Exposure To Insecticide May Play Role In Obesity Epidemic Among Some Women

Prenatal exposure to an insecticide commonly used up until the 1970s may play a role in the obesity epidemic in women, according to a new study involving several Michigan State University researchers.



More than 250 mothers who live along and eat fish from Lake Michigan were studied for their exposure to DDE - a breakdown of DDT. The study, published as an editor's choice in this month's edition of Occupational and Environmental Medicine, analyzed DDE levels of the women's offspring.



Compared to the group with the lowest levels, those with intermediate levels gained an average of 13 pounds excess weight, and those with higher levels gained more than 20 pounds of excess weight.



"Prenatal exposure to toxins is increasingly being looked at as a potential cause for the rise in obesity seen worldwide," said Janet Osuch, a professor of surgery and epidemiology at MSU's College of Human Medicine, who was one of the lead authors of the study. "What we have found for the first time is exposure to certain toxins by eating fish from polluted waters may contribute to the obesity epidemic in women."



Though DDT was banned in 1973 after three decades of widespread use, the chemical and its byproducts remain toxic in marine life and fatty fish. The study was funded by a $300,000 grant from the federal Agency for Toxic Substances and Disease Registry.



Osuch said the study's findings can have a huge impact on how researchers treat - and seek to prevent - obesity. The research team has been awarded a $1 million grant from the same federal agency, the ATSDR, to assess the impact of pollutants and toxins on a wide variety of disorders by determining the importance of second- and third-generation health effects.



"This line of research can transform how we think about the causes of obesity and potentially help us create prenatal tests to show which offspring are at higher risks," she said.



The mothers who were studied are part of a larger cohort of Michigan fish eaters along Lake Michigan who were recruited in the early 1970s. In 2000, Osuch and research partners approached the cohort and began to identify daughters aged 20 to 50 years old.



"These findings not only apply to the offspring of women in our cohort but to any woman who has been exposed to high levels of DDE when she was growing in her mother's womb," Osuch said. "Mothers with the highest DDE levels are women who have consumed a lot of fish or high-fat meats."



Current recommendations for eating fish call for limiting it to two meals per week; including tuna fish sandwiches. The study also looked at the effects of a second pollutant, PCBs, but found no correlation with weight and body mass index.



Notes:


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 Molecular Profiling Institute Launches Mammostrat(TM) A Novel, Molecular Targeted, Prognostic Test For Breast Cancer Patients

The Molecular Profiling Institute,
Inc. (Molecular Profiling) announced that they are now providing
Mammostrat, a new molecular-targeted breast prognostic test, to breast
cancer patients, nationwide. The Mammostrat prognostic test utilizes five
immunohistochemical (IHC) biomarkers to classify patients into high,
moderate, or low-risk categories for disease recurrence.


Robert Penny, M.D., Ph.D., the Chairman and CEO of the Molecular
Profiling Institute stated, "Mammostrat will benefit the care of breast
cancer patients nationwide by allowing their cancer to be quickly analyzed
for prognosis by a direct light-microscopic evaluation of the cancer cells
by a pathologist. This new test, which is performed on tissue preserved
according to standard practice, streamlines the process for patients while
providing the accuracy of direct visualization."



The test was developed by Applied Genomics, Inc. who rigorously
translated recent genomic insights in cancer into a novel
immunohistochemistry test. Mammostrat test results have been validated
using over a thousand patient samples in North America from
clinics/organizations such as the Cleveland Clinic Foundation and the
National Surgical Adjuvant Breast and Bowel Project -- generating results
with clear cut conclusions from multiple independent studies supporting the
prognostic value of the test.



"We are excited to have partnered with the Molecular Profiling
Institute, says Doug Ross, MD, PhD, Chief Scientific Officer of Applied
Genomics. "Their expertise in advanced genomic and proteomic testing will
provide a rigorous reference lab-based introduction of the test and broad
reach in order to offer quality testing to patients nationwide."



Because Mammostrat uses traditional immunohistochemistry technology,
the test is expected to be significantly less expensive than existing
molecular-based, prognostic tests for breast cancer and is typically
covered by insurance. Todd Maney, Ph.D., Vice President of New Product
Development, MPI, stated, "Mammostrat's cost-effective, molecular-targeted
analysis enables MPI to provide the test at a significant discount compared
to our competitors. Moreover, test results will be available quickly -- an
average of seven business days -- versus two weeks for alternative,
comparable tests."



Physicians may order the Mammostrat test direct from the Molecular
Profiling Institute or through their distribution partner AmeriPath by
visiting molecularprofiling.



About the Molecular Profiling Institute, Inc. -- Molecular Profiling is
a CLIA-certified specialty reference laboratory that helps patients,
worldwide, by applying the discoveries of the Human Genome Project to
personalized medicine. Molecular Profiling provides cutting-edge testing
facilities, products, and resources for genomic and proteomic profiling and
treatment of complex diseases, and pharmaceutical services to identify
populations that may respond to targeted therapies. Molecular Profiling
leverages strategic relationships with a number of organizations, including
AmeriPath, Inc., the International Genomics Consortium (IGC), and the
Translational Genomics Research Institute (TGen). Molecular Profiling's Web
site address is molecularprofiling.



About Applied Genomics -- Applied Genomics, Inc. develops targeted
diagnostics to improve treatment for cancer patients. Translating insights
from genomic analyses of cancer, AGI creates antibody-based diagnostic
tests for classifying cancer facilitating rational patient care decisions
and improving quality of life for all patients. AGI has ongoing product
development programs in breast, lung, ovarian, head and neck, and colon
cancer. Additional company information is available at:
applied-genomics.


The Molecular Profiling Institute, Inc.

molecularprofiling

Technology May Improve Success Rates For In Vitro Fertilization Procedures

Auxogyn, Inc., a privately held medical technology company focused on women's reproductive health, has announced that it acquired an exclusive license from Stanford University to develop a set of products that may allow medical practitioners in the field of assisted reproduction to significantly improve the effectiveness of in vitro fertilization (IVF) procedures.



The technology licensed from Stanford is described in a publication titled 'Non-invasive imaging of human embryos before embryonic genome activation predicts development to the blastocyst stage,' now appearing in the online edition of Nature Biotechnology. This landmark study demonstrated, for the first time, that human embryo fate is already determined at the four-cell stage of development. The article is authored by Professor Renee Reijo Pera, Dr. Connie Wong, Dr. Kevin Loewke, Dr. Nancy Bossert, Dr. Barry Behr, Dr. Christopher De Jonge and Dr. Thomas Baer and showed that measuring a unique set of non-invasive imaging parameters by day 2 may allow an embryologist to predict the embryos that will reach the blastocyst (day 5) stage of development with a very high degree of accuracy.



"Blastocyst formation is a critical time point in human embryo development and provides more objective criteria for selecting which embryo(s) to transfer," said Lissa Goldenstein, president and chief executive officer of Auxogyn, Inc. "For years, researchers have searched for ways to predict the embryos most likely to reach the blastocyst stage in order to enable earlier transfer and ultimately improve live birth rates for in vitro fertilization procedures."



"Building on the technology licensed from Stanford, we are developing a product that assesses early embryo viability at the 4-cell stage. We believe that generating key clinical data assessments may enable embryologists to improve the effectiveness of in vitro fertilization (IVF) procedures while providing women experiencing infertility the highest quality of patient care," continued Ms. Goldenstein.



Source:

Angela Bitting

AB Corporate Communications

Female Condoms Promoted Through Beauty Salon Initiative In Malawi

The United Nations Population Fund and Population Services International have introduced a program to distribute female condoms in Malawian beauty salons in an effort to encourage their use and curb the spread of HIV, VOA News reports. Pamela Msukwa, family planning and HIV technical coordinator for PSI/Malawi, said hair salons were chosen for the program because they "provide a very viable and highly targeted market" due to their popularity with women in Malawi. She added, "That's where they get to talk about issues, and there is always somebody they can discuss issues with." A team of women associated with the organization promote and distribute the condoms, and salon staff members are trained on how to talk about the products with their customers.

