Personal Health: Too Many Pills in Pregnancy

The thalidomide disaster of the early 1960s left thousands of babies with deformed limbs because their mothers innocently took a sleeping pill thought to be safe during pregnancy,

In its well-publicized wake, countless pregnant women avoided all medications, fearing that any drug they took could jeopardize their babies’ development.

I was terrified in December 1968 when, during the first weeks of my pregnancy, I developed double pneumonia and was treated with antibiotics and codeine. Before swallowing a single dose, I called my obstetrician, who told me to take what was prescribed, “reassuring” me that if I died of pneumonia I wouldn’t have a baby at all.

In the decades that followed, pregnancy-related hazards were linked to many medicinal substances: prescription and over-the-counter drugs and herbal remedies, as well as abused drugs and even some vitamins.

Now, however, the latest findings about drug use during pregnancy have ignited new concerns among experts who monitor the effects of medications on the developing fetus and pregnancy itself.

During the last 30 years, use of prescription drugs during the first trimester of pregnancy, when fetal organs are forming, has grown by more than 60 percent.

About 90 percent of pregnant women take at least one medication, and 70 percent take at least one prescription drug, according to the Centers for Disease Control and Prevention.

Since the late 1970s, the proportion of pregnant women taking four or more medications has more than doubled.

Nearly one woman in 10 takes an herbal remedy during the first trimester.

A growing number of pregnant women, naïvely assuming safety, self-medicate with over-the-counter drugs that were once sold only by prescription.

While many commonly taken medications are considered safe for unborn babies, the Food and Drug Administration estimates that 10 percent or more of birth defects result from medications taken during pregnancy. “We seem to have forgotten as a society that drugs pose risks,” Dr. Allen A. Mitchell, professor of epidemiology and pediatrics at Boston University Schools of Public Health and Medicine, said in an interview. “Many over-the-counter drugs were grandfathered in with no studies of their possible effects during pregnancy.”

Medical progress has contributed to the rising use of medications during pregnancy, Dr. Mitchell said. Various conditions, like depression, are now recognized as diseases that warrant treatment; drugs have been developed to treat conditions for which no treatment was previously available, and some conditions, like Type 2 diabetes and hypertension, have become more prevalent.

Misled by the Web

Now a new concern has surfaced: Bypassing their doctors, more and more women are using the Internet to determine whether the medication they are taking or are about to take is safe for an unborn baby.

A study, published online last month in Pharmacoepidemiology and Drug Safety, of so-called “safe lists for medications in pregnancy” found at 25 Web sites revealed glaring inconsistencies and sometimes false reassurances or alarms based on “inadequate evidence.”

The report was prepared by Cheryl S. Broussard of the Centers for Disease Control and Prevention with co-authors from Emory, Georgia State University, the University of British Columbia and the Food and Drug Administration.

“Among medications approved for use in the U.S.A. from 2000 to 2010, over 79% had no published human data on which to assess teratogenic risk (potential to cause birth defects), and 98% had insufficient published data to characterize such risk,” the authors wrote.

But that did not stop the 25 Web sites from characterizing 245 medications as “safe” for use by pregnant women, which “might encourage use of medications during pregnancy even when they are not necessary,” the authors suggested.

Furthermore, the information found online was sometimes contradictory. “Twenty-two of the products listed as safe by one or more sites were stated not to be safe by one or more of the other sites,” the study found.

The question of timing was often ignored. A drug that could interfere with fetal organ development might be safe to take later in pregnancy. Or one (for example, ibuprofen) that is safe early in pregnancy could become a hazard later if it raises the risk of excessive bleeding or premature delivery.

Fewer than half the sites advised taking medication only when necessary, and only 13 sites encouraged pregnant women to consult their doctors before stopping or starting a medication.

Doctors, too, are often poorly informed about pregnancy-related hazards of various medications, the authors noted. One woman I know was advised to wean off an antidepressant before she became pregnant, but another was told to continue taking the same drug throughout her pregnancy.

“In many instances the best bet is for mom to stay on her medication,” said Dr. Siobhan M. Dolan, an obstetrician and geneticist at Albert Einstein College of Medicine. She said that if a woman is depressed during pregnancy, her risk of postpartum depression is greater and she may have difficulty bonding with her baby.

Dr. Dolan, who is author, with Alice Lesch Kelly, of the March of Dimes’ newest book, “Healthy Mom Healthy Baby,” emphasized the importance of weighing benefits and risks in deciding whether to take medication during pregnancy and which drugs to take.

“In anticipation of pregnancy, a woman taking more than one drug to treat her condition should try to get down to a single agent,” Dr. Dolan said in an interview. “Of the various medications available to treat a condition, is there a best choice — one least likely to cause a problem for either the baby or the mother?”

She cautioned against sharing medications prescribed for someone else and assuming that a remedy labeled “natural” or “herbal” is safe. Virtually none have been tested for safety in pregnancy.

