Study Of Younger Postmenopausal Women Links Estrogen Therapy To Less Plaque In Arteries

New study shows that younger postmenopausal women who take estrogen-alone hormone therapy have significantly less buildup of calcium plaque in their arteries compared to their peers who did not take hormone therapy.

Coronary artery calcium is considered a marker for future risk of coronary artery disease.

Results of the WHI Coronary Artery Calcium Study are published in the June 21, 2007, issue of the New England Journal of Medicine. The WHI is sponsored by the National Heart, Lung, and Blood Institute (NHLBI) of the National Institutes of Health.

"These new results offer some reassurance to younger women who have had a hysterectomy and who would like to use hormone therapy on a short-term basis to ease menopausal symptoms," noted Elizabeth G. Nabel, M.D., NHLBI director. "We must emphasize, however, that these findings do not alter the current recommendations that when hormone therapy is used for menopausal symptoms, it should only be taken at the smallest dose and for the shortest time possible, and hormone therapy should never be used to prevent heart disease."

The new findings are from an ancillary study of 1064 women who were 50-59 years of age at the start of the WHI hormone therapy clinical trial. Participants were randomly assigned to either 0.625 milligrams per day of conjugated equine estrogens (Premarin™) or placebo (inactive pill). Participants took assigned medication for an average of nearly seven and one-half years. After slightly more than one year after treatment ended, researchers used computed tomography (CT scan) to measure the level of calcium plaque in the women's coronary arteries. Those who had taken estrogen were 30 to 40 percent less likely to have measurable levels of coronary artery calcium compared to those on placebo.

"Although our findings lend support to the theory that estrogen may slow early stages of plaque build-up in the coronary arteries, estrogen has complex effects and other known risks," said JoAnn Manson, M.D., chief of Preventive Medicine at Harvard's Brigham and Women's Hospital and lead author of the paper. "The results are consistent with our earlier findings that younger women treated with estrogen had a trend toward fewer heart attacks but, for an individual woman, it remains uncertain whether the benefits of estrogen would outweigh the risks. For this reason, estrogen should not be used for the express purpose of preventing cardiovascular disease, but it may be appropriate for the short-term treatment of moderate-to-severe hot flashes or night sweats among recently menopausal women."

In February 2006, WHI researchers reported that among the women in the estrogen-alone trial who were 50-59 years of age at study entry, women in the estrogen group had a non-significant trend towards lower rates of heart attacks compared to the placebo group, and significantly fewer women in the estrogen group required procedures to re-open clogged arteries. There was no suggestion of cardiovascular benefit in women who were 60 years or older.

"Heart attacks are uncommon among younger women, and the more relevant question is about long-term benefit as women grow older," noted Jacques Rossouw, M.D., chief of the NHLBI Women's Health Initiative Branch. "Conducting a clinical trial that would start any form of hormone therapy on postmenopausal women at a younger age and follow them for decades — when they would be more likely to have heart attacks — is not feasible.

"We cannot assume that any possible short-term, cardiovascular benefit from hormone therapy to postmenopausal women in their fifties would extend into older ages if they were to continue using hormones," Rossouw cautioned. "We already know that starting hormone therapy in older women increases their risk of heart disease. And long-term hormone therapy has other risks such as strokes and blood clots, and, with the use of combination therapy, breast cancer."

The WHI is a major, 15-year research program designed to address the most frequent causes of death, disability, and poor quality of life in postmenopausal women: cardiovascular disease, cancer, and osteoporosis. The principal findings from the WHI hormone therapy trials, which studied 27,347 postmenopausal women on estrogen-alone or estrogen plus progestin, found that the overall risks of hormone therapy outweigh the benefits. Both of these trials were stopped early because of increased health risks and failure to prevent heart disease, a key question of the studies. Even though the risks for coronary heart disease were less pronounced in the estrogen alone trial than in the estrogen-plus — progestin trial, both therapies increased the risk of stroke and of blood clots.

Overall, the estrogen-alone study involved 40 clinical centers and 10,739 generally healthy postmenopausal women ages 50-79 who did not have a uterus. The clinical trial was stopped in February 2004 after approximately 7 years of follow up because of increased risk of stroke and no reduction in risk of coronary heart disease. The study also found an increased risk of blood clots.

The estrogen-plus-progestin study (conducted in postmenopausal women with a uterus) was stopped in 2002 due to an increase in breast cancer. Like estrogen-alone, combination hormone therapy was also found to increase the risk of stroke and blood clots regardless of the women's age or time since menopause. Combination therapy was also found to increase the risk of heart disease in the first few years.