Although condom use and other methods of preventing pregnancy and the spread of sexually transmitted infections have been considered the "domain of males," the beauty salon initiative is attempting to change the situation, VOA News reports. A pilot project eight years ago to encourage female condom use failed in part because of a lack of information about the condoms and stigma associated with their use, according to VOA News. Msukwa said the "main goal" of the program is to reduce the rate of new HIV cases and unplanned pregnancies and "increase the adoption of safer-sex behavior through increased and consistent use of the female condom." She added that the successes of the program so far have lead PSI/Malawi to begin to consider ways of targeting men through barber shops. According to VOA News, fifteen PSI country programs distribute female condoms worldwide and more than seven million have been sold to date (Masina, VOA News, 9/15).


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.

Asian-American Women Born In The US More Likely To Think About, Attempt Suicide

Although Asian-Americans as a group have lower rates of thinking about and attempting suicide than the national average, U.S.-born Asian-American women seem to be particularly at risk for suicidal behavior, according to new University of Washington research.



The study shows 15.93 percent of U.S.-born Asian-American women have contemplated suicide in their lifetime, exceeding national estimates of 13.5 percent for all Americans. The finding comes in a study published in the current issue of the journal Archives of Suicide Research. Lifetime estimates of suicide attempts also were higher among U.S-born Asian-American women than the general population, 6.29 percent vs. 4.6 percent.



Data from the study were drawn from the larger National Latino and Asian-American Study and were based on bilingual interviews with almost 2,100 individuals at least 18 years of age. Two-thirds were immigrants from Asia and women made up 53 percent of the respondents. Participants included 600 Chinese, 520 Vietnamese, 508 Filipinos and 467 other Asians, including Japanese, Koreans and Asian Indians.



"It is unclear why Asian-Americans who were born in the United States have higher rates of thinking about and attempting suicide," said Aileen Duldulao, a UW doctoral student in social work and lead author of the study. "There is the theory of the 'healthy immigrant' that proposes immigrants may be healthier on average than U.S-born Americans, because of the selectivity of migration or the retention of culturally-based behaviors. But it is unclear if this theory is the mechanism at work with regard to our findings."



Evidence supporting this idea was previously found among Mexican-American and Latino American immigrants. However, Duldulao said, the health of immigrants tends to decline with the number of years they spend in the U.S. and start adopting behaviors that are less healthy than those found in their homeland.



The suicide data echo a 2006 study that showed Asian immigrants to the U.S. have significantly lower rates of psychiatric disorders than American-born Asians and other native-born Americans. That study's lead author was David Takeuchi, a UW professor of social work and sociology who is also a co-author of the suicide study. Seunghye Hong, who recently earned her doctorate in social work from the UW, also contributed to the suicide study.



The new research also found that:
The percentage of Asian-Americans who reported thinking about suicide increased the longer they lived in the U.S.


Young Asian-Americans, between 18 and 34, had the highest estimates of thinking about (11.9 percent), planning (4.38 percent) and attempting suicide (3.82 percent) of any age group


Asian-Americans who were never married reported the highest lifetime estimates of thinking about (17.9 percent) planning (7.6 percent) and attempting (5 percent) suicide.


There were few major differences by ethnicity, although Chinese (10.9 percent) and Filipinos (9.76 percent) reported the highest rates of thinking about suicide.

"This study highlights the fact that we may be underserving Asian-American women born in the U.S," said Duldulao. "While there was little evidence of sociodemographic differences in suicidal behaviors among various Asian-American groups, there was some anecdotal data from people working in the community. It is important for service providers, as well as policymakers, to know that U.S.-born Asian-Americans, particularly the second generation, are at high risk for mental health problems and suicidal behavior.



"In most cultures suicide is just as unacceptable as it is here. It is pretty much a taboo. That's why this study is important and why Asian-American communities need to talk more about suicide and mental health," she said.



The researchers used a modified version of a World Health Organization questionnaire to assess whether and at what age people had suicidal thoughts, made suicide plans or attempted suicide.



The research was funded by the National Institute of Mental Health, the Office of Behavioral and Social Science Research at the National Institutes of Health, and the Substance Abuse and Mental Health Services Administration.



Source:
Joel Schwarz


University of Washington

Genetic Variant Linked To Risk Of Preterm Birth

A team of researchers have identified a genetic variant that may account for the higher rates of premature delivery experienced by African-American women compared to European-American women, according to findings to be published online this week in the Proceedings of the National Academy of Sciences.


The findings may help physicians identify patients who may benefit from therapeutic interventions and preventative measures including lifestyle change or medical therapy to reduce the risk of premature birth.


Jerome F. Strauss III, M.D., Ph.D., dean of the Virginia Commonwealth University School of Medicine, and colleagues found that a change in a single nucleotide in the gene sequence, known as a single nucleotide polymorphism (SNP), in the SERPINH1 gene may be responsible for the increased risk of preterm premature rupture of membranes (PPROM) in women of African descent. The SERPINH1 gene encodes a heat shock protein known as Hsp47, which is essential for collagen production. Collagen lends strength to the membranes that surround the fetus and amniotic fluid.


The genetic variant identified reduces the amount of Hsp47 made and thus the collagen in the membranes, making them more prone to rupture. Other published research has reported that reduced collagen content has been found in PPROM fetal membranes. PPROM is the leading identifiable cause of preterm birth and occurs more frequently in African-American women.


"Our discovery of an association between a gene variation that is more common in individuals of African descent and a cause of premature birth, can explain in part the disparity in prematurity rates in African-Americans," said Strauss, who led the study.


"More importantly, the genetic signature can help us identify women at risk of early breakage of the "bag of waters" so that appropriate monitoring and therapy can be applied in order to prevent this serious pregnancy complication."


In this study, the researchers compared amnion samples carrying the minor "T" allele to samples carrying the major "C" allele. The minor "T" allele is a genetic variant that occurs with greater frequency among those with African ancestry. A reduction in the promoter activity of the amnion cells in the minor "T" allele compared to the major "C" allele was observed. According to Strauss, as a result, women carrying the minor "T" allele may produce decreased amounts of Hsp47 protein and thus, produce reduced amounts of collagen and a weaker amnion that is more prone to rupture.


This work was supported in part by grants from the National Institute of Child Health and Human Development and the March of Dimes Foundation.


Strauss collaborated with Hongyan Wang, Samuel Parry, and George Macones, with the Center for Research on Reproduction & Women's Health at the University of Pennsylvania; Mary D. Sammel, with the Center for Clinical Epidemiology and Biostatics at the University of Pennsylvania; Helena Kuivaniemi and Gerard Tromp, with the Center for Molecular Medicine and Genetics at Wayne State University Medical Center; George Argyropoulos with the Pennington Center for Biomedical Research; Indrani Halder and Mark D. Shriver with the Department of Anthropology at Pennsylvania State University; and Roberto Romero with the Perinatology Research Branch, NICHD, at Hutzel Hospital.


About VCU and the VCU Medical Center: Located on two downtown campuses in Richmond, Va., Virginia Commonwealth University ranks among the top 100 universities in the country in sponsored research and enrolls 30,000 students in more than 180 certificate, undergraduate, graduate, professional and doctoral programs in the arts, sciences and humanities in 15 schools and one college. Sixty of the university's programs are unique in Virginia, and 20 graduate and professional programs have been ranked by U.S. News & World Report as among the best of their kind. MCV Hospitals, clinics and the health sciences schools of Virginia Commonwealth University compose the VCU Medical Center, one of the leading academic medical centers in the country. For more, see vcu.edu.


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vcu.edu/uns

Association Betgween Vitamin D Deficiency In Younger Women And Increased Risk Of High Blood Pressure In Mid-Life

Vitamin D deficiency in premenopausal women may increase the risk of developing systolic hypertension 15 years later, according to research reported at the American Heart Association's 63rd High Blood Pressure Research Conference.



Researchers examined women enrolled in the Michigan Bone Health and Metabolism Study and analyzed data from 559 Caucasian women living in Tecumseh, Mich. The ongoing study began in 1992 when the women were 24 to 44 years old with an average age of 38 years.



Researchers took blood pressure readings annually throughout the study. They measured vitamin D blood levels once in 1993, and then compared their systolic blood pressure measurements taken in 2007.



Premenopausal women who had vitamin D deficiency in 1993 had three times the risk of developing systolic hypertension 15 years later compared to those who had normal levels of vitamin D, researchers said.



