Latinas participating in an educational intervention program were two-and-a-half times more likely to seek postpartum care than were those who did not have access to a similar program, a new study finds.
Although 80 percent of women with private insurance receive related health care after having a baby, only 59 percent of women with Medicaid insurance do, according to the Health Employer Data and Information Set (HEDIS). Women of low income, particularly Latinas and other minorities, have greater health risks due to below-average rates of postpartum follow-up visits, the authors write.
"Having patients come back for postpartum checkups is very important," said lead study author Flavio Marsiglia, Ph.D., the director of the Southwest Interdisciplinary Research Center (SIRC) at the School of Social Work at Arizona State University. "It is during this time that some health and mental problems, such as depression, may be recognized."
The study relied on the Familias Sanas, or Healthy Families, program and examined postpartum visit rates and other wellbeing measures. It appears in the August issue of the Journal of Health Care for the Poor and Underserved.
During a first prenatal visit, researchers invited women to participate in the randomized controlled study if they were less than 34 weeks pregnant, at least 18 years old and identified their ethnicity as Latina or Hispanic. The women each met between five and 20 times with a bicultural and bilingual prenatal partner a student in the social work program.
Among other things, the prenatal partner conducted a baseline assessment, provided education, assisted with communication and helped arrange regular prenatal and postpartum visits.
The study included 440 women seen at the Women's Care Clinic at Maricopa Medical Center in Phoenix. Of these, 221 women participated in the intervention and 219 were in the control group. Eighty-four percent of participants were first-generation immigrants and 73 percent had an annual income of less than $20,000. Most women were of Mexican heritage and in their late 20s. Eighty percent had a previous pregnancy.
"Educating patients and encouraging them to come back during visits near the termination of OB care are ways to increase the number of women who continue using health care between pregnancies," Marsiglia said. The time between pregnancies, called the interconception period, can be a time to address folic acid consumption before conception, family planning and pregnancy risks such as hypertension and diabetes.
"The program is very similar to the Comprehensive Perinatal Services Program in California that encourages educating patients throughout the antepartum period," said Peyman Banooni, M.D., an OB/GYN specialist who serves the Hispanic population in two downtown Los Angeles clinics. "Cultural sensitivity, resolving language barriers, educating patients about the system and longer health insurance coverage after delivery will definitely improve access to care and health outcomes."
However, he said "the assumption that by patients coming to postpartum visit, it will lead to better health outcomes for the patients" needs to be proven in further studies." He also said that the findings can only be applied to similar populations and not necessarily all Latino populations.
"Medical personnel are asked to do more and more and often they cannot humanly respond to all of those demands," Marsiglia said. "Cost-effective interventions like Familias Sanas can be relatively easy to implement and can significantly improve providers' and patients' outcomes."
Marsiglia FF, Bermudez-Parsai M, Coonrod D. Familias Sanas: an intervention designed to increase rates of postpartum visits among Latinas. J Health Care Poor Underserved 21(3), 2010.
Source: Health Behavior News Service
суббота, 25 июня 2011 г.
пятница, 24 июня 2011 г.
Women Need To Be Aware Of Changes, IU Simon Cancer Center Breast Expert Says
Every day, women face a barrage of headlines about breast cancer. What should they do with all of that information?
George Sledge, M.D., an internationally recognized breast cancer expert, pointed out that, despite all of the near-constant news and information about breast cancer, it is not the disease that impacts most women.
"It's important to know that, while breast cancer is a common cancer, it is not the most common cause of death in American women. Heart disease is far more common. Women need not be paralyzed by the prospect of breast cancer."
Overall, the American Cancer Society says a woman has about a one in eight chance of developing breast cancer during her lifetime. There will be 182,460 new cases of breast cancer in the United States in 2008.
Dr. Sledge, Ballve-Lantero Professor at the Indiana University School of Medicine and an oncologist and researcher at the Indiana University Melvin and Bren Simon Cancer Center, said women need to be knowledgeable - not overwhelmed - about steps they should take regarding their breasts.
For starters, women should undergo regular screening mammography, beginning at age 40.
"Fortunately, a great majority of women today are diagnosed with what we consider early-stage disease," Sledge said. "That's been a trend in recent years because of screening mammography."
Other than mammography, women need to pay attention to their bodies. "Women need to be aware of change in their breasts," Sledge added. "If they notice a lump, mass, or a new area of tenderness that they haven't noticed before, they should get that checked out promptly."
A woman should know about her family history. A woman is at greater risk of developing breast cancer if she has one of the following:
-- A personal history of breast, ovarian, or colon cancer
-- A close relative who was diagnosed with breast cancer before menopause or in both breasts
-- Never had children or who had her first child after age 30
Once detected, breast cancer is usually treated by both local therapy and systemic therapy.
In local therapy, the goal is to eliminate the cancer in the breast and the related lymph nodes and minimize the risk of recurrence. Treatment options include surgery - breast preservation, lumpectomy (removes only the breast lump and surrounding tissue), or mastectomy (removal of all breast tissue) - and radiation therapy.
Systemic therapy involves eliminating tumor cells that might have escaped into the circulation and minimizing the risk of developing distant sites of tumor growth. Treatment options include chemotherapy, hormonal therapy, and newer and an ever-expanding class of agents known as biological therapy.
"We live in an era where we have far more to offer women with breast cancer than ever before," Sledge said. "We live in an era where our ability to screen for breast cancer has gotten better than ever before. We live in an era where there's the prospect for new diagnostic and therapeutic technology for breast cancer."
George Sledge, M.D., an internationally recognized breast cancer expert, pointed out that, despite all of the near-constant news and information about breast cancer, it is not the disease that impacts most women.
"It's important to know that, while breast cancer is a common cancer, it is not the most common cause of death in American women. Heart disease is far more common. Women need not be paralyzed by the prospect of breast cancer."
Overall, the American Cancer Society says a woman has about a one in eight chance of developing breast cancer during her lifetime. There will be 182,460 new cases of breast cancer in the United States in 2008.
Dr. Sledge, Ballve-Lantero Professor at the Indiana University School of Medicine and an oncologist and researcher at the Indiana University Melvin and Bren Simon Cancer Center, said women need to be knowledgeable - not overwhelmed - about steps they should take regarding their breasts.
For starters, women should undergo regular screening mammography, beginning at age 40.
"Fortunately, a great majority of women today are diagnosed with what we consider early-stage disease," Sledge said. "That's been a trend in recent years because of screening mammography."
Other than mammography, women need to pay attention to their bodies. "Women need to be aware of change in their breasts," Sledge added. "If they notice a lump, mass, or a new area of tenderness that they haven't noticed before, they should get that checked out promptly."
A woman should know about her family history. A woman is at greater risk of developing breast cancer if she has one of the following:
-- A personal history of breast, ovarian, or colon cancer
-- A close relative who was diagnosed with breast cancer before menopause or in both breasts
-- Never had children or who had her first child after age 30
Once detected, breast cancer is usually treated by both local therapy and systemic therapy.
In local therapy, the goal is to eliminate the cancer in the breast and the related lymph nodes and minimize the risk of recurrence. Treatment options include surgery - breast preservation, lumpectomy (removes only the breast lump and surrounding tissue), or mastectomy (removal of all breast tissue) - and radiation therapy.
Systemic therapy involves eliminating tumor cells that might have escaped into the circulation and minimizing the risk of developing distant sites of tumor growth. Treatment options include chemotherapy, hormonal therapy, and newer and an ever-expanding class of agents known as biological therapy.
"We live in an era where we have far more to offer women with breast cancer than ever before," Sledge said. "We live in an era where our ability to screen for breast cancer has gotten better than ever before. We live in an era where there's the prospect for new diagnostic and therapeutic technology for breast cancer."
четверг, 23 июня 2011 г.
Women's Unique Connection To Nature Is Explored In Special Issue Of Ecopsychology
Women experience and interact with their natural surroundings in ways that differ from men. The way in which those differences affect a woman's sense of self, body image, and drive to protect and preserve the environment are explored in a thought-provoking special issue of Ecopsychology, a peer-reviewed, online journal published by Mary Ann Liebert, Inc. (liebertpub). The entire issue is available free online at liebertpub/eco
Guest Editors Britain Scott, PhD, from the University of St. Thomas (St. Paul, MN) and Lisa Lynch, PhD, from Antioch University (Seattle, WA) present a collection of articles that encompass observations and theories on how female gender, motherhood, human nature, and gender-based societal norms influence a woman's self-perception and behavior. Topics focus on what women may gain from interacting with their surroundings on a sensory level and how they may benefit from nature-based therapies.
In the article "Babes and the Woods: Women's Objectification and the Feminine Beauty Ideal as Ecological Hazards," Dr. Scott explains how cultural norms that promote a view of women as sex objects have led women to become preoccupied with, and generally critical of, their bodies. This feeling among women that they fall short of the feminine beauty ideal has a negative impact on their attitude toward, and ability to connect with, the environment.
Kari Hennigan, PhD, from Institute of Transpersonal Psychology, suggests that women who spend time in natural settings and interact with the environment are more likely to have a better body image and to distance themselves from societal definitions of beauty. Susan Logsdon-Conradsen, PhD and Sarah Allred, PhD, from Berry College (Mount Berry, GA), describe the concept of environmental mother-activism, which is based on the supposition that a woman's mothering instincts extends to a desire to protect and preserve the environmental for her children. In the article "Motherhood and Environmental Activism: A Developmental Framework," the authors propose that motherhood stimulates activist behavior, with environmental activism being one example of this transformation. Gwena?«l Salha, PhD, from Pacifica Graduate Institute (Carpinteria, CA), draws on the 4000-year-old Sumerian myth of Inanna to explore the promise of ecotherapy. In "The Heroine in the Underworld: An Ecopsychological Perspective on the Myth of Inanna," the author describes how the theme of people's perceived connections with the Earth and their local community, drawn from the myth, can be used as a model for rebuilding relationships and restoring positive communication.
"I was honored and pleased to collaborate with Lisa Lynch and Britain Scott on this special issue of Ecopsychology. In her own way, each guest editor embodies the role of ecopsychology scholar / educator and their selections highlight the promise of this exciting interdisciplinary perspective" says Editor-in-Chief Thomas Joseph Doherty, PsyD, Graduate School of Counseling, Lewis & Clark College (Portland, OR).
Source:
Vicki Cohn
Mary Ann Liebert, Inc./Genetic Engineering News
Guest Editors Britain Scott, PhD, from the University of St. Thomas (St. Paul, MN) and Lisa Lynch, PhD, from Antioch University (Seattle, WA) present a collection of articles that encompass observations and theories on how female gender, motherhood, human nature, and gender-based societal norms influence a woman's self-perception and behavior. Topics focus on what women may gain from interacting with their surroundings on a sensory level and how they may benefit from nature-based therapies.
In the article "Babes and the Woods: Women's Objectification and the Feminine Beauty Ideal as Ecological Hazards," Dr. Scott explains how cultural norms that promote a view of women as sex objects have led women to become preoccupied with, and generally critical of, their bodies. This feeling among women that they fall short of the feminine beauty ideal has a negative impact on their attitude toward, and ability to connect with, the environment.
Kari Hennigan, PhD, from Institute of Transpersonal Psychology, suggests that women who spend time in natural settings and interact with the environment are more likely to have a better body image and to distance themselves from societal definitions of beauty. Susan Logsdon-Conradsen, PhD and Sarah Allred, PhD, from Berry College (Mount Berry, GA), describe the concept of environmental mother-activism, which is based on the supposition that a woman's mothering instincts extends to a desire to protect and preserve the environmental for her children. In the article "Motherhood and Environmental Activism: A Developmental Framework," the authors propose that motherhood stimulates activist behavior, with environmental activism being one example of this transformation. Gwena?«l Salha, PhD, from Pacifica Graduate Institute (Carpinteria, CA), draws on the 4000-year-old Sumerian myth of Inanna to explore the promise of ecotherapy. In "The Heroine in the Underworld: An Ecopsychological Perspective on the Myth of Inanna," the author describes how the theme of people's perceived connections with the Earth and their local community, drawn from the myth, can be used as a model for rebuilding relationships and restoring positive communication.
"I was honored and pleased to collaborate with Lisa Lynch and Britain Scott on this special issue of Ecopsychology. In her own way, each guest editor embodies the role of ecopsychology scholar / educator and their selections highlight the promise of this exciting interdisciplinary perspective" says Editor-in-Chief Thomas Joseph Doherty, PsyD, Graduate School of Counseling, Lewis & Clark College (Portland, OR).
Source:
Vicki Cohn
Mary Ann Liebert, Inc./Genetic Engineering News
Lapatinib Shows Promise As Therapy For Inflammatory Breast Cancer, Study Finds
In the first multi-center and international clinical trial conducted to better understand the complexities of a rare, aggressive and often lethal form of breast cancer, researchers have discovered that the experimental biological agent, lapatinib, successfully and specifically treats inflammatory breast cancer (IBC).
Massimo Cristofanilli, M.D., associate professor in the Department of Breast Medical Oncology at The University of Texas M. D. Anderson Cancer Center, reported the findings of the international Phase II trial at the San Antonio Breast Cancer Symposium.
IBC is rare, representing just 1- 2 percent of all breast cancers diagnosed. Unlike other breast cancers that present as a lump, IBC??™s symptoms include redness, swelling, and warmth in the breast, skin that is reddish, purple or bruised, has ridges and/or appears pitted like an orange. Other symptoms can include burning, aching or tenderness, an increase in breast size, and/or an inverted nipple.
A fast growing and aggressive cancer, IBC is more likely than other breast cancers to be misdiagnosed, often diagnosed after the disease has metastasized, says Cristofanilli. According to Cristofanilli, 40 percent of women with IBC will survive five years. Until now, no therapies specific to IBC have been studied in multi-center trials. As a consequence, no effective therapies - standard or experimental - exist for women with IBC.
???We initiated this Phase II study because lapatinib is one of the few drugs that had shown any activity in Phase I studies in patients with recurrent IBC. It appeared that this agent could be the first to offer hope for women newly diagnosed with the disease,??? says Cristofanilli, the study??™s principal investigator.
Lapatinib is an epidermal growth factor receptor and HER2neu tyrosine kinase inhibitor. An experimental drug that has shown promise in patients with metastatic HER2-positive cancer in whom Herceptin has failed, the oral agent blocks the activity of the HER2 protein as well as EGFR by binding to the part of the protein found inside breast cancer cells, explains Cristofanilli.
The trial enrolled 49 newly diagnosed IBC patients, all of whom were HER2 and/or EGFR-positive and who had never been treated for their disease. Approximately 25 percent of the women had metastatic disease.
The women received two weeks of daily lapatinib alone, followed by three months of concurrent lapatinib (taken daily) and paclitaxel chemotherapy (given weekly). Thirty-five of the patients completed the trial and had surgery, as indicated by the protocol, and constitutes the data presented.
The study reports that 30 out of the 35 patients, or 86 percent, had a clinical response, defined as 50 percent reduction in tumor size, to the lapatinib-chemotherapy drug regimen. Only one patient progressed during therapy. Three of the first 21 patients that had surgery had a complete pathological response, meaning that there was no evidence of disease at the time of surgery.
Just as interesting and important is the finding that 25-30 percent of the patients responded in the first two weeks when receiving lapatinib alone, says Cristofanilli.
???For IBC patients, these results should be very encouraging because there??™s now more of a dedicated research effort for a type of breast cancer that has long been ignored and misunderstood. With lapatinib, we finally have a drug on which to build effective therapy - we just have to refine the most effective way to use it. The findings presented today will allow us to expedite future clinical trials.???
Planned studies with laptinib likely will include the agent in combination with different chemotherapy regimens. The trials also will focus on IBC patients who are HER2-positive, not EGFR positive, as indications from the Phase II trial showed that IBC patients who were HER2 positive responded better to the laptinib therapy.
Side effects to the laptinib were predictable and manageable, with diarrhea and a skin rash being the most common, he says.
In October, M. D. Anderson opened the first center in the world dedicated to IBC treatment and research. The clinic is under the co-direction of Cristofanilli and Thomas Buchholz, M.D., professor in the Department of Radiation Oncology, and is housed in M. D. Anderson??™s Nellie B. Connally Breast Center.
Already, M. D. Anderson sees approximately 30 new cases of IBC a year - more than any other institution in this country, says Cristofanilli. With the new clinic, Cristofanilli and his team hope to see 60-80 new cases annually. Lapatinib is manufactured by GlaxoSmithKline.
Contact: Julie Penne
University of Texas M. D. Anderson Cancer Center
View drug information on Herceptin.