All women who wish to lower their risk of heart disease should make healthy lifestyle choices, such as following a diet low in sodium, saturated fat, transfat and cholesterol; maintaining a healthy weight; engaging in regular physical activity; and not smoking. In addition, they should work with their healthcare provider to identify and manage other known risk factors such as high blood pressure, high blood cholesterol, and diabetes.

NHLBI collaborates on the WHI with the National Cancer Institute, the National Institute of Arthritis and Musculoskeletal and Skin Diseases, and the National Institute on Aging, and the Office of Research on Women's Health, all parts of the NIH. Wyeth-Ayerst Research provided the medication and placebo for both hormone studies.

source:www.emaxhealth.com

Number Of Abortions In England, Wales Increases 4% In 2006

Number Of Abortions In England

The number of abortions reported in England and Wales in 2006 increased 4% from 186,400 in 2005 to 193,700 last year, according to figures released Tuesday by the United Kingdom's Department of Health, London's Guardian reports (Ward, Guardian, 6/20). The figures show the overall rate of abortion is 18.3 abortions per 1,000 women and girls ages 15 to 44 living in England and Wales, compared with 17.8 abortions per 1,000 women and girls in 2005 for the same age group. About 89% of the procedures were performed before 13 weeks' gestation and 68% were performed under 10 weeks' gestation, according to the figures (Moynihan, Press Association, 6/19)

The abortion rate was highest among women age 19 at 35 per 1,000. According to the figures, there were 3.9 abortions per 1,000 girls under age 16 and 18.3 per 1,000 girls under age 18, London's Times reports (Hinds, Times, 6/19). The figures also showed that 32% of women who had an abortion had already had at least one previous abortion -- a percentage that remains unchanged from 2005 despite the government allocating 40 million pounds, or about $79.4 million, for contraception education, London's Telegraph reports (Davies, Telegraph, 6/20).

Reaction

Health Minister Caroline Flint said, "We welcome the fact that a higher percentage of abortions are taking place at an early stage." She added, "It is important that women have early access to abortion services as the earlier the abortion, the lower the risk of complications. However, the [National Health Service] needs to work harder to reduce the demand for abortions by improving access to contraception" (BBC News, 6/19). Abortion-rights groups are calling for increased spending on contraceptive services to prevent unintended pregnancy, noting that the average amount spent on contraception per woman in England is 11 pounds, or about $22, the Guardian reports (Guardian, 6/20). Contraceptive services are "in crisis," Anne Weyman, CEO of the Family Planning Service, said, adding, "Services are being cut and clinics are closing up and down the country."

Paul Tully, general secretary of the Society for the Protection of Unborn Children, said, "Without positive support, an abortion can seem unavoidable - but may be bitterly regretted later on," adding, "The government's approach of promoting early abortion is increasing the overall number of abortions" (BBC News, 6/19). Ann Furedi, chief executive of the British Pregnancy Advisory Service, which provides contraception and abortion services, said, "A rise in the number of abortions is not the problem in itself; the real problem is the number of women experiencing unintended pregnancy." Furedi added, "For some of these, abortion will be the solution to the very serious problem of being faced with an unplanned, unwanted pregnancy" (Press Association, 6/19).

According to the Telegraph, the Royal College of Obstetricians and Gynaecologists has called for a review of sex education to help address the issue. The British Medical Association next week is scheduled to vote on a proposal to relax abortion laws by eliminating language that requires women who are less than 13 weeks' pregnant to have the signature of two doctors before undergoing a procedure (Telegraph, 6/20). The proposal also would allow a wider range of medical professionals to perform an abortion (Guardian, 6/20).

Reprinted with permission from kaisernetwork.org. You can view the entire Kaiser Daily Women's Health Policy Report, search the archives, and sign up for email delivery at kaisernetwork.org/email . The Kaiser Daily Women's Health Policy Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation. © 2007 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

source:www.emaxhealth.com

Pregnancy Baby Watch from BBBoom Tells Fertility Time

Pregnancy is a time when pregnant women have to keep up with many issues related to timing and pregnancy calendar. There is a new invention from BBBoom, which is a watch and could be an interesting pregnancy calendar, helping to keep up with many calendar events related to pregnancy.

* BBBoom watch displays your fetile days. Simply enter your personal cycle data and your fertile days will be displayed. However, Please note that the predicted dates to not guarantee safe contraception.

