Main Category: Cardiovascular / Cardiology
Also Included In: Cancer / Oncology;  Nutrition / Diet;  Women’s Health / Gynecology
Article Date: 21 Feb 2012 – 0:00 PST

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Women with a previous history of cardiovascular pathologies seem to have a higher cancer risk after five years of Vitamin B and omega-3 supplementation. The research is published in detail in the Archives of Internal Medicine.

Although some studies have suggested that supplementation with B vitamins has some benefits for protecting against cancer, the few randomised clinical trials conducted internationally in recent years remain equivocal.

The results of studies of the influence of supplementation with polyunsaturated fatty acids have been mixed.

That is why Valentina Andreeva and Pilar Galan and their staff wanted to study the effects of B vitamins and omega-3 polyunsaturated fatty acids (PUFAs) on cancer by monitoring, for five years from 2003 to 2009, more than 2500 people aged between 45 and 80 who had survived a heart attack, stroke or angina in the last 12 months.

The aim of the trial was to check the hypothesis that supplementation with en5-methyl-THF (and vitamins B6 and B12) and/or omega-3 was of value in preventing the recurrence of ischaemic pathologies in subjects who had suffered a heart attack or stroke.

The results, published in the Archives of Internal Medicine, are the outcome of a specific analysis performed as part of the intervention study SU.FOL.OM3, the results of which were published in 2010 in the British Medical Journal

SU.FOL.OM3 is a randomised double-blind placebo-controlled secondary prevention trial in which participants aged from 45 to 80 years with a previous history of cardiovascular pathologies were given daily supplements for five years of B vitamins (3 mg of vitamin B6, 560 μg of folates and 20 μg of vitamin B12) and/or omega-3 PUFAs (600 mg of eicosapentaenoic acid, EPA, and docosapentaenoic acid, DHA, in a ratio of 2:1), according to a factorial design.

It tested the effect of supplementation on cancer development over the five-year monitoring period in 145 men and 29 women.

All types of cancer were monitored

“Despite the low numbers, the results are significant,” the authors believe, because the “methodology used – a randomised double-blind trial – is stringent”.

The researchers conclude that “Neither B vitamin supplementation nor omega-3 PUFA supplementation has a significant effect on the occurrence of cancer in men. However, women receiving omega-3 fatty acids tended to present a higher risk of cancer compared with the placebo group (adjusted HR =3.02; CI of 95 % = [1.33; 6.89]). Although the underlying mechanisms are not clear, a potential mediating effect on the metabolism of oestrogens is suggested,” they add.

To confirm or contradict these results, it is necessary to await new studies: randomised trials, cohort studies and mechanistic studies.

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Editor’s Choice
Academic Journal
Main Category: Cancer / Oncology
Also Included In: Women’s Health / Gynecology
Article Date: 20 Feb 2012 – 9:00 PST

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Women who survive cancer receiving mammography screening have “worse health behaviors”, than those who had never had cancer and receiving mammography screening, according to a study by researchers at Moffitt Cancer Center in Tampa, Fla., and the Mayo Clinic in Rochester, Minn. The study was published in the American Journal of Clinical Oncology.

The team questioned 2,713 female cancer survivors aged 35+ receiving mammography screening, and compared their responses of 19,947 women with no previous breast cancer presenting for mammography screening.

The researchers compared the two groups on alcohol use, weight status, physical activity, vitamin use, and smoking behaviors and found that:

• Women who survived cancer were more likely to use more than three vitamins.
• Those who survived cancer were less likely to take part in “strenuous exercise”, compared with those with no history of cancer. Regardless of cancer history, younger women were less likely to engage in “mild exercise” than older participants.
• Compared with women with no cancer history, cancer survivors were more likely to rate their overall health as “poor”.
• Women aged between 30-49, who survived cancer, had greater raters of smoking than those with no cancer history.
• The team found no different in Body Mass Index between the two groups, although they did find that those who survived cancer reported less weight gain over the past 5 years, than those with no cancer history.
• Women with no cancer history were more likely to use alcohol monthly or greater than cancer survivors. Younger cancer survivors were the most common alcohol users.

Sarah M. Rausch, Ph.D., study author and clinical psychologist and director of Integrative Medicine at Moffitt, explained:

“These results suggest that there are opportunities for tailored behavioral health risk factor interventions for cancer survivors. The differences in health behaviors between cancer survivors and those with no cancer history afford a ‘teachable moment’ in which a cancer survivor may be motivated to change behaviors to promote a healthier lifestyle and prevent cancer recurrence.”

The researchers found that women who survived cervical cancer reported having several unhealthy lifestyles. This finding is consistent with other surveys analyzing health behaviors of cancer survivors.

Rausch, said:

“As the population of cancer survivors increases, the importance of health status and quality of life in cancer survivors is even more critical. Approximately 10.5 million people in the U.S. have been diagnosed with cancer. Due to the progress in cancer diagnosis and treatment, there is a growing population of cancer survivors.”

Citing statistics from 2006 in their study, the researchers state that one-third of the half million cancer deaths each year in the U.S., was attributable to obesity, unhealthy diet, and lack of physical activity.