"This study differs from others because we are looking over the course of 15 years, a longer follow-up than many studies," said Flojaune C. Griffin, M.P.H., co-investigator of the study and a doctoral candidate in epidemiology at the University of Michigan School of Public Health in Ann Arbor, Mich. "Our results indicate that early vitamin D deficiency may increase the long-term risk of high blood pressure in women at mid-life."



At the study onset, 2 percent of women had been diagnosed or were being treated for hypertension and an additional 4 percent of the women had undiagnosed systolic hypertension, defined as 140 millimeters of mercury (mm Hg) or more. But 15 years later, 19 percent of the women had been diagnosed or were being treated for hypertension and an additional 6 percent had undiagnosed systolic hypertension, a significant difference.



Researchers controlled for age, fat mass, anti-hypertensive medication use, and smoking.



Systolic pressure is the pressure of blood in the vessels when the heart beats.



Researchers determined vitamin D status by measuring blood concentrations of 25-hydroxyvitamin D [25(OH)D] in 1993. 25(OH)D is a prehormone in blood that is produced in the liver from the metabolism of vitamin D3 cholecalciferol. Serum 25(OH)D is the primary form that is tested when examining vitamin D deficiency because it represents vitamin D storage in the body. This assessment in the blood reflects vitamin D obtained from ultraviolet B rays through sun exposure, vitamin D from foods such as fatty fish or fortified milk products and dietary supplements. The researchers did not examine the impact of these different sources of vitamin D.



Vitamin D deficiency was defined as less than 80 nanomoles per liter (nmol/L), while normal levels were considered more than 80 nmol/L. Experts in the medical community generally agree that vitamin D deficiency among women is widespread. Some researchers report many women don't get enough sunlight exposure to help keep vitamin D levels near to normal, nor do they have diets or practice supplementation that support normal levels of vitamin D, Griffin said. Vitamin D is either synthesized in the skin through exposure to ultraviolet B rays in sunlight or ingested as dietary vitamin D.



However, Griffin said there's no general agreement about the optimal intake of vitamin D. Some researchers said the current recommended intake of 400 international units (IU) to 600 IU daily is inadequate and suggest a much higher daily intake, from 1,000 IU to 5000 IU.



Vitamin D has a well-established role in bone health. Other recent research indicates vitamin D deficiency in women may increase the risk of some cancers and have a negative impact on immune function and inflammatory diseases, she said.



"Our study highlights the importance of vitamin D in the risk of high blood pressure later in life, a major health problem in the United States," Griffin said.



Co-authors are MaryFran R. Sowers, Ph.D., who directs the Health Study, and Crystal A. Gadegbeku, M.D. Author disclosures are on the abstract P253.



The National Institute of Arthritis and Musculoskeletal and Skin Diseases funded the study.



Source:
Karen Astle


American Heart Association

Is It Really About Alcohol? The Truth About Alcohol Abuse In Women

Six million women in the U.S. abuse or are dependent on alcohol, according to the National Center on Addiction and Substance Abuse at Columbia University. Frequent binge drinking in women's colleges increased by 124 percent between 1993 and 2001. Nearly 21.6 million Americans are in need of but have not received treatment for an alcohol problem, according to the Substance Abuse and Mental Health Services Administration (SAMHSA, 2003). April is Alcohol Awareness Month, and Brookhaven Retreat, a multidisciplinary treatment facility that helps women overcome emotional trauma and addiction challenges, is working to raise awareness about the number-one drug problem in the United States: alcohol.


"Alcohol abuse is a tool women use to numb out emotional pain, often not realizing that an addiction has developed because they are doing something perceived as legal and social, and therefore okay," said Jacqueline Dawes, the owner and founder of Brookhaven Retreat. "There are millions of American women trapped by alcohol dependency who, because of fear, shame, and the whole stigma associated with alcohol abuse, feel too afraid to seek help. They need to understand that the addiction is treatable and there is hope."


The highly-trained professionals at Brookhaven Retreat strive to help women understand how their need for a numbing-out escape began. What caused them to start using alcohol as a tool to relax, sleep, and hide, when the stress and fear were mounting? And why can they not find the strength to stop?


According to Dawes, alcohol conceals the real issues these women are facing, including depression, low self-esteem, trauma, and disempowerment.


"The alcohol is the tip of the iceberg, and is only a small part of what is really going on with the person," said Dawes. "At Brookhaven, we offer no judgment. It is overwhelmingly frightening to seek treatment, but that is the first step to recovery and is undoubtedly the most crucial."


Alcohol dependency is shrouded by many myths, one of which is that a person chooses to be an alcoholic. Many times, friends and family members think the person should be able to exert self-control, when in fact, the emotional breakage existing within the person has made it unbearable for them to live without their dependency on alcohol. Dawes says that these women have formed a relationship with the alcohol that makes them feel like they need it to function in society, and that once the dependency has been established, women must undergo residential treatment in order to disengage the dependency.


Brookhaven Retreat's philosophy is that each person must receive individualized attention, administered by highly-trained staff in order to facilitate long-term recovery. This recovery grows from an introspective journey to define the emotional breakage, followed by the development of life skills that allow lasting maintenance of emotional wellness.


Realizing that you or a loved one has a drinking problem can be a challenge. The following signs may indicate alcohol abuse:



-- Feeling guilt about drinking



-- Drinking to calm nerves, forget worries or to boost a sad mood



-- Unsuccessful attempts to cut down/stop drinking



-- Lying about or hiding drinking habits



-- Feeling irritable, resentful or unreasonable



-- Causing harm to oneself or someone else as a result of drinking



-- Needing to drink increasingly greater amounts in order to achieve desired effect



-- Identifying medical, social, family or financial problems caused by drinking


About Brookhaven Retreat


Brookhaven Retreat is a unique, voluntary residential treatment facility specially designed to help women overcome emotional trauma or addiction challenges. The fully accredited and certified dual-diagnosis center is America's premier treatment center for emotional trauma and addiction and offers female-specific treatment. Located on 48 beautiful acres in the foothills of the Great Smoky Mountains, it offers modern, holistic care with compassion and respect from a highly trained expert staff of licensed therapists, physicians, registered nurses, nurse practitioners and licensed practical nurses. Visit brookhavenretreat for more information.


Brookhaven Retreat

brookhavenretreat

Approval Of Nonprescription Plan B Sales To Women Over Age 18 "Not Enough" To Reduce Need For Abortion, Opinion Piece Says

FDA's decision to approve Barr Laboratories' application for nonprescription sales of its emergency contraceptive Plan B to women ages 18 and older is "welcome news," but it will not be "enough to overcome our nation's stalled progress in reducing unintended pregnancies and the need for abortion," Sharon Camp, president and CEO of the Guttmacher Institute, writes in a Philadelphia Inquirer opinion piece. According to Camp, the latest national statistics on abortion -- which show that "a decades-long decline in the U.S. abortion rate is stalling out" -- should "make no one happy." However, there are some "easy ways to get things back on track," such as using state Medicaid waivers to expand eligibility for family planning coverage to more low-income women; allocating sufficient funding to Title X, the federal family planning program; creating better public education programs for teenagers and adults that provide medically accurate information on the safety and effectiveness of contraceptives and stress personal responsibility; and looking for "ways to make effective contraceptive use easier and less expensive" for women, according to Camp. "We know how to make abortion rates start going down again," Camp writes, concluding, "Let's stop wasting time and get on with the job" (Camp, Philadelphia Inquirer, 10/26).

"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.

Traditional Pap Test Inferior To HPV Test

Researchers at McGill University have revealed that the HPV screening test is superior to the traditional Pap test in detecting cervical cancer. Accuracy for the HPV test was 94.6%, compared to 55.4% for the Pap test, say researchers.


Dr. Marie-H?©l??ne Mayrand, Centre hospitalier de l'Universit?© de Montr?©al (CHUM), and team from McGill, Universit?© de Montr?©al, the Newfoundland and Labrador Public Health Laboratory and McMaster University, published their findings in The New England Journal of Medicine, October 18th issue.


The controlled randomized trial, called CCCast, was the first of its kind carried out in North America for HPV testing as a stand-alone screening test for cervical cancer. Initially, it involved 10,154 women during the period 2002-2005 - they were aged 30-69 years.


