Reproductive Health News
PREGNANCY & CHILDBIRTH | Adverse Pregnancy Outcomes Increase Even if Rise in Blood Sugar Level is Not Severe, Study Says [May 9, 2008] Increasing maternal blood sugar levels during pregnancy can cause issues such as high birthweight or a need for Caesarean sections, even if the woman's blood sugar levels are far below the risk of developing gestational diabetes, according to a study published on Thursday in the New England Journal of Medicine, the Wall Street Journal reports. For the study, researchers analyzed data from the 1999 Hyperglycemia and Adverse Pregnancy Outcomes project that involved 23,000 women from nine countries. Most of the women had blood sugar levels that placed them below the risk of developing gestational diabetes. However, risk of high birthweights and need for c-sections for an infant increased if the pregnant woman's blood sugar increased, according to the study. Donald Coustan, head of obstetrics and gynecology at Brown University's Warren Alpert Medical School, said that the authors of the study could not decide on a blood sugar level at which to recommend treatment, including insulin shots. Coustan said that the findings from the study are "about the future, not about the present," adding that they won't "affect clinical practice this week or this month." The researchers are scheduled to discuss their findings in June to decide if guidelines are needed for physicians who may need to treat expectant women with blood sugar levels below those of gestational diabetes, the Journal reports. In a separate study published in the same issue of NEJM, researchers in New Zealand and Australia found that women who received treatment for gestational diabetes with insulin or a different drug, metformin, gave birth to infants with similar health outcomes. The study found women preferred metformin, in pill form, over insulin shots (Hechinger, Wall Street Journal, 5/8). An abstract of the blood sugar study is available online. An abstract of the second gestational diabetes drugs study also is available online. [READ MORE...]
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CONTRACEPTION & FAMILY PLANNING | Public Citizen Calls on FDA To Withdraw Ortho Evra Patch From Market Over Safety Concerns [May 9, 2008] Public Citizen's Health Research Group on Thursday filed a petition with FDA calling on the agency to withdraw the birth control patch Ortho Evra from the market because of safety concerns, Reuters reports. In the petition, the consumer advocacy group said the amount of estrogen released from the patch -- made by Johnson & Johnson subsidiary Ortho McNeil -- varies among women, which could result in up to double the number of blood clots and other negative health effects (Heavey, Reuters, 5/8). Sidney Wolfe, head of the group, suggested that FDA phase out sales of the patch during a six-month period so that only existing users can get refills, allowing them enough time to switch to another contraceptive (AP/Google.com, 5/8). FDA in January announced that the label for Ortho Evra will include new data on a study that found a higher risk of blood clots among women who use the patch. The study found that women ages 15 to 44 who use the patch are about twice as likely to have blood clots as women who use oral contraceptives. According to Reuters, women who use Ortho Evra are exposed to about 60% more estrogen than oral contraceptive users. FDA officials have said that the risk of developing blood clots while using hormonal contraceptives is low -- for every 10,000 women who use a hormonal contraceptive for one year, about three to five will develop a clot. Wolfe wrote that the "considerable safety concern of high-dose, variable estrogen exposure tips the balance of risks and benefits against the availability of Ortho Evra as a contraceptive." He added, "If Ortho Evra had been designed as a pill, it is unlikely to have been approved because of its increased estrogen content" (Reuters, 5/8). Gloria Vanderham, a spokesperson for J&J, said, "Ortho Evra is a safe and effective hormonal birth control option when used according to its labeling." She added, "Hormonal birth control methods have benefits and risks. The approved labeling has always stated the known risks associated with its use." (AP/Google.com, 5/8). Use of the patch has decreased in recent years. Last year, about 2.7 million prescriptions were written for the patch, down from more than 9.9 million prescriptions in 2004, according to data cited by the petition. FDA said that it has not reviewed the petition but that it will respond directly to Public Citizen after it does (AP/Google.com, 5/8). The petition is available online. [READ MORE...]