Among medications a woman should be certain to avoid, in some cases starting three months before becoming pregnant, are isotretinoin (Accutane and others) for acne; valproic acid for seizure disorders; lithium for bipolar disorder; tetracycline for infections, and angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor antagonists for hypertension, Dr. Dolan said.

“Many medications that are not recommended during pregnancy can be replaced with low-risk alternatives,” she wrote.

Dr. Broussard, who did the “safe lists” study, said in an interview, “We’ve heard about women seeing medications on these lists and deciding on their own that it’s O.K. to take them. “Women who are pregnant or even thinking about getting pregnant should talk directly to their doctors before taking anything. They should be sure they’re taking only what’s necessary for their health condition.”

A reliable online resource for both women and their doctors, Dr. Mitchell said, are fact sheets prepared by OTIS, the Organization of Teratology Information Specialists, which are continually updated as new facts become available: http://www.otispregnancy.org.

Read More..

Personal Health: Too Many Pills in Pregnancy

The thalidomide disaster of the early 1960s left thousands of babies with deformed limbs because their mothers innocently took a sleeping pill thought to be safe during pregnancy,

In its well-publicized wake, countless pregnant women avoided all medications, fearing that any drug they took could jeopardize their babies’ development.

I was terrified in December 1968 when, during the first weeks of my pregnancy, I developed double pneumonia and was treated with antibiotics and codeine. Before swallowing a single dose, I called my obstetrician, who told me to take what was prescribed, “reassuring” me that if I died of pneumonia I wouldn’t have a baby at all.

In the decades that followed, pregnancy-related hazards were linked to many medicinal substances: prescription and over-the-counter drugs and herbal remedies, as well as abused drugs and even some vitamins.

Now, however, the latest findings about drug use during pregnancy have ignited new concerns among experts who monitor the effects of medications on the developing fetus and pregnancy itself.

During the last 30 years, use of prescription drugs during the first trimester of pregnancy, when fetal organs are forming, has grown by more than 60 percent.

About 90 percent of pregnant women take at least one medication, and 70 percent take at least one prescription drug, according to the Centers for Disease Control and Prevention.

Since the late 1970s, the proportion of pregnant women taking four or more medications has more than doubled.

Nearly one woman in 10 takes an herbal remedy during the first trimester.

A growing number of pregnant women, naïvely assuming safety, self-medicate with over-the-counter drugs that were once sold only by prescription.

While many commonly taken medications are considered safe for unborn babies, the Food and Drug Administration estimates that 10 percent or more of birth defects result from medications taken during pregnancy. “We seem to have forgotten as a society that drugs pose risks,” Dr. Allen A. Mitchell, professor of epidemiology and pediatrics at Boston University Schools of Public Health and Medicine, said in an interview. “Many over-the-counter drugs were grandfathered in with no studies of their possible effects during pregnancy.”

Medical progress has contributed to the rising use of medications during pregnancy, Dr. Mitchell said. Various conditions, like depression, are now recognized as diseases that warrant treatment; drugs have been developed to treat conditions for which no treatment was previously available, and some conditions, like Type 2 diabetes and hypertension, have become more prevalent.

Misled by the Web

Now a new concern has surfaced: Bypassing their doctors, more and more women are using the Internet to determine whether the medication they are taking or are about to take is safe for an unborn baby.

A study, published online last month in Pharmacoepidemiology and Drug Safety, of so-called “safe lists for medications in pregnancy” found at 25 Web sites revealed glaring inconsistencies and sometimes false reassurances or alarms based on “inadequate evidence.”

The report was prepared by Cheryl S. Broussard of the Centers for Disease Control and Prevention with co-authors from Emory, Georgia State University, the University of British Columbia and the Food and Drug Administration.

“Among medications approved for use in the U.S.A. from 2000 to 2010, over 79% had no published human data on which to assess teratogenic risk (potential to cause birth defects), and 98% had insufficient published data to characterize such risk,” the authors wrote.

But that did not stop the 25 Web sites from characterizing 245 medications as “safe” for use by pregnant women, which “might encourage use of medications during pregnancy even when they are not necessary,” the authors suggested.

Furthermore, the information found online was sometimes contradictory. “Twenty-two of the products listed as safe by one or more sites were stated not to be safe by one or more of the other sites,” the study found.

The question of timing was often ignored. A drug that could interfere with fetal organ development might be safe to take later in pregnancy. Or one (for example, ibuprofen) that is safe early in pregnancy could become a hazard later if it raises the risk of excessive bleeding or premature delivery.

Fewer than half the sites advised taking medication only when necessary, and only 13 sites encouraged pregnant women to consult their doctors before stopping or starting a medication.

Doctors, too, are often poorly informed about pregnancy-related hazards of various medications, the authors noted. One woman I know was advised to wean off an antidepressant before she became pregnant, but another was told to continue taking the same drug throughout her pregnancy.

