Medicine Lessons and articles

Reprinted with kind permission from http://www.nationalpartnership.org. You can view the entire Daily Women’s Health Policy Report, search the archives, or sign up for email delivery here. The Daily Women’s Health Policy Report is a free service of the National Partnership for Women & Families, published by The Advisory Board Company.

© 2008 The Advisory Board Company. All rights reserved.

Two genetic variants of important biological proteins have been singled
out as increasing the risk of osteoporosis as well as resulting
osteoporotic fractures. Additionally, these genetic variants have a
high enough incidence in the population to potentially be screens for
the disease. This was published in an article released on April 29,
2008 in The Lancet.

Osteoporosis is a bone disease characterized by an increased risk of
fracture. Clinically, it is defined by measurement of bone mineral
density (BMD,) and this measurement is the current standard for
predicting osteoporotic fractures. Between osteoporosis and
osteoporotic fractures, the global health burden is US$17 billion every
year in direct expenditure. As it is a disorder that largely effects
the elderly, this number is only expected to increase as populations
age. Someone’s BMD is highly heritable, with estimates as high as 78%
heritability of the density of the lumbar spine, and 84% at the femoral
neck.

To examine heritable characteristics of
osteoporosis, Professor Tim Spector and Dr Brent Richards,
Department of Twin Research and Genetic Epidemiology, King’s College
London, UK and colleagues from the Wellcome Trust Sanger Institute, UK,
and Rotterdam performed a genome-wide association study of 2094 female
twins and identified the most promising single nucleotide polymorphisms
(SNPs). These were selected based on potential for responsibility for
conferring a higher risk of osteoporosis from a set of 314,075
potential sites. To confirm, these SNPs were examined in 6463 people
from three other studies in Western Europe.

There was evidence for an association between BMD and two different
SNPs. The first, on chromosome 11, is on the
lipoprotein-receptor-related protein (LRP5) gene, and is associated
with a decreased BMD as well as a 30% incrased risk of osteoporosis and
osteoporotic fractures. The second, on chromosome 8, is very close to
the osteoprotegerin gene (TNFRSF11B) and was found to decrease BMD and
increase the risk of osteoporosis by 20%.

Of the people tested, 22% had both of the risk alleles, and for this
sub-group the risk of osteoporotic fractures was increased by 30%. This
effect, notably, was independents of the person’s BMD. Both of these
genes are important targets for bone therapies, and drugs are already
in development to capitalize on this association.

The authors note that this is a great tool to identify osteoporosis
early and take preventative measures. “These alleles can be measured
with near-perfect precision and without bias years before the age at
which fractures tend to occur – which could provide ample lead-time for
preventive measures. Eventually, a panel of genetic markers could be
used in addition to environmental risk factors to identify individuals
who are most at risk for osteoporotic fractures.

They conclude, summarizing and pointing out the success of the study.
“We have identified genetic variants that decrease bone mineral density
and predispose people to osteoporosis and osteoporotic fracture. The
increase risk of osteoporotic fracture in people who had both risk
alleles was independent of the affect of these alleles on BMD…The
combined effect of these risk alleles on fractures is similar to that
of most well- replicated environmental factors, and they are present in
more than one in five white people, suggesting a potential role in
screening.”

Dr Joseph Zmuda, D and Dr Candace Kammerer, Graduate School of Public
Health, University of Pittsburgh, PA, USA, contributed an accompanying
Comment in which they describe this report as an important milestone
moving toward understanding the genetic basis of osteoporosis. They
point out that follow-up studies are now promising to identify the
genetic mechanisms involved in the disease. Additionally, they mention
that further study should be done in other populations, as this one
focused on white women of European descent.

