12 December 2018
WEDNESDAY, Dec. 12, 2018 (HealthDay News) — For many obese people, weight loss surgery can be a new lease on life, but too few who qualify for the procedure opt for it. One big reason: The widespread notion that surgery is an “easy way out,” signifying a weakness of willpower to slim down using diet and exercise. Almost 40 percent of nearly a thousand surveyed in a new study thought weight loss surgery (or “bariatric surgery”) was this kind of lazy, quick fix for weight loss. And a “large percentage of the population — nearly 50 percent — think that weight loss surgery is performed for mostly cosmetic reasons,” added lead researcher Dr. Heather Yeo. She’s an assistant professor of surgery at Weill Cornell Medical College in New York City. That’s “unfortunate, as there are clear health implications to obesity, and strong data which support the effectiveness and safety of weight loss surgery,” she said. Yeo believes people need to become aware of the health dangers linked with obesity. “Obesity is a public health epidemic that contributes to mortality and many other health conditions, such as hypertension and diabetes,” Yeo said. “Weight loss surgery has a low rate of complications and also has excellent success.” The patients who want weight loss surgery are not doing it to look better, agreed Dr. Eric DeMaria, president of the American Society for Metabolic and Bariatric Surgery. Mostly, “they want better health,” he said. “The effective treatment for this disease of obesity is bariatric surgery, and 99 percent of the people who could benefit by this treatment aren’t getting it.” But given the stigma around obesity, many patients don’t consider weight loss surgery, DeMaria noted. “You’re almost admitting to being a personal failure as a human being, because you can’t lose weight by yourself,” he said. But that’s a false perception, DeMaria said. Obesity is a complex disease of metabolism. “It’s extremely difficult to treat without assistance of medications or surgery in addition to all the behavioral stuff,” he explained. DeMaria said the surgery is safe and effective. In addition, he noted, “It also treats all the serious medical conditions that accompany obesity and even reverses the risk of premature death.” For the study, Yeo and colleagues asked 948 people throughout the United States about their attitudes on obesity and weight loss surgery. The researchers did find that women were less likely to think the surgery was cosmetic, and more likely to believe it was done for health reasons and not an easy way out. The stigma of obesity is also shared by insurance companies, said Dr. Mitchell Roslin, chief of bariatric surgery at Northern Westchester Hospital in Mount Kisco, N.Y. “We are not operating on patients that we potentially could show the greatest benefit because the insurance process is so rigorous and blames the patient,” he said. But this is just an extension of society’s view that people choose to be obese, Roslin added. “People don’t understand that obese people don’t eat more to become obese, they eat more because they are obese,” he explained. “They have a regulatory disorder, and we blame them for their disease.” Obese people should stop blaming themselves and choose treatments that work, like weight loss surgery, Roslin said. The report was published online Dec. 12 as a research letter in the journal JAMA Surgery. More information For more on weight loss surgery, visit the American Society for Metabolic and Bariatric Surgery.
11 December 2018
TUESDAY, Dec. 11, 2018 (HealthDay News) — The bites of insects, spiders and dogs are a $1 billion yearly drain on the U.S. health care system, a new study has calculated. And climate change is only going to make matters worse, researchers contend. Attacks by mountain lions, bears and alligators get the most press, but the tiniest critters create the most work for emergency room doctors. Bug bites and stings account for more than half of all animal-related trips to the ER, the study authors discovered. Bites from ticks, mosquitoes, fleas and spiders caused 41 percent of animal-related injuries, while another 13 percent of ER visits were prompted by a hornet, wasp or bee sting. “As climate change occurs, their habitat will increase,” said lead researcher Dr. Joseph Forrester, a trauma/critical care fellow at Stanford University in California. “We’ve already seen that with tick populations and mosquito populations. We would anticipate over time more people in traditionally temperate climates will be exposed.” For the study, Forrester and his colleagues reviewed five years of data to examine the extent and cost of animal-related injuries that are treated by emergency doctors. Between 2010 and 2014, nearly 6.5 million people wound up in an emergency department as a result of injuries sustained from creatures great and small. Beside insects, dogs were the next most common cause of injury, with canine bites accounting for 1 in 4 animal-related ER visits. Only 3 percent of people needed hospitalization due to an animal wound, with bites from insects and spiders accounting for a quarter of those admissions. Many of these hospitalizations likely were due to allergic reactions to insect venom, said Dr. Jennifer Stankus, an emergency physician with Madigan Army Medical Center in Tacoma, Wash. “The No. 1 cause for death in the back country is an allergic reaction,” said Stankus, who wasn’t involved with the study. “It’s funny to me how such a small little creature can take you down, but they can.” Another quarter of hospitalizations were due to bites from venomous