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IN THE COURTS | EEOC Takes Action on Case Against Detroit Police Department Over Maternity Leave Discrimination [May 9, 2008] The Equal Employment Opportunity Commission recently found discriminatory a Detroit Police Department policy that denies light duty to pregnant police officers and treats pregnancies as off-the-job injuries, the Detroit News reports. The case involves a complaint filed by police officer Tisha Prater, who was denied light-duty work and placed on unpaid leave in July 2007. An EEOC investigator who handled Prater's complaint wrote in an April 15 letter that the police department's policy likely violates Title VII of the federal Civil Rights Act of 1964 because Prater "was forced to take a leave of absence because of her sex." EEOC recommended the police department change its policy and give Prater about $35,000 in back pay and damages. EEOC sent the case to conciliation in an effort to resolve the case. If the city and Prater are unable to reach an agreement, EEOC is expected to issue a "right-to-sue" letter, the News reports. Prater said that she expects she will have to file a lawsuit against the department in federal court. Detroit police officials said they could not discuss details of the case because of privacy laws, but they denied that officers are put on unpaid leave as soon as they disclose they are pregnant. The officials said police officers are put on unpaid leave only when their physicians report that they cannot perform their full duties safely. Deputy Chief James Tate said the department changed the policy because of an arbitration ruling in 2004, when the police union filed a grievance on behalf of a male police officer with an off-work injury. According to police arbitration documents, the officer complained that 17 pregnant officers were able to get light duty while he could not. Joanna Grossman, a law professor at Hofstra University, said policy changes that limit light-duty work to on-the-job injuries could "run afoul" of federal law. She added that a federal court in New York ruled that the Suffolk County Police Department violated the Civil Rights Act when it made a similar change because the change targeted pregnant women and disproportionately affected them. Glen Lenhoff, an attorney who specializes in employment law, said it clearly would be illegal for the police department to require women to go on unpaid leave because of pregnancy. However, as long as changes in the officers' status is linked to their physician's recommendation -- as is the case with Prater -- the policy would not be deemed illegal, Lenhoff added. Lenhoff said the federal Family and Medical Leave Act does require the department to take Prater back when she returns from leave, but he added the "law does not require the police department to give her a less physically onerous assignment." Frank Guido, general counsel of the Police Officers Association of Michigan, said state police departments have a range of policies and collective bargaining provisions with respect to placing officers on restricted duty. "There's no set pattern," Guido said, adding that Detroit's situation is not unique (Egan, Detroit News, 5/8). [READ MORE...]
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STATE POLITICS & POLICY | Minn. House Passes Bill Clarifying That State Funds Can Be Used for Embryonic Stem Cell Research [May 9, 2008] The Minnesota House on Wednesday voted 71-62 to pass a bill (SF 100) that would clarify that state funding can be used for human embryonic stem cell research, the St. Paul Pioneer Press reports. According to bill sponsor Rep. Phyllis Kahn (D), the state does not specifically ban using state funding for embryonic stem cell research, but the University of Minnesota has applied federal restrictions to funds it receives from the state because of a lack of clear guidance (Olson, St. Paul Pioneer Press, 5/7). Federal funding for embryonic stem cell research is allowed only for research using embryonic stem cell lines created on or before Aug. 9, 2001, under a policy announced by President Bush on that date. Bush twice has vetoed bills that would have allowed federal funding for research using stem cells derived from human embryos originally created for fertility treatments and willingly donated by patients (Daily Women's Health Policy Report, 5/8). Gov. Tim Pawlenty (R) would veto the Minnesota measure, according to his spokesperson Brian McClung (Lohn, AP/Bemidji Pioneer, 5/8). In a letter sent to state lawmakers in February, Pawlenty outlined his opposition to the bill and emphasized that using state funding for adult stem cell research would create "ample opportunity to work toward lifesaving cures without crossing moral and ethical boundaries" (St. Paul Pioneer Press, 5/7). Kahn said that the measure would allow state funding only for research using embryos originally created for fertility treatments and donated by couples who would otherwise discard them. "Not one embryo that is destined for life would ever be used for embryonic stem cell research," Kahn said. Before passing the measure, the House voted 69-65 to reject an amendment that would have allowed state funding to be used only for research that does not involve the destruction of human embryos (AP/Bemidji Pioneer, 5/8). The House version of the legislation was amended from a version that passed the Senate last year, so House and Senate leaders will have to resolve any differences before the bill can be sent to Pawlenty (St. Paul Pioneer Press, 5/7). [READ MORE...]