Rausch, explained:

“Studies, including ours, have found that cancer survivors are not as healthy as the general public. As our study demonstrated, unhealthy behaviors, such as smoking and alcohol use, and a lack of physical exercise among cancer survivors presenting for screening mammography, may account for their generally less than healthy status when compared to their peers, who also presented for screening mammography, but who had never had a cancer diagnosis.”

According to the team, the “teachable moment” taken from their investigation should be taken advantage of by health care professionals to drive home the importance of leading a healthier lifestyle, in order to prevent cancer recurrence.

Written by Grace Rattue
Copyright: Medical News Today
Not to be reproduced without permission of Medical News Today

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Academic Journal
Main Category: Menopause
Also Included In: Endocrinology;  Women’s Health / Gynecology
Article Date: 20 Feb 2012 – 9:00 PST

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A report entitled “STRAW+10″ allows researchers and physicians to systematically and consistently identify the various reproductive stages women experience from adolescence to post-menopause. This support structure will help clinicians predict when a woman will enter menopause, as well as help them choose the most effective treatment options for menopausal symptoms and other associated conditions. The report is published in the journals Menopause, Journal of Clinical Endocrinology and Metabolism, Climacteric, and Fertility and Sterility.

In September 2011, a group of US and international experts met in Washington, DC, in order to examine the most recent scientific data on the hormonal changes that distinguish reproductive aging in women, and to reach an agreement on defining the reproductive stages in a woman’s life.

“STRAW+10″ represents an update to the STRAW (Stages of Reproductive Aging Workshop) system established a decade ago. STRAW has helped researchers across the world to better understand reproductive aging in women.

Janet E. Hall, M.D., president of The Endocrine Society, explained:

“STRAW+10″ provides a general road map to reproductive aging. The updates in the new report will guide future scientific studies of menopause and ultimately help predict the onset of the menopausal transition and menopause in individual women.”

Revisions in the “STRAW+10″ include:

• Revised criteria for the late reproductive and early post-menopause stages
• Recommended application of this staging system to a wider range of women without limitation by body size, lifestyle characteristics, age or ethnicity
• Simplified bleeding criteria for the early and late transition of menopause

The symposium was co-sponsored by The Endocrine Society, The National Institute on Aging (NIA), The Office of Research on Women’s Health (ORWH), as well as The North American Menopause Society (NAMS), The American Society for Reproductive Medicine (ASRM), and The International Menopause Society (IMS).

Written by Grace Rattue
Copyright: Medical News Today
Not to be reproduced without permission of Medical News Today

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Main Category: Nutrition / Diet
Also Included In: Women’s Health / Gynecology
Article Date: 21 Feb 2012 – 0:00 PST

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A new study published by researchers at SUNY Downstate Medical Center’s School of Public Health assesses mercury levels in pregnant women and examines dietary and environmental sources of exposure to mercury. The research, which focuses on an urban immigrant community, examined risk factors that may be associated with elevated mercury levels, measured through urine and cord blood samples. The study, published this month in the Journal of Environmental Monitoring, found that foreign-born immigrant women from the Caribbean are at higher risk for elevated levels of mercury in the blood, predominantly from dietary sources such as large fish.*

Laura Geer, PhD, MHS, assistant professor in the Department of Environmental and Occupational Health Sciences at SUNY Downstate’s School of Public Health, and Patrick J. Parsons, PhD, chief of the Laboratory of Inorganic and Nuclear Chemistry, Wadsworth Center, New York State Department of Health, were the main collaborators on the study, “Assessment of Prenatal Mercury Exposure in a Predominately Caribbean Immigrant Community in Brooklyn, NY.” The School of Public Health at SUNY’s University at Albany, where Dr. Parsons is professor and chair of the Department of Environmental Health Sciences, also contributed to the study, which was also conducted in collaboration with SUNY Downstate’s Department of Obstetrics and Gynecology. The research was sponsored by The New York Community Trust.

The study elaborates on previously identified risk factors of in utero mercury exposure. Mercury exposure is a continuing concern in immigrant communities due to risk factors such as maternal country of origin, fish consumption, and ritualistic use of elemental mercury in religious ceremonies. For infants and children, the primary health concern is possible damage to cognitive and central nervous system development related to maternal exposure.

Dr. Geer and her team used a combination of assessment methods to determine exposure levels. A questionnaire designed in collaboration with health professionals from the Caribbean community assessed the frequency of fish consumption, ritualistic practices, occupational exposures, number of dental amalgams, and use of mercury-containing skin and household products. [SUNY Downstate is located in an area of Brooklyn that includes one of the largest Caribbean-American communities in the United States.]

Analysis of cord blood for mercury revealed that 16 percent of samples exceeded the estimated equivalent of the U.S. Environmental Protection Agency’s Reference Dose. Cord blood samples generally reflect organic mercury that has been acquired through maternal food consumption. Predictors of cord blood levels included maternal fish consumption and foreign birth of the mother.