“In many instances the best bet is for mom to stay on her medication,” said Dr. Siobhan M. Dolan, an obstetrician and geneticist at Albert Einstein College of Medicine. She said that if a woman is depressed during pregnancy, her risk of postpartum depression is greater and she may have difficulty bonding with her baby.

Dr. Dolan, who is author, with Alice Lesch Kelly, of the March of Dimes’ newest book, “Healthy Mom Healthy Baby,” emphasized the importance of weighing benefits and risks in deciding whether to take medication during pregnancy and which drugs to take.

“In anticipation of pregnancy, a woman taking more than one drug to treat her condition should try to get down to a single agent,” Dr. Dolan said in an interview. “Of the various medications available to treat a condition, is there a best choice — one least likely to cause a problem for either the baby or the mother?”

She cautioned against sharing medications prescribed for someone else and assuming that a remedy labeled “natural” or “herbal” is safe. Virtually none have been tested for safety in pregnancy.

Among medications a woman should be certain to avoid, in some cases starting three months before becoming pregnant, are isotretinoin (Accutane and others) for acne; valproic acid for seizure disorders; lithium for bipolar disorder; tetracycline for infections, and angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor antagonists for hypertension, Dr. Dolan said.

“Many medications that are not recommended during pregnancy can be replaced with low-risk alternatives,” she wrote.

Dr. Broussard, who did the “safe lists” study, said in an interview, “We’ve heard about women seeing medications on these lists and deciding on their own that it’s O.K. to take them. “Women who are pregnant or even thinking about getting pregnant should talk directly to their doctors before taking anything. They should be sure they’re taking only what’s necessary for their health condition.”

A reliable online resource for both women and their doctors, Dr. Mitchell said, are fact sheets prepared by OTIS, the Organization of Teratology Information Specialists, which are continually updated as new facts become available: http://www.otispregnancy.org.

Read More..

Shell Suspends Arctic Drilling for 2013

WASHINGTON — Royal Dutch Shell, after a series of costly and embarrassing accidents in its efforts to drill exploratory wells off the north coast of Alaska last year, announced on Wednesday that it would not return to the Arctic in 2013.

The company’s two drill ships suffered serious accidents as they were leaving drilling sites in the Beaufort and Chukchi Seas last fall and winter and are being sent to Asia for repairs. Shell acknowledged in a statement that the ships would not be fixed in time to drill during the short summer window this year.

“Our decision to pause in 2013 will give us time to ensure the readiness of all our equipment and people,” said Marvin E. Odum, president of Shell Oil Company.

He said Arctic offshore drilling was a long-term project that the company would continue to pursue.

The Interior Department, the Coast Guard and the Justice Department are reviewing Shell’s operations, which have included groundings, environmental and safety violations, weather delays, the collapse of its spill-containment equipment and other failures.

The setbacks come after Shell has invested more than $4.5 billion in leases and equipment and spent several years on an intensive lobbying campaign to persuade federal officials that it could drill safely in the unforgiving waters of the Arctic Ocean. Shell now acknowledges that the venture has been much more difficult than it anticipated.

Shell had planned to drill as many as 10 wells in 2012 but was able to start only two. Federal regulators barred the company from drilling into oil-bearing formations because it did not have adequate spill prevention and cleanup equipment available.

“This is not a surprise, as Shell has had numerous serious problems in getting to and from the Arctic, as well as problems operating in the Arctic,” said Lois N. Epstein, Arctic program director for the Wilderness Society and a member of the Interior Department panel reviewing Shell’s operations. “Shell’s managers have not been straight with the American public, and possibly even with its own investors, on how difficult its Arctic Ocean operations have been this past year.”

Both ships involved in the drilling, the Noble Discoverer and the Kulluk, suffered serious accidents while moving to or from the oil fields. In addition, Coast Guard inspectors found numerous violations on the Discoverer and have referred the matter to federal prosecutors for investigation.

Shell executives said the Kulluk had sustained damage to its hull when it was grounded in a fierce storm on tiny Sitkalidak Island in late December. Seawater also caused electrical damage.

They said the propulsion systems on the Noble Discoverer required maintenance and might need to be replaced for the ship to be seaworthy and pass Coast Guard inspections.

The Noble Discoverer dragged its anchor last July and nearly ran aground on the Alaska coast, and four months later it was damaged by an explosion and fire while in port in the Aleutian Islands.

Senator Lisa Murkowski, Republican of Alaska, a strong proponent of Arctic oil exploration, said the delay would ensure that drilling could proceed safely in the future.

“This pause — and it is only a pause in a multiyear drilling program that will ultimately provide great benefits both to the state of Alaska and the nation as a whole — is necessary for Shell to repair its ships and make the necessary updates to its exploration plans that will ensure a safe return to exploration soon,” Ms. Murkowski said in a statement.

