St. Lawrence writes that she initially did not plan on having children and that the idea of embryo freezing occurred to her while she was researching ways to donate her eggs. "My husband and I could create embryos, freeze them and, essentially, donate them to our future selves," she states.
Through her research on IVF, St. Lawrence "learned that the younger the parents are when they produce the eggs and sperm involved in any conception, whether in the womb or in vitro, the better the chance of a healthy baby." The Society for Assisted Reproductive Technology reports that 47% of IVF pregnancies derived from fresh embryos resulted in live births, compared with 35% of pregnancies from frozen embryos that resulted in live births. "Initially, those success rates did not sound high," St. Lawrence writes, adding, "But the numbers referred to a single cycle; most couples ... produce several embryos during IVF, and if the first implantation is unsuccessful, they try again, and the cumulative success rate is much higher" (St. Lawrence, Washington Post, 7/6).
Reprinted with kind permission from nationalpartnership. You can view the entire Daily Women's Health Policy Report, search the archives, or sign up for email delivery here. The Daily Women's Health Policy Report is a free service of the National Partnership for Women & Families.
© 2010 National Partnership for Women & Families. All rights reserved.
четверг, 29 декабря 2011 г.
Washington Post Commentary Explores Embryo Freezing
The Washington Post on Tuesday featured a commentary from Gillian St. Lawrence, a 30-year-old woman who underwent in vitro fertilization and embryo freezing as "a way to postpone parenthood without risking the higher miscarriage and genetic disorder rates that occur in babies conceived from parents older than 35." Typically, women who undergo IVF take hormones to produce several blastocyts -- five- to seven-day-old embryos -- and one or two of the embryos are implanted into the woman shortly thereafter. The remaining embryos can be frozen for future pregnancy attempts.
четверг, 22 декабря 2011 г.
Women Account For Nearly 60% Of US Hospital Admissions - Leading Reasons Are Pregnancy And Childbirth
Women accounted for nearly 60 percent of the 39.4 million admissions to U.S. hospitals in 2007, according to the latest News and Numbers from the Agency for Healthcare Research and Quality. According to the analysis by the federal agency, the leading reasons that women are admitted to the hospital are for pregnancy and childbirth. About 5 million of the 23.2 million hospital admissions for women were related to delivery.
Nearly 2 million hospital stays for women involved cardiovascular disease - the number one killer of women. They included treatment of coronary artery disease, congestive heart failure, heart attacks, atrial fibrillation and other types of irregular heart beat, and chest pain with no determined cause.
Other leading reasons why women were hospitalized in 2007 included:
- Pneumonia - 608,000 admissions
- Osteoarthritis - 498,000 admissions
- Depression and bipolar disorder - 442,000 admissions
- Urinary tract infection - 383,000 admissions
- Blood infection (septicemia) - 354,000 admissions
- Skin infections - 282,000 admissions
This AHRQ News and Numbers summary is based on Exhibit 2.3 in HCUP Facts and Figures 2007 , which provides highlights of the latest data from the 2007 Nationwide Inpatient Sample, a part of AHRQ's Healthcare Cost and Utilization Project.
Source
Agency for Healthcare Research and Quality (AHRQ)
Nearly 2 million hospital stays for women involved cardiovascular disease - the number one killer of women. They included treatment of coronary artery disease, congestive heart failure, heart attacks, atrial fibrillation and other types of irregular heart beat, and chest pain with no determined cause.
Other leading reasons why women were hospitalized in 2007 included:
- Pneumonia - 608,000 admissions
- Osteoarthritis - 498,000 admissions
- Depression and bipolar disorder - 442,000 admissions
- Urinary tract infection - 383,000 admissions
- Blood infection (septicemia) - 354,000 admissions
- Skin infections - 282,000 admissions
This AHRQ News and Numbers summary is based on Exhibit 2.3 in HCUP Facts and Figures 2007 , which provides highlights of the latest data from the 2007 Nationwide Inpatient Sample, a part of AHRQ's Healthcare Cost and Utilization Project.
Source
Agency for Healthcare Research and Quality (AHRQ)
четверг, 15 декабря 2011 г.
Clashes In Southwest China Over One-Child Policy Prompt Officials To Ease Penalties
Recent violent clashes between police and in southwest China's Guangxi province over a campaign to enforce penalties, including fines and forced abortion, for couples who violate China's one-child-per-family policy has prompted local officials to ease "tough measures," officials said on Wednesday, Reuters AlertNet reports. Officials added that they will continue efforts to curb population growth (Buckley, Reuters AlertNet, 5/23).
China's one-child-per-family policy seeks to keep the country's population, now 1.3 billion, at about 1.7 billion by 2050. Methods of enforcing the policy, such as fines and work demotions, vary among Chinese provinces and cities. Dozens of women in southwest China last month reported being forced to undergo abortions as late as nine months into their pregnancies. Some women from Guangxi said they were forced to have abortions because they were unmarried, while other women were married and pregnant with their second child.
The Bobai county government in Guangxi recently increased fines for people who violate the policy and have been seizing or destroying the property of people who cannot pay the fines. Several people have said Guangxi officials have issued fines from 500 yuan, or about $65, to 70,000 yuan, or about $9,000, on families who violated the policy at any time since 1980. Some people said the fine, called a "social child-raising fee," was collected despite the fact most violators of the policy had already paid a fine. If violators failed to pay the fine within three days, their homes would be destroyed and their belongings seized.
Residents of Guangxi recently attacked family planning officials, overturned cars and set fire to government buildings. Witnesses and Hong Kong media reported on Monday that riot police entered at least four towns in the province (Kaiser Daily Women's Health Policy Report, 5/22). According to Xinhua News Agency, 28 residents were detained and are suspected of passing on details of the demonstration, as well as instigating and participating in the riots, the AP/International Herald Tribune reports (AP/International Herald Tribune, 5/23).
"Family planning is a national policy, and Yulin City has demanded that residents stop flouting laws and regulations," a Bobai official -- who only gave his surname, Luo -- said, adding, "There has been a lot of pressure on officials who don't understand family planning work and the situation got out of hand, but that's stopped now." Luo said the goal of curbing population growth "won't change, but the methods will be adjusted" (Reuters AlertNet, 5/23).
China's one-child-per-family policy seeks to keep the country's population, now 1.3 billion, at about 1.7 billion by 2050. Methods of enforcing the policy, such as fines and work demotions, vary among Chinese provinces and cities. Dozens of women in southwest China last month reported being forced to undergo abortions as late as nine months into their pregnancies. Some women from Guangxi said they were forced to have abortions because they were unmarried, while other women were married and pregnant with their second child.
The Bobai county government in Guangxi recently increased fines for people who violate the policy and have been seizing or destroying the property of people who cannot pay the fines. Several people have said Guangxi officials have issued fines from 500 yuan, or about $65, to 70,000 yuan, or about $9,000, on families who violated the policy at any time since 1980. Some people said the fine, called a "social child-raising fee," was collected despite the fact most violators of the policy had already paid a fine. If violators failed to pay the fine within three days, their homes would be destroyed and their belongings seized.
Residents of Guangxi recently attacked family planning officials, overturned cars and set fire to government buildings. Witnesses and Hong Kong media reported on Monday that riot police entered at least four towns in the province (Kaiser Daily Women's Health Policy Report, 5/22). According to Xinhua News Agency, 28 residents were detained and are suspected of passing on details of the demonstration, as well as instigating and participating in the riots, the AP/International Herald Tribune reports (AP/International Herald Tribune, 5/23).
"Family planning is a national policy, and Yulin City has demanded that residents stop flouting laws and regulations," a Bobai official -- who only gave his surname, Luo -- said, adding, "There has been a lot of pressure on officials who don't understand family planning work and the situation got out of hand, but that's stopped now." Luo said the goal of curbing population growth "won't change, but the methods will be adjusted" (Reuters AlertNet, 5/23).
Washington Post Examines Events Leading to Clashes
The Washington Post on Wednesday examined actions taken on enforcing the family planning policy in the region and details of the clashes. According to the Post, the "brutal fine-collection drive" is the "latest example of abusive local enforcement" of the one-child policy (Cody, Washington Post, 5/23).
NBC's "Nightly News" on Tuesday reported on the clashes in southwest China. The segment includes comments from Carl Minzner of the Council on Foreign Relations (Mullen, "Nightly News," NBC, 5/22). Video of the segment is available online.
"Reprinted with permission from kaisernetwork. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at kaisernetwork/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork, a free service of The Henry J. Kaiser Family Foundation . © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.
четверг, 8 декабря 2011 г.
Caffeine's Use In Cosmetic Dermatology
A new study recently published in the Journal of Cosmetic Dermatology reports on the discovery of caffeine's novel benefit in slenderizing thighs.
The Brazilian researchers studied 99 women treated with a cream consisting mostly of a 7 percent caffeine solution. The women used the cream twice daily for 30 days.
When the researchers took their subjects' measurements at the end of the study, the slimming effect was clear. More than 80 percent of the women had a reduction in the circumference of their upper and lower thighs. Nearly 68 percent also reduced their hip measurements.
Whether caffeine banishes cellulite is less clear. The researchers assessed cellulite changes with a handheld imaging instrument that reveals microcirculation in fat tissue. Imaging showed little change in cellulite even in the hips and thighs that slimmed down. The researchers speculate that the 30-day trial might not have been long enough for the cream to act on cellulite.
"This is no cure for cellulite", said lead researcher Omar Lupi of the Federal University of then State of Rio de Janeiro. "But it can help women who want to look thinner. Exercise is still the best way to go."
This study is published in the Journal of Cosmetic Dermatology.
Professor Omar Lupi, MD, PhD is affiliated with the Federal University of then State of Rio de Janeiro.
Journal of Cosmetic Dermatology is the official journal of the European Society for Cosmetic and Aesthetic Dermatology (ESCAD). Both the Journal and ESCAD wish to foster the highest standards of patient care in cosmetic dermatology. Each aims to facilitate continuing professional development and provide a forum for the exchange of scientific research and innovative techniques.
Wiley-Blackwell was formed in February 2007 as a result of the acquisition of Blackwell Publishing Ltd. by John Wiley & Sons, Inc., and its merger with Wiley's Scientific, Technical, and Medical business. Together, the companies have created a global publishing business with deep strength in every major academic and professional field. Wiley-Blackwell publishes approximately 1,400 scholarly peer-reviewed journals and an extensive collection of books with global appeal. For more information on Wiley-Blackwell, please visit blackwellpublishing/ or interscience.wiley/ .
Source: Amy Molnar
Blackwell Publishing Ltd.
The Brazilian researchers studied 99 women treated with a cream consisting mostly of a 7 percent caffeine solution. The women used the cream twice daily for 30 days.
When the researchers took their subjects' measurements at the end of the study, the slimming effect was clear. More than 80 percent of the women had a reduction in the circumference of their upper and lower thighs. Nearly 68 percent also reduced their hip measurements.
Whether caffeine banishes cellulite is less clear. The researchers assessed cellulite changes with a handheld imaging instrument that reveals microcirculation in fat tissue. Imaging showed little change in cellulite even in the hips and thighs that slimmed down. The researchers speculate that the 30-day trial might not have been long enough for the cream to act on cellulite.
"This is no cure for cellulite", said lead researcher Omar Lupi of the Federal University of then State of Rio de Janeiro. "But it can help women who want to look thinner. Exercise is still the best way to go."
This study is published in the Journal of Cosmetic Dermatology.
Professor Omar Lupi, MD, PhD is affiliated with the Federal University of then State of Rio de Janeiro.
Journal of Cosmetic Dermatology is the official journal of the European Society for Cosmetic and Aesthetic Dermatology (ESCAD). Both the Journal and ESCAD wish to foster the highest standards of patient care in cosmetic dermatology. Each aims to facilitate continuing professional development and provide a forum for the exchange of scientific research and innovative techniques.
Wiley-Blackwell was formed in February 2007 as a result of the acquisition of Blackwell Publishing Ltd. by John Wiley & Sons, Inc., and its merger with Wiley's Scientific, Technical, and Medical business. Together, the companies have created a global publishing business with deep strength in every major academic and professional field. Wiley-Blackwell publishes approximately 1,400 scholarly peer-reviewed journals and an extensive collection of books with global appeal. For more information on Wiley-Blackwell, please visit blackwellpublishing/ or interscience.wiley/ .
Source: Amy Molnar
Blackwell Publishing Ltd.
четверг, 1 декабря 2011 г.
Egg Donation: Most Women Report Satisfaction; Some Claim Problems
Two-thirds of women who donated eggs to fertility clinics reported satisfaction with the process, but 16 percent complained of subsequent physical symptoms and 20 percent reported lasting psychological effects, according to the first study to examine the long-term effects of donation.
The research by scientists at the University of Washington included women who donated eggs at clinics in 20 states and is the largest study to explore the effects of donation in the United States, where the practice is not regulated.
"We don't know how many egg donors there are because no official records are kept and reporting is on a voluntary basis to the Centers for Disease Control and Prevention," said Nancy Kenney, UW associate professor of psychology and women studies and lead author of the study.
The researchers were surprised at the low number of women who reported an awareness of possible physical risk prior to donation. Nearly 63 percent viewed the potential physical risk as minor and 20 percent did not recall being made aware of physical risks at the time of their first donation.
"Many of these women may be forgetting that they were warned of the lesser risks, such as bloating and the discomfort from hormone injections," said Kenney. "It has been quite a while since they read the material handed out by clinics or heard the risk lecture and it could be that they simple forgot. The age of the women also could be a factor. Risks don't mean much to young women. They may be discounting the risk. If you are 25 and are told that something may cause cancer when you are 45 that may seem to be forever."
Of those women who reported physical problems in the donation process, bloating, pain and cramping, ovarian hyperstimulation, mood changes and irritability, and weight gain or loss were the most common complaints. Several women claimed infertility or decreased fertility or damage to their ovaries.
However, most of the women - 73 percent - however, reported being aware of some of psychological risks associated with egg donation prior to donating. These included the chance they might develop concern for or attachment to their eggs or to a potential or resulting offspring, concern that the donor or resulting child might want a future relationship with them, the possibility of having a genetic child in the world or the stress resulting from the donation process.
The women were split in their reasons for donating eggs. Nearly one-third (32 percent) said their motivations were completely based on helping others while almost 19 percent said financial concerns were their sole reason. The remainder cited a combination of altruistic and monetary factors for donation.
The research drew on the experiences of 80 women who donated eggs for the first time at least two years before filling out an 84-item questionnaire. Respondents donated eggs for the first time two to 15 years before completing the questionnaire and were an average of 30.6 years old when surveyed.
The study also found that:
The average payment was $3,965, with fees ranging from $1,104 to $7,313. (The most recent first donation year was 2002 and payments were converted to 2002 dollars).
Donors who said money was a very significant factor in donation received higher payments on average ($4,453) compared to those who said money was not important ($3,413).
Seventy percent of the women donated eggs more than once. Most repeat donors underwent the procedure two or three times. One woman donated eggs on nine occasions.
Forty-five percent of the women were students when they first donated.
Ninety-four percent of the students said financial compensation was a significant factor in deciding to donate compared to 57 percent of the women who were not students.
Most of the donations took place in California (23), Massachusetts (7), New York (7), Washington (7) and New Jersey (7).
Kenney said a higher percentage of women who cited altruistic reasons as their primary motivation (84 percent) reported feeling happy about their donation experiences than did the women whose decisions were mainly financial (61 percent).
"We were asking these women years later and a feeling of helping may last longer than money," she said. "We know if clinics don't offer money most women won't donate. Great Britain, where there is no paid egg donation program, for example, has a tremendous shortage of donors. But, as one of our donors said, 'if you do this just for money, you'll be sorry.'"
Kenney noted that a number of women offered suggestions to improve the donation process and complained about unequal treatment from clinics.