Massimo Cristofanilli, M.D., associate professor in the Department of Breast Medical Oncology at The University of Texas M. D. Anderson Cancer Center, reported the findings of the international Phase II trial at the San Antonio Breast Cancer Symposium.
IBC is rare, representing just 1- 2 percent of all breast cancers diagnosed. Unlike other breast cancers that present as a lump, IBC??™s symptoms include redness, swelling, and warmth in the breast, skin that is reddish, purple or bruised, has ridges and/or appears pitted like an orange. Other symptoms can include burning, aching or tenderness, an increase in breast size, and/or an inverted nipple.
A fast growing and aggressive cancer, IBC is more likely than other breast cancers to be misdiagnosed, often diagnosed after the disease has metastasized, says Cristofanilli. According to Cristofanilli, 40 percent of women with IBC will survive five years. Until now, no therapies specific to IBC have been studied in multi-center trials. As a consequence, no effective therapies - standard or experimental - exist for women with IBC.
???We initiated this Phase II study because lapatinib is one of the few drugs that had shown any activity in Phase I studies in patients with recurrent IBC. It appeared that this agent could be the first to offer hope for women newly diagnosed with the disease,??? says Cristofanilli, the study??™s principal investigator.
Lapatinib is an epidermal growth factor receptor and HER2neu tyrosine kinase inhibitor. An experimental drug that has shown promise in patients with metastatic HER2-positive cancer in whom Herceptin has failed, the oral agent blocks the activity of the HER2 protein as well as EGFR by binding to the part of the protein found inside breast cancer cells, explains Cristofanilli.
The trial enrolled 49 newly diagnosed IBC patients, all of whom were HER2 and/or EGFR-positive and who had never been treated for their disease. Approximately 25 percent of the women had metastatic disease.
The women received two weeks of daily lapatinib alone, followed by three months of concurrent lapatinib (taken daily) and paclitaxel chemotherapy (given weekly). Thirty-five of the patients completed the trial and had surgery, as indicated by the protocol, and constitutes the data presented.
The study reports that 30 out of the 35 patients, or 86 percent, had a clinical response, defined as 50 percent reduction in tumor size, to the lapatinib-chemotherapy drug regimen. Only one patient progressed during therapy. Three of the first 21 patients that had surgery had a complete pathological response, meaning that there was no evidence of disease at the time of surgery.
Just as interesting and important is the finding that 25-30 percent of the patients responded in the first two weeks when receiving lapatinib alone, says Cristofanilli.
???For IBC patients, these results should be very encouraging because there??™s now more of a dedicated research effort for a type of breast cancer that has long been ignored and misunderstood. With lapatinib, we finally have a drug on which to build effective therapy - we just have to refine the most effective way to use it. The findings presented today will allow us to expedite future clinical trials.???
Planned studies with laptinib likely will include the agent in combination with different chemotherapy regimens. The trials also will focus on IBC patients who are HER2-positive, not EGFR positive, as indications from the Phase II trial showed that IBC patients who were HER2 positive responded better to the laptinib therapy.
Side effects to the laptinib were predictable and manageable, with diarrhea and a skin rash being the most common, he says.
In October, M. D. Anderson opened the first center in the world dedicated to IBC treatment and research. The clinic is under the co-direction of Cristofanilli and Thomas Buchholz, M.D., professor in the Department of Radiation Oncology, and is housed in M. D. Anderson??™s Nellie B. Connally Breast Center.
Already, M. D. Anderson sees approximately 30 new cases of IBC a year - more than any other institution in this country, says Cristofanilli. With the new clinic, Cristofanilli and his team hope to see 60-80 new cases annually. Lapatinib is manufactured by GlaxoSmithKline.
Contact: Julie Penne
University of Texas M. D. Anderson Cancer Center
View drug information on Herceptin.
Ontario Women Live Longer But Don't Prosper: Study
While Ontario women live longer than men, a majority are more likely to suffer from disability and chronic conditions, according to a new women's health study by St. Michael's Hospital researcher Dr. Arlene Bierman. What's more, low-income women have more chronic conditions, greater disability and a shorter life expectancy than women in high-income groups.
While inequities in health among men and women have been well documented, the findings strongly suggest that the size of the inequities among women is often larger than the overall differences between men and women.
"Women with less education and low income were found to experience a greater burden of illness overall compared to men and women with higher incomes," said Dr. Bierman. "While we already knew these inequities exist, we are quite startled by just how large the gap is among different groups of women. The good news is that there is much that can be done to close this gap. The inequities we found are associated with chronic disease, so by focusing on chronic disease prevention and management, and improving the living and working conditions that increase the risk of chronic disease, we can improve health outcomes for all women and men."
The joint study, titled POWER (the Project for an Ontario Women's Health Evidence-Based Report), from St. Michael's Hospital and the Institute for Clinical Evaluative Sciences (ICES), is the first in Ontario to provide a comprehensive overview of women's health in relation to gender, income, education, ethnicity and geography. POWER reports on indicators of population health and of how well the health system is performing. Policymakers and health-care providers may use these research findings to improve access, quality and outcomes of care for Ontario women. The POWER Study was funded by Echo: Improving Women's Health in Ontario, an agency of the Ontario Ministry of Health and Long-Term Care.
Key findings released include:
Chronic conditions
* The majority of women and men in Ontario have at least one chronic condition and many have two or more.
* Thirty-nine per cent of low income women have two or more chronic conditions compared to 28 per cent of women in the highest income group and 21 per cent of higher income men.
* Among women aged 65 and older, 70 per cent of low-income women have two or more chronic conditions compared to 57 per cent of higher-income women and 50 per cent of higher-income men.
Disease risk factors
* Overall, more than half of Ontario adults age 25 years and older reported physical inactivity (51 per cent) and inadequate fruit and vegetable intake (57 per cent), 53 per cent were overweight or obese and 22 per cent were current smokers
* Women are less physically active than men, but eat more fruits and vegetables, and are less likely to be overweight or obese and smoke than men.
* While rates of smoking have decreased over time, 28 per cent of women with less than a high school education report smoking compared to eight per cent of women who had a university degree or higher.
Length of Life
* Low-income women and men are more likely to die prematurely.
* Twenty-six per cent of women and 41 per cent of men in the lowest income range die before age 75 compared to 19 per cent of women and 28 per cent of men in the highest income bracket.
Pain
* Thirty-five per cent of low income women age 65 and older say their activities are limited by pain compared to 18 per cent of higher income women in this age group.
* Among women age 25-64, 26 per cent of low income women, and 10 per cent of higher income women report their activities are limited by pain.
Disabilities
* More than half of low-income women age 65 and older have a disability that requires the help of another person to carry out routine daily activities such as grocery shopping, housework and meal preparation.
* Older women are also about 50 per cent more likely than older men to be admitted to hospital for a fall-related injury, which can result in long-term disability and health problems.
Low income
* Across all age groups, women are more likely to live in lower-income households than men, with gender differences in income greatest among those age 65 years and older.
* Forty-four percent of women age 65-79 and 52 per cent of those aged 80 and older reported lower income compared to 33 per cent and 35 per cent of men in these age groups, respectively.
Common modifiable risk factors such as smoking, diet, and lack of exercise are responsible for much of the chronic illnesses present in both women and men. Chronic diseases are estimated to account for 87 per cent of disability in Canada.
According to the researchers, socioeconomic factors including income, education, housing, and environment as well as health behaviours must be addressed to eliminate the gap and improve population health. The POWER Study recommends:
* A comprehensive chronic disease prevention and management strategy that involves both community-based and health-sector interventions
* Better co-ordination of population-based health promotion, community-based services and clinical care services aimed at improving health among Ontarians
* Incorporation of gender and equity into health indicator reporting and monitoring to reduce disparities in health and health care.
"We must improve our knowledge of the diverse health needs of Ontario women. The POWER Study is a huge step in that direction," said Pat Campbell, CEO of ECHO. "By monitoring our progress in improving health outcomes and reducing disparities, there will be better care for women and more equitable care to all Ontarians. The findings of the study will provide strong evidence to inform priority setting and provide a baseline from which to measure progress in women's health."
Notes:
For more information on the POWER Study and to access the burden of illness report, visit powerstudy.
Dr. Arlene Bierman is a researcher in the Keenan Research Centre at the Li Ka Shing Knowledge Institute of St. Michael's Hospital, a scientist at ICES and Echo's Ontario Women's Health Council Chair in Women's Health at St. Michaels Hospital and the University of Toronto (Lawrence S. Bloomberg Faculty of Nursing).
Source:
Julie Saccone
St. Michael's Hospital
While inequities in health among men and women have been well documented, the findings strongly suggest that the size of the inequities among women is often larger than the overall differences between men and women.
"Women with less education and low income were found to experience a greater burden of illness overall compared to men and women with higher incomes," said Dr. Bierman. "While we already knew these inequities exist, we are quite startled by just how large the gap is among different groups of women. The good news is that there is much that can be done to close this gap. The inequities we found are associated with chronic disease, so by focusing on chronic disease prevention and management, and improving the living and working conditions that increase the risk of chronic disease, we can improve health outcomes for all women and men."
The joint study, titled POWER (the Project for an Ontario Women's Health Evidence-Based Report), from St. Michael's Hospital and the Institute for Clinical Evaluative Sciences (ICES), is the first in Ontario to provide a comprehensive overview of women's health in relation to gender, income, education, ethnicity and geography. POWER reports on indicators of population health and of how well the health system is performing. Policymakers and health-care providers may use these research findings to improve access, quality and outcomes of care for Ontario women. The POWER Study was funded by Echo: Improving Women's Health in Ontario, an agency of the Ontario Ministry of Health and Long-Term Care.
Key findings released include:
Chronic conditions
* The majority of women and men in Ontario have at least one chronic condition and many have two or more.
* Thirty-nine per cent of low income women have two or more chronic conditions compared to 28 per cent of women in the highest income group and 21 per cent of higher income men.
* Among women aged 65 and older, 70 per cent of low-income women have two or more chronic conditions compared to 57 per cent of higher-income women and 50 per cent of higher-income men.
Disease risk factors
* Overall, more than half of Ontario adults age 25 years and older reported physical inactivity (51 per cent) and inadequate fruit and vegetable intake (57 per cent), 53 per cent were overweight or obese and 22 per cent were current smokers
* Women are less physically active than men, but eat more fruits and vegetables, and are less likely to be overweight or obese and smoke than men.
* While rates of smoking have decreased over time, 28 per cent of women with less than a high school education report smoking compared to eight per cent of women who had a university degree or higher.
Length of Life
* Low-income women and men are more likely to die prematurely.
* Twenty-six per cent of women and 41 per cent of men in the lowest income range die before age 75 compared to 19 per cent of women and 28 per cent of men in the highest income bracket.
Pain
* Thirty-five per cent of low income women age 65 and older say their activities are limited by pain compared to 18 per cent of higher income women in this age group.
* Among women age 25-64, 26 per cent of low income women, and 10 per cent of higher income women report their activities are limited by pain.
Disabilities
* More than half of low-income women age 65 and older have a disability that requires the help of another person to carry out routine daily activities such as grocery shopping, housework and meal preparation.
* Older women are also about 50 per cent more likely than older men to be admitted to hospital for a fall-related injury, which can result in long-term disability and health problems.
Low income
* Across all age groups, women are more likely to live in lower-income households than men, with gender differences in income greatest among those age 65 years and older.
* Forty-four percent of women age 65-79 and 52 per cent of those aged 80 and older reported lower income compared to 33 per cent and 35 per cent of men in these age groups, respectively.
Common modifiable risk factors such as smoking, diet, and lack of exercise are responsible for much of the chronic illnesses present in both women and men. Chronic diseases are estimated to account for 87 per cent of disability in Canada.
According to the researchers, socioeconomic factors including income, education, housing, and environment as well as health behaviours must be addressed to eliminate the gap and improve population health. The POWER Study recommends:
* A comprehensive chronic disease prevention and management strategy that involves both community-based and health-sector interventions
* Better co-ordination of population-based health promotion, community-based services and clinical care services aimed at improving health among Ontarians
* Incorporation of gender and equity into health indicator reporting and monitoring to reduce disparities in health and health care.
"We must improve our knowledge of the diverse health needs of Ontario women. The POWER Study is a huge step in that direction," said Pat Campbell, CEO of ECHO. "By monitoring our progress in improving health outcomes and reducing disparities, there will be better care for women and more equitable care to all Ontarians. The findings of the study will provide strong evidence to inform priority setting and provide a baseline from which to measure progress in women's health."
Notes:
For more information on the POWER Study and to access the burden of illness report, visit powerstudy.
Dr. Arlene Bierman is a researcher in the Keenan Research Centre at the Li Ka Shing Knowledge Institute of St. Michael's Hospital, a scientist at ICES and Echo's Ontario Women's Health Council Chair in Women's Health at St. Michaels Hospital and the University of Toronto (Lawrence S. Bloomberg Faculty of Nursing).
Source:
Julie Saccone
St. Michael's Hospital
January 2008 AJPH Highlights: Poverty And Human Development
The articles below will be published online Nov.29, 2007, at 4 p.m. (EDT) by the American Journal of Public Health under "First Look" at ajph/first_look.shtml, and will appear in the January 2008 print issue of the Journal. The January 2008 issue is participating in the Global Theme Issue on Poverty and Human Development, organized by the Council of Science Editors. "First Look" articles have undergone peer review, copyediting and approval by authors but have not yet been printed to paper or posted online by issue. The American Journal of Public Health is published by the American Public Health Association, apha, and is available at ajph.
Immigrant children at higher risk of lead poisoning
Foreign-born children were five times more likely to have elevated blood lead levels than were U.S.-born children.
Researchers conducted a study among children in New York City to investigate associations of childhood lead poisoning with birth and residence in a foreign country. After controlling for housing characteristics and child behaviors such as eating non-food items, data suggested that foreign-born children were five times more likely than were U.S.-born children to have elevated blood lead levels. In addition, children living abroad within 6 months of their blood test had a 10-times increased risk for lead poisoning relative to U.S.-born children with no history of foreign residence.
"These results suggest a need for considering recent immigration as a risk factor for childhood lead poisoning and allocating resources to identify and remove lead exposure sources in the immigrant communities at greater risk," said the study's authors. "Equally important is educating immigrant families about methods of reducing children's exposure to lead paint hazards, given that paint may be an unfamiliar source for many immigrant families." [From: "Immigration and Risk of Childhood Lead Poisoning: Findings From a Case-Control Study of New York City Children." ]
Nearly 60 percent of women trafficked and sexually exploited suffered from posttraumatic stress
Study is first to quantitatively document the health symptoms of trafficked women and adolescent girls in Europe.
Researchers interviewed 192 women and adolescent girls within 14 days of accessing post-trafficking services to investigate the health of women trafficked for sexual exploitation in Europe. Almost 60 percent of participants reported experiences of sexual or physical violence before being trafficked, and 12 percent had a forced or coerced sexual experience before the age of 15. Ninety-five percent of participants reported physical or sexual violence while in the trafficking situation. Symptoms associated with depression were most often reported, with 39 percent of participants acknowledging having suicidal thoughts within the past seven days.
"The severe symptom patterns identified suggest that diagnostic and treatment services should be made immediately available to survivors of trafficking," said the study's authors. "However, dissecting the constellation of women's symptoms and formulating treatment plans are not likely to be easy or short-term tasks." [From: "The Health of Trafficked Women: A Survey of Women Entering Post-trafficking Services in Europe." ]
Increased health care spending in developing countries not enough by itself to increase utilization of skilled birth attendants
Access to education, however, contributes to birth attendant use, so the optimal scenario in a country combines higher health care expenditures and equitable access policies.
The study analyzed data from Demographic and Health Surveys of 45 developing countries to investigate the extent to which redistributive education policies modify the impact of higher health spending on the utilization of skilled birth attendants among the poorest compared with the least poor women. Data suggests that at any given level of health care spending, women's use of skilled birth attendants varied substantially, depending on the equity of distribution of education.
"This work supports the thesis that higher levels of health expenditure do not automatically mean substantially greater use of skilled birth attendants by poor women," said the study's authors. "Poor women's access to education, which is in the domain of government policy and reflects a redistributive policy environment, is an important influence on improving the equity of access." [From: "Equity of Skilled Birth Attendant Utilization in Developing Countries: Financing and Policy Determinants." ]
Early and late sexual debut associated with problems in sexual functioning
Early initiation of sexual intercourse is associated with increased number of sexual partners, increased sexual risk behaviors and problems in sexual functioning.
Researchers examined the adult consequences of early or late sexual debut by conducting a secondary analysis of data from the National Sexual Health Survey. Researchers also compared individuals whose first sexual intercourse occurred after marriage with those whose first experience occurred before marriage.