Bone mineral density, osteoporosis, and osteoporotic fractures: a
genome-wide association study
J B Richards, F Rivadeneira, M Inouye, T M Pastinen, N Soranzo, S G
Wilson, T Andrew, M Falchi, R Gwilliam, K R Ahmadi, A M Valdes, P Arp,
P Whittaker, D J Verlaan, M Jhamai, V Kumanduri, M Moorhouse, J B van
Meurs, A Hofman, H A P Pols, D Hart, G Zhai, B S Kato, B H Mullin, F
Zhang, P Deloukas, A G Uitterlinden, T D Spector
The Lancet, April 29, 2008
DOI:10.1016/S0140-6736(08)60599-1
Click
Here For Abstract

Snipping away at osteoporosis susceptibility
Joseph M Zmuda, Candace M Kammerer
The Lancet, April 29, 2008
DOI:10.1016/S0140- 6736(08)60600-5
Click Here For Journal

Written by Anna Sophia McKenney

Copyright: Medical News Today

Not to be reproduced without permission of Medical News Today

Reprinted with kind permission from http://www.nationalpartnership.org. You can view the entire Daily Women’s Health Policy Report, search the archives, or sign up for email delivery here. The Daily Women’s Health Policy Report is a free service of the National Partnership for Women & Families, published by The Advisory Board Company.

© 2008 The Advisory Board Company. All rights reserved.

With the prevalence of diabetes rapidly increasing, an alarming number of pregnancies are also becoming affected, leading to increased health risks for both the mothers and their unborn children. The seriousness of this problem is brought home by a new study being published in the May issue of the American Diabetes Association’s (ADA) Diabetes Care, which shows a doubling of the number of pregnant women with diabetes over a seven-year period.

“With Mother’s Day approaching, it’s a good time for women of childbearing age to think about the importance of maintaining their health, especially if they wish to become pregnant,” said Sue Kirkman, MD, of the American Diabetes Association. “Type 2 diabetes can be prevented. And the consequences of not knowing your risk are not only harmful to the women, they’re potentially quite serious for their unborn children.”

The study, by researchers at Kaiser Permanente in Southern California, found the prevalence of pre-existing type 1 or type 2 diabetes among pregnant women doubled, from less than one (0.81) out of 100 pregnancies in 1999 to close to two (1.82) out of 100 pregnancies in 2005. This increase was largely in type 2 diabetes. During the same period, the prevalence of gestational diabetes (diabetes that develops during the last trimester of pregnancy and then disappears after the baby is born) remained relatively stable.

Having diabetes before you get pregnant – especially if it is poorly controlled or undiagnosed – raises the risk of having a miscarriage or a child with birth defects. Having diabetes before pregnancy or developing gestational diabetes increases the risk of having a very large baby, which can lead to birth complications. And gestational diabetes places both mother and child at a greater risk of developing type 2 diabetes later in life.

Women who are overweight or obese, whose families have a history of diabetes, or who had gestational diabetes in a prior pregnancy should take the ADA’s no-cost, online diabetes risk test to see if there is a strong chance that they have developed this chronic disease. The test can be found at http://www.diabetes.org/risktest. A paper version of the test can be obtained by calling ADA at 800-DIABETES. If the test indicates a high risk, or if a woman is thinking of becoming pregnant and wants to be certain, she should follow up with her doctor for a full diabetes screening.

The increased prevalence of pre-existing diabetes among pregnant women exists across all age groups and racial and ethnic backgrounds, the Kaiser Permanente researchers found. Because women are developing diabetes at younger ages, the number of women affected during their early, reproductive years has risen dramatically.

Additionally, the earlier onset and longer duration of type 2 diabetes also suggests the women may develop diabetes-related complications at an earlier age, the researchers concluded.

Dr. Jean Lawrence, the lead author on this study, suggests that “interventions that focus on reducing overweight and obesity can help decrease the number of women who have diabetes during their reproductive years. Given the increasing prevalence of diabetes in childbearing-age women, the awareness that preconception care reduces maternal and infant complications for women with diabetes as well as the availability of these services becomes increasingly important.”

Numerous studies have shown that type 2 diabetes can be prevented through lifestyle changes such as moderate weight loss and increased daily physical activity. For more information on how to prevent diabetes and its many complications, visit http://www.diabetes.org or call 800-DIABETES. Information is available in English and Spanish.

The American Diabetes Association is the nation’s premier voluntary health organization supporting diabetes research, information and advocacy. Founded in 1940, the Association’s mission is to prevent and cure diabetes and to improve the lives of all people affected by diabetes.

