Study: IUDs, implants vastly more effective than the pill

2012-05-24

The small fraction of women who choose intrauterine devices (IUDs) or under-skin implants as their preferred method of birth control may be on to something: According to a new study, these long-acting forms of contraception are 20 times better at preventing unintended pregnancies than the Pill and other short-term methods.

The study, published this week in the New England Journal of Medicine, compared the effectiveness of various types of birth control in a group of about 7,500 sexually active women in the St. Louis area. Over a period of three years, 9.4% of women using birth control pills, patches, or vaginal rings became pregnant accidentally, compared to just 0.9% of women who opted for IUDs or implants.

Continue reading Study: IUDs, implants vastly more effective than the pill →

Why we need a good screening test for ovarian cancer

2012-05-22

CNN conditions expert Dr. Otis Webb Brawley is the chief medical officer of the American Cancer Society, a world-renowned cancer expert and a practicing oncologist. He is also the author of the book, “How We Do Harm: A Doctor Breaks Ranks About Being Sick in America.”

(CNN) — Q: This week the U.S. Preventive Services Task Force issued preliminary guidelines for ovarian cancer screening. It recommends against routine screening saying that the risk of false positive diagnoses outweighs the benefits. How can this be and why is it so hard to find a good screening test for ovarian cancer?

A: The U,S. Preventive Services Task Force is a group of medical experts who assess the scientific literature on an issue, such as ovarian cancer screening, before making a recommendation. They do influence how doctors practice medicine.

The statement recommends against routine ovarian cancer screening because they find the evidence of harm associated with screening is greater than the evidence of benefit.

Unfortunately we do not have a good screening test for ovarian cancer, the fifth leading cause of cancer death in women. We need something as effective for ovarian cancer screening as pap smears are for cervix cancer screening.

It is a surprise to many that a screening test could be considered more harmful than helpful. The problem is routine ovarian cancer screening starts a cavalcade of medical procedures associated with harms that are greater than the ultimate benefits. Importantly, it is not that there is no benefit to ovarian cancer screening. The problem is there is not a “net benefit.”
Olympic gymnast battles cancer

The blood test CA 125 is elevated in about half of women who are known to have ovarian cancer. If effectively treated by surgery or chemotherapy, the CA 125 level in the blood goes down. It has been used for nearly three decades to follow progress in treatment.

This test was suggested for screening in the late 1980s. Screening is doing a test in asymptomatic patients who are not suspected of having the disease but are at risk because of age and gender. Very early on, many thought CA 125 would not work well as a screening test.

A teacher gave me this example more than 20 years ago and it still holds. It is dense in numbers, but I think it is followable. It illustrates how a public health physician thinks of a screening test and the trouble with CA 125.

A group of investigators tested the CA 125 blood test for screening in a group of 915 women average age 55, and a total of 36 or 3.9% were abnormal (a level greater than 35 U/ml). These women were evaluated for ovarian cancer and followed. Ultimately none had ovarian cancer.

What if one was to screen 100,000 women? That means 3.9% of the 100,000 or 3,900 women will have false positive findings. Using U.S. cancer incidence data, 13 women in the 100,000 would have ovarian cancer in a given year.

Given that most of the 13 women will be diagnosed with incurable advanced ovarian cancer, a fair assumption is six of the 3,900 will be diagnosed with a potentially curable ovarian cancer.

Given that CA 125 is positive in half of ovarian cancer patients, one would reasonably estimate that three of the six women with curable disease would be identified. That is three potential cures in the more than 3,900 women screened.

Of the 100,000 women, we expect 148 will die of cancer and nine of the 148 will be die because of ovarian cancer within a year of the screen.

That might sound worthwhile at face value, but lets look at the harms of screening. Most of the 3,900 women will get further testing. This consists mostly of ultrasounds and CAT scans. Several hundred will need to get laparoscopy or more invasive abdominal surgery for evaluation.

This is the area of greatest concern. One survey shows 14% of women over the age of 65 have complications after abdominal surgery. Surgical complications cause death in 1% to 2% of women over 65 and one-half of 1% of women over 50, Several hundred women will get abdominal surgery.