* Keeps a record of all lab data. BBBOOM remembers all lab test data. BBBOOM keeps a record of all lab data and knows what information to present to you at the right time to protect your health. BBBOOM also features a list of all your usual tests, so your mother can schedule and discuss them with your doctor.

* Reminds you when you should see your gynecologist.

BBBOOM never forgets any appointments. Upon request, BBBOOM reminds you with sufficient time when you and your mom should see your gynecologist or undergo an important test. It also supplies you with a list of important tests after birth and into infancy.

* Will show you how large the most important parts of a baby's body should be at specific times.

BBBOOM knows your baby's size. BBBOOM will show you how large (statistically speaking) the most important parts of a baby's body (head diameter, arm length, etc.) should be at specific times during pregnancy. Compare this data with the data your doctor gives you and watch your baby grow healthy and happy.

* Lets you know how long you have been pregnant.

BBBOOM lets you know how long you have been pregnant. Nine months is a considerable length of time. You may perhaps be unsure how long since the time of pregnancy conception. BBBOOM can help. Just press a button and BBBOOM will let you know, down to the very day.

* Finding the best name isn't easy! BBBOOM offers you a database list of 5,000 names.

* Celebrates your baby's birthday with you.

No mother would ever forget the birth day of her child. Neither will BBBOOM. Count on BBBOOM to congratulate you on your first birthday at noon.

* Will give you access to mother's and child's medical history.

Just press the right button and BBBOOM will give you access to mother's medical history. Some things tend to be forgotten over time. Your mother's own medical history is one of them. BBBOOM keeps an alphabetical record of her past medical history to have on hand next time you both see your doctor. Rest assured she's giving your doctor reliable information for your proper development.

source:www.emaxhealth.com

Fetus At Risk At Lower Levels Of Maternal Blood Glucose Than Thought

Gestational diabetes may place a much higher percentage of pregnant women -- and their unborn babies -- at risk for adverse outcomes than previously believed.

"We found that the risk of having a large baby, a first-time Cesarean delivery, low blood glucose levels in the newborn requiring treatment, and high blood insulin levels in the baby that may signal problems ahead, all increased as the mother's blood glucose level during pregnancy increased," said Boyd E. Metzger, MD, Professor of Medicine, Division of Endocrinology, Northwestern University Feinberg School of Medicine, Chicago, and Principal Investigator of the study, in a recent interview. "These relationships were continuous over the entire range of blood glucose levels found in over 23,000 pregnancies, even in ranges previously considered to be within the normal range for pregnant women." Nonetheless, the higher the mother's blood glucose, the higher the risk that these problems will occur.

The Hyperglycemia and Adverse Pregnancy Outcome (HAPO) Study was a seven- year international study that recruited approximately 25,000 pregnant women at 15 centers in 9 countries to achieve a major advance in knowledge on levels of blood glucose during pregnancy that place the mother, fetus, and newborn at increased risk for adverse outcomes. Ultimately, 23,325 women completed the study. HAPO was a basic epidemiologic investigation designed to clarify unanswered questions on the association of various levels of glucose intolerance during the third trimester of pregnancy and risk of adverse outcomes.

Nearly 21 million Americans have diabetes, a group of serious diseases characterized by high blood glucose levels that result from defects in the body's ability to produce and/or use insulin. Diabetes can lead to severely debilitating or fatal complications, such as heart disease, blindness, kidney disease, and amputations. Diabetes is the fifth leading cause of death by disease in the U.S.

Pregnant women who have never had diabetes before but who have high blood glucose levels during pregnancy are said to have gestational diabetes (GDM). GDM affects about 4% of all pregnant women -- about 135,000 cases of gestational diabetes in the United States each year. GDM usually goes away after pregnancy, but chances are 2 in 3 that this condition will return in future pregnancies. In some women, however, pregnancy uncovers type 1 or type 2 diabetes. Obstetricians normally test women for GDM around the 28th week of pregnancy. Treatment for GDM involves diet and physical activity, and may also include daily blood glucose testing and insulin injections.