Urine mercury levels, which are more likely to reflect environmental exposure to inorganic mercury, were significantly lower than cord blood levels. Predictors of urine mercury also included foreign birth of the mother, as well as the number of dental amalgams and special product use. There were no reports of mercury use in ritualistic practices or in cosmetics; however, some women reported use of religious medals and charms. Women participating in the study were informed of any elevated test results.

Although the study population was selected as a convenience sample, the mercury levels were lower – in this higher-risk population – than those estimated based on maternal blood levels from the NYC Health and Nutrition Examination Survey (HANES) of 2004, indicating the possibility of lower exposure since the NYC HANES study was conducted.

Putting this into context, Dr. Geer explains that the elevated cord blood mercury samples seen in some study subjects were still not at levels that are known to be associated with adverse health or developmental effects. However, she notes that the study indicates a need for further study and mercury-exposure prevention efforts tailored to this group, and that subjects were contacted and offered further testing. Furthermore, efforts should target health care providers, health agencies, and community advocates who provide avenues of education for women of childbearing age concerning appropriate dietary fish selection, and potential sources of mercury in the home. Dr. Geer points out that the new widespread use of fluorescent light bulbs, which contain a small amount of inorganic mercury and may expose people when they break, as well as the possibility of exposure from discarded computer equipment, are two current but little recognized sources.

Dr. Geer said, “Our study shows that women of Caribbean origin are at high risk for mercury exposure, owing to the consumption of specific types of fish and other factors. Since mercury can harm a child’s development both in and beyond the womb, mercury should be kept at the lowest possible levels. Community education efforts should target Caribbean-American women to accomplish this.”

Dr. Geer, assisted by Fay Callejo, MPH, from the School of Public Health, is in the process of completing a follow-up study to identify educational strategies to facilitate community awareness of mercury exposure sources, particularly for women of childbearing age.

Dr. Geer recommends that people familiarize themselves with how to protect their children and their homes from mercury exposure. As suggested by the U.S. Environmental Protection Agency (EPA), five things they can do include:

Learn how to enjoy a diet that includes fish while minimizing exposure to fish species that have high mercury levels.

Learn which products are likely to contain mercury. Avoid use of mercury-containing skin-lightening creams.

Properly recycle or dispose of any mercury-containing products in the home.

Handle mercury-containing products such as thermometers and compact fluorescent bulbs carefully to avoid breakage.

And learn how properly to clean up a mercury spill. Never use a vacuum cleaner.

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Main Category: Ovarian Cancer
Also Included In: Pancreatic Cancer;  Women’s Health / Gynecology
Article Date: 17 Feb 2012 – 1:00 PST

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Highly elevated platelet levels fuel tumor growth and reduce the survival of ovarian cancer patients, an international team of researchers led by scientists at The University of Texas MD Anderson Cancer center reports in the New England Journal of Medicine.

By pinpointing a powerful cause-and-effect relationship at the heart of a clinical observation that dates back more than 100 years, the team’s findings reveal a new factor in cancer progression and new potential approaches for treatment.

“We’ve long known that ovarian cancer patients often have markedly increased platelet counts but we haven’t known why this happens or understood its relevance, if any, to disease progression,” said senior author Anil Sood, M.D., professor in MD Anderson’s Departments of Gynecologic Oncology and Reproductive Medicine and Cancer Biology.

“Our collaborative study not only identified a mechanism that explains platelet count elevation, but also connects this state, called thrombocytosis, to the severity of ovarian cancer,” Sood said. “This suggests drugs that interfere with coagulation might be a useful addition to conventional therapies.”

Tumor makes IL-6, liver produces TPO, platelets abound, tumor grows

Drawing on clinical data from ovarian cancer patients and following up with mouse model experiments and a clinical trial, Sood and colleagues discovered:

• Ovarian cancers produce the inflammatory cytokine interleukin-6 (IL-6);
• Triggering creation of the platelet-production regulating hormone thrombopoietin (TPO) in the liver;
• Causing platelet counts to soar to more than 450,000 per cubic millimeter in the blood, the threshold for thrombocytosis, and
• Stimulating tumor growth and continuation of the cycle.

“Platelets may function as a fuel depot for tumors by providing them with growth factors,” Sood said. They were found not only in the blood but also in the tumor’s microenvironment, in the tumor bed, and in ascites, fluid build-up in the abdominal cavity common in ovarian cancer.

In a clinical trial conducted at the Barts Cancer Institute, Queen Mary, University of London, the team also found that treatment of 18 ovarian cancer patients in a phase I/II clinical trial with siltuximab, an antibody to IL-6, sharply reduced platelet counts over a three-week period.

Clinical observation leads to survival connection

“This research comes from clinical observations,” Sood said. “We have many ovarian cancer patients with thrombocytosis and decided to look into the causes for it.”

A literature search revealed that the association between what was then called a “hyper-coagulable state” and cancer was noted as far back as 1867, but no relationship between the two had been established.

Of 619 ovarian cancer patients, 192 (31 percent) had thrombocytosis. Importantly, less than 2 percent of those had an iron deficiency or a non-cancerous inflammatory condition, the two most common causes of elevated platelet levels.

