Clinical Trial Offers Hope To Thousands Of Women With Incontinence And Could Save The NHS Millions Pounds Per Year

Tens of thousands of women every day suffer from the misery of stress incontinence, a condition which costs the NHS in excess of ??400m a year to treat. Now a new clinical trial of a simple medical device offers hope to women worldwide.


Bristol Urological Institute, one of the UK's leading research centres in the field of urodynamics, is recruiting patients for a randomised clinical trial that could revolutionise the treatment of female stress incontinence - a distressing and socially embarrassing condition which affects a third of new mums and half of all women.


Paul Abrams, Professor of Urology at the Bristol Urological Institute said: "It is 60 years since Arnold Kegel proposed pelvic floor exercises as a treatment for stress incontinence but a simple, effective method of putting all his principles into practice has eluded us."


"The PelvicToner™ seems to meet all the requirements that Kegel envisaged - it is a simple, patient-friendly, progressive resistance exercise device and provides feedback to the patient that the correct muscles are being engaged."


"Our specialists, led by Mr Marcus Drake, are undertaking a full-scale randomised clinical trial and are hoping that the results will confirm our optimism for the PelvicToner".


An initial small scale clinical trial in the US had very promising results. 87% of subjects showed improved Kegel tone after the programme - the average improvement in resting muscle tone was nearly 10% and in the active squeeze (Kegel tone) the average improvement was nearly 30%. As a result nearly 90% of the sample reported that their bladder problems were brought under control within a matter of weeks. This success has been confirmed by a UK user survey - see notes to editors


The BUI study will involve a considerably larger randomised sample and pelvic floor muscle strength will be measured before, during and after the 16 week programme to quantitatively compare the benefits of the PelvicToner with traditional conservative treatment methods.


The cost to the NHS of treating stress incontinence is estimated to exceed ??400 million [Source: The Continence Foundation ] but many millions of women suffer in silence and just treat the symptoms by using disposable pads - contributing to a long-term environmental problem.


One of the major issues facing the NHS is that whilst 'traditional' pelvic floor exercises remain the recommended primary treatment, and can bring cure or relieve in over 80% of suitable cases, the Continence Foundation and many health professionals recognise that they are rarely taught correctly and are rarely persevered with because of the lack of immediate benefit.















Squeezing thin air may bring some benefit after several months but, by comparison, nearly 80% of PelvicToner users become more aware of their pelvic floor after just one week and over 85% report improved bladder control within just 2 weeks.


Being able to recommend an effective exercise regime means that NHS budgets could be focussed on bringing faster relief to those with more serious complications and those requiring surgical intervention.


Women with stress incontinence living in the Bristol area and aged over 18 can contact bazspml.biz for details of the inclusion and exclusion criteria.


The PelvicToner is on general sale and costs just ??29.99

mypelvicfitness

Telephone information line and sales: 0117 968 7744


Notes


Stress incontinence is very common amongst women who have experienced natural childbirth and the natural stretching of the birth canal; menopausal women whose falling oestrogen levels have led to a natural slackening of the pelvic floor muscles; and women who have not maintained a regular effective programme of pelvic floor exercises throughout their lives. Unfortunately the latter situation applies to the vast majority of women!


For the past 60 years many health practitioners, physiotherapists, midwives and childbirth counsellors have failed to heed the advice of Arnold Kegel that there should be a resistance to squeeze against and a positive feedback that the correct muscles were being engaged. The result is that stress incontinence is now a global problem affecting half of all women.



For any exercise to be effective the muscle must be worked regularly, repetitively and against resistance - the essential 3 Rs!


Imploring women to squeeze their pelvic floor against thin air and to 'exercise' whilst vacuuming or waiting for a bus is not only a complete waste of time but also totally demoralising. In the absence of a rapid improvement in their condition most women become frustrated and give up exercise altogether.


Arnold Kegel recommended his pelvic floor exercises to treat stress incontinence in 1948 and then published further research in 1952 suggesting that lack of pelvic floor muscle tone was a major contributor to 'female sexual dysfunction':


"Observations in [more than 3,000 women,] both parous and nulliparous..., ranging in age from 16 to 74 years, have led to the conclusion that sexual feeling within the vagina is closely related to muscle tone, and can be improved through muscle education and resistive exercise." "78 of 123 women complaining explicitly of sexual deficits achieved orgasm following the training".
Arnold H. Kegel "Sexual Functions of the Pubococcygeus Muscle "Western Journal of Surgery, Obstetrics & Gynecology, 60, pp. 521-524, 1952


The PelvicToner is an highly effective progressive resistance vaginal exerciser specifically designed to meet Kegel's criteria.