Although HPV tests were 40% more accurate than Pap tests, as far as the specifity scale was concerned, the Pap test faired better. Pap tests' ability to accurately detect pre-cancerous lesions without false positives was better - 96.8% compared to 94.1%.


The researchers explained "We already knew before conducting this study that the sensitivity of Pap left a lot to be desired. However, 55.4% accuracy is only slightly above chance. Flipping a coin gives you 50%."


The Pap test, which was created by Dr. Georgios Papanicolaou during the 1940s, require that cell samples are gathered from the patients cervix and examined under a microscope by technicians. This procedure has been the norm for more than half a century. The HPV test, on the other hand, although requiring cervical samples, is analyzed automatically - it detects the DNA of HPV strains which are known to cause cervical cancer.


A test's sensitivity is generally thought of as more useful than specifity. Event though a false positive is psychologically distressing, the patient is free of the disease, explain the researchers.


Even though the results of this study may have some relevance regarding the current debate about HPV vaccinations on young females, the issues should be looked at separately, say the scientists. Vaccination is all about primary prevention (screening), while this study focuses on secondary prevention, the researchers stress.


Women who receive the vaccine will still have to be screened because their vaccine only protects them against 70% of cervical cancers.


Read the article at McGill University web site

Abused women less likely to be in stable relationships

Poor women who are physically or sexually abused at some point in their lives are less likely to maintain stable intimate
relationships, according to a new study of more than 2,500 women by sociologists from The Johns Hopkins University and Penn
State University.


The women involved in the study said they want fair treatment and companionship from their partners, just like everybody
does, the researchers said. Many of those who had been abused as adults told ethnographers that they had decided to forego
marriage and cohabiting relationships, at least temporarily. Those who were sexually abused in childhood were not as likely
to avoid relationships altogether; rather, they tended to engage in a series of short-term, transient relationships, many of
them abusive.


While there is no evidence that abuse rates have increased, the number of women postponing intimate relationships may be
growing, said Andrew Cherlin, the Griswold Professor of Public Policy at Johns Hopkins and lead author of the report, "The
Influence of Physical and Sexual Abuse on Marriage and Cohabitation," to be published in the Jan. 21 issue of American
Sociological Review.


"What's changed over the past few decades is the social context of abuse," Cherlin said. "Women don't have to stay with
abusive men anymore because they have alternatives to marriage."


The researchers, working in Boston, Chicago and San Antonio as part of the long-term research project called "Welfare,
Children and Families: A Three-City Study," surveyed a random sample of 2,402 Hispanic, African American, and white women.
Ethnographic research teams studied another 256 women in depth for several years, observing day-to-day activities and
conducting repeated interviews. All of the women studied were the primary caregivers of at least one child.


Fifty-two percent of women in the random-sample survey reported being physically or sexually abused at some point during
their lives. Twenty-four percent said they were sexually abused during childhood or adolescence. Forty-two percent of women
who had never been abused were married at the time of the survey, compared to 22 percent of women who had ever been abused.
Of the 256 women studied in depth, one-sixth -- many of whom had been physically abused as adults -- said they were taking a
timeout from intimate relationships with men.


"Women's decision to take a timeout from such relationships is an important one for policymakers to understand," said
co-author Linda Burton, director of the ethnographic component and Penn State professor of human development and sociology.
"These women are not saying they will never enter intimate relationships again, but, rather, they need recovery and
reflection time from abuse they experienced as adults to avoid entering a subsequent abusive relationship."


Cherlin and Burton suggest that reducing levels of sexual abuse and physical violence in families could increase the number
of healthy, stable, long-term unions. They argue that current marriage promotion policy debates at the federal and state
levels, which tend to blame declining cultural values or unemployment for lower marriage rates among the poor, should also
focus on the consequences of abuse.


Other authors are: Tera Hurt, University of Georgia; and Diane Purvin, Wellesley College.


Funding support came from National Institute of Child Health and Human Development, Office of the Assistant Secretary for
Planning and Evaluation, Administration on Developmental Disabilities, Administration for Children and Families, Social
Security Administration, National Institute of Mental Health, The Boston Foundation, The Annie E. Casey Foundation, The Edna
McConnell Clark Foundation, The Lloyd A. Fry Foundation, Hogg Foundation for Mental Health, The Robert Wood Johnson
Foundation, The Joyce Foundation, The Henry J. Kaiser Family Foundation, W. K. Kellogg Foundation, Kronkosky Charitable
Foundation, The John D. and Catherine T. MacArthur Foundation, Charles Stewart Mott Foundation, The David and Lucile Packard
Foundation, and Woods Fund of Chicago.


To speak with Andrew Cherlin, contact Amy Cowles at 443-287-9960. To speak with Linda Burton, contact Vicki Fong at
vfongpsu.edu or 814-865-9481. For a copy of the report, e-mail amycowlesjhu.edu.

Johns Hopkins University

Internet Kiosks Help Reduce Infant Mortality Rates

A new study by a researcher at the University of Arkansas shows that Internet kiosks providing information on prenatal and postnatal care for mother and baby have helped reduce infant, child and maternal mortality rates in rural India. Contrary to traditional assumptions about the positive effects of social networks, the study's findings demonstrated that strong social ties in rural villages did not help women seek and obtain appropriate medical care.


"Based on our knowledge of religious beliefs and various customs within rural Indian culture, as well as the basic tendency of people to associate and bond with others similar to themselves, we hypothesized that strong network ties would be detrimental to women seeking good information about health care," said Viswanath Venkatesh, professor in the Sam M. Walton College of Business. "The results of this study provided evidence that this was indeed the case. Women with strong network ties seemed to be influenced by strong pressure not to change traditional practices and customs."


Although in recent years India has experienced a growing economy and burgeoning middle class in primarily urban centers, most people in rural areas live in extreme poverty. For example, according to a recent study that used a multidimensional poverty index, eight Indian states are worse off than people in sub-Saharan Africa. As part of this problem, India has high infant mortality rates - approximately 55 per 1,000 live births - and child mortality rates - 78 per 1,000 live births. In response to this problem, several private organizations have installed Internet kiosks to provide valuable information about prenatal and postnatal care for mother and baby. The kiosks are public Internet stations, similar to those found in a library or caf?©, where rural Indians can gain access to the World Wide Web.


In direct connection to a United Nations Millennium Development Goal to reduce infant, child and maternal mortality rates in underdeveloped areas, Venkatesh examined the impact of the Internet kiosks. He wanted to know if the kiosks had contributed to systematic benefits related to reducing infant, child and maternal deaths, and if so, who was most likely to benefit.


Venkatesh and former doctoral student Tracy Sykes, now assistant professor at the Australian National University, conducted a five-year study of women in 20 rural villages, 10 with Internet kiosks and 10 with no such intervention. They used surveys and health records from government archives to gather data. A general survey was taken at the deployment of each kiosk. In each village, approximately 300 women participated.


From 2004 to 2009, infant and child mortality rates in both groups decreased, but overall the intervention group - those villages with Internet kiosks - experienced a more rapid decline. In 2004, the year the Internet kiosks were installed, overall mortality rates were approximately the same number - 68 per 1,000 live births. Below are results from an equally weighted index of infant, child and maternal mortalities over the five-year period:


Control group Intervention group


2004 68.4 68.5

2005 66.2 65.1

2006 64.1 61.8

2007 61.8 56.4

2008 59.4 52.2

2009 57.3 49.1


The percentage of women using the kiosks was low, only 4.8 percent in 2004 and rising steadily each year to 8.8 percent in 2009. Venkatesh said this information was valuable because it showed that the transfer of information about health issues depended not only on the kiosk but also on women's ties to other women who had used them.


Venkatesh and Sykes then tested the classic social network hypothesis, which argues that strong ties among community members result in positive social benefits. In this case, they found the opposite, that strong community ties among women in the villages were associated with negative effects on them seeking health information and medical care. They found positive effects - access to health information and medical care - for women with weak community ties.


"Mortality rates in rural India have shown a steady decline, which is great," Venkatesh said. "But it's important to dig a little deeper and find out why. We have empirical evidence of the positive impact of Internet kiosks and, perhaps counterintuitively, both the detrimental effects of a strong social network and positive effects of a weak network."