Patients with thrombocytosis survived for a median of 2.62 years, compared to 4.65 years for those with normal platelet counts. After accounting for age, disease stage, tumor grade and type and the extent of surgical tumor reduction, thrombocytosis remained an independent predictor of poor survival.

Tracking down cause and effect

The team found elevated platelet counts in three separate mouse models of epithelial ovarian cancer and in pancreatic and uterine cancer models, but not breast cancer.

They also found a connection between high platelet counts and higher levels of large cells called megakaryocytes, which occur in the bone marrow and fragment into platelets under the direction of thrombopoietin.

Next, in a cohort of 150 ovarian cancer patients, they analyzed plasma levels of 10 factors in the blood known to regulate creation of megakaryocytes. Again, 31 percent had thrombocytosis.

Levels of interleukin-6 and thrombopoietin in blood serum were substantially elevated in patients with thrombocytosis. A separate analysis of 310 ovarian cancer patients showed that elevated IL-6 is also associated with reduced progression-free survival.

Blocking thrombopoietin and interleukin-6 reduces platelets, shrinks tumors

To understand the functional role TPO and IL-6 play in raising platelet levels, the researchers used short interfering RNA to shut them down separately and together in mice. In each case, platelet levels fell steeply, with thrombocytosis completely eliminated when both IL-6 and TPO were silenced.

To test IL-6 as a target, they treated two strains of mice with ovarian cancer with the IL-6 antibody siltuximab, paclitaxel chemotherapy, or both. All three treatments reduced platelet count and tumor burden. The combination was most effective, reducing tumor growth by 90 percent.

Treatment of mice with an anti-platelet antibody cut both the circulating platelet count and average tumor size in half, reduced cell proliferation by 44 percent and tumor blood vessel density by 51 percent.

More to study: precise mechanisms, potential treatments

While the researchers note that platelets are likely to promote cancer growth by strengthening tumor blood vessels, the precise mechanisms involved remain to be discovered via prospective collection and in-depth analysis of platelets from cancer patients.

The authors note their findings might explain why some blood-thinning agents improve survival in some cancer patients independent of their prevention of vascular blood clotting, and why daily use of aspirin after diagnosis of colorectal cancer also improved survival in a prospective clinical trial.

Platelet levels may also serve as biomarkers for ovarian and other cancers, Rebecca Stone, M.D., clinical fellow in gynecologic oncology and the first author of the study, noted. “If you see high platelets, absent inflammation or iron deficiency, it would be important to look for cancer.”

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Main Category: Cancer / Oncology
Also Included In: Women’s Health / Gynecology;  Public Health
Article Date: 17 Feb 2012 – 1:00 PST

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A recent study conducted by researchers at Moffitt Cancer Center in Tampa, Fla., and the Mayo Clinic in Rochester, Minn., has found that female cancer survivors receiving screening mammography have “worse health behaviors” than women receiving mammography screening and who had never had cancer.

The study was published in a recent issue of the American Journal of Clinical Oncology.

Researchers surveyed 19,948 women age 35 and older presenting for screening mammography with no prior breast cancer and compared their responses of 2,713 cancer survivors, also receiving screening mammography. The two groups were compared on smoking behaviors; alcohol use; physical activity; weight status; and vitamin use.

Study results demonstrated that:

• Cancer survivors age 30-49 had greater rates of smoking when compared with those with no cancer history.
• Cancer survivors were less likely than those with no cancer history to use alcohol monthly or greater. Younger cancer survivors were the most frequent alcohol users.
• Cancer survivors were less likely than those with no cancer history to engage in “strenuous exercise.” Regardless of cancer history, older participants were more likely than their juniors to engage in “mild exercise.”
• Body Mass Index did not differ by cancer survivor status. However, cancer survivors reported less weight gain than the noncancer group over the last five years.
• Cancer survivors were more likely to use more than three vitamins.
• Cancer survivors were more likely than those with no cancer history to rate their overall health as “poor.”

“These results suggest that there are opportunities for tailored behavioral health risk factor interventions for cancer survivors,” said study author Sarah M. Rausch, Ph.D., a clinical psychologist and director of Integrative Medicine at Moffitt. “The differences in health behaviors between cancer survivors and those with no cancer history afford a ‘teachable moment’ in which a cancer survivor may be motivated to change behaviors to promote a healthier lifestyle and prevent cancer recurrence.”

In the survey, cervical cancer survivors reported having many unhealthy lifestyles, consistent with other surveys examining health behaviors of cancer survivors.

“As the population of cancer survivors increases, the importance of health status and quality of life of cancer survivors is even more critical,” explained Rausch. “Approximately 10.5 million people in the U.S. have been diagnosed with cancer. Because of the progress in cancer diagnosis and treatment there is a growing population of cancer survivors.”

According to the study authors, of the half million cancer deaths annually in the U.S. (they cited statistics from 2006 in their study) one-third of cancer deaths were attributed to tobacco use and one third was attributable to poor diet, physical inactivity and obesity.