Michael LeVine, senior Pacific counsel for the environmental advocacy group Oceana, said that Shell and the federal authorities who permitted it to begin drilling needed to think carefully about whether it would ever be safe to resume.

“The decisions to allow Shell to operate in the Arctic Ocean clearly were premature,” Mr. LeVine wrote in an e-mail. “The company is not prepared and has absolutely no one but itself to blame for its failures.”

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Immigrants Released Ahead of Automatic Budget Cuts

In a highly unusual move, federal immigration officials have released hundreds of detainees from immigration detention centers around the country, an effort to save money as automatic budget cuts loom in Washington, officials said Tuesday.

The government has not dropped the deportation cases against the immigrants, however. The detainees have been freed on supervised release while their cases continue in court, officials said.

But the move angered some Republicans, including Rep. Robert W. Goodlatte of Virginia, chairman of the House Judiciary Committee, who said the releases were a political gambit by the Obama administration that undermined the continuing negotiations over comprehensive immigration reform and jeopardized public safety.

“It’s abhorrent that President Obama is releasing criminals into our communities to promote his political agenda on sequestration,” said Mr. Goodlatte, who is running the House hearings on immigration reform. “By releasing criminal immigrants onto the streets, the administration is needlessly endangering American lives.”

While administration officials did not explain how they selected detainees for release, they suggested that the population did not include immigrants who were the focus of the administration’s stated enforcement priorities, including those convicted of serious crimes.

“Priority for detention remains on serious crminal offenders and other individuals who pose a significant threat to public safety,” said Gillian M. Christensen, a spokeswoman for Immigration and Customs Enforcement, or ICE, an arm of the Department of Homeland Security.

The releases, which began several days ago and continued on Tuesday, were intended “to make the best use of our limited detention resources in the current fiscal climate,” Ms. Christensen said. “As fiscal uncertainty remains over the continuing resolution and possible sequestration, ICE has reviewed its detained population to ensure detention levels stay within ICE’s current budget.”

The government-wide budget cuts, known as the sequester, are scheduled to take effect on Friday. Immigration officials declined to say whether they intended to make any further cutbacks in detention programs this week.

The agency, Ms. Christensen added, “is continuing to prosecute their cases in immigration court and, when ordered, will seek their removal from the country.”

Officials did not reveal precisely how many detainees were released or where the releases took place, but immigrants’ advocates around the country have been reporting that hundreds of detainees were freed in numerous locations, including Hudson County, N.J.; Polk County, Texas; Broward County, Fla.; and New Orleans; and from centers in Arizona, Alabama, Georgia and New York.

While immigration officials occasionally free detainees on supervised release, this mass release — so many in such a short span of time — appears to be unprecedented in recent memory, immigration advocates said.

Under supervised release, defendants in immigration cases have to adhere to a strict reporting schedule that might include attending appointments at their regional ICE office as well as electronic monitoring, immigration officials said.

Immigrants’ advocacy groups, citing the cost of detaining immigrants, have for years argued that the federal government should make greater use of practical and less expensive alternatives to detention for low-risk defendants being held on administrative charges.

The National Immigration Forum estimated last year that it cost the federal government between $122 and $164 per day to hold a detainee in its immigration system. In contrast, the organization said, alternative forms of detention could cost 30 cents to $14 per day per immigrant.

Advocacy groups applauded the releases but pressed the Obama administration to do more, including adhering more closely to its declared enforcement priorities like focusing on serious criminals and those who pose a threat to public safety, rather than immigrants accused of misdemeanors and administrative immigration violations.

“It shouldn’t take a manufactured crisis in Washington to prompt our immigration agencies to actually take steps towards using government resources wisely or keeping families together,” said Carolina Canizales, a leader of United We Dream, the nation’s largest organization of young illegal immigrants.

At a White House news briefing on Monday, Janet Napolitano, Homeland Security secretary, seemed to hint at the move. “All I can say is, look, we’re doing our very best to minimize the impacts of sequester,” she told reporters. “But there’s only so much I can do. I’m supposed to have 34,000 detention beds for immigration. How do I pay for those?”

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Gadgetwise Blog: Measuring Your Health With Jawbone’s Up

The Up band, made by Jawbone, is an electronic bracelet that helps you log your activities, eating and rest, and it can record an awful lot of data. But the more detailed the data you want, the more work you’ll have to do to get it.

Up, costing $130, is the technological cousin of devices like the Striiv, Fitbit, and Fit Link, among others, which range in list price from $70 to $150. The idea is that measuring your activities, what you eat and how much you sleep will help you develop a healthier lifestyle and stick to it.

The Up band is available in seven colors and is worn loosely on the wrist. Initially it got in the way when I typed, but I got used to sliding it up my sleeve at the keyboard.

It has one feature not found in the others mentioned above — a vibration motor. You can set the band to remind you with a vibration to get up and walk around if you’ve been at the desk too long. Or set it as an alarm to buzz you awake in the morning.