snakes or lizards, which can be costly to treat, Stankus said. “If you are bitten by a rattlesnake, it requires an anti-venom, and often it requires multiple vials. Each of those vials is $10,000,” Stankus said. Only 1,162 patients in the study — 0.02 percent — died from their injury. Bites accounted for the highest rates of death, by rat (6.5 deaths per 100,000 bites), venomous snake/lizard (6.4/100,000 bites), or dog (6.1/100,000 bites). During the five-year period studied, treating animal-related injuries cost $5.96 billion, or about $1.2 billion per year. This figure is likely an underestimate, researchers said, because it doesn’t include doctors’ fees, outpatient clinic charges, lost productivity or rehabilitation. “We’ve seen our numbers in the emergency department go up as access to primary care physicians goes down,” Stankus said. “Where in the past people would go in on a same-day basis for a wasp sting or a minor dog bite, we now see those cases because people can’t get in to see their primary care doctor.” Dog bites, nonvenomous insect and spider bites, and bites from venomous snakes and lizards accounted for 60 percent of the total costs. The study findings were published Dec. 11 in the journal Trauma Surgery and Acute Care Open. Many bites associated with large animals and snakes can be avoided with a little common sense, Stankus said. “The demographics for a rattlesnake bite is a late-teen/early 20s male having consumed alcohol, on the right index finger,” Stankus said. “It’s typically because a human is antagonizing or messing with that animal.” Dog bites can be avoided by never leaving children unsupervised around dogs, Forrester said. People should not approach unfamiliar dogs, or disturb a dog that is eating, sleeping or caring for puppies. People can avoid insect bites by using insect repellent, wearing long-sleeved shirts and pants to cover exposed skin, and avoiding areas where insects nest, the American College of Emergency Physicians says. These include stagnant pools of water, garbage cans, and places where flowers are in bloom. More information The American College of Emergency Physicians has more about animal bites and stings.
11 December 2018
TUESDAY, Dec. 11, 2018 (HealthDay News) — You’d think vitamin deficiencies would be rare in the United States, but many people are running low on vitamin D, and it’s a serious health threat. Being short on vitamin D not only affects bone density, it’s also been linked to conditions such as heart disease, mental decline, some types of cancer, autoimmune diseases, infectious diseases and type 2 diabetes. The problem is twofold: Not knowing how much vitamin D you really need, and how to get it. While 600 to 800 International Units (IUs) is the recommended daily amount, it can take more than that to bring you up to a healthy level and maintain it once you have a deficit. The body can make vitamin D through sun exposure, but there are many variables, from time of day and the season to your location and your skin color. People with pale skin make vitamin D more quickly than those with darker skin. While there is concern about skin cancer risk, under the right conditions, exposing arms and legs (and your torso when possible) for only a few minutes two to three times a week allows the skin to produce enough vitamin D. Very few foods naturally contain D. Many others are fortified with it, but it’s usually only 100 IUs per serving, making it unlikely that you’ll get even the daily minimum just from diet. An effective strategy may be a combination approach — sensible sun exposure, fortified foods and a supplement. Talk to your doctor about getting the simple blood test that measures your level of vitamin D and the best way to get to — and stay in — the desired range, if necessary. More information Find out more about the importance of vitamin D from the U.S. National Institutes of Health.
10 December 2018
MONDAY, Dec. 10, 2018 (HealthDay News) — In a feat that might help pave the way to restoring hair on patients with skin wounds from burns, injuries or surgery, scientists report regrowing hair on damaged skin in mice. In their experiments with the rodents, the researchers found that activating what’s called the sonic hedgehog cell signaling pathway triggered communication between cells called fibroblasts. These cells secrete collagen, a protein that plays a major role in maintaining the shape and strength of skin and hair. The sonic hedgehog pathway is very active during the early stages of growth in the womb, when hair follicles are formed, but is not active in wounded skin in adults. This may be why hair follicles don’t grow in damaged skin, the researchers said. “Our results show that stimulating fibroblasts through the sonic hedgehog pathway can trigger hair growth not previously seen in wound healing,” said study senior investigator Mayumi Ito. She’s an associate professor in the department of dermatology at NYU Langone Health in New York City. However, animal research frequently doesn’t pan out in humans. It had been believed that as part of the healing process, scarring and collagen buildup in damaged skin prevented hair regrowth. “Now we know that it’s a signaling issue in cells that are very active as we develop in the womb, but less so in mature skin cells as we age,” Ito said in an NYU news release. The team said it will continue its research in an effort to identify possible drug targets for hair regrowth. The study was published recently in the journal Nature Communications. More information The American Academy of Dermatology offers advice on wound care.