“Studies, including ours, have found that cancer survivors are not as healthy as the general public,” said Rausch. “As our study demonstrated, unhealthy behaviors, such as smoking and alcohol use, and a lack of physical exercise among cancer survivors presenting for screening mammography, may account for their generally less than healthy status when compared to their peers, who also presented for screening mammography, but who had never had a cancer diagnosis.”

The researchers concluded that the “teachable moment” drawn from their study should be exploited by health care professionals to impress upon cancer survivors the importance of practicing healthier activities to prevent cancer recurrence.

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Main Category: Bones / Orthopedics
Also Included In: Women’s Health / Gynecology;  Medical Devices / Diagnostics;  Clinical Trials / Drug Trials
Article Date: 18 Feb 2012 – 0:00 PST

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Osteoporosis patients could soon ditch daily injection pens for an implantable microchip that releases medication at the push of a remote-controlled button, reports a new study appearing in the journal Science Translational Medicine.

The clinical trial, composed of a group of women with osteoporosis in Denmark, is the first to test a wirelessly controlled microchip capable of releasing drugs into the body at any time.

“Patients will be freed from having to remember to take their medication and don’t have to experience the pain of multiple injections,” said Robert Farra, President and Chief Operating Officer of MicroCHIPS, Inc., the Massachusetts-based company behind the device. Farra is a co-author of the study, along with colleagues from MIT, Harvard Medical School, OnDemand Therapeutics Inc and Case Western Reserve University.

Unlike most drug delivery devices, which release small amounts of drug slowly over time, the microchip releases medication on command from an external wireless device. This controlled system gets medicine into the bloodstream quickly, similar to an injection.

“Physicians will be able to seamlessly adjust their patients’ therapy using a computer or cell phone,” said Farra.

The authors figure the microchip may be a more appealing and possibly cheaper alternative to long-term use of prefilled daily injection pens.

Patients with severe osteoporosis often have to give themselves daily injections of medication that requires refrigeration. Aside from the psychological burden of daily injections, older people may have arthritis or other problems that make injections physically difficult.

Moreover, since osteoporosis is a “silent” disease – affected individuals don’t feel better or worse as their bone density decreases – many patients simply stop taking medication to avoid the hassle of daily injections.

The implant could help circumvent the high drop off in compliance and dramatically boost the quality of life for millions of osteoporosis patients. The device may also be useful for treating other chronic diseases like multiple sclerosis, heart disease or even cancer.

Roughly the size of a pacemaker, the device holds daily doses of a drug inside tiny wells that pop open either on a pre-programmed schedule or via a wireless signal.

“The drugs are in different wells. Each of these wells is covered by a nano-thin layer of gold which protects the drug for years if needed and prevents it from being released,” said Robert Langer, Professor at MIT and co-author of the Science Translational Medicine paper.

Sending a wireless signal to the well causes the gold to dissolve, freeing medication into the bloodstream.

Adapting microchip technology for human use is no small feat. The team first had to figure out a way to seal each reservoir airtight at room temperature. They developed a special compression welding process designed to provide a long-term seal. The researchers also developed the gold layer, which is strong enough to protect the contents of each reservoir, but thin enough to dissolve on command.

Despite the microchip’s proven ability to deliver drugs in the lab, once it was implanted into animals, a fibrous collagen-based membrane tended to develop around the device.

The researchers were concerned that this fibrous tissue could potentially slow down the absorption of medication, and one of the aims of this study was to determine if the membrane decreased effectiveness.

The researchers implanted the microchip just below the waistline, into seven women between the ages of 65 and 70. The procedure can be performed in a doctor’s office with local anesthetic.

Tracking the women for 12 months, the team showed that the implant delivered the drug teriparatide just as effectively as daily injections, although the fibrous membrane did form around the device. Treatment improved bone formation and reduced the risk of bone fracture, as evidenced by the presence of biochemical markers signaling bone formation, bone mass and bone resorption.

“And there is much less variation from dose to dose than injections, so it’s safer and more effective in that sense,” Langer said. The chip was removed from participants at the end of the one-year treatment.

The company hopes to make the device available for mainstream use in five years.

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Main Category: Cardiovascular / Cardiology
Also Included In: Women’s Health / Gynecology;  Stroke
Article Date: 17 Feb 2012 – 0:00 PST

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Women with peripheral artery disease, or PAD, are two to three times more likely to have a stroke or heart attack than those without it – yet it’s often unrecognized and untreated, especially in women, according to a new American Heart Association scientific statement.

The statement is published in Circulation: Journal of the American Heart Association.

The American Heart Association, in collaboration with the Vascular Disease Foundation and its Peripheral Artery Disease Coalition, recommends healthcare providers proactively increase awareness of and test women at risk for PAD and calls for more women-focused research into the disease.

PAD is a serious circulatory disease caused by a buildup of fat and other materials in blood vessels outside of the heart, usually in the legs, feet and arms. Left untreated, it can increase heart attack and stroke risk, severely limit walking ability and cause tissue death requiring limb amputation.

