Saturday, December 30, 2006

Pharmacists Help Diabetic Patients

The New York Times has an interesting piece today, New Job Title for Druggists: Diabetes Coach, which describes a program in Asheville, North Carolina to give free diabetes supplies and medications to municipal employees who agree to get monthly counseling from specially trained pharmacists. The city claims that as a result, "Within months of enrolling in the program, almost twice as many have their blood sugar levels under control. In addition, the city’s health plan has saved more than $2,000 in medical costs per patient each year." The pharmacists help the patients by reminding them of the importance of controlling the disease, answering questions, and identifying problems, solutions, and small steps the patients can take to improve their condition. Also from the story:
  • "During the first five years of the program, participants took an average of six sick days from work a year, half the number of previous years. Within three years of enrolling in the program, patients had halved their chances of going blind or needing dialysis or an amputation, a founder of the program said."
  • "What makes the Asheville Project unusual, the study found, is that at the end of the first year of the program, half the participants had their blood sugar under control. That number increased to two-thirds of the original group at the end of the program’s third year."
  • "John Miall, one of the founders of the Asheville program, who recently retired as the city’s director of risk management, said that within its first year the average annual health care cost for diabetic employees dropped to $3,554 from $6,127."

    Technorati Tags: ; ;
    MeSH Tags: Diabetes Mellitus; Disease Management; Pharmacists
  • On Health and Housework

    According to BBC News, "The research on more than 200,000 women from nine European countries found doing household chores was far more cancer protective than playing sport. Dusting, mopping and vacuuming was also better than having a physical job."

    The citation: Lahmann PH, Friedenreich C, Schuit AJ, Salvini S, Allen NE, Key TJ, Khaw KT, Bingham S, Peeters PH, Monninkhof E, Bueno-de-Mesquita HB, Wirfalt E, Manjer J, Gonzales CA, Ardanaz E, Amiano P, Quiros JR, Navarro C, Martinez C, Berrino F, Palli D, Tumino R, Panico S, Vineis P, Trichopoulou A, Bamia C, Trichopoulos D, Boeing H, Schulz M, Linseisen J, Chang-Claude J, Chapelon FC, Fournier A, Boutron-Ruault MC, Tjonneland A, Johnson NF, Overvad K, Kaaks R, Riboli E. Physical Activity and Breast Cancer Risk: The European Prospective Investigation into Cancer and Nutrition. Cancer Epidemiol Biomarkers Prev. 2006 Dec 19; [Epub ahead of print]
    The abstract is online, but you can also download the PDF for free.

    Let's take a look at the details, since you're unlikely to get those in the media reports of "Ladies! Do more housework! Forget about your careers! It's good for you, we swear!"

    Who was included: Women from several European countries. Most were invited from the "general population" (although it's not clear how or where they were recruited) and were 25-70 years old.

    Who was excluded: Women with any kind of existing cancer, missing questionnaire data, or on the extreme ends of energy intake, or who were surgically menopausal.

    How the study was done: Women completed questionnaires (in person or self-administered) about food and lifestile. "Anthropometric" measurements were obtained at enrollment in the study. The women were followed to see who got breast cancer, via the countries' population cancer registries, or by active follow-up (health insurance claims, contact with woman or next of kin, cancer/pathology registries). Women were followed from the time they entered the study until their first breast cancer diagnosis, death, emigration, or end of the follow-up period.

    What the questionnaires asked about: current occupational activity, employment status, and level of physical activity done at work; frequency and duration of nonoccupational physical activity during the past year, including housework, home repair, gardening, stair climbing, and recreational activities such as walking or cycling; vigorous physical activity; reproductive, sociodemographic, and lifestyle characteristics; age at menarche; age at first pregnancy; education; smoking status; alsohol consumption, BMI; oral contraceptive and hormone replacement therapy use. According to the authors, "Housework, home repair, gardening, and stair climbing were combined to obtain an overall estimate of household activity. Walking (including walking to work, shopping, and leisure time), cycling (including cycling to work, shopping, and leisure time), and sports activities were combined to derive overall recreational activity. Because the intensity of recreational and household activities was not directly recorded, a MET value was assigned to each reported activity according to the Compendium of Physical Activities."

    Findings: Data was analyzed for 218,169 women, ages 20-80, followed for an average period of 6.4 years.
  • There was no significant association between total physical activity and breast cancer risk in premenopausal women. In postmenopausal women, the authors report that increased total activity level was associated with decreased overall breast cancer risk, but this was not statistically significant, either.
  • Occupational activity was unrelated to breast cancer risk.
  • Regarding activity, the authors state:
    For total physical activity (i.e., combined occupational, recreational, and household activities), increasing activity level was associated with an overall decrease in risk of breast cancer in all women. Stronger and significant risk reductions became apparent for combined recreational and household activities and for household activity alone. Among postmenopausal women, compared with women in the lowest quartile of combined recreational and household activities, women in the top quartile had a 17% reduced risk of breast cancer after adjusting for multiple covariates. A similar risk reduction was observed in premenopausal women, but none of the individual categorical risk estimates reached statistical significance when adjusted for other risk factors. Household activity on its own was significantly inversely related to breast cancer risk in premenopausal and postmenopausal women; the HRs for the highest versus the lowest quartile of household activity were 0.71 (95% CI, 0.55-0.90) for premenopausal women and 0.81 (95% CI, 0.70-0.93) for postmenopausal women. Recreational activity alone was not significantly associated with risk.
    Keep in mind that "household activity" was defined not just as sweeping and dusting, but also to include home repair, stair climbing, gardening, etc. What the authors are asserting here is that postmenopausal women with the most household activity (among four levels) had a lower risk of breast cancer than those in the group with the least amount of household activity. They are also saying that this difference was not found to be significant in premenopausal women.
  • Also on activity:
    The individual activities, housework, home repair, gardening, stair climbing, walking, cycling, and sports activities, in MET-hours per week, were each inversely associated with breast cancer risk with nonsignificant trends, except for housework (Ptrend = 0.002, premenopausal women; Ptrend = 0.016, postmenopausal women) and sports activities (Ptrend = 0.01, postmenopausal women). Housework was the predominant component of household activity. On average, premenopausal women spent a mean (SD) of 17.7 (14.3) h and postmenopausal women 16.1 (13.2) h on housework chores. Vigorous activity, defined as MET-hours per week, was not significantly associated with breast cancer risk in either of the menopausal groups. Overall, <40% of all women engaged in vigorous activity (data not shown).
    What this tells you is that of the types of household activity, only housework and sports were associated with reduction in breast cancer risk. Vigorous activity was not associated with a decreased risk. Housework made up the biggest part of the household activity.