The food logging also worked quite well for me, The bar-code scanner correctly recorded all of the food I tried  — often not the case with other devices — but as with any food log, if you want precision, you have to type in every ingredient in a meal. It can take longer to enter what you ate than to eat it.

Also, as with all these kinds of devices, it can recognize and count your steps, but unlike some of the others, the Up band cannot tell the difference between walking, running or going up stairs. Exercise like bicycling or weight lifting has to be manually entered.

To monitor your sleep, you have to remember to press a button that sets the band to sleep mode; I sometimes forgot to do this. You switch back when you wake, although after 25 or so steps, Up will change to wake mode itself.

The social component lets you post selected statistics to Facebook and Twitter, or share privately with other Up users you pick. The camaraderie (or competition) is a big help in achieving a goal.

Plug the band into an iPhone with the Up app to see colorful charts of your progress, share results and see suggestions based on your performance. The band lasts about 10 days on a charge and can even be worn in the shower, though not while swimming.

The Up band is not really for the devoted athlete, and it’s not quite as simple as some other devices, but for the modestly active who would like to be more so, the Up band can keep track when you make tracks.

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Recipes for Health: Roasted Carrots and Scallions — Recipes for Health

Andrew Scrivani for The New York Times

I bought incredibly sweet, thick red scallions and multicolored bunches of carrots from a farmer at my market and roasted them with fresh thyme. Then I sprinkled on some crushed toasted hazelnuts, which contributed a nice crunchy texture and nutty finish to the dish. If you have a bottle of hazelnut oil or walnut oil on hand, a small drizzle just before serving is a welcome touch.

1 ounce hazelnuts (about 1/4 cup)

1 pound carrots, preferably young small carrots, any color (but a mix is nice)

1 bunch white or purple spring onions or scallions

Salt and freshly ground pepper

2 teaspoons fresh thyme leaves

2 tablespoons extra virgin olive oil

Optional: a drizzle of hazelnut oil or walnut oil for serving

1. Preheat the oven to 325 degrees. Place the hazelnuts on a baking sheet and roast for 8 to 10 minutes, until they smell toasty and they are golden all the way through (cut one in half to check). Remove from the oven and turn up the heat to 425 degrees.

2. Immediately wrap the hazelnuts in a clean, dry dish towel. Rub them in the towel to remove the skins. Then place the skinned hazelnuts in a plastic bag or, if you have one, a disposable pastry bag and set on your work table in one layer. Use a rolling pin to crush the nuts by rolling over them with the pin. Set aside.

3. Line a sheet pan with parchment or oil a baking dish large enough to fit all of the vegetables in a single layer. If the carrots are small, just peel and trim the tops and bottoms. If they are medium-sized, peel, cut in half and cut into 4-inch lengths. Quarter large carrots and cut into 4-inch lengths. Trim the root ends and greens from the spring onions or scallions. If they are bulbous, cut them in half. Season with salt and pepper, add the thyme and olive oil and toss well, either directly on the pan or in the dish or in a bowl. Spread in an even layer in the baking dish or on the baking sheet.

4. Roast in the oven for 20 to 30 minutes, stirring every 10 minutes. The onions may be done after 10 minutes – they should be soft and lightly browned. Remove them from the pan if they are and hold on a plate. When the carrots and onions are tender and browned in places, remove from the oven. Add the onions back into the mix if you removed them and toss together. Sprinkle on the toasted ground hazelnuts, drizzle on the optional nut oil, and serve.

Yield: Serves 4

Advance preparation: The vegetables can hold for a few hours once roasted; cover and reheat in a medium oven.

Nutritional information per serving: 171 calories; 11 grams fat; 1 gram saturated fat; 1 gram polyunsaturated fat; 8 grams monounsaturated fat; 0 milligrams cholesterol; 16 grams carbohydrates; 6 grams dietary fiber; 89 milligrams sodium (does not include salt to taste); 2 grams protein

Martha Rose Shulman is the author of “The Very Best of Recipes for Health.”

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Recipes for Health: Roasted Carrots and Scallions — Recipes for Health

Andrew Scrivani for The New York Times

I bought incredibly sweet, thick red scallions and multicolored bunches of carrots from a farmer at my market and roasted them with fresh thyme. Then I sprinkled on some crushed toasted hazelnuts, which contributed a nice crunchy texture and nutty finish to the dish. If you have a bottle of hazelnut oil or walnut oil on hand, a small drizzle just before serving is a welcome touch.

1 ounce hazelnuts (about 1/4 cup)

1 pound carrots, preferably young small carrots, any color (but a mix is nice)

1 bunch white or purple spring onions or scallions

Salt and freshly ground pepper

2 teaspoons fresh thyme leaves

2 tablespoons extra virgin olive oil

Optional: a drizzle of hazelnut oil or walnut oil for serving

1. Preheat the oven to 325 degrees. Place the hazelnuts on a baking sheet and roast for 8 to 10 minutes, until they smell toasty and they are golden all the way through (cut one in half to check). Remove from the oven and turn up the heat to 425 degrees.

