Wednesday, March 29, 2006

Update on NIH Elective Cesarean Conference

The National Institutes of Health has wrapped up its State of the Science Conference: Cesarean Delivery on Maternal Request. Video of day 1 and day 2 of the conference are available online; Day 3 is coming soon. A draft consensus statement on the topic (PDF) was issued today. The statement points out that rates of cesarean delivery have been increasing since the mid-1990's (reaching a record high of 29.1% in 2004), while rates of vaginal birth after cesarean (VBAC) have been falling since that time. The panel found that quality evidence was sparse for assessing differences in long-term and short-term outcomes between planned vaginal delivery (PVD) and cesarean delivery (CD), and so could not assess a number of outcomes, including hospital readmissions, adhesions, and chronic abdominal and pelvic pain syndrome. The panel did find moderate-quality evidence for two outcome measures, hemorrhage and maternal length of hospital stay. These indicated (according to the conference panel's assessment) that the frequency of postpartum hemorrhage was less for planned CD than for the combination of PVD and unplanned CD. They also found that maternal hospital stays were longer for CD than for vaginal delivery.

Overall, the conference results suggest that more quality vidence is needed with regards to outcomes in elective cesarean vs vaginal delivery. Other commentary/resources related to the conference:
  • Childbirth Connection offers a list of questions that need answers (PDF)
  • Lamaze International's press release on the topic, and white paper on elective cesarean vs vaginal birth (PDF)
  • American College of Nurse Midwives media briefing materials
  • WebMD's Healthy Pregnancy blogger responds to the idea, and gets a fair number of comments

    I hope to have time to watch the conference videos over the weekend, and may have additional commentary then.

    Technorati Tags: ; ;
    MeSH Tags: Cesarean Section/trends OR /utilization; Surgical Procedures, Elective
  • Women's Health Advocacy Websites

    Childbirth Connection
    Childbirth Connection provides a wealth of information for both women and healthcare professionals to enable them to "make informed maternity care decisions." The section for women provides consumer-friendly information on choosing a caregiver and birth setting, labor support, labor pain, and other issues. It outlines a list of rights for pregnant women, a free online book - "A Guide to Effective Care in Pregnancy and Childbirth," recommended resources, and news items. The section of the site for healthcare providers addresses evidence-based maternity care, including evidence columns and systematic reviews on pregnancy and childbirth topics.

    National Advocates for Pregnant Women
    The NAPW describes its work as "to secure the human and civil rights, health and welfare of all women, focusing particularly on pregnant and parenting women, and those who are most vulnerable - low income women, women of color, and drug-using women. NAPW seeks to ensure that women do not lose their constitutional and human rights as a result of pregnancy, that addiction and other health and welfare problems they face during pregnancy are addressed as health issues, not as crimes; that families are not needlessly separated, based on medical misinformation; and that pregnant and parenting women have access to a full range of reproductive health services, as well as non-punitive drug treatment services. " The group works via public education. legal advocacy, and organizing; the website provides information on these activities and outlines the NAPW's stance on issues such as abortion and contraception restrictions, drug addiction, workplace discrimination, and other topics. NAPW launched a blog on March 21st.

    Women's Human Rights Net
    WHRnet provides information on current issues in global human rights for women.

    Technorati Tags: ; ;
    MeSH Tags: Human Rights; Parturition; Pregnancy

    Update from Childbirth Connection

    In a previous post, I provided some information from Childbirth Connection's survey of women regarding childbirth experiences, and expressed a couple of questions about the results. The organization's Director of Programs, Carol Sakala, responded very promptly via email with some additional detail.

    Survey Finding: "Close to half of survey participants (42% to 45%) were 'not sure' about how to reply to four statements about complications of cesareans, and 21% to 33% responded incorrectly."
    Question: It's not clear whether these results are only among the women who had c-sections, which would make a difference in the interpretation of the results.
    Response: "Thusfar, we have just released the intial 'topline' results. We will be looking at and comparing different subgroups in future reports. It is accurate to say that there were notable overall concerns with knowledge about adverse effects of cesarean section, as well as notable concerns among women who had had cesareans."

    Survey Finding:"Just 12% of women with a previous cesarean had a VBAC. Of the remaining women who had a repeat cesarean, 45% were interested in the option of VBAC, but more than half (56%) of them were denied this option, primarily because their caregiver (45%) or hospital (23%) was unwilling to do a VBAC."
    Question: It's not clear how many of these women should legitimately have been denied VBAC, which makes a difference in what these results mean as well.
    Response: "We did get the mothers' assessment about whether this action was medically appropriate. The question that was asked of women who said they hadn't had the option of VBAC was: 'What was the reason that you didn't have the option of a vaginal birth after cesarean (or VBAC)? Please select all that apply' and one of the choices was 'A medical reason for this cesarean not related to my prior cesarean' (selected by 13% of respondents)."

    Look for more detailed results from this study later this year. I'll provide a more thorough review of the Childbirth Connection website later today. Big thanks to Carol for responding to my questions so quickly.

    For those of you keeping score at home: It was very easy to get a quick response from Childbirth Connections regarding my questions. By comparison, getting answers about HB3199 & SB3402 from sponsors Nathan Vaughn and Rusty Crowe has been impossible. At the advice of my local rep, I emailed these two with my questions, first on Feb 21, then again later after not receiving a response. On March 19, I contacted my rep again to ask if he could facilitate an answer, and he promptly forwarded my message to the sponsors and asked for a response. I still have not received a reply from Vaughn or Crowe, after more than a month of trying. I realize that at this stage I should start making phone calls, but c'mon, over a month to respond to a few questions about a bill that you sponsored?

    Technorati Tags: ; ; ; ; ; ;
    MeSH Tags: Abortion, Induces/legislation and jurisprudence; Cesarean Section/statistics and numerical data; Cesarean Section, Repeat/statistics and numerical data; Vaginal Birth After Cesarean

    Monday, March 27, 2006

    New-ish Blog That I Like, and Milk Banks

    I just came across The Lactivist Breastfeeding Blog today, and I'll be returning. On the front page right now are commentary on a study of home birth safety, criticism of the Britney birth statue, the c-section stuff I covered Saturday, and other breastfeeding and birth topics. Plus, you can buy a shirt reading "these breasts save lives," and profits from the sale will be donated to the Mother's Milk Bank of Ohio (please note that I did not verify this). Check it out.

    Some of you are thinking, "What, exactly, is a milk bank?" The simple answer is that it's like a blood bank, but with breastmilk, like the modern version of a wet nurse. According to the Human Milk Banking Association of America, "In North America, the interest in donor milk banks is also growing. Many families, aware of some of the problems associated with artificial feeding products, are requesting donor milk, particularly when they have an ill or premature infant and maternal milk is insufficient or unavailable." According to this directory, however, there are not yet very many banks in the U.S. There are, apparently, milk banks which accept donations from out of state if you're interested. Banked milk can help women who, for example, don't have sufficient milk supply (such as in a premature birth or multiple births), who are on medications that prevent breastfeeding (such as chemotherapy), or have an infection such as HIV that can be passed through breastmilk.