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STATE POLITICS & POLICY | California Stem Cell Research Program Approves Statewide Laboratory Construction Program [May 9, 2008] The California Institute for Regenerative Medicine's Independent Citizens' Oversight Committee on Wednesday approved $271 million in grants to build 12 stem cell laboratories at academic and not-for-profit research institutions in the state, the New York Times reports. The grants represent the largest amount of money awarded at one time by the program. The approval has sparked debate as to whether it is unnecessary because of possible changes to the ban on federal funding on research that uses embryonic stem cell lines created after August 2001. According to the Times, all three main presidential candidates have expressed support for expanded funding for the research. According to the Times, one reason CIRM distributed the grants for construction is because research on embryonic stem cell lines created after August 2001 "cannot share even a microscope with a project that is federally financed." However, Jesse Reynolds -- a policy analyst at the Center for Genetics and Society, which supports stem cell research but has criticized CIRM -- said that now that "the money is flowing" in California, those federal restrictions are going to be removed." Robert Klein, chair of CIRM, argued that the state could not take for granted that the federal restrictions would be lifted by the next president. He added that Republican presidential candidate Sen. John McCain (Ariz.) has expressed opposition to some types of stem cell research. Klein said that even if the restrictions are lifted, new laboratory space will be needed to expand research and to recruit scientists. Some CIRM officials also said the construction would provide an economic stimulus during a time of a large state budget deficit and a weak economy (Pollack, New York Times, 5/8). California voters in 2004 approved a plan to invest $3 billion of tax funds over 10 years into embryonic stem cell research, and CIRM has already approved 156 research grants totaling $260 million (Daily Women's Health Policy Report, 2/13). The new grant recipients include nine of the 10 University of California campuses, Stanford University and the San Diego Consortium for Regenerative Medicine. California Gov. Arnold Schwarzenegger (R) in a statement released after the board's decision said, "[T]his kind of public-private investment in a growing jobs section is exactly the kind of good news our economy needs right now." He added, "This will go a long way toward medical research that could save lives and improve them for people with chronic diseases" (Mohajer, AP/Examiner.com, 5/7). Wesley Smith -- a fellow of the Discovery Institute in Seattle and critic of CIRM -- said the spending is irresponsible. "Whether one supports or opposes the CIRM, the voters were told that their borrowed money would be used to pay for research into cures, not the construction of high-end luxury buildings," Smith said, adding, "And this at a time when [California] is drowning in $20 billion of red ink" (Russell, San Francisco Chronicle, 5/8). [READ MORE...]
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STATE POLITICS & POLICY | Advocates Rally for Paid Family Leave Proposal in New York State [May 9, 2008] Advocates of a paid family leave law for New York state on Wednesday rallied at the state Capitol in Albany to pass legislation that would provide 12 weeks of paid leave for workers who are on leave to care for an infant or a sick family member, the Rochester Democrat and Chronicle reports. The state Assembly passed a paid leave bill last year, but the Republican-controlled Senate did not vote on it. The proposal would allow workers to collect up to a maximum of $170 weekly while on leave. The program would be funded through an employee-only payroll deduction of 45 cents weekly. Under the measure, paid family leave would come under the existing state Temporary Disability Insurance program. "Too many people fear losing their jobs if they do what they need to do to take care of their family," Assembly Labor Committee Susan John (D) said, adding, "Surely, New York state can ask employers to do the right thing by their working people, whether they're male or female." Scott Reif, a spokesperson for Senate Majority Leader Joseph Bruno (R), said, "We believe that paid family leave is an important issue, and we will continue to hold discussions in an effort to strike the right balance among the interested parties." According to the Democrat and Chronicle, the Business Council of New York State opposes paid leave because of cost concerns for businesses (Matthews, Rochester Democrat and Chronicle, 5/8). Opinion Piece Lawmakers in New York state need to help the state "join California, Washington state and ... New Jersey by passing legislation creating a groundbreaking paid family leave program," Linda Lisi Juergens, executive director of the National Association of Mothers' Centers, writes in a Long Island Newsday opinion piece. A bill that would provide New York residents with paid family leave "will again come to a vote in the Assembly, and it is very likely to pass," Juergens writes. She adds, "For it to become law, however, Senate Republicans need to see the benefits of the pioneering legislation and bring the paid family leave bill to a vote." No person "should have to risk a job or financial well-being to take care of a newborn, but today, thousands of families face that exact choice," Juergens writes, concluding, "Let's hope this year Albany gives New York's women a Mother's Day gift they will remember" (Juergens, Long Island Newsday, 5/8). [READ MORE...]