GDM is similar to type 2 in that it involves insulin resistance (an inability of the body to use its insulin properly) and an inability to make sufficient insulin -- so blood glucose levels rise. If left untreated or poorly controlled, GDM pours excess glucose across the placenta to the fetus. This causes the fetal pancreas to make extra insulin to get rid of the blood glucose. Since the fetus is getting more energy than it needs,the extra energy is stored as fat, which can lead to macrosomia -- a large baby. Babies with macrosomia face health problems of their own, including damage to their shoulders during birth. Because of the extra insulin made by the pancreas, newborns may have very low blood glucose levels at birth and may also be at higher risk for breathing problems. Babies with excess insulin may be at risk for obesity in childhood and, in adulthood, at risk for type 2.

For the last 40 years, the diagnosis of GDM has been based on criteria that predict the risk of the mother developing diabetes in the future. But GDM also carries a risk for the baby. However, the point at which maternal blood glucose elevation carries risk for the fetus has been unknown, in part due to such confounding factors as hypertension, overweight, and older age in the mother, which also may contribute to risk. Consequently, some experts have long said that the diagnosis of GDM is not made often enough, while others believe that mild elevations of blood glucose have no adverse effects. Further, physicians have not had guidelines to use to make a diagnosis of GDM related to fetal outcome.

At about 28 weeks of gestation (range 24 to 32), three blood samples were taken from each pregnant woman: a morning fasting blood glucose (FPG); an oral glucose tolerance test (OGTT) involving one sample taken one hour after drinking 75 grams of glucose; and another sample taken a second hour later. Medical caregivers were "blinded" to the test results, except those that exceeded pre-defined cutoff values requiring treatment, in which case -- for safety and ethical reasons -- the woman was removed from the study and treated. Otherwise, pregnancies proceeded and then outcomes were observed and tabulated.

"We found major independent effects of the mother's blood glucose level on each of the outcomes -- the size of the baby, the need for a first Cesarean delivery, low blood glucose requiring treatment, and high insulin levels in the newborn," said Metzger.

The definition of a "large" baby differed from center to center, reflecting the local population, and was defined as being in the largest 10% of the population.

"Low blood glucose levels in a newborn that require treatment are thought to be a consequence of exposure to higher than normal blood glucose levels in the mother, leading to a more difficult transition from the womb to surviving independently -- a classical medical problem in newborns of mothers with known diabetes," he explained.

In the HAPO study, insulin levels in newborns were measured from a blood sample taken from the umbilical cord at delivery. "While high insulin levels are not a problem per se, this indicator is considered a primary outcome because of a longstanding hypothesis and much evidence that many of the problems that these babies develop arise from high insulin levels, and our goal is to document that their presence and such problems are related to these levels," said Metzger.

"It is probable that the level of maternal blood glucose at which a diagnosis of gestational diabetes is made will soon be lowered based on the findings of this study," he said.

Nonetheless, Metzger acknowledged that, although their objective was to learn where elevated glucose clinically becomes a problem, they still cannot immediately say exactly where along the range of the blood glucose spectrum the effects of higher levels are clinically important. "We found that some problems occurred even in ranges previously considered within the normal range for pregnant women," he said.

For example, using just one of the three blood tests taken -- the fasting blood glucose -- results ranged from 75 to 105 mg/dl, and within that range 95 to 100 mg/dl is currently considered the upper range of normal in a pregnant woman. However, the chances of having a big baby increased four to six times over that spread from the lowest to the highest blood glucose results seen in the study. Similarly, the chances of the baby having a high insulin level at delivery increased by as much as 10 times over the range of low to high blood glucose levels in the mother.

"Because these relationships are continuous over the entire range of blood glucose levels, it's not immediately obvious where we should call the value abnormal -- at what level it is important to intervene to normalize blood glucose," he explained. "That cannot immediately be decided from looking at the data." Further, none of the blood glucose measurements used could be identified as best because all provided different but complementary information.

"We are not making diagnostic recommendations," he emphasized. "Those decisions need a consensus translation of a complex set of results and input from everyone interested in the impact, such as researchers, clinicians who care for patients -- including obstetricians, diabetologists, family physicians, pediatricians, and nutritionists -- as well as patients, patient advocates, and third-party payers." A conference to translate the results into new clinical criteria is in the planning stages.

source;www.emaxhealth.com

NPR Examines High Infant Mortality Among Blacks In Southern States

Infant Mortality

NPR's "Morning Edition" on Thursday reported on efforts to lower the infant mortality rate among blacks. Infants born to black women are twice as likely to die in their first year as infants born to white women, "Morning Edition" reports. The disparity exists both among low-income women and well-educated, affluent women. While infant mortality nationwide has declined steadily since 1960, some Southern states have seen the rate stagnate or increase in recent years.