    Now I'm thirsty. More tomorrow.

    Resources:
    Becoming a Donor to a Human Milk Bank - La Leche League
    Human Milk Banks - National Women's Health Information Center
    Banking on Breast Milk - breastfeeding.com

    Technorati Tags: ;
    MeSH Tags: Milk, Human; Milk Banks

    Belly Ads and Sponsored Birth

    This piece on Alternet tells the story of 21-year-old Asia Francis, who "sold the rights to sponsor the birth of her first child to Globat LLC, a Los Angeles-based Web hosting company" via eBay for $1,000. According to the article:
    "In return, Francis agreed to wear Globat.com T-shirts whenever she stepped out of her home before her delivery and to sport a temporary tattoo of the company's red-and-black logo on her swollen belly. On the morning of March 17 when Francis drove to the hospital to induce labor, her car was decorated with Globat decals and car magnets. In the delivery room the expectant mother had Globat stickers around her pillow, her well-wishers all wore company T-shirts while the walls were decked with company posters and a banner. At 2:35am the next day, her baby, named Samiah Wynn Francis, was born, weighing 6 pounds, 15 ounces. The delivery itself was videotaped and selected segments will be posted for viewing on the company's Web site."
    This is apparently not the only instance of such a pregnancy or birth sponsorship involving ads. For example, "From December 2005 to February 2006, three pregnant sisters from St. Petersburg, Fla., who were all giving birth within a month of each other, agreed to advertise for the company. Photographs of the sisters displayed their swollen bellies under rolled-up T-shirts, with the Web address GoldenPalace.com stamped across their stomachs in bold letters."

    Author Jean Kilbourne ("Can't Buy My Love: How Advertising Changes the Way We Think and Feel") doesn't approve of the move, says women should refuse to be turned into billboards, and is quoted as saying (with regards to whether this would help promote varied body images for women), "Pregnant women are the only ones who have permission to be fat. I still wouldn't see that as progress. What this shows is who owns her body. She's allowing herself to be used which is demeaning in itself. But it's particularly degrading when linked to something like pregnancy."

    What do you think about this? How does your opinion change when you find out that Francis is a single mother, a receptionist, is not going to be paid during maternity leave, and is not covered by her company's health insurance? How does this compare with being compensated to be a surrogate mother? Does the privacy of one and the display of the other make a difference with regards to monetary exchange for pregnancy?

    Technorati Tags: ; ;
    MeSH Tags: Advertising; Parturition; Pregnancy

    Men Can Stop Rape Commentary

    Aunt B posted today about the Men Can Stop Rape campaign, which is intended to give men tools to reduce rape, and mentioned that she and another woman were not sure what to think about it. The MCSR homepage states that they "build young men's capacity to challenge harmful aspects of traditional masculinity, to value alternative visions of male strength, and to embrace their vital role as allies with women and girls in fostering healthy relationships and gender equity." Based on their posters, the program seems to be about challenging rape myths in a certain segment of the population, college-aged men. The campaign's images are clearly not targeted at the kind of violent serial rapist we see on shows like Law & Order. These posters are about men with unclear boundaries, young men who might be inclined to keep pushing a reluctant woman, or have sex with a girl who is intoxicated; they're designed to remind men that rape doesn't have to be brutal and take place on a dark street, but can take place when you step over certain lines, in your own bedroom, with a woman you know.

    Are these materials, and this type of campaign, effective? I poked around in PubMed and PsycInfo for articles on rape prevention campaigns targeted at men, and found a few pieces that looked at programs such as MCSR. One study1 compared fraternity men in a control group or a rape prevention program, and found "Although no evidence of change in sexually coercive behavior was found, significant 7-month declines in rape myth acceptance and the likelihood of committing rape were shown among program participants. In the case of rape myth acceptance, the 7-month decrement remained lower in the participant group than in the control group." Another study looked at the effect of a rape prevention video on sexually coercive and non-coercive men, and found "For the noncoercives, the anti-rape video resulted in lower rape-myth acceptance and sex-related alcohol expectancy scores than the control video. Coercives--who presumably most need to be deterred--exhibited no such effects."2 Another study noted that numerous men who participated in an anti-rape training session commented that the program was beneficial in helping them understand how to avoid rape charges by gaining explicit consent for sex.3 There are other studies out there, some which found that attitude changes in men immediately post-training disappeared over time, and some that looked at how "hypermasculinity" and certain notions of gender reduced the training's effectiveness, for example. It would take some time to review all of these, but I wanted to get a general idea of what the literature was saying.

    So where does this leave us? The evidence suggests that some men can have improved attitudes that would reduce their likelihood of committing rape for some period of time following the sessions. Does it work for all men? Is it a perfect method? No. However, I'm inclined to think that if this type of program provides some window in which men's attitudes toward sexual consent improve, then the program may make some difference. Perhaps it's not a long-term difference, but rape is not typically a long-term event. As a result, while this may not be my favorite solution, I think it's one that may make a difference for some men, and as a result, some potential victims of rape.

    1) Foubert JD. The longitudinal effect of a rape-prevention program on fraternity men's attitudes, behavioral intent, and behavior. J Am Coll Health. 2000 Jan; 48(4):158-63.
    2) Stephens KA, George WH. Effects of anti-rape video content on sexually coercive and noncoercive college men's attitudes and alcohol expectancies. J Appl Soc Psych. 2004 Feb; 34(2):402-16.
    3) Choate LH. Sexual assault prevention programs for college men: an exploratory evaluation of the men against violence model. J Coll Couns. 2003; 6(2):166-76.

    Technorati Tags: ;
    MeSH Tags: Rape/prevention and control

    Saturday, March 25, 2006

    Search Request Roundup #4, My Yahoo! Answers Part 3

    This is the fourth installment of Search Request Roundup, in which I look at recent searches that led to my blog and provide some information relevant to the desired topics.

  • Does RoundUp contribute to cancer?
    Well, the Search Request Roundup doesn't! The Household Products Database is a good starting point for health information about a particular product. You can browse by categories of products, product names, or search for what you're interested in. There are several records for different Roundup products (browse the R's), and they all seem to indicate that Glyphosate (a main ingredient) is not thought to be a carcinogen. Information on known hazards of the product (such as eye irritation) is provided.

  • Real life stories of cervical cancer
    The National Cervical Cancer Coalition has a section of their website for cervical cancer survivors, and it includes stories about the disease contributed by survivors. The most recent stories are on this page, but you may want to click on the years (listed in the lower right) for additional and older contributions.