10 December 2018
MONDAY, Dec. 10, 2018 (HealthDay News) — Electronic health records are supposed to help doctors, but stress from using them may lead to burnout — and primary care doctors are at greatest risk, new research suggests. “You don’t want your doctor to be burned out or frustrated by the technology that stands between you and them,” said study author Dr. Rebekah Gardner. She’s an associate professor of medicine at Brown University’s Warren Alpert Medical School in Providence, R.I. “In this paper, we show that EHR [electronic health record] stress is associated with burnout, even after controlling for a lot of different demographic and practice characteristics,” she added in a university news release. In the study, Gardner’s team analyzed the responses of nearly 1,800 doctors in Rhode Island who took part in a state health department survey about health information technology-related stress. Of the 91 percent who reported using EHRs, 70 percent reported at least one measure of EHR-related stress. Those measures included frustration with using EHRs, spending time on EHRs while at home, and not having enough time for documentation while at work. Doctors who didn’t have enough time for documentation while at work were 2.8 times more likely to have burnout symptoms than those without that pressure. The other two measures were associated with about a two-times higher risk of burnout symptoms. The researchers also found that all three measures were reported by more than one-third of dermatologists (36 percent) and primary care doctors, including general internists (40 percent), family medicine physicians (37 percent) and pediatricians (34 percent). Nearly 31 percent of hospital medicine specialists reported all three measures. Meanwhile, less than 10 percent of anesthesiologists and radiologists reported all three measures, according to the study. The findings are “a signal to health care organizations that if they’re going to ‘fix’ burnout, one solution is not going to work for all physicians in their organization,” Gardner said. “They need to look at the physicians by specialty and make sure that if they are looking for a technology-related solution, then that’s really the problem in their group,” she concluded. The study was published Dec. 5 in the Journal of the American Medical Informatics Association. More information The U.S. Agency for Healthcare Research and Quality has more on doctor burnout.
05 December 2018
WEDNESDAY, Dec. 5, 2018 (HealthDay News) — A new mint-sized, battery-free patch that alerts wearers to potentially harmful sunlight exposure in real time might become a powerful weapon in preventing skin cancer. Powered by the sun while designed to measure its rays, the patch automatically transmits sun readings to a user’s smartphone. It works wet or dry, is fully reusable, and weighs next to nothing. “In the U.S., we’re in a skin cancer epidemic, which is driven by excessive UV exposure,” noted study author Dr. Steve (Shuai) Xu. He is a dermatology instructor at Northwestern University Feinberg School of Medicine in Chicago. “Thus, this technology would be useful for the majority of individuals by empowering them to know how much UV they are actually getting,” he said. So, what does it look like and how does it work? Xu said the device weighs less than a single tic tac, is half the diameter of a dime, and thinner than a credit card. What’s more, “the devices are virtually indestructible,” said Xu. “We’ve washed them, dunked them in boiling water. They will last forever.” As to function, Xu said a solar-powered sensor embedded in the patch picks up UV, infrared and/or visible light readings, sending exposure numbers wirelessly to the wearer’s smartphone app. Caregivers could also use the patch to monitor blue light phototherapy when treating jaundice (in newborns), psoriasis and/or atopic dermatitis, Xu explained. But the prized benefit is that “we’re able to give actionable, accurate information to the user” about sun exposure in real time, he noted. In fact, his team’s earlier work with a sensor prototype found that nearly two-thirds of patch users got fewer sunburns, while roughly one-third said they wore more sunscreen and looked for more shade. “We’re expecting even better results with this sensor,” Xu said. “It’s more accurate and sensitive than anything else out there.” Xu is also medical director for Northwestern’s Center for Bio-Integrated Electronics. In the study, two outdoor UV patch trials involving more than 10 participants per experiment were conducted in the sunny locales of Rio de Janeiro and St. Petersburg, Fla. In addition, blue light therapy patch trials were conducted in three babies undergoing neonatal care in a hospital setting. The cosmetics company L’Oreal contributed research funding (along with the U.S. National Cancer Institute and the U.S. National Institutes of Health), and has recently launched a UVA-monitoring version of the patch for consumers. On the downside, the trials highlighted a “fundamental limitation” of