Data suggested that timing of first sexual intercourse was associated with several sexual risk factors in men and women. Men and women who had an early sexual debut reported more sexual partners, were more likely to have had sexual intercourse with at least one risky partner in the preceding year and preceding five years and were more likely to have had sexual intercourse under the influence of alcohol or drugs in the past year. When compared to those who debuted at a normative age, early starters were more likely to have a history of an STI, whereas late starting women were less likely than those who had started at a normative age to have such a history. Early initiation and late initiation were both associated with various problems in sexual functioning, especially in men. Differences observed between individuals whose first sexual intercourse occurred before marriage and those whose first intercourse occurred after marriage were similar to those observed between early and late starters.
"Although our findings support an association between early initiation and long-term STI risk, they also suggest a more complicated picture of sexual functioning. Contrary to the suggestions of proponents of abstinence-only education, we found that both early and late initiators are more likely to experience problems with sexual functioning than those who initiate sexual activity at a normative age," said the study's authors. "Such a finding in regard to late initiation lends credence to research showing that abstinence-only education may actually increase health risks and that strategies designed to promote relevant sexual health information, motivation and skills are likely to be more effective than abstinence-only messages in helping young people avoid short- as well as long-term health consequences." [From: "Long-term Health Consequences of Timing of Sexual Debut: Results from a National U.S. Study" by Sandfort, Orr, Hirsch & Santelli; ]
The American Journal of Public Health is the monthly journal of the American Public Health Association (APHA), the oldest organization of public health professionals in the world. APHA is a leading publisher of books and periodicals promoting sound scientific standards, action programs and public policy to enhance health. More information is available at apha.
American Public Health Association (APHA)
800 I St. NW
Washington, DC 20001
United States
ajph
Immigrant children at higher risk of lead poisoning
Foreign-born children were five times more likely to have elevated blood lead levels than were U.S.-born children.
Researchers conducted a study among children in New York City to investigate associations of childhood lead poisoning with birth and residence in a foreign country. After controlling for housing characteristics and child behaviors such as eating non-food items, data suggested that foreign-born children were five times more likely than were U.S.-born children to have elevated blood lead levels. In addition, children living abroad within 6 months of their blood test had a 10-times increased risk for lead poisoning relative to U.S.-born children with no history of foreign residence.
"These results suggest a need for considering recent immigration as a risk factor for childhood lead poisoning and allocating resources to identify and remove lead exposure sources in the immigrant communities at greater risk," said the study's authors. "Equally important is educating immigrant families about methods of reducing children's exposure to lead paint hazards, given that paint may be an unfamiliar source for many immigrant families." [From: "Immigration and Risk of Childhood Lead Poisoning: Findings From a Case-Control Study of New York City Children." ]
Nearly 60 percent of women trafficked and sexually exploited suffered from posttraumatic stress
Study is first to quantitatively document the health symptoms of trafficked women and adolescent girls in Europe.
Researchers interviewed 192 women and adolescent girls within 14 days of accessing post-trafficking services to investigate the health of women trafficked for sexual exploitation in Europe. Almost 60 percent of participants reported experiences of sexual or physical violence before being trafficked, and 12 percent had a forced or coerced sexual experience before the age of 15. Ninety-five percent of participants reported physical or sexual violence while in the trafficking situation. Symptoms associated with depression were most often reported, with 39 percent of participants acknowledging having suicidal thoughts within the past seven days.
"The severe symptom patterns identified suggest that diagnostic and treatment services should be made immediately available to survivors of trafficking," said the study's authors. "However, dissecting the constellation of women's symptoms and formulating treatment plans are not likely to be easy or short-term tasks." [From: "The Health of Trafficked Women: A Survey of Women Entering Post-trafficking Services in Europe." ]
Increased health care spending in developing countries not enough by itself to increase utilization of skilled birth attendants
Access to education, however, contributes to birth attendant use, so the optimal scenario in a country combines higher health care expenditures and equitable access policies.
The study analyzed data from Demographic and Health Surveys of 45 developing countries to investigate the extent to which redistributive education policies modify the impact of higher health spending on the utilization of skilled birth attendants among the poorest compared with the least poor women. Data suggests that at any given level of health care spending, women's use of skilled birth attendants varied substantially, depending on the equity of distribution of education.
"This work supports the thesis that higher levels of health expenditure do not automatically mean substantially greater use of skilled birth attendants by poor women," said the study's authors. "Poor women's access to education, which is in the domain of government policy and reflects a redistributive policy environment, is an important influence on improving the equity of access." [From: "Equity of Skilled Birth Attendant Utilization in Developing Countries: Financing and Policy Determinants." ]
Early and late sexual debut associated with problems in sexual functioning
Early initiation of sexual intercourse is associated with increased number of sexual partners, increased sexual risk behaviors and problems in sexual functioning.
Researchers examined the adult consequences of early or late sexual debut by conducting a secondary analysis of data from the National Sexual Health Survey. Researchers also compared individuals whose first sexual intercourse occurred after marriage with those whose first experience occurred before marriage.
Data suggested that timing of first sexual intercourse was associated with several sexual risk factors in men and women. Men and women who had an early sexual debut reported more sexual partners, were more likely to have had sexual intercourse with at least one risky partner in the preceding year and preceding five years and were more likely to have had sexual intercourse under the influence of alcohol or drugs in the past year. When compared to those who debuted at a normative age, early starters were more likely to have a history of an STI, whereas late starting women were less likely than those who had started at a normative age to have such a history. Early initiation and late initiation were both associated with various problems in sexual functioning, especially in men. Differences observed between individuals whose first sexual intercourse occurred before marriage and those whose first intercourse occurred after marriage were similar to those observed between early and late starters.
"Although our findings support an association between early initiation and long-term STI risk, they also suggest a more complicated picture of sexual functioning. Contrary to the suggestions of proponents of abstinence-only education, we found that both early and late initiators are more likely to experience problems with sexual functioning than those who initiate sexual activity at a normative age," said the study's authors. "Such a finding in regard to late initiation lends credence to research showing that abstinence-only education may actually increase health risks and that strategies designed to promote relevant sexual health information, motivation and skills are likely to be more effective than abstinence-only messages in helping young people avoid short- as well as long-term health consequences." [From: "Long-term Health Consequences of Timing of Sexual Debut: Results from a National U.S. Study" by Sandfort, Orr, Hirsch & Santelli; ]
The American Journal of Public Health is the monthly journal of the American Public Health Association (APHA), the oldest organization of public health professionals in the world. APHA is a leading publisher of books and periodicals promoting sound scientific standards, action programs and public policy to enhance health. More information is available at apha.
American Public Health Association (APHA)
800 I St. NW
Washington, DC 20001
United States
ajph
Experimental Microbicide Gel Offers Some Protection Against HIV Transmission, Study Finds
An experimental vaginal microbicide gel shows a small level of protection against HIV transmission, according to a study presented Monday at the ongoing 16th Conference on Retroviruses and Opportunistic Infections in Montreal, Canada, the Washington Post reports (Brown, Washington Post, 2/10). The gel, called PRO 2000 and manufactured by Indevus Pharmaceuticals, is designed to prevent HIV from attaching to certain white blood cells. According to the study -- which primarily aimed to test the gel's safety -- the PRO 2000 gel is 30% effective in preventing HIV transmission. Although the findings might be inconclusive, the study is the first to demonstrate a possible beneficial effect from using microbicides (Stobbe, AP/Google, 2/9). Researchers for many years have worked to develop effective microbicides to prevent HIV transmission, but no earlier studies have shown promising results, and two previous trials showed that the gels being studied actually increased the risk of contracting HIV. According to the Post, because microbicides can be applied without the knowledge of sexual partners, they are considered "especially important in cultures where the subservient status of women makes it difficult for them to insist on abstinence or condom use" (Washington Post, 2/10).
For the study, Salim Abdool Karim of the Center for the AIDS Program of Research in South Africa and colleagues divided 3,100 women from Malawi, South Africa, the U.S., Zambia and Zimbabwe into four groups. They provided the first group of women with the PRO 2000 gel; the second with ReProtect's microbicide gel BufferGel; the third group with a placebo gel; and the remaining group with no microbicide gel. All the women received counseling to encourage condom use (AP/Google, 2/9). At the conclusion of the 20-month study period, 194 women had contracted HIV, including 36 women from the PRO 2000 group, 54 from the BufferGel group, 51 from the placebo group and 53 from the group that used no microbicides. Although the PRO 2000 gel was 30% effective, the researchers noted that the results are not statistically significant (Reichard, CQ HealthBeat, 2/9). According to the National Institutes of Health, which funded the study, an effectiveness rate of 33% would be statistically significant (AFP/Google, 2/9). The researchers also found no significant indication that BufferGel protected against HIV transmission (Fox, Reuters, 2/9).
Although the results of the Indevus trial show promise, the study did not provide data on the percentage of cases in which PRO 2000 was effective if actually applied. According to NIH, participants reported use of the gels in 81% of sex acts. Kathy Stover, NIH communications officer, said the study was based on self-reporting, and therefore the researchers "have no way to verify that the gel was actually applied prior to sexual intercourse" (CQ HealthBeat, 2/9). According to health officials, further research will be necessary to determine the gel's efficacy. London's Medical Research Council currently is conducting a study of the PRO 2000 gel involving 9,500 women, which is three times the size of the first study, Bloomberg reports. Mitchell Warren, executive director of the AIDS Vaccine Advocacy Coalition, said the "positive" result from the first trial "increases the anticipation of those from the next" (Lauerman, Bloomberg, 2/9).
Karim, who presented the PRO 2000 study at the conference, said the gel "could be a niche product for a group of women who have no other option." In sub-Saharan Africa, about 60% of HIV-positive people are women, the Post reports. (Washington Post, 2/10). Karim added that the study, "while not conclusive, provides a glimmer of hope to millions of women at risk for HIV, especially young women in Africa." Anthony Fauci, director of NIH's National Institute of Allergy and Infectious Diseases, added, "An effective microbicide would be a valuable tool that women could use to protect themselves against HIV and one that could substantially reduce the number of new HIV infections worldwide (AFP/Google, 2/9).
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.
For the study, Salim Abdool Karim of the Center for the AIDS Program of Research in South Africa and colleagues divided 3,100 women from Malawi, South Africa, the U.S., Zambia and Zimbabwe into four groups. They provided the first group of women with the PRO 2000 gel; the second with ReProtect's microbicide gel BufferGel; the third group with a placebo gel; and the remaining group with no microbicide gel. All the women received counseling to encourage condom use (AP/Google, 2/9). At the conclusion of the 20-month study period, 194 women had contracted HIV, including 36 women from the PRO 2000 group, 54 from the BufferGel group, 51 from the placebo group and 53 from the group that used no microbicides. Although the PRO 2000 gel was 30% effective, the researchers noted that the results are not statistically significant (Reichard, CQ HealthBeat, 2/9). According to the National Institutes of Health, which funded the study, an effectiveness rate of 33% would be statistically significant (AFP/Google, 2/9). The researchers also found no significant indication that BufferGel protected against HIV transmission (Fox, Reuters, 2/9).
Although the results of the Indevus trial show promise, the study did not provide data on the percentage of cases in which PRO 2000 was effective if actually applied. According to NIH, participants reported use of the gels in 81% of sex acts. Kathy Stover, NIH communications officer, said the study was based on self-reporting, and therefore the researchers "have no way to verify that the gel was actually applied prior to sexual intercourse" (CQ HealthBeat, 2/9). According to health officials, further research will be necessary to determine the gel's efficacy. London's Medical Research Council currently is conducting a study of the PRO 2000 gel involving 9,500 women, which is three times the size of the first study, Bloomberg reports. Mitchell Warren, executive director of the AIDS Vaccine Advocacy Coalition, said the "positive" result from the first trial "increases the anticipation of those from the next" (Lauerman, Bloomberg, 2/9).
Karim, who presented the PRO 2000 study at the conference, said the gel "could be a niche product for a group of women who have no other option." In sub-Saharan Africa, about 60% of HIV-positive people are women, the Post reports. (Washington Post, 2/10). Karim added that the study, "while not conclusive, provides a glimmer of hope to millions of women at risk for HIV, especially young women in Africa." Anthony Fauci, director of NIH's National Institute of Allergy and Infectious Diseases, added, "An effective microbicide would be a valuable tool that women could use to protect themselves against HIV and one that could substantially reduce the number of new HIV infections worldwide (AFP/Google, 2/9).
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.
93 Lawmakers Sign Letter To Pelosi Asking For Legislative Action To Cut Contraception Prices
Rep. Joseph Crowley (D-N.Y.) and 92 other lawmakers recently wrote a letter to House Speaker Nancy Pelosi (D-Calif.) asking that she "take action on an appropriate legislative vehicle" to curb the price of birth control at college health clinics and family planning facilities, CQ Today reports (Allen/Adams, CQ Today, 5/18).
Changes in a Medicaid law resulting from a 2005 deficit-reduction bill resulted in drugmakers having reduced incentives to provide large discounts on some drugs to universities. Many colleges tried to maintain costs for contraceptives for a few months by buying in bulk before the new law took effect in January, but now their stocks are low and they have had to increase prices. The American College Health Association has said that CMS should have included college health centers to the list of providers who are exempt from the law, and the group has supported a proposal to change the law (Kaiser Daily Women's Health Policy Report, 3/26).
Crowley and Rep. Tim Ryan (D-Ohio) earlier this year added into a draft war funding bill (HR 1591) a provision reversing the changes in the 2005 law, but the language was later removed, CQ Today reports (CQ Today, 5/18).
"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.
Changes in a Medicaid law resulting from a 2005 deficit-reduction bill resulted in drugmakers having reduced incentives to provide large discounts on some drugs to universities. Many colleges tried to maintain costs for contraceptives for a few months by buying in bulk before the new law took effect in January, but now their stocks are low and they have had to increase prices. The American College Health Association has said that CMS should have included college health centers to the list of providers who are exempt from the law, and the group has supported a proposal to change the law (Kaiser Daily Women's Health Policy Report, 3/26).
Crowley and Rep. Tim Ryan (D-Ohio) earlier this year added into a draft war funding bill (HR 1591) a provision reversing the changes in the 2005 law, but the language was later removed, CQ Today reports (CQ Today, 5/18).
"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.
Oral Contraceptives Increase Risk For Breast Cancer In Some Women, Meta-analysis Finds
A meta-analysis published in the October issue of Mayo Clinic Proceedings indicts oral contraceptives as putting premenopausal women at significantly increased risk for breast cancer, especially women who use them prior to having a child.
The meta-analysis builds on many studies with similar findings. But even as the findings stack up, many women are unaware of the risks posed by oral contraceptive use prior to pregnancy, says lead study author Chris Kahlenborn, M.D., of Altoona Hospital in Altoona, Pa.
Dr. Kahlenborn says the discrepancy between risk and patient awareness prompted the meta-analysis, which involved extracting data from 34 studies on whether oral contraceptive (OC) use is associated with premenopausal breast cancer. Included in the studies were women who were premenopausal or younger than 50 and who had been, in most cases, diagnosed with breast cancer during or after 1980.
"As I studied the medical literature, I noticed that a trend appeared," says Dr. Kahlenborn. "Namely, OC use prior to first-term pregnancy seemed to consistently increase the risk of premenopausal breast cancer. Although the trend was apparent, premenopausal women have continued to hear that OCs are basically safe."
Rather, patients should know that sustained oral contraceptive use prior to pregnancy increases a premenopausal woman's risk of developing breast cancer, saysDr. Kahlenborn. He says physicians should better inform their patients of the risks associated with oral contraceptives and calls it a "clear-cut informed consent issue."
The study noted that 21 out of 23 retrospective studies have shown an increased risk of breast cancer in women who took oral contraceptives prior to pregnancy. It also showed that those women experienced an increased risk of 44 percent.
What's more, in 2005, the World Health Organization officially classified oral contraceptives as a class one carcinogen, the study's authors say.
These are staggering results given that more that more than 45,000 women each year develop breast cancer prior to menopause, Dr. Kahlenborn says.
"My hope is that physicians will provide more detailed information to their patients about hormonal contraceptives," he says. "The authors of our meta-analysis believe that women deserve to be fully informed."
Other authors of the meta-analysis study are Francesmary Modugno, Ph.D., and Douglas Potter, Ph.D., both of the University of Pittsburgh Cancer Institute, and Walter Severs, Ph.D., of Pennsylvania State University in University Park.