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NPR's "Morning Edition" on Thursday reported on the increase in the average age at which women give birth for the first time in the U.S. According to "Morning Edition," the "average age of mothers in the U.S. has been steadily increasing," with the current average age of first birth slightly above 25. PREGNANCY & CHILDBIRTH | NPR Examines Shift To Later Age of First Childbirth in U.S.[May 9, 2008] NPR's "Morning Edition" on Thursday reported on the increase in the average age at which women give birth for the first time in the U.S. According to "Morning Edition," the "average age of mothers in the U.S. has been steadily increasing," with the current average age of first birth slightly above 25. More than one-third of women are more than 30 years old when they give birth for the first time, "Morning Edition" reports. Marcelle Cedars, a reproductive specialist at the University of California-San Francisco, said that fertility in women peaks around age 22 and that pregnancy becomes much more difficult to achieve after age 35. After age 35, "[e]ach egg is more likely to be genetically abnormal. And a genetically abnormal egg is less likely to fertilize," Cedars said, adding, "It's less likely to develop. It's less likely to implant. If it implants, it's more likely to miscarry." Cedars said many women are unaware that they likely would need reproductive assistance to have children at an older age. Helen Fisher, an anthropologist at Rutgers University, said social shifts have led women to delay having children. Fisher said that many women are "concerned about getting a career before they marry. And that takes time." She added, "I think that even the established business community is beginning to really realize that men and women were built to work together, so that women can have their children when they're young and also sustain their career" (Wilson, "Morning Edition," NPR, 5/8). [READ MORE...]
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OPINION | McCain's View of Judicial Philosophy is More Than 'Campaign Plank,' Opinion Piece Says [May 9, 2008] Republican presidential candidate Sen. John McCain's (Ariz.) speech on Tuesday, during which he outlined his judicial philosophy and "pledged to nominate qualified judges who will leave the legislating to the people," is not a "campaign plank" but "one of our nation's core ideas," Tony Perkins, president of the Family Research Council, writes in a USA Today opinion piece. According to Perkins, McCain's speech placed "one of the most important issues of 2008 squarely in focus. Will social policy in the U.S. continue to be made by panels of unelected judges with lifetime tenure, or will we have a judiciary governed by self-restraint and fidelity to the rule of law?" Perkins adds that throughout history, "overreaching judges have attempted to seize power on questions that span the social and political spectrum." The U.S. Supreme Court's recognition of abortion rights has created a "national issue" and is "actually delaying -- because it doubted -- the ability of the American people to reason together to solutions," Perkins writes. He adds that McCain, with "clarity" and a "personal history of fairness in judicial matters," has established the case for a judiciary that "rises above political strife but does not undermine representative government" (Perkins, USA Today, 5/9). [READ MORE...]
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RESEARCH | Study Finds Carcinogenic HPV Infections Often Clear Within One Year [April 24, 2008] Summary of "Rapid Clearance of Human Papillomavirus and Implications for Clinical Focus on Persistent Infections," Rodriguez et al., Journal of the National Cancer Institute, April 2, 2008. Researchers examined the outcomes of 800 carcinogenic human papillomavirus infections among 599 women enrolled in a population-based cohort in Guanacaste, Costa Rica, in order to better understand the natural history of human papillomavirus, or HPV, and to gauge the extent of treatment that women with HPV infections should receive. The study found that detection of carcinogenic HPV infections is "extremely common" on a cross-sectional screening but that the majority of infections clear quickly. Ana Cecilia Rodriguez of the National Cancer Institute and colleagues enrolled women ages 18 and older for the study. The study found a 13.7% prevalence of carcinogenic HPV among women in the study, with the highest prevalence (24.4%) among women ages 18 to 24. According to Rodriguez and colleagues, studies have found similar HPV prevalence in the U.S. The study found that 55% of the 800 infections cleared within six months and that 67% cleared within 12 months. In addition, persistence of carcinogenic HPV infections was less common in women younger than age 30. Researchers focused on the first 30 months of follow-up. According to the researchers, it is important for health care providers during that time frame to decide whether to treat HPV and to weigh the chance of clearance against the possibility that the patient will develop cervical intraepithelial neoplasia grade 2 or worse (CIN2+), which can lead to cervical cancer. The women in the study were screened regularly for HPV, cervical cytology and viral clearance, and women who developed CIN2+ were treated appropriately. Only 4% of the HPV infections were linked to newly diagnosed CIN2+ 30 months after detection. If the virus had not cleared after 12 months, the study found a 21% risk of a CIN2+ diagnosis by 30 months. According to the researchers, the findings indicate that some patients with normal cytology and an initial positive HPV result could be carefully watched instead of treated because a 12-month follow-up can safely determine more than 50% of such infections as transient. The findings suggest that health care providers should focus on the persistence of an HPV infection rather than only on an initial screening in order to effectively treat the virus and cervical cancer. [READ MORE...]