"Some women talked about how they were treated like delivery suppliers. Some clinics had separate entrances at the rear for donors and poorer waiting room facilities than for egg recipients. Some said they were handed a check at the end of he procedure and told 'see you around.' Others complained that they were offered limited extra health insurance for only a very limited time after a serious procedure," she said.
The study is in the current issue of the journal Fertility and Sterility and was funded by the UW's Royalty Research Fund. Co-author of the study is Michelle McGowan, who earned her doctorate at UW and is now a post-doctoral researcher in bioethics at Case Western Reserve University.
Source: Joel Schwarz
University of Washington
The research by scientists at the University of Washington included women who donated eggs at clinics in 20 states and is the largest study to explore the effects of donation in the United States, where the practice is not regulated.
"We don't know how many egg donors there are because no official records are kept and reporting is on a voluntary basis to the Centers for Disease Control and Prevention," said Nancy Kenney, UW associate professor of psychology and women studies and lead author of the study.
The researchers were surprised at the low number of women who reported an awareness of possible physical risk prior to donation. Nearly 63 percent viewed the potential physical risk as minor and 20 percent did not recall being made aware of physical risks at the time of their first donation.
"Many of these women may be forgetting that they were warned of the lesser risks, such as bloating and the discomfort from hormone injections," said Kenney. "It has been quite a while since they read the material handed out by clinics or heard the risk lecture and it could be that they simple forgot. The age of the women also could be a factor. Risks don't mean much to young women. They may be discounting the risk. If you are 25 and are told that something may cause cancer when you are 45 that may seem to be forever."
Of those women who reported physical problems in the donation process, bloating, pain and cramping, ovarian hyperstimulation, mood changes and irritability, and weight gain or loss were the most common complaints. Several women claimed infertility or decreased fertility or damage to their ovaries.
However, most of the women - 73 percent - however, reported being aware of some of psychological risks associated with egg donation prior to donating. These included the chance they might develop concern for or attachment to their eggs or to a potential or resulting offspring, concern that the donor or resulting child might want a future relationship with them, the possibility of having a genetic child in the world or the stress resulting from the donation process.
The women were split in their reasons for donating eggs. Nearly one-third (32 percent) said their motivations were completely based on helping others while almost 19 percent said financial concerns were their sole reason. The remainder cited a combination of altruistic and monetary factors for donation.
The research drew on the experiences of 80 women who donated eggs for the first time at least two years before filling out an 84-item questionnaire. Respondents donated eggs for the first time two to 15 years before completing the questionnaire and were an average of 30.6 years old when surveyed.
The study also found that:
The average payment was $3,965, with fees ranging from $1,104 to $7,313. (The most recent first donation year was 2002 and payments were converted to 2002 dollars).
Donors who said money was a very significant factor in donation received higher payments on average ($4,453) compared to those who said money was not important ($3,413).
Seventy percent of the women donated eggs more than once. Most repeat donors underwent the procedure two or three times. One woman donated eggs on nine occasions.
Forty-five percent of the women were students when they first donated.
Ninety-four percent of the students said financial compensation was a significant factor in deciding to donate compared to 57 percent of the women who were not students.
Most of the donations took place in California (23), Massachusetts (7), New York (7), Washington (7) and New Jersey (7).
Kenney said a higher percentage of women who cited altruistic reasons as their primary motivation (84 percent) reported feeling happy about their donation experiences than did the women whose decisions were mainly financial (61 percent).
"We were asking these women years later and a feeling of helping may last longer than money," she said. "We know if clinics don't offer money most women won't donate. Great Britain, where there is no paid egg donation program, for example, has a tremendous shortage of donors. But, as one of our donors said, 'if you do this just for money, you'll be sorry.'"
Kenney noted that a number of women offered suggestions to improve the donation process and complained about unequal treatment from clinics.
"Some women talked about how they were treated like delivery suppliers. Some clinics had separate entrances at the rear for donors and poorer waiting room facilities than for egg recipients. Some said they were handed a check at the end of he procedure and told 'see you around.' Others complained that they were offered limited extra health insurance for only a very limited time after a serious procedure," she said.
The study is in the current issue of the journal Fertility and Sterility and was funded by the UW's Royalty Research Fund. Co-author of the study is Michelle McGowan, who earned her doctorate at UW and is now a post-doctoral researcher in bioethics at Case Western Reserve University.
Source: Joel Schwarz
University of Washington
четверг, 24 ноября 2011 г.
China Intermediate Court Rejects Human Rights Advocate Chen's Appeal
The Intermediate People's Court in China's Shandong Province on Friday rejected an appeal by human rights advocate Chen Guangcheng -- who was arrested in China after attempting to bring a class-action lawsuit against the government for alleged human rights abuses associated with the enforcement of the country's one-child-per-family policy -- to reverse a four-year, three-month prison sentence, Xinhuanet reports (Xinhuanet, 1/12). For his lawsuit, Chen recorded testimony from men and women in communities in and around China's Linyi province who experienced forced abortions and sterilizations. In August 2006, he was sentenced by a court in Shandong to four years and three months in prison for allegedly "willfully damaging property" and "organizing a mob to disturb traffic." An appeals court in Shandong in October ordered a retrial. According to Li Jingsong, one of Chen's attorneys, the court overturned the sentence "because the process of the first trial was unfair, and facts and evidence ... were not tenable and did not hold water." However, in the retrial, a court in Shandong in December upheld prison sentence (Kaiser Daily Women's Health Policy Report, 12/1/2006). The verdict from the Intermediate People's Court said "the facts were clear and the evidence was sufficient" at the retrial, according to Li. Li said Chen is not permitted another appeal; however, Li said he plans to petition China's high court and possibly the central leadership to have the sentence reversed. Chen also plans to apply for medical parole because he is legally blind, the AP/International Herald Tribune reports (Olesen, AP/International Herald Tribune, 1/12). Li said, "We are not about to give up until these people are fully exposed," adding, "This case is about local officials abusing their powers and using illegal methods to implement policy." Human Rights Watch in its annual report released Thursday highlighted Chen's case as an example of the "significant deterioration" of human rights conditions in China," Agence France-Presse reports (Agence France-Presse, 1/12). Chen's wife Yuan Weijing said the court had not notified her of the final verdict, but she added, "I am really angry. It is just lawless here. They can make up whatever charges and put you behind bars" (Reuters, 1/12).
"Reprinted with permission from kaisernetwork. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at kaisernetwork/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork, a free service of The Henry J. Kaiser Family Foundation . © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.
"Reprinted with permission from kaisernetwork. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at kaisernetwork/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork, a free service of The Henry J. Kaiser Family Foundation . © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.
четверг, 17 ноября 2011 г.
Chinese Officials Dispatched To Handle Complaints Concerning Penalties For One-Child Policy Violations
Recent clashes between police and residents in southwest China's Guangxi province over a campaign to enforce penalties, including fines and forced abortion, for couples who violate China's one-child-per-family policy has prompted the country to dispatch officials to address complaints concerning the penalties, the New York Times reports (Kahn, New York Times, 5/24).
China's one-child-per-family policy seeks to keep the country's population, now 1.3 billion, at about 1.7 billion by 2050. Methods of enforcing the policy, such as fines and work demotions, vary among Chinese provinces and cities. Dozens of women in southwest China last month reported being forced to undergo abortions as late as nine months into their pregnancies. Some women from Guangxi said they were forced to have abortions because they were unmarried, while other women were married and pregnant with their second child.
The Bobai county government in Guangxi recently increased fines for people who violate the policy and have been seizing or destroying the property of people who cannot pay the fines. Several people have said Guangxi officials have issued fines from 500 yuan, or about $65, to 70,000 yuan, or about $9,000, on families who violated the policy at any time since 1980. Some people said the fine, called a "social child-raising fee," was collected despite the fact most violators of the policy had already paid a fine. If violators failed to pay the fine within three days, their homes would be destroyed and their belongings seized.
Residents of Guangxi recently attacked family planning officials, overturned cars and set fire to government buildings. Witnesses and Hong Kong media reported on Monday that riot police entered at least four towns in the province. Twenty-eight residents were detained and are suspected of passing on details of the demonstration, as well as instigating and participating in the riots (Kaiser Daily Women's Health Policy Report, 5/23).
According to Huang Shaoming, chief of Bobai county, the recent violence is because of "backward ideas about birth control and the rule of law" among residents. He added, "It's also possible that problems exist in the government's birth control work, which led to the frustration of the people." Huang pledged to address residents' complaints and also to push for stricter enforcement of the one-child policy (New York Times, 5/24).
The Los Angeles Times on Thursday examined the situation. The article is available online.
"Reprinted with permission from kaisernetwork. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at kaisernetwork/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork, a free service of The Henry J. Kaiser Family Foundation . © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.
China's one-child-per-family policy seeks to keep the country's population, now 1.3 billion, at about 1.7 billion by 2050. Methods of enforcing the policy, such as fines and work demotions, vary among Chinese provinces and cities. Dozens of women in southwest China last month reported being forced to undergo abortions as late as nine months into their pregnancies. Some women from Guangxi said they were forced to have abortions because they were unmarried, while other women were married and pregnant with their second child.
The Bobai county government in Guangxi recently increased fines for people who violate the policy and have been seizing or destroying the property of people who cannot pay the fines. Several people have said Guangxi officials have issued fines from 500 yuan, or about $65, to 70,000 yuan, or about $9,000, on families who violated the policy at any time since 1980. Some people said the fine, called a "social child-raising fee," was collected despite the fact most violators of the policy had already paid a fine. If violators failed to pay the fine within three days, their homes would be destroyed and their belongings seized.
Residents of Guangxi recently attacked family planning officials, overturned cars and set fire to government buildings. Witnesses and Hong Kong media reported on Monday that riot police entered at least four towns in the province. Twenty-eight residents were detained and are suspected of passing on details of the demonstration, as well as instigating and participating in the riots (Kaiser Daily Women's Health Policy Report, 5/23).
According to Huang Shaoming, chief of Bobai county, the recent violence is because of "backward ideas about birth control and the rule of law" among residents. He added, "It's also possible that problems exist in the government's birth control work, which led to the frustration of the people." Huang pledged to address residents' complaints and also to push for stricter enforcement of the one-child policy (New York Times, 5/24).
The Los Angeles Times on Thursday examined the situation. The article is available online.
"Reprinted with permission from kaisernetwork. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at kaisernetwork/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork, a free service of The Henry J. Kaiser Family Foundation . © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.
четверг, 10 ноября 2011 г.
FDA Scientists Cite Ineffectiveness, Side Effects In Review Of Female Libido Drug
An FDA background document released Wednesday found that a pill aimed at treating female sexual dysfunction failed to make a significant difference in two studies, although some women reported slightly more sexually satisfying experiences, the AP/Detroit Free Press reports. On Friday, an FDA panel of experts will consider the drug -- flibanserin -- for premenopausal women who report a lack of sexual desire. The agency is not required to follow the panel's advice.
According to the FDA document, two studies conducted by the drug's maker, Boehringer Ingelheim, failed to show a significant increase in female participants' libido, as recorded by the women in a daily journal. Although some women reported a boost in satisfying sexual experiences, the FDA document said agency scientists "wanted to see that an effect of treatment is an overall increase in sexual desire regardless of whether a sexual event occurred or not" (Perrone, AP/Detroit Free Press, 6/16).
FDA also noted that certain side effects -- fatigue, sedation and drowsiness -- were "commonly reported." The review said that "it is not clear if labeling alone will be sufficient to alert women to the numerous drug interactions that exist" with the drug, adding that nearly 15% of women who participated in the study stopped taking the drug before the study ended because of possible side effects (Richwine, Reuters, 6/16).
Debate on Sexual Desire Surrounds Approval Efforts
The effort to obtain FDA approval of flibanserin has triggered a debate on female sexual dysfunction, with some critics saying that Boehringer "is trying to turn a low libido into a medical pathology," the New York Times reports. In seeking approval for the drug, the company cites a legitimate psychiatric condition called hypoactive sexual desire disorder, or HSDD.
Although there is "no dispute" that some women experience lower levels of sexual desire, sexual dysfunction issues are "much harder" to diagnose and treat in women than in men, the Times reports. Critics argue that the company's marketing campaign for the pill overstates the prevalence of female sexual dysfunction and falsely leads women to think they need medical treatment, the Times reports (Wilson, New York Times, 6/16).
NBC News Examines Flibanserin Debate
NBC's "Nightly News" on Wednesday also reported on the FDA review and efforts to treat HSDD (Snyderman, "Nightly News," NBC, 6/17).
Reprinted with kind permission from nationalpartnership. You can view the entire Daily Women's Health Policy Report, search the archives, or sign up for email delivery here. The Daily Women's Health Policy Report is a free service of the National Partnership for Women & Families.
© 2010 National Partnership for Women & Families. All rights reserved.
четверг, 3 ноября 2011 г.
Young Professionals Put Career Ahead Of Motherhood, While Older Women Are Still Waiting For Mr. Right
Women of different ages differ in their reasons for wishing to undergo egg freezing, show two studies presented to the 26th annual meeting of the European Society of Human Reproduction and Embryology. A large number of female university students would be prepared to undertake egg freezing in an attempt to combine career success and motherhood, said Dr. Srilatha Gorthi, a research fellow at the Leeds Centre for Reproductive Medicine, Leeds, UK, adding that her team's research emphasised the importance of educating young women about their biological clocks in order that they could take informed decisions about future reproduction.
Dr. Gorthi surveyed 98 medical students (group A) and 97 students of education and sports studies (group B) from the University of Leeds. Information regarding egg freezing was provided, including the fact that they would have to finance their own egg freezing. The average age was 21 with age range from 18-30 years in both the groups; 63.3% of the medical students were not in a relationship, as opposed to 25.8% in group B, probably reflecting the level of commitment and time needed for their courses.
While 85.7% in group A said that they would be prepared to delay starting a family, only 49.5% in group B said they would consider this. Eight out of ten from group A said they would undergo egg collection and freezing, compared with only half as many (four out of ten) from group B. In group A, 85.3% were prepared to undergo up to three cycles of egg collection to bank enough eggs to give them a realistic chance of pregnancy. In contrast, the majority (79%) of those who would bank their eggs from group B said they would be prepared to undergo only one cycle of egg collection.
"Career considerations were given as the commonest reason to delay starting a family in group A, followed by financial stability and marriage or a stable relationship," said Dr. Gorthi. "However, in group B, financial stability came first, followed by a stable relationship and then career reasons. We think that this is the first time that young women's attitudes to egg freezing have been studied in this way."
Egg freezing is still a relatively new technology; a woman has to go through an IVF treatment cycle, which takes two to four weeks and carries certain risks: ovarian hyperstimulation, haemorrhage, infection and a possible, albeit small, effect on future natural fertility.
Until a few years ago, egg freezing was largely restricted to women undergoing chemotherapy for cancer because the chances of an egg surviving the slow freezing and thawing process was as low as two percent. Now, thanks to new techniques such as vitrification, where water from the eggs is removed and they are flash-frozen, frozen eggs are as good as the fresh ones. Women seem to have a realistic prospect of delaying motherhood if they wish to do so, similar to men. The average cost of egg freezing is around ??3000 per attempt and some women may have to undergo up to three cycles in order to cryopreserve a good number of eggs.
At a time when women are increasingly delaying having children until their late 30s and even 40s, clinics offering egg freezing are in need of information on the attitudes and expectations of young women in order to enable them to tailor counselling more appropriately. "There has been a vogue for offering freezing for social reasons to women, especially those embarking on their careers, or those who haven't found their Prince Charming, as a kind of insurance policy for later life. Research has proven that young eggs have a better genetic competency than older ones, and the chance of egg freezing working also declines with age. While the best results are likely to be in those under 30 years old, in reality it is predominantly women in their late thirties who are requesting egg freezing," said Dr. Gorthi.