A peer-review journal, Mayo Clinic Proceedings publishes original articles and reviews dealing with clinical and laboratory medicine, clinical research, basic science research and clinical epidemiology. Mayo Clinic Proceedings is published monthly by Mayo Foundation for Medical Education and Research as part of its commitment to the medical education of physicians. The journal has been published for more than 80 years and has a circulation of 130,000 nationally and internationally. Articles are available online at mayoclinicproceedings/.
Contact: John Murphy
Mayo Clinic
The meta-analysis builds on many studies with similar findings. But even as the findings stack up, many women are unaware of the risks posed by oral contraceptive use prior to pregnancy, says lead study author Chris Kahlenborn, M.D., of Altoona Hospital in Altoona, Pa.
Dr. Kahlenborn says the discrepancy between risk and patient awareness prompted the meta-analysis, which involved extracting data from 34 studies on whether oral contraceptive (OC) use is associated with premenopausal breast cancer. Included in the studies were women who were premenopausal or younger than 50 and who had been, in most cases, diagnosed with breast cancer during or after 1980.
"As I studied the medical literature, I noticed that a trend appeared," says Dr. Kahlenborn. "Namely, OC use prior to first-term pregnancy seemed to consistently increase the risk of premenopausal breast cancer. Although the trend was apparent, premenopausal women have continued to hear that OCs are basically safe."
Rather, patients should know that sustained oral contraceptive use prior to pregnancy increases a premenopausal woman's risk of developing breast cancer, saysDr. Kahlenborn. He says physicians should better inform their patients of the risks associated with oral contraceptives and calls it a "clear-cut informed consent issue."
The study noted that 21 out of 23 retrospective studies have shown an increased risk of breast cancer in women who took oral contraceptives prior to pregnancy. It also showed that those women experienced an increased risk of 44 percent.
What's more, in 2005, the World Health Organization officially classified oral contraceptives as a class one carcinogen, the study's authors say.
These are staggering results given that more that more than 45,000 women each year develop breast cancer prior to menopause, Dr. Kahlenborn says.
"My hope is that physicians will provide more detailed information to their patients about hormonal contraceptives," he says. "The authors of our meta-analysis believe that women deserve to be fully informed."
Other authors of the meta-analysis study are Francesmary Modugno, Ph.D., and Douglas Potter, Ph.D., both of the University of Pittsburgh Cancer Institute, and Walter Severs, Ph.D., of Pennsylvania State University in University Park.
A peer-review journal, Mayo Clinic Proceedings publishes original articles and reviews dealing with clinical and laboratory medicine, clinical research, basic science research and clinical epidemiology. Mayo Clinic Proceedings is published monthly by Mayo Foundation for Medical Education and Research as part of its commitment to the medical education of physicians. The journal has been published for more than 80 years and has a circulation of 130,000 nationally and internationally. Articles are available online at mayoclinicproceedings/.
Contact: John Murphy
Mayo Clinic
New Research In Women's Health To Be Presented In Washington, DC
Obstetrician-gynecologists from around the country and the globe will convene in Washington, DC, to present 300 new research abstracts at The American College of Obstetricians and Gynecologists' 59th Annual Clinical Meeting. The latest research on a wide range of women's health issues will be released in both oral and poster formats at the Walter E. Washington Convention Center, Monday, May 2, and Tuesday, May 3.
A few highlighted research findings slated for presentation include:
Obstetrics
Monday, May 2, 10:30 am - 4:30 pm
- #18 Intimate Partner Violence: A Predictor of Postpartum Depression
Mahua Mandal, MPH
- #61 Neonatal Encephalopathy, Sentinel Events and the Placenta
Taeun Chang, MD
- #64 Effects of Environmental Tobacco Smoke on Perinatal Outcomes
Joan M. G. Crane, MD, MSc
- #81 Obesity and Fetal Demise
Johannes M. Jones, MD
- #83 The Impact of Route of Delivery on Pelvic Pain and Urinary Symptoms
Daniel G. Kiefer, MD
- #96 (Prize Poster) Subsequent Pregnancy Outcome After Mid-Trimester Pregnancy Termination: Induction Vs. D&E
Meredith Rochon, MD
- #106 Postoperative, Personalized Pain Management for Cesarean Section
Mary E. Stauble, MD
- #108 The Snuffing Out of Cocaine: Trends in Drug-Exposed Deliveries, 2001-2009
Mishka Terplan, MD, MPH
Tuesday, May 3, 10:30 am - 4:30 pm
- #16 Pregnancy Coercion and Birth Control Sabotage in Western North Carolina
Jessica L. Versage, MD
- #73 The Case for Including Doula Services in Obstetric Care for Underserved Women: Preliminary Analysis
Irene B. Frederick, MD
- #108 The Impact of Prepregnancy Body Mass Index (BMI) on the Risk of Preeclampsia
Jasbir Singh, MD
- #114 Outcomes of Twin Pregnancies Receiving 17P Prophylaxis With and Without Prior Preterm Delivery
Elizabeth R. Unal, MD
- #125 Cigarette Smoking and Its Association with Postpartum Depression
Diana Cheng, MD
Gynecology
Monday, May 2, 10:30 am - 4:30 pm
- #3 Contraceptive Care for Women with Cardiovascular Disease
Julie Chor, MD, MPH
- #34 Randomized Trial of Medication Versus Radiofrequency Ablation in the Initial Management of Menorrhagia
Abimbola O. Famuyide, MD
- #36 Comparative Study Between Laparoscopic Myomectomy and Abdominal Myomectomy
Magdi M. Hanafi, MD
- #39 A Randomized Controlled Trial of Vitamin E Supplementation in the Treatment of Primary Dysmenorrhea
Gregory K. Lewis, Bsc, MD
- #41 Laparoscopic Versus Vaginal Hysterectomy: An Evaluation of Length of Stay and Surgical Complications
Annika R. Malmberg, MD
- #112 Lichen Sclerosus: Five Years Follow-Up After Topical, Subdermal or Combined Therapy
Gary Ventolini, MD
- #127 Patient Perception of Mammogram Screening Guidelines Changes
Autumn S. Davidson, MD
- #132 Cost-Effective, Outpatient-Safe, Minilaparotomy Myomectomy
Dominique M. Butawan, MD
Tuesday, May 3, 10:30 am - 4:30 pm
- #46 Underrecognition of Endometriosis in the African American Female
Kevin S. Smith, MD
- #132 How Knowledge of a Woman's Egg Supply (Ovarian Reserve) Influences Her Reproductive Choices
Erum Azhar, MD
Source:
American College of Obstetricians and Gynecologists
A few highlighted research findings slated for presentation include:
Obstetrics
Monday, May 2, 10:30 am - 4:30 pm
- #18 Intimate Partner Violence: A Predictor of Postpartum Depression
Mahua Mandal, MPH
- #61 Neonatal Encephalopathy, Sentinel Events and the Placenta
Taeun Chang, MD
- #64 Effects of Environmental Tobacco Smoke on Perinatal Outcomes
Joan M. G. Crane, MD, MSc
- #81 Obesity and Fetal Demise
Johannes M. Jones, MD
- #83 The Impact of Route of Delivery on Pelvic Pain and Urinary Symptoms
Daniel G. Kiefer, MD
- #96 (Prize Poster) Subsequent Pregnancy Outcome After Mid-Trimester Pregnancy Termination: Induction Vs. D&E
Meredith Rochon, MD
- #106 Postoperative, Personalized Pain Management for Cesarean Section
Mary E. Stauble, MD
- #108 The Snuffing Out of Cocaine: Trends in Drug-Exposed Deliveries, 2001-2009
Mishka Terplan, MD, MPH
Tuesday, May 3, 10:30 am - 4:30 pm
- #16 Pregnancy Coercion and Birth Control Sabotage in Western North Carolina
Jessica L. Versage, MD
- #73 The Case for Including Doula Services in Obstetric Care for Underserved Women: Preliminary Analysis
Irene B. Frederick, MD
- #108 The Impact of Prepregnancy Body Mass Index (BMI) on the Risk of Preeclampsia
Jasbir Singh, MD
- #114 Outcomes of Twin Pregnancies Receiving 17P Prophylaxis With and Without Prior Preterm Delivery
Elizabeth R. Unal, MD
- #125 Cigarette Smoking and Its Association with Postpartum Depression
Diana Cheng, MD
Gynecology
Monday, May 2, 10:30 am - 4:30 pm
- #3 Contraceptive Care for Women with Cardiovascular Disease
Julie Chor, MD, MPH
- #34 Randomized Trial of Medication Versus Radiofrequency Ablation in the Initial Management of Menorrhagia
Abimbola O. Famuyide, MD
- #36 Comparative Study Between Laparoscopic Myomectomy and Abdominal Myomectomy
Magdi M. Hanafi, MD
- #39 A Randomized Controlled Trial of Vitamin E Supplementation in the Treatment of Primary Dysmenorrhea
Gregory K. Lewis, Bsc, MD
- #41 Laparoscopic Versus Vaginal Hysterectomy: An Evaluation of Length of Stay and Surgical Complications
Annika R. Malmberg, MD
- #112 Lichen Sclerosus: Five Years Follow-Up After Topical, Subdermal or Combined Therapy
Gary Ventolini, MD
- #127 Patient Perception of Mammogram Screening Guidelines Changes
Autumn S. Davidson, MD
- #132 Cost-Effective, Outpatient-Safe, Minilaparotomy Myomectomy
Dominique M. Butawan, MD
Tuesday, May 3, 10:30 am - 4:30 pm
- #46 Underrecognition of Endometriosis in the African American Female
Kevin S. Smith, MD
- #132 How Knowledge of a Woman's Egg Supply (Ovarian Reserve) Influences Her Reproductive Choices
Erum Azhar, MD
Source:
American College of Obstetricians and Gynecologists
University Of Manchester Researchers Say HIV Drug Could Be Used To Prevent Cervical Cancer
Researchers at the University of Manchester are developing a topical treatment against the human papilloma virus (HPV) which is responsible for pre-cancerous and cancerous disease of the cervix as well as other genital malignancies.
In the UK many thousands of women undergo surgery to remove precancerous lesions of every year. Instead they may be able to apply a simple cream or pessary to the affected area. The discovery may be even more significant in developing countries which lack surgical facilities and where HPV related cervical cancer is one of the most common forms of cancer in women.
Drs Ian and Lynne Hampson at the School of Medicine's Division of Human Development and Reproduction are developing the treatment from a type of drug that is given orally to treat HIV. This protease inhibitor can selectively kill cultured HPV infected cervical cancer cells and, since it is already available as a liquid formulation, it is possible it may work by direct application to the cervix.
The research, funded by the Humane Research Trust, is to be published in the September issue of the journal Anti-Viral Therapy (2006; 11(6): in press) and is also being presented at the International HPV meeting in Prague on 5 September.
Group leader Dr Ian Hampson, who is based at St Mary's Hospital, Manchester, said: "It is very exciting to find such a significant new use for this HIV drug which is already licensed and FDA-approved for oral administration. We are currently exploring the means of delivering this drug directly to the affected tissue. We would then move to a clinical trial that would be supervised by our head of unit Professor Henry C. Kitchener. If this proves successful we could see the treatment available fairly rapidly."
He added: "Anti HPV vaccines are currently in the process of being licensed but, not all lesions will be prevented and not all women will be vaccinated. A non surgical therapy will have significant advantages - better preservation of obstetric function, the potential for use in resource poor settings such as underdeveloped countries and it may appeal more to women than surgery.
"We are very grateful for the strong support we have had from the Humane Research Trust, the charity who funded the development of this work."
Professor Kitchener said: "The significance of this finding is that a simple medical treatment could be used in place of surgery which many women dislike and fully preserve the cervix. First we need to demonstrate that it can be effective."
Editor's note:
Human Papilloma Virus (HPV): Infection with high risk HPV is the cause of the vast majority of cervical carcinomas. The disease is characterised by sequential progression over a period of several years. In the developed world the incidence of cervical cancer has been declining steadily due to the use of cervical screening and surgery where necessary. This is highly effective with an efficacy of 90-95 percent and although re-treatment may be required, the subsequent risk of cancer is around 0.5%. Even though many low grade cervical lesions may regress without the need for surgical intervention, current clinical practice is to treat all high-grade lesions.
The Division of Human Development & Reproductive Health is one of the largest within the School of Medicine, with around 200 employees. It is a successful centre of postgraduate teaching and research and achieved a 5* rating in the 2001 Research Assessment Exercise. Its work covers a broad range of interests in human development including genetics, pregnancy (implantation/fertilisation, placental biology) peri/neo-natology, childhood growth and development, paediatric oncology and immunology, reproductive medicine and women's health, and eye development and disease. The research themes produce internationally recognised work and have attracted significant funding from UK research councils, government sources such as the Department of Health, NHS research and development, as well as EU funding initiatives and charities.
St Mary's Hospital was founded in 1790 and today forms the directorate for women's and children's services within Central Manchester Healthcare Trust. It provides a unique range of inter-related services specifically for women and children. Out-patient and in-patient facilities exist to provide services including Obstetrics, Gynaecology, Paediatrics, Neonatal medicine, Neonatal surgery, Genetics/Immunogenetics Laboratory and Reproductive Medicine. The multi-disciplinary approach adopted by clinicians aims to provide the highest standard of care for mother and child.
The Humane Research Trust is a registered charity that raises the necessary finance to fund and promote pioneering medical research into human disease without the use of animals or animal tissue. The aim is to eliminate the need for animals in human medical research. For more information visit humaneresearch/
Contact: Mikaela Sitford
University of Manchester
In the UK many thousands of women undergo surgery to remove precancerous lesions of every year. Instead they may be able to apply a simple cream or pessary to the affected area. The discovery may be even more significant in developing countries which lack surgical facilities and where HPV related cervical cancer is one of the most common forms of cancer in women.
Drs Ian and Lynne Hampson at the School of Medicine's Division of Human Development and Reproduction are developing the treatment from a type of drug that is given orally to treat HIV. This protease inhibitor can selectively kill cultured HPV infected cervical cancer cells and, since it is already available as a liquid formulation, it is possible it may work by direct application to the cervix.
The research, funded by the Humane Research Trust, is to be published in the September issue of the journal Anti-Viral Therapy (2006; 11(6): in press) and is also being presented at the International HPV meeting in Prague on 5 September.
Group leader Dr Ian Hampson, who is based at St Mary's Hospital, Manchester, said: "It is very exciting to find such a significant new use for this HIV drug which is already licensed and FDA-approved for oral administration. We are currently exploring the means of delivering this drug directly to the affected tissue. We would then move to a clinical trial that would be supervised by our head of unit Professor Henry C. Kitchener. If this proves successful we could see the treatment available fairly rapidly."
He added: "Anti HPV vaccines are currently in the process of being licensed but, not all lesions will be prevented and not all women will be vaccinated. A non surgical therapy will have significant advantages - better preservation of obstetric function, the potential for use in resource poor settings such as underdeveloped countries and it may appeal more to women than surgery.
"We are very grateful for the strong support we have had from the Humane Research Trust, the charity who funded the development of this work."
Professor Kitchener said: "The significance of this finding is that a simple medical treatment could be used in place of surgery which many women dislike and fully preserve the cervix. First we need to demonstrate that it can be effective."
Editor's note:
Human Papilloma Virus (HPV): Infection with high risk HPV is the cause of the vast majority of cervical carcinomas. The disease is characterised by sequential progression over a period of several years. In the developed world the incidence of cervical cancer has been declining steadily due to the use of cervical screening and surgery where necessary. This is highly effective with an efficacy of 90-95 percent and although re-treatment may be required, the subsequent risk of cancer is around 0.5%. Even though many low grade cervical lesions may regress without the need for surgical intervention, current clinical practice is to treat all high-grade lesions.
The Division of Human Development & Reproductive Health is one of the largest within the School of Medicine, with around 200 employees. It is a successful centre of postgraduate teaching and research and achieved a 5* rating in the 2001 Research Assessment Exercise. Its work covers a broad range of interests in human development including genetics, pregnancy (implantation/fertilisation, placental biology) peri/neo-natology, childhood growth and development, paediatric oncology and immunology, reproductive medicine and women's health, and eye development and disease. The research themes produce internationally recognised work and have attracted significant funding from UK research councils, government sources such as the Department of Health, NHS research and development, as well as EU funding initiatives and charities.
St Mary's Hospital was founded in 1790 and today forms the directorate for women's and children's services within Central Manchester Healthcare Trust. It provides a unique range of inter-related services specifically for women and children. Out-patient and in-patient facilities exist to provide services including Obstetrics, Gynaecology, Paediatrics, Neonatal medicine, Neonatal surgery, Genetics/Immunogenetics Laboratory and Reproductive Medicine. The multi-disciplinary approach adopted by clinicians aims to provide the highest standard of care for mother and child.