When done as a routine test it is quite easy to see that ovarian cancer screening could actually cause the death of more women than the number of women saved. Most of the women who have bad outcomes will not have ovarian cancer.

The gold standard for proving effectiveness of a screening test is a prospective randomized clinical trial comparing a screened group to a group that is not screened over time.

The U.S. National Cancer Institute began such a study in 1993 and published the result in 2011. The trial included 78,216 women aged 55 to 74. It randomly assigned 39,105 to screening and 39,111 to usual care. After an average of more than 12 years of follow-up, the groups had no difference in the ovarian cancer death rate. This means that the trial showed no evidence of routine screening saving lives.

CA 125 is not a good test for ovarian cancer screening, and ovarian cancer may not be a good cancer for screening. What we need is a test that flags fewer people who do not have the disease as suspicious of having the disease. It would be even better if the test found more than half of the women who have the disease. Screening also works better in cancers that tend to stay localized for longer periods of time. Many ovarian cancers spread throughout the abdomen very early in the life of the cancer when the tumor is still very small.

It is important to note that the task force addressed routine screening. The test can be appropriate for screening a woman known to be at high risk for ovarian cancer because of a family history. The test may also be appropriate in assessing a woman who has lower abdominal discomforts.

The opinions expressed in this article do not necessarily represent those of CNN, The American Cancer Society, or Emory University.

Child deaths: Preventable infections ‘the leading cause’

2012-05-14

Most deaths of young children around the world are from mainly preventable infectious causes, experts have said.

A US team, writing in the Lancet, looked at mortality figures from 2010.

They found two-thirds of the 7.6m children who died before their fifth birthday did so due to infectious causes – and pneumonia was found to be the leading cause of death.

One expert said it was very important to “translate such findings into action”.

The team from Johns Hopkins Bloomberg School of Public Health looked at data from a range of sources, including household surveys and registration systems for 193 countries. Mathematical modelling was used where data was incomplete.

They found child deaths had fallen by two million (26%) since 2000, and there have been significant reductions in leading causes of death including diarrhoea and measles – as well as pneumonia.

But they say there are still significant challenges.
International targets

Half of child deaths occurred in Africa – two thirds (2.6m) were due to infectious causes, including malaria and Aids.

In South East Asia, neonatal causes were the leading cause of death.

Five countries (India, Nigeria, Pakistan, Democratic Republic of Congo and China) accounted for almost half (3.75m) of deaths in children under five.

The researchers warn that very few countries will achieve international targets for improving child survival – the Millennium Development Goal (MDG) 4 – by the 2015 deadline.

Only tetanus, measles, and HIV/Aids have fallen enough to meet the target.

Writing in the Lancet, the researchers say: “Across all the previous and current rounds of causes of childhood death estimation, pneumonia and pre-term birth complications consistently rank as the leading causes at the global level.

“Africa and South East Asia are repeatedly the regions with the most deaths in children younger than five years.

“Our trend analysis shows that accelerated reductions are needed in the two major causes and in the two high-burden regions to achieve MDG4 by 2015.”

Should Pregnant Women Be Accommodated in the Workplace?

Earlier this week, a coalition of legislators introduced the Pregnant Workers Fairness Act, designed to encourage employers to make nice to their pregnant employees. If they need extra bathroom breaks or help lifting heavy things or a chair to sit in, employers shouldn’t balk.

But many are. Complaints about pregnancy-related work discrimination have soared 50% since 2000. Consider the case of Angie, a train conductor in Mississippi whose employer wouldn’t agree to accommodate her when she presented a doctor’s note limiting the amount of weight she should lift. Employees at her workplace routinely helped each other out, but her employer forced her to take three months of unpaid leave rather than assign her to lighter duty. She contacted an advice hotline maintained by Equal Rights Advocates (ERA), a nonprofit law firm that focuses on employment and educational equity for women, but there wasn’t much ERA could do in the absence of comprehensive laws championing pregnant women’s rights to reasonable accommodations in order to keep working.

