keeping your relationships active.

Interviewer: Okay.

Dr. Jones: Basically, making sure you have healthy relationships with your significant other, your spouse, children, friends, all of those things, because that, having a good social health really makes a positive impact on any other illnesses that you may have. So, that is a huge key to keep in mind.

Interviewer: Okay, so number two.

Dr. Jones: Number two is keeping your mind active. So, specifically, this can help avoid Alzheimer's disease, but it can also help with other things. So, things that, what we would call cognitive engagement which are basically keeping involved with different puzzles like Sudoku, crossword puzzles, jig saw puzzles. But even just learning something, making sure that you are stimulating your brain just try to learn something new everyday.

Interviewer: Is there something that might be too much for your brain like, I don't know, learning a second language?

Dr. Jones: Not at all.

Interviewer: No, not at all.

Dr. Jones: Not at all. Those are great things that can help keep your mind active.

Interviewer: All right and what is the number one key in keeping yourself healthy as you age?

Dr. Jones: Keeping your body active.

Interviewer: Of course.

Dr. Jones: So, that seems pretty easy, but that is so important. So that's exercise, that's proper diet, making sure that you are eating the right things, drinking lots of water, trying to avoid junk food, soda, things like that. That is the biggest thing that's going to help prevent cardiovascular disease, Alzheimer's, depression as well as other things.

Interviewer: All right, to summarize it up the three keys to aging healthy, number three...

Dr. Jones: Keep your relationships active.

Interviewer: Number two is your brain and your mind active as well.

Dr. Jones: Absolutely.

Interviewer: And, the top key, obviously, is to keep your body healthy.

Dr. Jones: Yes, focus on the exercise and diet.

Interviewer: All right, any other thoughts?

Dr. Jones: So, if you are keeping those things in mind, you're going to age more healthfully. You're going to feel a lot better and you're also going to be happier.

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Dr. Kirtly Parker Jones: America is not the best place in the world to become a mother. Fifteen years ago, the U.S. was number four in the world in terms of newborn and maternal safety, and now we're 31st in the world. The risk of dying in childbirth in the U.S. is now equal to that of Iran. What's happening to mother's and newborns and what could we be doing about this? This is Dr. Kirtly Jones from Obstetrics and Gynecology at University of Utah Healthcare. Today we're going to talk about save motherhood, the scope of the problem. Today on The Scope.

Announcer: Medical news and research from University of Utah physicians and specialists you can use for a happier and healthier life. You're listening to The Scope.