The Humane Research Trust is a registered charity that raises the necessary finance to fund and promote pioneering medical research into human disease without the use of animals or animal tissue. The aim is to eliminate the need for animals in human medical research. For more information visit humaneresearch/
Contact: Mikaela Sitford
University of Manchester
India Witnessing Growth Of 'High-Price' Commercial Sex Workers, Reuters Reports
A new group of "high-price" commercial sex workers is emerging in India and "servicing India's nouveau riche and the throng of foreign businessmen drawn to a booming economy," Reuters reports. Although the group largely constitutes educated women from middle-class families who consider sex work a "lucrative and even glamorous profession," many sex workers in India -- which has the world's third highest HIV/AIDS caseload -- are HIV-positive and are forced into the work by "crushing poverty," according to Reuters.
The growth of "high-end" sex work in the country highlights not only the affluence of India's upper classes but also the "changing role of women in a deeply conservative society," Reuters reports. Ranjana Kumari, director of the Centre for Social Research in New Delhi, said, "Only 2% to 3% of India's prostitutes enter the profession willingly. These are the high-class girls, and it is them exercising their democratic rights." Anuja Agrawal, a sociologist at the University of Delhi, said, "With the changes in the economy and increased consumerism, the Indian woman is under pressure to conform to a highly capitalistic image which requires a lot of money to upkeep," adding, "If Indian society were to really allow their women to be free, they won't be forced to conform to such a rigid behavior." Commercial sex work is illegal in India, but some groups estimate that there are two million sex workers in the country (Lee, Reuters, 9/14).
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.
The growth of "high-end" sex work in the country highlights not only the affluence of India's upper classes but also the "changing role of women in a deeply conservative society," Reuters reports. Ranjana Kumari, director of the Centre for Social Research in New Delhi, said, "Only 2% to 3% of India's prostitutes enter the profession willingly. These are the high-class girls, and it is them exercising their democratic rights." Anuja Agrawal, a sociologist at the University of Delhi, said, "With the changes in the economy and increased consumerism, the Indian woman is under pressure to conform to a highly capitalistic image which requires a lot of money to upkeep," adding, "If Indian society were to really allow their women to be free, they won't be forced to conform to such a rigid behavior." Commercial sex work is illegal in India, but some groups estimate that there are two million sex workers in the country (Lee, Reuters, 9/14).
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.
Over Three Quarters Of Current Hormonal Contraceptive Users Have Concerns About Their Current Birth Control Method
Women's feelings and behaviors concerning contraception are conflicted, yet many don't seek out methods that could better satisfy their needs, according to a new survey conducted on behalf of Schering-Plough by Harris Interactive®. In the survey, "Contraceptive Habits," a small percentage of women (six percent) said they worry most about the possibility of getting pregnant when it comes to sex, yet 46 percent of women using birth control say they often feel relieved to get their periods if they've been sexually active. One in five women (21 percent) who currently use, or have previously used, hormonal contraceptives say they have difficulty remembering to use their birth control sometimes. Yet 75 percent of these same women say they never sacrifice spontaneity due to their birth control method.
"With more than half of all unintended pregnancies in the United States occurring among couples who used some type of birth control, it's very troubling that the majority of women are not confident in their contraceptive methods," said Mary Jane Minkin, M.D., clinical professor of obstetrics and gynecology at Yale University School of Medicine. "It only takes one birth control slip up to get pregnant, and if women are not feeling confident in their current method, they should express their concerns with their healthcare providers to find an option that suits them better."
Findings from the survey include:
-- Seventy-nine percent of current hormonal contraceptive users have concerns about their current birth control method. Despite these concerns, 39 percent have stayed with their chosen method for five or more years.
-- Sixty-two percent of women who currently use a hormonal contraceptive report that having sex increases stress levels when they've not used their birth control correctly. Yet, when it comes to sex, women using birth control say they worry more about their own or their partner's satisfaction (29 percent) and body image (24 percent) than pregnancy (10 percent) or contracting a sexually-transmitted disease (8 percent).
-- Twenty-three percent of 18 to 34-year-old women say daily birth control would be most convenient for them, yet 46 percent of women in the same age group who currently use a hormonal contraceptive have more difficulty remembering to use their current method correctly when their daily routine is interrupted.
-- Of women aged 18 to 34 who currently use birth control, 80 percent use contraception primarily to prevent pregnancy. However, 93 percent of women aged 18 to 34 (both on and off birth control) do not know that half of unintended pregnancies in the United States occur with couples that used some method of birth control.
Another revelation highlighted in the survey data is the degree to which women seek input from people in their lives - from physicians to their partners, friends and family - when making decisions about birth control. Sixty-two percent of women indicated they discuss birth control with a potential partner. Women of all ages who currently use, or have previously used hormonal contraceptives, reported that a physician's recommendation was among the top five attributes that are most important to them in choosing a birth control method.
"The findings from this survey signal that while we may be living at a time when women have many contraceptive options and are empowered to make their own informed decisions, many are either dissatisfied with or have concerns about their method," says Dr. Minkin. "Overall, this is a wake-up call for women to evaluate how happy they really are with their current method and recognize that they don't have to settle for the status quo when it comes to birth control options."
For complete survey results, visit wwwntraceptivehabits.
About the Survey
Harris Interactive, on behalf of Schering-Plough, conducted an online survey within the U.S. among 1,302 women ages 18 and over between July 7 and July 9, 2008, (percentages for some questions are based on a subset of respondents, based on their responses to certain questions). Respondents for the survey were selected from among those who have agreed to participate in Harris Interactive surveys. The data have been weighted to reflect the composition of the U.S. adult female population. Because the sample is based on those who agreed to be invited to participate in the Harris Interactive online research panel, no estimates of theoretical sampling error can be calculated.
About Mary Jane Minkin, M.D.
Mary Jane Minkin, M.D., is a clinical professor of obstetrics and gynecology at Yale University School of Medicine and has a private practice in New Haven, Connecticut. Dr. Minkin is co-author, with Carol Wright, of "A Woman's Guide to Menopause and Perimenopause" and "The Yale Guide to Women's Reproductive Health." Dr. Minkin is lead author and co-author of articles in numerous peer-reviewed journals, and she also advises and gives lectures to the menopause support group PRIME PLUS/Red Hot Mamas.
About Harris Interactive®
Harris Interactive is a global leader in custom market research. With a long and rich history in multimodal research that is powered by our science and technology, we assist clients in achieving business results. Harris Interactive serves clients globally through our North American, European and Asian offices and a network of independent market research firms. For more information, please visit www.harrisinteractive.
About Schering-Plough
Schering-Plough is an innovation-driven, science-centered global health care company. Through its own biopharmaceutical research and collaborations with partners, Schering-Plough creates therapies that help save and improve lives around the world. The company applies its research-and-development platform to human prescription and consumer products as well as to animal health products. Schering-Plough's vision is to Earn Trust, Every Day with the doctors, patients, customers and other stakeholders served by its colleagues around the world. The company is based in Kenilworth, N.J., and its Web site is www.schering-plough.
"With more than half of all unintended pregnancies in the United States occurring among couples who used some type of birth control, it's very troubling that the majority of women are not confident in their contraceptive methods," said Mary Jane Minkin, M.D., clinical professor of obstetrics and gynecology at Yale University School of Medicine. "It only takes one birth control slip up to get pregnant, and if women are not feeling confident in their current method, they should express their concerns with their healthcare providers to find an option that suits them better."
Findings from the survey include:
-- Seventy-nine percent of current hormonal contraceptive users have concerns about their current birth control method. Despite these concerns, 39 percent have stayed with their chosen method for five or more years.
-- Sixty-two percent of women who currently use a hormonal contraceptive report that having sex increases stress levels when they've not used their birth control correctly. Yet, when it comes to sex, women using birth control say they worry more about their own or their partner's satisfaction (29 percent) and body image (24 percent) than pregnancy (10 percent) or contracting a sexually-transmitted disease (8 percent).
-- Twenty-three percent of 18 to 34-year-old women say daily birth control would be most convenient for them, yet 46 percent of women in the same age group who currently use a hormonal contraceptive have more difficulty remembering to use their current method correctly when their daily routine is interrupted.
-- Of women aged 18 to 34 who currently use birth control, 80 percent use contraception primarily to prevent pregnancy. However, 93 percent of women aged 18 to 34 (both on and off birth control) do not know that half of unintended pregnancies in the United States occur with couples that used some method of birth control.
Another revelation highlighted in the survey data is the degree to which women seek input from people in their lives - from physicians to their partners, friends and family - when making decisions about birth control. Sixty-two percent of women indicated they discuss birth control with a potential partner. Women of all ages who currently use, or have previously used hormonal contraceptives, reported that a physician's recommendation was among the top five attributes that are most important to them in choosing a birth control method.
"The findings from this survey signal that while we may be living at a time when women have many contraceptive options and are empowered to make their own informed decisions, many are either dissatisfied with or have concerns about their method," says Dr. Minkin. "Overall, this is a wake-up call for women to evaluate how happy they really are with their current method and recognize that they don't have to settle for the status quo when it comes to birth control options."
For complete survey results, visit wwwntraceptivehabits.
About the Survey
Harris Interactive, on behalf of Schering-Plough, conducted an online survey within the U.S. among 1,302 women ages 18 and over between July 7 and July 9, 2008, (percentages for some questions are based on a subset of respondents, based on their responses to certain questions). Respondents for the survey were selected from among those who have agreed to participate in Harris Interactive surveys. The data have been weighted to reflect the composition of the U.S. adult female population. Because the sample is based on those who agreed to be invited to participate in the Harris Interactive online research panel, no estimates of theoretical sampling error can be calculated.
About Mary Jane Minkin, M.D.
Mary Jane Minkin, M.D., is a clinical professor of obstetrics and gynecology at Yale University School of Medicine and has a private practice in New Haven, Connecticut. Dr. Minkin is co-author, with Carol Wright, of "A Woman's Guide to Menopause and Perimenopause" and "The Yale Guide to Women's Reproductive Health." Dr. Minkin is lead author and co-author of articles in numerous peer-reviewed journals, and she also advises and gives lectures to the menopause support group PRIME PLUS/Red Hot Mamas.
About Harris Interactive®
Harris Interactive is a global leader in custom market research. With a long and rich history in multimodal research that is powered by our science and technology, we assist clients in achieving business results. Harris Interactive serves clients globally through our North American, European and Asian offices and a network of independent market research firms. For more information, please visit www.harrisinteractive.
About Schering-Plough
Schering-Plough is an innovation-driven, science-centered global health care company. Through its own biopharmaceutical research and collaborations with partners, Schering-Plough creates therapies that help save and improve lives around the world. The company applies its research-and-development platform to human prescription and consumer products as well as to animal health products. Schering-Plough's vision is to Earn Trust, Every Day with the doctors, patients, customers and other stakeholders served by its colleagues around the world. The company is based in Kenilworth, N.J., and its Web site is www.schering-plough.
U.S. Women Significantly Increase Use Of Contraceptive Services
Using nationally representative survey data, researchers examined the patterns and trends in the use of sexual and reproductive health care services in U.S. women aged 15 to 44 between 1995 and 2002. The results conclude that the receipt of contraceptive services (a birth control method or a prescription) among American women rose significantly during the time of this study (1995-2002) from 36 percent to 41 percent; however the overall receipt of sexual and reproductive health care services remained constant, with 74 percent of U.S. women reporting receipt of such services.
"Possible explanations for this trend include both increased demand for contraceptive services (e.g., because of changing contraceptive use patterns) and improved financial accessibility of contraceptive care within the private sector (e.g., because of better insurance coverage of contraceptive services)," the study's author inferred.
From: "Trends in U.S. Women's Use of Sexual Reproductive Health Care Services, 1995-2002"
The American Journal of Public Health is the monthly Journal of the American Public Health Association (APHA), the oldest and most diverse organization of public health professionals in the world. APHA is a leading publisher of books and periodicals promoting sound scientific standards, action programs and public policy to enhance health.
American Public Health Association
"Possible explanations for this trend include both increased demand for contraceptive services (e.g., because of changing contraceptive use patterns) and improved financial accessibility of contraceptive care within the private sector (e.g., because of better insurance coverage of contraceptive services)," the study's author inferred.
From: "Trends in U.S. Women's Use of Sexual Reproductive Health Care Services, 1995-2002"
The American Journal of Public Health is the monthly Journal of the American Public Health Association (APHA), the oldest and most diverse organization of public health professionals in the world. APHA is a leading publisher of books and periodicals promoting sound scientific standards, action programs and public policy to enhance health.
American Public Health Association
Maine High School Offering Contraceptives, Sexual Health Screenings Deemed Eligible For Title X Funds
Education officials have determined that Noble High School in North Berwick, Maine, can receive federal funds to pay for contraceptives and sexually transmitted infection screenings, Foster's Daily Democrat reports.
School officials originally believed the facility's reproductive health center was ineligible for Title X money because the school board had stipulated the center could not offer emergency contraception. However, George Hill -- Director of the Family Planning Association of Maine, which distributes Title X funds in Maine -- said on Tuesday that the center is eligible for the funds and that not offering EC would not affect the center's eligibility.
In October 2009, the district school board overseeing Noble High School approved a package of reproductive services for the school’s health center but did not approve any funding for the program. The health center has secured $18,000 in state funding and also is seeking federal money. The center now must submit an application for the Title X funds.
Noble High School is the 10th high school in Maine and one of about 500 nationwide to offer reproductive services (Claffey, Foster’s Daily Democrat, 1/13).
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.
© 2010 The Advisory Board Company. All rights reserved.
After A Stroke Women Are Less Likely To Receive Critical Care, MSU Researchers Find
Women are 30 percent less likely than men to receive a critical clot-busting drug than can limit brain damage after a stroke, according to a Michigan State University study.
The study findings were presented Feb. 19 in San Diego at the International Stroke Conference, organized by the American Heart Association and American Stroke Association.
Tissue plasminogen activator, or tPA, first approved as a treatment in the mid-1990s, is a potent blood thinner used to dissolve artery-clogging clots, which cause most strokes. As part of its study, a team of MSU researchers reviewed all stroke studies published between 1995 and March 2008 that presented data on tPA treatment rates. Eighteen studies provided data on more than 2.3 million patients.
Overall, despite some study-to-study variation, women with acute stroke were 30 percent less likely to receive the treatment compared with men, said Archit Bhatt of the Department of Neurology and Opthalmology in MSU's College of Human Medicine.
"More than 60 percent of all stroke deaths are in women, and the functional outcomes and quality of life following stroke are poorer in women than in men," said Bhatt, who presented the study at the San Diego conference. "Clearly, more research is needed to understand the barriers to acute stroke therapy in women so this critical health disparity can be eliminated."
To begin to address the problem, Bhatt encourages the development of a consistent set of operational definitions to determine which patients are eligible for tPA treatment.
Gender differences in stroke care is part of a larger research effort at MSU led by Mathew Reeves, an associate professor in the MSU's Department of Epidemiology who also worked on the tPA study. Reeves and fellow MSU researchers are publishing two additional studies related to gender differences and stroke care, both of which will be published in a special April issue of the journal Stroke published by the American Heart Association:
*Researchers found women were 14 percent less likely to receive perfect stroke care - referred to as defect-free care - compared to men, said Reeves, lead author on the study. The study compared the use of several evidence-based treatments in more than 380,000 men and women hospitalized with stroke: the timely use of clot-busting drugs, aspirin (both in the hospital and at discharge), blood thinners, cholesterol treatment, smoking cessation and prevention of blood clots in the legs.
"Although the absolute differences were modest, lower quality of care in women was seen in all measures," Reeves said. "These sex differences in care could not be explained by the obvious gender differences in factors, such as age."
*MSU researchers using data from a Michigan stroke registry found women who had an acute stroke experienced greater emergency room delays than men, and that the delays were not attributable to obvious gender differences in age or symptom presentation, according to Julia Gargano, a doctoral student in the Department of Epidemiology. Women had 12 percent longer "door-to-doctor" and 16 percent longer "door-to-image" intervals than men.
"Two critical factors immediately after a stroke are how quickly a patient sees a doctor upon arrival at a hospital and how quickly there is an image taken of the brain," Reeves said. "This study indicates
that it takes longer for women to receive both of these care measures."
Both studies can be viewed online at stroke.ahajournals, where the entire April issue of Stroke magazine has been published early as part of Women's Heart Awareness Month during February.
Michigan State University has been advancing knowledge and transforming lives through innovative teaching, research and outreach for more than 150 years. MSU is known internationally as a major public university with global reach and extraordinary impact. Its 17 degree-granting colleges attract scholars worldwide who are interested in combining education with practical problem solving.
