Wednesday, March 22, 2006

JAMA Focuses on Women's Health

This week's issue [392(12)] of JAMA: The Journal of the American Medical Association is a special focus issue on women's health. Topics such as gene mutations in families at hight risk of breast cancer, maternal depression and its effect in children, and physical exertion and sudden cardiac death in women are addressed by research papers in the issue. You'll need access to a library to obtain copies, but some comments are below.

Walsh T, Casadei S, Coats KH, Swisher E, Stray SM, Higgins J, Roach KC, Mandell J, Lee MK, Ciernikova S, Foretova L, Soucek P, King MC. Spectrum of Mutations in BRCA1, BRCA2, CHEK2, and TP53 in Families at High Risk of Breast Cancer. JAMA. 2006;295:1379-1388. (abstract)
Testing of the genes BRCA1 and BRCA2 has been used to look for mutations that put women at increased risk of breast cancer. The authors wanted to find out how often relevant mutations appear but are not detected in women at high familial risk for breast or ovarian cancer, and what kind of mutations are not detected by the standard test. The researchers did genetic analysis that was more comprehensive than the usual BRCA1 and BRCA2 tests, and found multiple types of mutations in those two genes, as well as in other genes examined, that the normal test does not detect but which may be associated with cancer risk or are not understood at this time. This research may help guide future test development or decision-making in women at high risk for breast cancer. The New York Times published an article discussing the research results, "Flaw Seen in Genetic Test for Breast Cancer Risk."

Weissman MM, Pilowsky DJ, Wickramaratne PJ, Talati A, Wisniewski SR, Fava M, Hughes CW, Garber J, Malloy E, King CA, Cerda G, Sood AB, Alpert JE, Trivedi MH, Rush AJ, for the STAR*D-Child Team. Remissions in Maternal Depression and Child Psychopathology: A STAR*D-Child Report. JAMA. 2006;295:1389-1398. (abstract)
This study is fairly clearly summarized in this piece available via MedlinePlus, Mom's Depression Can Put Kids at Same Risk. The authors looked at the children of women with major depressive disorder received outpatient care for the condition. Women under 18, over 75, or with certain other conditions such as bipolar disorder or schizophrenia were excluded from the study. The children were assessed for psychiatric disorders initially and after 3 months, and the results were compared to the mothers' progress in treatment. The analysis found that the children of women whose depression had remitted fared better/improved more psychiatrically than those of women with continuing depression.

Kuehn BM. Massage During Last Weeks of Pregnancy Reduces Episiotomies During Delivery. JAMA. 2006;295:1361-1362.(extract)
This news item reports on a literature review recently conducted by the Cochrane Group that addresses perineal massage during the final weeks of pregnancy. According to the report, "The review, which included data from three trials of manual perineal massage involving 2434 women, found a 15% reduction in the number of episiotomies among those who practiced perineal massage during the last four or five weeks of pregnancy (Beckmann MM et al. Cochrane Database Syst Rev. 2006;[1]:CD005123)."
The reviewers found that the benefit was most pronounced for women having their first vaginal delivery. With regards to why this benefit might occur, two possible explanations were offered: "The first is that massage may make the tissues of the lower genital tract more supple and stretchable, allowing the baby's head to pass more easily. Alternatively, women who are advised about the value of maintaining an intact perineum may be more motivated to push longer and otherwise work with their birth attendants to avoid episiotomy or tears."

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MeSH Tags: Breast Neoplasms/genetics; Depressive Disorder, Major; Episiotomy; perineal massage (keyword search)


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