About 8 million people in the United States have peripheral artery disease. Most research available suggests nearly equal prevalence among men and women.

Only about 10 percent of those with PAD experience the warning sign of leg pain typically associated with it, and this pain usually goes away while resting. Many people experience no symptoms at all. As a result, few sufferers receive prompt treatment. Even so, PAD care leads to more than 1.1 million medical office visits annually, according to the new statement.

“The rate of deaths and the healthcare costs associated with PAD are at least comparable to those of heart disease and stroke,” said Alan T. Hirsch, M.D., lead author of the statement and professor of medicine, epidemiology and community health at the Lillehei Heart Institute at the University of Minnesota Medical School in Minneapolis. “Women, in particular, suffer an immense burden from peripheral artery disease, yet current data demonstrate most women still remain unaware of their risk.”

Therefore, this common disease often goes unrecognized among women and all people age 50 and older, who are most likely to develop PAD, he said.

“Although PAD is known to affect women and men equally, research in women has lagged far behind that in men,” Hirsch said. “As healthcare providers, we must take seriously our responsibility to include women as a key target audience when we work to study, prevent, diagnose and treat PAD.”

There isn’t an adequate number of women in clinical trials to provide a clear understanding of how the disease progresses, or to determine with accuracy the incidence and prevalence of peripheral artery disease in women, the statement authors said. They recommend conducting more research studies of PAD specifically among women and pooling results from previous studies to obtain an adequate sample size of females.

Other recommendations include funding new research that would help determine how gender may affect the rate of development of PAD, the response to medications, or the potential benefits of vessel-opening procedures. The authors recommend that all heart health promotion campaigns, like the American Heart Association’s Go Red For Women, provide specific education regarding peripheral artery disease risk, screening and treatment in women.

“It’s discouraging but not surprising to hear of the lack of research and awareness of PAD and its risks among women because we know a gender gap exists in these areas for most heart and circulatory diseases,” said Mary Ann Bauman, M.D., a Go Red For Women volunteer and Medical Director for Women’s Health and Community Relations at INTEGRIS Health in Oklahoma City. “Through Go Red For Women, we are making a difference in raising women’s awareness of their unique risks, encouraging them to talk openly and honestly with their healthcare provider about those risks and teaching them about the prevention and treatment options that can help them save their lives.” Major risk factors of peripheral artery disease include being 50 and older, smoking and diabetes. High blood pressure and high cholesterol, obesity, sedentary lifestyle and a family history of PAD also may increase the risk.

Treatment includes diet and lifestyle changes, medication and supervised exercise. Rarely, patients may require procedures to insert stents – small, wire mesh tubes – to open constricted blood vessels or surgical bypass surgery.

Typically, diagnosis involves a simple test, called an ankle-brachial index to compare arm blood pressure to leg blood pressure.

“Our statement is a call to action,” Hirsch said. “We must provide a clear and strong PAD message, along with aggressive diagnosis and treatment for both women and men, to improve PAD-related-health. Ultimately, through this, we’ll improve global cardiovascular health.”

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Main Category: Alcohol / Addiction / Illegal Drugs
Also Included In: Women’s Health / Gynecology;  Public Health
Article Date: 17 Feb 2012 – 0:00 PST

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Intimate partner violence (IPV) has been linked to heavy drinking, substance use by one or both partners, and living in a neighborhood characterized by poverty and social disadvantage. Alcohol outlet density has been linked to assaultive violence in a community. A study of the association between alcohol outlet densities and IPV-related visits to the Emergency Department (ED) throughout California between July 2005 and December 2008 has found that density of bars is associated with IPV-related ED visits.

Results will be published in the May 2012 issue of Alcoholism: Clinical & Experimental Research and are currently available at Early View.

“Most of the research on IPV-related ED visits has focused on individual-level risk factors,” explained Carol B. Cunradi, senior research scientist at Prevention Research Center and corresponding author for the study. “We wanted to extend this line of research by testing whether alcohol outlet densities are associated with IPV-related ED visits, while also taking into account other neighborhood-level characteristics previously shown to be linked with risk for IPV.”

“While a handful of international studies have looked at the geographic association between IPV and neighborhood conditions, this is the first study in the US documenting a relationship,” added Richard Scribner, D’Angelo Professor of Alcohol Research at the LSU School of Public Health. “This particular study is unique in that it uses an innovative data source only available in California that compiles IPV-related ED visits, namely the Office of Statewide Health Planning and Development. Having a statewide data source that provides some assurance of standardized reporting across the state is a major improvement in studying IPV which, typically, requires the use of police reports whose reporting reliability tends to vary across police departments.”

“Although it is true that both bars/pubs and restaurants sell alcohol and food, we hypothesized that the context surrounding use of these two types of outlets would be quite different,” said Cunradi. “For example, we expect that restaurants that also sell alcohol are frequented by couples and/or families primarily to have a meal that may or may not be accompanied by alcohol. On the other hand, we expect that bars/pubs are primarily frequented by men with or without their female partners, with the primary goal of drinking alcohol that may or may not be served with some food. There is also a large literature linking bar attendance, but not restaurants that serve alcohol, with aggression.”