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RESEARCH | Study Examines Delivery of Preventive Services From Gynecologists, General Medical Physicians [April 24, 2008] Summary of "Preventive Services Use Among Women Seen by Gynecologists, General Medical Physicians or Both," Lewis et al., Obstetrics & Gynecology, April 2008. Beth Lewis of the Department of Medicine at Saint Peters University Hospital and colleagues examined data from the 2000 National Health Interview Survey. The study looked at women ages 18 to 64 who were under the care of a general medical physician or gynecologist, or both. The researchers studied the association of provider type with Pap tests, tobacco-use screening, and exercise and dieting counseling among women ages 18 to 64, as well as provision of the above services and clinical breast examinations, mammograms and colon cancer screening among women ages 50 to 64. These services were further divided into gender-specific services -- Pap tests, mammograms and clinical breast examinations -- and gender-neutral services -- diet and exercise counseling, and screening for tobacco use and colorectal cancer. The study also accounted for such variables as age, race, education, income, insurance status, census region, urban residence and immigration status. Researchers also considered measures of health, such as self-reported health status, hospitalization in the past year, number of physician visits in the past year and smoking. Results Of the 7,317 women studied, 5,766, or 78.8%, were between ages 18 and 49, and 1,551, or 21.2%, were ages 50 to 64. Fifteen percent were seen by general medical physicians, 62.2% by gynecologists and 22.9% by both. Women who visited only a gynecologist or both types of providers were typically younger and of higher socioeconomic status than the women who saw only a general medical physician. The women who visited only a gynecologist or both types of providers also tended to have better health in terms of self-rated general health and chronic diseases. For all of the services examined, women seeing gynecologists alone reported receiving preventive care as frequently or more frequently than women seeing only a general medical physician. In addition, women seeing gynecologists and women seeing both providers were more likely to receive gender-specific care. With the exception of tobacco screening -- which occurred more often among women who went to gynecologists -- there were no differences across provider groups for gender-neutral services. In addition, the combination of receiving care from both types of providers significantly increased the chance that women would receive diet and exercise counseling, as well as colorectal cancer screening. Overall, patients of both gynecologists and general medical physicians had low rates of gender-neutral care; only about half of women in the study had colorectal cancer and tobacco screening, and about one-fourth had diet and exercise counseling. Discussion The results indicate that “gynecologists perform as well as or better than general medical physicians” in the delivery of the services studied. According to the researchers, the findings validate policy decisions that increase women's access to gynecologists, such as identifying gynecologists as primary care providers in managed care plans. The results add credibility to some women's decisions to rely on gynecologists for basic health care screening and counseling, according to the authors. However, because patients of both general medical physicians and gynecologists had overall low rates of gender-neutral care, "comprehensive preventive health care remains suboptimal for women seeing either type of provider," the researchers write, adding that gynecologists and general medical physicians "must remain vigilant about the prevention of diseases in women for which good screening measures exist." [READ MORE...]