Alan Brann, professor of pediatrics at Emory University, said it is unclear why the infant mortality rate is greater among blacks, but a high rate of very low birth weight infants contributes to the problem. Low birthweight "is an indicator of the status of health of the community," Brann said, adding, "It's the best canary we have in the mine to say this population that has high rates of very low birthweight babies are not healthy people."

Access to prenatal care and primary care between pregnancies also contributes to poor maternal and fetal health, "Morning Edition" reports. In addition, requirements that Medicaid applicants present original birth certificates and apply in person make it difficult for some women to obtain coverage. In rural areas, women must travel long distances to see providers, few of whom accept Medicaid, according to Janice Johnson, a social worker with Delta Health Partners.

Oleta Fitzgerald, Southern regional director of the Children's Defense Fund, said the high infant mortality rate in the Southern U.S. is tied to poverty. "Nobody wants to take care of poor children, whether they are black or white or whatever color," Fitzgerald said, adding, "So it is a moral issue, and it is something that we are going to have to deal with" (Lohr, "Morning Edition," NPR, 6/21).

Reprinted with permission from kaisernetwork.org. You can view the entire Kaiser Weekly Health Disparities Report, search the archives, and sign up for email delivery at kaisernetwork.org/email . The Kaiser Weekly Health Disparities Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation. © 2007 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

source:www.emaxhealth.com

Antidepressants during pregnancy and birth defects

The New England Journal of Medicine published today two research studies on the link between the use of antidepressants by the mother during pregnancy and the risk of the baby being born with birth defects.

Studies, conducted respectively by researchers from Boston University's Slone Epidemiology Center and the US Centers for Disease Control and Prevention (CDC), Atlanta, suggest that the use of anti-depressant drugs from the family of SSRI-s (selective serotonin reuptake inhibitors) during pregnancy did not increase the overall risk for birth defects significantly.

However, both studies also concluded that individual anti-depressants, taken during pregnancy, may increase the risk for specific birth defects, but that these birth defects are different and each one is rare and that the risks are small.

The SSRI anti-depressant drug family includes common and "famous" names like Celexa, Paxil, Prozac and Zoloft. The effect of their use during pregnancy on the babies and the risks of birth defects associated to this use have been the topic of many studies, but previous research was less in favor of them.

After analyzing birth defects that were previously associated with SSRI use during pregnancy, the researches found that overall use of these anti-depressants does not significantly increase the risk of the babies having heart defects overall, with craniosynostosis (where connections between skull bones close prematurely), omphalocele (intestines or other abdominal organs protrude from the naval).

Carol Louik, assistant professor of epidemiology at Boston University's Slone Epidemiology Center and the lead author of the first study thinks that although "these studies make a large contribution to the field, they're not the final word by any means", and that "it's a fairly reassuring message for women who need antidepressants and are pregnant or who plan on becoming pregnant"--the risks are not large, " and the fewer elevated risks observed would only lead to very small absolute risks.

Because the other side of the coin should also be considered--should women on anti-depressants continue their medication or should they stop the treatment and risk a relapse during pregnancy?

Previous studies have suggested possible links between the use of anti-depressants by pregnant women and some fetal heart problems as well as birth defects such as withdrawal symptoms in newborns, pulmonary hypertension of the newborn (PPHN, a rare, but serious heart and lung disorder), low birthweight, preterm delivery, etc. But, on the other hand, depressed moms may be more inclined to be health "unconscious" --bad eating habits, alcohol or drug abuse, etc, none of which are good for the fetus. Depression, if untreated, has also been associated with an increase in the risk of miscarriage and again, premature birth and low birthweight.

Dr Jon Shaw, director of child and adolescent psychiatry at the University of Miami's Miller school of Medicine thinks that these studies make a valuable contribution -"It substantiates the need to always be prudent in prescribing antidepressants."

Dr. Michael Katz, acting Medical Director of the March of Dimes, a non-for-profit organization dedicated to the improvement of the health of babies by preventing birth defects, premature birth, and infant mortality, thinks that the studies show just how important post-market surveillance is. "Most prescription drugs are not tested on pregnant women, so we must start monitoring the effects of these medications as soon as they reach consumers, and keep monitoring for as long as it takes to get good data on risks to mothers and babies." Furthermore, most prescription drugs and specially anti-depressants are not tested on pregnant women, says Dr. Katz, "So we must keep monitoring the effects of these medications for as long as it takes to get good data on risks to mothers and babies."