(MORE: Jessica Simpson: Just Another Celeb Capitalizing on Her Pregnancy)

Just seven states — Connecticut, Hawaii, Louisiana, Alaska, Texas, Illinois and California — have some sort of pregnancy accommodation legislation; New York is in the process of trying to pass a law. California’s is among the most protective for pregnant women: it guarantees the right to job-protected — albeit unpaid — leave and mandates a pregnant woman’s right to be transferred to another position if medically necessary.

Given California’s generosity toward pregnant working women, one might wonder if litigation has gone gangbusters there in the 12 years since its law took effect. And that’s precisely the subject of a new report, Expecting a Baby, Not a Lay-Off: Why Federal Law Should Require the Reasonable Accommodation of Pregnant Workers, released Friday by ERA. It tracks all pregnancy discrimination cases filed in California since 2000 and finds that there just 23 — about two a year. The number of federal law discrimination charges have increased by 54% since 1997, but the charges filed in California dropped, perhaps because the law’s existence compelled employers to negotiate.

(MORE: Pregnant at Work? Why Your Job Could Be at Risk)

“At a time when American families are struggling to make ends meet, it’s imperative that we do everything we can to keep people in their jobs, and this is especially true for pregnant women on the verge of having another mouth to feed,” said U.S. Representative Jerrold Nadler (D-NY), one of the legislators who introduced the Pregnant Workers Fairness Act, in a statement.

Related legislation is particularly important to low-income workers, who tend to be those most impacted. Most women who file pregnancy discrimination claims work at lower-paying jobs in demanding physical environments. “We see that male firefighters who throw out their backs are given desk jobs, but women who are pregnant don’t get them,” says Noreen Farrell, ERA’s executive director. “There is an ability to provide accommodations, but employers don’t want to.”

The legislation is important because other protections out there — namely the Americans with Disabilities Act and the Pregnancy Discrimination Act (PDA), part of the Civil Rights Act — are limited in their application. The PDA, for example, requires employers to treat pregnant workers similarly to the way they treat other workers who may be sick or disabled. But it’s an apples-to-oranges comparison as most pregnant workers are neither sick nor disabled. “There is a gap in how these laws have been applied,” says Farrell. “Some employers say they will provide light duty for people who are injured on the job but not for pregnant women because they are not injured.”

(MORE: Study: Why Maternity Leave Is Important)

To further complicate matters, some workers are afraid to ask for accommodations for fear they’ll be placed on leave. “They don’t want to start taking leave months before they give birth,” says Farrell. The Family and Medical Leave Act of 1993 provides workers with just 12 weeks of job-protected leave. “They can’t risk starting leave at month three because by month seven, they’ve got no more time left. Even if their employer agrees to keep them on, they’re no longer getting paid.”

All of which is why ERA, along with a host of other organizations, is really hoping the Pregnant Workers Fairness Act will eventually get the seal of approval. “The law has allowed women to continue working at a time when they need to shore up their financial resources and continue to have company health care,” says Farrell. “It’s a win-win for businesses to be able to hang on to happy, well-trained employees.”

MORE: ‘The Pregnancy Project’: Why One Girl Decided to Fake Her Baby Bump

Bonnie Rochman is a reporter at TIME. Find her on Twitter at @brochman. You can also continue the discussion on TIME’s Facebook page and on Twitter at @TIME.

Read more: http://healthland.time.com/2012/05/11/how-much-should-pregnant-women-be-accommodated-in-the-workplace/?iid=hl-main-lede#ixzz1upAvrWiU

Blood Clot Warning Added to Yaz and Other Newer Birth Control Pills

2012-04-13

Yaz, Yasmin and other newer birth control pills will soon be bearing warning labels that detail the potential risk of blood clot risks, the U.S. Food and Drug Administration (FDA) announced on Tuesday.

The FDA is updating the labels based on recent studies that suggest that birth control pills containing drospirenone, a synthetic version of the female hormone progesterone, have a slightly increased risk of blood clots, compared with older birth control pills.