Source: Jason Cody
Michigan State University
The study findings were presented Feb. 19 in San Diego at the International Stroke Conference, organized by the American Heart Association and American Stroke Association.
Tissue plasminogen activator, or tPA, first approved as a treatment in the mid-1990s, is a potent blood thinner used to dissolve artery-clogging clots, which cause most strokes. As part of its study, a team of MSU researchers reviewed all stroke studies published between 1995 and March 2008 that presented data on tPA treatment rates. Eighteen studies provided data on more than 2.3 million patients.
Overall, despite some study-to-study variation, women with acute stroke were 30 percent less likely to receive the treatment compared with men, said Archit Bhatt of the Department of Neurology and Opthalmology in MSU's College of Human Medicine.
"More than 60 percent of all stroke deaths are in women, and the functional outcomes and quality of life following stroke are poorer in women than in men," said Bhatt, who presented the study at the San Diego conference. "Clearly, more research is needed to understand the barriers to acute stroke therapy in women so this critical health disparity can be eliminated."
To begin to address the problem, Bhatt encourages the development of a consistent set of operational definitions to determine which patients are eligible for tPA treatment.
Gender differences in stroke care is part of a larger research effort at MSU led by Mathew Reeves, an associate professor in the MSU's Department of Epidemiology who also worked on the tPA study. Reeves and fellow MSU researchers are publishing two additional studies related to gender differences and stroke care, both of which will be published in a special April issue of the journal Stroke published by the American Heart Association:
*Researchers found women were 14 percent less likely to receive perfect stroke care - referred to as defect-free care - compared to men, said Reeves, lead author on the study. The study compared the use of several evidence-based treatments in more than 380,000 men and women hospitalized with stroke: the timely use of clot-busting drugs, aspirin (both in the hospital and at discharge), blood thinners, cholesterol treatment, smoking cessation and prevention of blood clots in the legs.
"Although the absolute differences were modest, lower quality of care in women was seen in all measures," Reeves said. "These sex differences in care could not be explained by the obvious gender differences in factors, such as age."
*MSU researchers using data from a Michigan stroke registry found women who had an acute stroke experienced greater emergency room delays than men, and that the delays were not attributable to obvious gender differences in age or symptom presentation, according to Julia Gargano, a doctoral student in the Department of Epidemiology. Women had 12 percent longer "door-to-doctor" and 16 percent longer "door-to-image" intervals than men.
"Two critical factors immediately after a stroke are how quickly a patient sees a doctor upon arrival at a hospital and how quickly there is an image taken of the brain," Reeves said. "This study indicates
that it takes longer for women to receive both of these care measures."
Both studies can be viewed online at stroke.ahajournals, where the entire April issue of Stroke magazine has been published early as part of Women's Heart Awareness Month during February.
Michigan State University has been advancing knowledge and transforming lives through innovative teaching, research and outreach for more than 150 years. MSU is known internationally as a major public university with global reach and extraordinary impact. Its 17 degree-granting colleges attract scholars worldwide who are interested in combining education with practical problem solving.
Source: Jason Cody
Michigan State University
New Orleans, Toxic flood lifts lid on common urban pollution problem
Broken sewers, flooded industrial plants and dead bodies are all likely to blame for poisoning the waters being drained from New Orleans.
But the water - and the muck it is leaving behind -- also owes its contamination to a source as mundane as it is unexpected: Toxins common in most urban environments that made their way en masse into the water as it stagnated atop the city.
So says a University of Florida professor who has spent years studying the harmful contaminants that turn up in urban runoff, or rainwater that washes across streets and other hard surfaces in cities. Environmental engineering professor John Sansalone's perspective is especially relevant because it is based on field research in New Orleans and Baton Rouge, where he was a professor at Louisiana State University before taking a job at UF this summer.
"What we see in New Orleans is that when you put a lot of water in contact with the urban environment, all the potential contaminants that stayed around in that environment are now back in the water - definitely, to our horror," Sansalone said.
Federal and Louisiana officials continue to sound alarms about the contaminated waters and scum left behind by the retreating flood. Early September test results released late last week showed high levels of bacteria, lead and harmful levels of chemicals including arsenic, according to the Environmental Protection Agency.
While the sources of these and other contaminants remain under investigation, public scrutiny has focused on broken sewer pipes and other major failures in the city's infrastructure attributed to Hurricane Katrina. Though these are certainly real problems, it's also highly likely that the stagnant waters are contaminated because they've soaked up "legacy" pollutants that accumulated during normal conditions on the city's streets, sidewalks, roofs and other impermeable surfaces, Sansalone said.
These pollutants, which normally appear in urban runoff, are more toxic than commonly understood, he said. In a study published last month in Water Environment Research, Sansalone and three co-authors report that runoff from an elevated section of Interstate 10 in Baton Rouge contained some contaminants at levels "greater than those found in untreated municipal wastewater from the same service area," according to the study.
The findings were based on periodic analysis of runoff that drains off Interstate 10 into Baton Rouge's City Park Lake just below the highway. Based on data first gathered in 1999, they revealed high levels of particulates, or microscopic- to millimeter-sized particles of material, as well as high chemical oxygen demand, an indicator of the presence of organic chemicals in oil, gas, grease, cigarette filters and other pollution.
Other research on urban runoff, meanwhile, has detected high levels of toxic metals and nutrients including phosphorus thought to leach from building materials, Sansalone said.
Organic chemicals are particularly dangerous to fish and other aquatic life because they reduce the levels of oxygen in the water, impinging on its ability to support life. Particulates cloud water, reducing sunlight penetration and plant growth. Once they cross a certain threshold, organic chemicals and metals also can be harmful to people.
New Orleans officials remain extremely concerned about bacterial contamination in the flood waters. Typically the result of contamination from untreated sewage, bacteria also can come from urban runoff, Sansalone said. Although it was not measured as part of his published study, other studies have found that such runoff contains heightened levels of bacteria stemming from bird and animal droppings, among other sources.
Sansalone said based on his studies of urban runoff alone, it's critical that environmental officials scour the city of flood residue. "How we clean up this residual matter - which will not be easy - will be a chronic issue to the health of the city," he said.
He said the contamination in New Orleans also highlights the need for other cities nationwide to do more to remove the toxins in urban runoff before, rather than after, it gets washed into waterways. There are several good strategies, he said. Increasingly affordable "permeable pavements" allow runoff to be stored, evaporate or percolate through pavement and into the ground, where soil and microorganisms can help filter the contaminants. Planting vegetation and especially trees also creates aesthetically pleasing buffer zones, providing storm water flooding control and other benefits. Finally, cities can use high-tech street sweeping equipment that is very effective at capturing pavement contaminants.
"If you pick up this potentially toxic material before it gets into the hydrological cycle, it is far more economical than if you try to take it out of the water after the fact," he said.
John Sansalone
jsansalufl.edu
352-846-0176
University of Florida
ufl.edu
But the water - and the muck it is leaving behind -- also owes its contamination to a source as mundane as it is unexpected: Toxins common in most urban environments that made their way en masse into the water as it stagnated atop the city.
So says a University of Florida professor who has spent years studying the harmful contaminants that turn up in urban runoff, or rainwater that washes across streets and other hard surfaces in cities. Environmental engineering professor John Sansalone's perspective is especially relevant because it is based on field research in New Orleans and Baton Rouge, where he was a professor at Louisiana State University before taking a job at UF this summer.
"What we see in New Orleans is that when you put a lot of water in contact with the urban environment, all the potential contaminants that stayed around in that environment are now back in the water - definitely, to our horror," Sansalone said.
Federal and Louisiana officials continue to sound alarms about the contaminated waters and scum left behind by the retreating flood. Early September test results released late last week showed high levels of bacteria, lead and harmful levels of chemicals including arsenic, according to the Environmental Protection Agency.
While the sources of these and other contaminants remain under investigation, public scrutiny has focused on broken sewer pipes and other major failures in the city's infrastructure attributed to Hurricane Katrina. Though these are certainly real problems, it's also highly likely that the stagnant waters are contaminated because they've soaked up "legacy" pollutants that accumulated during normal conditions on the city's streets, sidewalks, roofs and other impermeable surfaces, Sansalone said.
These pollutants, which normally appear in urban runoff, are more toxic than commonly understood, he said. In a study published last month in Water Environment Research, Sansalone and three co-authors report that runoff from an elevated section of Interstate 10 in Baton Rouge contained some contaminants at levels "greater than those found in untreated municipal wastewater from the same service area," according to the study.
The findings were based on periodic analysis of runoff that drains off Interstate 10 into Baton Rouge's City Park Lake just below the highway. Based on data first gathered in 1999, they revealed high levels of particulates, or microscopic- to millimeter-sized particles of material, as well as high chemical oxygen demand, an indicator of the presence of organic chemicals in oil, gas, grease, cigarette filters and other pollution.
Other research on urban runoff, meanwhile, has detected high levels of toxic metals and nutrients including phosphorus thought to leach from building materials, Sansalone said.
Organic chemicals are particularly dangerous to fish and other aquatic life because they reduce the levels of oxygen in the water, impinging on its ability to support life. Particulates cloud water, reducing sunlight penetration and plant growth. Once they cross a certain threshold, organic chemicals and metals also can be harmful to people.
New Orleans officials remain extremely concerned about bacterial contamination in the flood waters. Typically the result of contamination from untreated sewage, bacteria also can come from urban runoff, Sansalone said. Although it was not measured as part of his published study, other studies have found that such runoff contains heightened levels of bacteria stemming from bird and animal droppings, among other sources.
Sansalone said based on his studies of urban runoff alone, it's critical that environmental officials scour the city of flood residue. "How we clean up this residual matter - which will not be easy - will be a chronic issue to the health of the city," he said.
He said the contamination in New Orleans also highlights the need for other cities nationwide to do more to remove the toxins in urban runoff before, rather than after, it gets washed into waterways. There are several good strategies, he said. Increasingly affordable "permeable pavements" allow runoff to be stored, evaporate or percolate through pavement and into the ground, where soil and microorganisms can help filter the contaminants. Planting vegetation and especially trees also creates aesthetically pleasing buffer zones, providing storm water flooding control and other benefits. Finally, cities can use high-tech street sweeping equipment that is very effective at capturing pavement contaminants.
"If you pick up this potentially toxic material before it gets into the hydrological cycle, it is far more economical than if you try to take it out of the water after the fact," he said.
John Sansalone
jsansalufl.edu
352-846-0176
University of Florida
ufl.edu
Kaiser Daily Health Policy Report Feature Highlights Recent Blog Entries
"Blog Watch" offers readers a roundup of health policy-related blog posts.
Igor Volsky of the Center for American Progress Action Fund's Wonk Room looks at a Wall Street Journal opinion piece in which former acting CMS Administrator Kerry Weems and former HHS Assistant Secretary Benjamin Sasse argue that "the administrative expenses of private insurance plans represent money well spent for their members." Volsky disagrees, noting that the "breakdowns of how private plans allocate their administrative dollars are unavailable and Weems and Sasse's argument is a hypothesis at best."
Trudy Lieberman of the Columbia Journalism Review's Campaign Desk looks at two recent items on health care from The Nation and "60 Minutes," saying that the pieces "have shown what's wrong with U.S. health care in no uncertain terms."
TIE of the Finance Buff offers a primer on fee-for-service Medicare.
John Joseph Leppard IV of Healthcare Manumission explains why he thinks a public plan option would be unfair competition, saying, "Like a wrestler with the WWF behind him, the government option is almost always the winner; but that doesn't necessarily mean there won't be a whole lot of struggling and acrobatics before all is said and done."
Henry Stern of Insure Blog discusses a new study that showed a DNA test could be more effective than annual Pap tests for women and whether it could reduce health costs for women.
Ramesh Ponnuru of the National Review Online's The Corner defends criticism of his New York Times opinion piece on health reform.
Paul Testa of the New America Foundation's New Health Dialogue looks at HHS Secretary-nominee Gov. Kathleen Sebelius' (D-Kan.) written responses to questions from the Senate Finance Committee.
Jacob Hacker on the New Republic's The Treatment looks at a new report from the Lewin Group on public plan options and says that because of the way Lewin modeled a public plan, the report "has basically nothing to say about the effects of proposals similar to mine or Senator Baucus' or President Obama's campaign plan on the distribution of public and private coverage."
Glenn Laffel of Pizaazz hosts the most recent edition of Health Wonk Review, a biweekly compendium of more than two dozen health policy, infrastructure, insurance, technology and managed care bloggers. A different participant's blog hosts each issue.
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.
© 2009 Advisory Board Company and Kaiser Family Foundation. All rights reserved.
Igor Volsky of the Center for American Progress Action Fund's Wonk Room looks at a Wall Street Journal opinion piece in which former acting CMS Administrator Kerry Weems and former HHS Assistant Secretary Benjamin Sasse argue that "the administrative expenses of private insurance plans represent money well spent for their members." Volsky disagrees, noting that the "breakdowns of how private plans allocate their administrative dollars are unavailable and Weems and Sasse's argument is a hypothesis at best."
Trudy Lieberman of the Columbia Journalism Review's Campaign Desk looks at two recent items on health care from The Nation and "60 Minutes," saying that the pieces "have shown what's wrong with U.S. health care in no uncertain terms."
TIE of the Finance Buff offers a primer on fee-for-service Medicare.
John Joseph Leppard IV of Healthcare Manumission explains why he thinks a public plan option would be unfair competition, saying, "Like a wrestler with the WWF behind him, the government option is almost always the winner; but that doesn't necessarily mean there won't be a whole lot of struggling and acrobatics before all is said and done."
Henry Stern of Insure Blog discusses a new study that showed a DNA test could be more effective than annual Pap tests for women and whether it could reduce health costs for women.
Ramesh Ponnuru of the National Review Online's The Corner defends criticism of his New York Times opinion piece on health reform.
Paul Testa of the New America Foundation's New Health Dialogue looks at HHS Secretary-nominee Gov. Kathleen Sebelius' (D-Kan.) written responses to questions from the Senate Finance Committee.
Jacob Hacker on the New Republic's The Treatment looks at a new report from the Lewin Group on public plan options and says that because of the way Lewin modeled a public plan, the report "has basically nothing to say about the effects of proposals similar to mine or Senator Baucus' or President Obama's campaign plan on the distribution of public and private coverage."
Glenn Laffel of Pizaazz hosts the most recent edition of Health Wonk Review, a biweekly compendium of more than two dozen health policy, infrastructure, insurance, technology and managed care bloggers. A different participant's blog hosts each issue.
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.
© 2009 Advisory Board Company and Kaiser Family Foundation. All rights reserved.
Gender Bias In The Drug Treatment Of Heart Failure
While the treatment of heart failure has improved over the past two decades, a new study reported in the European Journal of Heart Failure finds that "the use of evidence-based treatments appears to be imbalanced according to the gender of the patient".
In particular, the study found
that female patients were less frequently treated with guideline-recommended medications (such as angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers ARBs) or beta-blockers)
and that doses were lower in female than in male patients.
However, the patient's gender was not the only influence on treatment; so was the gender of the physician. For example, the study demonstrated for the first time that drug treatment is more complete when female physicians are taking care of the patient. Thus, the use of ACE inhibitors or ARBs was significantly lower in female patients treated by a male physician than in male patients treated by either a female or male physician.
Similarly, the dose of ACE inhibitors and ARBs was highest in male patients treated by female physicians and was significantly different from the reverse combination (female patient, male physician). Dosage of beta-blockers was comparable in male patients irrespective of the physician's gender, whereas female patients treated by a male physician received the lowest doses.
The investigators thus concluded that "male patients with chronic heart failure are more likely to receive evidence-based drug treatment than female", particular so for the prescription of ACE inhibitors and dosage of beta-blockers.
The study was an evaluation of 1857 consecutive patients treated at the centres in Germany; treatment records involving 829 physicians (65 per cent general practitioners, 27 per cent internists, and 7 per cent cardiologists) were analysed with regard to evidence-based drug treatments to improve survival. Assessment of dosages was calculated as a percentage of averages documented in treatment guidelines for heart failure.
Commenting on the results, the study's first author Dr Magnus Baumhakel from the University Hospital of the Saarland, Homburg, Germany, said: "The use of evidence-based treatments as described in the latest guidelines has undoubtedly improved the treatment of chronic heart failure. But there is still evidence of a gender imbalance in both patients and physicians. From our results it seems fair to say that the gender of the physician plays an important role in adherence to drug treatment recommendations in chronic heart failure."
This is one of several recent studies to find gender differences in medical care (and survival) in cardiovascular disease. Many have found that women are treated less intensively than men, especially in the acute phase of the disease.