What should future moms feeling blue do? Should they stop taking anti-depressants during pregnancy? "There's a careful tightrope that patients and doctors have to walk to minimize exposure to antidepressants but to avoid depression in pregnancy as well," says Charles Lockwood, chair of obstetrics, gynecology, and reproductive science at Yale University School of Medicine and spokesperson for the American College of Obstetricians and Gynecologists. Every expecting mom, no matter how depressed she is, should be reminded that each pregnancy is the start of a new life - both for her still unborn baby and for herself.

Therefore, mothers should be very careful and closely work with their doctors before considering antidepressants during pregnancy.

source:www.emaxhealth.com

Sling Surgery Is More Effective For Bladder Control In Women

Bladder Control

Among women with incontinence, 50 to 80 percent have stress urinary incontinence.

For many women coughing, laughing, sneezing, running or lifting heavy objects causes urine to leak, a condition commonly known as stress urinary incontinence.

Urinary incontinence in women a team of urologists and urogynecologists, including University of Alabama at Birmingham (UAB) urogynecologist Holly E. Richter, Ph.D., M.D., found that an autologous fascial sling procedure is significantly more effective than the Burch technique.

The study is being released early by the New England Journal of Medicine (NEJM) to coincide with a presentation at the annual meeting of the American Urological Association on May 21. Results will appear in the May 24 print edition of NEJM.

The Stress Incontinence Surgical Treatment Efficacy Trial (SISTEr) found that an autologous rectus fascia sling is significantly more successful than the Burch colposuspension technique for treating both overall urinary incontinence and stress-specific incontinence.

In the autologous sling procedure, a harvested strip of rectus fascia is placed transvaginally at the level of the proximal urethra. The fascial strip is secured superiorly to the rectus fascia with permanent sutures. In the Burch modified colposuspension, the anterior vaginal wall is suspended at the level of the bladder neck with permanent sutures tied to the iliopectineal ligament.

Two years after surgery, overall success rates were 47 percent and 38 percent for the sling and Burch groups, respectively. Success rates in stress incontinence alone rose to 66 percent and 49 percent for sling and Burch, respectively. These outcomes were based on a combination of both subjective and objective measures, not just one or two as in most previous studies.

"For the first time, we have a rigorous, relatively long-term comparison of these traditional surgeries," Richter said. "These two procedures have been considered the gold standards of surgical treatment for urinary incontinence for many years. Not only does the information provided by this trial enable women with stress incontinence and their doctors to make more-informed choices based on clear benefits and risks and personal preferences, but because it is the most robust randomized trial, this study lays the ground work for future research trials for stress urinary incontinence in women."

SISTEr randomized 655 women to assess whether a rectus fascial sling or a Burch colposuspension was more effective for bladder control overall and for stress incontinence specifically. Primary outcomes data were available for 520, or 79 percent, of participants at 24 months. Secondary outcomes assessed quality of life, patient satisfaction and side effects.

While all women in the study were highly satisfied with the treatment they received, those with a sling were significantly more satisfied. Eighty-six percent with a sling were satisfied, compared to 78 percent of the Burch group.

Side effects were more common among women with slings, tempering the positive results of the procedure. The most common side effect was urinary tract infections, which occurred in 63 percent of women undergoing a sling procedure and 47 percent of the Burch group. Women with a sling also had more voiding problems (14 percent versus 2 percent) and persistent urge incontinence, the loss of urine just before feeling a strong, sudden urge to empty the bladder, (27 percent versus 20 percent).

source:www.emaxhealth.com

Egypt Imposes Total Ban On Female Genital Cutting

Female Genital Cutting

Egypt recently announced that it will impose a total ban on female genital cutting, rescinding a provision that allowed the practice to be performed by qualified physicians in exceptional cases, BBC News reports (Abdelhadi, BBC News, 6/28).

Female genital cutting -- sometimes referred to as female circumcision or female genital mutilation -- is a practice in which there is a partial or full removal of the labia, clitoris or both. About 6,000 girls undergo genital mutilation daily, and the World Health Organization estimates that 100 million to 140 million women worldwide are circumcised. At least 90% of women who undergo genital cutting live in developing countries -- such as Djibouti, Ethiopia, Sierra Leone, Somalia and Sudan -- while almost no women undergo the practice in Iran, Iraq and Saudi Arabia, according to UNICEF (Kaiser Daily Women's Health Policy Report, 12/7/06).