"There is still a lot of misinformation about the age at which the women could start their families, the likelihood of success of treatment and the number of oocytes that need to be retrieved and frozen in order to give a realistic prospect for future success. Women thinking about undergoing this procedure must be provided with accurate information and have counselling to both the benefits and limitations of oocyte freezing compared with other options. This will enable them to take the decision which is right for their circumstances," she said.
"In addition, support from society is warranted for young women who choose to have a family when they are ready without compromising their careers. Experience from clinics who offer egg freezing for social reasons has shown that the use of frozen eggs is considered the last resort when women fail to conceive naturally," Dr. Gorthi said.
In a second study, Dr. Julie Nekkebroeck*, a senior psychologist at the Centre for Reproductive Medicine, UZ Brussel, Brussels, Belgium, found that a group of highly educated and financially secure women with an average age of just over 38 years had applied to have their eggs frozen because they had not yet found the right partner with whom to have children. Dr. Nekkebroeck and colleagues interviewed the 15 egg-freezing candidates in order to ascertain their reasons for wishing to undergo the procedure.
"We found that they had all had partners in the past, and one was currently in a relationship, but they had not fulfilled their desire to have a child because they thought that they had not found the right man," she said. The women found out about the possibility of egg freezing via the internet; before that, 46.7% had thought about becoming a single mother through the use of donor sperm, and 26.7% of them had considered adoption or staying childless.
The main reasons for opting for oocyte freezing were taking the pressure off the search for the right partner (53.3%), and giving a future relationship more time to blossom before bringing up the subject of their desire for a child (26.7%), whereas for 33.3% it was an insurance against future infertility. All 15 candidates had shared their intentions with their family and close friends and none of them felt discouraged by their entourage.
Out of the 15 women, 53.3% felt that the financial cost was a disadvantage of undergoing treatment, and 26.7% considered that the use of hormones was a deterrent. However, all of them accepted that they needed to undergo treatment while they were still healthy and fertile and they were also willing to repeat the treatment at least twice.
"The average age that the women thought they would use their frozen oocytes was 43.4 years, an age at which, for most women, there is considerable difficulty in achieving a spontaneous conception. But if they found a suitable partner, most of them would prefer to try to become pregnant spontaneously, rather than perform IVF with fresh material or, in the last instance, use their frozen oocytes," said Dr. Nekkebroeck.
If the women did not need their oocytes, 46.7% said that they would donate them for scientific research, 13.3% would donate them to another woman, and 26.7% were unsure about what to do with them.
"We intend to continue interviewing these women in order to confirm our preliminary results and will also arrange follow-up interviews after their egg collection and freezing, and when they return to the hospital to collect and use their vitrified eggs. Because women have only just gained access to this efficient method of preserving their fertility, we believe that our results will add to the continuing debate about egg freezing for social reasons. Such research seems to indicate that social freezing might be added to the list of preventive measures to be taken against future age-related subfertility in women, besides fertility awareness campaigns, but only on the understanding that these women are properly counselled and educated about success rates, fees, treatment procedure etc.," Dr. Nekkebroeck concluded.
Source:
Mary Rice
European Society of Human Reproduction and Embryology
Dr. Gorthi surveyed 98 medical students (group A) and 97 students of education and sports studies (group B) from the University of Leeds. Information regarding egg freezing was provided, including the fact that they would have to finance their own egg freezing. The average age was 21 with age range from 18-30 years in both the groups; 63.3% of the medical students were not in a relationship, as opposed to 25.8% in group B, probably reflecting the level of commitment and time needed for their courses.
While 85.7% in group A said that they would be prepared to delay starting a family, only 49.5% in group B said they would consider this. Eight out of ten from group A said they would undergo egg collection and freezing, compared with only half as many (four out of ten) from group B. In group A, 85.3% were prepared to undergo up to three cycles of egg collection to bank enough eggs to give them a realistic chance of pregnancy. In contrast, the majority (79%) of those who would bank their eggs from group B said they would be prepared to undergo only one cycle of egg collection.
"Career considerations were given as the commonest reason to delay starting a family in group A, followed by financial stability and marriage or a stable relationship," said Dr. Gorthi. "However, in group B, financial stability came first, followed by a stable relationship and then career reasons. We think that this is the first time that young women's attitudes to egg freezing have been studied in this way."
Egg freezing is still a relatively new technology; a woman has to go through an IVF treatment cycle, which takes two to four weeks and carries certain risks: ovarian hyperstimulation, haemorrhage, infection and a possible, albeit small, effect on future natural fertility.
Until a few years ago, egg freezing was largely restricted to women undergoing chemotherapy for cancer because the chances of an egg surviving the slow freezing and thawing process was as low as two percent. Now, thanks to new techniques such as vitrification, where water from the eggs is removed and they are flash-frozen, frozen eggs are as good as the fresh ones. Women seem to have a realistic prospect of delaying motherhood if they wish to do so, similar to men. The average cost of egg freezing is around ??3000 per attempt and some women may have to undergo up to three cycles in order to cryopreserve a good number of eggs.
At a time when women are increasingly delaying having children until their late 30s and even 40s, clinics offering egg freezing are in need of information on the attitudes and expectations of young women in order to enable them to tailor counselling more appropriately. "There has been a vogue for offering freezing for social reasons to women, especially those embarking on their careers, or those who haven't found their Prince Charming, as a kind of insurance policy for later life. Research has proven that young eggs have a better genetic competency than older ones, and the chance of egg freezing working also declines with age. While the best results are likely to be in those under 30 years old, in reality it is predominantly women in their late thirties who are requesting egg freezing," said Dr. Gorthi.
"There is still a lot of misinformation about the age at which the women could start their families, the likelihood of success of treatment and the number of oocytes that need to be retrieved and frozen in order to give a realistic prospect for future success. Women thinking about undergoing this procedure must be provided with accurate information and have counselling to both the benefits and limitations of oocyte freezing compared with other options. This will enable them to take the decision which is right for their circumstances," she said.
"In addition, support from society is warranted for young women who choose to have a family when they are ready without compromising their careers. Experience from clinics who offer egg freezing for social reasons has shown that the use of frozen eggs is considered the last resort when women fail to conceive naturally," Dr. Gorthi said.
In a second study, Dr. Julie Nekkebroeck*, a senior psychologist at the Centre for Reproductive Medicine, UZ Brussel, Brussels, Belgium, found that a group of highly educated and financially secure women with an average age of just over 38 years had applied to have their eggs frozen because they had not yet found the right partner with whom to have children. Dr. Nekkebroeck and colleagues interviewed the 15 egg-freezing candidates in order to ascertain their reasons for wishing to undergo the procedure.
"We found that they had all had partners in the past, and one was currently in a relationship, but they had not fulfilled their desire to have a child because they thought that they had not found the right man," she said. The women found out about the possibility of egg freezing via the internet; before that, 46.7% had thought about becoming a single mother through the use of donor sperm, and 26.7% of them had considered adoption or staying childless.
The main reasons for opting for oocyte freezing were taking the pressure off the search for the right partner (53.3%), and giving a future relationship more time to blossom before bringing up the subject of their desire for a child (26.7%), whereas for 33.3% it was an insurance against future infertility. All 15 candidates had shared their intentions with their family and close friends and none of them felt discouraged by their entourage.
Out of the 15 women, 53.3% felt that the financial cost was a disadvantage of undergoing treatment, and 26.7% considered that the use of hormones was a deterrent. However, all of them accepted that they needed to undergo treatment while they were still healthy and fertile and they were also willing to repeat the treatment at least twice.
"The average age that the women thought they would use their frozen oocytes was 43.4 years, an age at which, for most women, there is considerable difficulty in achieving a spontaneous conception. But if they found a suitable partner, most of them would prefer to try to become pregnant spontaneously, rather than perform IVF with fresh material or, in the last instance, use their frozen oocytes," said Dr. Nekkebroeck.
If the women did not need their oocytes, 46.7% said that they would donate them for scientific research, 13.3% would donate them to another woman, and 26.7% were unsure about what to do with them.
"We intend to continue interviewing these women in order to confirm our preliminary results and will also arrange follow-up interviews after their egg collection and freezing, and when they return to the hospital to collect and use their vitrified eggs. Because women have only just gained access to this efficient method of preserving their fertility, we believe that our results will add to the continuing debate about egg freezing for social reasons. Such research seems to indicate that social freezing might be added to the list of preventive measures to be taken against future age-related subfertility in women, besides fertility awareness campaigns, but only on the understanding that these women are properly counselled and educated about success rates, fees, treatment procedure etc.," Dr. Nekkebroeck concluded.
Source:
Mary Rice
European Society of Human Reproduction and Embryology
четверг, 27 октября 2011 г.
American College Of Gastroenterology Offers Tips To Ease The Heartburn Of Pregnancy
Heartburn symptoms are
one of the most commonly reported complaints among pregnant women.
Heartburn usually starts during the first trimester and tends to worsen
during the second and third trimesters.
Studies have shown elevated levels of the hormone progesterone
accompanied by increased intra-abdominal pressures from the enlarging
uterus, may lower esophageal sphincter (LES) pressure in pregnant women
contributing to heartburn symptoms, according to research highlighted in
the newly updated "Pregnancy in Gastrointestinal Disorders" monograph by
the American College of Gastroenterology (ACG).
From the monograph, physician experts from ACG have compiled important
health tips on managing heartburn symptoms, and importantly, identifying
which heartburn medications are safe for use in pregnant women and those,
which should be avoided.
Strategies to Ease Heartburn Symptoms during Pregnancy
According to the ACG, pregnant women can treat and relieve their
heartburn symptoms through lifestyle and dietary changes. The following
tips can help reduce heartburn discomfort:
-- Avoid eating late at night or before retiring to bed. Common
heartburn triggers include greasy or spicy food, chocolate, peppermint,
tomato sauces, caffeine, carbonated drinks, and citrus fruits.
-- Wear loose-fitting clothes. Clothes that fit tightly around your
waist put pressure on your abdomen and the lower esophageal sphincter.
-- Eat smaller meals. Overfilling the stomach can result in acid reflux
and heartburn.
-- Don't lie down after eating. Wait at least 3 hours after eating
before going to bed. When you lie down, it's easier for stomach contents
(including acid) to back up into the esophagus, particularly when you go to
bed with a full stomach.
-- Raise the head of the bed 4 to 6 inches. This can help reduce acid
reflux by decreasing the amount of gastric contents that reach the lower
esophagus.
-- Avoid tobacco and alcohol. Abstinence from alcohol and smoking can
help reduce reflux symptoms and avoid fetal exposure to potentially harmful
substances.
The Do's and Don'ts of Using Heartburn Drugs during Pregnancy
Pregnant women with mild reflux usually do well with simple lifestyle
changes. If lifestyle and dietary changes are not enough, you should
consult your doctor before taking any medication to relieve heartburn
symptoms.
According to ACG President Amy E. Foxx-Orenstein, DO, FACG, "Heartburn
medications to treat acid reflux during pregnancy should be balanced to
alleviate the mother's symptoms of heartburn, while protecting the
developing fetus."
Based on a review of published scientific clinical studies (in animals
and humans) on the safety of heartburn medications during pregnancy,
researchers conclude there are certain drugs that are considered safe for
use in pregnancy and those which should be avoided.
Antacids are one of the most common over-the-counter medications to
treat heartburn. As with any drug, antacids should be used cautiously
during pregnancy.
Antacids
-- Antacids containing aluminum, calcium, or magnesium are considered
safe and effective in treating the heartburn of pregnancy.
-- Magnesium-containing antacids should be avoided during the last
trimester of pregnancy because it could interfere with uterine contractions
during labor.
-- Avoid antacids containing sodium bicarbonate. Sodium bicarbonate
could cause metabolic alkalosis and increase the potential of fluid
overload in both the fetus and mother.
Histamine-type II (H-2) Receptor Antagonists
While limited data exists in humans on the safety of histamine-type II
(H-2) receptor antagonists, ranitidine (Zantac(R)) is the only H-2
antagonist, which has been studied specifically during pregnancy.
In a double-blind, placebo controlled, triple crossover study,
ranitidine (Zantac(R)) taken once or twice daily in pregnant heartburn
patients not responding to antacids and lifestyle modification, was found
to be more effective than placebo in reducing the symptoms of heartburn and
acid regurgitation. No adverse effects on the fetus were reported. (Larson
JD, et al., "Double-blind placebo-controlled study of ranitidine for
gastroesophageal reflux symptoms during pregnancy." Obstet Gynecol 1997;
90:83-7.)
A study on the safety of cimetidine (Tagamet(R)) and ranitidine
(Zantac(R)) suggests that pregnant women taking these drugs from the first
trimester through their entire pregnancy have delivered normal babies.
(Richter JE., "Gastroesophageal reflux disease during pregnancy.
Gastroenterol Clin N Am 2003; 32:235-61.)
Proton Pump Inhibitors
Proton pump inhibitors should be reserved for pregnant patients with
more severe heartburn symptoms and those not responding to antacids and
lifestyle and dietary changes. Lansoprazole (Prevacid(R)) is the preferred
PPI because of case reports of safety in pregnant women. Limited data
exists about human safety during pregnancy with the newer PPIs.
American College of Gastroenterology
acg.gi
View drug information on Cimetidine Hydrochloride Oral Solution; Ranitidine Capsules.
one of the most commonly reported complaints among pregnant women.
Heartburn usually starts during the first trimester and tends to worsen
during the second and third trimesters.
Studies have shown elevated levels of the hormone progesterone
accompanied by increased intra-abdominal pressures from the enlarging
uterus, may lower esophageal sphincter (LES) pressure in pregnant women
contributing to heartburn symptoms, according to research highlighted in
the newly updated "Pregnancy in Gastrointestinal Disorders" monograph by
the American College of Gastroenterology (ACG).
From the monograph, physician experts from ACG have compiled important
health tips on managing heartburn symptoms, and importantly, identifying
which heartburn medications are safe for use in pregnant women and those,
which should be avoided.
Strategies to Ease Heartburn Symptoms during Pregnancy
According to the ACG, pregnant women can treat and relieve their
heartburn symptoms through lifestyle and dietary changes. The following
tips can help reduce heartburn discomfort:
-- Avoid eating late at night or before retiring to bed. Common
heartburn triggers include greasy or spicy food, chocolate, peppermint,
tomato sauces, caffeine, carbonated drinks, and citrus fruits.
-- Wear loose-fitting clothes. Clothes that fit tightly around your
waist put pressure on your abdomen and the lower esophageal sphincter.
-- Eat smaller meals. Overfilling the stomach can result in acid reflux
and heartburn.
-- Don't lie down after eating. Wait at least 3 hours after eating
before going to bed. When you lie down, it's easier for stomach contents
(including acid) to back up into the esophagus, particularly when you go to
bed with a full stomach.
-- Raise the head of the bed 4 to 6 inches. This can help reduce acid
reflux by decreasing the amount of gastric contents that reach the lower
esophagus.
-- Avoid tobacco and alcohol. Abstinence from alcohol and smoking can
help reduce reflux symptoms and avoid fetal exposure to potentially harmful
substances.
The Do's and Don'ts of Using Heartburn Drugs during Pregnancy
Pregnant women with mild reflux usually do well with simple lifestyle
changes. If lifestyle and dietary changes are not enough, you should
consult your doctor before taking any medication to relieve heartburn
symptoms.
According to ACG President Amy E. Foxx-Orenstein, DO, FACG, "Heartburn
medications to treat acid reflux during pregnancy should be balanced to
alleviate the mother's symptoms of heartburn, while protecting the
developing fetus."
Based on a review of published scientific clinical studies (in animals
and humans) on the safety of heartburn medications during pregnancy,
researchers conclude there are certain drugs that are considered safe for
use in pregnancy and those which should be avoided.
Antacids are one of the most common over-the-counter medications to
treat heartburn. As with any drug, antacids should be used cautiously
during pregnancy.