American Diabetes Association

Even part-time work can have a negative effect on breastfeeding rates, says new study

Part-time and casual work among new mothers has almost as big a negative impact on breastfeeding rates as returning to work full-time, says a new study led by the University of Melbourne.

While previous studies have shown that women who return to full-time work are far less likely to be breastfeeding at six months, the new Australian study is the first to show dramatically reduced breastfeeding rates in those who return on a part-time or casual basis.

The paper, to be published in the May issue of Acta Paediatrica, says a lack of paid maternity leave and low workplace support for breastfeeding are interfering with the establishment of breastfeeding among Australian women.

Lead researcher Amanda Cooklin, from the University of Melbourne’s Key Centre for Women’s Health, and colleagues Susan Donath (Murdoch Children’s Research Institute and University of Melbourne) and Lisa Amir (La Trobe University) analysed the breastfeeding rates among almost 3700 mothers and babies at six months after the birth.

They found:

• Mothers who returned to work full-time within three months of birth were twice as likely to have stopped breastfeeding by the time their baby was six months, than those who were not employed;

• Mothers who returned to work full time between three and six months of birth were three times as likely to have stopped breastfeeding by the time their baby was six months than non-employed women.
• Women who returned to work on either a part-time or casual basis after three months were almost as likely to have stopped breastfeeding as those who worked full-time.

Ms Cooklin said study results showed that early postnatal employment was a significant risk factor for an early end to breastfeeding in Australian infants.

Ms Cooklin said the findings in relation to part-time and casual work were surprising.

Previous studies in the US had found mothers who worked part-time had similar breastfeeding patterns to those who were not employed.

“In Australia however, a reduced working week does not contribute to mothers’ ability to maintain breastfeeding for six months,” Ms Cooklin said.

“Part-time employment is almost as much of a risk factor as full-time employment for an early end to breastfeeding.”

Ms Cooklin said a lack of privacy, fatigue, inflexible work schedules and unsupportive employers and colleagues prevented many employed women from maintaining breastfeeding.

“Given that the provision of workplace support for breastfeeding remains a matter for individual negotiation, it’s not surprising that a return to work spells the end of breastfeeding for many women.”

Ms Cooklin said lack of paid maternity leave was also affecting breastfeeding rates.

“Many women return to work sooner than they would like for financial reasons and this interferes with the establishment of breastfeeding,” she said.

The World Health Organisation recommends exclusive breastfeeding for the first six months of life.

However, only half of Australian infants receive any breast milk by six months and very few of these infants are exclusively breastfed.

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Article adapted by Medical News Today from original press release.
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Source: Janine Sim-Jones

University of Melbourne

Endogun Medical Systems Ltd., a leading developer and manufacturer of novel solutions for minimally-invasive fastening of soft tissue, today announced that it has received FDA clearance to market in the USA its next-generation, single-incision, trans-vaginal Endofast Reliant device for soft tissue reinforcement and attachment.

According to Endogun’s Chairman of the Board, Elad Naggar, The FDA approval for our single use, disposable EndoFast Reliant”! product is a key milestone towards bringing Endogun’s products to the Prolapse and Stress Urinary Incontinence (SUI) markets. This regulatory approval, together with very positive clinical validation from key opinion leaders, indicates a product with a unique value proposition. We believe that our solution may have significant advantages over what is available today, for patients, physicians, payers and providers.”

Pelvic Organ Prolapse occurs in women, often following multiple births or excess weight, and develops as a result of weakening of the pelvic muscles which support internal organs (womb, bladder, rectum and vagina). Side effects of this condition include discomfort, a feeling of heaviness, and pain and the disorder carries the risks of inflammation and infection.

More than 600,000 procedures are performed annually in the USA and Europe (combined), with direct costs of associated surgical equipment reaching hundreds of millions of dollars. Estimates suggest that close to 7 million women are in need of such treatment; the gap between the potential market size and the actual number of procedures performed to date may stem from the fact that the current surgical offerings are significantly invasive, and require substantial surgical skills.