- 92% of PelvicToner users reported greater awareness of their pelvic floor after just 2 weeks

- 87% of PelvicToner users reported improved bladder control within 2 weeks, 96% after 4 weeks

- 80% of PelvicToner users reported an improved sex life within 4 weeks
(source: User survey)


Visit mypelvicfitness
The Continence Foundation

Over 25% NYC Births in 2003 Were C-Sections, Public Advocate Report Says; Findings Reflect National Trend

In 2003, 26.4% of deliveries in New York City were caesarean sections, with the percentage of c-section deliveries varying greatly among city hospitals, according to a report issued on Wednesday by the... Public Advocate for the City of New York, the New York Times reports. Public advocate Betsy Gotbaum and colleagues surveyed 44 hospitals in New York City to determine their c-section delivery rate in 2003. Nine of the hospitals reported that more than 30% of deliveries were by c-section, with New York-Presbyterian hospital reporting a c-section rate of 37.3%, the highest rate among hospitals surveyed. Statewide, 28.4% of women who gave birth in 2003 delivered by c-section, and 27% of births were c-sections nationwide in 2003, according to data compiled by HHS. More than one million infants were delivered by c-section in the U.S. in 2003, five times the number delivered by c-section in 1980. Under the state's 1989 Maternity Information Act, hospitals are required to provide data on the number of c-section deliveries they perform to any patients who request the data. Although the state's c-section rates dropped in the years following enactment of the law, they have since risen. Gotbaum said that the trend toward more c-sections is not good, adding that performing unnecessary c-sections represents a "tremendous risk." She cited World Health Organization and CDC recommendations that c-section deliveries be conducted only when necessary to protect the infant or woman and make up no more than 15% of all births. Gotbaum also blamed the New York State Department of Health for not monitoring the issue more closely. However, William Van Slyke, the city's deputy health commissioner, said that the health department compiles data on c-sections as quickly as possible and reports the findings to the hospitals, which then are responsible for providing information on c-sections to patients. However, there is no penalty for hospitals that fail to do so (Santora, New York Times, 7/13).


"Reprinted with permission from kaisernetwork. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at kaisernetwork/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork, a free service of The Henry J. Kaiser Family Foundation . © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

Guideline Calls For Changes In Practice To Increase Uptake Of Antenatal Care For Pregnant Women In Difficult Social Circumstances

Too many women faced with difficult social circumstances are not accessing or engaging with maternity services with potential negative consequences for them and their baby's health. Now, a new NHS guideline published yesterday calls for the re-organisation of these services to improve access to and uptake of antenatal care for women in difficult social circumstances, thereby helping to prevent complications and potentially save the lives of these mothers and their babies.


Difficult social circumstances, or complex social factors, can include poverty, homelessness, unemployment, substance misuse, difficulty reading or speaking English, teenage pregnancy and domestic abuse. Pregnant women in these situations often do not attend antenatal appointments as traditional services are often not adequate for their needs. However, a lack of good antenatal care can increase the risk of women dying from complications during pregnancy or after birth, with women living in areas of high deprivation in England five times more likely to die during pregnancy or after childbirth than women in more affluent areas (from Confidential Enquiry into Maternal and Child Health (CEMACH) Saving Mothers' Lives 2003-2005: United Kingdom. CEMACH: London, 2007). Babies born into these circumstances are also around twice as likely to be stillborn or die shortly after birth as those who are not (from Confidential Enquiry into Maternal and Child Health (CEMACH) Perinatal Mortality 2007: United Kingdom. CEMACH: London, 2009).


The new guideline, developed by the National Institute for Health and Clinical Excellence (NICE) in close collaboration with the Social Care Institute for Excellence (SCIE), calls on antenatal services to become flexible and supportive. This includes the NHS working with social care providers and, in some cases charities and the police, where appropriate, in order to properly care for these vulnerable women. Its aim is to help encourage access to and uptake of effective care for pregnant women with complex social factors to ensure they and their babies are kept as safe and healthy during pregnancy as possible. The guideline highlights the following groups as examples of women who need particular, tailored support throughout their pregnancies although it provides guiding principles for care for all women whose pregnancies are complicated by difficult social circumstances;


- Those aged under 20

- Women who misuse substances

Women who experience domestic abuse

- Pregnant women who are recent migrants, asylum seekers or refugees, or who have difficulty reading or speaking English


Dr Gillian Leng, NICE Deputy Chief Executive, said: "Expectant mothers need support throughout their pregnancy yet some groups of women do not access, or continue to maintain contact with, traditional antenatal care services because of issues such as domestic violence, teenage pregnancy or not having English as a first language. They might feel scared, overwhelmed, judged, unable to communicate, or may be physically stopped from attending appointments. Although these women represent a small proportion of those having babies in the UK each year, they and their unborn children deserve the same level of care as anyone else."















"This guideline will help midwives, GPs, obstetricians, commissioners and managers and other professionals who come into contact with these women across the NHS and social care to develop services that will improve access to care for these pregnant women, giving them better and effective support."


Amanda Edwards, SCIE Deputy Chief Executive, said: "Social care providers can play an important part in the design of maternity services. It is important that women receive adequate, timely, flexible care that gives them the right support throughout pregnancy, so that they and their babies are kept safe and healthy. A multi-agency approach is an absolute necessity to make sure their needs are fully met."