    The American Cancer Society also hosts a website called The Cancer Survivors Network, which includes stories and artwork as well as personal web pages from survivors. Users can search by cancer type to view only cervical cancer survivors' stories and materials. A free registration is required to view other's pages.

  • States considering abortion legislation
    The National Abortion Rights Action League (a pro-choice organization) has a state bill tracker on its website. Simply choose your state, and you will be able to view a list of pro-choice and anti-abortion bills, with the bill number, brief summary, sponsor name, date it was introduced, last action, and last action date.

  • Midwifery programs
    The American College of Nurse-Midwifery provides a pretty good list of graduate programs in nurse-midwifery (including the program at Vanderbilt), and has a brief list of freestanding institutions. This website provides a list of education programs for direct-entry midwifery, including a Tennessee program at The Farm. For midwifery programs in other countries, you can find a lot by doing a Google search for "midwifery training" or "midwifery schools".

  • My sister-in-law's vagina
    Nope, can't help you on that one.

    Previous installments:
    Search Request Roundup #1
    Search Request Roundup #2
    Search Request Roundup #3


    Now, the 3rd installment of my answers at Yahoo! Answers:
  • How many people get vulvar cancer each year?
    According to the American Cancer Society, "vulvar cancer accounts for about 4% of cancers in the female reproductive organs and 0.6% of all cancers in women. The American Cancer Society estimates that in the year 2006, about 3,740 cancers of the vulva will be diagnosed in the United States, and about 880 women will die of this cancer."
    Detailed Guide: Vulvar Cancer - American Cancer Society
    General Information About Vulvar Cancer - National Cancer Institute

  • Top ten leading causes of death in the USA and the world
    Based on 2002 CDC data, the top 10 causes of death in the United States are heart diseases; cancer; cerebrovascular disease; chronic lower respiratory diseases; accidents; diabetes mellitus; influenza & pneumonia; Alzheimers disease; nephritis, nephrotic syndrome & nephrosis; suicide. The data is available in a table as a PDF. The CDC provides additional US mortality data at http://www.cdc.gov/nchs/deaths.htm.

    As for global causes, The World Health Organization has a table ranking the most deadly conditions in the world at http://www.who.int/features/qa/18/en/. These are somewhat different and include conditions such as HIV/AIDS, tuberculosis, and malaria.

  • Information on a bone disease called mms
    There is a cancer called multiple myeloma that begins in the blood cells and affects the bones.
    What You Need to Know About Multiple Myeloma - National Cancer Institute
    Intro to Myeloma - Multiple Myeloma Research Foundation

  • History of informed consent
    The National Cancer Institute provides A Guide to Understanding Informed Consent, which includes a section on its history. The Office of NIH History also provides a timeline of laws related to the protection of human subjects.

    Technorati Tags: ; ; ; ; ; ; ; ; ; ; ;
    MeSH Tags: Abortion, Induced/legislation and jurisprudence; Cause of Death; Ethics, Research/history; Herbicides/adverse effects; Informed Consent/history; Midwifery/education; Mortality; Neoplasms/chemically induced; Uterine Cervical Neoplasms; Vulvar Neoplasms; World Health
  • Efforts to Reduce Unnecessary C-Sections

    The REDUCE campaign of the American College of Nurse-Midwives and allies seeks to call attention to the rising C-section rate in America, and explains that its primary aim is "to compel the United States Congress to scrutinize this issue and examine the various factors underlying the rise in Cesareans in this country. Congress should be concerned about the direct and indirect costs associated with Cesarean section (one of the most frequently performed medical procedures in this country), the impact the increased rate of surgery having on publicly financed health care systems such as Medicaid, and the long-term health implications for mothers and babies."

    The campaign's frequently asked questions document (PDF) further explains the issue, and provides the following info:
  • "1.2 million cesarean sections are done each year and cost $14.6 billion in 2003.1 Cesarean section is the number one most common hospital procedure performed in this country, according to the Agency for Healthcare Research and Quality."
  • “The cesarean delivery rate rose 6 percent in 2004 to 29.1 percent of all births, the highest rate ever reported in the United States. The rate has increased by over 40 percent since 1996. For 2003–04 the primary cesarean rate rose 8 percent, and the rate of vaginal birth after cesarean delivery (VBAC) dropped 13 percent. The primary rate has climbed 41 percent and the VBAC rate has fallen 67 percent since 1996, according to the National Center for Health Statistics."
  • "No research has been done to quantify the risk of elective (no medical indication) primary cesarean section compared to the risk of normal vaginal birth. Thus, providers must refrain from claiming that cesarean sections are as safe as or better than normal vaginal births."

    Additional information is available on the REDUCE site, including risks of C-section, resources for local advocacy, and consumer-friendly information.

    ACNM's partners in the REDUCE campaign include the American Association of Birth Centers, Citizens for Midwifery, the Coalition for Improving Maternity Services, the International Cesarean Awareness Network, and Lamaze International.

    Childbirth Connection recently released preliminary results from a survey of over 1,000 US women who gave birth in 2005. Among the findings, as reported in this press release (PDF):
  • "Eight-one percent of mothers stated that before consenting to a cesarean section, it is necessary to know every possible complication, and 17% felt it necessary to know most complications."
  • "Close to half of survey participants (42% to 45%) were "not sure" about how to reply to four statements about complications of cesareans, and 21% to 33% responded incorrectly."
    (It's not clear whether these results are only among the women who had c-sections, which would make a difference in the interpretation of the results.)

  • "Just 12% of women with a previous cesarean had a VBAC. Of the remaining women who had a repeat cesarean, 45% were interested in the option of VBAC, but more than half (56%) of them were denied this option, primarily because their caregiver (45%) or hospital (23%) was unwilling to do a VBAC."
    (It's not clear how many of these women should legitimately have been denied VBAC, which makes a difference in what these results mean as well.)


    The results of the survey are being interpreted as indicating that many women are not in fact choosing elective c-section, but may be persuaded to have them when there is insufficient evidence that they are needed and women may perhaps not be fully informed of the risk. More information on the survey is available here, and Kaiser network coverage is online here.

    Additional Resources:
    Cesarean Section - MedlinePlus
    What You Need to Know About Cesarean Birth - March of Dimes Foundation
    Vaginal Birth After C-Section - MayoClinic.com
    Fastats A-Z: Obstetrical Procedures - National Center for Health Statistics
    Cesarean Section: A Brief History - online exhibit from the National Library of Medicine

    Thanks go to Tim Clarke Jr, who is certainly doing his job as Associate Director of Communications for the American College of Nurse-Midwives, for pointing me to the REDUCE information.