the patch: Given that not all parts of the body get the same degree of sun exposure, the small detection area of the patch means that readings may not truly represent sun exposure across the full surface of the body. But the results indicated that the patch was easily wearable on those parts of the body that might be of “critical” sun exposure interest, including the shoulders and ears. It could even be placed on a pair of sunglasses, the researchers noted. The findings were published Dec. 5 in the journal Science Translational Medicine. Arielle Grabel, public relations manager for the Skin Cancer Foundation in New York City, pointed to the foundation’s cautionary position statement on the device. The foundation “can’t speak to the technology and reliability of these [wearable] devices,” the statement read. The group also warned “against relying on these devices to determine when to take sun protection measures. Rather, the Skin Cancer Foundation counsels the public to consider sun protection a healthy habit to be practiced daily. This includes seeking shade during peak sun hours, covering up with clothing, hats and sunglasses, and applying sunscreen daily. When spending time outdoors, sunscreen should be reapplied every two hours or immediately after swimming or sweating,” the statement concluded. Each year, there are 5.4 million new cases of basal cell carcinoma and squamous cell carcinoma of the skin in the United States, alongside 178,000 new cases of melanoma, resulting in an estimated 9,000 deaths, the investigators noted. More information There’s more about sun protection at the Skin Cancer Foundation.
05 December 2018
WEDNESDAY, Dec. 5, 2018 (HealthDay News) — Botox has other uses beyond enhancing lips and minimizing facial wrinkles. Scientists now say it may help prevent atrial fibrillation after heart surgery. A-fib — an abnormal heart rhythm — is common after heart surgery, and it’s linked to stroke and heart failure. But two new studies suggest that botox injections during surgery temporarily freeze nerve bundles in the heart, preventing the dangerous complication. In one study, botox injected into the fat pads near each pulmonary vein reduced odds of atrial fibrillation by 64 percent. The effect lasted over three years, long after the botox itself dissipated, said lead researcher Dr. Jonathan Steinberg. “Atrial fibrillation typically lengthens hospital stays and can have complications. Other drugs have been tried, but nothing has come out that is a solid, reliable performer, and there is no standard of care,” said Steinberg. He is director of the SMG Arrhythmia Center at the Summit Medical Group in Short Hills, N.J. In his study, 60 patients undergoing heart bypass surgery were randomly assigned to either botox or an inactive placebo. All received implantable cardiac monitors that tracked occurrence of atrial fibrillation. In the botox group, risk of a-fib dropped immediately after surgery, and fell fivefold to ninefold each year of the three-year follow-up, the researchers found. Also during follow-up, significantly fewer botox recipients were hospitalized for a-fib or needed treatment for it compared to the placebo group. Botox, or botulinum toxin, blocks signals from the nerves to the muscles. It’s a well-known tool in cosmetic surgery, and some doctors use it to treat neurological disorders including migraine, excessive sweating and eye muscle problems. In heart surgery, Steinberg said the drug appears to interrupt “cardiac neural traffic.” He believes the findings suggest a new approach to treatment. In the other study, Dr. Nathan Waldron and colleagues randomly assigned 130 patients to receive an injection of either botox or placebo while undergoing heart bypass surgery. “Injecting botulinum toxin into fat pads surrounding the heart during cardiac surgery may be a promising strategy to reduce atrial fibrillation after cardiac surgery, but further study is needed,” said Waldron, an assistant professor of anesthesiology at Duke University in Durham, N.C. The reduction in a-fib risk among the botox group wasn’t statistically significant — only 11 percent — but the episodes were shorter and less severe, researchers found. This finding may be due to the small size of the study, Waldron’s team said. Dr. Gregg Fonarow is director of the cardiomyopathy center at the University of California, Los Angeles, and co-director of the UCLA preventative cardiology program. Developing effective and safe strategies to lower a-fib risk after surgery has been a challenge, he said. “These new studies, while modest in size, suggest that there is the potential for epicardial fat pad injection of botulinum toxin performed during the cardiac surgery to lower the risk of postoperative atrial fibrillation,” Fonarow said. However, additional studies involving larger numbers of patients are needed, he added. The reports were recently published online in the journal HeartRhythm. More information For more about atrial fibrillation, visit the American Heart Association.