Venkatesh presented these results to a United Nations panel of experts on gender, science and technology. At a conference in Paris, the group explored gender dimensions of science and technology and identified policies and programs to accelerate progress toward Millennium Development Goals.


Venkatesh holds the George and Boyce Billingsley Chair in Information Systems.


Source:
University of Arkansas, Fayetteville

Researchers Discover New Way Men Can Transmit HIV To Women

Researchers at Northwestern University have discovered a critical new way a man can transmit the HIV virus to a woman.



Scientists had long believed that the normal lining of the female vaginal tract was an effective barrier to invasion of the HIV virus during sexual intercourse. They thought the large HIV virus couldn't penetrate the tissue.



But new research from Northwestern University's Feinberg School of Medicine has shown for the first time that the HIV virus does indeed penetrate a woman's normal, healthy genital tissue to a depth were it can gain access to its immune cell targets.



"This is an unexpected and important result," said Thomas Hope, principle investigator and professor of cell and molecular biology at the Feinberg School. "We have a new understanding of how HIV can invade the female vaginal tract."



"Until now, science has really had no idea about the details of how sexual transmission of HIV actually works," Hope added. "The mechanism was all very murky."



Hope, his Northwestern colleagues, and collaborators at Tulane University discovered that interior vaginal skin is vulnerable to HIV invasion at the level where it naturally sheds and replaces skin cells, a point where the cells are not as tightly bound together. He will present his findings December 16 at the American Society for Cell Biology 48th annual meeting in San Francisco.



Women and female adolescents now account for 26 percent of all new HIV cases in the U.S., according to the Centers for Disease Control. Based on its most recent analysis of 2005 data, the CDC estimated that there were 56,300 new HIV infections that year and traced 31 percent of the total to high-risk heterosexual contact. More than half of the new cases of HIV infection worldwide are in women.



Hope said he hopes his findings, if confirmed by future studies, will provide information to help develop microbicides and vaccines to protect against HIV.



"We urgently need new prevention strategies or therapeutics to block the entry of HIV through a woman's genital skin," Hope said. While condoms are 100% effective in blocking the virus, "people don't always use them for cultural and other reasons," he noted.



By labeling the HIV viruses with photo-activated fluorescent tags, Northwestern researchers were able to view the virus as it penetrated the outermost lining of the female genital tract, called the squamous epithelium, in female human tissue obtained from a hysterectomy and in animal models.



Researchers found that HIV penetrated the genital skin barrier primarily by moving quickly -- in just four hours -- between skin cells to reach 50 microns beneath the skin, a depth similar to the width of a human hair. This is the depth at which some of the immune cells targeted by HIV are located.



HIV penetration was more common in the outermost superficial layers of skin and likely occurred during the normal turnover and shedding of skin cells. In the shedding process, the skin cells are no longer as tightly bound together so water -- and HIV -- can easily enter.
















"As pieces of the skin flake off, that's the loose point in the system where the virus can get in," Hope said.



Previously, scientists thought that the HIV virus invaded a woman's immune system through the single layer of skin cells that line her cervical canal. "That was always thought to be the weak point in the system," Hope said.



However, a previous trial in Africa in which women used a diaphragm to block the cervix did not reduce transmission. Nor are women who have had hysterectomies less vulnerable to contracting HIV through sex.



Hope said researchers had also believed the only way HIV could enter the vaginal tract was if a woman had an open lesion on her skin, for example caused by the herpes virus. When breaks are present in the skin it should be easier for HIV to enter the skin and bind to and infect immune cells. But in studies where women were given anti-herpes drugs to decrease their lesions, there was no decrease in transmission. In light of the new results, it is possible that HIV can enter the vaginal tissue and initiate infection without any physical breaks.



"A big mistake in this field is the idea that transmission only takes place one way," Hope said. "Our perspective is the viruses can infect people in more than one way. We say one of those ways that needs to be in the equation is that the virus can be transmitted directly through the skin."



The next step will be to prove that the virus actually infects the immune cells in the vaginal tract. "A key experiment in the future is to identify the first cells to get infected in the epithelium, which is not necessarily where people would have looked for them before," Hope said.



Source:

Marla Paul

Northwestern University

FDA Approves New Indication For Mirena(R) To Treat Heavy Menstrual Bleeding In IUD Users

Bayer HealthCare Pharmaceuticals, Inc., announced that the U.S. Food and Drug Administration (FDA) approved a new indication for Mirena® (levonorgestrel-releasing intrauterine system) for the treatment of heavy menstrual bleeding in women who choose to use intrauterine contraception as their method of contraception. Mirena provides an effective, non-surgical option for the treatment of heavy menstrual bleeding and is the first and only contraceptive approved in the U.S. for this indication.


Heavy menstrual bleeding is a problem that affects between nine and 14 percent of otherwise healthy women(1) and is a common reason a woman sees her doctor. Heavy menstrual bleeding is defined as menstrual cycles with 5 tablespoons or more of blood loss (> 80 mL). Signs of heavy menstrual bleeding include:



-- the need to use double sanitary protection to control the heavy flow



-- menstrual flow that soaks through one or more sanitary pads or tampons every hour



-- the need to change sanitary protection during the night(2)


"Many women with heavy periods often suffer privately with their symptoms. And because approved effective non-surgical treatment options are limited, women who do seek treatment for heavy periods often face the choice of having surgical procedures, such as hysterectomies" said Dr. Andrew Kaunitz, M.D., FACOG, Professor and Associate Chairman, Department of Obstetrics and Gynecology, University of Florida College of Medicine-Jacksonville. "In a clinical trial, nearly nine out of 10 women were treated successfully for heavy menstrual bleeding with Mirena -- meaning it reduced monthly blood loss by more than 50 percent from baseline and to below 80 milliliters. This makes it an effective, nonsurgical first-line option."


"Mirena has a proven track-record as an effective contraceptive that lasts for up to five years. We are pleased to now also offer Mirena as a treatment option for women with heavy menstrual bleeding who choose to use an IUD for contraception," said Stefan Oelrich, Vice President and General Manager, Women's Health Care, Bayer HealthCare Pharmaceuticals. "Today's announcement demonstrates our continuing efforts to improve women's health."


Only a woman and her healthcare provider can decide if Mirena is right for her. Mirena is recommended for women who have had a child. Mirena should not be used by a woman who has a pelvic infection, gets infections easily or has certain cancers. Less than 1% of users get a serious infection called pelvic inflammatory disease. A woman should talk to her healthcare provider about problems related to this condition. Mirena may attach to or go through the wall of the uterus and cause other problems. If Mirena comes out, a woman should use back-up birth control and call her healthcare provider. In the uncommon event a woman gets pregnant while using Mirena, she should seek emergency care because pregnancy with an intrauterine device may result in loss of pregnancy or loss of fertility. Pelvic and/or abdominal pain may occur. If persistent, women should talk to their healthcare provider. Ovarian cysts may occur and usually disappear. Bleeding and spotting may increase in the first few months and continue to be irregular. Periods may become shorter, lighter or even stop. Mirena does not protect against HIV or STDs.















About the Heavy Menstrual Bleeding Study


FDA approval is based on data from a randomized, open-label, active-control, parallel-group clinical trial of 160 healthy women of reproductive age who had confirmed heavy menstrual bleeding and did not have any medical conditions known to cause HMB, with the exception of small uterine fibroids in some patients. Heavy menstrual bleeding, defined as menstrual blood loss (MBL) of greater than or equal to 80 mL, was determined using the alkaline hematin method. In the study, Mirena (n=79) was compared to an approved first-line hormonal therapy, medroxyprogesterone acetate (n=81), over six menstrual cycles. Successful treatment was defined when two outcomes were met: 1) a proportion of subjects with end-of-study MBL < 80 mL and 2) a greater than or equal to 50% decrease in MBL from baseline to end-of-study. Mirena demonstrated a significantly superior reduction in MBL. Additionally, a greater number of women in the Mirena arm achieved successful treatment vs. those in the medroxyprogesterone acetate arm (85% vs. 22%: respectively, p= 5 mL). The most common reported adverse events for Mirena in the study were uterine bleeding/spotting at irregular intervals, headache, ovarian cysts, vaginitis, pain during menstruation (dysmenorrhea), pelvic pain, and breast tenderness.