A spokesperson for the ministry of health said that under the ban, no member of the medical profession would be allowed to perform the operation in public or private clinics, adding that any person breaks the law will be punished. The country's top religious authorities, including the head of the Coptic Church and Grand Mufti, have expressed unequivocal support for the ban, BBC News reports (BBC News, 6/28).

Grand Mufti Ali Gomaa on Sunday said the practice is not allowed under Islamic law. He added, "The harmful tradition of [female] circumcision that is practiced in Egypt in our era is forbidden" (Reuters, 6/24). According to BBC News, the announcement comes after a young girl recently died while undergoing the procedure in a private medical clinic in Egypt (BBC News, 6/28).

Reprinted with permission from kaisernetwork.org. You can view the entire Kaiser Daily Women's Health Policy Report, search the archives, and sign up for email delivery at kaisernetwork.org/email . The Kaiser Daily Women's Health Policy Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation. © 2007 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

source:www.emaxhealth.com

Florida To Reduce Infant Mortality Rates Among Minorities

Infant Mortality Rates Among Minorities

Florida Gov. Charlie Crist (R) on Monday signed a bill into law that will fund research examining the cause of high infant mortality rates among minorities, the Fort Meyers News-Press reports. According to a legislative staff analysis, Florida's infant mortality rate in 2005 was 12.5 deaths per 1,000 live births among minorities, compared with 5.3 deaths per 1,000 live births among whites (Booth Reed, Fort Meyers News-Press, 7/3).

The bill, sponsored by Democratic lawmakers Rep. Betty Reed and Sen. Arthenia Joyner, provides a one-time, $1 million grant to be used by researchers to find the cause of the disparity (Mishkin, St. Petersburg Times, 7/3). The grant also will go toward two or more Healthy Start coalitions in areas with a black infant mortality rate nearly double that of whites, according to the News-Press (Fort Meyers News-Press, 7/3). The Florida Department of Health will administer the programs and allocate the funds.

Rochelle Barberio, a registered nurse with Healthy Start in Hillsborough County, said that researchers will have to address health issues -- such as obesity, hypertension, inadequate prenatal care, and environmental and personal stress -- that contribute to pre-term labor. Pre-term labor is one of the leading causes of infant death, Estrellita Berry, project director of Healthy Start in Hillsborough, said.

Reed said, "With the signing of that bill today, ... I hope I started the process of really taking charge of the disparity" (St. Petersburg Times, 7/3).

Reprinted with permission from kaisernetwork.org. You can view the entire Kaiser Weekly Health Disparities Report, search the archives, and sign up for email delivery at kaisernetwork.org/email . The Kaiser Weekly Health Disparities Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation. © 2007 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

source:www.emaxhealth.com

Preimplantation Genetic Diagnosis Reduces Older Women's Chances Of Pregnancy

Preimplantation Genetic Diagnosis

Using preimplantation genetic diagnosis to screen for potential birth defects reduces the likelihood of an older woman becoming pregnant through in vitro fertilization by one-third, according to a study published Thursday in the New England Journal of Medicine, the Los Angeles Times reports. PGD involves removing a single cell from a three-day-old embryo to test for potential birth defects and then implanting the embryos most likely to result in a healthy infant, according to the Times.

Sebastiaan Mastenbroek of the Academic Medical Center at the University of Amsterdam and colleagues enrolled 408 women ages 35 to 41. Half of the women received IVF with PGD and the other half received IVF without PGD. All of the women in the study went through as many as three IVF cycles, the Times reports (Maugh, Los Angeles Times, 7/5). Among the women who received PGD, 25% reached the 12th week of pregnancy, compared with 37% of the women who did not receive PGD. The birth rate was 24% among women receiving PGD and 35% among women not receiving PGD, the study found (Armstrong, Wall Street Journal, 7/5).

According to the Times, only a few thousand PGD procedures are performed annually, although some researchers say the procedure has been increasing by as much as 30% per year (Los Angeles Times, 7/5). About seven in 10 fertility clinics nationwide offer PGD to women undergoing IVF at a cost of $3,000 to $5,000, according to the Journal (Wall Street Journal, 7/5).

The study did not examine why PGD reduces women's chances of pregnancy, London's Independent reports. According to Mastenbroek, it is possible that PGD "hampers the potential of an embryo to successfully implant." According to the Independent, PGD also might not identify all chromosomal abnormalities, leading to possible implantation of embryos with abnormalities.