Endogun’s product is aimed at offering a single-incision, simpler and safer procedure, which is performed entirely trans-vaginally.

About Endogun

Endogun Medical Systems Ltd. (”Endogun”) was founded in March 2004 to offer improved soft tissue attachment technology and products to the world of Minimally Invasive Surgery (MIS). It offers procedures that are easier for surgeons to use and safer for patients than today’s options. Endogun aims to significantly improve the quality and outcome of many minimally invasive procedures in the world of urogynecology and urology.

Endogun Medical Systems Ltd

Researchers in East Anglia in the UK are looking for 150 postmenopausal women with type 2 diabetes to take part in a study to find out if compounds in
chocolate reduce the risk of heart disease in women with diabetes.

The study is funded by leading charity Diabetes UK, and is led by a team at the University of East Anglia (UEA) in Norwich, partnered by the Elsie Bertram
Diabetes Centre, Norfolk, Norwich University Hospital (NNUH) and the Institute of Food Research (IFR).

For this first clinical trial of its kind, the researchers are looking for postmenopausal women with type 2 diabetes to eat specially formulated chocolate
bars for a year.

(Before you get too excited, please read to the end of the article to make sure you meet the entry criteria!).

Lead researcher Aedin Cassidy, Professor of Diet and Health at UEA, said:

“Despite postmenopausal women being at a similar risk to men for developing cardiovascular disease, to date they are under-represented in clinical
trials.”

The flavanoids in chocolate’s main ingredient, cocoa, are known to reduce the risk factors for heart disease, but most of the chocolate we eat is made using
a process that unfortunately destroys these health-giving compounds.

So the researchers have employed the services of a Belgian chocolatier to formulate a special bar of chocolate that contains higher amounts of flavanoids
than standard commercially available chocolate.

The special chocolate bar will also contain soy, another rich source of flavanoids that are thought to be good for women’s hearts.

One of the researchers and a consultant in diabetes at the NNUH, Dr Ketan Dhatariya said:

“The hypothesis of this exciting study is that flavonoids, in this case compounds found in cocoa and soy, may improve the level of protection against heart
disease over and above that provided by conventional drugs.”

“If the trial confirms this, it could have a far-reaching impact on the advice we give to postmenopausal women who have type 2 diabetes,” added
Dhatariya.

Cassidy said they hoped to show that by adding flavanoids to their diet, the women will gain extra protection from heart disease and an opportunity to take
more control over reducing their risk of heart disease in the future.

The researchers are hoping to recruit 150 women under the age of 70, who have type 2 diabetes, are not on hormone therapy and have been menopausal (ie no
periods) for at least one year.

A woman’s risk of dying from heart disease increases rapidly after the menopause, and considerably more so, up to three and half times more, if she has type
2 diabetes. That’s why this group is the focus of the trial.

Another requirement is that the volunteers must have been taking prescribed cholesterol busting medication (statins) for at least one year, since the purpose
of the study is to examine the effect of flavanoids over and above heart-protecting drugs.

Once recruited, the women will have their risk of heart disease assessed five times over the year. The tests will be done at UEA or NNUH in Norwich and
travel costs will be paid.

Prospective volunteers will be paid a screening visit and approval sought from their GP, who will receive the screening results.

Interested potential volunteers should contact Andrea Brown (study nurse) or Dr Peter Curtis (study co-ordinator) at FLAVO@uea.ac.uk. You can also phone
them on 01603 288570.

Sources: University of East Anglia.

Written by: Catharine Paddock, PhD

Copyright: Medical News Today

Not to be reproduced without permission of Medical News Today

A third of parents could refuse to allow their teenage daughters to receive a new cervical cancer vaccination, The Daily Telegraph reports. Results from a study show that a “significant proportion of parents will not give permission for their child to receive the injection”, the newspaper says. It works by stopping the spread of the human papilloma virus (HPV), a primary cause of cervical cancer. The newspaper adds that “scientists estimate it will prevent 70% of all cases of cervical cancer, which kills about 1,000 women every year”.