The new labels will note that some studies have found as high as a threefold increase in the risk of blood clots with drospirenone-containing pills, and will include a summary of a previous FDA-funded study on the risk, officials said in a statement.

Continue reading Blood Clot Warning Added to Yaz and Other Newer Birth Control Pills →

Can you predict a baby’s sex from the size of the bump?

2012-04-04

The shape of the bump, a difficult labour, or dangling a wedding ring over the belly. All are supposed to predict the sex of a baby. But only one works.

If a pregnant woman has a neat bump that sticks out in front like a netball, then it is a boy. If the weight is more spread out around her middle then it is a girl. Or so they say.

As any mother will tell you, there is no shortage of family members and friends offering folk stories about how to tell the sex of your baby during pregnancy. Even strangers stop pregnant women in the street to pronounce on the sex of their baby based on such “conclusive” signs as the shape of their bump.

Sadly, it is not as simple as that.

Two variables determine the nature of a pregnant woman’s bump. The first is the size of the baby. It is true that on average baby boys weigh more at birth than baby girls, and so this could make the bump for a boy slightly bigger. But this small difference in weight does not change the shape of the bump.

The second is the position of the foetus in the womb. If it has its back alongside the mother’s front this makes her belly stick right out. If the baby’s back is parallel with the mother’s back the result is that the abdomen looks flatter. And as the position the developing baby adopts is not dependent on its sex, it is a myth that the shape indicates whether it is a boy or a girl.

Tall tales

So, if you cannot predict the baby’s sex from the shape of the bump, then how about the other folklore tales? Dangling a wedding ring on a string over the bump and looking to see which way it spins will not reveal the answer, because the foetus can have no impact on how something external moves. Nor is there any evidence that the types of food craved by the mother-to-be are related to the sex of the foetus.

But how about the idea that morning sickness is worse if the woman is expecting a girl? The theory is that if you are carrying a girl you get a double dose of female hormones, and this makes you feel sick. Again this is a myth. Most morning sickness occurs during the first 12 weeks when the developing embryo is very small and the levels of sex-related hormones are low.

The only reliable way of knowing the sex of a baby is medical screening – through ultrasound scanning, amniocentesis or through chorionic villus sampling where a sample of cells is taken from the placenta. The latter two tests are only used to determine the sex if there is a risk of a gender-related problem with the foetus. Ultrasound scans are far more common, but some hospitals have a policy of not telling parents the sex of the baby.

But there is one indication, admittedly rather late on pregnancy, which could give you a clue. For years, midwives have joked during long labours that “If it is difficult it must be a boy”. But it seems there could be some truth in this. An Irish study published in the British Medical Journal examined 8,000 births at a Dublin hospital between 1997 and 2000. The authors found that on average labour lasted longer when delivering a baby boy, and that there were more complications requiring interventions such as caesarian sections.

So if you find yourself in the midst of a difficult labour this could hint that you are having a boy. But remember that these are only average figures and there are plenty of difficult labours with female babies too. And that once labour is finally over, you will find out the sex soon enough.

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Disclaimer
All content within this column is provided for general information only, and should not be treated as a substitute for the medical advice of your own doctor or any other health care professional.

Moms Say It’s Too Hard to Breast-Feed for the Recommended Six Months

2012-03-30

A Scottish study finds that moms think the advice to breast-feed for six months is unrealistic. They call for scaling back expectations, but advocates say that’s the wrong approach.

The advice to breast-feed infants exclusively until they’re at least 6 months old is unequivocal: it’s healthier for mom, and it’s healthier for baby. But it can also be really hard.

A recent Scottish study that consisted of multiple interviews with 36 mothers and some of their relatives — 35 of whom intended to breast-feed their babies — concluded that the widely touted recommendations are in fact “unhelpful” and overly idealistic.

The study, published in an open-access publication of the British Medical Journal, acknowledges the health benefits of breast milk that have prompted many governments — including the U.S. — to urge moms to nurse their infants. But they argue that scaling back expectations is necessary if more mothers are going to give it a try.