Commissioners play an important role in the design and delivery of services, yet antenatal care for these vulnerable groups of women can be unsuitable, inflexible and judgmental. The guideline makes recommendations to help commissioners ensure services are fit for purpose, including:


- Recording information on the numbers of women with complex social factors attending antenatal care to ensure services are organised in the most effective manner.


- Working with relevant local agencies, including social care and voluntary services to co-ordinate antenatal care for women who misuse substances


- Providing information about pregnancy and antenatal services in a variety of formats, settings and languages for women who are recent migrants or for whom English is not their first language


- Consider commissioning a specialist antenatal service for young women under the age of 20. This could include antenatal care and education in peer groups in different locations (e.g. schools, colleges, GP surgeries) or offering peer group support at the same time as antenatal appointments in a one-stop shop where a range of services can be accessed at the same time, offering a named midwife, who should take responsibility for and provide the majority of the woman's antenatal care, and provide a direct phone number for the midwife.


- Supporting women who experience domestic abuse by ensuring that a local protocol is developed jointly with social care providers, the police and voluntary agencies and that it is a healthcare professional with expertise in the care of women experiencing domestic abuse


Asking women from how services can be improved


Rhona Hughes, Lead Obstetrician at NHS Lothian and Chair of the Guideline Development Group (GDG), said: "Commissioners of health and social care services will play a vital role in making sure mums-to-be with complex social factors get the right kind of support. However, the difficulty they face is that traditional services often do not provide these women with the right type of support, which is why many women with complex social factors do not access antenatal services in the first place. This makes it difficult to know how services need to change to best serve their local population.


"The first step will be to record information from those women with complex social factors who do access services as this will be the best way to learn how services need to adapt. Working with other agencies and organisations will also be important to ensure flexibility in services and make sure women have a co-ordinated care plan to give them the best standard of care possible."


The guideline also targets GPs, midwives, obstetricians and other healthcare professionals involved in antenatal care, making practical recommendations to make women with complex social factors feel safer, better understood and reassured. These include:


- Give women with complex social factors a telephone number to contact a healthcare professional outside of normal working hours, at their booking appointment


- Provide women with a private one-to-one consultation on at least one occasion to facilitate discussion of sensitive issues


- Use a variety of methods (e.g. text messages) to remind women who misuse substances of upcoming and missed antenatal appointments


- For women who have difficulty speaking or reading English, provide them with an interpreter (not a member of their family, legal guardian or partner) who can communicate with them in their preferred language


Yana Richens, Consultant Midwife for University College London Hospitals NHS Foundation Trust and guideline developer, said: "There will be inevitable challenges for midwives in putting these recommendations into practice, but I passionately believe this guideline will make a real difference to the care of pregnant women with complex social factors. It is unacceptable that mums and babies are still dying in this country because of a lack of contact with antenatal care. We need to do everything we can to help and support these women to ensure they - and ultimately their babies - survive and are safe and healthy."


Sarah Fishburn, who runs the Pelvic Partnership Charity, supports women with complex social factors. She helped to develop the guideline and said:

"I represent and help look after pregnant women through a variety of ways including peer support. I became interested in helping women with complex social factors after meeting women in my local area who were experiencing domestic abuse and I couldn't believe how difficult it was to help them access services. I also became aware of how many women do not fit into the glossy magazine picture of a pregnant woman and how challenging this can be both for the women involved and for those caring for them. This guideline should enable services to develop flexibility as well as specialist care, which is what these groups of women need."


Professor Sir Sabaratnam Arulkumaran, President of the Royal College of Obstetricians and Gynaecologists (RCOG), said: "Personal circumstances such social deprivation, substance misuse and domestic abuse may complicate an otherwise healthy pregnancy.


"At-risk pregnancies need to be identified and the involvement of the GP at least once in early pregnancy is useful. GPs have information about the woman's medical history, including the complex social issues she may face. With the woman's consent, such information should then be shared with the obstetrician and midwife so that tailored care can be provided in a sensitive and caring manner.


"This new guideline provides us with guidance on the appropriate care of such women. Working closely with social services, the NICE recommendations will help doctors provide the extra support that these vulnerable women need."


Jane Brewin, Chief Executive of the baby charity Tommy's, said: "Women with complex needs have a deplorably high risk of experiencing pregnancy problems.


"Any barrier that prevents a pregnant woman from getting the care that both she and her baby need, be it substance misuse, being a teenager, not speaking English, domestic abuse, homelessness or anything else, poses a preventable risk to both mum and baby. Making maternity services both accessible and able to meet the often complex needs of these women is vital in mitigating these circumstances and helping their babies be born healthy."


Mary Newburn, Head of Research and Information at NCT, the UK's largest parenting charity, said: "If implemented, this guidance has real potential to make maternity services more effective in reducing health inequalities. It provides clear recommendations to make maternity care more accessible and responsive to the complex needs of vulnerable women who can often slip through the net. NCT particularly supports the emphasis on multi-agency working to ensure holistic care provision and improve the health and wellbeing of vulnerable pregnant women, their partners and children."