    Limitations of the study: The researchers only asked women about their activity levels for the past year compared to whether they got breast cancer in some relatively short-term later year. Not only is this subject to women's recollection or reporting of the events, it means that the authors cannot make statements about physical activity over a lifetime or longer period of time and breast cancer risk. The authors also report that studies in the U.S. and China that examined hours of household activity in a lifetime physical assessment found no association with breast cancer risk. In the French group of this study, women with 14 or greater weekly hours of light household activity did not have a significant decrease in breast cancer risk.

    Overall: In general, the authors are finding that regular non-intense physical activity may reduce risk of breast cancer. The authors specifically state that their findings require further confirmation, and only go so far as to say that "increasing physical activity reduces breast cancer risk." They do not suggest that work outside the home is bad for women, but state that moderate types of activities may benefit middle-aged and older women.

    The Bottom Line: As often occurs, the hype over this study is not warranted given its actual conclusions. The women in this study were doing an average of 16-17 hours of housework per week, and it is likely to be the regularity of activity and intensity of activity that confers the benefit, rather than the location or purpose of the activity.

    Becky J sent me this post from one of the Nature blogs, Spoonful of Medicine, "Housework's suspicious new benefit," which makes the point, "Apparently, the women who showed this benefit did at least 16-17 hours a week of housework. Well, that probably explains it then: the poor things were probably so busy cooking and cleaning that they never got a chance to go out and drink alcohol, eat unhealthy or skip going to the gym because that new Daniel Craig movie opened and they just had to see it. Seems to me that being a hardworking housewife may go along with some other good habits that just might explain the extra benefit."

    Tennessee Guerilla Women has a roundup of the interesting and obnoxious comments found on other blogs in response to the study.

    Technorati Tags: ; ; ; ;
    MeSH Tags: Breast Neooplasms/Epidemiology; Exercise; Exertion; Risk; Risk Reduction Behavior
  • Thursday, December 28, 2006

    Off-Topic: 5 Things

    I've been tagged by both Becky and David, and I'm on vacation, so I might as well do it.

    Five Things You (Presumably) Don't Know About Me:

    1. I'm the first person in my family to go to college (Oberlin). My parents both come from big families where only the eldest (which they are not) eventually went to college . Now I have a Masters (from Pitt, earned while working full-time). The husband has an undergrad degree, which only his father obtained. Movin' on up!

    2. I'm 1/4 Korean - my maternal grandmother was Korean. I don't look it unless you pay attention when I laugh, or see me have an alcoholic beverage and turn red. The red is more noticeable on me than some other Koreans, because of my pale whitey skin. My mom has straight black hair and brown eyes, but my dad is a strawberry blonde with freckly skin and greenish eyes, resulting in nobody believing either one was my "real" parent when I was a kid. As for the rest, maybe I'll know more when Taneya (who I'm tagging) finds out more about my family tree (big thanks, TK!).

    3. I grew up in a small, small town in east Tennessee. I couldn't wait to get out, and went 500 miles away and north for college. Parts of Evil Dead were filmed there, and some folks I know worked on the film. It also features overhead sidewalks in the downtown area.

    4. I have a husband (of 4 years). I didn't change my name. He's an audio engineer. He rocks (99% of the time). We met at a Waffle House. My parents met at a Burger King.

    5. Okay, one health-related thing. I've had arthroscopic knee surgery for an injury obtained in high school. My kneecap dislocated with such force that it cracked a chunk off the back of my patella. I blacked out standing up, and came to standing up, which I think is pretty impressive. I also waited until after lunch and through another class before leaving school (only because I was pretty sure I couldn't make it up the stairs for the next class) to go to the hospital, which I think is pretty stubborn. The ER docs (in my small, small town) thought it was just a dislocation that would heal, so I spent 6 weeks on crutches with a broken kneecap (and a chunk of bone floating around inside) before I had the corrective surgery. I also had a partial thyroidectomy a few years back for a "hot nodule," so I have a nice several inch scar running right across the front of my neck. My standard response to nosy strangers who ask is, "You should've seen the other guy." I once got a sunburn so severe that it caused my feet and ankles to become so swollen I couldn't walk. I've also had my wisdom teeth extracted (during undergrad commencement week, precipitated by an abscess), and have O+ blood, a penicillin allergy (my mom wasn't allergic until she had me), and a pretty bad sensitivity to artificial sweeteners. I can, however, roll around in poison ivy and not get it.

    I think you got more than 5 things there. More like 5 categories of things. Hey, I'm a librarian.

    I second Becky's tagging of Taneya and Tao.

    Wednesday, December 27, 2006

    Fun With Google Patent

    Okay, so you've been able to search patents via the U.S. Patent and Trademark Office's Full-Text and Image Database for a while. However, Becky from the Clinical Evidence blog posted on the new Google Patent search, and I've been having some fun playing around with the tool.

    Patents Worth Viewing (click the links to see full descriptions, drawings, claims, dates, etc.):
  • Method and apparatus for treating and preventing urinary tract infections - "The method includes inserting a urine control device into a vagina of a female; followed by having the female urinate; and followed by removing the urine control device from the vagina. Preferably, the urine control device includes an anti-microbial agent." I don't think I want to know. Skipping to the next patent...