2. Immediately wrap the hazelnuts in a clean, dry dish towel. Rub them in the towel to remove the skins. Then place the skinned hazelnuts in a plastic bag or, if you have one, a disposable pastry bag and set on your work table in one layer. Use a rolling pin to crush the nuts by rolling over them with the pin. Set aside.

3. Line a sheet pan with parchment or oil a baking dish large enough to fit all of the vegetables in a single layer. If the carrots are small, just peel and trim the tops and bottoms. If they are medium-sized, peel, cut in half and cut into 4-inch lengths. Quarter large carrots and cut into 4-inch lengths. Trim the root ends and greens from the spring onions or scallions. If they are bulbous, cut them in half. Season with salt and pepper, add the thyme and olive oil and toss well, either directly on the pan or in the dish or in a bowl. Spread in an even layer in the baking dish or on the baking sheet.

4. Roast in the oven for 20 to 30 minutes, stirring every 10 minutes. The onions may be done after 10 minutes – they should be soft and lightly browned. Remove them from the pan if they are and hold on a plate. When the carrots and onions are tender and browned in places, remove from the oven. Add the onions back into the mix if you removed them and toss together. Sprinkle on the toasted ground hazelnuts, drizzle on the optional nut oil, and serve.

Yield: Serves 4

Advance preparation: The vegetables can hold for a few hours once roasted; cover and reheat in a medium oven.

Nutritional information per serving: 171 calories; 11 grams fat; 1 gram saturated fat; 1 gram polyunsaturated fat; 8 grams monounsaturated fat; 0 milligrams cholesterol; 16 grams carbohydrates; 6 grams dietary fiber; 89 milligrams sodium (does not include salt to taste); 2 grams protein

Martha Rose Shulman is the author of “The Very Best of Recipes for Health.”

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News Analysis: Italian Deadlock Rekindles Anxiety About Euro Zone

ROME — The political gridlock in Italy revives a question that hasn’t been heard lately: Is the euro zone crisis really over?

Judging by the panic that seized financial markets on Monday, and carried over into European stock and bond trading Tuesday, the answer seems to be no.

After months of calm, investors are jittery not only because Italy, once again, seems to have once again become ungovernable after an inconclusive political election. It is also because voters in the euro zone’s third-largest economy — after Germany and France — soundly repudiated government austerity policies that the region’s leaders have long embraced but that have hampered growth in Italy and elsewhere in the euro currency union.

By supporting a protest-vote candidate, the comedian Beppe Grillo, and backing the return of former prime minister Silvio Berlusconi, who has vowed to reject austerity, Italians appear to be embracing a return to nationalism, experts say.

Swept aside by the Italian elections was the technocratic government led for the past 13 months by Mario Monti, who has been crucial to an unwritten accord: The European Central Bank promised to help contain the financial contagion that was threatening the euro zone as long as political leaders like him made headway in improving their economies.

The upheaval in Italy means that other euro zone leaders may no longer have a reliable partner in the drive to create a more durable currency union, and that Rome’s voice in European policy making will be diminished, for now at least.

“This brings back all the political risk issues” that had seemed to fade from the euro zone, said Jacob Funk Kirkegaard, a senior fellow at the Peterson Institute for International Economics in Washington.

To be sure, Europe’s debt crisis is not nearly as dire as it once was. Even though Italy’s borrowing costs, as measured by its 10-year bond yield, hit a three-month high on Tuesday of nearly 4.9 percent, that is still nowhere near the 6.5 percent danger zone of last summer.

And despite renewed fears of instability, no one is talking about a breakup of the euro zone — as might have happened last year if such political uncertainty had beset one of Europe’s most crucial economies. The newfound stability follows a shift in sentiment that took hold last autumn after European politicians, led by Chancellor Angela Merkel of Germany, made clear that the euro union is here to stay — no matter what.

Experts said the vote served as a warning shot that a new round of political instability could be coming in the neighboring large economies of Spain and France, whose leaders have also adopted austerity programs to keep the euro debt crisis from engulfing their economies — despite concerns that the programs are impeding the economic rebound that might help them grow their way out of financial distress.

With Italy sidelined and France and Spain weakened, Germany will very likely be even more dominant in European policy forums. Ms. Merkel may be tempted to talk even tougher with weaker euro zone members. And facing elections herself in the fall, she may be less willing to commit German taxpayer money to holding together the currency union.

“We are going to have six or nine months of Italy being absent, which leaves Germany as dominant as ever,” Mr. Kirkegaard said. “For the rest of the year Germany is primus inter pares.”