This is the latest in a series of guidance produced by NICE that aims to reduce complications in pregnancy Other, recently published guidance in this series includes guidelines for healthcare professionals on preventing, diagnosing and managing hypertension (high blood pressure) in pregnancy and public health guidance on quitting smoking in pregnancy and following childbirth and also weight management before, during and after pregnancy.


Notes


- The NICE guideline on pregnancy and complex social factors , including a version for patients and carers and corresponding implementation tools, are available from the NICE website . (from Wednesday 22 September 2010)


- This NICE guideline was developed in close collaboration with the Social Care Institute for Excellence (SCIE) and in conjunction with the National Collaborating Centre for Women's and Children's Health.


Key recommendations to raise standards of care for...


Pregnant women who misuse substances


- Working with local agencies, including social care and voluntary organisations that provide substance misuse services, to coordinate antenatal care


- Offer referral to an appropriate substance misuse programme, the first time a woman who misuses substances discloses that she is pregnant


- Offer each woman a named midwife or doctor who has specialised knowledge of, and experience in, the care of women who misuse substances, and provide a direct phone number for the named midwife or doctor


- Working with social care professionals to provide supportive and coordinated care


- Training for healthcare professionals on the social and psychological needs of women who misuse substances. They should also be given training on how to communicate sensitively with women who misuse substances, as should non-clinical staff such as receptionists


Pregnant women who experience domestic abuse


- Supporting women who experience domestic abuse by ensuring that a local protocol is developed jointly with social care providers, the police and voluntary agencies and that it is a healthcare professional with expertise in the care of women experiencing domestic abuse


- Providing for flexibility in the length and frequency of antenatal appointments, to allow more time for women to discuss the domestic abuse they are experiencing


- Offering the woman a named midwife, who should take responsibility for and provide the majority of her antenatal care


- Joint training for health and social care professionals to facilitate greater understanding of each other's roles and enable healthcare professionals to inform and reassure women who are apprehensive about the involvement of social services.


- Tell the woman that the information she discloses will be kept in a confidential record and will not be included in her handheld antenatal record and consider offering her a domestic abuse support worker.


Pregnant women who have difficulty speaking or reading English


- Working with local agencies that provide housing and other services for recent migrants, asylum seekers and refugees, such as asylum centres, to ensure that antenatal care services have accurate and up-to-date information about a woman's current address during her pregnancy


- Providing an interpreter (who should not be a member of the woman's family, her legal guardian or her partner) who can communicate with the woman in her preferred language


- Offer flexibility in the number and length of antenatal appointments when interpreting services are used


- Provide information in a variety of formats, settings and languages


- Healthcare professionals should be given training on:

- the specific health needs of women who are recent migrants, asylum seekers or refugees, such as needs arising from female genital mutilation or HIV

- the specific social, religious and psychological needs of women in these groups.


Pregnant women aged under 20 years old


- Working in partnership with local education authorities and voluntary agencies to improve access to, and continuing contact with, antenatal services for young women aged under 20.


- Consider commissioning a specialist antenatal service for young women under the age of 20. This could include antenatal care and education in peer groups in different locations (e.g. schools, colleges, GP surgeries) or offering peer group support at the same time as antenatal appointments in a one-stop shop where a range of services can be accessed at the same time .


- Offering a named midwife, who should take responsibility for and provide the majority of the woman's antenatal care, and provide a direct phone number for the midwife.


- Training for healthcare professionals to ensure they are knowledgeable about safeguarding responsibilities for both the young woman and her unborn baby and the most recent government guidance on consent for examination or treatment


- Be aware that the young woman may be dealing with other social problems and offer age-appropriate information in a variety of formats.


Source:

NICE

The Social Care Institute for Excellence (SCIE)

Rett Protein Needed For Adult Neuron Function

The protein MeCP2 is porridge to the finicky neuron. Like Goldilocks, the neuron or brain cell needs the protein in just the right amount. Girls born with dysfunctional MeCP2 (methyl-CpG-binding protein 2) develop Rett syndrome, a neurological disorder. Too much MeCP2 can cause spasticity or developmental delay with autism-like symptoms in boys.



Now, researchers at Baylor College of Medicine and Texas Children's Hospital have found that the neuron needs a steady supply of this protein for its entire existence. A report on this research appears online in Science Express.



MeCP2 was found in 1999 in the laboratory of Dr. Huda Zoghbi, director of the Jan and Dan Duncan Neurological Research Institute at TCH and professor of neurology, neuroscience, pediatrics and molecular and human genetics at BCM and a Howard Hughes Medical Institute Investigator. A mutation in MeCP2 results in Rett syndrome, a neurological disorder that strikes mainly girls. Male fetuses born with the mutation (which results in dysfunctional protein) die before birth, but girls appear normal until they are between 6 and 18 months. Then they begin to regress and their growth slows. They develop abnormal hand motions such as wringing. Their crawling and walking regresses and they eventually lose the ability to speak or communicate. They exhibit some symptoms of autism.