Continue reading Moms Say It’s Too Hard to Breast-Feed for the Recommended Six Months →

Does Your Sperm Need a Diet? Fatty Foods Linked to Poor Sperm Quality

2012-03-15

Gentlemen, you may want to hold the bacon. A new study suggests that eating a high-fat diet may be associated with lower sperm quality.

The study, published online in the European journal Human Reproduction, found that men who ate diets higher in saturated fat had lower sperm counts and concentration than men who consumed less fat. But men who consumed more omega-3 fatty acids — healthy fats found in fish and plant oils — had better formed sperm.

Researchers looked at 99 American men in their mid-30s who were participating in an ongoing study on fertility and environment, at the Massachusetts General Hospital Fertility Center. From December 2006 to August 2010, the researchers questioned the men about their diet and analyzed their semen samples.

The men were divided into three groups based on their total fat intake. The men in highest third of fat consumption (at least 37% of their total calories) had a 43% lower sperm count and 38% lower sperm concentration than the men with the lowest fat intake.

Saturated fats appear to be the star culprit behind poor sperm quality in this study. Men who consumed the most saturated fat (at least 13% of their daily calories) had a 35% lower total sperm count and a 38% lower sperm concentration than the men consuming the lowest levels.

Men who ate the most omega-3 fatty acids, however, had more correctly formed sperm.

MORE: Could a Healthy Diet Boost Sperm?

According to Dr. Richard Sharpe of the Medical Research Council’s Human Reproductive Sciences Unit at the University of Edinburgh, for normal functionality, sperm depend on their plasma membrane, which is mainly composed of fats. “It is therefore not unreasonable to imagine that the type of fats in the diet may affect sperm membrane fat composition which, in turn, may affect sperm function. To an extent, we are what we eat,” he said in an email statement. Dr. Sharpe is the deputy editor of Human Reproduction and is unaffiliated with the study.

“Diets containing higher amounts of omega-3 fat and lower amounts of saturated fat are associated with favorable semen quality parameters and may be beneficial to male reproductive health,” says study author Dr. Jill Attaman, assistant professor of obstetrics and gynecology at Dartmouth Medical School. “Although these findings need to be reproduced, adapting these nutritional modifications may not only be beneficial for reproductive health but for global general health as well. Given the impact infertility has worldwide, many men as well as couples may benefit from such lifestyle changes.”

The new study has its limits. For starters, the researchers acknowledge that the study sample was small and 71% of the participants were overweight or obese. Although previous research has associated obesity with poor sperm quality, the researchers were able to control for this factor. ”We were able to isolate the independent effects of fat intake from those of obesity using statistical models,” said Dr. Attaman in a statement. “The frequency of overweight and obesity among men in this study does not differ much from that among men in the general population in the U.S.A.”

Since it is the first study reporting a relationship between dietary fat and semen quality, the study authors stress the need for further research.

But, men, there’s no shortage of health reasons to adopt a lower-fat diet now. “It is common sense to recommend that men adopt such a diet. If this should also improve their sperm concentration and quality, then it is icing on the cake,” said Dr. Sharpe.

Read more: http://healthland.time.com/2012/03/14/does-your-sperm-need-a-diet-high-fat-intake-linked-to-poor-semen-quality/?iid=hl-main-lede#ixzz1pAB69gio

Does sex ed keep girls from becoming teen moms?

2012-02-14

In a new study, states with more comprehensive sex education programs had lower teen birth rates — but the effect seemed to be due more to political, religious and social differences between those states than the sex ed itself.

That doesn’t mean sex ed never helps prevent pregnancy, researchers said. But attitudes of family and friends, and whether teens have access to contraception and family planning services, might be just as important to putting a dent in the number of new teen moms.

“Although the teen birth rates and teen pregnancy rates are dropping year after year… we still have disparities between states, and we have higher teen birth and teen pregnancy rates when we’re compared to other industrialized countries,” said Patricia Cavazos-Rehg, from Washington University in St. Louis, who worked on the study.

Continue reading Does sex ed keep girls from becoming teen moms? →