  • Personal Pelvic Viewer - "a hand-held instrument which a woman may place by herself into her own vagina to conveniently view and record video images of the interior of her vagina and cervix on a remote monitor, such as a television, computer display, or computer monitor...The PPV provides a convenient instrument that allows a lone female to observe the interior of her own vagina in total privacy for medical reasons, to determine her own fertility, and to observe her sexual response." Sweet. I want one. Science for Medical Advocates, Inc., send me one of these puppies for review.

  • Female condom

  • Body fat measuring system for pregnant woman and health care system for pregnant woman

  • Method for the selection of a feminine hygiene product system - "The method includes an information collection step, a system selection step, and a product provision step. In the information collection step, information is collected from a consumer regarding her menstrual cycle protection needs. In the system selection step, the information collected is used to select a system of feminine hygiene products from at least two of such available systems." This "system" would contain two "feminine hygiene" products from which to choose from. Apparently, we womenfolk need a complicated system for picking between two products. Or not.

  • Air sensitive rupture indicating condom - "When the colorless, air sensitive material is exposed to air because of a rupture in said first or third layers of said condom, the colorless, air sensitive material changes color to alert the user that the integrity of the condom is compromised." I was really hoping for a sound-based alert system. Preferably with Hal's voice - "Close the pod bay door, Rachel."

  • Contraception and flavor delivery system - "A contraception and flavor delivery system (10) includes an extended tubular member (20) having a closed distal end (22) and an open proximal end (24). The contraception and delivery system (10) further includes a mechanism for flavor delivery (30) formed on an external surface of the tubular member (20)." I think this is just a flavored condom, but you have to love patent language.

  • One for the men - Protective tube and harness - "Protective tube and harness for the masculine member. The tube continues with a hinge with a hole at their end. The member is placed into the said tube, fixed with adhesive tape to the hinge. This hinge is introduced in an external tube with another hole which matches with the hinge hole. A padlock fixes the hinge and the external tube. Two rings are added to the external tube in their ends being fixed to the human body with a harness by a cable or chain." I'm pretty sure the words "masculine member" and "adhesive tape" should never occur in the description of one product. It's proposed as a "method to assure masculine chastity ."

  • One more for the men... - Safe sex assurance devices - "A device which is worn as an undergarment which cannot be removed without destroying the device. The device is worn in order to guarantee that the wearer has been sexually faithful to ones partner."

  • Penis locking and lacerating vaginal insert - "whereby the rigid member is permanently locked within the housing member...a plurality of barbs formed on a front edge of the blade, whereby the blade may further lacerate a penis locked within the device." On the serious side, I'd really prefer if there wasn't a sexual assault problem such that someone thought carrying blades around in one's vagina was a good solution. Also, not really interested in being so intimately locked to an attacker.

  • Another anti-rape device - Anti-rape device - "...having a hollow housing adapted to be worn within a human vagina. The housing has a front opening and contains a hypodermic syringe having a volume of rape-deterring fluid and a needle facing and aligned with the front opening... Preferably, the fluid is a quick-acting, safe narcotic such as scopolamine, or the like to render the rapist unconscious." Nope, don't want to have to carry a syringe in my vagina, either. Points for being so very James Bond, though.

  • And another... - Anti-rape device - includes a "harpoon-like" device for "impaling" the penis. Here's another, with description featuring the words "barbed shank." And another, "to adhere to any rapist and an irritant-containing pouch positioned within the housing which ruptures upon forceful contact with the rapist." Oh, here's here's one more. And this one includes a belt. Or perhaps you prefer a crotch-covering web.. Okay, now I'm seriously disturbed by the number of these proposed products, and what they say about us.

  • Weighted sports bra - The last thing I want is more weight in my sports bra.

  • Forecasting system for menstruation of women - "A forecasting system takes advantage of an E-mail system of the internet to forecast different days of a following menstruation period of a woman via different terminals, such as a mobile telephone which supports WAP and a personal computer which is capable of connecting with the internet. The working of the forecasting system includes entering via a terminal relative information of menstruation of a woman, establishing a data base in a data server of the internet depending on the entered information, calculating an ovulation day, impregnable days, starting and ending days of a following menstrual flow of the woman, and sending out inquired forecast information to the woman via the different terminals." - That's high tech. I just go by the sore boobs and crankiness.

  • Female physical condition managing apparatus - "This permits women to realize quickly what physical or mental condition they are put in. The female physical condition includes the premenstrual syndrome." - Hoo boy, this is what we women have been waiting on! I never know what my mind is up to! Gah.

  • Labial sanitary pad - "A labial pad (30) having an anatomically conformable configuration with a generally ovate geometry defined by a principal longitudinal axis (L), a minor transverse axis (T) and a generally orthogonal lateral or height axis (H), is comprised of a laterally upwardly directed projection (52) lying generally along the longitudinal axis within the posterior region (54) of the pad and having a prominence (64) proximate the distal end (60) thereof tapering toward the proximal end (58) along the longitudinal axis and to the opposed sides (62) along the transverse axis, wherein the projection is configured for disposition within the vestibule (32) of a wearer over a region bounded generally by the posterior labial commissure (36) and the labia terminating at or about the latter and extending forwardly therefrom over the vulva, to occlude the vestibule against flow of menses or the like while protecting the urogenitals from chafing contact." - Huh, wha?

  • Sanitary napkin with hump and groove - Included just for the title.

  • Disposable combined panty with sanitary napkin - That's just wasteful.
  • Post-Holiday News Roundup

    Shopping:
    Okay, y'all can just use Medgadget as a shopping guide for me, given all the interesting devices they describe.
  • Via Medgadget, "Cuddly Dolls Offer Honest Answers About Anatomy." Key info: anatomically correct. More at Women's eNews, and the product website, which provides this info: "These cuddly cloth dolls are great for playtime and can also be used as sex education props when explaining the human reproductive cycle to boys and girls ages 3 to 9. Amamanta Family doll sets can help guide you on sex education topics such as conception and birth of babies, breastfeeding, and demonstrating appropriate versus inappropriate touching."
  • Also via Medgadget, the vaginal molecular condom, a "fluid substance to be inserted by a woman vaginally, that becomes a gel at body temperature and at the vaginal fluid pH of 4.2, and then in the presence of sperm with a pH of 7.7, it become a liquid again, only to release an antiviral drug load to block infection by the HIV."
  • Last on the list is the home yeast infection detection kit.