Antacids
-- Antacids containing aluminum, calcium, or magnesium are considered
safe and effective in treating the heartburn of pregnancy.
-- Magnesium-containing antacids should be avoided during the last
trimester of pregnancy because it could interfere with uterine contractions
during labor.
-- Avoid antacids containing sodium bicarbonate. Sodium bicarbonate
could cause metabolic alkalosis and increase the potential of fluid
overload in both the fetus and mother.
Histamine-type II (H-2) Receptor Antagonists
While limited data exists in humans on the safety of histamine-type II
(H-2) receptor antagonists, ranitidine (Zantac(R)) is the only H-2
antagonist, which has been studied specifically during pregnancy.
In a double-blind, placebo controlled, triple crossover study,
ranitidine (Zantac(R)) taken once or twice daily in pregnant heartburn
patients not responding to antacids and lifestyle modification, was found
to be more effective than placebo in reducing the symptoms of heartburn and
acid regurgitation. No adverse effects on the fetus were reported. (Larson
JD, et al., "Double-blind placebo-controlled study of ranitidine for
gastroesophageal reflux symptoms during pregnancy." Obstet Gynecol 1997;
90:83-7.)
A study on the safety of cimetidine (Tagamet(R)) and ranitidine
(Zantac(R)) suggests that pregnant women taking these drugs from the first
trimester through their entire pregnancy have delivered normal babies.
(Richter JE., "Gastroesophageal reflux disease during pregnancy.
Gastroenterol Clin N Am 2003; 32:235-61.)
Proton Pump Inhibitors
Proton pump inhibitors should be reserved for pregnant patients with
more severe heartburn symptoms and those not responding to antacids and
lifestyle and dietary changes. Lansoprazole (Prevacid(R)) is the preferred
PPI because of case reports of safety in pregnant women. Limited data
exists about human safety during pregnancy with the newer PPIs.
American College of Gastroenterology
acg.gi
View drug information on Cimetidine Hydrochloride Oral Solution; Ranitidine Capsules.
четверг, 20 октября 2011 г.
Health Experts React To Report Linking 7% Drop In Breast Cancer Incidence With Decrease In HRT Use
Health experts reacted from a "fury to disbelief to a kind of complacency" to a study presented Thursday at the 29th Annual San Antonio Breast Cancer Symposium that said a 7% drop in breast cancer incidence among U.S. women from 2002 to 2003 was possibly because of a decrease in hormone replacement therapy use, the New York Times reports (Kolata, New York Times, 12/18). Peter Ravdin, a research professor in the Department of Biostatistics at M.D. Anderson Cancer Center, and colleagues examined records from nine regions across the U.S. that supply data to the National Cancer Institute's Surveillance Epidemiology and End Results. According to the study, age-adjusted breast cancer incidence decreased by 7% by the end of 2003, compared with 2002. There were about 124 breast cancer cases per 100,000 women in 2003, compared with about 134 cases per 100,000 women in 2002. Breast cancer incidence decreased by 6% in the first half of 2003 and by 9% in the second half of the year. The study found that breast cancer rates dropped by 15% among women ages 50 and older. The study -- which was funded by NCI and M.D. Anderson -- concluded that about 14,000 fewer women were diagnosed with breast cancer in 2003 than 2002. The decline in incidence was the largest since 1990, the researchers found. According to researchers, the decrease in breast cancer rates is most likely associated with a drop in both HRT use and mammography rates. HRT use decreased by about 30% in 2002 after the Women's Health Initiative found that breast cancer risk increased for women who used the treatment for an extended period of time. In addition, mammography rates between 2000 and 2003 dropped by 1% overall and by 3% among women between ages 50 and 64, which could in part explain why fewer breast cancer cases were detected. Ravdin said that it is possible that other factors -- including anti-estrogen drugs, such as raloxifene; statin drugs that reduce cholesterol; or drugs used to treat pain -- also might have contributed to the decrease (Kaiser Daily Women's Health Policy Report, 12/15).
Reaction
The study's findings are "very good news," Elsa Ford, president of Brentwood/Bay Shore Breast Cancer Coalition, said, adding, "It was so easy to embrace [HRT] without close attention to potential side effects, especially on a long-term basis." Julia Smith, director of the New York University Cancer Institute's Breast Cancer Screening and Prevention Program, said, "We believe that HRT contributes to hormone receptor positive cancers in postmenopausal women, but it's hard to believe that HRT would play the sole role in such a significant decline." She added, "Further study is necessary to see if this drop is a trend, a blip or if other factors played a role" (Ricks, Long Island Newsday, 12/18). Wyeth -- maker of combination HRT Prempro -- in a statement Sunday said that the "potential impact of hormone therapy on breast cancer has long been warned in product labels." The new research does not prove cause and effect, the company said, adding that "caution and further examination over a longer period of time is advised before these data can be fully understood" (New York Times, 12/18). The statement also said that the study included short-term and incomplete data and that the decline in breast cancer incidence might be explained by other factors (Agovino, AP/Houston Chronicle, 12/15). Ronald Strickler, chief of women's health services at the Henry Ford Health System, said, "My concern is that these statistics bounce around from year to year," adding, "We will be hearing from the same 10[%] to 20% of patients who react to every report in the news media that is negative, and they ask, 'Does this say you have put me at increased risk of cancer?'" (Anstett, Detroit Free Press, 12/15). JoAnn Manson, a women's health expert at Brigham and Women's Hospital in Boston said she worries that some women as a result of the study who "really require" HRT "will be talked out of it" (Marchione, AP/Charlotte Observer, 12/15).
Other Research Presented at Symposium
The following highlights other studies presented at the San Antonio Breast Cancer symposium.
E-75 compound: Col. George Peoples, a staff surgeon at Brooke Army Medical Center, and colleagues tested the compound E-75 -- a peptide derived from the protein HER-2/neu, which is found at elevated levels in one-fourth of breast cancers -- on 101 military and civilian women whose breast cancer had been treated and who had high levels of HER2/neu. Researchers aimed to determine if it would boost the immune system at certain times. Eighty-five additional women without HER2/neu were followed as a control group. The study found that after two years of treatment, the women who received the compound had a 50% lower risk of their cancer recurring, compared with women in the control group (Tumiel, San Antonio Express-News, 12/15).
Fat intake, Journal of the National Cancer Institute: Researchers at the National Cancer Institute at 39 sites nationwide examined 2,437 women with early-stage breast cancer who were an average age of 58 years old. All of the women had undergone surgery followed by chemotherapy, as well as five years of tamoxifen if their tumors were fueled by hormones, the AP/Yahoo! News reports. The study found that 66% of women without hormone-fueled breast cancer tumors who reduced their fat intake to about 20% of daily calories had a 66% lower risk of death, compared with women without hormone-fueled tumors who were told to continue their normal diet. Among women who had hormone-fueled tumors, there was a 24% lower risk of death five years later for women who reduced fat intake (Marchione, AP/Yahoo! News, 12/16).
Inflammatory breast cancer: Massimo Cristofanilli, associate professor in the Department of Breast Medical Oncology at M.D. Anderson, and colleagues tested 35 women with inflammatory breast cancer using the experimental drug lapatinib by itself and also in combination with chemotherapy to determine the drug's effectiveness in treating inflammatory breast cancer, the San Antonio Express-News reports. The study found that 80% of the women who took the drug alone and then in combination with chemotherapy saw a reduction in their breast tumors by 50%. There was no evidence of remaining cancer in three women who later had surgery, the study found (Tumiel [2], San Antonio Express-News, 12/15).
Post-chemotherapy menstruation: Michael Gnant of the Medical University of Vienna and colleagues reported results from a study that found women whose menstrual cycles returned after they underwent chemotherapy had higher breast cancer relapse rates than those who did not resume menstruation. Gnant said, "Additional hormone suppression may be advisable" to keep periods from returning (Marchione, AP/ABC7Chicago, 12/16).
NPR's "All Things Considered" on Friday reported on the connection between declining breast cancer incidence and the use of hormone replacement therapy. The segment includes comments from Deborah Armstrong, a medical oncologist at Johns Hopkins University's Kimmel Cancer Center; Mary Daly, a researcher at Fox Chase Cancer Center; and Manson (Palca, "All Things Considered," NPR, 12/15). Audio of the segment is available online.
"Reprinted with permission from kaisernetwork. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at kaisernetwork/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork, a free service of The Henry J. Kaiser Family Foundation . © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.
четверг, 13 октября 2011 г.
Married women have more sexual difficulties than single women or married men
Married women are more likely to have sexual difficulties than either single women or married men, suggest the findings of a national survey in Sexually Transmitted Infections.
The nationally representative survey (Natsal 2000) involved over 11,000 men and women between the ages of 16 and 44, who were asked about their sex lives between 1999 and 2001.
Older age was associated with reporting sex life problems for both men and women, but otherwise there were considerable differences between the sexes.
Women were significantly more likely than men to say that they had experienced a short or longer term problem with their sex lives over the past year.
While married or cohabiting men were significantly less likely to say they had sexual problems than single men, the reverse was true for women.
Married women were significantly more likely to report a problem with their sex lives than single women, as were mothers with young children at home.
Men who drank more than the recommended weekly units of alcohol, or who had had a sexually transmitted infection within the previous five years, were also more likely to report problems with their sex lives.
And the quality of the first sexual experience was also identified as important for both men and women, with those reporting a poor first experience more likely to report subsequent problems.
The responses also revealed the importance of good communication. Men and women who felt they could not talk to their partner about sex were around twice as likely to report problems with their sex lives.
The authors of an accompanying editorial comment: "Despite its prevalence, sexual dysfunction is often endured in silence." And they go on to say that studies suggest that as many as 54% of women and 35% of men have problems, but fewer than 11% of men and 21% of women seek help.
Who reports sexual function problems? Empirical evidence from Britain's 2000 National Survey of Sexual Attitudes and Lifestyles Sex Transm Infect 2005; 81: 394-9
Emma Dickinson
edickinsonbmj
44-20-7383-6529
BMJ Specialty Journals
bmj
The nationally representative survey (Natsal 2000) involved over 11,000 men and women between the ages of 16 and 44, who were asked about their sex lives between 1999 and 2001.
Older age was associated with reporting sex life problems for both men and women, but otherwise there were considerable differences between the sexes.
Women were significantly more likely than men to say that they had experienced a short or longer term problem with their sex lives over the past year.
While married or cohabiting men were significantly less likely to say they had sexual problems than single men, the reverse was true for women.
Married women were significantly more likely to report a problem with their sex lives than single women, as were mothers with young children at home.
Men who drank more than the recommended weekly units of alcohol, or who had had a sexually transmitted infection within the previous five years, were also more likely to report problems with their sex lives.
And the quality of the first sexual experience was also identified as important for both men and women, with those reporting a poor first experience more likely to report subsequent problems.
The responses also revealed the importance of good communication. Men and women who felt they could not talk to their partner about sex were around twice as likely to report problems with their sex lives.
The authors of an accompanying editorial comment: "Despite its prevalence, sexual dysfunction is often endured in silence." And they go on to say that studies suggest that as many as 54% of women and 35% of men have problems, but fewer than 11% of men and 21% of women seek help.
Who reports sexual function problems? Empirical evidence from Britain's 2000 National Survey of Sexual Attitudes and Lifestyles Sex Transm Infect 2005; 81: 394-9
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четверг, 6 октября 2011 г.
Alaska Gov. Palin Voices Support For State Parental Consent Bill
Alaska Gov. Sarah Palin (R) on Thursday voiced support for legislation (H.B. 35, S.B. 6) that would require parental consent for a minor to receive an abortion in the state, the AP/Fairbanks Daily News-Miner reports. The House and Senate bills were introduced in their respective chambers at the beginning of the session. The House version, sponsored by Rep. John Coghill (R), would revise the 1997 Parental Consent Act, which the Alaska Supreme Court overturned in a 3-2 vote in 2007. The court said the parental consent requirement was unconstitutional because it infringed on pregnant teenagers' right to reproductive freedom. According to the AP/Daily News-Miner, the court is "more conservative now with a Palin-appointee replacing a justice who cast a vote to overturn" the act.
Although Palin "voiced strong antiabortion views" as Sen. John McCain's (R-Ariz.) running mate in the 2008 presidential election, she "has not pushed that agenda in the Legislature until now," the AP/Daily News-Miner reports. Palin said she did not propose her own bill this year because she did not want to create competing legislation (Sutton, AP/Fairbanks Daily News-Miner, 2/27). According to the Anchorage Daily News, the bill might have "trouble in the state Senate," after Senate President Gary Stevens (R) said months ago that "far left and far right issues" would not be on the table in the Senate. Sen. Hollis French (D), who chairs the Senate Judiciary Committee, said that he has not yet analyzed the bill but would give it a hearing (Demer, Anchorage Daily News, 2/27). The AP/Daily News-Miner reports that an identical bill passed the House in 2008 but ultimately failed because it did not have a Senate hearing. Sen. Charlie Huggins (R), a supporter of the bill, said a citizen's initiative would be filed if the bill failed to pass this year (AP/Fairbanks Daily News-Miner, 2/27).
Palin said, "Wherever you fall on the abortion issue, right or left, this legislation is about family, and it's about parents' rights and protecting our children." She added that legislators "on both sides of the aisle" support the bill (Anchorage Daily News, 2/27). Palin also said the "most important thing is the right of Alaska children to receive support and the ability for them to receive the support and input of their parents as they face a life-changing decision."
Clover Simon, executive director of Planned Parenthood of the Great Northwest, said the bill violates the constitutional rights of pregnant teens. She said that although the group wants parents to be included in decisions regarding abortion, it does not "believe you can mandate parental communication with their teens." She added parental involvement "has to be something that starts long before the unintended pregnancy." PPGN also said it is concerned with a section of the bill that would allow teens to bypass parental consent by petitioning a court. Smith said the requirements are difficult for teens who might be in abusive situations at home (AP/Fairbanks Daily News-Miner, 2/27).
Reprinted with kind permission from nationalpartnership. You can view the entire Daily Women's Health Policy Report, search the archives, or sign up for email delivery here. The Daily Women's Health Policy Report is a free service of the National Partnership for Women & Families, published by The Advisory Board Company.
© 2009 The Advisory Board Company. All rights reserved.
Although Palin "voiced strong antiabortion views" as Sen. John McCain's (R-Ariz.) running mate in the 2008 presidential election, she "has not pushed that agenda in the Legislature until now," the AP/Daily News-Miner reports. Palin said she did not propose her own bill this year because she did not want to create competing legislation (Sutton, AP/Fairbanks Daily News-Miner, 2/27). According to the Anchorage Daily News, the bill might have "trouble in the state Senate," after Senate President Gary Stevens (R) said months ago that "far left and far right issues" would not be on the table in the Senate. Sen. Hollis French (D), who chairs the Senate Judiciary Committee, said that he has not yet analyzed the bill but would give it a hearing (Demer, Anchorage Daily News, 2/27). The AP/Daily News-Miner reports that an identical bill passed the House in 2008 but ultimately failed because it did not have a Senate hearing. Sen. Charlie Huggins (R), a supporter of the bill, said a citizen's initiative would be filed if the bill failed to pass this year (AP/Fairbanks Daily News-Miner, 2/27).
Palin said, "Wherever you fall on the abortion issue, right or left, this legislation is about family, and it's about parents' rights and protecting our children." She added that legislators "on both sides of the aisle" support the bill (Anchorage Daily News, 2/27). Palin also said the "most important thing is the right of Alaska children to receive support and the ability for them to receive the support and input of their parents as they face a life-changing decision."
Clover Simon, executive director of Planned Parenthood of the Great Northwest, said the bill violates the constitutional rights of pregnant teens. She said that although the group wants parents to be included in decisions regarding abortion, it does not "believe you can mandate parental communication with their teens." She added parental involvement "has to be something that starts long before the unintended pregnancy." PPGN also said it is concerned with a section of the bill that would allow teens to bypass parental consent by petitioning a court. Smith said the requirements are difficult for teens who might be in abusive situations at home (AP/Fairbanks Daily News-Miner, 2/27).