    Technorati Tags: ; ;
    MeSH Tags: Cesarean Section/statistics and numerical data; Cesarean Section, Repeat/statistics and numerical data; Vaginal Birth After Cesarean
  • Opportunity to Join the Bone Marrow Donor Registry

    On Monday and Tuesday, Vanderbilt is holding a marrow donor registration drive which is open to the public. The announcement is below:

    VANDERBILT STUDENTS MEETING FOR THE AWARENESS OF CANCER PRESENTS A BONE MARROW DONOR REGISTRATION DRIVE

    Monday, March 27th. 12noon -8pm
    Tuesday, March 28th 9am-3pm
    Location -Vanderbilt Student Life Center - 25th Ave South & Garland Ave. http://www.vanderbilt.edu/studentlifecenter/directions.html

    Marrow Donor REGISTRATION Drive (requires a small blood sample)
    (This event will include an optional blood drive for those who wish to donate a unit of blood)

    FREE PIZZA and T-shirts, and hourly prize drawings include:
    A night for 2 at the Loews Hotel + dinner
    dinner for 2 at Sunset Grill
    gift certificates to Carrabbas, Starbucks, and more!

    For questions, email: marrowthon@gmail.com or call Helene Di Iorio 421-5922 or on campus 1-5922

    To PREREGISTER (will reduce wait time at the drive) and for more information, go to: http://sitemason.vanderbilt.edu/site/fukdeE

    Registration on the National Bone Marrow Donor List only requires a very small blood sample and you will be kept on the list until age 61. The chances of finding a bone marrow match for a transplant is 1 in 20,000 so the more people who are registered, the more lives that can be saved. There are thousands of people across the country in desperate need of a marrow transplant to save their life. ALSO, those who normally can't donate blood due to weight limitations, anemia, certain medications, etc. can still join the marrow donor list. Many of the restrictions for blood donation do not apply to bone marrow registration.

    Sponsored by:
    Vanderbilt Students Meeting for the Awareness of Cancer
    Vanderbilt Intercultural Affairs & Diversity Education
    Vanderbilt SGA Multicultural Committee
    Vanderbilt Dining Services
    Brentwood Rotary Club
    Sigma Chi
    Signing up for the registry typically costs $70 - the fee has been waived thanks to the sponsors above. Participants are asked to consider donating a pint of blood while they're there.

    Marrow Donation Resources:
    National Marrow Donor Program
    Donor Information - National Marrow Donor Program
    Donor FAQs - National Marrow Donor Program
    Factors to Consider Before Joining - National Marrow Donor Program
    Diseases that may be treated by a bone marrow or cord blood transplant - National Marrow Donor Program
    Bone Marrow Transplantation - MedlinePlus
    BMT and Peripheral Blood Stem Cell Transplantation - National Cancer Institute
    How to be a bone marrow or blood stem cell donor - MayoClinic.com
    Blood and Marrow Stem Cell Transplantation - The Leukemia & Lymphoma Society

    Full disclosure: I have not yet personally committed to joining the registry. Before doing so, I want to be absolutely sure that if I matched to someone needing a transplant, I would be willing and able to donate (you make the decision as a match is found), regardless of the needed method of donation. There are two ways donation can be done; one involves drugs and blood removal via the arm (similar to donating blood), while the other requires anesthesia and insertion of a hollow needle into the pelvic bone. I'm not yet willing to commit to going through the second, surgical procedure. Because suitable matches can be very difficult to find, I would feel obligated to donate if I were ever to match to someone. It doesn't seem fair to the patient otherwise. I don't want to discourage anyone from joining the registry. If you plan to do so, though, please talk it over with your family, consider the risks, and don't do it just because I posted about it.

    Technorati Tags: ; ;
    MeSH Tags: Bone Marrow; Bone Marrow Cells; Bone Marrow Transplantation; Tissue Donors

    Wish This Had Been Around 4 Years Ago...

    The National Women's Health Information Center has a news piece up, "New Thyroid Surgeries Require Smaller Incisions," which says, "Both techniques use smaller neck incisions and speed patient recovery. One method is minimally invasive thyroidectomy, in which surgeons work through an incision about half the size of the usual three-to-four inch incision used in standard surgery. The other method uses an even smaller incision to provide access for a thin, ultrasonic scalpel that's guided by a tiny video camera at the tip of the instrument." It also says that about 30% of patients will still require the standard approach (i.e. the 3-4 inch neck incision).

    Your women's health blogger (thyroid diseases are more likely to occur in women) had thyroid surgery in late 2001 for a hyperfunctioning ("hot") nodule. This basically means that there was a chunk of my thyroid that was cranking out hormones independently of what my brain/body said I needed. It can be much like hyperthyroidism, but perhaps not as straightforward - other non-nodule parts of the thyroid just shut down. The physical/psychological symptoms are pretty harsh, including rapid heart rate (once clocked at 115 bpm, resting), nervousness, always being hot and sweaty (sometimes didn't need a coat in winter close to Lake Erie), anxiety, irritability, tremor, sleeping problems, fatigue, muscle weakness, changes in menstrual and bowel patterns, and changes in appetite. The fatigue was sometimes overwhelming. Luckily, I eventually found an excellent endocrinologist, who figured out the problem and sent me for surgery, the result of which being that the remaining parts of my thyroid work as expected with no meds needed.

    So what is the thyroid surgery experience like? It's fairly uncomfortable. I had previously had surgery for a knee injury, which was a quick in and out thing. The thyroid operation requires overnight observation in case of swelling that can cause breathing problems. In fact, they put a tracheotomy kit in the hospital room just in case. This really disturbed my parents, but a good friend who had worked in a hospital warned me of this before I went in so I was expecting it (thanks, Vickie!). The worst part is the positioning - they have your neck elevated and your head back throughout the procedure, resulting in one hell of a sore neck. Beyond that, the IV was the most irritating, because medical tape causes me to have red, swelling, painful skin.

    So, anybody wanna see my scar? :)

    Resources:
    American Thyroid Association
    My Endocrine Disorder - American Association of Clinical Endocrinologists
    Thyroid Nodules - MayoClinic.com
    Thyroid Diseases - MedlinePlus
    Thyroid Surgery - Interactive Tutorial
    Thyroid Disorders and Treatment - Thyroid Foundation of America

    Technorati Tags: ;
    MeSH Tags: Thyroid Gland/surgery; Thyroid Nodule/surgery

    Friday, March 24, 2006

    Almost Makes Sense: More TN Abortion Legislation

    The Tennessee State Senate voted yesterday (29-0) to approve SB2993, which amends the TN Code (Title 39, Chapter 15, Part 2) to require that any person who performs an abortion on a minor less than 13 years of age to preserve a fetal tissue sample which must then be submitted to the Tennessee Bureau of Investigation or a lab designated by the TBI, along with the complete name and address of the minor obtaining the abortion and the same information for a parent or legal guardian. The stated intent for this bill is to preserve evidence (fetal tissue) that can be used in prosecuting rapes.