About Mirena


Mirena (levonorgestrel-releasing intrauterine system) is a removable intrauterine contraceptive that delivers small amounts of hormone directly to the uterus. It is among the most efficacious forms of birth control and works for up to five years. Mirena received FDA approval for the prevention of pregnancy in December 2000. It is currently used by approximately two million women in the U.S. and has been used by more than 15 million women worldwide.(3)


About Bayer HealthCare Pharmaceuticals Inc.


Bayer HealthCare Pharmaceuticals Inc. is the U.S.-based pharmaceuticals operation of Bayer HealthCare LLC, a division of Bayer AG. One of the world's leading, innovative companies in the healthcare and medical products industry, Bayer HealthCare combines the global activities of the Animal Health, Consumer Care, Diabetes Care, and Pharmaceuticals divisions. In the United States, Bayer HealthCare Pharmaceuticals comprises the following business units: Women's Healthcare, Diagnostic Imaging, General Medicine, Hematology/Neurology, and Oncology. The company's aim is to discover and manufacture products that will improve human health worldwide by diagnosing, preventing and treating diseases.


This news release may contain forward-looking statements based on current assumptions and forecasts made by Bayer Group or subgroup management. Various known and unknown risks, uncertainties and other factors could lead to material differences between the actual future results, financial situation, development or performance of the company and the estimates given here. These factors include those discussed in Bayer's public reports which are available on the Bayer website at www.bayer. The company assumes no liability whatsoever to update these forward-looking statements or to conform them to future events or developments.


BAYER, the Bayer Cross, and Mirena are registered trademarks of Bayer HealthCare Pharmaceuticals.


References


(1) van Eijkeren MA, Christiaens GC, Sixma JJ, Haspels AA. Menorrhagia: A review. Obstet Gynecol Surv 1989; 44:421.


(2) Mayo Clinic


(3) Bayer: data on file.


Source: Bayer HealthCare Pharmaceuticals


View drug information on Mirena.

Promising New Research Offers Hope To Female Cancer Patients At Risk Of Infertility

A promising new therapy for protecting the fertility of women with cancer and auto-immune diseases such as lupus was revealed at the 23rd annual conference of the European Society of Human Reproduction and Embryology. Dr. Kate Stern, Research Director of the Royal Women's Hospital, Melbourne, Australia, told the conference that her pilot study had shown gonadotropin-releasing hormone (GnRH) antagonists were likely to be able to protect the ovary in women receiving potentially toxic doses of chemotherapy. "We are now hoping to carry out a randomised controlled trial to assess the long term protective effect of this treatment", she said



GnRH analogues are commonly used in the management of women's disorders that are dependent on oestrogen production, and in IVF therapies. Dr. Stern and her team studied women between the ages of 18 and 35 years who were due to receive high doses of cyclophosphamide, a chemotherapy drug. They knew that GnHR analogues were already used for the temporary suppression of ovulation in infertility treatment, so reasoned that it would be possible to use it to shut down the ovaries temporarily during the time that chemotherapy was administered, and hence protect them from the effect of the drugs.



The women were given the GnRH antagonist cetrorelix by 3 subcutaneous injections, each of them four days apart, concurrently with their chemotherapy. The scientists observed that there was evidence that ovarian function was suppressed, but that this returned to normal after chemotherapy stopped. Follicle stimulating hormone levels were up in 73% of the patients, but these also subsequently returned to normal. 94% of the patients resumed spontaneous ovulation and menses within 12 months.



"We believe that using GnRH antagonists in this way could reduce the side effects of chemotherapy over a long period", said Dr. Stern. "Other studies have tried to analyse whether similar treatments work, but the medications used have been long-acting and therefore cause shutdown for the whole time the patient is in chemo. This means that patients get unpleasant side effects related to having low oestrogen levels, such as hot flushes, and can also lead to loss of bone mass."



The side effects associated with the cyclical use of GnRH antagonists were minimal, she said. "19% of patients did not experience any at all, and only 6% reported persistent side effects, none of which were dangerous or serious."



Dr. Stern and her team are currently completing a five year follow up of the pilot study. "We are optimistic that this will prove to be an effective way of protecting fertility for women without the problems that have been associated with GnRH agonists in the past", she said. "The medical community needs to acknowledge the importance of future fertility for young people having cancer treatment. Not all patients who are having cancer treatment have the opportunity to talk with a fertility specialist before beginning treatment, and yet there are already several options for protecting the ovaries and even preserving eggs, embryos, or ovarian tissue. In addition to raising awareness among the medical profession, more support is needed for research in this important area."





Source: Mary Rice


European Society for Human Reproduction and Embryology

New Emergency Contraceptive 'Ella' Expected To Reach Market By End Of Year

A recently approved emergency contraceptive that is effective for up to five days after sex is likely to be on the market by the end of the year, according to the drug's manufacturer, Watson Pharmaceuticals, USA Today reports. The drug, to be marketed under the name ella, contains a compound called ulipristal. Existing EC products -- including Teva Pharmaceutical's Plan B One-Step and the generic EC, Next Choice -- contain levonorgestrol.

According to USA Today, there are two main differences between ella and other EC products. Ella, which FDA approved in August, will be available by prescription only, whereas the levonorgestrol products are available without a prescription for women ages 17 and older. The other major difference is that the existing dedicated EC products only are effective at preventing pregnancy for up to 72 hours after sex.

It remains to be seen whether more EC choices will help reduce the roughly 50% of pregnancies that are unintended in the U.S., USA Today reports. However, in a letter to FDA in June, a coalition of 20 women's health groups -- including the American College of Obstetricians and Gynecologists -- wrote, "We do not believe technology holds all the answers, but having two types of safe and effective [EC] will increase the likelihood that a woman can access a product that works for her situation."

James Trussell, head of Princeton University's Office of Population Research, said that women's health advocates "can't depend on doctors to spread the word about" EC, adding, "My suspicion is it's fallen off the radar for many because they know that women are going directly to the pharmacist for it."

According to Watson spokesperson Charlie Mayr, "one of the problems is that a lot of women don't know that emergency contraceptives exist" (Rubin, USA Today, 9/28).


Reprinted with kind permission from nationalpartnership. You can view the entire Daily Women's Health Policy Report, search the archives, or sign up for email delivery here. The Daily Women's Health Policy Report is a free service of the National Partnership for Women & Families.


© 2010 National Partnership for Women & Families. All rights reserved.

View drug information on ella.

In Pediatric Cardiology Parents Are The Unsung Heroes

It's a parents worst nightmare, a newborn baby going under the knife to repair a heart defect. If the baby survives, that's when the real work begins for parents. University of Alberta nursing professor Gwen Rempel has seen hundreds of babies on the brink as a former pediatric cardiology nurse; she wanted to find out just what parents go through.



"I'm not 100 per cent convinced that health-care professionals get what these parents are doing," said Rempel. "I think [pediatric cardiology nurses] really pleased to offer what we offer and we're proud of ourselves that these kids are now surviving."



Rempel interviewed parents from across Western Canada, talking to both mothers and fathers about their day-to-day life with a child growing up with a congenital heart defect.



"These parents are extraordinary in what they're doing. Not just what they're doing for their child, but what they're doing to take care of themselves," said Rempel.



In these families, it's all about teamwork. Common public perception is that mothers do most of the work with newborns, but in these families fathers know just as much about their baby. The study found that some of the things both the mothers and the fathers were doing included calculating how much formula the baby needed, feeding the baby and monitoring both the baby's weight and oxygen levels.



"I was very struck by how these couples work together," said Rempel. "I'm continually struck by that. It's stressful because one parent might be in the hospital all the time, and one's at home trying to keep things spinning," she said. "They really do have to make an effort to keep on the same page."



The study also found that the parents in the study have a great support network. "These parents were never alone and it's family that's with them. It's amazing the amount of time grandparents will spend at hospitals, as well as aunts and uncles."



That's exactly what these parents need, says Rempel. For these kids to survive, the parents need to look after themselves.



"The parents are the ones safeguarding the child's survival. So if the parents are doing okay, there's a better chance the child's going to be okay."



But the parents' ability to succeed starts with asking for help. Rempel says a lot of these parents are just happy their child survived and don't want to ask for anything more. She suggests that health-care professionals need to be stepping up for these families.