Clearly, MeCP2 is critical to normal mental functioning, but a question remained. Do neurons need MeCP2 throughout life or would they be protected and work properly if MeCP2 is provided only early in life and then discontinued during adulthood?



To the surprise of Zoghbi and M.D./Ph.D. student Christopher McGraw, the paper's first author, the neurons need the protein throughout life.



"To continue the porridge analogy, taking it away puts you in the same position as someone who never had it," said McGraw.



To demonstrate this, they developed a mouse from which they could eliminate MeCP2 in adulthood.



"We found that they appeared just like the mice born without the protein," said McGraw. The mice developed the Rett-like behaviors, including the limb "clasping" behavior and impaired learning and memory. The mice also died prematurely, 13 weeks after the protein was deleted. Mice born lacking the protein die at about 13 weeks of age as well.



"What this suggests is that the function of this protein is always needed," said McGraw. "Having this protein up to adulthood does not result in the construction of a nervous system that is any more resilient to the loss of MeCP2 than one born without it."



"That was the most surprising to us," said Zoghbi. "The upside of this is if you can add the protein back, you can rescue the neurons, which is indeed what happened when the lab of Dr. Adrian Bird, researcher with the Wellcome Trust Center for Cell Biology, added the gene back in adults in past research," she said. "The new study shows there are no developmental abnormalities. It is all about needing the protein right there to tell the neurons what to do."



MeCP2 affects the epigenetic program of the cell, changing the expression levels of certain genes without changing the sequence of the DNA itself. Scientists are still trying to determine exactly what it does in the cell, and that may enable physicians to develop a treatment that patients would take throughout their lives.



"If we can figure a way to provide the functions of this protein we have a chance to treat these patients successfully and maintain their health," she said.



Just giving patients MeCP2 would not work because of the need to fine-tune the amount of protein in the cell.



She and colleagues are looking instead for drugs that can serve the same function as MeCP2 or that can alter the pathways through which this gene works.


Notes:


Dr. Rodney C. Samaco of BCM also participated in this research.



Funding for this work came from the National Institutes of Health, the Baylor College of Medicine Research Advocates for Student Scientists, the International Rett Syndrome Foundation, the Simons Foundationand the Rett Syndrome Research Trust.



Source:

Graciela Gutierrez


Baylor College of Medicine

Antiabortion Activists Refocusing Strategies After Election Results Washington Post Says Democratic-Controlled Congress Might Force Bush To Reconsider

Antiabortion activists are refocusing their strategies to "reduce access to abortion" after a "string of Election Day victories" for abortion-rights supporters, the Los Angeles Times reports (Simon, Los Angeles Times, 11/9). South Dakota voters on Tuesday rejected by a 55% to 45% margin a law (HB 1215) that would have banned all abortions in the state except to save a pregnant woman's life. Oregon voters defeated a measure that would have required physicians to notify a parent or guardian at least 48 hours before performing an abortion on a minor between ages 15 and 17. In California, Proposition 85, a statewide ballot measure that would have required doctors to notify parents or guardians before performing an abortion on a minor, lost by a 54% to 46% margin (Kaiser Daily Women's Health Policy Report, 11/8). Antiabortion activists are "[d]rawing motivation from their defeats" and are working on new strategies to persuade more women not to undergo abortions and to reduce access to the procedure, the Times reports. "We're going back to the drawing board to see where we can make inroads," Troy Newman -- president of Operation Rescue West, which opposes abortion rights -- said. According to the Times, the goals of antiabortion groups include expanding and rewriting "informed consent" laws; expanding requirements for "emotional" counseling, which includes telling women seeking abortions that the fetus can feel pain and that abortions end the life of a "unique human being"; requiring women to see a three-dimensional ultrasound of the fetus; and increasing regulation of clinics that provide abortion services (Los Angeles Times, 11/9). Nancy Keenan, president of NARAL Pro-Choice America, said, "Voters in every corner of the country made it clear they are tired of divisive attacks on a woman's right to choose." According to Sarah Stoesz, president of Planned Parenthood Minnesota-North Dakota-South Dakota, the election results "sen[d] a very strong message to the rest of the country," adding, "This was really a rebellion in the heart of red-state, pro-life America" (AP/Baltimore Sun, 11/9).

Embryonic Stem Cell Research
With the Democratic Party on the "verge of capturing the Senate" on Wednesday to "go along with the House majority they won on Tuesday, the resulting new "political dynamic" of Congress might "force" President Bush to reconsider his position on federal funding for human embryonic stem cell research, the Washington Post reports (Weisman/Babington, Washington Post, 11/9). Federal funding for embryonic stem cell research in the U.S. is allowed only for research using embryonic stem cell lines created on or before Aug. 9, 2001, under a policy announced by President Bush on that date. Bush in July vetoed the Stem Cell Research Enhancement Act of 2005 (HR 810), which would have expanded stem cell lines that are eligible for federal funding and allowed funding for research using stem cells derived from embryos originally created for fertility treatments and willingly donated by patients (Kaiser Daily Women's Health Policy Report, 10/26). Congress at the time lacked the two-thirds majority to override Bush's veto, and the House still seems to be "short of a two-thirds majority favoring more embryonic stem cell research," according to the Post. In Missouri, voters on Tuesday approved a measure that would amend the state constitution to ensure that stem cell research permitted under federal law is protected in the state and would prohibit human cloning. The proposal, titled the Missouri Stem Cell Research and Cures Initiative, would allow stem cell research that involves somatic cell nuclear transfer, which some consider a type of human cloning (Kaiser Daily Women's Health Policy Report, 11/8).