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RESEARCH | Researchers Examine Effect of Sex Education on Risk of Pregnancy, STIs Among Teens [April 24, 2008] Summary of "Abstinence-Only and Comprehensive Sex Education and the Initiation of Sexual Activity and Teen Pregnancy," Kohler et al., Journal of Adolescent Health, April 2008. Pamela Kohler and Lisa Manhart of the University of Washington's Center for AIDS and STD and William Lafferty of UW's Department of Health Services examined the effect of formal sex education programs on the risk of pregnancy and sexually transmitted infections by analyzing data from 1,150 teenage girls and 1,121 teenage boys ages 15 to 19 who responded to the National Survey of Family Growth's general questionnaire and special adolescent interview. The sample was restricted to participants who were heterosexual and had never been married. To determine what type of education the participants received, the researchers asked whether the teens ever received "any formal instruction at school, church, a community center or some other place about how to say no to sex" before age 18. A follow-up question asked about receiving instruction on birth control methods. Those who reported receiving both education about birth control and education that emphasized a "say no to sex" approach were classified as having participated in comprehensive sex education. Those who reported only receiving sex education about how to say no to sex were classified as having received abstinence-only sex education. The researchers excluded respondents who reported exposure to sex education that taught only birth control without discussing abstinence, those who did not answer sex education questions or those who reported an age of first intercourse younger than 10. They also excluded those who reported having had sex before they received formal sex education. Characteristics associated with risky behavior among teens -- including age, household income, race or ethnicity, geographical residence and "intactness" of the family unit -- were assessed as potential variables. Findings Of the 1,719 teens included in the study, 47.4% were female respondents, and the median age was 17. In addition, 76.7% of the participants were classified as white, and 14% were classified as black. About half of household incomes reported were less than $40,000 annually, and a little more than half of the participants resided in a central city. About 41.3% of the participants reported a "nonintact" family unit. Overall, 9.4% reported not having received any formal sex education, 23.8% reported abstinence-only sex education, and 66.8% said they had received comprehensive sex education. Those who had not received formal sex education tended to be black, from rural areas and from low-income, nonintact families. Participants receiving abstinence-only education were typically younger and from low- to moderate-income, intact families. Those who reported having received comprehensive sex education were somewhat older, white and from higher-income families in more urban areas. Almost half of the respondents reported having engaged in sex by the time of the survey. After adjusting for other predictors, the researchers found that abstinence-only sex education was not significantly associated with a teenager ever engaging in intercourse. However, comprehensive sex education was associated with slightly reduced reports of engaging in intercourse. Among all the respondents, 7.3% reported a pregnancy. After adjusting for other variables, abstinence-only sex education was not significantly associated with reported teen pregnancy, compared with those who had received no formal sex education. Teenagers who reported having had comprehensive sex education were significantly less likely to report a teen pregnancy, compared with those who had not received sex education. In addition, comprehensive sex education was associated with a 50% lower risk of teen pregnancy compared with abstinence-only education. The study also found that neither abstinence-only nor comprehensive sex education programs were significantly associated with risk of STIs, compared with no sex education. Conclusions The researchers noted that abstinence-only programs have no significant effect on "delaying the initiation of sexual activity or in reducing the risk for teen pregnancy" and STIs. They added that when compared with no sex education or abstinence-only education, comprehensive sex education programs were associated with a significantly reduced risk of pregnancy. Comprehensive sex education also was associated with a marginally reduced likelihood of a teen becoming sexually active, when compared with no sex education. In addition, the report showed a "strong relationship" between a family's "intactness" and whether teens' received sex education. Teenagers from intact families were more likely to have received formal sex education, compared with those from nonintact families. The researchers noted that because the findings indicated a decreased likelihood of pregnancy among teens who received comprehensive sex education, adolescents who received abstinence-only education might "engage in higher-risk behaviors once they initiate sexual activity." Although further research is needed to examine the effects of formal sex education, the study's findings "suggest that formal comprehensive sex education programs reduce the risk for teen pregnancy without increasing the likelihood that adolescents will engage in sexual activity," the researchers write, adding that the findings "confirm results from randomized controlled trials that abstinence-only programs have minimal effect on sexual risk behavior." [READ MORE...]