    Amusement:
  • Comparative Sex-Specific Body Mass Index in the Marvel Universe and the "Real" World.
  • BMJ's (a medical journal) traditionally goofy Christmas issue is available for free online.

    For The Home:
  • This domestic violence guideline includes a detailed list of risk factors and warning signs for domestic violence.
  • The New York Times has a piece on self breast exams, "Self-Exams Are Passé? Believers Beg to Differ."

    Money:
  • The CDC has grants available for Understanding Risk and Protective Factors for Sexual Violence Perpetration and the Overlap with Bullying Behavior. They list "independent school districts" as the eligible applicants; there is an award ceiling of $300,000, and the closing date for applications is 2/21/07. See the full announcement.

    Gossip:
  • From the FDA: Randall Lutter Appointed Acting Deputy Commissioner for Policy. According to the release, "Before joining FDA Lutter was a resident scholar with the American Enterprise Institute and fellow with the AEI-Brookings Joint Center for Regulatory Studies. From 1991 to 1997 he served at the Office of Management and Budget in the Office of Information and Regulatory Affairs and from 1997 to 1998 he was senior economist for regulation and the environment at the President’s Council of Economic Advisers." Also, "he will be a senior advisor to Acting FDA Commissioner Dr. Lester M. Crawford on all major agency matters including regulations, policy and administrative programs. In particular, Dr. Lutter's office will assess the public policy implications of FDA's regulatory and administrative activities."
    As Associate Commissioner for Policy and Planning, Lutter [an economist] authored the June 2006 letter [PDF] denying the (2001) petition of family planning and health organizations for exemption of Plan B from prescription requirements (related news item). Lutter had previously been in the news related to his FDA work most often for his remarks on counterfeit drugs and RFID technologies.

    Family, Or, In Praise of Medical Librarians:
  • Congrats to fellow medical librarian blogger the Krafty Librarian, who had her second son on Monday, and had blogged that fact by Wednesday.
  • Another medlib blogger, Dean Giustini, has an (free full-text online) editorial in BMJ, "How Web 2.0 is Changing Medicine."
  • Online Diabetes Monitoring, Follow-Up for Gestational Diabetes

    Via Diabetes Today:
    Internet Helps People with Diabetes Monitor Blood Sugar
    Patients load self-testing results to a website monitored by physicians, nurses, and a dietician, who respond as needed. A recent study found lower average blood sugar levels and fluctuations in the internet group compared to those who weren't uploading levels and receiving responses. I'm guessing it's not so much "The Internet" that was important in improving the patients' levels, but the fact that they had more frequent contact with clinicians via the online system compared to the group that made regular office visits only. It's not clear whether the patients also had better long term outcomes with regards to common diabetes-related complications - this was essentially a study of lab values. Still, good use of technology, if clinicians have the staff/time/$ to do this for more patients.
    Citation for the study: Cho JH, Chang SA, Kwon HS, Choi YH, Ko SH, Moon SD, Yoo SJ, Song KH, Son HS, Kim HS, Lee WC, Cha BY, Son HY, Yoon KH. Long-Term Effect of the Internet-Based Glucose Monitoring System on HbA1c Reduction and Glucose Stability: A 30-month follow-up study for diabetes management with a ubiquitous medical care system. Diabetes Care. 2006 Dec;29(12):2625-2631. Read the abstract

    Follow-up Often Lacking After Gestational Diabetes
    "According to a report in the current issue of the journal Obstetrics and Gynecology, only 45 percent women in the study group underwent postpartum glucose testing, which is recommended by the American Diabetes Association and the American College of Obstetricians and Gynecologists. More than one third of those tested (36 percent) had persistent abnormal glucose levels, Dr. Michelle A. Russell, from the Department of Veterans Affairs Medical Center in White River Junction, Vermont, and colleagues report."
    Citation for the study: Russell MA, Phipps MG, Olson CL, Welch HG, Carpenter MW. Rates of postpartum glucose testing after gestational diabetes mellitus. Obstet Gynecol. 2006 Dec;108(6):1456-62. Read the abstract
    This article is in the same issue of Obstetrics & Gynecology that has the piece about young pregnant women fearing that they were infertile. Hoo, there's a lot of good stuff in this issue. A couple of findings from the full article:
  • "Women who returned to the hospital-based clinic were twice as likely be tested as were women seen in the hospital-affiliated community clinics"
  • The rate of testing was 3 times higher in women who attended the postpartum visit. This is sort of a no-brainer - if women don't go for follow-up, they won't get the recommended follow-up testing.
  • No relationship was found between the women's actual risk of diabetes and the likelihood that they got the postpartum test.
  • "The rate of testing in Hispanic women was 52% higher than in non-Hispanic white women. None of the other demographic factors were significantly associated with testing."
    These results are difficult to interpret because they are affected by both providers who may or may not perform the recommended test, and women who may or may not complete the recommended follow-up, or mention to community providers their history of gestational diabetes. Nonetheless, it seems that women are not receiving the proper follow-up for gestational diabetes a lot of the time.
  • Top Health Stories of 2006

    The Society for Women's Health Research has posted their top 5 list of women's health stories from 2006.

    Thursday, December 21, 2006

    Pre-Marital Sex Report Now Available

    The Guttmacher Institute now has a press release up with a link to a PDF download of the report on pre-marital sex mentioned in yesterday's post.

    The report uses data from the 1982, 1988, 1995, and 2002 National Survey of Family Growth, avoluntary, in-person survey conducted by the U.S. Department of Health & Human Services to collect information "on family life, marriage and divorce, pregnancy, infertility, use of birth control, sexual experience, and men’s and women’s health." The report defines premarital sex as having had sex prior to the month of first marriage or having had sex but never having been married by the time of the survey, and "sex" is defined as vaginal intercourse.