Reprinted with kind permission from nationalpartnership. You can view the entire Daily Women's Health Policy Report, search the archives, or sign up for email delivery here. The Daily Women's Health Policy Report is a free service of the National Partnership for Women & Families, published by The Advisory Board Company.
© 2009 The Advisory Board Company. All rights reserved.
четверг, 29 сентября 2011 г.
Actions Taken On Women's Health-Related Legislation, Programs In Arizona, Maryland, Wisconsin
The following highlights recent news of state and local actions on women's health-related issues.
Emergency Contraception
Wisconsin: Senate Majority Leader Judy Robson (D) on Tuesday said she plans to reintroduce legislation that would require hospitals to inform rape victims that emergency contraception is highly effective at preventing pregnancy and dispense EC if survivors requested it, the AP/LaCrosse Tribune reports. According to the legislation, hospitals that refused to follow the mandate would face sanctions from the state. Democrats have failed to gather enough support to pass similar legislation introduced in at least the last three legislative sessions, the AP/Tribune reports. Assembly Speaker Mike Huebsch (R) said he has not taken a stance on the bill and could not predict its chances for passage in the House. EC can prevent pregnancy if taken within 72 hours after intercourse (AP/LaCrosse Tribune, 3/6).
Prenatal Care
Arizona: The Senate Appropriations Committee last week unanimously approved a bill (SB 1361) that would require the Arizona Health Care Cost Containment System to provide no-cost prenatal care to women whose household incomes are below 185% of the federal poverty level, the Capitol Media Services/Arizona Daily Star reports. State law now requires the system to cover prenatal care cost to women whose household incomes are below 133% of the poverty level. The legislation would make about 2,700 more women eligible for no-cost care annually. According to legislative aides, the program would cost about $4.4 million if 20% of eligible women enroll and would cost about $17.7 million if 80% of eligible women enroll. Sen. Barbara Leff (R), who is co-sponsoring the legislation, said the bill eventually would save the state money because providing prenatal care to more women would reduce costs related to preterm births and childbirth-related complications. The legislation now moves to the full Senate for consideration (Fischer, Capitol Media Services/Arizona Daily Star, 2/28).
Sex Education
Maryland: Montgomery County, Md., Public Schools on Tuesday began a pilot program at a middle school in the district for a new sex education curriculum that teaches eighth- and 10th-grade students about sexual and gender identity issues and that includes a condom demonstration video, the Washington Post reports (de Vise, Washington Post, 3/7). The Montgomery County Board of Education in January voted 8-0 to approve the curriculum for the program, which includes two 45-minute classes for eighth-grade students and three 45-minute classes for 10th-grade students. Only students whose parents have provided written consent can participate in the lessons (Kaiser Daily Women's Health Policy Report, 1/11). The program, which began on Tuesday at Argyle Middle School in Silver Spring, Md., is scheduled to begin at five schools by the end of the month and throughout the district by the fall (Washington Post, 3/7). The groups Citizens for a Responsible Curriculum, Family Leader Network and Parents and Friends of Ex-Gays and Gays on Feb. 7 filed a petition against implementation of the curriculum with the Maryland State Board of Education (de Vise [1], Washington Post, 3/8). The groups also sought to halt the pilot program, but Maryland Superintendent Nancy Grasmick on Wednesday denied the request (Marech, Baltimore Sun, 3/8). Grasmick in the five-page order also told the education board to rule by July on whether the curriculum should be implemented district-wide. The groups claim that the "content of the lessons is inherently harmful because it violates their First Amendment rights," Grasmick wrote, adding, "I have read the lessons, and I am not convinced of the certainty of such violations. I am convinced, however, of the value of going forward with the field test" (de Vise [2], Washington Post, 3/8).
"Reprinted with permission from kaisernetwork. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at kaisernetwork/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork, a free service of The Henry J. Kaiser Family Foundation . © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.
четверг, 22 сентября 2011 г.
American Academy Of Dermatology Says FDA Not Likely To Postpone Start Date For Accutane Registry
The American Academy of Dermatology on Tuesday said that, despite its concerns about a program that seeks to reduce the number of pregnant women who use the acne medication isotretinoin, sold under the brand name Accutane, FDA has said the program will begin as planned, the AP/San Jose Mercury News reports (Schmid, AP/San Jose Mercury News, 2/21). FDA on Dec. 30, 2005, began to register physicians, prescription drug wholesalers, pharmacists and women into the program, known as iPledge, after an FDA advisory committee in March 2004 recommended the program. Under the program, women must submit two negative pregnancy tests before they can receive an initial prescription for isotretinoin and must undergo a monthly pregnancy test before each refill. In addition, women must agree to use two forms of birth control at the same time or to abstain from intercourse for one month prior to treatment with isotretinoin, during treatment and for one month after treatment has ended, according to FDA. Women also must sign a document to acknowledge that isotretinoin can increase risk for birth defects, depression and suicidal thoughts. The program also requires physicians who prescribe isotretinoin and wholesalers and pharmacists who distribute the medication to register with the database. About 88% of the nation's 55,000 pharmacies and 56% of the estimated 36,000 doctors who prescribe Accutane have registered with system, and 17,881 patients had registered with the program as of the week of Feb. 13. FDA officials earlier this month said they were considering postponing the mandatory start date of March 1 after glitches in the program delayed registration (Kaiser Daily Women's Health Policy Report, 2/13). AAD President Clay Cockerell said in a statement that with the decision not to delay the iPledge start date, "it is now the duty of the FDA to guarantee that the flaws, inconsistencies and confusion" in the program are fixed. According to the AP/San Jose Mercury News, FDA has not confirmed that it will not postpone the start date (AP/San Jose Mercury News, 2/21).
"Reprinted with permission from kaisernetwork. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at kaisernetwork/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork, a free service of The Henry J. Kaiser Family Foundation . ?© 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.
"Reprinted with permission from kaisernetwork. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at kaisernetwork/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork, a free service of The Henry J. Kaiser Family Foundation . ?© 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.
четверг, 15 сентября 2011 г.
New England Journal Of Medicine Publishes Perspective Pieces Responding To Supreme Court Ruling Federal Abortion Ban Constitutional
The New England Journal of Medicine on Thursday published three perspective pieces responding to the Supreme Court's 5-4 ruling on Wednesday to reinstate a federal law banning so-called "partial-birth" abortion, overturning the rulings of three appeals courts. Chief Justice John Roberts and Justices Samuel Alito, Clarence Thomas and Antonin Scalia joined Justice Anthony Kennedy in the majority opinion and Justices Stephen Breyer, John Paul Stevens and David Souter joined Justice Ruth Bader Ginsburg in the dissent. President Bush signed the Partial-Birth Abortion Ban Act (S 3) into law in November 2003. The Planned Parenthood Federation of America, the American Civil Liberties Union on behalf of the National Abortion Federation, and the Center for Reproductive Rights on behalf of four abortion providers filed lawsuits alleging that the law is unconstitutional because of the absence of an exception for procedures preformed to protect the health of the pregnant woman. In place of a health exception, the law includes a long "findings" section with medical evidence presented during congressional hearings that, according to supporters of the law, indicates the procedures banned by the law are never medically necessary. The law says a physician who performs the banned procedures could face criminal prosecution, fines and up to two years in jail. The law allows an exception for cases in which the life of the woman is in danger, but it does not permit doctors to use the procedure because they believe using another method would increase risks to the woman's health (Kaiser Daily Women's Health Policy Report, 4/19). Summaries appear below.
R. Alta Charo: The ruling marks "a significant change in abortion jurisprudence," with "women's health no longer paramount but rather societal morality and the state's interest in life even before the point of viability outside the womb," Charo -- a professor of law and bioethics at the University of Wisconsin-Madison and member of the Guttmacher Institute board -- writes in a NEJM perspective. According to Charo, the ruling "illustrates how fragile are the constitutional interpretations by which reproductive rights are guaranteed" (Charo, New England Journal of Medicine, 4/23).
Jeffrey Drazen: With "this decision, the Supreme Court has sanctioned the intrusion of legislation into the day-to-day practice of medicine," Drazen, a pulmonary and intensive care physician, writes in a NEJM editorial. "It is not that physicians do not want oversight and open discussion of delicate matters but, rather, that we want these discussions to occur among informed and knowledgeable people who are acting in the best interests of a specific patient," Drazen writes, adding, "Government regulation has no place in this process" (Drazen, New England Journal of Medicine, 4/23).
Michael Greene: The ruling has "cast a pall over those who practice reproductive medicine" by creating an "intimidating environment surrounding pregnancy terminations at more advanced gestational ages," Greene -- an associate NEJM editor and professor of obstetrics, gynecology and reproductive biology at Harvard Medical School -- writes in a NEJM perspective. Greene adds, "Both health care providers and patients should be alarmed by the current degree of intrusion by our government into the practice of medicine and even more so by the apparent trajectory that it seems poised to follow in the near future" (Greene, New England Journal of Medicine, 4/23).
"Reprinted with permission from kaisernetwork. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at kaisernetwork/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork, a free service of The Henry J. Kaiser Family Foundation . © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.
R. Alta Charo: The ruling marks "a significant change in abortion jurisprudence," with "women's health no longer paramount but rather societal morality and the state's interest in life even before the point of viability outside the womb," Charo -- a professor of law and bioethics at the University of Wisconsin-Madison and member of the Guttmacher Institute board -- writes in a NEJM perspective. According to Charo, the ruling "illustrates how fragile are the constitutional interpretations by which reproductive rights are guaranteed" (Charo, New England Journal of Medicine, 4/23).
Jeffrey Drazen: With "this decision, the Supreme Court has sanctioned the intrusion of legislation into the day-to-day practice of medicine," Drazen, a pulmonary and intensive care physician, writes in a NEJM editorial. "It is not that physicians do not want oversight and open discussion of delicate matters but, rather, that we want these discussions to occur among informed and knowledgeable people who are acting in the best interests of a specific patient," Drazen writes, adding, "Government regulation has no place in this process" (Drazen, New England Journal of Medicine, 4/23).
Michael Greene: The ruling has "cast a pall over those who practice reproductive medicine" by creating an "intimidating environment surrounding pregnancy terminations at more advanced gestational ages," Greene -- an associate NEJM editor and professor of obstetrics, gynecology and reproductive biology at Harvard Medical School -- writes in a NEJM perspective. Greene adds, "Both health care providers and patients should be alarmed by the current degree of intrusion by our government into the practice of medicine and even more so by the apparent trajectory that it seems poised to follow in the near future" (Greene, New England Journal of Medicine, 4/23).
"Reprinted with permission from kaisernetwork. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at kaisernetwork/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork, a free service of The Henry J. Kaiser Family Foundation . © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.
четверг, 8 сентября 2011 г.
Multiple Birth Mothers Aren't Restricted To Cesarean Surgeries
When it comes to twin births, two times the fun doesn't always mean twice as many complications. Cesarean surgeries are not requirements for women pregnant with multiple babies. Not only is it possible for mothers of multiples to give birth vaginally, but research shows that it often is the safer option.
From the beginning of their pregnancy, women carrying multiple babies may be labeled high-risk and inundated with precautionary information. The assumption, which often is supported by hospitals, is that unplanned cesarean surgery in labor is likely and therefore planned cesarean surgery is the safer option. Lamaze International, an advocate for normal birth and a leader in childbirth education, warns women not to make this assumption and points to research showing the dangers of unnecessary cesarean surgery.
A study published in the Cochrane Library, an international repository research on the effects of health care practices, reports that there is not enough evidence to suggest that elective cesarean surgery with twins results in better outcomes. A second study on multiple births reveals that cesarean surgery for delivery of the second twin (when the baby is not in the head-down position) increases the risk of infection and produces no obvious benefit for mother or baby.
At a rate of 29.1 percent in 2004, birth by cesarean surgery is on a drastic rise. The increase is attributed to several factors, including fear of malpractice claims, the incorrect perception that cesarean surgeries are safer and will prevent future urinary and uterine problems, hospitals' policies against vaginal birth after cesarean (VBAC) and the increase in multiple births. The Public Citizen Health Research Group in Washington, D.C., estimates that half of the nearly one million cesareans performed every year are medically unnecessary.
In today's "culture of cesareans," mothers of multiples face an uphill battle for choices in childbirth. While women carrying multiple babies are more likely to encounter complications than mothers of single babies, cesarean surgery is not mandatory and increases risks. Research indicates that women who undergo cesarean surgery increase the risk of infection, hemorrhage, surgical and anesthetic complications, and maternal death, as well as newborn respiratory problems. Future reproductive problems associated with previous cesarean surgery include infertility, uterine rupture, preterm birth, low birth weight, and stillbirth. According to the American College of Obstetricians and Gynecologists, a vaginal birth is possible for mothers of twins when the first twin is positioned head-down, which is nearly 80 percent of the time. Additionally, a mother of triplets is a candidate for a vaginal birth if she has an uncomplicated pregnancy, has not has previous uterine surgery and is at least 32 weeks pregnant at the time of birth.
"I would advise any woman expecting twins to find a caregiver who does not routinely perform cesareans for twin births," Judith A. Lothian, RN, PhD, LCCE, FACCE, author of The Official Lamaze Guide: Giving Birth with Confidence. Choosing a caregiver skilled in multiple births is important for mothers who want to increase their chances of having a vaginal birth. The Official Lamaze Guide is a guide for expectant mothers, and covers pregnancy, birth and early parenthood.
Lamaze International, based in Washington, DC, envisions a world of confident women choosing normal birth.
For more information about Lamaze and the Institute for Normal Birth, visit lamaze.
From the beginning of their pregnancy, women carrying multiple babies may be labeled high-risk and inundated with precautionary information. The assumption, which often is supported by hospitals, is that unplanned cesarean surgery in labor is likely and therefore planned cesarean surgery is the safer option. Lamaze International, an advocate for normal birth and a leader in childbirth education, warns women not to make this assumption and points to research showing the dangers of unnecessary cesarean surgery.
A study published in the Cochrane Library, an international repository research on the effects of health care practices, reports that there is not enough evidence to suggest that elective cesarean surgery with twins results in better outcomes. A second study on multiple births reveals that cesarean surgery for delivery of the second twin (when the baby is not in the head-down position) increases the risk of infection and produces no obvious benefit for mother or baby.
At a rate of 29.1 percent in 2004, birth by cesarean surgery is on a drastic rise. The increase is attributed to several factors, including fear of malpractice claims, the incorrect perception that cesarean surgeries are safer and will prevent future urinary and uterine problems, hospitals' policies against vaginal birth after cesarean (VBAC) and the increase in multiple births. The Public Citizen Health Research Group in Washington, D.C., estimates that half of the nearly one million cesareans performed every year are medically unnecessary.
In today's "culture of cesareans," mothers of multiples face an uphill battle for choices in childbirth. While women carrying multiple babies are more likely to encounter complications than mothers of single babies, cesarean surgery is not mandatory and increases risks. Research indicates that women who undergo cesarean surgery increase the risk of infection, hemorrhage, surgical and anesthetic complications, and maternal death, as well as newborn respiratory problems. Future reproductive problems associated with previous cesarean surgery include infertility, uterine rupture, preterm birth, low birth weight, and stillbirth. According to the American College of Obstetricians and Gynecologists, a vaginal birth is possible for mothers of twins when the first twin is positioned head-down, which is nearly 80 percent of the time. Additionally, a mother of triplets is a candidate for a vaginal birth if she has an uncomplicated pregnancy, has not has previous uterine surgery and is at least 32 weeks pregnant at the time of birth.