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RESEARCH | Researchers Examine Hormonal Contraception Prescription Patterns Among Adolescents [April 24, 2008] Summary of "Trends in Prescribing Patterns of Hormonal Contraceptives for Adolescents," O'Brien et al., Contraception, April 2008. Researchers in the April issue of Contraception examined whether there was a drop in prescriptions given to adolescents for oral contraceptives that contain the hormone desogestrel, after it was found that the hormone increased the risk of deep vein thrombosis. Researchers from the Center for Innovation in Pediatric Practice looked at the patterns of hormonal contraceptive prescriptions given to young women between 1993 and 2004. The researchers hypothesized that prescriptions for contraceptives that contain the hormone desogestrel would decline after 1995, when a higher risk of deep vein thrombosis was first linked to desogestrel and other types of progestin. After this 1995 "scare," fewer clinicians in Europe prescribed contraceptives that contained progestin, particularly to adolescents; however, little was known about whether prescribing patterns of hormonal contraceptives in the U.S. had changed over time. Methods and Findings Sarah O'Brien of the Center for Innovation in Pediatric Practice at the Research Institute at Nationwide Children's Hospital and colleagues analyzed data from the National Ambulatory Medical Care Survey. They looked at 1,672 outpatient visits among girls and women ages 11 to 21 that included a prescription for hormonal contraception. The researchers classified data according to the type of contraceptive prescribed in two ways. The first method classified the contraceptives according to estrogen dose, with ultra-low doses defined as 20 micrograms to 25 mcg, low doses as 30 mcg to 40 mcg and high doses as 50 mcg or greater. The second method looked at the type of progestin prescribed: nondesogestrel, desogestrel and drospirenone. The researchers also classified data on provider specialty, including general practice, pediatrics and adolescent medicine, obstetrics and gynecology, or another specialty. Variables included age; race; expected source of payment; and whether the primary reason for the visit was general care, menstrual problems or other reasons. The study found that 4.6% of visits for female patients ages 11 to 21 included a prescription for contraception during the study period. The proportion of prescriptions for contraceptives containing desogestrel was lower in the U.S. than in Europe in 1995 and remained constant during the study period. Prescriptions for contraceptives containing ultra-low doses of estrogen increased, while prescriptions for those containing low doses decreased. Use of high-dose estrogen-containing contraceptives increased, mainly because of the introduction of the transdermal contraceptive patch Ortho Evra in 2001. The type of contraceptive prescribed in terms of progestin or estrogen did not vary by age, race, expected source of payment or reason for visit. Prescriptions of progestin-only birth control pills and the injectable contraceptive Depo-Provera accounted for 11.6% and 6.3% of all prescriptions, respectively. Prescriptions of intrauterine devices and vaginal rings were rare, accounting for approximately 1% of all prescriptions. Ob-gyn clinics and family medicine practices accounted for the majority of prescriptions, at 55% and 35%, respectively. Most prescriptions for adolescents age 14 and older were made at ob-gyn offices. Discussion According to the researchers, it is particularly concerning for adolescents that the risk of DVT "appears to be even higher among first-time users of oral contraception." Although prescription rates of such contraceptives were lower in the U.S. than in Europe during the "pill scare," U.S. prescribing patterns have not changed. In addition, FDA has not issued a warning about the increased risk of DVT associated with desogestrel-containing contraceptives despite concerns about the hormone and petitions from the consumer advocacy group Public Citizen to ban desogestrel-containing contraceptives. A "significant minority of adolescents are still prescribed desogestrel-containing oral contraceptives, and a greater number of adolescents are now exposed to higher doses of estrogen, due to the increasing prescribing of the transdermal contraceptive patch," the researchers write. The authors conclude that additional studies are needed to determine the absolute risk of DVT in adolescents taking contraceptives and to ensure that physicians have accurate safety information when prescribing contraceptives to adolescents. [READ MORE...]
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RESEARCH | HRT Increases Risk of Breast Cancer Recurrence Among Survivors of Disease, Study Finds [April 24, 2008] Summary of "Increased Risk of Recurrence After Hormone Replacement Therapy in Breast Cancer Survivors," Holmberg, Journal of the National Cancer Institute, April 2008. Hormone replacement therapy for menopausal symptoms is known to increase the risk of breast cancer in healthy women, but HRT's effect on breast cancer risk among breast cancer survivors has been unclear. A study -- called Hormonal Replacement After Breast Cancer: Is it Safe, or HABITS -- aimed to determine the risk of breast cancer among survivors of the disease who were taking HRT. The study was halted in December 2003 after two separate studies linked HRT use to an increased breast cancer risk in healthy women. The current study -- led by Lars Holmberg of the Department of Surgical Sciences at Uppsala University in Sweden -- followed up with 447 women who had participated in the HABITS study for a median of four years to determine whether breast cancer survivors taking HRT have an increased risk of their cancer coming back. The researchers followed up with women who had completed primary treatment of stage 0 to stage 2 breast cancer, including tumor removal and axillary surgery, radiotherapy and chemotherapy. The women were required to be free of breast cancer recurrence, have no other cancer or serious disease and have no contraindications to HRT. Women also were required to have menopausal symptoms that they and their physicians believed required treatment. Local networks of oncologists, surgeons and gynecologists recruited, assigned groups and followed the participants. The researchers recommended that women visit a breast cancer specialist twice annually for three years after the HABITS study ended and at least once annually for another two years. In addition, the researchers recommended that the women receive mammograms every 12 to 24 months or participate in routine mammography screening in intervals of 18 to 24 months. Participants also were required to visit a gynecologist annually. New breast cancer events, as well as other cancers, compliance and treatment side effects were recorded. Findings, Conclusions Participants were randomly assigned to take HRT or the best systematic management of menopausal symptoms. Women taking HRT were asked to stop taking the therapy after two years, and those experiencing serious withdrawal symptoms received gradually decreased dosages for six to 12 months. The researchers were able to follow 442 of the women for a median of four years. There were 39 breast cancer events in the HRT group and 17 in the non-HRT group. At the end of the follow-up period, six women in the HRT group had died of breast cancer, and six were living with distant metastases, compared with five deaths and four distant metastases in the non-HRT group. The researchers concluded that breast cancer survivors taking HRT had a "significantly increased risk of a new breast cancer event." Other observational studies and analyses had suggested breast cancer survivors did not have an increased risk of breast cancer recurrence when taking HRT. However, the researchers were not surprised their results deviated from those of earlier studies because they were not conducted formally and did not control for bias. The researchers added that the findings suggest HRT "induces and promotes" breast cancer in survivors of the disease and "may also stimulate" tumor growth. Further research is needed to determine the impact of specific HRT regimens on the risk of breast cancer recurrence following exposure to HRT among survivors of the disease, the researchers concluded. [READ MORE...]