    That seems rather reasonable, given that a 13-year-old cannot legally consent to sex. What is not clear is what issues this raises about ownership of the fetal tissue, what privacy rights apply when the information is taken out of the medical setting and handed over to the TBI, and why this bill wasn't extended to cover all minors. According to the TN Code [39-13-506], statutory rape is defined as "sexual penetration of a victim by the defendant or of the defendant by the victim when the victim is at least thirteen (13) but less than eighteen (18) years of age and the defendant is at least four (4) years older than the victim." This would seem to prove that we consider 13-17 year olds to also be incapable of legally consenting to sex, and they can certainly also be raped in the non-statutory sense. If there is a genuine interest in prosecuting individuals who rape minors, why would the bill not cover those in the 13-17 age range? Why would it not also protect adult women who are raped and seek abortion?

    The TN House has not yet voted on the bill - Bill status information
    (found via the Kaiser network)

    Technorati Tags: ; ; ;
    MeSH Tags: Abortion, Induced/legislation and jurisprudence; Rape/legislation and jurisprudence

    Women's Health-Related Events at Vanderbilt

    For the upcoming World Health Week, Vanderbilt is hosting several lectures, a couple of which may be particularly relevant to women's health. The following events will begin at noon and take place in 208 Light Hall.

    Wednesday, March 29
    "Contraception/HIV links: What we know about the overlapping fields of family planning and HIV prevention," Willard Cates Jr., M.D., M.P.H., president and CEO of Family Health International's Institute for Family Health. Cates, who formerly directed the Division of STD/HIV Prevention at the Centers for Disease Control and Prevention, also chairs the executive committee of the National Institutes of Health's HIV Prevention Trials Network (HPTN)."

    Friday, March 31
    "Beyond Stereotypes: The Feminization of the HIV Pandemic," Quarraisha Abdool Karim, Ph.D., associate professor of Epidemiology at Columbia University's Mailman School of Public Health. Abdool Karim directs the Columbia University-Southern African Fogarty AIDS International Training and Research Program (AITRP), and the Women and AIDS program at CAPRISA (Center for the AIDS Program of Research in South Africa).


    The Margaret Cuninggim Women's Center at Vanderbilt is also hosting some relevant events:

    Tuesday, March 28
    The Margaret Cuniniggim Lecture: Sexuality, Spirituality, and Religion: What's the Connection?
    7pm in Vanderbilt's Wilson Hall room 103
    What: The Reverend Debra W. Haffner, an ordained minister and a
    sexologist for the past 30 years, will help us explore the
    connection between our sexuality and our faiths. Rev. Haffner will
    be speaking on topics such as: What does the Bible really say
    about sex? Why are so many religious institutions concerned about
    your sex life? What's the new movement for sexual justice in faith
    communities?
    Co-sponsored with Women and Gender Studies, The Carpenter Program
    in Religion, Gender and Sexuality, The Chaplain's Office, and CABLE.
    Who: This event is free and open to the public.
    For more information, contact katie.protos@vanderbilt.edu

    Ongoing
    Making Connections: A discussion group about Body Image.
    What: Come join a discussion group to learn about making closer
    connections with others, your body, and most importantly -
    yourself. Topics may include body image, intimate relationships,
    self confidence, managing anxiety and stress, and many others.
    Come check it out. Confidential.
    Who: Free and open to anyone 18 and up with an interest in these
    issues.
    For more information and location: call Pamela
    Fishel-Ingram, Ph.D. at 343-3561 or email
    pamela.ingram@vanderbilt.edu, or call the Women's Center at
    322-4843.

    Technorati Tags: ; ; ; ; ; ;
    MeSH Tags: Body Image; Contraception; HIV; Religion and Sex

    Thursday, March 23, 2006

    Woo-hoo!

    For my April graduation with a Masters in Library and Information Science, I got tickets to the upcoming Ani Difranco show at the Mercy Lounge. Wheeeee!

    (Uh, there are some Ani songs that are relevant to women's health, I swear)

    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."

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

    Sunday, March 19, 2006

    Midwifery & Doula Blogs

    There is a growing set of blogs by and about midwives, doulas and midwifery students. Here's a sampling:

  • 20 Years of Birth Stories
  • A Womb of Her Own: Stumbling Towards Midwifery
  • Babycatcher - stories from Africa
  • Becoming a Midwife: a journal of self-exploration
  • Belly Tales: The Diary of a Student Midwife
  • Birthing Bliss: Aerlyn's Adventures in Midwifery
  • Doulicia
  • Dreams of Midwifery: A midwifery student's journey...and current midwifery and birth news
  • Midwife: Sage Femme, Hebamme, Comadrona, Partera: The insights, passions and opinions of a homebirth midwife and mother
  • Midwiffle Seed: Emotional, spiritual and intellectual growth within the ancient art of midwifery
  • RedSpiral
  • Sarah the Doula
  • Vancouver Doula

    Technorati Tags: ; ; ; ;
    MeSH Tags: Midwifery; Nurse Midwives; doula* [keyword search]
  • Clits and Giggles

    Two brief things I came across this week whose slogans made me laugh:

    Clitoris Celebration: Think Outside the Box
    Unbeknownst to me (and found via Feministing), "March 20 of every year is International Clitoris Day Celebration." The Julia Morgan Center for the Arts in Berkeley, CA hosted an event yesterday to celebrate, featuring Annie Sprinkle (NSFW). The sponsoring organization is Global Women Intact, which has a serious mission: to "end female circumcision through education, information, and alternative form of initiation ceremony."

    No Room for Contraception, Always Room for Love
    Also via Feministing, the site's purpose is to "expose the potential harms that contraception, birth control and sterilization bring to marriage and society. NRFC believes that the greatest goods of the sexual act are both the procreation of children and the union of the spouses." The site goes on to say, "The use of contraception has created a society that does not welcome children as the natural outcome of the sexual act" and "While some purport that contraception enables a couple to 'carefully plan' the births of their children, the use of a barrier or chemical rather than abstinence from the marital act redefines the function and purpose of sexual intercourse." The group also advocates "'sidewalk counseling' at pharmacies giving out information on the harms of birth control" and says "What women do and want will be decisive in determining whether the West survives the demographic clash with Islam." Okay, that's not nearly as funny as the slogan.