"I would advise any woman expecting twins to find a caregiver who does not routinely perform cesareans for twin births," Judith A. Lothian, RN, PhD, LCCE, FACCE, author of The Official Lamaze Guide: Giving Birth with Confidence. Choosing a caregiver skilled in multiple births is important for mothers who want to increase their chances of having a vaginal birth. The Official Lamaze Guide is a guide for expectant mothers, and covers pregnancy, birth and early parenthood.
Lamaze International, based in Washington, DC, envisions a world of confident women choosing normal birth.
For more information about Lamaze and the Institute for Normal Birth, visit lamaze.
четверг, 1 сентября 2011 г.
Pulmonary Hypertension Discrimination: Mortality Highest Among African American Women
African-American women have the highest mortality rate for idiopathic pulmonary arterial hypertension (IPAH), according to new research. The study, presented at CHEST 2006, the 72nd annual international scientific assembly of the American College of Chest Physicians (ACCP), revealed that racial disparities exist in pulmonary hypertension mortality and morbidity, with African-American women exhibiting the highest mortality rate when compared with all other groups.
"Idiopathic pulmonary arterial hypertension, by definition, means that there is no clear attributable cause for this disease," said study author Kala Davis, MD, Stanford University School of Medicine, Stanford, CA. "What has become apparent from this and other studies is that we have been operating with a very limited understanding of the epidemiology of IPAH, and that understanding is now changing."
Dr. Davis and colleagues reviewed data from the United States National Center for Health Statistics from the years 1994 to 1998 for deaths, in which the underlying cause was IPAH. The age, gender, race, and state of residence of the deceased were abstracted, and state-age-gender-race-specific tabulations of deaths, as a result of IPAH, were aggregated into nine geographic regions of the United States, as defined by the Census Bureau. Average, annual, age-adjusted, region-race-gender-specific rates were then calculated.
According to the United States National Center for Health Statistics, a total of 10,053 IPAH-related deaths were reported from 1994 to 1998. Researchers found that, although more Caucasian women reported having the disease, African-American women had the highest mortality rate among all IPAH-related deaths. In addition, researchers found that the highest mortality rates in IPAH were also observed at the extremes of the age spectrum.
"Women overall have higher mortality rates for IPAH, but the substantial difference shown in mortality rates between African-American women and Caucasian women, of all ages, was surprising," said Dr. Davis. "Further analysis of IPAH mortality data from 1999 to 2002 confirms that this trend is continuing." While the reasons for this disparity remain unclear, researchers suggest that under-recognized comorbidities, access to care, insurance, and race-specific genetic factors, are now being recognized as potential causes.
"Race, gender, and age have become defining factors in assessing the risk of death in IPAH," Dr. Davis concluded. "Clinicians must therefore be cognizant of this emerging demographic profile, which contrasts with the classic description of the condition as being a disease of middle aged, Caucasian women."
Pulmonary arterial hypertension is a rare disorder that affects the blood vessels within the lungs and leads to an increase in the pressure within the pulmonary arteries. This can lead to symptoms, such as unexplained shortness of breath on exertion, chest pain, fainting, and death. In the United States, an estimated 500 to 1,000 new cases of idiopathic pulmonary hypertension are diagnosed each year.
"Idiopathic pulmonary hypertension is a serious illness that is difficult to diagnose and manage," said Mark J. Rosen, MD, FCCP, President of the American College of Chest Physicians. "The results of this study provide a new outlook in terms of race and gender as risk factors for increased mortality in IPAH and may provide further insight into the management of IPAH in specific populations."
CHEST 2006 was the 72nd annual international scientific assembly of the American College of Chest Physicians, held October 21-26 in Salt Lake City, UT. ACCP represents 16,500 members who provide clinical respiratory, critical care, sleep, and cardiothoracic patient care in the United States and throughout the world. The ACCP??™s mission is to promote the prevention and treatment of diseases of the chest through leadership, education, research, and communication. For more information about the ACCP, please visit the ACCP Web site at chestnet/.
Contact: Jennifer Stawarz
American College of Chest Physicians
"Idiopathic pulmonary arterial hypertension, by definition, means that there is no clear attributable cause for this disease," said study author Kala Davis, MD, Stanford University School of Medicine, Stanford, CA. "What has become apparent from this and other studies is that we have been operating with a very limited understanding of the epidemiology of IPAH, and that understanding is now changing."
Dr. Davis and colleagues reviewed data from the United States National Center for Health Statistics from the years 1994 to 1998 for deaths, in which the underlying cause was IPAH. The age, gender, race, and state of residence of the deceased were abstracted, and state-age-gender-race-specific tabulations of deaths, as a result of IPAH, were aggregated into nine geographic regions of the United States, as defined by the Census Bureau. Average, annual, age-adjusted, region-race-gender-specific rates were then calculated.
According to the United States National Center for Health Statistics, a total of 10,053 IPAH-related deaths were reported from 1994 to 1998. Researchers found that, although more Caucasian women reported having the disease, African-American women had the highest mortality rate among all IPAH-related deaths. In addition, researchers found that the highest mortality rates in IPAH were also observed at the extremes of the age spectrum.
"Women overall have higher mortality rates for IPAH, but the substantial difference shown in mortality rates between African-American women and Caucasian women, of all ages, was surprising," said Dr. Davis. "Further analysis of IPAH mortality data from 1999 to 2002 confirms that this trend is continuing." While the reasons for this disparity remain unclear, researchers suggest that under-recognized comorbidities, access to care, insurance, and race-specific genetic factors, are now being recognized as potential causes.
"Race, gender, and age have become defining factors in assessing the risk of death in IPAH," Dr. Davis concluded. "Clinicians must therefore be cognizant of this emerging demographic profile, which contrasts with the classic description of the condition as being a disease of middle aged, Caucasian women."
Pulmonary arterial hypertension is a rare disorder that affects the blood vessels within the lungs and leads to an increase in the pressure within the pulmonary arteries. This can lead to symptoms, such as unexplained shortness of breath on exertion, chest pain, fainting, and death. In the United States, an estimated 500 to 1,000 new cases of idiopathic pulmonary hypertension are diagnosed each year.
"Idiopathic pulmonary hypertension is a serious illness that is difficult to diagnose and manage," said Mark J. Rosen, MD, FCCP, President of the American College of Chest Physicians. "The results of this study provide a new outlook in terms of race and gender as risk factors for increased mortality in IPAH and may provide further insight into the management of IPAH in specific populations."
CHEST 2006 was the 72nd annual international scientific assembly of the American College of Chest Physicians, held October 21-26 in Salt Lake City, UT. ACCP represents 16,500 members who provide clinical respiratory, critical care, sleep, and cardiothoracic patient care in the United States and throughout the world. The ACCP??™s mission is to promote the prevention and treatment of diseases of the chest through leadership, education, research, and communication. For more information about the ACCP, please visit the ACCP Web site at chestnet/.
Contact: Jennifer Stawarz
American College of Chest Physicians
четверг, 25 августа 2011 г.
Prosopamnesia: A Woman's Struggle To Recognize New Faces
The woman's condition, known as prosopamnesia, is extremely rare and has only been found in a handful of people around the world, according to University of Queensland cognitive neuroscientist Professor Jason Mattingley.
"For many years, scientists have been interested in how people learn to recognise new faces, and people who have difficulty with faces often have trouble interacting in social settings," he said.
The woman -- whose identity remains protected -- presented herself to researchers after experiencing social embarrassment when she found she was unable to recognise colleagues, people to whom she had already been introduced.
The research, in collaboration with colleagues at Macquarie and La Trobe universities, is published in this month's edition of Current Biology. The work suggests the woman's "disability" might lie in her inability to encode or recognise new faces, rather than her ability to perceive them.
"She reports relying heavily on featural cues such as hair colour and style, eyeglasses, and eyebrows to recognise new acquaintances," Professor Mattingley said.
On a battery of standard face-recognition tests, the woman consistently registered scores that indicated her ability to recognise new faces was severely impaired.
The woman experiences a similar difficulty in recognising characters on television, but after months of repeated viewing could slowly learn to identify key individuals.
For example, when the woman was shown 42 images of pre-nominated movie celebrities, she correctly identified nine-out-of-10 of the faces.
The researchers also noted that it was only after six months of testing that the woman was able to recognise the faces.
The group's findings were backed up by brain-imaging investigations, which indicated that the woman's exposure to an unfamiliar face, even over 'multiple encoding episodes', was not enough to leave a lasting memory.
"It may be that enduring face representations are slow to form or are degraded in quality, or they may decay rapidly following normal encoding," Professor Mattingley said.
While face recognition is currently thought to be an innate capacity that human babies have at birth, aspects of this ability are probably shaped by experience.
Prosopamnesia is probably a condition linked to an irregularity during neural development, Professor Mattingley said.
To add to the researchers' intrigue, the young woman has reported that some of her family members experience similar problems with face memory.
"If this is true, this woman's condition might present us with tantalising evidence for a genetic link as well," Professor Mattingley said.
While more studies are planned, the woman has placed any additional investigations on hold until she establishes her career.
Scientific paper: Williams et al., Abnormal fMRI Adaptation to Unfamiliar Faces in a Case of Developmental Prosopamnesia, Current Biology (2007), doi:10.1016/j.cub.2007.06.042.
Source: Jason Mattingley
Research Australia
"For many years, scientists have been interested in how people learn to recognise new faces, and people who have difficulty with faces often have trouble interacting in social settings," he said.
The woman -- whose identity remains protected -- presented herself to researchers after experiencing social embarrassment when she found she was unable to recognise colleagues, people to whom she had already been introduced.
The research, in collaboration with colleagues at Macquarie and La Trobe universities, is published in this month's edition of Current Biology. The work suggests the woman's "disability" might lie in her inability to encode or recognise new faces, rather than her ability to perceive them.
"She reports relying heavily on featural cues such as hair colour and style, eyeglasses, and eyebrows to recognise new acquaintances," Professor Mattingley said.
On a battery of standard face-recognition tests, the woman consistently registered scores that indicated her ability to recognise new faces was severely impaired.
The woman experiences a similar difficulty in recognising characters on television, but after months of repeated viewing could slowly learn to identify key individuals.
For example, when the woman was shown 42 images of pre-nominated movie celebrities, she correctly identified nine-out-of-10 of the faces.
The researchers also noted that it was only after six months of testing that the woman was able to recognise the faces.
The group's findings were backed up by brain-imaging investigations, which indicated that the woman's exposure to an unfamiliar face, even over 'multiple encoding episodes', was not enough to leave a lasting memory.
"It may be that enduring face representations are slow to form or are degraded in quality, or they may decay rapidly following normal encoding," Professor Mattingley said.
While face recognition is currently thought to be an innate capacity that human babies have at birth, aspects of this ability are probably shaped by experience.
Prosopamnesia is probably a condition linked to an irregularity during neural development, Professor Mattingley said.
To add to the researchers' intrigue, the young woman has reported that some of her family members experience similar problems with face memory.
"If this is true, this woman's condition might present us with tantalising evidence for a genetic link as well," Professor Mattingley said.
While more studies are planned, the woman has placed any additional investigations on hold until she establishes her career.
Scientific paper: Williams et al., Abnormal fMRI Adaptation to Unfamiliar Faces in a Case of Developmental Prosopamnesia, Current Biology (2007), doi:10.1016/j.cub.2007.06.042.
Source: Jason Mattingley
Research Australia
четверг, 18 августа 2011 г.
Tamoxifen Discontinuation Rates Surprisingly High In Clinical Practice
In the clinical practice setting almost a quarter of women treated for breast cancer stop tamoxifen within one year, a rate twice as high as indicated by previous studies. The new study, published in the March 1, 2007 issue of CANCER, a peer-reviewed journal of the American Cancer Society, says early termination of this highly effective breast cancer drug may negatively affect treatment efficacy. At 3.5 years, the study also reveals that over one third of women have ceased tamoxifen treatment.
Tamoxifen is a selective estrogen receptor modulator that inhibits the stimulatory effect that estrogen has on the development of specific types of breast cancer. Scientists estimate that over 40,000 recurrences are prevented each year worldwide because of this drug. However, the optimal duration of therapy is five years. Less than five years of continual treatment is associated with higher rates of recurrence and higher mortality rates. The most common reason for discontinuation is adverse effects, including mood swings and hot flashes; these are often successfully treated with a specific antidepressant.
Discontinuation or non-persistence rates estimated by clinical trials range from 16 to 32 percent. Studies of usage outside clinical trials report non-persistence rates of only 17 percent at two years and 31 percent at five years. However, these rates are compiled from self-reporting data collection methods and target elderly patients ??" an inherently biased data collection method in a population accustomed to chronic medications. Led by Thomas I. Barron, M.Sc. of the Department of Pharmacology & Therapeutics at Trinity College Dublin & St James's Hospital, Dublin, researchers reviewed pharmaceutical data from a national database of 2816 women aged 35 years and older who started tamoxifen for breast cancer.
The researchers found that at 12 months 22 percent of women had ceased using the drug. At 24 months 28 percent had stopped tamoxifen, and at 3.5 years 35 percent had stopped the treatment without commencing an alternative therapy.
Analysis for risk factors for discontinuing tamoxifen identified age and history of antidepressant use. Women between the ages of 35 and 44 or over 75 as well as women who reportedly used an antidepressant within one year of starting tamoxifen were more likely to stop tamoxifen.
"This study demonstrates that persistence with tamoxifen cannot be assumed and raises concerns about persistence with other oral hormonal therapies for breast cancer and oral anti-neoplastics in general," the authors write. "This is of particular importance," they conclude, "as longer durations of adjuvant therapy may be recommended for breast cancer in the future and as cancer survivorship becomes a priority area in clinical practice and research."
Article: "Early Discontinuation of Tamoxifen: A Lesson for Oncologists," Thomas I. Barron, R??is?n M. Connolly, Kathleen Bennett, John Feely, M. John Kennedy, CANCER; Published Online: January 22, 2007 (DOI: 10.1002/cncr.22486); Print Issue Date: March 1, 2007.
Contact: Amy Molnar
John Wiley & Sons, Inc.
Tamoxifen is a selective estrogen receptor modulator that inhibits the stimulatory effect that estrogen has on the development of specific types of breast cancer. Scientists estimate that over 40,000 recurrences are prevented each year worldwide because of this drug. However, the optimal duration of therapy is five years. Less than five years of continual treatment is associated with higher rates of recurrence and higher mortality rates. The most common reason for discontinuation is adverse effects, including mood swings and hot flashes; these are often successfully treated with a specific antidepressant.
Discontinuation or non-persistence rates estimated by clinical trials range from 16 to 32 percent. Studies of usage outside clinical trials report non-persistence rates of only 17 percent at two years and 31 percent at five years. However, these rates are compiled from self-reporting data collection methods and target elderly patients ??" an inherently biased data collection method in a population accustomed to chronic medications. Led by Thomas I. Barron, M.Sc. of the Department of Pharmacology & Therapeutics at Trinity College Dublin & St James's Hospital, Dublin, researchers reviewed pharmaceutical data from a national database of 2816 women aged 35 years and older who started tamoxifen for breast cancer.
The researchers found that at 12 months 22 percent of women had ceased using the drug. At 24 months 28 percent had stopped tamoxifen, and at 3.5 years 35 percent had stopped the treatment without commencing an alternative therapy.
Analysis for risk factors for discontinuing tamoxifen identified age and history of antidepressant use. Women between the ages of 35 and 44 or over 75 as well as women who reportedly used an antidepressant within one year of starting tamoxifen were more likely to stop tamoxifen.
"This study demonstrates that persistence with tamoxifen cannot be assumed and raises concerns about persistence with other oral hormonal therapies for breast cancer and oral anti-neoplastics in general," the authors write. "This is of particular importance," they conclude, "as longer durations of adjuvant therapy may be recommended for breast cancer in the future and as cancer survivorship becomes a priority area in clinical practice and research."