Notes:
1. The European Journal of Heart Failure is a journal of the European Society of Cardiology.
2. Heart failure is by far the single biggest reason for acute hospital admission. Around 30 million people in Europe have heart failure and its incidence is still increasing: more cases are being identified, more people are living to an old age, and more are surviving a heart attack but with damage to the heart muscle. According to one study, the reported prevalence among those aged 65-74 years is one in 35, and among the over-85s one in seven.
3. Heart failure is a cluster of symptoms resulting from the heart's inability to pump blood as required by the body. This is usually because of previous damage to the heart muscle, following a heart attack, coronary disease or hypertension. The resulting symptoms of heart failure are breathlessness, exercise intolerance, and a build-up of fluid in the lungs and abdomen.
4. New ESC Guidelines for the Diagnosis and Treatment of Acute and Chronic Heart Failure simplify the definitions of new, transient and chronic disease. According to the latest guidelines, published in 2008:
- an ACE inhibitor and beta-blocker are recommended in all patients with symptomatic heart failure; both "improve ventricular function and patient well-being, reduce hospital admission for worsening heart failure, and increases survival"
- an angiotensin receptor blocker (ARB) is recommended in all patients who remain symptomatic despite optimal treatment with an ACE inhibitor and beta blocker.
The 2008 ESC Guidelines can be seen in various formats here.
5. A statement issued by the ESC in December 2008 on gender differences in the treatment of heart attack said that definitive answers about optimal treatment will only be derived from studies powered to draw significant conclusions in both men and women in the same prospective cohort: "The optimal treatment recommendations for men and women respectively will only be resolved by inclusion of sufficient numbers of both women and men in future clinical trials." It is not clear if men and women should be treated to the same extent but, until we have further information, this is assumed to be the case in heart failure.
Source: ESC Press Office
European Society of Cardiology
In particular, the study found
that female patients were less frequently treated with guideline-recommended medications (such as angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers ARBs) or beta-blockers)
and that doses were lower in female than in male patients.
However, the patient's gender was not the only influence on treatment; so was the gender of the physician. For example, the study demonstrated for the first time that drug treatment is more complete when female physicians are taking care of the patient. Thus, the use of ACE inhibitors or ARBs was significantly lower in female patients treated by a male physician than in male patients treated by either a female or male physician.
Similarly, the dose of ACE inhibitors and ARBs was highest in male patients treated by female physicians and was significantly different from the reverse combination (female patient, male physician). Dosage of beta-blockers was comparable in male patients irrespective of the physician's gender, whereas female patients treated by a male physician received the lowest doses.
The investigators thus concluded that "male patients with chronic heart failure are more likely to receive evidence-based drug treatment than female", particular so for the prescription of ACE inhibitors and dosage of beta-blockers.
The study was an evaluation of 1857 consecutive patients treated at the centres in Germany; treatment records involving 829 physicians (65 per cent general practitioners, 27 per cent internists, and 7 per cent cardiologists) were analysed with regard to evidence-based drug treatments to improve survival. Assessment of dosages was calculated as a percentage of averages documented in treatment guidelines for heart failure.
Commenting on the results, the study's first author Dr Magnus Baumhakel from the University Hospital of the Saarland, Homburg, Germany, said: "The use of evidence-based treatments as described in the latest guidelines has undoubtedly improved the treatment of chronic heart failure. But there is still evidence of a gender imbalance in both patients and physicians. From our results it seems fair to say that the gender of the physician plays an important role in adherence to drug treatment recommendations in chronic heart failure."
This is one of several recent studies to find gender differences in medical care (and survival) in cardiovascular disease. Many have found that women are treated less intensively than men, especially in the acute phase of the disease.
Notes:
1. The European Journal of Heart Failure is a journal of the European Society of Cardiology.
2. Heart failure is by far the single biggest reason for acute hospital admission. Around 30 million people in Europe have heart failure and its incidence is still increasing: more cases are being identified, more people are living to an old age, and more are surviving a heart attack but with damage to the heart muscle. According to one study, the reported prevalence among those aged 65-74 years is one in 35, and among the over-85s one in seven.
3. Heart failure is a cluster of symptoms resulting from the heart's inability to pump blood as required by the body. This is usually because of previous damage to the heart muscle, following a heart attack, coronary disease or hypertension. The resulting symptoms of heart failure are breathlessness, exercise intolerance, and a build-up of fluid in the lungs and abdomen.
4. New ESC Guidelines for the Diagnosis and Treatment of Acute and Chronic Heart Failure simplify the definitions of new, transient and chronic disease. According to the latest guidelines, published in 2008:
- an ACE inhibitor and beta-blocker are recommended in all patients with symptomatic heart failure; both "improve ventricular function and patient well-being, reduce hospital admission for worsening heart failure, and increases survival"
- an angiotensin receptor blocker (ARB) is recommended in all patients who remain symptomatic despite optimal treatment with an ACE inhibitor and beta blocker.
The 2008 ESC Guidelines can be seen in various formats here.
5. A statement issued by the ESC in December 2008 on gender differences in the treatment of heart attack said that definitive answers about optimal treatment will only be derived from studies powered to draw significant conclusions in both men and women in the same prospective cohort: "The optimal treatment recommendations for men and women respectively will only be resolved by inclusion of sufficient numbers of both women and men in future clinical trials." It is not clear if men and women should be treated to the same extent but, until we have further information, this is assumed to be the case in heart failure.
Source: ESC Press Office
European Society of Cardiology
Patient Plans "Pinot For Prevention" Parties To Raise Awareness Of Women's Heart Disease
Evan McCabe wants every woman to know that heart disease not cancer is the number one killer of women. And she's counting on a glass of wine pinot noir, to be exact to help her get the point across.
McCabe, a registered nurse with a master's degree in nursing, is an associate professor of nursing at Santa Barbara City College. She also has heart disease, is a patient of cardiologist C. Noel Bairey Merz, M.D., at Cedars-Sinai Medical Center, and recently became an advocate for other women through WomenHeart, the National Coalition for Women with Heart Disease. That's where her idea of Pinot for Prevention Parties was born.
Bairey Merz, Women's Guild endowed chair in Women's Health and medical director of the Preventive and Rehabilitative Cardiac Center at Cedars-Sinai, nominated McCabe and several other patients to receive grants from WomenHeart, based in Washington, D.C., to attend a four-day symposium at the Mayo Clinic in Rochester, Minn. Nearly 60 women from across the country participated, learning about cutting-edge research on heart disease in women and being coached on interview and presentation skills.
"We had a breakout session where we brainstormed how we can go back into our communities and make a difference by educating women about heart disease," says McCabe. "On the way home on the plane, I was thinking, what's important about Santa Barbara County? Tourism is number one, and number two is our wine industry. I thought, I'm going to go and talk to women's groups about prevention of heart disease my number one issue. Getting my foot in the door is talking about pinot noir."
Santa Barbara County has become well known for pinot noir, and anecdotal evidence suggests limited amounts of alcohol may be good for prevention of heart disease.
"Based on observational studies, not rigorous clinical trials, it looks like moderate consumption of alcohol may be beneficial. This may be up to one serving of alcohol per day for women and up to two servings per day for men," according to Bairey Merz, adding that a serving is defined as two ounces of hard liquor, six ounces of wine or 12 ounces of beer. All contain an equivalent amount of alcohol.
"The health advantage is maximized when alcohol is served regularly and with meals, so the answer to a common question is no, you should not have all of your weekly servings on Saturday night," says Bairey Merz. "It's also important to note that there clearly are some problems associated with alcohol, from drinking and driving to the fact that some people are genetically at risk of abuse. Be careful. Check with your health care provider, especially if you have a family history of alcoholism. The potential health benefits are not necessarily a reason to start drinking alcohol."
In addition to organizing parties, McCabe, who turns 51 on Dec. 12, is volunteering to speak to health care professionals and women's groups. Already, one woman who heard her presentation subsequently went to a cardiologist and was diagnosed with congenital heart disease.
Although McCabe had been to the emergency room twice earlier with chest pain, she was not diagnosed with heart disease until the first day of fall semester three years ago. A climb up a steep hill at the campus where she teaches brought on another episode, but she still waited a week to see a cardiologist, an example she urges others not to follow.
Whether in her presentations or at the informal gatherings, McCabe hopes participants will grasp and remember several points, including:
-- Heart disease is the number one killer of women. (Only 13 percent of women know this.)
-- Many women do not have symptoms until it is too late.
-- Women are likely to have different symptoms than men.
-- Women's complaints are often ignored or trivialized.
-- Keys for survival are early detection, accurate diagnosis and proper treatment.
-- Denial is a common response to the possibility of heart disease or any other serious condition.
"I was horrified when I got a diagnosis, as most women are," she says, adding that her nursing and teaching background did not prepare her for accepting reality. "The thought that I could have heart disease was just overwhelming."
Most people who hear about the Pinot for Prevention Parties first laugh, and then say, "Sign me up," McCabe reports with a chuckle. "I've been a cardiology nurse for 30 years, and it's alcohol that everyone's interested in."
But a good bottle of pinot noir can be costly. Therefore, she sometimes recommends that several participants pool their funds to buy one or two bottles. After all, the purpose of the party is not to overindulge but to allow women to sit and sip as they listen and learn about preventing and recognizing heart disease in women.
The first in Southern California and one of only 10 hospitals in the state whose nurses have been honored with the prestigious Magnet designation, Cedars-Sinai Medical Center is one of the largest nonprofit academic medical centers in the Western United States. For 19 consecutive years, it has been named Los Angeles' most preferred hospital for all health needs in an independent survey of area residents. Cedars-Sinai is internationally renowned for its diagnostic and treatment capabilities as well as breakthroughs in biomedical research and superlative medical education. It ranks among the top 10 non-university hospitals in the nation for its research activities and is fully accredited by the Association for the Accreditation of Human Research Protection Programs, Inc. (AAHRPP). Additional information is available at cedars-sinai.edu.
Cedars-Sinai Medical Center
8700 Beverly Blvd., Rm 2429A
Los Angeles, CA 90048
United States
cedars-sinai.edu
McCabe, a registered nurse with a master's degree in nursing, is an associate professor of nursing at Santa Barbara City College. She also has heart disease, is a patient of cardiologist C. Noel Bairey Merz, M.D., at Cedars-Sinai Medical Center, and recently became an advocate for other women through WomenHeart, the National Coalition for Women with Heart Disease. That's where her idea of Pinot for Prevention Parties was born.
Bairey Merz, Women's Guild endowed chair in Women's Health and medical director of the Preventive and Rehabilitative Cardiac Center at Cedars-Sinai, nominated McCabe and several other patients to receive grants from WomenHeart, based in Washington, D.C., to attend a four-day symposium at the Mayo Clinic in Rochester, Minn. Nearly 60 women from across the country participated, learning about cutting-edge research on heart disease in women and being coached on interview and presentation skills.
"We had a breakout session where we brainstormed how we can go back into our communities and make a difference by educating women about heart disease," says McCabe. "On the way home on the plane, I was thinking, what's important about Santa Barbara County? Tourism is number one, and number two is our wine industry. I thought, I'm going to go and talk to women's groups about prevention of heart disease my number one issue. Getting my foot in the door is talking about pinot noir."
Santa Barbara County has become well known for pinot noir, and anecdotal evidence suggests limited amounts of alcohol may be good for prevention of heart disease.
"Based on observational studies, not rigorous clinical trials, it looks like moderate consumption of alcohol may be beneficial. This may be up to one serving of alcohol per day for women and up to two servings per day for men," according to Bairey Merz, adding that a serving is defined as two ounces of hard liquor, six ounces of wine or 12 ounces of beer. All contain an equivalent amount of alcohol.
"The health advantage is maximized when alcohol is served regularly and with meals, so the answer to a common question is no, you should not have all of your weekly servings on Saturday night," says Bairey Merz. "It's also important to note that there clearly are some problems associated with alcohol, from drinking and driving to the fact that some people are genetically at risk of abuse. Be careful. Check with your health care provider, especially if you have a family history of alcoholism. The potential health benefits are not necessarily a reason to start drinking alcohol."
In addition to organizing parties, McCabe, who turns 51 on Dec. 12, is volunteering to speak to health care professionals and women's groups. Already, one woman who heard her presentation subsequently went to a cardiologist and was diagnosed with congenital heart disease.
Although McCabe had been to the emergency room twice earlier with chest pain, she was not diagnosed with heart disease until the first day of fall semester three years ago. A climb up a steep hill at the campus where she teaches brought on another episode, but she still waited a week to see a cardiologist, an example she urges others not to follow.
Whether in her presentations or at the informal gatherings, McCabe hopes participants will grasp and remember several points, including:
-- Heart disease is the number one killer of women. (Only 13 percent of women know this.)
-- Many women do not have symptoms until it is too late.
-- Women are likely to have different symptoms than men.
-- Women's complaints are often ignored or trivialized.
-- Keys for survival are early detection, accurate diagnosis and proper treatment.
-- Denial is a common response to the possibility of heart disease or any other serious condition.
"I was horrified when I got a diagnosis, as most women are," she says, adding that her nursing and teaching background did not prepare her for accepting reality. "The thought that I could have heart disease was just overwhelming."
Most people who hear about the Pinot for Prevention Parties first laugh, and then say, "Sign me up," McCabe reports with a chuckle. "I've been a cardiology nurse for 30 years, and it's alcohol that everyone's interested in."
But a good bottle of pinot noir can be costly. Therefore, she sometimes recommends that several participants pool their funds to buy one or two bottles. After all, the purpose of the party is not to overindulge but to allow women to sit and sip as they listen and learn about preventing and recognizing heart disease in women.
The first in Southern California and one of only 10 hospitals in the state whose nurses have been honored with the prestigious Magnet designation, Cedars-Sinai Medical Center is one of the largest nonprofit academic medical centers in the Western United States. For 19 consecutive years, it has been named Los Angeles' most preferred hospital for all health needs in an independent survey of area residents. Cedars-Sinai is internationally renowned for its diagnostic and treatment capabilities as well as breakthroughs in biomedical research and superlative medical education. It ranks among the top 10 non-university hospitals in the nation for its research activities and is fully accredited by the Association for the Accreditation of Human Research Protection Programs, Inc. (AAHRPP). Additional information is available at cedars-sinai.edu.
Cedars-Sinai Medical Center
8700 Beverly Blvd., Rm 2429A
Los Angeles, CA 90048
United States
cedars-sinai.edu
Republican Presidential Candidates Discuss Abortion Rights, Other Issues During Debate
Nine candidates for the Republican presidential nomination on Sunday discussed their views on abortion rights and other issues in a televised debate held at Drake University in Des Moines, Iowa, the Washington Post reports (Shear, Washington Post, 8/6). The 90-minute debate -- which aired on ABC's "This Week" and was moderated by the program's host, George Stephanopoulos -- "highlighted differences among the candidates on the issues of health care, abortion" and other global concerns, the New York Times reports. According to the New York Times, Iowa has been "teeming with activity by Republicans" during the past week in preparation for the debate and the upcoming Republican straw poll in Ames, Iowa (Nagourney/Cooper, New York Times, 8/6).
The debate began with an exchange between former Massachusetts Gov. Mitt Romney -- who has been criticized for changing his views on abortion rights -- and Sen. Sam Brownback (R-Kan.), the Los Angeles Times reports. Brownback's campaign in recent weeks has left automated phone messages that target Romney's campaign with Iowa Republicans (Braun, Los Angeles Times, 8/6). "Mitt Romney is telling Iowans he is firmly pro-life," the Brownback campaign's phone message says, adding, "Nothing could be further from the truth." The message also notes that Romney's wife, Ann, has "contributed money to Planned Parenthood." Romney spokesperson Tim Albrecht called the phone messages "despicable" and "negative," adding that the campaign "should apologize to Ann Romney and Governor Romney for this personal attack" (Kaiser Daily Women's Health Policy Report, 7/25).
Brownback defended the calls in the debate, saying, "There's one word that describes that ad, and it's 'truthful.'" Romney said, "I never said I was pro-choice, but my position was effectively pro-choice." He added, "I've said that time and time again. I changed my position" (New York Times, 8/6). Romney said that he gets "tired of people that are holier than thou because they've been pro-life longer than" he has. According to the Washington Times, polls indicate that Romney is the leading Republican presidential candidate (Dinan, Washington Times, 8/6).
In addition, former HHS Secretary Tommy Thompson during the debate pledged to "end breast cancer by the year 2015 for all the women in America." He noted that his mother, wife and daughter all have been diagnosed with the disease (Washington Post, 8/6).
ABC News video of the candidates' comments on abortion is available online. Expanded ABC News coverage is available online (ABC News, 8/5).
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. © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.
