Main Category: HIV / AIDS

Also Included In: Women’s Health / Gynecology;  Sexual Health / STDs

Article Date: 29 Nov 2011 – 1:00 PST

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A large-scale clinical trial evaluating whether daily use of an antiretroviral-containing oral tablet or vaginal gel can prevent HIV infection in women is being modified because an interim review found that the gel, an investigational microbicide, was not effective among study participants.

On Nov. 17, an independent data and safety monitoring board (DSMB) recommended that the Vaginal and Oral Interventions to Control the Epidemic (VOICE) study evaluating daily use 1 percent tenofovir vaginal gel be discontinued because there was no difference in effect demonstrated between the drug-containing gel and a placebo gel. The DSMB found a 6 percent HIV incidence rate among participants in the tenofovir gel group and the placebo gel group.

The study is being conducted by the National Institutes of Health (NIH)-funded Microbicide Trials Network (MTN). As the trial’s primary sponsor, the National Institute of Allergy and Infectious Diseases (NIAID), part of NIH, concurred with the DSMB’s recommendation and has requested that the MTN discontinue use of tenofovir gel (and placebo gel) in the VOICE study. Because the trial is continuing, all other study data remain confidential, so NIAID cannot speculate about why tenofovir gel showed no benefit among VOICE study participants. Factors that may have contributed to this outcome are being further investigated.

Importantly, the DSMB found no major safety concerns with either the tenofovir gel or oral tablets containing tenofovir and emtricitabine given to women in a different arm of the study. Oral tenofovir and emtricitabine, a combination drug called Truvada that currently is used to treat HIV infection, will continue to be investigated in the VOICE study to determine whether it can prevent HIV infection in women in this trial.

The VOICE study, or MTN-003, began in September 2009 and originally enrolled more than 5,000 HIV-uninfected women in South Africa, Uganda and Zimbabwe. The trial was designed to test the safety, effectiveness and acceptability of two different, daily HIV prevention strategies. One was an investigational microbicide gel containing tenofovir. The other involved oral tablets containing tenofovir either alone (Viread) or co-formulated with the drug emtricitabine (Truvada). The tablets were designed to be taken by HIV-negative women in an approach known as pre-exposure prophylaxis, or PrEP.

The study was first modified in September 2011, following the DSMB recommendation to discontinue evaluating oral tenofovir tablets based on interim data demonstrating that the study would be unable to show a difference in effect between tenofovir tablets and placebo tablets in preventing HIV infection. No safety concerns with oral tenofovir were found. Since that time, the study participants who were taking oral tenofovir have been informed of the discontinuation of this arm of the trial, and currently they are undergoing their final study-associated tests and procedures.

Based on its Nov. 17 scheduled review, the DSMB recommended that the roughly 2,000 women in the tenofovir gel and placebo gel groups stop applying the study product.

The study team will immediately begin informing all VOICE participants of this new development and will soon start the orderly discontinuation of the two gel arms of the trial. Participants who were using the tenofovir gel or the placebo gel will stop using the product at their next scheduled clinical site visit. They will then return eight weeks later for a final evaluation before exiting the study. At that visit, they will be given information about where they can continue to receive HIV testing and counseling, contraception and other medical and support services. Follow up for all of the VOICE study participants is expected to be completed in June 2012, with final study results anticipated in early 2013.

Although it is disappointing that the study first found oral tenofovir and now daily 1 percent tenofovir gel to be ineffective among the VOICE participants, NIAID recognizes the scientific importance of having clear outcomes and is pleased that the trial will continue to examine the question of whether oral Truvada is a safe and effective HIV prevention measure for women in this study. NIAID thanks all VOICE study participants and site staff for their significant contribution to furthering HIV prevention research. This study is an important component of NIH’s comprehensive HIV prevention research program articulated in the HHS National HIV/AIDS Strategy Operational Plan.

NIAID remains committed to supporting research to develop HIV prevention tools that women can implement. Slightly more than half of all new HIV infections globally occur in women, mostly through unprotected sex with HIV-infected men. Safe and effective female-controlled HIV prevention methods would be particularly helpful to women who find it difficult or impossible to refuse sex or to negotiate condom use with their male partners.