Cunradi and her colleagues computed half-yearly counts of ED visits related to IPV for individual zip codes taken from patient-level public datasets. Alcohol outlet density measures – calculated separately for bars, off-premise outlets such as liquor stores and grocery stores that sell alcohol, and restaurants – were derived from California Alcohol Beverage Control records.

“The key findings of the study are that the density of bars was positively associated with IPV-related ED visits, and the density of off-premise outlets was negatively associated with IPV-related visits,” said Cunradi. “For the latter finding, the association was weaker and smaller than the bar association. There was no association between density of restaurants and IPV-related ED visits. These findings suggest that environmental factors, such as alcohol outlet density, affect IPV behaviors resulting in ED visits, but further research is needed to understand the mechanisms that underlie these associations.”

“These findings are impressive if for no other reason than the growing realization of the robustness of a measure like bar density in identifying neighborhoods where alcohol-related outcomes like IPV are more common,” said Scribner. “Clearly, these results suggest bar density is a marker for some as-yet-unidentified mechanism that geographically concentrates a broad array of health outcomes.”

Both Cunradi and Scribner noted that ED visits represent a much more serious level of IPV than police reports.

“Police-reported IPV cases may involve threatening behavior, property damage, loud arguments, and physical aggression that may or may not result in injury,” said Cunradi. “In contrast, IPV-related ED visits are, by definition, injuries requiring medical attention.”

Scribner noted, however, that it is not clear that emergency room (ER) reports represent a more valid measure given the study design that included both urban and rural zip codes. “It is likely that cases at greater distance from the ER – that is, rural census tracts – may be less likely to drive the greater distance to the ER.” Notwithstanding, he noted the utility of these findings for medical professionals.

“The obvious message for physicians is that they should have some familiarity with the neighborhood environment from which their patient population is derived,” said Scribner. “Clearly, if their patient population is derived from a high-risk neighborhood environment in terms of the density of alcohol outlets, the suspicion of IPV in any trauma case should be heightened. This is also a general call for clinicians to realize the important role they can play in addressing alcohol abuse problems in their patient population. Brief motivational interventions, especially when conducted by health care providers, have been shown to be effective in reducing problem drinking among the abusing population.”

“The take-home message is that environmental factors, such as alcohol outlet density, affect IPV behaviors resulting in ED visits,” said Cunradi. “However, the absence of individual-level data do not allow us to determine the precise mechanisms that link an increase of one bar per square mile with a three percent increased likelihood of IPV-related ED visits in a given zip code. There is nonetheless research evidence linking bar attendance with aggressive behavior, both in and out of the bar. Additional research is needed to investigate how bar density results in increased risk for IPV-related ED visits.”

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Editor’s Choice
Main Category: Women’s Health / Gynecology
Also Included In: Sexual Health / STDs
Article Date: 15 Feb 2012 – 13:00 PST

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Female genital mutilation, also known as FGM refers to all procedures which partially or completely remove the external female genitalia. FGM also includes any other injury to a woman’s or girl’s genitalia for reasons other than medical ones. In most parts of the world, FGM is done by non-medical practitioners who also attend childbirths and carry out male circumcisions. According to WHO (World Health Organization), over 18% of all female genital mutilation procedures are carried out by health care professionals in clinical setting, a trend which appears to be growing.

Virtually every country in the world agrees that female genital mutilation is a violation of a female’s human rights. It is seen as an extreme form of discriminating against females in the community. As most procedures are carried out on young girls, it is also a violation against children’s rights.

According to WHO:

“(female genital mutilation also) violates a person’s rights to health, security and physical integrity, the right to be free from torture and cruel, inhuman or degrading treatment, and the right to life when the procedure results in death.”

The World Health Organization informs that there are four main types of female genital mutilations:

• Clitoridectomy – the clitoris is partially or completely removed. The clitoris (see picture) is the most sensitive erogenous zone of the human female, and the main cause of her sexual pleasure. It is a small erectile part of the female genitalia. Upon being stimulated, the clitoris produces sexual excitement, clitoral erection, and orgasm.
• Excision – the clitoris and labia minora are partially or completely removed. It may also include the removal of the labia majora. “Labia” refers to the lips that surround the vagina. (see picture)
• Infibulation – the vaginal opening is narrowed; a covering seal is created. The inner or outer labia are cut and repositioned. This procedure may include (or not) the removal of the clitoris.
• Other – procedures not listed above which damage the female genitalia and are not carried out for medical pursposes. This may include cauterizing, scraping, incising, pricking or piercing the genital area.

FGM may involve cutting out all or part of the clitoris, the labia majora and/or minora, and stitching the labia together so as to narrow the opening

Female genital mutilation offers the female no health benefits

Not only does FGM offer no health benefits for the female, it is associated with serious risks of harm. Healthy and normal (natural) female genital tissue is removed. In fact, these procedures undermine a girl’s and woman’s natural functions.