    Among the results:
  • "males were slightly more likely to have had premarital sex at virtually every age; by exact age 44, 96% of males and 94% of females had had premarital sex"
  • "Figure 2 and the Table show premarital sex proportions using data from all four surveys (for women only) by 10-year cohort. The figure and table show a trend from the 1950s through the 1990s toward a higher proportion experiencing premarital sex: 48% of the cohort who turned 15 from 1954 to 1963 had done so by exact age 20, while 65% of the 1964–73 cohort, 72% of the 1974–83 cohort, and 76% of the 1984–93 cohort had done so. For the 1994–2003 cohort, 74% had had premarital sex by exact age 20, a figure between that of the 1974–83 and 1984–93 cohorts."
    Interpretation: More premarital sex among women now, but for those of you who are my age - your moms were lying to you. :)
  • "The slight decrease between the 1984–93 and 1994–2003 cohorts was not statistically significant."
  • "The increase seen beginning with the 1964–73 cohort may be partly due to increased availability of effective contraception (in particular, the pill), which made it less likely that sex would lead to pregnancy; but even among women who were born in the 1940s, nearly nine in ten had had premarital sex by age 44. Among those who did not have sex at all during their teen years, eight in ten eventually had premarital sex."
  • "Ninety-four percent of those who abstained until at least age 15 and 89% of those who abstained until at least age 18 had had premarital sex by age 44. Even among the 28% of the population who had not had sex by age 20, 81% had had premarital sex by age 44."
    So abstinence-only sex is is just fine for about 28% of kids. The other 72% maybe could use some information.

    Again, the Guttmacher Institute has an established stance against abstinence-only sex ed, and indeed this report starts and ends with discussion of how current policies may not reflect the reality of the situation. If you want to be absolutely certain, you'll have to go crunch the numbers yourself. Still, something to think about.

    Citation: Finer LB. Trends in premarital sex in the United States, 1954-2003. Public Health Rep. 2007 Jan-Feb;122(1):73-8.
  • Wednesday, December 20, 2006

    How Do You Like Abstinence Only Sex-Ed Now?

    A new report from the Guttmacher Institute published in Public Health Reports says 95% of Americans have premarital sex by age 44. Our subscription is not yet up to date with this issue for me to read and assess, so see the summary from the Kaiser Network in the meantime: About 95% of U.S. Residents Have Premarital Sex, Guttmacher Report Says

    Notes: The Guttmacher Institute has an agenda. You may or may not agree with it. Public Health Reports is a peer-reviewed journal, published by the Association of Schools of Public Health.

    Tuesday, December 19, 2006

    More On Paying Women Not To Have Children

    Women's Bioethics Blog has a post on Project Prevention, which pays drug addicts to use long-term birth control or get sterilized, and asks these questions: "Does[sic] these women feel coerced? Or do they feel a sense of relief? And what of the ethics of public health, that we all pay when our children suffer?" The post is in response to this piece from the New Haven Register. A couple of excerpts:
  • "'The ethical dilemma is that (Project Prevention) has a good goal, but is it taking advantage of someone who doesn't have a lot of economic options. Is the money a coercion, does it force them to close their reproductive options,' said professor Brian Stiltner, chairman of the Philosophy and Religious Studies at Sacred Heart University in Fairfield. ...'There is a general principle in research ethics to not give financial incentives big enough to be the primary reason for people to make a decision.'"
  • "'If we were paying alcoholics with a record of DUIs to never get behind the wheel of a car again, nobody would have a problem with that. It's the same thing,' Harris argued." Is it? Because you probably wouldn't cut off their hands or feet so they couldn't drive...

    From Project Prevention's website:
    "For a tubal ligation or Norplant, the client receives $200. For Depo-Provera or an IUD they receive $50 every 3 months ($200 maximum per year), but can continue for future years. Project Prevention offers a $200 incentive for any of these birth control methods (those not included are subject to Board approval):
    Depo Provera - paid over the period of one year
    Essure
    IUD
    Norplant (5 year contraceptive)
    Tubal ligation"

    From Project Prevention's frequently asked questions [emphasis mine throughout]:
    Q: Some say these people are not capable of deciding on long term birth control.
    A: If you can not trust someone with their reproductive choices, how can you trust them with a child?
    Q: Are you targeting blacks?
    A: It is racist, or at least ignorant, for someone to learn about Project Prevention and assume that only black addicts (or minorities) will be calling us. The reality is, not all drug addicts are black. [Thanks for clearing that up...]

    Project Prevention's promotional flyer [PDF], with headline, "Get Birth Control. Get Cash."

    I don't have a problem with helping women make smart choices about family planning. I still do have a problem with incentivizing women to get sterilized. It simply leaves no room for a woman to clean up her life and bear healthy children later. It takes away future options through a short-term money fix.

    Previous Post: Bribing Women to be Sterilized

    Update: What I said to Carter, who thinks women should get sterilized to receive welfare as well:
    One big problem I have with this program is that it's not "normal" birth control, it's long-term or permanent birth control - sterilization is one of the options. That is permanent. So you're essentially saying to these women, "I don't think you can ever clean up your act to the point that you could have children. If you do, too bad for you." As I understand it, the longer-term methods of hormonal birth control tend to have more severe side effects as well. They are not providing rehab, although they are referring to rehab, so rehab is *not* a condition of being paid to get sterilized. Additionally, there's the aspect of incentivizing people to take a drug or have a permanent surgical procedure, which would generally not be considered good medical ethics. If you're having a truly hard time in life, perhaps with drug addiction and associated financial hardships, you might be tempted to have something done to your body that you otherwise wouldn't, so you can have the cold hard cash to eat or get your fix. How voluntary is it to an addict who has cash waved in front of them? Is that truly informed consent? I think these women are being bribed and abandoned more than they're being helped.
  • Reactions to the Drop in Breast Cancer Rate