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Editor’s Choice
Academic Journal

Main Category: HIV / AIDS

Also Included In: Women’s Health / Gynecology

Article Date: 25 Nov 2011 – 7:00 PST

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In this week’s PLoS Medicine, an researchers analyzed the experiences of stigma and coping tactics among HIV-positive women in Ontario, Canada.

Using focus groups, Mona Loutfy of the University of Toronto, Canada and colleagues discovered that women attributed their experiences of discrimination and stigma to HIV-related stigma, racism, homophobia, transphobia, involvement in sex work, sexism, and gender discrimination.

According to the women, they used coping tactics, such as:

• Resilience (at a micro level)
• Challenging stigma (at a macro level)
• Social networks and support groups (at a meso level)

The researchers explain that:

“Overall, this investigation highlights a complex system of intersectional stigma that necessitates multifaceted strategies to promote health and equity for HIV-positive women.

Findings can inform treatment, care, and support guidelines and practice recommendations for health care practitioners, social workers, HIV prevention and support workers, and mental health specialists working with HIV-positive women.”

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

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Editor’s Choice
Academic Journal

Main Category: Nutrition / Diet

Also Included In: Diabetes;  Alcohol / Addiction / Illegal Drugs;  Women’s Health / Gynecology

Article Date: 25 Nov 2011 – 7:00 PST

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Females in middle age who drink alcohol moderately and consume large amounts of refined carbohydrates have a 30% lower chance of developing diabetes type 2, compared to women with similar dietary habits who don’t drink, researchers from the Harvard School of Public Health wrote in the American Journal of Clinical Nutrition. Examples of refined carbohydrate foods include sugary drinks, white bread, some pastas, and (polished) white rice.

The authors explained, as background information to their report, that very little prior research has focused on whether there might be an association between glycemic index load, glycemic index, alcohol consumption and diabetes type 2 risk.

Dr. Frank Hu and team set out to determine what impact alcohol intake (or lack of it) might have on diabetes risk in middle aged women whose refined carbohydrate (carb) intake was high. They tracked 81,827 women for 26 years. The women had participated in the Nurses’ Health Study and were all free of diabetes type 2 when the study began.

Their cumulative averages of glycemic index, glycemic load, total carb intake and total alcohol intake were calculated every two to four years using questionnaires.

During the follow-up period 6,950 participants developed diabetes type 2.

They found that the women with a high refined-carb intake who consumed moderate amounts of alcohol had a 30% lower chance of developing diabetes type 2 compared to women whose refined-carb intake was also high but consumed no alcohol.

In an interview with Reuters news agency, Dr. Hu said:

“If you eat a high carb diet without drinking alcohol, your risk of developing diabetes is increased by 30 percent.

However, if you eat a high carb diet, but (drink) a moderate amount of alcohol, the increased risk is reduced.”

The authors concluded in an Abstract in the journal:

“Our findings suggest that a higher alcohol intake (≥15 g/d) attenuates the positive association between GL and T2D incidence.”

The moderate drinkers in this study consumed an average of 0.8 once (24 grams) of alcohol each day, the equivalent of approximately two drinks each week. A very small percentage were classed as heavy drinkers – consuming at least two ounces of alcohol each day – they did not have a lower diabetes type 2 risk.

The authors stressed that their study should not encourage people to start drinking if they do not do so now. Rather, they encourage a diet low in refined carbs and high in whole grains. If you are a drinker, they added, you should do so with moderation.

Refined and unrefined grains

Refined grains have been milled so that their outer bran coating has gone, leaving just the endosperm. Examples include white rice, white pasta and white bread. When referring to rice, the term polished is often used with the meaning ‘milled’.

Unpolished long-grain rice with bran

Polished Indian sona masuri rice grains

In whole grain products, the germ and endosperm are still there. Bran is a good source of fiber, while the germ has protein, minerals and vitamins – the endosperm has carbohydrates (mainly in the form of starch).