The debate began with an exchange between former Massachusetts Gov. Mitt Romney -- who has been criticized for changing his views on abortion rights -- and Sen. Sam Brownback (R-Kan.), the Los Angeles Times reports. Brownback's campaign in recent weeks has left automated phone messages that target Romney's campaign with Iowa Republicans (Braun, Los Angeles Times, 8/6). "Mitt Romney is telling Iowans he is firmly pro-life," the Brownback campaign's phone message says, adding, "Nothing could be further from the truth." The message also notes that Romney's wife, Ann, has "contributed money to Planned Parenthood." Romney spokesperson Tim Albrecht called the phone messages "despicable" and "negative," adding that the campaign "should apologize to Ann Romney and Governor Romney for this personal attack" (Kaiser Daily Women's Health Policy Report, 7/25).
Brownback defended the calls in the debate, saying, "There's one word that describes that ad, and it's 'truthful.'" Romney said, "I never said I was pro-choice, but my position was effectively pro-choice." He added, "I've said that time and time again. I changed my position" (New York Times, 8/6). Romney said that he gets "tired of people that are holier than thou because they've been pro-life longer than" he has. According to the Washington Times, polls indicate that Romney is the leading Republican presidential candidate (Dinan, Washington Times, 8/6).
In addition, former HHS Secretary Tommy Thompson during the debate pledged to "end breast cancer by the year 2015 for all the women in America." He noted that his mother, wife and daughter all have been diagnosed with the disease (Washington Post, 8/6).
ABC News video of the candidates' comments on abortion is available online. Expanded ABC News coverage is available online (ABC News, 8/5).
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. © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.
Louisiana, New Jersey, Oregon Legislatures Take Actions On Abortion-, Stem Cell Research-Related Legislation
The following highlights recent news of state actions on abortion- and human embryonic stem cell research-related legislation.
Abortion
Louisiana: The House on Tuesday voted 104-0 to pass a bill (HB 614) that would ban so-called "partial-birth" abortion in the state and create criminal penalties for physicians who perform the procedure, the Baton Rouge Advocate reports. The Senate passed the bill by a 36-0 vote on Monday, and the measure now goes to Gov. Kathleen Blanco (D). Under the legislation, sponsored by Rep. Gary Beard (R), doctors who provide the procedure could receive fines up to $100,000 and jail sentences of up to 10 years (Sentell, Baton Rouge Advocate, 6/27). The ban would allow exceptions when the life of the pregnant woman is in danger (Kaiser Daily Women's Health Policy Report, 5/31). According to the AP/Houston Chronicle, Blanco has not indicated whether she would sign the measure (Simpson, AP/Houston Chronicle, 6/26).
Stem Cell Research
New Jersey: The Legislature on Thursday adopted a bill that would authorize a referendum in November to ask voters to approve borrowing $450 million over 10 years to fund stem cell research in the state, the AP/Yahoo! News reports. The Assembly voted 50-27 and the Senate 31-3 to approve the legislation (Hester, AP/Yahoo! News, 6/21). If approved by voters, the funds would be used to award grants to institutions -- including colleges, universities, and state and local government agencies -- that conduct research on both adult and embryonic stem cells and umbilical cord blood, Rep. Neil Cohen (D) said (Kaiser Daily Women's Health Policy Report, 6/15). Gov. Jon Corzine (D) is expected to sign the legislation authorizing the referendum (AP/Yahoo! News, 6/21). Corzine last year signed a measure into law that authorizes $270 million in state funds for the expansion of embryonic stem cell research and facilities in the state (Kaiser Daily Women's Health Policy Report, 12/22/06).
Oregon: The House on Thursday voted 30-29 in favor of a bill (HB 2801B) that would provide about $160,000 over the next 18 months to a committee to examine the use of public funds for embryonic stem cell research, but the measure needed 31 votes to pass the chamber, the AP/OregonLive reports. Under the legislation, the committee of researchers, medical ethicists, family law specialists and members of the public would be tasked with drafting guidelines for future state investment in stem cell research, as well as seeking public and private donations. The Republican caucus and one Democrat voted against the bill. According to the AP/OregonLive, Rep. Larry Galizio (D) changed his vote on the measure, which could allow it to be reconsidered (Silverman, AP/OregonLive, 6/21).
"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.
Vatican, Legislators Call For Change In Abortion Law After Error Performed During Abortion
The Vatican and some Italian legislators on Monday called for changing the country's abortion law after news of a case in which a healthy twin fetus mistakenly was aborted instead of the other fetus, which had been diagnosed with Down syndrome, AFP/New York Times reports.
The abortion was preformed on a woman in Milan who had two fetuses at 18 weeks' gestation. Physicians said the mistake was the result of the movement by the fetus between the examination and the abortion procedure. Italian news agencies reported that the woman had the remaining fetus aborted and then informed police about the matter (AFP/New York Times, 8/28).
The Vatican newspaper l'Osservatore Romano said the woman's choice was "illegitimate even though it was authorized by law" (Agence France-Presse, 8/27). Sen. Paola Binetti in the Corriere della Sera newspaper wrote, "The time has come to re-examine the abortion law," adding, "What happened in this hospital was not a medical abortion but an abortion done for the purposes of eugenics." According to AFP/Philippine Daily Inquirer, Binetti has close ties to the Vatican (AFP/Philippine Daily Inquirer, 8/27).
Health Minister Livia Turco defended the law, saying it is "very wise" and would not be changed (Agence France-Presse, 8/27).
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© 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.
The abortion was preformed on a woman in Milan who had two fetuses at 18 weeks' gestation. Physicians said the mistake was the result of the movement by the fetus between the examination and the abortion procedure. Italian news agencies reported that the woman had the remaining fetus aborted and then informed police about the matter (AFP/New York Times, 8/28).
The Vatican newspaper l'Osservatore Romano said the woman's choice was "illegitimate even though it was authorized by law" (Agence France-Presse, 8/27). Sen. Paola Binetti in the Corriere della Sera newspaper wrote, "The time has come to re-examine the abortion law," adding, "What happened in this hospital was not a medical abortion but an abortion done for the purposes of eugenics." According to AFP/Philippine Daily Inquirer, Binetti has close ties to the Vatican (AFP/Philippine Daily Inquirer, 8/27).
Health Minister Livia Turco defended the law, saying it is "very wise" and would not be changed (Agence France-Presse, 8/27).
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© 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.
Gender (dis)advantages In Cardiac Remodeling; Female Gender, Myocardial Remodelling And Cardiac Function
The topic of gender related differences in cardiac care is an extremely complex one. Unfortunately women have been neglected in several fields of medicine for too long. I think that cardiology is only one of the many fields in the past where the male predominance was obvious. As most of the original studies tended to include more men, this generated the idea that women were less likely to be affected and because they presented differently from men were labeled as 'atypical presentation'. In reality we never had enough data to define what 'typical' angina in women really is.
The differences between men and women are therefore not only biological but also social. Moreover the biology of heart disease is extremely complex as it involves differences in epidemiology and prevalence in risk factors, incidence of the inciting event, differences in the response to the insult, and differences in outcome, making therefore even more complex to appreciate true gender-dependent differences.
Many studies have shown that women with MI are usually diagnosed late during the course, are often misdiagnosed at first, are less likely to receive optimal medical care, and in many series their crude mortality is higher than men. This has lead to the idea that women are disadvantaged. Indeed they are disadvantaged if they are diagnosed late and if they are treated less aggressively (social disadvantage). The question whether they are biologically disadvantaged on the other hand is still debated. It is indeed plausible that female gender is protective toward adverse remodeling after MI.
After an insult (i.e. ischemia, infarct, pressure overload) the heart attempts to compensate by remodeling which usually entails hypertrophy of the walls and enlargement of cavity. This process although initially beneficial in maintaining an adequate cardiac output eventually leads to unfavorable outcome. It has been described that females (humans and animals) tend to have a prevalent hypertrophic response rather than dilatation of the cavity and this associated with preserved contractile function and overall better outcome. There may indeed be a gender-dependent difference in the pathway dominating the remodeling process. Several candidate molecules have been proposed but no definite data are available. An increased resistance to apoptosis in females is suggested.
The role of estrogens in gender-related differences in cardiac care is also complex. Estrogens play a major role in the difference in incidence of ischemic heart disease. As a general rule, premenopausal women have a more favorable lipid profile and are relatively protected from atherosclerosis which is however lost as time goes by after menopause. Estrogens however do not explain other differences in the outcome. The differences in remodeling seem to persist even when the role of circulating estrogens is limited (post-menopausal). The plot thickens as it has been shown that estrogens are not only produced in the ovaries which undergo failure at menopause but also in other organs such as the heart. Myocardial synthesis of estrogens has been demonstrated, and it remains not completely clear how it is affected by menopause. It is indeed possible that although the circulating levels of estrogens are low, the tissue levels may still be higher than men and mediate the beneficial effects. The data on this topic is scattered and inconclusive, and further studies are necessary.
EUROPEAN SOCIETY OF CARDIOLOGY (ESC)
The European Heart House
2035 Route des Colles
B.P. 179 - Les Templiers
FR-06903 Sophia Antipolis
escardio
The differences between men and women are therefore not only biological but also social. Moreover the biology of heart disease is extremely complex as it involves differences in epidemiology and prevalence in risk factors, incidence of the inciting event, differences in the response to the insult, and differences in outcome, making therefore even more complex to appreciate true gender-dependent differences.
Many studies have shown that women with MI are usually diagnosed late during the course, are often misdiagnosed at first, are less likely to receive optimal medical care, and in many series their crude mortality is higher than men. This has lead to the idea that women are disadvantaged. Indeed they are disadvantaged if they are diagnosed late and if they are treated less aggressively (social disadvantage). The question whether they are biologically disadvantaged on the other hand is still debated. It is indeed plausible that female gender is protective toward adverse remodeling after MI.
After an insult (i.e. ischemia, infarct, pressure overload) the heart attempts to compensate by remodeling which usually entails hypertrophy of the walls and enlargement of cavity. This process although initially beneficial in maintaining an adequate cardiac output eventually leads to unfavorable outcome. It has been described that females (humans and animals) tend to have a prevalent hypertrophic response rather than dilatation of the cavity and this associated with preserved contractile function and overall better outcome. There may indeed be a gender-dependent difference in the pathway dominating the remodeling process. Several candidate molecules have been proposed but no definite data are available. An increased resistance to apoptosis in females is suggested.
The role of estrogens in gender-related differences in cardiac care is also complex. Estrogens play a major role in the difference in incidence of ischemic heart disease. As a general rule, premenopausal women have a more favorable lipid profile and are relatively protected from atherosclerosis which is however lost as time goes by after menopause. Estrogens however do not explain other differences in the outcome. The differences in remodeling seem to persist even when the role of circulating estrogens is limited (post-menopausal). The plot thickens as it has been shown that estrogens are not only produced in the ovaries which undergo failure at menopause but also in other organs such as the heart. Myocardial synthesis of estrogens has been demonstrated, and it remains not completely clear how it is affected by menopause. It is indeed possible that although the circulating levels of estrogens are low, the tissue levels may still be higher than men and mediate the beneficial effects. The data on this topic is scattered and inconclusive, and further studies are necessary.
EUROPEAN SOCIETY OF CARDIOLOGY (ESC)
The European Heart House
2035 Route des Colles
B.P. 179 - Les Templiers
FR-06903 Sophia Antipolis
escardio
New Clinical Practice Guidelines On The Treatment Of Hirsutism
The Endocrine Society has released new clinical practice guidelines for the treatment of hirsutism in premenopausal women. The guidelines appear in the April issue of the Journal of Clinical Endocrinology & Metabolism (JCEM), a publication of The Endocrine Society.
Hirsutism is defined medically as excessive terminal hair that appears in a male pattern in women. Terminal hair refers to the stiff, pigmented hairs normally seen in men on the face, chest, abdomen, and back, and which are not normal in women. The cause of hirsutism can be either an increased level of androgens in women or an oversensitivity of hair follicles to natural levels of androgens in women.
"Hirsutism is a potential indication of an underlying medical disorder that may require specific treatment, and such a disorder may have implications for menstrual function, fertility, and metabolic risks," said Kathryn Martin, MD, of the Reproductive Endocrine Unit at Massachusetts General Hospital in Boston, Massachusetts, and member of the Society's task force that developed the guidelines. "These evidence-based guidelines give healthcare professionals an approach to treating hirsutism based upon a comprehensive review of clinical trials of drug therapy and hair removal techniques such as laser and electrolysis."
The guidelines suggest testing for elevated androgen levels in women with moderate or severe hirsutism, or hirsutism of any degree when it is sudden in onset, rapidly progressive, or associated with other abnormalities such as menstrual dysfunction or obesity.
For pharmacological therapy, the guidelines suggest oral contraceptives for the majority of women, adding an antiandrogen after six months if the response in suboptimal. An antiandrogen is a substance that prevents or inhibits the effects of male sex hormones. The guidelines recommend against using antiandrogens alone unless adequate contraception is used, because antiadrogens pose a potential risk to the normal sexual development of a male fetus.
Almost all women with hirsutism use temporary methods of hair removal such as shaving, plucking, and waxing. For those considering more "permanent" methods of hair removal the guidelines suggest photoepilation (laser and intense pulsed light) as first line therapy. Photoepilation methods, when compared to electrolysis, are more expensive per treatment session, but are more efficient, less painful, and may be associated with less scarring.
The guidelines were developed by a task force chaired by Dr. Martin. Other members of the task force included R. Jeffrey Chang of the University of California School of Medicine-San Diego in La Jolla, California; David Ehrmann of the University of Chicago General Clinical Research Center in Chicago, Illinois; Lourdes Ibanez of the University of Barcelona in Barcelona, Spain; Rogerio Lobo of Columbia University Medical Center in New York, New York; Robert Rosenfeld of the University of Chicago Comer Children's Hospital in Chicago, Illinois; Jerry Shapiro of the University of British Columbia in Vancouver, Canada; and Victor Montori and Brian Swiglo of Mayo Clinic in Rochester, Minnesota.
Endocrine Society
8401 Connecticut Ave., Ste 900
Chevy Chase, MD 20815
United States
endo-society
Hirsutism is defined medically as excessive terminal hair that appears in a male pattern in women. Terminal hair refers to the stiff, pigmented hairs normally seen in men on the face, chest, abdomen, and back, and which are not normal in women. The cause of hirsutism can be either an increased level of androgens in women or an oversensitivity of hair follicles to natural levels of androgens in women.
"Hirsutism is a potential indication of an underlying medical disorder that may require specific treatment, and such a disorder may have implications for menstrual function, fertility, and metabolic risks," said Kathryn Martin, MD, of the Reproductive Endocrine Unit at Massachusetts General Hospital in Boston, Massachusetts, and member of the Society's task force that developed the guidelines. "These evidence-based guidelines give healthcare professionals an approach to treating hirsutism based upon a comprehensive review of clinical trials of drug therapy and hair removal techniques such as laser and electrolysis."
The guidelines suggest testing for elevated androgen levels in women with moderate or severe hirsutism, or hirsutism of any degree when it is sudden in onset, rapidly progressive, or associated with other abnormalities such as menstrual dysfunction or obesity.
For pharmacological therapy, the guidelines suggest oral contraceptives for the majority of women, adding an antiandrogen after six months if the response in suboptimal. An antiandrogen is a substance that prevents or inhibits the effects of male sex hormones. The guidelines recommend against using antiandrogens alone unless adequate contraception is used, because antiadrogens pose a potential risk to the normal sexual development of a male fetus.
Almost all women with hirsutism use temporary methods of hair removal such as shaving, plucking, and waxing. For those considering more "permanent" methods of hair removal the guidelines suggest photoepilation (laser and intense pulsed light) as first line therapy. Photoepilation methods, when compared to electrolysis, are more expensive per treatment session, but are more efficient, less painful, and may be associated with less scarring.
The guidelines were developed by a task force chaired by Dr. Martin. Other members of the task force included R. Jeffrey Chang of the University of California School of Medicine-San Diego in La Jolla, California; David Ehrmann of the University of Chicago General Clinical Research Center in Chicago, Illinois; Lourdes Ibanez of the University of Barcelona in Barcelona, Spain; Rogerio Lobo of Columbia University Medical Center in New York, New York; Robert Rosenfeld of the University of Chicago Comer Children's Hospital in Chicago, Illinois; Jerry Shapiro of the University of British Columbia in Vancouver, Canada; and Victor Montori and Brian Swiglo of Mayo Clinic in Rochester, Minnesota.
Endocrine Society
8401 Connecticut Ave., Ste 900
Chevy Chase, MD 20815
United States
endo-society
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