Article: "Early Discontinuation of Tamoxifen: A Lesson for Oncologists," Thomas I. Barron, R??is?n M. Connolly, Kathleen Bennett, John Feely, M. John Kennedy, CANCER; Published Online: January 22, 2007 (DOI: 10.1002/cncr.22486); Print Issue Date: March 1, 2007.
Contact: Amy Molnar
John Wiley & Sons, Inc.
четверг, 11 августа 2011 г.
Rapid Population Growth In Uganda Affecting Efforts To Fight HIV/AIDS
Rapid population growth in Uganda is undermining efforts to fight the spread of HIV/AIDS, Uganda AIDS Commission Director General Kihumuro Apuuli said Wednesday at a press briefing in the capital of Kampala, New Vision/Allafrica reports. Apuuli spoke with journalists ahead of the four-day HIV/AIDS global implementers meeting scheduled to start June 3 in Kampala.
There are an estimated 30 million people living in Uganda, New Vision/Allafrica reports. Apuuli said about 1.1 million of them are HIV-positive, but 90% are not aware that they are living with the disease. He also noted that more than 30,000 new HIV cases occur there annually. In addition, HIV-related deaths had increased 30% to 100,000 last year from 72,000 a few years ago, when a national survey was conducted.
According to Apuuli, mother-to-child HIV transmission accounts for 22% of new HIV cases in Uganda, and 25% of infants born to HIV-positive women contract the virus. Women in Uganda have an average of seven children, according to New Vision/Allafrica. Apuuli said that people often engage in risky behavior under the assumption that new medications to treat HIV/AIDS will soon be available. "If we do not prevent new infections, we will be chasing a mirage," he said.
The country's AIDS commission has created a five-year plan that focuses on HIV prevention, according to Apuuli. He added, "There are 120,000 people on antiretroviral drugs out of an estimated 240,000 who need it. We intend to make the drugs available to 300,000 people" (Mugisa, New Vision/Allafrica, 4/30).
Reprinted with kind permission from kaisernetwork. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at kaisernetwork/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork, a free service of The Henry J. Kaiser Family Foundation.
© 2008 Advisory Board Company and Kaiser Family Foundation. All rights reserved.
There are an estimated 30 million people living in Uganda, New Vision/Allafrica reports. Apuuli said about 1.1 million of them are HIV-positive, but 90% are not aware that they are living with the disease. He also noted that more than 30,000 new HIV cases occur there annually. In addition, HIV-related deaths had increased 30% to 100,000 last year from 72,000 a few years ago, when a national survey was conducted.
According to Apuuli, mother-to-child HIV transmission accounts for 22% of new HIV cases in Uganda, and 25% of infants born to HIV-positive women contract the virus. Women in Uganda have an average of seven children, according to New Vision/Allafrica. Apuuli said that people often engage in risky behavior under the assumption that new medications to treat HIV/AIDS will soon be available. "If we do not prevent new infections, we will be chasing a mirage," he said.
The country's AIDS commission has created a five-year plan that focuses on HIV prevention, according to Apuuli. He added, "There are 120,000 people on antiretroviral drugs out of an estimated 240,000 who need it. We intend to make the drugs available to 300,000 people" (Mugisa, New Vision/Allafrica, 4/30).
Reprinted with kind permission from kaisernetwork. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at kaisernetwork/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork, a free service of The Henry J. Kaiser Family Foundation.
© 2008 Advisory Board Company and Kaiser Family Foundation. All rights reserved.
четверг, 4 августа 2011 г.
Risk-Free Treatment For Low Female Sexual Desire
According to the Journal of Sexual Medicine, people who engage in regular sexual activity gain several health benefits, such as longer lives, healthier hearts, lower blood pressure, and lower risk of breast cancer. However, approximately 33 percent of women may not receive these benefits due to low sexual desire. Also, the marriages of women with low sexual desire may also be at risk, given a recent statistic that 25 percent of divorce is due to sexual dissatisfaction.
Some doctors are prescribing testosterone patches for women with low sexual desire. However, research shows that testosterone patches might increase the risk of breast cancer when used for just a year. Researchers are currently testing a new drug, flibanserin, which was developed as an antidepressant and affects neurotransmitters in the brain, to treat women with low sexual desire. However, experts are concerned about the side effects of this possible treatment. Now, a University of Missouri researcher has found evidence that a low-cost, risk-free psychological treatment is effective and may be a better alternative to drugs that have adverse side effects.
"Low sexual desire is the number one problem women bring to sex therapists," said Laurie Mintz, associate professor of educational, school and counseling psychology in the MU College of Education. "Drugs to treat low sexual desire may take the focus away from the most common culprits of diminished desire in women, including lack of information on how our own bodies work, body image issues, relationship issues and a stressful lifestyle. Indeed, research demonstrates that relationship issues are far more important in predicting women's sexual desire than are hormone levels. Before women seek medical treatments, they should consider psychological treatment."
Mintz has authored a book based on this premise. In her book, Mintz suggests a six-step psycho-educational and cognitive-behavioral treatment approach that she based on scientific literature and more than 20 years of clinical knowledge. The treatment plan includes chapters about one's thoughts about sex, how to talk with your partner, the importance of spending time together, ways to touch each other in both erotic and non-erotic ways, how to make time for sex and different ways to make sexual activity exciting and thus, increase women's sexual desire.
In a study demonstrating the effectiveness of her treatment, Mintz recruited married women between the ages of 28 to 65, who said they were uninterested in sexual activity. All the women were employed and a majority had children. All participants completed an online survey that measured sexual desire and sexual functioning. Then half of the participants were selected randomly to read her book and perform the exercises outlined in her book. After six weeks, they were emailed the same survey again. The control group did not read the book. Mintz found that the intervention group who read the book made significant gains in sexual desire and sexual functioning, compared to the control group who did not read the book. On average, women who read the book increased their level of sexual desire by almost 30 percent.
"This finding is especially exciting because low sexual desire among women has been not only the most common, but the least successfully treated of all the sexual problems brought to therapists" Mintz said. "Also, although other books have been written on the topic, this is the first to be tested for its effectiveness. In addition, unlike medical treatments such as testosterone, there are certainly no known negative medical side effects associated with the treatment strategies in my book."
Mintz will present her findings at the American Association of Sexuality Educators, Counselors and Therapists (AASECT) annual conference.
Source:
Laurie Mintz
University of Missouri-Columbia
Some doctors are prescribing testosterone patches for women with low sexual desire. However, research shows that testosterone patches might increase the risk of breast cancer when used for just a year. Researchers are currently testing a new drug, flibanserin, which was developed as an antidepressant and affects neurotransmitters in the brain, to treat women with low sexual desire. However, experts are concerned about the side effects of this possible treatment. Now, a University of Missouri researcher has found evidence that a low-cost, risk-free psychological treatment is effective and may be a better alternative to drugs that have adverse side effects.
"Low sexual desire is the number one problem women bring to sex therapists," said Laurie Mintz, associate professor of educational, school and counseling psychology in the MU College of Education. "Drugs to treat low sexual desire may take the focus away from the most common culprits of diminished desire in women, including lack of information on how our own bodies work, body image issues, relationship issues and a stressful lifestyle. Indeed, research demonstrates that relationship issues are far more important in predicting women's sexual desire than are hormone levels. Before women seek medical treatments, they should consider psychological treatment."
Mintz has authored a book based on this premise. In her book, Mintz suggests a six-step psycho-educational and cognitive-behavioral treatment approach that she based on scientific literature and more than 20 years of clinical knowledge. The treatment plan includes chapters about one's thoughts about sex, how to talk with your partner, the importance of spending time together, ways to touch each other in both erotic and non-erotic ways, how to make time for sex and different ways to make sexual activity exciting and thus, increase women's sexual desire.
In a study demonstrating the effectiveness of her treatment, Mintz recruited married women between the ages of 28 to 65, who said they were uninterested in sexual activity. All the women were employed and a majority had children. All participants completed an online survey that measured sexual desire and sexual functioning. Then half of the participants were selected randomly to read her book and perform the exercises outlined in her book. After six weeks, they were emailed the same survey again. The control group did not read the book. Mintz found that the intervention group who read the book made significant gains in sexual desire and sexual functioning, compared to the control group who did not read the book. On average, women who read the book increased their level of sexual desire by almost 30 percent.
"This finding is especially exciting because low sexual desire among women has been not only the most common, but the least successfully treated of all the sexual problems brought to therapists" Mintz said. "Also, although other books have been written on the topic, this is the first to be tested for its effectiveness. In addition, unlike medical treatments such as testosterone, there are certainly no known negative medical side effects associated with the treatment strategies in my book."
Mintz will present her findings at the American Association of Sexuality Educators, Counselors and Therapists (AASECT) annual conference.
Source:
Laurie Mintz
University of Missouri-Columbia
четверг, 28 июля 2011 г.
Diabetes Increases Risk Of Heart Disease Death For Women
The word is out: women are at risk for heart disease, just like men. In fact, roughly twice as many women in this country will die of heart disease, stroke, and other cardiovascular diseases than from all forms of cancer combined, including breast cancer, according to the American Heart Association.
Risk factors for heart disease and stroke have long been identified. Several risk factors cannot be controlled by the individual, such as sex, increasing age and a family history of heart disease. Others can be modified and include:
-- Smoking
-- High blood pressure and cholesterol
-- Diabetes
-- Sedentary lifestyle
-- Body weight
Diabetes continues to be a growing problem in the United States for both men and women. A study published in the December 2007 issue of the European Heart Journal reveals that diabetes is a stronger risk factor for heart disease death in women than in men.
"The reason for the higher relative risk of coronary heart disease in women with diabetes than in men with diabetes is still unclear," explains Ane Cecilie Dale, M.D., the study's lead researcher and head of the Department of Circulation and Medical Imaging at the Norwegian University of Science and Technology in Trondheim. "But research in this field continues to go on."
According to the U.S. Food and Drug Administration, diabetes affects approximately 8.9 percent of American women. The occurrence of diabetes is significantly higher among African American, Hispanic/Latino, American Indian, and Asian/Pacific Islander women than in white women.
Women with diabetes have a two to four times higher risk of dying from heart disease and stroke compared to women without diabetes, according to data from the American Heart Association. Women with diabetes are often overweight and suffer from high blood pressure, also known as hypertension, and high cholesterol levels, which can add to the risk.
"Women with diabetes need to be aware of the associated risk of heart disease. The most important thing to do for all persons with diabetes to protect themselves from heart disease and other diabetes complications is to have a good glucometabolic control with a blood glucose as near normal as possible," Dale said. "They also need to control other risk factors like hypertension and blood cholesterol levels. In addition it is important to quit smoking, have a healthy diet and practice regularly exercise."
Considering how complex the management of diabetes and heart diseases risks are, women should talk to their health care providers to develop a plan of action. Without the support of health care professionals, patients can easily feel overwhelmed.
February is American Heart Month. For tips on reducing your heart disease risk, visit the American Heart Association Web site: http:/www.heart. For diabetes information, visit the American Diabetes Association: diabetes. WomenHeart, the National Coalition for Women with Heart Disease, provides patients with education and grassroots support networks. WomenHeart is online at womenshealthresearch.
Society for Women's Health Research (SWHR)
1025 Connecticut Ave. NW, Ste. 701
Washington, DC 20036
United States
womenshealthresearch
Risk factors for heart disease and stroke have long been identified. Several risk factors cannot be controlled by the individual, such as sex, increasing age and a family history of heart disease. Others can be modified and include:
-- Smoking
-- High blood pressure and cholesterol
-- Diabetes
-- Sedentary lifestyle
-- Body weight
Diabetes continues to be a growing problem in the United States for both men and women. A study published in the December 2007 issue of the European Heart Journal reveals that diabetes is a stronger risk factor for heart disease death in women than in men.
"The reason for the higher relative risk of coronary heart disease in women with diabetes than in men with diabetes is still unclear," explains Ane Cecilie Dale, M.D., the study's lead researcher and head of the Department of Circulation and Medical Imaging at the Norwegian University of Science and Technology in Trondheim. "But research in this field continues to go on."
According to the U.S. Food and Drug Administration, diabetes affects approximately 8.9 percent of American women. The occurrence of diabetes is significantly higher among African American, Hispanic/Latino, American Indian, and Asian/Pacific Islander women than in white women.
Women with diabetes have a two to four times higher risk of dying from heart disease and stroke compared to women without diabetes, according to data from the American Heart Association. Women with diabetes are often overweight and suffer from high blood pressure, also known as hypertension, and high cholesterol levels, which can add to the risk.
"Women with diabetes need to be aware of the associated risk of heart disease. The most important thing to do for all persons with diabetes to protect themselves from heart disease and other diabetes complications is to have a good glucometabolic control with a blood glucose as near normal as possible," Dale said. "They also need to control other risk factors like hypertension and blood cholesterol levels. In addition it is important to quit smoking, have a healthy diet and practice regularly exercise."
Considering how complex the management of diabetes and heart diseases risks are, women should talk to their health care providers to develop a plan of action. Without the support of health care professionals, patients can easily feel overwhelmed.
February is American Heart Month. For tips on reducing your heart disease risk, visit the American Heart Association Web site: http:/www.heart. For diabetes information, visit the American Diabetes Association: diabetes. WomenHeart, the National Coalition for Women with Heart Disease, provides patients with education and grassroots support networks. WomenHeart is online at womenshealthresearch.
Society for Women's Health Research (SWHR)
1025 Connecticut Ave. NW, Ste. 701
Washington, DC 20036
United States
womenshealthresearch
четверг, 21 июля 2011 г.
New Hampshire Senate Approves Bill That Would Allow Emergency Contraception To Be Sold Without Doctor's Prescription
The New Hampshire Senate on Thursday approved 14-10 a bill... (SB 30) that would allow emergency contraception to be sold without a doctor's prescription, the Concord Monitor reports. The measure would allow specially trained pharmacists to dispense EC, which can prevent pregnancy if taken within 72 hours of intercourse (Heckman, Concord Monitor, 4/1). Under the measure, only pharmacists who choose to participate in a training session sponsored by the state pharmacy board could provide the pills to patients without prescriptions. Pharmacists would not be required to undergo the training to dispense EC to patients with prescriptions (Kaiser Daily Reproductive Health Report, 6/9/04). Before approving the measure, the state Senate rejected 16-8 an amendment to the bill that would have allowed pharmacists to sell EC without a prescription to people ages 18 or older only, according to the AP/Nashua Telegraph (Love, AP/Nashua Telegraph, 4/1). Supporters of the bill say that easier access to EC will help to reduce the number of unintended pregnancies and abortions, according to the Monitor (Concord Monitor, 4/1). Opponents of the measure say it would "encourage promiscuity," according to the AP/Telegraph. The bill now goes to the state House. Pamela Walsh, a spokesperson for New Hampshire Gov. John Lynch (D), said the governor will sign the measure if it passes the state House, according to the AP/Telegraph (AP/Nashua Telegraph, 4/1). Former New Hampshire Gov. Craig Benson (R) in June 2004 vetoed an identical measure (SB 484) (Kaiser Daily Reproductive Health Report, 6/9/04).
"Reprinted with permission from kaisernetwork kaisernetwork. You can view the entire Kaiser Daily Reproductive Health Report, search the archives, or sign up for email delivery at www.kaisernetwork/dailyreports/repro The Kaiser Daily Reproductive Health Report is published for kaisernetwork, a free service of The Henry J. Kaiser Family Foundation . © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.
"Reprinted with permission from kaisernetwork kaisernetwork. You can view the entire Kaiser Daily Reproductive Health Report, search the archives, or sign up for email delivery at www.kaisernetwork/dailyreports/repro The Kaiser Daily Reproductive Health Report is published for kaisernetwork, a free service of The Henry J. Kaiser Family Foundation . © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.
четверг, 14 июля 2011 г.