This story is based on a study in two NHS primary care trusts in Greater Manchester. Although the study indicates that high levels of uptake of the first two doses of the three-dose programme are possible, these estimates may not be indicative of the national vaccination programme. High levels of coverage will need to be achieved for the vaccine to have maximum effect and this study highlights some of the barriers that will need to be tackled to achieve this. After routine vaccination for those aged 12 and 13 is introduced in September, the Department of Health plans a two-year catch-up campaign in Autumn 2009, for all girls up to 18.

Where did the story come from?

Dr Loretta Brabin and colleagues from the University of Manchester, Stockport and Bury Primary Care Trusts and the Greater Manchester Health Protection Unit carried out this research. The study was funded by the University of Manchester and GlaxoSmithKline. The authors report that the research was conducted independently of the funders. The first author was funded by the Max Elstein Foundation. It was published in the peer-reviewed British Medical Journal.

What kind of scientific study was this?

This was a prospective cohort study assessing the feasibility and acceptability of the HPV vaccine being given to adolescent girls.

The researchers asked 10 primary care trusts (PCTs) in Greater Manchester to participate in their study, and only two agreed. The PCTs were responsible for providing the bivalent HPV vaccine (the vaccine that targets two HPV strains) in the 36 secondary schools in their areas. The PCTs planned to give the vaccine in three doses, with the second and third doses being given one and six months after the first. The eligible pupils were 2,817 girls aged 12 to 13 (school year 8). Their parents were informed about the study and given an educational flier about the vaccine, details about parents’ information evenings, a slip on which to record reasons for refusal, and a slip asking for consent for a follow-up questionnaire by post, including pre-paid envelopes for reply. Parents were also sent reminders by post. Missed vaccination appointments could be rescheduled.

The researchers obtained anonymous details about the uptake of the first two doses of the vaccine from child heath departments. They also obtained information about the type of school, the ethnic makeup of the school population and whether school meals were available. The researchers then looked for relationships between uptake of the vaccine and characteristics of the schools.

What were the results of the study?

Among the 2,817 participants, 71% received the first vaccination and 69% received the second dose. About 8% of parents refused the vaccination completely, 20% failed to reply to the invitation and 1% agreed to vaccination, but their daughter did not receive it. About 16% of girls who received the first vaccination did not receive it at the original scheduled time and 24% of those who received the second vaccination did not receive it at the scheduled time. No serious side effects of the vaccinations occurred.

Vaccine uptake was lower in schools with higher proportions of girls who were eligible for school meals and in schools with higher proportions of ethnic minorities. The most common reason given by parents for refusing the vaccination was insufficient information about the vaccine and its long-term safety. Other reasons included not wanting to participate in a research study, wanting to wait for the national HPV vaccine programme or preferring the quadrivalent vaccine. Fewer parents gave reasons relating to their daughter’s age (10%) or the effect of the vaccine on adolescent sexual behaviour (3%).

What interpretations did the researchers draw from these results?

The researchers concluded that it was possible to obtain an acceptable level of uptake of the first two doses of the bivalent HPV vaccine among adolescent girls. They note that the success of the vaccination programme will depend on uptake of the third dose.

What does the NHS Knowledge Service make of this study?

This study gives us some idea of what the uptake rates of the HPV vaccine by adolescent girls might be. However, there are aspects of this study that should be taken into account when extrapolating this study to the general population:

- The fact that this was a research study deterred some parents from taking part and they may have been more likely to take part in a national programme.
- This study used the bivalent vaccine. There is also a quadrivalent vaccine and uptake of this vaccine might differ. It is as yet unclear which vaccine will be used in the UK national programme.
- This study was conducted in two areas in Greater Manchester. Uptake rates may differ in different areas with different population characteristics.
- Although 10 PCTs were asked to participate, eight refused and the reasons for this were not clear. Two schools within the PCT areas that did agree refused to participate on religious grounds, but other schools from the same religious denomination did agree to participate.

This study indicates that the high rates that need to be achieved for vaccination programmes to be effective may be feasible in consenting schools. However, it’s the overall rate of uptake in the country as a whole that will determine the effectiveness of a national campaign.