    As noted in this previous post, researchers presented news of a dramatic decline in breast cancer rates at a recent conference, and suggested it was linked to a reduction in women using hormone replacement therapy. The Kaiser Network has a summary of reactions to the news. Other reaction pieces:
  • Breast cancer news brings range of reactions - New York Times, emphasis on consumer reactions
  • Wyeth, lawyers clash over cancer study - Houston Chronicle, "Wyeth countered that the study won't have a significant impact on the litigation because the risk of breast cancer has always been included on the product's label."
  • Don't panic about hormones, docs say - Detroit Free Press
  • Breast cancer diagnoses took sudden drop in '03 - Boston Globe
  • Breast cancer treatment and evidence based medicine - Women's Bioethics Project
  • On evidence-based medicine - Medical Humanities Blog
  • Friday, December 15, 2006

    Decline in Breast Cancer Cases

    "About 14,000 fewer women were diagnosed with the disease than had been expected, researchers reported Thursday at the San Antonio Breast Cancer Symposium."[AP] - News outlets are reporting that a 7% drop in breast cancer rates in the U.S. in 2003 may be tied to women going off of or electing not to have hormone replacement therapy in menopause. The findings were presented at a conference this week, so they are not yet available in a peer-reviewed publication with complete data.

    For now, in the news:
  • Breast Cancer Drop Tied to Hormones - AP via the Washington Post
  • Reversing Trend, Big Drop Is Seen in Breast Cancer - New York Times
  • Breast Cancer Cases Drop - American Cancer Society
  • Do Drugs for Pain During Birth Affect Breastfeeding?

    Via 4women.gov, Epidural During Birth May Negatively Affect Breast-Feeding.

    The full study is free online [click the Provisional PDF link to download], as International Breastfeeding is an open access journal via BioMed Central. Citation: Torvaldsen S, Roberts CL, Simpson JM, Thompson JF, Ellwood DA. Intrapartum epidural analgesia and breastfeeding: a prospective cohort study. Int Breastfeed J. 2006;1(24).

    The authors followed 1260 Australian women who had a live birth in 1997 and were available for follow-up. Women were excluded from the study if they had babies who were admitted in intensive care or were adopted, if the women were critically ill, unable to give informed consent or complete the questionnaires, or had multiple pregnancies. Women received questionnaires via mail at 8, 16, and 24 weeks postpartum; the first survey collected information on characteristics of the mother, partner, obstetric details, and breastfeeding information. Women were also asked about breastfeeding in subsequent questionnaries, allowing the women to be categorized as fully breastfeeding, partially breastfeeding (milk+some formula) or not breastfeeding. If they had stopped breastfeeding since the previous survey, they indicated when.

    Women's use of analgesia (pain relief) during labor was classified as: 1) non-pharmacological only (breathing exercises, massage, hypnosis, etc.); 2) gas (nitrous oxide); 3) pethidine (with or without gas); 4) epidural (with or without pethidine or gas; 5) general anesthetic (with or without any of 1-4). Epidural drug in use at the time was bupivacain 0.16% with fentanyl 3.3micrograms/ml.

    Findings:
  • Of the 1260 women, 416 (33%) had epidurals.
  • In the first week postpartum, 1182 (93%) were either fully or partially breastfeeding.
  • 704 (60%) of those were continuing to breastfeed at 24 weeks.
  • Of 85 women not breastfeeding at all in the first week, 48% indicated they had planned not to breastfeed. The only survey factor associated with no breastfeeding was maternal education (less educated women were more likely not to breastfeed at all in the first postpartum week).
  • Factors associated with partial breastfeeding in the first week were intrapartum analgesia (drugs during birth), type of birth, onset of labor, and parity.
  • Women who were partially breastfeeding in the first week were almost twice as likely to have ceased breastfeeding by 24 weeks compared to women who had been fully breastfeeding during that week.
  • The authors found that women who did not use phamarcological analgesia during birth had the lowest rate of breastfeeding cessation during the first 24 weeks. Women who used epidurals had the highest rates of cessation.
    Additional details are provided in the article tables.

    One common concern about the research (and similar studies): women who are motivated to go through childbirth without traditional drug-based pain relief may also be more motivated to breastfeed. The authors also do not attempt to provide any sort of physiologic explanation for epidurals causing problems with breastfeeding, so the study finds a correlation but not causation. It also does not describe the type/amount of lactation support the women received, nor fully compare the women's intent for the duration of their breastfeeding.

    Additional References:
  • Chang ZM, Heaman MI. Epidural analgesia during labor and delivery: effects on the initiation and continuation of effective breastfeeding. J Hum Lact. 2005 Aug;21(3):305-14. [Abstract; these authors did not find a significant difference in breastfeeding at 4 weeks dependent on analgesia use during labor]
  • Crowell MK, Hill PD, Humenick SS. Relationship between obstetric analgesia and time of effective breast feeding. J Nurse Midwifery. 1994 May-Jun;39(3):150-6.
  • Dickinson JE, Paech MJ, McDonald SJ, Evans SF. The impact of intrapartum analgesia on labour and delivery outcomes in nulliparous women. Aust N Z J Obstet Gynaecol. 2002 Feb;42(1):59-66.
  • Halpem SH, Ioscovich A. Epidural analgesia and breast-feeding. Anesthesiology. 2005 Dec;103(6):1111-2.
  • Henderson JJ, Dickinson JE, Evans SF, MdDonald SJ, Peach MJ, Impact of intrapartum epidural analgesia on breast-feeding duration. Aust N Z J Obstet Gynaecol. 2003 Oct;43(5):373-7.
  • Lee N. Comments on "Epidural analgesia during labor and delivery" article by Chang and Heaman. J Hum Lact. 2006 Feb;22(1):11; author reply 11-2.
  • Rajan L. The impact of obstetric procedures and analgesia/anaesthesia during labour and delivery on breast feeding. Midwifer. 1994 Jun;10(2):87-103.
  • Riordan J, Gross A, Angeron J, Krumwide B, Melin J. The effect of labor pain relief medication on neonatal suckling and breastfeeding duration. J Hum Lact. 2000 Feb;16(1):7-12.
  • Vomanen P, Valanne J, Alahuhta S. Breast-feeding problems after epidural analgesia for labour: a retrospective cohort study of pain, obstetrical procedures and breast-feeding practices. Int J Obstet Anesth. 2004 Jan;13(1):25-9.