The following complications may occur during or soon after FGM procedures:

• Excruciating pain, which can sometimes result in loss of consciousness
• Bleeding (hemorrhage)
• Bacterial infection (sepsis)
• Open sores in the genital area
• Urine retention and other problems urinating
• Nearby genital tissue is damaged

The following long-term complications are also common:

• Bladder infections which keep coming back
• Cysts
• Infertility
• A considerably higher risk of newborn deaths
• A significantly higher rate of childbirth complications
• Further surgeries – if the opening has been narrowed, later on it will need to be “opened-up” again so that the female can have sex and give birth. In some cultures, this opening and narrowing is done several times throughout a female’s life.

How common is female genital mutilation?

According to WHO, over 140 million females have undergone some form of female genital mutilation and currently live with its consequences. In Africa alone, it is believed that approximately 92 million girls aged 10+ years have undergone FGM procedures.

In the majority of cases, FGMs are done on girls aged between infancy and 15 years – FGMs are also done on adult women.

Approximately 3 million girls in Africa are deemed “at risk” for FGM each year.

FGM is most commonly performed in the north-eastern, western and eastern regions of Africa, as well as some parts of the Middle East and Asia – usually among African migrants who have moved there.

Prevalence of female genital mutilation in Africa and Yemen (women aged 15 – 49) (Source: MICS, DHS and other national surveys, 1997-2006. Map developed by UNICEF, 2007)

Why does female genital mutilation occur?

FGM is due to several factors, and often a combination of them, including those of a religious, social and cultural nature.

• Social convention – “it is what others do, and what we have always done..” Social pressure and a desire not to stand out as a rebel is a powerful force, especially in societies with low literacy rates.
• Proper thing to do – in some societies, FGM is part of proper female upbringing. It is said to prepare her for marriage and adult life.
• Decent sexual behavior – in some cultures, FGM is linked to virginity and being faithful during marriage. If a woman’s libido is reduced (by cutting the clitoris), it is believed that her chances of taking part in “illicit” sex is much smaller. Narrowing the vaginal opening is thought to keep females from taking any sexual risks, for fear of pain or widening the opening, being found out and getting into trouble for it.
• Femininity and modesty – some societies believe that FGM makes girls cleaner and more beautiful. Some body parts, such as the clitoris (which sticks out) are seen as male or unclean.
• Religions – even though not written in any of the major religions, practitioners are either convinced, or have convinced their communities that the practice is a religious one and should be carried out for that reason. It must be pointed out that many religious leaders are against FGM, and are involved in the movement to eradicate its practice.
• Power and authority – in some cases, local chiefs, religious leaders, practitioners of FGM and circumcision, and even some health care professionals all agree that it is a practice that must prevail.
• A new practice – in some cases, some communities have adopted the practice of FGM because they picked it up from neighboring communities. In some cases, it is the revival of an old custom.
• Immigrants – sometimes, people who come from communities that don’t practice FGM, and come to live in societies that do, adopt the practice to fit in.

Amnesty International informs that in some cultures, it is believed that a man would die if his penis touched a woman’s clitoris. Some say that if a baby’s head comes into contact with the clitoris, he/she could die. In some communities, women who have not undergone FGM are not allowed to handle food and water because of the perceived health risks for others.

Percentage of females aged 14 to 49 years living with FGM, according to year quoted (Source: UNICEF)

Benin – 2006 – 12.9%
Burkina Faso – 2006 – 72.5%
Cameroon – 2004 – 1.4%
Central African Republic – 2008 – 25.7%
Chad – 2004 – 44.9%
Côte d’Ivoire – 2006 – 36.4%
Djibouti – 2006 – 93.1%
Egypt – 2008 – 91.1%
Eritrea – 2002 – 88.7%
Ethiopia – 2005 – 74.3%
Gambia – 2005/6 – 78.3%
Ghana – 2006 – 3.8%
Guinea – 2005 – 95.6%
Guinea-Bissau – 2006 – 44.5%
Kenya – 2008/9 – 27.1%
Liberia – 2007 – 58.2%
Mali – 2006 – 85.2%
Mauritania – 2007 – 72.2%
Niger – 2006 – 2.2%
Nigeria – 2008 – 29.6%
Senegal – 2005 – 28.2%
Sierra Leone – 2006 – 94%
Somalia – 2006 – 97.9%
Sudan, northern (about 80% of all surveyed) – 2000 – 90%
Togo – 2006 – 5.8%
Uganda – 2006 – 0.8%
Tanzania – 2004 – 14.6%
Yemen – 2003 – 38.2%

Response to eradicate female genital mutilation

Resolution WHA61.16 was passed by the World Health Assembly in 2008; the aim being to eliminate FGM. Participants stressed the need for comprehensive action by all those involved in justice, women’s affairs, education, finance and health.

Of concern, is the following quote from WHO:

“WHO is particularly concerned about the increasing trend for medically trained personnel to perform FGM. WHO strongly urges health professionals not to perform such procedures.”

Written by Christian Nordqvist
Copyright: Medical News Today
Not to be reproduced without permission of Medical News Today

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