APM's "Marketplace" on Wednesday reported on the passage of Missouri's stem cell ballot measure. The segment includes comments from Joseph Haslag, economist at the University of Missouri-Columbia; William Neaves, director of the Stowers Institute for Medical Research; and Gail Pressberg, co-author of the book "The Promise and Politics of Stem Cell Research" (Palmer, "Marketplace," APM, 11/8). A transcript and audio of the segment are available online.

NPR's "All Things Considered" on Wednesday examined the changing landscape of abortion rights in the U.S. The segment includes comments from Keenan; Daniel McConchie, vice president of Americans United for Life; and Leslee Unruh, campaign manager for the South Dakota antiabortion group VoteYesForLife (Rovner, "All Things Considered," NPR, 11/8). Audio of the segment is available online.

"Reprinted with permission from kaisernetwork. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at kaisernetwork/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork, a free service of The Henry J. Kaiser Family Foundation . © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

Hospitals Tighten Rules For Elective Inductions, C-Sections Ahead Of New Joint Commission Reporting Requirements

In anticipation of new quality reporting requirements that will take effect in the spring, some hospitals are tightening rules for elective inductions and caesarean sections, the AP/Google News reports. National guidelines from the American College of Obstetricians and Gynecologists discourage elective deliveries prior to 39 weeks' gestation, but many physicians and hospitals allow inductions and scheduled c-sections at 37 weeks, according to the AP/Google News. According to the Centers for Disease Control and Prevention, one in five pregnancies is induced, double the rate in 1990. There is little data on the percentage of inductions that are elective, though a Hospital Corporation of America study of nearly 18,000 births at its 27 hospitals placed the figure at 10% of all births before 39 weeks. Recent research shows that infants born prior to 39 weeks face a higher risk of breathing disorders and other problems than those who remain in the womb longer.

The Joint Commission, which accredits hospitals, this spring will begin requiring hospitals to report all elective deliveries to a public database. Hospitals will also have to report gestational age at induction and c-sections for first-time births, which can be linked with failed inductions. "We believe this will be a very important driver of improvement in prenatal care," Mark Chassin, the organization's president, said (Neergaard, AP/Google News, 10/27).


Reprinted with kind permission from nationalpartnership. 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.


© 2009 The Advisory Board Company. All rights reserved.

Novo Nordisk Launches Vagifem(R) 10??g , The Lowest Dose Of Local Oestrogen Available For Post-Menopausal Women With Vaginal Atrophy

Almost half (45%) of post-menopausal women suffer or have suffered from vaginal atrophy,
manifested as vaginal discomfort, increased tendency of infection, and pain during sexual
intercourse1. But only a fraction actually receives the most appropriate treatment for the
underlying cause - oestrogen deficiency. One reason is concern about the risk of excessive
oestrogen exposure. With most recent treatment guidelines there is a move towards
advocating the use of lower dose oestrogens to treat vaginal atrophy2.


This trend has led to a new product being introduced by Novo Nordisk. The company, which
markets a 25??g oestrogen vaginal tablet, has just launched the first ultra low dose local
oestrogen - it contains just 10??g of oestrogen. This helps meet the changing needs of patients
and healthcare professionals for products that limit oestrogen exposure but still provide
symptom relief. Clinical data demonstrates that the 10??g product relieves symptoms3, yet
notably, circulating oestrogen remains within normal post-menopausal levels4.


Esben Bruun Mortensen, Director of Biopharm, Novo Nordisk Limited, commented on the
launch, saying 'vaginal atrophy is a big issue for women, affecting around 40% of them at any
one time. It has negative consequences for sexual intimacy and self-esteem. Some women
mistakenly attribute symptoms to other conditions such as thrush or bladder infections, and
use treatments such as lubricants and moisturisers in an attempt to help them cope with their
symptoms. This fails to treat the underlying cause. Others are reluctant to take an oral
hormone replacement therapy (HRT) or patch because of concerns about excessive oestrogen
exposure. The arrival of the first ultra low dose 10??g local oestrogen provides a step forward
for patients and healthcare professionals. It provides effective local oestrogen replacement
directly into the vagina, whilst minimising oestrogen exposure, in line with the latest expert
guidelines'.


Notes:


Vaginal atrophy


Vaginal atrophy (VA) sometimes known as 'Atrophic vaginitis', is the thinning and inflammation
of the vaginal walls due to a decline in oestrogen caused by the menopause. Symptoms
include vaginal dryness, vaginal discomfort due to inflammation, itching, increased tendency of
infection and pain during sexual intercourse.