05 December 2018
WEDNESDAY, Dec. 5, 2018 (HealthDay News) — Checking for low hemoglobin in the blood — otherwise known as anemia — usually means drawing blood for testing. But scientists say they’ve developed a wireless smartphone app that does the same by “reading” a quick photo of your fingernail. The app converts fingernail colors into quick readings of blood hemoglobin levels, according to researchers at Emory University in Atlanta. They said the technology could be used by anyone at any time, but its use right now is limited to screening, not a formal diagnosis of anemia. Anemia is a blood condition affecting 2 billion people worldwide. If untreated, it can lead to fatigue, paleness and heart problems. Typical methods of screening for anemia “require external equipment, and represent trade-offs between invasiveness, cost and accuracy,” lead researcher Dr. Wilbur Lam, associate professor of pediatrics, explained in an Emory news release. But the new app has an accuracy that’s “on par with currently available point-of-care tests, without the need to draw blood,” Lam said. The investigators believe the app could be useful for screening pregnant women, women with abnormal menstrual bleeding, or runners and other athletes. Its simplicity also means it could help people in developing countries. The app could be available for download as soon as spring 2019, the researchers said. One member of the development team, Rob Mannino, had a personal stake in the technology’s success. The former biomedical engineering graduate student has an inherited blood disorder called beta-thalassemia. “Treatment for my disease requires monthly blood transfusions,” Mannino explained in the news release. “My doctors would test my hemoglobin levels more if they could, but it’s a hassle for me to get to the hospital in between transfusions to receive this blood test. Instead, my doctors currently have to just estimate when I’m going to need a transfusion, based on my hemoglobin level trends.” In the new study, published Dec. 4 in Nature Communications, Lam’s team used data on 237 people — some anemic, some not — to develop an algorithm that converted fingernail color to represent blood hemoglobin levels. It was then tested on 100 patients and proved highly accurate in people with both dark and light skin tones, the research team said. That’s because the nail bed does not contain melanin, which gives skin its color. The app should enable patients with chronic anemia to monitor themselves to know when they need to adjust their therapies or receive transfusions. This could reduce side effects or complications of having transfusions too early or too late, Lam’s team said. Mannino’s experience proved integral to the research. “This whole project couldn’t have been done by anyone but Rob,” Lam said. “He took pictures of himself before and after transfusions as his hemoglobin levels were changing, which enabled him to constantly refine and tweak his technology on himself in a very efficient manner. So essentially, he was his own perfect initial test subject with each iteration of the app.” One doctor who often treats anemia in children was optimistic about the new technology, with one caveat. Dr. Michael Grosso directs pediatrics at Huntington Hospital in Huntington, N.Y. He agreed that “the availability of a rapid, accurate and non-invasive anemia screening test could have significant benefits.” But he was concerned that the app might miss more subtle forms of anemia. “It turns out that mild iron deficiency can affect the body without triggering anemia, and children in that situation would be missed by the non-invasive test,” Grosso said. “So, the smartphone test definitely falls short of the tried-and-true blood count, but it is better than no test at all.” For their part, Lam and colleagues said further research, conducted with a variety of patient types, is ongoing. That means the app’s sensitivity and accuracy should improve with time. “This is just a snapshot of the accuracy right now,” Lam said. “The algorithm gets smarter with every patient enrolled.” The research was funded in part by the U.S. National Science Foundation and the U.S. National Institutes of Health. Lam and Mannino have filed a patent application for the anemia app, and will have financial interest in its success. More information The U.S. National Heart, Lung, and Blood Institute has more on anemia.