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RESEARCH | Sexual Health Communication Between Parents, Children Lacking [April 24, 2008] Summary of "Communication Between Parents and Their Children About Sexual Health," Ogle, S., et. al., Contraception, April 2008. A questionnaire completed by students ages 13 to 15 in a public school in Edinburgh, Scotland, and their parents or guardians shows that there are barriers to communicating effectively about sexual health issues. The findings indicate that the lack of communication about sexual health issues between parents and their children stems mainly from the children's reluctance to talk about such issues rather than reluctance by parents. The study suggests adolescent children do not often seek out parents or guardians as sources of advice or information about sexual health and particularly about sexual intercourse. Questionnaires Given To Determine Comfort Levels Sharron Ogle and Simon Riley of the University of Edinburgh's Queen's Medical Research Institute and Anna Glasier of the Scottish group Family Planning and Well Women Services distributed a self-completed questionnaire to 317 teenagers in an Edinburgh public school and 575 of their parents. The questionnaire was designed to determine relative comfort levels about discussing six sexual health topics: girlfriends/boyfriends, homosexuality, sexual intercourse, contraception, sexually transmitted infections and abortion. Three hundred and forty-five parents, 162 female students and 155 male students completed the questionnaire. Parents were asked to provide information about their age, occupation, their child's age and gender, their relationship with their child, how comfortable they were discussing each of the topics and any other comments they wanted to share. The level of comfort was identified on a scale of one to four, where one was "very comfortable," two was "comfortable," three was "uncomfortable" and four was "very uncomfortable." A total "discomfort score" was derived by adding the responses to all six topics. The children were asked how likely they were to talk to their parents or guardians about various scenarios related to the six topics. Children who indicated they definitely would not speak to either parent for any topic were asked to provide an explanation. The study found that parents were most comfortable discussing girlfriends or boyfriends and least comfortable talking about sexual intercourse with their children. The children's surveys also revealed that they were least likely to discuss sexual intercourse with their parents and more likely to talk about girlfriends or boyfriends. The level of discomfort for fathers was significantly higher than for mothers, regardless of the gender of the child. The level of discomfort for fathers with daughters was higher, compared with all other groups. Girls were less likely to talk to fathers than mothers about the six topics, while boys were equally likely to talk to their mothers or fathers. According to the study, 57% of the children said the main reason for not talking to parents about the six topics was embarrassment, and 26% said they preferred using other sources of advice. Among girls, 42% said they discussed the issues with friends, 28% with their mothers and 5% with their fathers. These findings were similar for all topics except abortion, where friends and mothers equally accounted for 33%. The study found that for boys, 34% discussed sexual issues with friends, 20% with their mothers and 18% with their fathers. Parents Are Not 'Widely Used' The researchers noted that despite the parents' "overall high comfort levels," the children generally were unwilling to discuss sexual health with their parents. The findings suggest that parents and guardians are not "widely used" by their children as sources of advice and information concerning the six sexual health topics. In part because the questionnaire format could not delve deeper into the reasons parents are underutilized as resources on such topics, the researchers said further study is needed. [READ MORE...]
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