Perhaps more significant is the role of the European Central Bank, in this period of renewed euro zone uncertainty. The E.C.B. rode in as a white knight last September by agreeing to buy large amounts of bonds from countries with shaky finances, including Italy, to calm a contagion of fear then sweeping the euro zone. The E.C.B., run by Italy’s former central banker, Mario Draghi, vowed to do “whatever it takes” to hold the euro union together.

The issue now, experts say, is that Mr. Draghi’s promise was based on a quid pro quo with euro zone governments. If countries agreed to conditions designed to make their economies perform better, the E.C.B. would buy their bonds to hold down market interest rates.

So far, the E.C.B. has not bought any bonds. The mere commitment to do so has been enough to reassure international markets. But Italy’s new political turmoil might now prompt investors to test the E.C.B.’s resolve. If so, many experts doubt whether the bond-buying program is workable — for Italy at least.

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Lens Blog: The Largely Unknown Photography of Lola Álvarez Bravo

The year 2007 was a pretty good one for rediscovering long-forgotten images in Mexico. Most people already know about Robert Capa’s Mexican suitcase, a trove of his work from the Spanish Civil War. But that same year an unknown archive of vintage prints by Mexico’s greatest photographers was also discovered, left behind in the longtime home of Lola Álvarez Bravo.

The find, known as the Gonzalez-Rendon archive, had prints and original photomontages by Lola, as well as some beautifully printed images by Manuel Álvarez Bravo, to whom she had been married for several years. The find also included work by some of Lola’s students who had gone on to become noted photographers, Mariana Yampolsky and Raul Conde, among them.

Though overshadowed by her more famous partner, who had resisted her foray into photography, Lola ranks among Mexico’s most celebrated photographers, having done portraits of fellow artists and intellectuals as well as work among the indigenous and poor, whom she portrayed with a sense of compassion and social criticism. Her images provide a window in what she — a working photographer and teacher most of her life — valued as an artistic statement.

“It’s what an art historian dreams about, finding the missing pieces,” said James Oles, a lecturer at Wellesley College who was among the first to inspect the images in Mexico. “The material fleshes out some aspects of her work, giving us original titles and dates that radically change the meaning and interpretation of a work of art. And the original photomontages give an idea how she created them.”

Born Dolores Concepcion Martinez in 1903, she grew up in a wealthy family, although she had to move in with relatives when her father died. She first met Manuel in her youth, marrying him in 1925. As an accountant, he was sent to work in Oaxaca, where the couple began to take pictures, Mr. Oles wrote in his recently published book, “Lola Álvarez Bravo and the Photography of an Era.”

The area’s poverty struck her, and it elicited a compassion in her work that was different from her husband’s more complex images.

“Lola was maybe a little more natural,” Mr. Oles said. “She was interested in more candid and less intrusive images. She was certainly more interested in people than things.”

The couple separated in 1934, divorcing in 1949. Throughout, she kept his name and did not remarry. She supported herself as a photographer working for government agencies, as well as teaching, where she influenced many.

“I think Lola was a remarkable photographer, especially given all the challenges she faced,” said Elizabeth Ferrer, who published “Lola Álvarez Bravo” with Aperture. “There were women artists, though women were not supposed to be working in the street but in the studio. But the kind of photography done at the time involved a greater public interface, and the fact that she did that showed her incredible strength and desire to photograph the world around her.”

Although she found her own path apart from her more famous husband — she was more gregarious, enjoying the company of artists, writers and intellectuals — work and circumstance worked against her. It was not until the 1980s, Mr. Oles said, that her work as an artist came to the fore.

Mr. Oles visited her in the early 1990s, around the time when the Center for Creative Photography at the University of Arizona acquired an archive of her work. Lola was moved by her son to another apartment, and she died in 1993.

Fourteen years later, Mr. Oles got a call from a museum in Mexico City. Relatives of one of Lola’s friends, who had purchased her old apartment, had been safeguarding several boxes that had been left behind. One of them had taken the time to preserve and order the prints.

“She didn’t sell anything or have it framed in her apartment, but just organized it,” Mr. Oles said. “When I went there, it was amazing. It showed what had been separated at some time by Lola, and God knows when or why, there were a lot of her own photos. Many were by students of hers as well as a group of extraordinary vintage photos by Manuel Álvarez Bravo.”

Her photos — including some vintage prints that were exhibited in Philadelphia in 1943 — shed new light on her work. In some cases, original titles gave new meaning to old images. One shot of an indigenous woman seated against a wrought-iron fence that had long been titled “By the Fault of Others” turned out to have “Death Penalty” (Slide 6) as its original title.

“That changes how we interpret this photo of this woman who looks trapped by this grille,” Mr. Oles said. “You can go into the archive of any major photographer and find images they never printed and exhibit them after their death without knowing what they mean. Finding this material tells us these are the photos she chose which she thought were the key images that she was interested in during that era.”

While her photomontages are well known, the archive has the originals, which she made by gluing together cut-out images she would later photograph for the final montage.