Links to the headlines

Third of parents ‘refuse cancer jab’. The Daily Telegraph, April 25 2008
20% of parents ‘block cancer jab’. BBC News, April 25 2008
1 in 5 parents refuse daughters’ cervical cancer jab. The Guardian, April 25 2008

This news comes from NHS Choices

Matria Healthcare, Inc., (NASDAQ: MATR) announced that it will expand its maternity services to a major national health plan by providing maternity risk assessment, member education and case management support services. When fully implemented, annualized revenues are expected to be in the range of $2.2 million.

Under the new terms, employers in the health plan’s network will be able to use Matria’s services to assist in the management of their employees’ and members’ pregnancy-related needs across the entire continuum of maternity care. The health plan network includes more than 4,200 hospitals, approximately 575,000 physician and ancillary providers nationally and provides health care coverage to more than 5,000 employers and over two million people.

“We look forward to building on our established relationship to deliver a more complete continuum of pregnancy care,” said Gregg Raybuck, president of Women’s and Children’s Health at Matria. “It has been our experience that the earlier risk factors can be identified — even before the pregnancy has occurred — the better the clinical and financial outcomes for patients and healthcare providers.”

Matria’s expanded services to the client comprise a preconception education program, maternity risk screening, member education, case management of complicated cases and 24/7 access to highly experienced OB trained nurses. Matria currently provides the health plan with its comprehensive suite of home-based obstetrical services. Additionally, Matria provides a full suite of health enhancement programs and services, including wellness solutions and the management of chronic conditions.

“Matria’s extensive national network of obstetrical RNs has vast experience in assisting physicians manage hundreds of thousands of complicated pregnancies with excellent clinical outcomes, while helping drive down costs,” said Raybuck. “With the addition of these services, it is our aim to further improve clinical outcomes and increase overall member satisfaction in our expanded relationship.”

According to Raybuck, the vital link to successful outcomes is how Matria’s home-based obstetrical programs closely partner with healthcare providers to manage and monitor complicated pregnancy patients.

About Matria Healthcare

Matria Healthcare is a leading provider of integrated comprehensive health enhancement programs to health plans, employers and government agencies. Matria is dedicated to developing better educated, motivated and self-enabled healthcare consumers and supporting clinicians in managing the care of their patients. The Company manages major chronic diseases and episodic conditions including diabetes, congestive heart failure, coronary artery disease, asthma, chronic obstructive pulmonary disease, high-risk obstetrics, cancer, musculoskeletal and chronic pain, depression, obesity, and other conditions. Matria delivers programs that address wellness, healthy living, productivity improvement and navigation of the healthcare system, and provides case management of acute and catastrophic conditions. Headquartered in Marietta, Georgia, Matria operates through nearly 50 offices around the United States. More information about Matria can be found online at http://www.matria.com.

Safe Harbor Statement

This press release contains forward-looking statements. Such statements include but are not limited to the revenue expectations from the expanded relationship and the impact of the Company’s maternity services on providing earlier risk identification, better pregnancy clinical and financial outcomes and increased member satisfaction. These statements are based on current information and belief, and are not guarantees of future performance. Among the important factors that could cause actual results to differ materially from those indicated by such forward-looking statements include failure to achieve the anticipated revenues, inability of the maternity services to provide earlier risk identification, better pregnancy outcomes and improved member satisfaction, developments in the healthcare industry, third-party actions over which Matria does not have control, regulatory requirements applicable to Matria’s business and the risk factors detailed from time to time in Matria’s periodic reports and registration statements filed with the Securities and Exchange Commission, including Matria’s Annual Report on Form 10-K for the year ended December 31, 2007. By making these forward-looking statements, Matria does not undertake to update them in any manner except as may be required by Matria’s disclosure obligations in filings it makes with the Securities and Exchange Commission under the federal securities laws.

Matria Healthcare

Reprinted with kind permission from http://www.nationalpartnership.org. You can view the entire Daily Women’s Health Policy Report, search the archives, or sign up for email delivery here. The Daily Women’s Health Policy Report is a free service of the National Partnership for Women & Families, published by The Advisory Board Company.

© 2008 The Advisory Board Company. All rights reserved.