Colorado Title Board Approves Proposal For Personhood Amendment
The Colorado Title Board on Wednesday voted in favor of a proposal that would amend the state constitution to extend legal protections to embryos, the AP/Colorado Springs Gazette reports. The proposal's language fundamentally is the same as that used in a ballot measure rejected by voters last year. However, this year the proposal also would protect embryos created through asexual methods of reproduction such as cloning, the Gazette reports.
Opponents say it would ban abortion as well as some types of birth control and in vitro fertilization. A rehearing on the Title Board's decision would have to be requested by Aug. 12 or else supporters can begin collecting signatures to have it put on the state ballot next year (AP/Colorado Springs Gazette, 8/5).
Reprinted with kind permission from nationalpartnership. You can view the entire Daily Women's Health Policy Report, search the archives, or sign up for email delivery here. The Daily Women's Health Policy Report is a free service of the National Partnership for Women & Families, published by The Advisory Board Company.
© 2009 The Advisory Board Company. All rights reserved.
Opponents say it would ban abortion as well as some types of birth control and in vitro fertilization. A rehearing on the Title Board's decision would have to be requested by Aug. 12 or else supporters can begin collecting signatures to have it put on the state ballot next year (AP/Colorado Springs Gazette, 8/5).
Reprinted with kind permission from nationalpartnership. You can view the entire Daily Women's Health Policy Report, search the archives, or sign up for email delivery here. The Daily Women's Health Policy Report is a free service of the National Partnership for Women & Families, published by The Advisory Board Company.
© 2009 The Advisory Board Company. All rights reserved.
четверг, 7 июля 2011 г.
Society Of Gynecologic Oncology Sets New Standards To Monitor Recurrence Of Gynecologic Cancer More Effectively
Although gynecologic cancers account for only 10 percent of all new cancer cases in women, these cancers account for 20 percent of all female cancer survivors. Because long-term survival is now more common, it is increasingly important to detect recurrence. The Clinical Practice Committee of the Society of Gynecologic Oncology (SGO) has released a Clinical Document outlining their expert recommendations for cancer surveillance, published today in the American Journal of Obstetrics & Gynecology (AJOG).
"The goal of follow-up evaluation for the detection of recurrent disease requires both clinical and cost-effectiveness," commented Ritu Salani, MD, MBA, Assistant Professor, Department of Obstetrics and Gynecology, The Ohio State University College of Medicine. "Currently, most recommendations are based on retrospective studies and expert opinion. Taking a thorough history, performing a thorough examination, and educating cancer survivors about concerning symptoms is the most effective method for the detection of gynecologic cancer recurrences. There is very little evidence that routine cytologic procedures or imaging improves the ability to detect gynecologic cancer recurrence at a stage that will impact cure or response rates to salvage therapy. This article reviews the most recent data on surveillance for gynecologic cancer recurrence in women who have had a complete response to primary cancer therapy."
SGO's Clinical Documents are designed to improve the overall quality of women's cancer care, to reduce the use of unnecessary, ineffective, or harmful interventions, and to facilitate the treatment of patients with a goal to maximum the chance of benefit with a minimum risk of harm and at an acceptable cost. The role of surveillance is to provide clinical and cost-effective practices that detect recurrence and impact survival outcomes.
"Prevention is a big part of our mission as a collective membership," said SGO President John Curtin. "By sharing our best knowledge regarding surveillance of patients who have had a gynecologic malignancy with the medical team in the best position to detect a recurrence, we are helping our patients who do have a recurrence obtain appropriate care as soon as possible."
The article outlines in detail the surveillance techniques and appropriate monitoring intervals for endometrial, ovarian, nonepithelial ovarian, cervical, vulvar, and vaginal cancers. In some cases, certain techniques have been found ineffective in detecting recurrence and are discouraged in the recommendations. Patients should be counseled on the benefits and pitfalls of disease monitoring, which should include the psychologic impact of surveillance programs.
Coordination of care between gynecologic oncologists, primary care providers, other healthcare providers (such as radiation oncologists), and patients ideally will allow for compliance with cancer follow-up care and routine health maintenance. However, the Committee notes that as survivors are transitioned from oncology care to primary care, primary care providers may not be trained to deal with specific follow-up needs or practice standards for patients with cancer. The information in this clinical document is intended to help bridge that gap. The provision of a clear understanding of recommendations and responsibilities of appropriate surveillance will reduce unnecessary tests, ultimately result in cost savings, and better, earlier detection of disease recurrence.
"Post treatment surveillance and diagnosis of recurrence in women with gynecologic malignancies: Society of Gynecologic Oncology recommendations"
Ritu Salani, MD, MBA; Floor J. Backes, MD; Michael Fung Kee Fung, MB, BS; Christine H. Holschneider, MD; Lynn P. Parker, MD; Robert E. Bristow, MD, MBA; and Barbara A. Goff, MD
American Journal of Obstetrics & Gynecology, Volume 204, Issue 6 (June 2011), doi: 10.1016/j.ajog.2011.03.008
"The goal of follow-up evaluation for the detection of recurrent disease requires both clinical and cost-effectiveness," commented Ritu Salani, MD, MBA, Assistant Professor, Department of Obstetrics and Gynecology, The Ohio State University College of Medicine. "Currently, most recommendations are based on retrospective studies and expert opinion. Taking a thorough history, performing a thorough examination, and educating cancer survivors about concerning symptoms is the most effective method for the detection of gynecologic cancer recurrences. There is very little evidence that routine cytologic procedures or imaging improves the ability to detect gynecologic cancer recurrence at a stage that will impact cure or response rates to salvage therapy. This article reviews the most recent data on surveillance for gynecologic cancer recurrence in women who have had a complete response to primary cancer therapy."
SGO's Clinical Documents are designed to improve the overall quality of women's cancer care, to reduce the use of unnecessary, ineffective, or harmful interventions, and to facilitate the treatment of patients with a goal to maximum the chance of benefit with a minimum risk of harm and at an acceptable cost. The role of surveillance is to provide clinical and cost-effective practices that detect recurrence and impact survival outcomes.
"Prevention is a big part of our mission as a collective membership," said SGO President John Curtin. "By sharing our best knowledge regarding surveillance of patients who have had a gynecologic malignancy with the medical team in the best position to detect a recurrence, we are helping our patients who do have a recurrence obtain appropriate care as soon as possible."
The article outlines in detail the surveillance techniques and appropriate monitoring intervals for endometrial, ovarian, nonepithelial ovarian, cervical, vulvar, and vaginal cancers. In some cases, certain techniques have been found ineffective in detecting recurrence and are discouraged in the recommendations. Patients should be counseled on the benefits and pitfalls of disease monitoring, which should include the psychologic impact of surveillance programs.
Coordination of care between gynecologic oncologists, primary care providers, other healthcare providers (such as radiation oncologists), and patients ideally will allow for compliance with cancer follow-up care and routine health maintenance. However, the Committee notes that as survivors are transitioned from oncology care to primary care, primary care providers may not be trained to deal with specific follow-up needs or practice standards for patients with cancer. The information in this clinical document is intended to help bridge that gap. The provision of a clear understanding of recommendations and responsibilities of appropriate surveillance will reduce unnecessary tests, ultimately result in cost savings, and better, earlier detection of disease recurrence.
"Post treatment surveillance and diagnosis of recurrence in women with gynecologic malignancies: Society of Gynecologic Oncology recommendations"
Ritu Salani, MD, MBA; Floor J. Backes, MD; Michael Fung Kee Fung, MB, BS; Christine H. Holschneider, MD; Lynn P. Parker, MD; Robert E. Bristow, MD, MBA; and Barbara A. Goff, MD
American Journal of Obstetrics & Gynecology, Volume 204, Issue 6 (June 2011), doi: 10.1016/j.ajog.2011.03.008
четверг, 30 июня 2011 г.
Specialists Perform Area's First Fetal Surgery To Correct Twin-Twin Transfusion Syndrome
Jessica and Chad Browning were ecstatic last fall when they learned they were expecting twins. They had two children already, but wanted a third to round out their family. Twins were a bonus.
About 19 weeks into the pregnancy, however, they received a shattering diagnosis: Their babies had Twin-Twin Transfusion syndrome (TTTS), a life-threatening condition in which the placenta is shared unequally by identical twins.
"We were devastated," said Mrs. Browning. "It was very overwhelming. We were not going to do what's good for just one of the twins. We wanted to do what would be best for both."
The condition, which occurs in about 15 percent of identical twins, can lead to a severe discrepancy in blood flow, amniotic fluid volume and fetal growth, and can result in up to a 90 percent mortality rate for one or both twins, said Dr. Michael Zaretsky, assistant professor of obstetrics and gynecology at UT Southwestern Medical Center and the maternal-fetal medicine specialist to whom Mrs. Browning was referred.
"It's shattering for parents to get this diagnosis," Dr. Zaretsky said. "They'll do anything to make it a good outcome. Our goal is to do it right."
Dr. Zaretsky is one of the only maternal-fetal medicine specialists in North Texas who had been trained in a procedure to correct the syndrome. In December 2010, he and Dr. Ashley Hickman, also an assistant professor of obstetrics and gynecology and a maternal-fetal medicine specialist at UT Southwestern, along with nursing staff at Parkland Memorial Hospital, successfully performed for the first time in Dallas a fetoscopic laser procedure to correct TTTS.
The surgery improved the twins' chances of survival to between 60 percent to 70 percent and 90 percent for at least one survivor.
On Feb. 25, the twins were delivered by Cesarean section at 32 weeks, and both were healthy. Alexis Nicole weighed 3 pounds, 9 ounces, and Amber Rose weighed 4 pounds, 6 ounces. They spent just two weeks in a Carrollton hospital before being released.
In TTTS, blood vessels on the surface of the shared placenta do not provide an equal volume of blood for each fetus. The result is that one twin becomes the donor and the other the recipient. The donor becomes anemic, has less amniotic fluid and is growth-restricted. The recipient gets larger, and its amniotic fluid becomes very elevated. The recipient twin is weakened faster because the increased amniotic volume creates high blood pressure and cardiomyopathy, or a thickening of the heart.
Dr. Zaretsky, with colleagues from Parkland, UT Southwestern and Children's Medical Center Dallas, developed the fetal surgery over a four-year period in partnership with the Cincinnati, Ohio-based Fetal Care Center, one of only a dozen institutions in the U.S. that offers the procedure.
During the 60- to 90-minute surgery, a surgical telescope (fetoscope) was inserted into the amniotic sac of the recipient twin, allowing Drs. Zaretsky and Hickman to "map" the placenta and determine which blood vessels crossed the vascular equator, or the point at which blood flows to one twin or the other. Dr. Zaretsky, who is also director of maternal-fetal medicine at Children's Medical Center at Legacy in Plano, then used laser fiber technology to seal off several vessels and reroute blood flow to both twins.
The team of specialists also drained two liters of amniotic fluid from the larger fetal sac and created small openings in the fetal membrane to equalize fluid faster.
Mrs. Brown spent the remainder of her pregnancy with bed rest. When her girls were delivered, the larger twin needed some help with continuous positive airway pressure (CPAP), which blows air through an infant's nostrils to gently inflate the lungs. CPAP machines are routinely used by adults with sleep apnea to aid breathing.
"I thought, 'If I could just hear them cry, then I'd know they were alright," she said. "Alexis just wailed, and I started crying. Amber needed some help; she would forget to breathe at times. But after 12 hours on a CPAP, she picked it up on her own. It was just wonderful."
Dr. Zaretsky said the most common complication of the procedure is the initiation of preterm labor, caused by breaking the amniotic sac; this occurs about 8 percent of the time. Other medical concerns are possible rapid fluctuation of blood flow for the fetuses during the procedure, or placenta blood vessels that begin bleeding.
Looking back, Mrs. Browning said she was willing to take those risks.
"It is very scary, but honestly and truly, if we hadn't had this procedure, we know we would not have both girls here. This surgery really does save lives."
Source: UT Southwestern Medical Center
About 19 weeks into the pregnancy, however, they received a shattering diagnosis: Their babies had Twin-Twin Transfusion syndrome (TTTS), a life-threatening condition in which the placenta is shared unequally by identical twins.
"We were devastated," said Mrs. Browning. "It was very overwhelming. We were not going to do what's good for just one of the twins. We wanted to do what would be best for both."
The condition, which occurs in about 15 percent of identical twins, can lead to a severe discrepancy in blood flow, amniotic fluid volume and fetal growth, and can result in up to a 90 percent mortality rate for one or both twins, said Dr. Michael Zaretsky, assistant professor of obstetrics and gynecology at UT Southwestern Medical Center and the maternal-fetal medicine specialist to whom Mrs. Browning was referred.
"It's shattering for parents to get this diagnosis," Dr. Zaretsky said. "They'll do anything to make it a good outcome. Our goal is to do it right."
Dr. Zaretsky is one of the only maternal-fetal medicine specialists in North Texas who had been trained in a procedure to correct the syndrome. In December 2010, he and Dr. Ashley Hickman, also an assistant professor of obstetrics and gynecology and a maternal-fetal medicine specialist at UT Southwestern, along with nursing staff at Parkland Memorial Hospital, successfully performed for the first time in Dallas a fetoscopic laser procedure to correct TTTS.
The surgery improved the twins' chances of survival to between 60 percent to 70 percent and 90 percent for at least one survivor.
On Feb. 25, the twins were delivered by Cesarean section at 32 weeks, and both were healthy. Alexis Nicole weighed 3 pounds, 9 ounces, and Amber Rose weighed 4 pounds, 6 ounces. They spent just two weeks in a Carrollton hospital before being released.
In TTTS, blood vessels on the surface of the shared placenta do not provide an equal volume of blood for each fetus. The result is that one twin becomes the donor and the other the recipient. The donor becomes anemic, has less amniotic fluid and is growth-restricted. The recipient gets larger, and its amniotic fluid becomes very elevated. The recipient twin is weakened faster because the increased amniotic volume creates high blood pressure and cardiomyopathy, or a thickening of the heart.
Dr. Zaretsky, with colleagues from Parkland, UT Southwestern and Children's Medical Center Dallas, developed the fetal surgery over a four-year period in partnership with the Cincinnati, Ohio-based Fetal Care Center, one of only a dozen institutions in the U.S. that offers the procedure.
During the 60- to 90-minute surgery, a surgical telescope (fetoscope) was inserted into the amniotic sac of the recipient twin, allowing Drs. Zaretsky and Hickman to "map" the placenta and determine which blood vessels crossed the vascular equator, or the point at which blood flows to one twin or the other. Dr. Zaretsky, who is also director of maternal-fetal medicine at Children's Medical Center at Legacy in Plano, then used laser fiber technology to seal off several vessels and reroute blood flow to both twins.
The team of specialists also drained two liters of amniotic fluid from the larger fetal sac and created small openings in the fetal membrane to equalize fluid faster.
Mrs. Brown spent the remainder of her pregnancy with bed rest. When her girls were delivered, the larger twin needed some help with continuous positive airway pressure (CPAP), which blows air through an infant's nostrils to gently inflate the lungs. CPAP machines are routinely used by adults with sleep apnea to aid breathing.
"I thought, 'If I could just hear them cry, then I'd know they were alright," she said. "Alexis just wailed, and I started crying. Amber needed some help; she would forget to breathe at times. But after 12 hours on a CPAP, she picked it up on her own. It was just wonderful."
Dr. Zaretsky said the most common complication of the procedure is the initiation of preterm labor, caused by breaking the amniotic sac; this occurs about 8 percent of the time. Other medical concerns are possible rapid fluctuation of blood flow for the fetuses during the procedure, or placenta blood vessels that begin bleeding.
Looking back, Mrs. Browning said she was willing to take those risks.
"It is very scary, but honestly and truly, if we hadn't had this procedure, we know we would not have both girls here. This surgery really does save lives."
Source: UT Southwestern Medical Center
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