    Resources:
  • Female Genital Mutilation - World Health Organization
  • Female Genital Cutting - National Women's Health Information Center
  • Female Genital Mutilation: Legal Prohibitions Worldwide - Center for Reproductive Rights
  • Female Genital Mutilation: A Human Rights Information Pack - Amnesty International
  • Female Genital Mutilation - UNICEF
  • STOPFGM
  • Prevalence of FGM - U.S. Department of State
  • Female Genital Cutting - USAID
  • Female Genital Mutilation - American Academy of Pediatrics Bioethics Committee policy statement
  • MedlinePlus: Birth Control - National Library of Medicine

    Technorati Tags: ; ; ; ; ; ;
    MeSH Tags: Circumcision, Female; Contraception; Human Rights
  • Medical Abortion Deaths

    Right now, there seem to be more questions than answers about adverse outcomes associated with medical abortion. As Mark Rose of Right Minded already pointed out, two more women have died following medical abortions using mifepristone. Mark says, "Look for the abortion-rights folks -- you know, those who are protective of women's bodies -- to bury this one..." Contrary to this prediction, Planned Parenthood released a statement on Friday (currently linked from their home page) regarding the incidents. PPFA has responded by changing their protocol, stating, "Our health centers will no longer recommend the option of administering misoprostol vaginally (misoprostol is the second drug in the two-drug medication abortion regimen). Patients will now receive misoprostol orally or buccally (where the pill is placed between the cheek and gum and dissolves). This change in protocol is effective immediately." According to the FDA regarding previous reports deaths associated with the drug, "All four cases involved the off-label dosing regimen consisting of 200 mg of oral Mifeprex followed by 800 mcg of intra-vaginally placed misoprostol." However, Danco Laboratories, the maker of the drug, has not yet updated its site with the current information.

    This is an interesting story on several points. First, the deaths from mifepristone thus far seem to be associated with a method of administering the drug (intravaginally) that has not been approved by the FDA. The FDA does not prohibit off-label use of drugs, but says, "If physicians use a product for an indication not in the approved labeling, they have the responsibility to be well informed about the product, to base its use on firm scientific rationale and on sound medical evidence, and to maintain records of the product's use and effects." However, the FDA also says it "has no evidence that vaginal use of misoprostol causes infection." Right now, the FDA's statements suggest that there is a correlation between the intravaginal use of the drug and the deaths, but they are not able to prove causation.

    So, what information led prescribers to use the drug intra-vaginally? Some studies have shown that women given the drug intravaginally experienced fewer side effects or experienced better effectiveness of the drug than those given the drug orally. Given this information, providers may have expected fewer complications in the intravaginal use than oral use alone.

    Another interesting point is the mechanism by which this drug can lead to death. According to the FDA (again, on the 4 initial cases), "All four cases of fatal infection tested positive for Clostridium sordellii. In addition, FDA tested drug from manufacturing lots of mifepristone and misoprostol and found no contamination with Clostridium sordellii." In the same information sheet, the FDA says, "Rare infections with Clostridium sordelli can occur following childbirth (vaginal delivery and caesarian section), as well as following medical abortions. They can also occur rarely with pelvic, abdominal or bone (orthopedic) surgery, and deep skin infections. The bacteria may also be present in women’s intestinal and rectal areas and cause no symptoms whatsoever, not producing any toxins. This is called 'colonization' and is not known to be a health problem. It is unclear exactly what factors cause the bacteria to produce the toxins in women." Essentially, the FDA is saying that each woman tested positive for the bacteria, infection can occur either with medical abortion, vaginal birth, or c-section, and it's not proven that intravaginal use was the cause. It seems that we need a bit more information on what exactly is going on in these cases. With better understanding of how the toxin is produced and individual risk factors, providers should be able to make better decisions with their patients.

    The third point that I've seen little discussion of is how dangerous this drug is compared to surgical abortion or childbirth, or compared to other drugs. The FDA states, "Reports of fatal sepsis in women undergoing medical abortion are very rare (approximately 1 in 100,000)." This table from the 2005 Health, United States report lists the 2002 maternal mortality rate as 7.6 per 100,000 live births. This would suggest that of 100,000 women who either have medical abortion or a live birth, live birth is more deadly to women, although more information is likely needed. Information on mortality rates for other prescription drugs was not readily available, but would be interesting to compare.

    One thing I didn't know until I started looking into this is that mifepristone has been looked at as a treatment for endometriosis and several cancers and is currently being investigated for use in other conditions, including whether it improves the outcome of electroconvulsive therapy in patients with major depressive disorder, how it might affect prostate cancer, and effects on uterine leiomyomas. Meanwhile, bills have been introduced in the House (HR1079) and Senate (SB511) to have the FDA's approval of the drug withdrawn.

    Some resources:
  • FDA Public Health Advisory: Sepsis and Medical Abortion Update, March 17, 2006 - U.S. Food & Drug Administration
  • Questions and Answers on Mifeprix (Mifepristone) - U.S. Food & Drug Administration
  • Mifiprex (mifepristone) Information - U.S. Food & Drug Administration
  • MedlinePlus Drug Information - Mifepristone - National Library of Medicine/MedMaster
  • Risks of Mifepristone Abortion in Context - March 2005 Contraception editorial
  • What You Need to Know: Mifepristone Safety Overview - Association of Reproductive Health Professionals
  • Two More Women Die after Taking "Abortion Pill" - cnn.com

    Technorati Tags: ; ; ;
    MeSH Tags: Clostridium sordelli; Mifepristone
  • Friday, March 17, 2006

    The Breast Cancer Site - Click for Mammograms

    If you're not already familiar with it, The Breast Cancer Site allows users to click on a button once daily to raise funds for the National Breast Cancer Foundation to provide free mammograms (see Charity Navigator's assessment of NBCF). This does not cost you anything - funds are raised by your clicks through the presence of site sponsors. Answers to frequently asked questions about the site are available here. The site does utilize pop-unders, but these are limited and are part of the fundraising ability of the site.

    Accessible from The Breast Cancer Site are other similar one-click charity opportunities, via the Hunger Site, Child Health Site, Literacy Site, Rainforest Site, and Animal Rescue Site. You can visit each of these individually to see where the money goes.

    Technorati Tags: ; ;
    MeSH Tags: Breast Neoplasms/diagnosis; Charities; Mammography

    FDA Approves Device for Detection of Cervical Pre-Cancer

    The FDA issued a press release yesterday announcing its approval of an imaging system to improve detection of pre-cancerous cervical cells using light for women with abnormal Pap test results. Intended for use alongside colposcopy, the "LUMA Cervical Imaging System shines a light on the cervix and analyzes how different areas of the cervix respond to this light. The LUMA Systems assigns a score to tiny areas of the cervix and produces a color map that helps the doctor decide where to biopsy. The colors and patterns on the map help the doctor distinguish between healthy tissue, and potentially diseased tissue."