Dr. Kirtly Parker Jones: New reports on women and children show that the U.S. has increasing rates of death and complications due to pregnancy and childbirth especially compared to European countries. The U.S. is among just eight countries in the world to have an increase in maternal mortality, death during pregnancy, delivery, or in the six weeks after delivery. Of course many countries are doing better because they were doing so poorly ten years ago. When you're doing pretty well it's hard to do better, but we are doing worse.
It's very dangerous to be a mother in Somalia. The lifetime chance of a woman dying in childbirth is 1 in 7. Put another way, looking at how women die in Somalia, 1 in 7 die in complications relating to pregnancy. In Finland which is number 1 in the world as the safest place to get through pregnancies, the chance is 1 in 12,000. Somalia 1 in 7. Finland 1 in 12,000. In the U.S. the lifetime risk of dying in pregnancy was 1 in 3700 in 2000, and today it's 1 in 2400. That is 50% higher. Ten years later, 50% higher. That means a woman today is more likely to die from a pregnancy than she is from breast cancer.
So let's look at some reasons, there's been a dramatic increase in the rate of cesarean section in the U.S. Now 30% of babies are born by Cesarean Section, the third highest rate in the world. Having a baby by Cesarean increases the risk of hemorrhage and infection and pulmonary embolism, blood clot to the lungs. It increases the risk of problems in future pregnancies. It also affects the risk of newborn mortality but more about that later. You can see one of my previous blogs on decreasing the rate of cesareans.
More women are having babies later and they may not be in such great health, but that's not where the biggest increase in maternal mortality is noted. The biggest increase in the U.S. is in deaths in women 20 to 24. There are very large disparities in health outcomes in the U.S. compared to countries in the top performers for safety, that's Finland, Norway, Sweden, Iceland, Denmark, Switzerland, you know, those cold places. The U.S. has the largest income disparity in the industrialized nations and the most disparities in access to healthcare.
Now not all moms in the U.S. are getting equal treatment. In Scandinavia where healthcare is universal and almost everyone has access, moms fare very well. That's not the same in the U.S. What's really heartbreaking about being a mother in the U.S. is inequality. In the U.S., 18 mothers died for every 100,000 live births in 2013 which is double the rate of Saudi Arabia and Canada where 7 mothers died per 100,000 live births. The number more than triples for black women in urban America.
Now the rise in obesity in the U.S., in particular morbid obesity, increases the risk of dying in pregnancy, are greater risk of cesarean, greater risk of infection, greater risk of blood clots, and of diabetes.
Lastly but not leastly, at least to me, the U.S. has the highest rate of unplanned pregnancies in the industrialized world. Planning pregnancies gives mom a chance to get medical problems under control and seek healthcare. You can read my bit on cleaning out the incubator. So unplanned pregnancies and pregnancies that happen close together, less than 18 months apart, are more likely to have problems for the mom, and of course, low income women and women with little access to healthcare are more likely to have unplanned pregnancies.
What about the babies? We've made progress in newborn mortality in the past ten years but not much, not nearly as much as other countries. We haven't really made a dent in prematurity which is the biggest cause of newborn mortality. Repeat Cesareans, obesity, and unplanned pregnancy are all risk factors for prematurity and some of the same risk factors for maternal mortality.
We as women, as doctors and citizens have a responsibility to our most vulnerable member society, pregnant women and children. If we had the will, we do have the resources, and we could do more.
Number one, all women should space their babies, plan their pregnancies, make sure they're in good health prior to conception or under medical care, and seek prenatal care.
Number two, all OB/GYNs should take care in not delivering babies too soon unless there's a very good reason and should only do Cesarean Sections for very good reasons.
Number three, all healthcare systems should dictate good practices for deliveries and reach out to their most vulnerable moms.
Number four, the affordable care act had as a goal to get coverage for more women and mandates that insurance cover 100% of prenatal care, maternity care, and contraception, but there's been a lot of push back from industry and political groups. I hope that they're taking a long, hard look at our track record for maternal mortality. A lot of women still don't have healthcare. There is a white ribbon pin for safe motherhood. Check out the White Ribbon Alliance for safe motherhood. We should do better. We can do better.
This is Dr. Kirtly Jones, and thank you for joining us on The Scope.

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Interviewer: You're concerned about the MERS virus. What can you do to protect yourself? It's pretty simple actually. Infectious Disease physician from the University of Utah, Adi Gundlapalli, will talk about that next on The Scope.

Announcer: Medical news and research from University of Utah physicians and specialists you can use for a happier and healthier life. You're listening to The Scope.

Interviewer: How bad of a thing is this MERS?

Dr. Adi Gundlapalli: It's quite scary because they've had several hundred cases reported, and I think the latest they were talking about was about one-third of them died and so it's a pretty high mortality rate in terms of it. This is sort of reminiscent of the SARS outbreak, or the Severe Acute Respiratory Syndrome, in 2003 that caused several thousands of cases around the world. Fortunately, what they've seen is the MERS-Co virus may be less communicable person to person than the SARS was so that may be our saving grace.
As always, in infectious disease/infection control, I think it's very important to go back to the basics. Number one is hand hygiene, or washing your hands. So the buzz word is "hand hygiene." You can do hand hygiene using alcohol-based gel solutions. Sometimes when your hands or soiled or you're dealing with certain types of organisms you have to do soap and water wash.

Interviewer: So even with a virus like this, washing your hands is actually a good weapon against it?

Dr. Adi Gundlapalli: It is a good weapon I think, and the other real good maneuver that helped the world in terms of infection control were isolation precautions. Using what we call personal protective equipment, glove and gown and mask in different combinations for different organisms, is really what helped during SARS and I would think for MERS also it should be and for any other.

Interviewer: It sounds really low tech to me. I kind of want something a little fancier to prevent this from happening.

Dr. Adi Gundlapalli: Well, then maybe we'll charge you more for the very basic preventive ideas. I think back to basics is a good campaign to have.

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