Development of Vagifem® 10??g


Vagifem® 10??g was approved by the European Member States on 18 January 2010. Its
approval was based on a randomised, placebo-controlled 52-week multicentre trial,3 which
found statistically significant improvements in VA symptoms with the 10??g preparation versus
placebo, including:















- Vaginal Maturation Index and Value, starting from wk 2 (p

Lack Of Information Fuels Cancer Screening Fears According To Review Covering Nearly 6,000 Women

Fear plays a major role in whether women decide to go for cancer screening or not, but healthcare providers underestimate how much women need to know and wrongly assume that they will ask for information if they want it.



Those are the two key findings from a study published in the June issue of the UK-based Journal of Advanced Nursing.



US researchers Dr Kelly Ackerson and Dr Stephanie Preston reviewed 19 studies that between them explored the attitudes of 5,991 women to breast and cervical cancer screening. The studies, which covered the period 1994 to 2008, included women of all ages, from 14 year-old teenagers to women in their eighties.



"Our review showed that fear could motivate women to either seek screening or to avoid screening" says nurse researcher Dr Ackerson, an Assistant Professor at Western Michigan University, USA.



"Some women complied because they feared the disease and saw screening as routine care, but other women feared medical examinations, healthcare providers, tests and procedures and didn't seek screening if their health was good.



"Lack of information was a big barrier. It was clear from our review that very few women understood that cervical smear testing aims to identify abnormal cells before they become malignant and that breast screening can detect cancer in the early stages when treatment is most effective.



"The review also highlighted that many women had misconceptions about breast and cervical cancer and who was at risk. For example, some women felt they did not need breast or cervical screening after a certain age and some believed that they could not develop cervical cancer if they weren't in a current sexual relationship.



"Women who did not have a family history of cancer were also less likely to think they were at risk. Because there has been a lot of publicity about the role that family history can play in breast cancer, many women assumed wrongly that the same family patterns can apply to cervical cancer."



Figures from the USA and UK show that there is a big gap between the number of women invited for screening and the number who actually attend.



In 2007 the Centers for Disease Control and Prevention in America estimated that 25 per cent of women aged 40 plus had not had breast screening in the last two years and 16 per cent aged 18 and over had not had a cervical smear in the last three years.



Cancer Research UK figures for the same year suggest that 4.4 million women were invited for cervical smears but only 3.6 million (82 per cent) attended.



Breast cancer rates are similar in both countries, despite differently funded healthcare systems and screening criteria, but a lower percentage of UK women die from cervical cancer.



The researchers have come up with three key recommendations as a result of their review:
Nurses should promote screening by educating women of the benefits of breast and cervical screening even when they do not ask for information.


Initiatives aimed at increasing uptake rates should focus on women's fears about the procedure or a possible positive result.


Public health messages need to specifically target women who do have access to healthcare but fail to undergo routine testing.

"Nurses have a key role to play in addressing the fears and lack of knowledge that women have when it comes to screening for breast and cervical cancer" concludes Dr Ackerson.



"They need to help women understand both the risks and benefits of screening so that they can make informed choices about whether or not they want to be tested."



Notes:

A decision theory perspective on why women do or do not decide to have cancer screening: systematic review. Ackerson K and Preston S. Journal of Advanced Nursing. 65.6, 1130-1140. (June 2009).



Source:
Annette Whibley


Wiley-Blackwell

Indian Government Drops Requirement For Female Government Workers To Disclose Information About Menstrual Cycle, Maternity Leave

The Indian government on Thursday announced that it has removed questions about female workers' menstrual cycles and maternity leaves from government appraisal forms due to "the sensitivity of the issue," an unnamed official from the Ministry for Personnel, Public Grievances and Pensions said, AFP/Yahoo! News reports. The new appraisal forms, which were introduced in March, required women to disclose details about their menstrual history, most recent maternity leave, Pap tests and mammograms (AFP/Yahoo! News, 4/12). According to the AP/Raleigh News & Observer, all civil servants in the country undergo routine health screenings, but the results are not supposed to go in appraisals. Seema Vyas, joint secretary for general administration in the Indian state Maharashtra, said the new rule was "insensitive" (AP/Raleigh News & Observer, 4/12). Satyanand Mishra, head of the personnel department, said the questions in the All-India Services Performance Appraisal Rules 2007 were based on advice from the Ministry of Health and Family Welfare (Ghoge, Hindustan Times, 4/11). K. Ramchandran, a spokesperson for the health ministry, said a committee had developed the rule. Nearly 10% of India's 4,000 federal government workers are women, the AP/News & Observer reports (AP/Raleigh News & Observer, 4/12). The unnamed official said that a new "notification deleting those female-specific clauses will be issued shortly" (AFP/Yahoo! News, 4/12).