Whole grains, also known as unrefined grains (unrefined carbs) are rich in antioxidants and phytochemicals – these help protect us against diabetes, some cancers and coronary heart disease. Some studies have demonstrated that individuals who consume at least three portions of whole grains each day have a lower risk of developing heart disease compared to people who don’t.

Here you can see the bran, germ and endosperm

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

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Main Category: HIV / AIDS

Also Included In: Women’s Health / Gynecology

Article Date: 25 Nov 2011 – 0:00 PST

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In this week’s PLoS Medicine, Mona Loutfy of the University of Toronto, Canada and colleagues report their study examining experiences of stigma and coping strategies among HIV-positive women in Ontario, Canada.

Using focus groups, the researchers found that women attributed their experiences of stigma and discrimination to HIV-related stigma, sexism and gender discrimination, racism, homophobia and transphobia, and involvement in sex work. The coping strategies they used included resilience (at a micro level), social networks and support groups (at a meso level), and challenging stigma (at a macro level).

The authors state that: “Overall, this investigation highlights a complex system of intersectional stigma that necessitates multifaceted strategies to promote health equity for HIV-positive women. Findings can inform treatment, care, and support guidelines and practice recommendations for health care practitioners, social workers, HIV prevention and support workers, and mental health specialists working with HIV-positive women.”

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Main Category: Cosmetic Medicine / Plastic Surgery

Also Included In: IT / Internet / E-mail;  Women’s Health / Gynecology

Article Date: 29 Nov 2011 – 3:00 PST

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You know they couldn’t possibly look that good. But what did those models and celebrities look like before all the retouching? How different is the image we see from the original?

Dartmouth Computer Science Professor Hany Farid and Eric Kee, a PhD student at Dartmouth College, are proposing a method to not only answer such questions but also to quantify the changes.

As Farid writes, “Impossibly thin, tall, and wrinkle- and blemish-free models are routinely splashed onto billboards, advertisements, and magazine covers.” He says that this is “creating a fantasy of sorts.” Going beyond considerations of aesthetics or any dishonesty of photo editors or advertisers, Farid and Kee voice public health concerns.

In a paper published in the Proceedings of the National Academy of Sciences (PNAS) on November 28, 2011, they point out that these highly idealized images have been linked to eating disorders and body image dissatisfaction in men, women, and children. The authors note that the American Medical Association has recently adopted a policy to “discourage the altering of photographs in a manner that could promote unrealistic expectations of appropriate body image.”

There have already been repercussions in the United Kingdom. A Reuters news story from July 2011 reports: “Two L’Oreal cosmetics adverts [advertisements] featuring actress Julia Roberts and supermodel Christy Turlington were banned in Britain by the Advertising Standards Agency, following complaints by MP [Member of Parliament] Jo Swinson. Liberal Democrat MP Swinson said the magazine adverts for foundations made by Maybelline and Lancome, both owned by L’Oreal, were misleading because the photos had been digitally altered.” On a prior occasion, L’Oreal had been forced to add a disclaimer to another ad.

But Farid and Kee assert that outright bans or simple disclaimers may not be addressing the issue fairly or completely. They are seeking a way to for advertisers to truthfully and accurately characterize the extent to which an image has been altered while allowing the public to make informed judgments. The goal is to create a metric that provides an objective assessment of how much alteration has been made.

The authors propose a rating system that takes into account common practices such as cropping and color adjustment while providing assessment of other kinds of modifications that dramatically change a person’s appearance. They consider geometric alterations such as slimming legs, adjusting facial symmetry, and correcting posture, as well as photometric manipulations that might include removing wrinkles, “bags” under the eyes and skin blemishes.

“We start with the before and after digital images from which we automatically estimate the geometric and photometric changes, effectively reverse engineering the manipulations that a photo retoucher has made,” Farid says.

In the study, to crosscheck and validate their metric, human observers were asked to compare and rank the differences in hundreds of pairs of before and after retouching images. The results correlated highly with the mathematical metric.

“Such a rating may provide incentive for publishers and models to reduce some of the more extreme forms of digital retouching that are common today,” the authors conclude, but they add, “It remains to be seen if this rating can mediate the adverse effects of being inundated with unrealistic body images.”

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