04 December 2018
TUESDAY, Dec. 4, 2018 (HealthDay News) — Exposure to chemicals found in a wide array of personal care products has been linked to early puberty among girls, a new investigation warns. The issue centers on specific chemicals including phthalates, parabens and phenols. They’re found in an array of products, including perfumes, soaps, shampoos, nail polish, cosmetics, toothpaste, lipstick, hairsprays and skin lotions — to name just a few. These chemicals “get into our bodies either by absorption through the skin, by being inhaled, or being ingested [like lipstick],” explained study author Kim Harley. “Once they are in the body, they are quite quickly metabolized and [then] excreted in urine.” Harley is associate director of the Center for Environmental Research and Children’s Health at the University of California, Berkeley. As to how routine exposure to the chemicals might affect puberty, she said they’ve “been shown to mimic estrogen in certain laboratory conditions.” In fact, prior animal studies have suggested that exposure can throw puberty timing out of whack, Harley said. Now, her team found that “the higher the levels of the chemicals in mothers’ or daughters’ bodies, the earlier the puberty” among girls. No such link was found for the timing of male puberty, however. “We were a little surprised that the associations were only with girls and we didn’t see much with boys,” Harley said. “But since these tend to be estrogenic chemicals, it makes sense that they might impact girls.” To explore the issue, investigators analyzed data collected in a study that enrolled pregnant women between 1999 and 2000. The women had blood tests twice throughout their pregnancy, and interviews were also conducted to gauge exposure to the chemicals in question. Nine in 10 of all the urine samples taken from the expectant moms tested positive for chemicals that fall into one of the three chemical classes of concern, with slightly lower percentages (about seven in 10) with respect to a chemical called triclosan. An antimicrobial, triclosan was banned for use in soap by the U.S. Food and Drug Administration in 2017, but it can still be found in some toothpastes, the researchers noted. In the study, the scientists tracked 338 of the women’s offspring through adolescence, with urine samples analyzed at the age of 9. Onset of puberty was then checked regularly between the ages of 9 and 13. The researchers determined that for every doubling of a woman’s blood level of phthalates, the development of her daughter’s pubic hair started 1.3 months earlier than usual. A doubling of a mother’s triclosan levels was also linked to a one-month earlier start of her daughter’s first period, the study found. Blood tests were also take of the children themselves. Harley’s group found that a doubling of paraben levels in girls was linked to the one-month earlier onset of both breast and pubic hair development. Harley stressed that the findings are “definitely not” absolute proof that such chemical exposure actually causes early puberty among girls. “There is always the possibility that there were confounding factors that we were not able to control, or that our findings were due to chance,” she explained. “That said, our findings are consistent with what we know about the endocrine-disrupting properties of these chemicals,” said Harley. “So, although we are not ready to say that early life exposure to these chemicals causes earlier puberty in girls, we have enough evidence to be concerned.” The findings were published in the Dec. 4 issue of the journal Human Reproduction. An industry group said the study had limitations. “Levels were determined in the mothers’ urine by measurement of a single sample at each of two time points during pregnancy. In the children, levels were determined in a single sample taken at age 9,” noted Linda Loretz, chief toxicologist at the Personal Care Products Council. “Patterns of exposure may have varied greatly over the course of pregnancy in the mothers, and between the ages of 9 and 13 in the boys and girls, so the representativeness of the exposure levels is unknown,” she added. “Furthermore, as phthalates, parabens and phenols are all rapidly excreted from the body, measured levels will change not just over months and years, but over the course of a single day, so that any given measurement reflects only a specific moment in time,” she added. Last but not least, “the researchers also acknowledge exposure to other environmental chemicals, such as pesticides encountered during farm working, might also affect the results,” Loretz concluded. But one other expert said the findings aren’t so surprising. Dr. Margaret Cuomo is a board-certified radiologist who formerly served as an attending physician in diagnostic radiology at North Shore University Hospital in Manhasset, N.Y. She said “many previous studies have reported the association between the chemicals that are called ‘endocrine disruptors’ and human health”. As to what consumers can do, Cuomo suggested checking out the website of the watchdog organization Environmental Working Group. There you can “find a list of those products that are relatively safe to use,” meaning products that are free of parabens, phthalates, triclosan and similar chemicals. Cuomo also advised picking household cleaners and detergents are that “environmentally safe,” and opting for organic foods when possible. “States such as California and Washington have laws protecting consumers from harmful chemicals in a variety of products,” she added. “[And] New York is the first state to require disclosure of harmful chemicals by manufacturers of household cleaning agents. Hopefully, New York State’s initiative will be extended soon to include many other consumer products.” More information There’s more on puberty at the U.S. National Institute of Child Health and Human Development.