"Can we teach them to ask for help? They're already doing what they do really well," she said. "We need to be more pro-active so that they can do even better."







Source: Quinn Phillips


University of Alberta

First Babies Born Following Genetic Screening Study

Two women taking part in the world's first controlled study of a comprehensive genetic screening test before IVF have given birth to healthy babies. The babies, twin girls born in Germany in June and a singleton boy born in Italy in September, are the first deliveries in a pilot study of comparative genomic hybridisation (CGH) by microarray, a new method of screening oocytes for IVF for a full range of chromosomal disorders.



Dr Cristina Magli, embryologist at the SISMER Centre in Bologna, one of the two centres taking part in the trial, said: " All the babies and their mothers are doing very well in terms of weight and overall developmental performance."



The births, as well as several ongoing pregnancies in the study group, are the final stage in the "proof of principle" that the screening of oocytes and embryos before transfer in IVF can increase birth rates; both these pregnancies were derived from oocytes whose complete chromosomal status had been assessed by microarray CGH.



The study, which was conducted in Bologna, Italy, and Bonn, Germany, was designed and organised by a task force of ESHRE to determine the clinical value of CGH as a non-subjective means of genetic screening before embryo transfer.



"We have learnt from more than 30 years of IVF that many of the embryos we transfer have chromosome abnormalities," explains ESHRE's chairman Luca Gianaroli. "Indeed, it's still the case that two out of every three embryos we transfer fail to implant as a pregnancy, many of them because of these abnormalities.



"The whole world of IVF has been trying to find an effective way of screening for these abnormalities for more than a decade, but results so far have been disappointing with the technology available. Now we have a new technology in array CGH and our hopes are that this will finally provide a reliable means of assessing the chromosomal status of the embryos we transfer."



The microarray CGH technique as evaluated in the ESHRE study has several advantages over other methods:
CGH tests all 23 pairs of chromosomes in a cell, and not just a limited number (as in former methods)
The cell tested (known as the polar body) is taken from an oocyte at fertilisation, and so does not require biopsy of a cell from a developing embryo for its analysis
Earlier chromosome tests were on cells biopsied from growing embryos and did not necessarily reflect the total status of the embryo (because of chromosome "mosaicism"); polar body analysis removes this potential problem
Other CGH tests on biopsies from five-day-old embryos require several days to deliver complete results - and thus require the freeze-storage of the embryo before it can be transferred; polar body CGH can be done in real time and does not require freezing

At the everyday clinical level, polar body CGH is likely to have two more important consequences: first, because the analysis is performed on oocytes and not on embryos, countries like Germany which outlaw embryo analysis and freezing will now have at their disposal a reliable method of preimplantation genetic screening; and second, because the chromosomal status of the transferred embryo can be accurately predicted (with no more than a 10 per cent error rate as found in the ESHRE study), the reduction of multiple pregnancies in IVF by single embryo transfer will become more attractive.



In the short term, the IVF patients most likely to benefit from preimplantation screening by polar body CGH are those of an older maternal age (over 37 years), those with a record of unsuccessful IVF, and those with a history of miscarriage; all these conditions are associated with a higher than average rate of embryonic chromosomal abnormality.



"The study has already caused huge interest in the scientific and clinical community," says Dr Magli, "and we are very proud to announce these results. It is the first time that a scientific society like ESHRE has organised a study to determine the clinical value of a technique which could prove a revolution in IVF."



The next step for ESHRE will be to upgrade the pilot study into a large-scale international clinical trial, which is planned to start in 2011.



Source:

Hanna Hanssen


European Society of Human Reproduction and Embryology

Contralateral Prophylactic Mastectomy Associated With Survival In Select Group Of Breast Cancer Patients

Contralateral prophylactic mastectomy (CPM), a preventive procedure to remove the unaffected breast in patients with disease in one breast, may only offer a survival benefit to breast cancer patients age 50 and younger, who have early-stage disease and are estrogen receptor (ER) negative, according to researchers at The University of Texas M. D. Anderson Cancer Center.


Published online in the Journal of the National Cancer Institute, it's the first population-based study to find an association between the procedure and survival in any group of breast cancer patients. The findings should offer evidence to both the women making this often agonizing decision and the physicians responsible for their care.


According to Isabelle Bedrosian, M.D., assistant professor in M. D. Anderson's Department of Surgical Oncology, a growing number of breast cancer patients are opting for the procedure; recent statistics have shown that the rate of CPM in women with stage I-III breast cancer increased by 150 percent from 1998 to 2003 in the United States.


"In our clinic, we've seen a dramatic increase in the number of women requesting CPM, and across the breast cancer community, studies have shown that the utilization of the procedure is skyrocketing," said Bedrosian, the study's co-corresponding author. "Until now, we've counseled these patients on a very important, personal decision in a vacuum. With our study, our goal was to understand the implications of the surgery and who may benefit."


For the retrospective, population-based study, the researchers used the National Cancer Institute's Surveillance, Epidemiology and End Results (SEER) registry, the premier population-based cancer registry now representing 26 percent of the country's population, to identify 107,106 breast cancer patients who underwent a mastectomy for treatment, as well as a subset of 8,902 women who had CPM. All of the women were treated for stages I - III breast cancer between 1998 and 2003. Patients were stratified for ER status, stage of disease and age. Breast cancer-specific survival served as the study's primary endpoint.


Rigorous analysis was paramount in the design of the study, said George J. Chang, M.D., assistant professor in M. D. Anderson's Department of Surgical Oncology.


"It was important to take a critical eye and look at all the different ways the data could be misinterpreted to ensure that biases were not impacting our findings," said Chang, the study's co-corresponding author. "Using multi-variable analysis as well as risk stratification, we did our analysis in many different ways - through SEER, comparing the survival of these patients to that of the general population, as well as examining non-cancer related versus cancer-specific survival. All alternative analyses resulted in the same conclusion; we found one group for whom this surgery offers a true survival benefit."















The researchers found a clear survival benefit for a select group of women that represents less than 10 percent of the breast cancer population. Those younger than age 50 with stage I or II cancer with ER negative disease had a survival benefit of 4.8 percent at five years. However, both Bedrosian and Chang expect that future research will show increased survival benefit with longer follow-up in the population, as a patient's likelihood of getting a second breast cancer increases with time.


While the findings should serve as a guideline for breast cancer patients and their physicians to have an informed, medically-based discussion about CPM, they do not determine that CPM is medically inappropriate for all others with the disease, said the researchers.


"Our research found that breast cancer patients over the age of 60 can be reassured that they will not benefit from CPM," said Bedrosian. "However, there are other populations - such as women between the age of 50 and 60 - where the findings about the procedure remain less clear. In addition, for young women with early stage, estrogen receptive positive breast cancer who receive Tamoxifen for only five years, we really do not know whether they would derive a life-long protective effective from a second breast cancer event. Therefore, for some additional breast cancer patients, CPM may very well be a medically-appropriate option."


In addition, the researchers note, the study captured neither family history nor BRCA status; it also did not include DCIS, or stage 0 breast cancer patients.


In addition to Bedrosian and Chang, Chung Yuan Hu in the Department of Surgical Oncology, also authored the all-M. D. Anderson study.


About M. D. Anderson


The University of Texas M. D. Anderson Cancer Center in Houston ranks as one of the world's most respected centers focused on cancer patient care, research, education and prevention. M. D. Anderson is one of only 39 Comprehensive Cancer Centers designated by the National Cancer Institute. For six of the past eight years, M. D. Anderson has ranked No. 1 in cancer care in "America's Best Hospitals," a survey published annually in U.S. News and World Report.


Source: University of Texas M. D. Anderson Cancer Center

Violence Against Women: Stories You Rarely Hear About

Every day, women all over the world are abducted into forced marriage; subjected to harmful traditional practices; married, while still children, to far older men; and injured through gang rape and rape with foreign objects - usually during conflict. In Guatemala, the death toll of murdered and mutilated women has already reached more than 500 for this year alone and has climbed steadily during the last five years. In 2005, 665 women were found murdered, compared to 494 in 2004. For a small country of 12 millions, these numbers are alarming and by far surpass those of the better-known homicides of young women in Ciudad Juarez, Mexico.