    Additional information on the device is available here. The summary of safety and effectiveness, and labeling details, which the FDA requires for devices as well as drugs, are not yet available but will be at http://www.fda.gov/cdrh/pdf4/p040028.html when available.

    Technorati Tags: ; ;
    MeSH Tags: Diagnostic Imaging; Equipment and Supplies; Uterine Cervical Neoplasms/diagnosis; Vaginal Smears

    Thursday, March 16, 2006

    NIH to Hold Conference on Elective Cesarean

    The National Institutes of Health will hold a conference to "weigh the available scientific evidence regarding the risks and benefits of Caesarean delivery on maternal request (also referred to as elective Caesarean delivery) on March 27 – 29. The panel will issue a statement of its findings on the final day and will hold a press conference at 2:00 p.m. on Wednesday, March 29."

    Questions to be addressed by the panel include:
  • What is the trend and incidence of Caesarean delivery over time in the United States and other countries?
  • What are the short-term (under one year) and long-term benefits and harms to mother and baby associated with Caesarean by request versus attempted vaginal delivery?
  • What factors influence benefits and harms?
  • What future research directions need to be considered to get evidence for making appropriate decisions regarding Caesarean on request or attempted vaginal delivery?

    The conference will be webcast live at http://videocast.nih.gov/.

    Technorati Tags: ; ;
    MeSH Tags: Cesarean Section/trends OR /utilization; Surgical Procedures, Elective
  • Menstrual Blood May Be Good Stem Cell Source

    Preliminary findings reported at the Scientific Sessions of the American College of Cardiology suggest that stem cells from mentrual blood may be a good source of cardiomyocytes (heart muscle cells), and may be a better source than bone-marrow derived stem cells. Endometrial stem cells were harvested from the stem cells of 6 women, after which researchers "were able to obtain 30 million stem cells from a single menstrual blood cell, compared with a rate of approximately one million stem cells from marrow-derived blood cell." Slightly more information is available via the Medscape website; you will need a login, but may borrow one from BugMeNot.

    Technorati Tags: ;
    MeSH Tags: Endometrium; Menstruation; Myocytes, Cardiac; Stem Cells

    Global Children's Health Event in Nashville

    On Thursday, March 30, the Scarritt Bennett Center will host "Rx for Child Survival," a discussion forum with speakers "which zeroes in on global healthcare for children, and discover what you can do to easily make a dramatic and positive difference on an issue that affects everyone." Speakers are Stephanie B.C. Bailey, M.D. (Director of Health, Metro Public Health), Sten Vermund, M.D. (Director of Vanderbilt University Institute for Global Health), and Mario Rojas, M.D. (Neonatologist and Researcher, Vanderbilt Children’s Hospital). This evening event is free and open to the public; more details are available here.

    Technorati Tags: ; ;
    MeSH Tags: Child OR Child, Preschool; Public Health

    Wednesday, March 15, 2006

    Study Examines Emergency Contraception Availability

    A study in the current issue [April 2006; 73(4): 382-385 - view the abstract] of the journal Contraception surveyed 186 pharmacies who agreed to participate (out of 204 contacted) with regards to the availability of emergency contraception. The pharmacies were located in the northeastern region of Pennsylvania and consisted of 93 in urban counties and 93 in rural counties. 54% of those sampled were nationally recognized chain stores. The pharmacists who agreed to participate were asked about whether emergency contraceptives were in stock (and if not, why), type of EC in stock, price for uninsured patients, and accessibility (weekend hours, etc.).

    Among the reported results:
  • "Out of the 186 participating pharmacies, only 60 (32%) pharmacies had EC in stock. Whether pharmacies carried EC in stock did not significantly differ by urban vs. rural location (30% vs. 34%, p=.64) or by chain vs. nonchain designation (33% vs. 32%, p=.63)."
  • "Pharmacies stocking EC were most likely to carry Plan B® only (77%), with 12% stocking Preven® only and 12% stocking both Plan B® and Preven®. "
  • "The median cost of Plan B® and Preven® for uninsured clients was $33 and $30, respectively, which did not significantly differ between urban and rural pharmacies."
  • "Of the pharmacies stocking EC, urban pharmacies were significantly more likely than rural pharmacies to be open after 6 p.m. on weeknights (93% vs. 63%, p=.01). Rural pharmacies were less likely to have store hours on both weekend days, but the difference was not significant (63% vs. 44%, p=.19)."
  • Of pharmacies not stocking EC, the reasons cited were as follows: no perceived need (61%); don't know (12%); against store policy (9%); against personal beliefs (8%); do not know what EC is (3%); temporarily out of stock (3%); other (4%). This result suggests that women may need to be more vocal in informing pharmacies of the need for available emergency contraception, given that "no perceived need" was the most popular rationale for not stocking the drug.

    The results also include information on what the pharmacist would tell patients if EC was not in stock, with many stating they would tell the woman to go to another pharmacy. Somewhat shockingly, "Other responses included 'we don't carry it because we are a prolife store' and 'we would tell her to have the baby.'"

    Technorati Tags: ; ; ; ;
    MeSH Tags: Contraception, Postcoital; Levonorgestrel
  • Status of HPV Vaccine and Cervical Cancer Prevention

    The current issue of the New England Journal of Medicine contains a Perspective piece authored by Dr. Robert Steinbrook entitled, "The Potential of Human Papillomavirus Vaccines" (free full-text available). Steinbrook explains the advance an HPV vaccine could represent with regards to preventing cervical cancer, as well as some anal, penile, vaginal, and vulvar cancers. The investigational vaccines in development by Merck and GlaxoSmithKline are described; questions about the vaccine's long-term effectiveness, appropriate age of administration, and public response are also outlined.

    A second, related piece in this issue of the NEJM is entitled, "Preventing Cervical Cancer in the Developing World" (also free full-text). The authors state, "Most women in low-income countries do not have access to routine screening: only 5 percent have undergone a Pap smear in the past five years.1 In parts of Latin America and the Caribbean, more women die from cervical cancer than from complications of childbirth" and explain that, "In the United States, rates of cervical cancer have fallen by 75 percent since the Pap smear's introduction more than 40 years ago." The authors, who are likely correct, point out that at at an estimated $300 to $500 per course, women most in need of the vaccine may not have access to it. Perhaps less correctly, the authors state, "In addition to cost, there is the worry that the vaccine could have a negative effect on screening — offering false security to vaccinated women, who may incorrectly believe that they no longer need to undergo Pap smears." This is an issue that is not at all limited to "the developing world" - all women will need to understand what the vaccine can and cannot do, regardless of nationality. With their statement, the authors come very close to implying that this concept cannot be communicated to women who are underprivileged due to some deficiency of the women themselves.