Reaction

The researchers recommended that PGD should not be offered routinely to women undergoing IVF (Connor, Independent, 7/5). The study "rings the death knell" for using PGD to routinely screen older women, Richard Scott, founder of the IVF clinic chain Reproductive Medicine Associates, said. However, the procedure is still recommended to test for specific genetic defects that the mother and father are known to carry, the Times reports (Los Angeles Times, 7/5).

John Collins, a professor at McMaster University, in a NEJM editorial accompanying the study wrote that PGD "appears to do no more than interfere with the natural screening and selection process." Collins added that the procedure should not be targeted toward older women. Kathy Hudson, director of the Genetics and Public Policy Center at Johns Hopkins University, said that more research is needed into the effectiveness of PGD, adding, "The question is: Are these results truly generalizible to other clinics?" (Wall Street Journal, 7/5).

Reprinted with permission from kaisernetwork.org. You can view the entire Kaiser Daily Women's Health Policy Report, search the archives, and sign up for email delivery at kaisernetwork.org/email . The Kaiser Daily Women's Health Policy Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation. © 2007 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

source;www.emaxhealth.com

Prenatal Disorder Gastroschisis

Prenatal Disorder Gastroschisis

The San Francisco Chronicle on Tuesday examined the increasing incidence of gastroschisis, a prenatal disorder in which parts of a fetus' intestines grow outside of its body and contaminate the amniotic sac. Researchers say gastroschisis incidence in the U.S. has doubled in the last two decades. There are about 1,380 cases of the condition reported nationwide annually, according to the California Birth Defects Monitoring Program.

According to the Chronicle, the condition is believed to develop during the fifth to eighth week of pregnancy when there is a disruption in the blood supply of a fetus' developing abdominal wall. About 85% of infants who are treated for gastroschisis survive, but the condition can be fatal if it is not treated (DeFao, San Francisco Chronicle, 7/3). The standard treatment for the disorder, which is not performed until after childbirth, often requires one or more surgeries to replace the intestines within the infant's abdominal cavity and close the abdominal wall (Kaiser Daily Women's Health Policy Report, 7/16/02).

Pregnant women and girls younger than age 20 are at greatest risk of having an infant with the defect, the Chronicle reports. Girls and women ages 17 to 19 are three times more likely to give birth to an infant with the condition than an average woman and girls under age 17 are 4.5 times more likely.

A recent study -- conducted by Edward Lammer, a researcher at Children's Hospital Oakland Research Institute; Gary Shaw, former research director of the California Birth Defects Monitoring Program; and colleagues -- found a link between smoking and gastroschisis. Other risk factors include using recreational drugs and drinking alcohol, as well as taking medications that reduce blood flow -- including aspirin, ibuprofen and some decongestants -- according to the California monitoring program.

Lammer and his team recently received a three-year, $670,000 research grant from the California Tobacco Related Diseases Research Program to study the genes of infants with gastroschisis and their mothers. "It's clear that it's on the rise," Shaw said, adding, "We need to know why" (San Francisco Chronicle, 7/3).

Reprinted with permission from kaisernetwork.org. You can view the entire Kaiser Daily Women's Health Policy Report, search the archives, and sign up for email delivery at kaisernetwork.org/email . The Kaiser Daily Women's Health Policy Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation. © 2007 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

source:www.emaxhealth.com

Lack Of Investment In Maternal, Infant Health Is 'Tragedy'

Given that healthy women "deliver not just babies but paychecks and economic growth," it is a "mystery why maternal and newborn health still receives inadequate international attention and funding," Jill Sheffield, president of Family Care International, writes in a Washington Post letter to the editor.

According to Sheffield, Afghanistan's "devastated health care system" has contributed to one of the world's highest maternal mortality rates. "The sad truth is that if the Afghan government and its U.S. backers had invested in things that keep pregnant women alive -- such as emergency care facilities and training and security for paramedics, including midwives -- the country would now have at least a bare bones health care system," Sheffield writes.

"Pregnancies don't take timeouts to await solutions to political struggles, and meanwhile, every generation loses 10 million women worldwide," Sheffield writes, concluding, "It's a real tragedy, and not only in Afghanistan" (Sheffield, Washington Post, 7/5).

Reprinted with permission from kaisernetwork.org. You can view the entire Kaiser Daily Women's Health Policy Report, search the archives, and sign up for email delivery at kaisernetwork.org/email . The Kaiser Daily Women's Health Policy Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation. © 2007 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

source:www.emaxhealth.com