Every year, the plight of these women is too often ignored, consigned to the back pages of newspapers or relegated to no more than a passing mention in mainstream broadcast media-if at all.



To kick off the annual 16 Days of Activism Against Gender-Based Violence, UNFPA, the United Nations Population Fund, is highlighting five under-reported stories relating to gender-based violence for 2006.



These stories are as hidden as they are diverse. They include:



The rising tide of 'bridenapping'-the abduction, rape and forced marriage of young women throughout Central Asia;



Breast-ironing, a traditional practice in a number of West African countries that involves crushing the breasts of young girls in order to deter male attention;



The epidemic of traumatic fistula in Africa, which is caused by gang rape and often the forced insertion of foreign objects into the rape victim. This results in the tearing of the delicate tissues separating the birth canal from the bowel and/or the bladder. Seriously injured and psychologically traumatized, the victim is left incontinent, leaking faeces, urine, or both. Too often, her family and community rejects her, to live out the remainder of her life as a pariah - doubly stigmatized - both by the rape itself and its terrible consequences.



The ongoing femicide of women in the Central American country of Guatemala. Unlike the killings of young women in Ciudad Juarez, on the El Paso/Mexico border, the wholesale murder and mutilation of Guatemala's women continues to be enacted under a cloak of media silence and official neglect.



Child marriage - the forced marriage of girl children - most often against their will, to (usually) older men. Most of these marriages take place in the world's poorest nations and mean girls are unable to complete their education; are at greater risk of being exploited, of contracting sexually transmitted infections, including HIV, and of dying or being injured in childbirth owing to the fact that their bodies are too immature to withstand the rigours of birth.



To learn more about five under reported stories on gender-based violence, please visit unfpa.







The United Nations Population Fund is an international development agency that promotes the right of every woman, man and child to enjoy a life of health and equal opportunity. UNFPA supports countries in using population data for policies and programmes to reduce poverty and to ensure that every pregnancy is wanted, every birth is safe, every young person is free of HIV/AIDS, and every girl and woman is treated with dignity and respect.



For more information please go to:
The United Nations Population Fund

ASPS Studies Re-Evaluate Psychological Benefits And Health Concerns Of Silicone Breast Implants

Plastic surgeons are re-evaluating past scientific findings and developing new knowledge about the effects of silicone breast implants. A recent supplement to Plastic and Reconstructive Surgery® (PRS), the official medical journal of the American Society of Plastic Surgeons (ASPS), sheds new light on the psychological impact and health concerns of silicone breast implants.


Body Image


One review of important recent studies refuted a common perception - women who want breast augmentation do not suffer from lower overall body image than other women.


"Breast augmentation patients do not have a poorer overall self-image, nor are they more self-critical and preoccupied with their appearance than other women," said Mary McGrath, MD, ASPS Member Surgeon and study author. "It appears it is their significant dissatisfaction with their breasts that serves as the motivation for surgery, not a poor overall body image."


The positive effect of breast augmentation on women's thoughts and feelings is also limited to their breasts. After surgery, they report being less embarrassed about their breasts and spending less time feeling upset about and camouflaging their breasts.


Cancer Risk


While some studies have raised concerns about the potential link between silicone breast implants and breast cancer, others have suggested the implants could cause other types of cancer (cervical, vulvar, lung, etc). A National Cancer Institute (NCI) review of past epidemiologic studies showed little support for an increased risk of cancer among breast implant patients.


"At present, there is no convincing evidence that breast implants alter the risk of cancer," said Louise Brinton, Ph.D., NCI, and study author. "The few increases in risk that have been noted in studies appear to be largely attributable to lifestyle characteristics of the women, such as smoking, rather than the implants."


Effect on Breast-feeding


Despite the overwhelming advantages of breast-feeding, some women with silicone breast implants may fear silicone could be passed on to their child, possibly affecting growth and development. However, according to a study, that measured silicon as an indicator of silicone, the levels of silicon found in lactating mothers with implants, as compared to lactating mothers without implants, was not significantly different.


"Our findings suggest there is no difference in silicone levels in the breast milk of women with silicone breast implants than in the breast milk of women without implants," said John Semple, MD, ASPS Member Surgeon and study author.


More than 329,000 breast augmentations were performed in 2006, according to the ASPS. For the first time since ASPS began collecting statistics in 1992, breast augmentation was the top cosmetic surgical procedure performed.


Visit plasticsurgery for referrals to ASPS Member Surgeons and to learn more about cosmetic and reconstructive plastic surgery.


The American Society of Plastic Surgeons is the largest organization of board-certified plastic surgeons in the world. With more than 6,000 members, the Society is recognized as a leading authority and information source on cosmetic and reconstructive plastic surgery. ASPS comprises more than 90 percent of all board-certified plastic surgeons in the United States. Founded in 1931, the Society represents physicians certified by The American Board of Plastic Surgery or The Royal College of Physicians and Surgeons of Canada.

American Society of Plastic Surgeons

Population-Based Breast-Cancer Screening Not Best Use Of Limited Health-Care Resources In Low And Middle-Income Countries

There is increasing pressure from national and international advocacy groups on low-income and middle-income countries (LMICs) to implement population-based mammography screening. But according to a Personal View published Online First in The Lancet Oncology, this "one-size-fits-all" approach although proven to be effective in high-income countries would be impractical in most LMCs and an ineffective use of limited health-care resources. A better solution might be to raise awareness and encourage more women with breast symptoms to seek and receive timely treatment.


Globally, breast cancer is the most common female cancer accounting for an estimated 1.4 million cases each year, with more than half of the 400 000 breast-cancer deaths occurring in LMICs. Breast-cancer screening programmes are regularly used in high-income countries where the incidence of breast cancer is highest. However, the value and practicality of such screening programmes in LMICs is less clear. Women in LMICs have a lower risk of breast cancer but tend to be diagnosed at a later stage when curative treatments are less likely to work.


Because rates of breast cancer are generally lower in LMICs, screening programmes aimed at early detection in women without symptoms would have a lower yield and substantially more women would have to be screened to find a case of breast cancer, explains Joe Harford from The National Cancer Institute, Bethesda, USA.


Indeed, he adds, for screening to be effective a high level of compliance is necessary, not only with initial screening but also with treatment in those found to have breast cancer.


The WHO suggests that participation of at least 70% is needed for screening to substantially reduce the number of deaths. But evidence from LMICs suggests this might be difficult. For example, a screening trial involving clinical breast exam in the Philippines was stopped because of the reluctance of women to participate in follow-up and obtain a definitive diagnosis and treatment. Additionally, in the first attempt at screening mammography in Egypt, 2.1% of women were recalled, but more than half were lost to follow up.


In many LMICs the cost of setting up and running screening programmes is high compared with total health spending. A recent analysis concluded that breast screening in India is not cost effective because of the lower incidence and therefore lower yield from screening, and the lack of health-care resources in a country where total health spending per capita is about the same cost as a single mammogram screen in the USA.


Studies of breast-cancer screening in LMICs also suggest that organised screening of women without symptoms might be impractical: "Cultural and economic barriers to participation are one issue, but the magnitude of effort required to screen a large population is another", says Harford. For example, to screen the projected target population of women aged 40 - 69 years in Egypt in 2025 (an estimated 24 million women) would need a 250-fold increase in government-funded mammography screening capacity.


He adds: "It is difficult to envision that the already stretched Egyptian health-care system could increase from 200 mammograms per day to 50 000 mammograms and 5000 follow-up procedures per day, as well as state-of-the-art treatment, to reduce breast-cancer mortality by around 30% as in high-income countries."


So is there an alternative solution? According to Harford, a more effective approach might be to: "Shift the focus from large asymptomatic populations - who make up most of the participants in a screening programme in LMICs, and most of whom will never have breast cancer - to the much smaller populations of women with breast symptoms."


He points out that key to this approach is the need for more evidence-based research into why women with breast symptoms delay
seeking care and the barriers within health-care systems that prevent earlier diagnosis.


"Raising breast awareness is a laudable goal and one that should be aggressively pursued by advocacy groups and health-care systems in LMICs, without necessarily seeking population-based mammographic screening", concludes Harford.


Link to personal view



Source
The Lancet Oncology