    In related news, although a representative of the conservative Family Research Council was previously quoted as stating, "Giving the HPV vaccine to young women could be potentially harmful, because they may see it as a licence to engage in premarital sex," the organization released a statement on February 21st in support of the vaccine. One interesting point of the release: "We are grateful to representatives of both Merck and GlaxoSmithKline for taking time to meet with us at the Family Research Council to explain their goals in developing these vaccines and their plans for the marketing and distribution of them." It's intriguing to me that pharmaceutical corporations felt it necessary to "explain their goals" to a non-healthcare-focused organization due to the concern of some that such a vaccine would encourage sexual activity, while the primary purpose of the vaccine is clearly not to prevent all STDs or give the "go ahead" for unprotected sex, but to prevent a common and deadly cancer caused by the virus.

    Resources:
    Cervical Cancer Prevention - National Cancer Institute
    The Pap Test - Questions and Answers - National Cancer Institute
    Cervical Cancer Treatment - National Cancer Institute
    Human Papillomavirus (HPV) and Genital Warts - National Women's Health Information Center
    Frequently Asked Questions About Human Papilloma Virus (HPV) Vaccines - American Cancer Society
    What Every Woman Should Know About Cervical Cancer and Human Papilloma Virus - American Cancer Society
    HPV vaccine clinical trials - ClinicalTrials.gov

    Technorati Tags: ; ;
    MeSH Tags: Papillomavirus, Human/immunology; Uterine Cervical Neoplasms/prevention and control; Vaccination

    Book Review: Unequal Treatment

    Nechas E, Foley D. Unequal treatment: what you don't know about how women are mistreated by the medical community. New York, NY: Simon & Schuster, 1994.

    Unequal Treatment explores the ways in which women are overlooked or affected by medical treatment and research, with in-depth chapters exploring issues of medical education, clinical research, heart disease, breast cancer, AIDS, aging, mental health, violence, addiction, poverty, maternal and fetal rights, and the sexual abuse of patients. For each of these topics, biases in research and thought affecting women's care are described, along with commentary from experts in the field, women's personal stories, and historical details. Although Unequal Treatment is now outdated, the text serves as an intriguing reference work for anyone interested in women's health or who wonders why a focus on women's health in particular is necessary.

    This work does have certain limitations. Although each chapter is packed with references to studies, documents, events, and individuals, the actual citations are not numbered or noted in the text, and appear only as a chapter-by-chapter list of "Key Sources" at the end of the book. This arrangement makes it very difficult for the interested reader to verify the authors' statements or view the cited facts in their original contexts. This is especially troubling when the authors make statements along the lines of a particular inequity which "may be the result of" or "many women experience" - it is unclear to the reader whether these statements are backed up by any research, or are simply matters of opinion. The authors also gloss over certain topics which may have been more in the public consciouness at the time of publication, such as problems with the Dalkon Shield contraceptive device. Finally, Unequal Treatment focuses almost exclusively on the 1980's and 1990's in the United States, ignoring broader historical context and the state of women's health in other nations.

    Despite these limitations, Unequal Treatment is an excellent primer on the problems which American women recently experienced and still face with regards to the healthcare system. Sometimes shocking and saddening, this work will be informative and eye-opening for almost any reader.

    Technorati Tags: ; ;
    MeSH Tags: Books

    Sunday, March 12, 2006

    Search Request Roundup #3

    This is the third installment of Search Request Roundup, in which I look at recent searches that led to my blog and provide some information on the desired topics.

  • Videos of Childbirth:
    There aren't a lot of free educational videos of birth online. There may be some interesting results in this You Tube search for videos tagged "birth," although they're likely to be personal videos. I found some resources that are more instructional available for purchase at the Amazon website, in both DVD and VHS.

    An interactive tutorial on vaginal birth is available from MedlinePlus. The MayoClinic.com website provides an animated slideshow of labor positions. Also via MedlinePlus is a surgical video of birth by c-section. The American Pregnancy Association provides a lot of text information on labor and birth as well.

  • Federal guidelines for prophylactic mastectomy:
    The National Guidelines Clearinghouse is an excellent starting point for evidence-based guidelines. Ten mastectomy-related guidelines are available, although none of them focus specifically on prophylaxis. The National Cancer Institute and MayoClinic.com provide additional information on this topic, and explain when women might consider this procedure.

  • Planned Parenthood in Memphis:
    Planned Parenthood's website offers a nationwide health clinic finder online. The website of the Memphis Regional Planned Parenthood is at http://www.plannedparenthood.org/pp2/mmp/; click here for the address, phone number, and hours of the Memphis clinic.

  • 2005 articles on women’s health:
    There are numerous articles on all aspects of health published every year, and numerous aspects of women's health, so this is hard to narrow down. Some popular academic/research journals related specifically to reproduction are: American Journal of Obstetrics & Gynecology; BJOG; Current Opinion in Obstetrics & Gynecology; Fertility & Sterility; Journal of Midwifery & Women's Health; Midwifery. You'll need access to a library to view or order articles from these subscription publications.

    The Journal of the American Medical Association has a list of their top 25 most accessed 2005 articles. Of these, a few focus specifically on women's health issues: Consumption of Vegetables and Fruits and Risk of Breast Cancer (abstract; Effects of Estrogen With and Without Progestin on Urinary Incontinence (abstract); Vitamin E in the Primary Prevention of Cardiovascular Disease and Cancer: The Women's Health Study: A Randomized Controlled Trial (abstract); Outcomes of Routine Episiotomy: A Systematic Review (abstract); Screening for Breast Cancer (abstract).

    Finally, the National Women's Health Information Center often summarizes results of new studies related to women's health; their health news archive is available for free online.

  • Female teenagers cortisol levels:
    Lab Tests Online is a good starting point for understanding various medical lab results. The section on cortisol indicates that a standard reference range (i.e. the levels it should fall between) has not been established, but provides explanation of what increased or decreased levels might mean. Also, here is a PubMed search for articles on the topic limited to English, female, and adolescents (13-18 years of age).

  • Scar tissue constipation c-section:
    I didn't find anything on constipation after C-section specifically related to scar tissue, although there are other possible adverse effects of the procedure. MayoClinic.com's page on the topic mentions that decreased bowel function can occur after the surgery, stating, "Any abdominal surgery may slow the transit of waste material through your large intestine for a few days. Some medications for pain relief may further contribute to this problem, leading to constipation."

    Previous Installments:
    Search Request Roundup #1
    Search Request Roundup #2

    Technorati Tags: ; ; ; ; ; ; ; ; ; ;
    MeSH Tags: Breast Neoplasms/prevention & control; Cesarean Section/adverse effects; Parturition OR Home Childbirth OR Natural Childbirth; Constipation; Hydrocortisone/diagnostic use; Laboratory Techniques and Procedures; Mastectomy; Planned Parenthood (keyword search)