“In Mexico, photomontage was mainly a strategy of media and advertising, not an artistic project,” Mr. Oles said. “What Lola was trying to do was elevate it to the realm of high art and view it as equivalent to muralism. The multiple perspectives of photomontage and the fragmented images resolved into a whole are what a muralist like Diego Rivera does when he shows multiple perspectives of a factory and resolving them together. Lola understood that.”

Among the greatest finds in the archive are works by her students. Even in death, though, Lola’s own images prove to affect a current generation. Mr. Oles said her photos of prostitutes, titled “Triptych of the Martyrs,” has a powerful element of feminist criticism.

“Their faces are obscured with wound-like shadows,” he said. “There is this undercurrent of social critique. Whenever my students see those pictures, they are moved sometimes to the point of tears. I don’t think any of Manuel Álvarez Bravos’s photos move them to tears.”

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The exhibit “Lola Álvarez Bravo and the Photography of an Era” will be on view at the Center for Creative Photography in Tucson from March 30 through June 23.

Follow @dgbxny and @nytimesphoto on Twitter. Lens is also on Facebook.

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HTC Settles F.T.C. Charges Over Security Flaws in Devices

WASHINGTON — More than 18 million smartphones and other mobile devices made by HTC, a Taiwanese company that is one of the largest sellers of smartphones in the United States, had security flaws that could allow location tracking of users against their will and the theft of personal information stored on their phones, federal officials said Friday.

The Federal Trade Commission charged HTC with customizing the software on its Android- and Windows-based phones in ways that let third-party applications install software that could steal personal information, surreptitiously send text messages or enable the device’s microphone to record the user’s phone calls.

The action is the first attempt by the commission to police a manufacturer of mobile devices. As smartphones and tablets become a common way for consumers to shop, bank and chat online, personal information and privacy will need to be guarded.

HTC America, based in Bellevue, Wash., agreed to settle the civil suit with the commission by issuing software patches that close the security holes, and by creating a security program that will be monitored by an independent party for the next 20 years. The F.T.C. does not have the authority to assess fines in consumer protection cases.

“The company didn’t design its products with security in mind,” Lesley Fair, a senior lawyer in the commission’s Bureau of Consumer Protection, wrote in a blog post. “HTC didn’t test the software on its mobile devices for potential security vulnerabilities, didn’t follow commonly accepted secure coding practices and didn’t even respond when warned about the flaws in its devices.”

An HTC official said Friday that the company had already started to update its software and distribute it to users of some, but not all, of the affected phones.

“Working with our carrier partners, we have addressed the identified security vulnerabilities on the majority of devices in the U.S. released after December 2010,” Sally Julien, an HTC spokeswoman, said in a statement. “We’re working to roll out the remaining software updates now and recommend customers download them once available.”

“Privacy and security are important,” the statement added, “and we are committed to improving practices that help safeguard our customers’ devices and data.”

The trade commission charged that the security flaws resulted from HTC’s modifying the operating system software used on most of the affected phones. In the case of Android, created by Google, the system is designed to protect sensitive information and phone functions through what is known as a permission-based security model.

That requires a user, when installing an application that is not a standard part of the operating system, to be notified and to agree that the application could gain access to certain information or functions.

HTC, however, preinstalled certain apps on its phones in a way that, in addition to preventing consumers from removing them, disabled the permission-based model and allowed newly installed apps to have immediate access to personal data.

“The analogy isn’t exact,” wrote Ms. Fair of the F.T.C., “but it’s like giving a friend the combination to a safe only to find out he’s handing it over to anyone who asks.”

That security hole could, for example, let the rogue software secretly record users’ phone conversations or track their location.

Flaws in the security system could also give third-party apps access to phone numbers, contents of text messages, browsing history and information like credit card numbers and banking transactions. Those flaws also affected HTC phones that used Windows-based operating systems.

While HTC’s actions introduced numerous security vulnerabilities to its phones, a commission official said it was not clear how many users experienced illegal incursions into their phones and personal information.

The flaw in the company’s phones has been known since at least 2011. HTC acknowledged the problems at that time and developed software patches for at least some of the deficiencies that year.

But the problems were far from minor. The F.T.C. said that text-message toll fraud, in which a hacker causes a phone to send text messages to a number that charges the user for delivery of the message, “is one of the most common types of Android malware,” or malicious software.

HTC’s user manuals either said or implied that a user was protected against malware because of the permission-based security, the commission said.

The commission will collect public comments on the proposed remedies for 30 days, after which it will decide whether to formally carry out the order. If HTC subsequently violates the order’s restrictions and requirements, it faces civil penalties of up to $16,000 a violation.

This article has been revised to reflect the following correction:

Correction: February 25, 2013

A picture with an earlier version of this article was published in error. The settlement between HTC and the F.T.C. involves phones running Windows Mobile; it did not involve the later operating system Windows 8, which the phone in the picture was running.

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