    See the MedlinePlus Medical Dictionary, powered by Merriam-Webster, to look up unfamiliar terms.

    Technorati Tags: ; ; ;
    MeSH Tags: Analgesia, Obstetrical; Breast Feeding
  • Sunday, December 10, 2006

    Off Topic: The Blogger Meat-Up

    The Mothership BBQ graciously hosted a holiday party last night for Nashville-area bloggers. A recap:

  • I finally got to see Bad Bad Ivy's hair in person. The Husband was worried, before I gave him the explanation, that she had cancer and he wasn't being sufficiently sympathetic.

  • I finally met Kerry Woo in person, and his lovely wife. Joel pointed out to me that I overexplained the eating cats and dogs thing to her, and that I made it awkward in doing so. Kerry Woo's Wife - I'm sorry, it was just so LOUD in there, I didn't realize you two had just told me Kerry had already explained it. And how on earth did Kerry Woo get so tall?

  • Kathy T always brings some kind of functional goody. She also matched Blake in his monkey suit perfectly. :)

  • I also finally met Kate O, who is both lovely and charming.

  • The Knucklehead won't let me work the Mothership cash register one Saturday, because it's Sophie's job. Dude, I don't want to get paid for it, I just think it would be fun. Is this because of what I said about the "wine?" :)

  • There were enough blogger spouses there that y'all should really form a support group.

  • CLC, I swear I would have gotten the "No L" button faster under "normal" circumstances. At the time, my first thought was, "What is 'L,' and should I be against it too?" Hee.

  • Did I suggest that we could give your Korean kids alcohol in order to prove the point that it makes us (partly)Asian types turn red? No, I thought not. ;) Just you remember what I said when they're teenagers and try to tell you how "cold" it is outside.

  • A hometown friend+2 dropped by, and received a tour of the bathrooms. Thanks to Milo for accomodating their late requests for food.

  • Imagine my surprise when a coworker+3 dropped by on a scavenger hunt. Joel thought I was being exceptionally outgoing when I talked to her about the clue, until he realized I already know her. Don't you love it when they say, "Oh, I was going to be really proud of you?" :P

  • As always, nice to see the ladies Kat and Aunt B again, as well as the Bunco gals, and very nice to meet the rest of you last night.

  • I came home and found one more cave cricket leg. Just one leg. When we bought the house we noticed that the things, which are my worst wild kingdom nightmare, tend to frequent the place. Now that we've moved in with the kitties, all I ever see of them at a time is one detached drumstick leg. Ugh. And someone dropped his phone in the toilet when we got home.

    If I forgot you, I'm sorry. I haven't had enough coffee yet to properly reconstruct the events of the evening.
  • Saturday, December 09, 2006

    Two More Things

    You Southeasterners, stand by for the flu, headed your way.

    Also, when lost in the wilderness, you are to stick together and stay put.
    Safety in the Great Outdoors - Canada Safety Council
    The National Park Service also has safety information for specific parks, such as this one for the Great Smoky Mountains National Park.

    Saturday News Roundup

    The short stack:
    From CNN: 7 Kids' Health Myths Every Mom Should Ignore

    Chewable Birth Control. I'm puzzled as to why minty fresh and chewable pills are necessary. Then again, I've never understood why people insist they can't swallow pills, when they generally swallow blobs of food larger than your average pill every day. Why don't you just go ahead and make a Pez dispenser full of birth control?

    From Radiology Picture of the Day, and found via Kevin, MD, you'll poke your eye out. Also found via KMD, "Wife Sues Estranged Husband Over STD."

    From the National Institutes of Health, "Hormonal Contraception Does Not Appear To Increase HIV Risk."

    Newsweek: On pro-anorexia websites, "Proponents say they offer 'support,' but a Stanford University study finds that patients who visited pro-anorexia Web sites were sicker longer."

    New England Journal of Medicine editorial, "The Ethics and Politics of Compulsory HPV Vaccination."

    From the FDA, "What Every Consumer Should Know About Trans Fatty Acid" [July 2003]

    E. Coli infection information from the National Library of Medicine

    New York Times article on false pregnancy

    Fetal pain bill fails in the House. [View votes]

    Ryan White HIV/AIDS Treatment Modernization Act of 2006 has passed in the Senate and House.

    Underweight women more likely to miscarry. You may have seen this in other places, but weight was not the only factor. According to the piece in BJOG, "the following were independently associated with increased risk: high maternal age; previous miscarriage, termination and infertility; assisted conception; low pre-pregnancy body mass index; regular or high alcohol consumption; feeling stressed (including trend with number of stressful or traumatic events); high paternal age and changing partner."

    Belly Tales has a Selected Bibliography on Birth Centers, Cesarean Rate Rises and VBAC Rate Declines, and The Out-of-Hospital Birth Debate Continues. All well worth a look, with links to additional resources.

    Via Feministing, White House subpoenaed over Plan B delay, "The Office on Violence Against Women gets a new (scary) director," and the Washington Post's article, "Abortion Pill Thwarts Breast Cancer Gene.

    Via the Kaiser Network:
  • One in 1,000 Women Hospitalized for Mental Illness After Delivering First Infant, Study Says
  • New York City C-Section Delivery Rate Up; City Hospitals Not Complying With State Maternity Information Act, Report Says
  • Study Put Pregnant Women at Risk by Giving Them Placebo Rather Than Alternative Herpes Drug, Advocacy Group Says
  • Wall Street Journal Examines 'Period Management' Options, Benefits, Risks
  • New Hampshire To Offer Gardasil to Girls at No Cost Under State Immunization Program

    Who wants to buy me a present? :)

    RHRealityCheck has an interesting piece, Unsafe Abortion as Human Rights Abuse.

    The meat:
    The CDC issued preliminary 2003 U.S. abortion surveillance data. From the results:
  • "A total of 848,163 legal induced abortions were reported to CDC for 2003 from 49 reporting areas, representing a 0.7% decline from the 854,122 legal induced abortions reported by 49 reporting areas for 2002."
  • "The abortion ratio, defined as the number of abortions per 1,000 live births, was 241 in 2003, a decrease from the 246 in 2002."
  • "The abortion rate was 16 per 1,000 women aged 15--44 years for 2003, the same as for 2002."
  • "During 2001--2002 (the most recent years for which data are available), 15 women died as a result of complications from known legal induced abortion. One death was associated with known illegal abortion."
  • "The highest percentages of reported abortions were for women who were unmarried (82%), white (55%), and aged <25 years (51%)."
  • "Of all abortions for which gestational age was reported, 61% were performed at <8 weeks' gestation and 88% at <13 weeks. From 1992 (when detailed data regarding early abortions were first collected) through 2002, steady increases have occurred in the percentage of abortions performed at <6 weeks' gestation, with a slight decline in 2003."

    The CDC also reports that teen births have dropped to their lowest level ever. From the press release:
  • "...between 2004 and 2005, the birth rate for teenagers aged 15-19 fell 2 percent, to 40.4 births per 1,000 - a 35 percent decrease from the peak of 61.8 births per 1,000 in 1991"
  • "There was another increase in unmarried childbearing in 2005. The number of births to unmarried mothers of all ages rose 4 percent from 1.47 million in 2004 to 1.52 million in 2005; while the rate increased to 47.6 births per 1,000 unmarried females aged 15-44 in 2005, up from 46.1 in 2004. The percentage of births to unmarried mothers also increased in 2005, from 35.8 to 36.8 percent."
  • "Childbearing by women in their early 20s increased slightly in 2005, and also continued to increase among women in their 30s and 40s. Birth rates for women aged 20-24 and 30-34 rose less than 1 percent between 2004 and 2005, while rates for women aged 35-44 years rose by 2 percent."
  • "The Caesarean delivery rate rose 4 percent in 2005 to 30.2 percent of all births, a record high. The C-section rate has risen 46 percent since 1996."
  • Pregnant Teens Thought They Might Be Infertile

    I'm back! After being out of town 2 1/2 weeks of the last month, moving into my first house, and *finally* getting the internet connection set up, I have a lot of catching up to do.

    First up: A paper appears in the current [see citation] issue of the journal Obstetrics and Gynecology, "Fear of Inability to Conceive in Pregnant Adolescents" [See abstract]. The researchers surveyed "pregnant adolescents attending their first prenatal visit about their pregnancy intentions, including whether they had fears about not being able to conceive before their current pregnancy."

    Population
    The 300 pregnant adolescents surveyed were from one women's primary care center and recruited during their first prenatal visit. They were included in the study if their estimated delivery date was prior to their 20th birthday, they agreed to review of their medical records, were able to give informed consent, and and able to speak and read English.

    Methods
    30 minute interviews were conducted with each participating teen, including "questions regarding the teenager’s demographic background, life plans, social supports, family and peer relationships, financial status, health history, and behavioral risks." Demographic results were: "The study participants were 48% Hispanic, 18% white, and 19% African American. Forty-two percent of the participants were 18 or 19 years old and 53% were currently enrolled in high school (Table 1). Eighty-three percent of the participants were less than 20 weeks of gestation during the interview."

    Findings
    126 (42%) of the surveyed teens reporting have been afraid that they were not able to get pregnant, without significant differences between younger and older teens. There was also no significant difference in reported sexually transmitted infections between the groups that were and were not afraid they could not get pregnant, and age at first intercourse was similar. There was a significant difference in length of sexual activity, averaging 2.6 years in those who were afraid they could not get pregnant vs 2.0 years in those who were not. There were no differences when comparing previous pregnancy terminations or live births, although those with past spontaneous abortion were more likely to fear not being able to conceive.

    There was no significant difference in contraception use between those who were afraid they were unable to conceive (17%) and those who weren't (26%). According to the authors, "A significantly higher proportion of teenagers with the fear of not being able to conceive agreed with the following statements, “I wanted to get pregnant,” “I didn’t think I could get pregnant,” “I didn’t want to use birth control,” and “my partner didn’t want to use birth control.” The two groups had similar proportions agree that they experienced side effects from birth control or that they didn’t think they were going to have sex." Regarding thinking they could not get pregnant, 61% of those who had "fertility fears" agreed that they thought they could not get pregnant, while only 19% of those without "fertility fears" agreed.

    What does it all mean?
    This is an interesting study, because when we think about how adolescent girls think about sex, we tend to think they are worried about getting pregnant. It may be less common for discussions of teen sexuality to address the actual fertility of these girls, to address their worries about not being able to conceive or perception that birth control is not needed because they can't get pregnant. This may be one new piece of the puzzle in educating teens about the risks of their sexual activity choices.

    The cranky anti-abstinence only sex ed part of me questions whether this is related to that policy - if you hear repeatedly that there is no such thing as safe sex and contraceptives fail (which they do, but we're talking fear and emotions here, not statistics), yet you have sex repeatedly without getting pregnant, might you worry that you are not able to become pregnant? And thus not take proper precautions or cease sexual activity? The girls with fears of not being able to get pregnant were not that statistically different from those without the fears, except that they had been having sex for longer on average. Regardless of the cause, however, this is a health fear/concern that some young girls have which I think has not been adequately discussed.

    Citation: White E, Rosengard C, Weitzen S, Meers A, Phipps MG. Fear of inability to conceive in pregnant adolescents. Obstet Gynecol. 2006 Dec;108(6):1411-6.

    Technorati Tags: ; ; ;
    MeSH Tags: Fertility AND Adolescent; Pregnancy in Adolescence