"Reprinted with permission from kaisernetwork. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at kaisernetwork/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork, a free service of The Henry J. Kaiser Family Foundation . © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

Blogs Comment On Cultural Notions Of Virginity, Hormone Replacement, Other Topics

The following summarizes selected women's health related blog entries.

~ "Virginity Around the World," Silvana Naguib, American Prospect's "Tapped": After reviewing customs and cultural expectations related to virginity in Arab countries, India and the U.S., Naguib writes that "cultural emphasis on virginity hurts girls and women, placing undue emphasis on an existential state of 'purity' rather than encouraging safe behavior." She notes that in some Arab countries, a woman is expected to "physically demonstrate [virginity] by experiencing tearing and bleeding on her wedding night," leading some women to "pay thousands of dollars to modify their genitals." In the U.S., Naguib says, "[w]e still have federal funding for abstinence-only education, which emphasizes purity as the path to the greatest happiness and health." She adds that on the Internet "[w]e still have young women auctioning off their virginity to the highest bidder, receiving bids of thousands and even millions of dollars." Naguib continues, "By continuing to prize virginity, Americans support a violent narrative about young women and sex, increasing the value of their sexual purity only to gain power by depriving them of it." She writes, "Instead of focusing on virginity, we should conceive of whether people are 'sexually active,' since people go through different phases of sexual activity throughout their lives" (Naguib, "Tapped," American Prospect, 4/30).

~"Beyond Ovaries: Is There Room for Men in the Pro-Choice Movement," Feminists for Choice: The blogger, who identifies himself as "a gay pro-choice feminist, discusses Florida Rep. Janet Long's (D) comment that supporters of an antiabortion measure should "[s]tand down if [they] don't have ovaries." He writes, "I think it's important to recognize, especially as an arbiter of male privilege, that women have been marginalized in traditional legal discourse on abortion rights," but it is "problematic to assume that men have no responsibility or role in advancing reproductive justice in the United States." Because "men have traditionally occupied the social and political positions of power to authorize or limit women's reproductive choices, … it [is] perfectly understandable that many women have a problem with men dominating the conversation about women's reproductive choices," he continues. "It's important to point out this necessary distinction between 'men participating in the struggle for reproductive justice,' and 'men trying to make choices for women,'" the blogger writes. "In other words, men certainly have a place in the struggle for the right to choose; however, they have ZERO right to tell women what they can or cannot do with their bodies," he concludes (Feminists for Choice, 5/2).














~ "Oklahoma -- Not OK," Robin Lakoff, Huffington Post blogs: Lakoff, a professor of linguistics at the University of California-Berkeley, criticizes two recently enacted antiabortion laws in Oklahoma. The first law (HB 2780) "makes it mandatory for a doctor to show a woman requesting an abortion an ultrasound, along with an interpretation of it," while the second law (HB 2656) "indemnifies a doctor who has failed to inform a pregnant woman that the fetus she is carrying is defective," Lakoff writes. The two laws "deprive female human beings -- and only females -- of the ability to determine for themselves what they need to know and to be given the information they want, and only that information, in order to be in a position to make intelligent decisions concerning their bodies and their lives," according to Lakoff. She continues, "There is a presumption that women are so stupid, or so evil, that they cannot make proper use of information to which they are privy, as well as an assumption that they are too stupid or evil to have the right to determine for themselves what they want and need to know." The laws constitute a "return of 'don't bother your pretty little head about it' paternalism, only worse," she argues. "[T]hese laws should make it clear" that antiabortion-rights bills are not "first and foremost about protecting fetuses," she adds. Rather, such laws "are about returning women to age-old positions of subordination and male control, based on a biblical presumption that women are meant to be in such a status based on their inferiority to men," Lakoff writes (Lakoff, Huffington Post, 5/3).

~ "'The Estrogen Dilemma' and the Holy Grail of Menopausal Symptom Management," Patricia Yarberry Allen, Huffington Post blogs: Patricia Yarberry Allen, publisher of Women's Voices for Change, writes about a recent article in the New York Times Magazine by Cynthia Gorney exploring the "suffering experienced by some women during the perimenopausal transition" and Gorney's struggle with hormone therapy. Allen writes that "over the next few years," ongoing research into estrogen and hormone replacement "will begin to give us clues about the impact of hormone use on many clinical aspects of the lives of women who are symptomatic during some part of the menopausal transition." She adds, "Questions of benefit and risk in the use of hormone therapy will always be a part of the treatment decisions that the patient and doctor must make throughout the medical management of menopausal symptoms." While "[t]here will never be an easy answer" or a "right answer," the "conversation has been enlivened by Gorney's investigation into current hormone research and years of personal experience with the use of hormone therapy for the treatment of perimenopausal depression," she concludes (Allen, Huffington Post, 4/30).


Reprinted with kind permission from nationalpartnership. 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.


© 2010 The Advisory Board Company. All rights reserved.

Videos Discuss Health Reform Abortion Debate, Maternal Health Efforts

The following summarizes selected women's health-related videos.

 Maddow Tracks Reform Developments: MSNBC host Rachel Maddow on Thursday discussed Rep. Bart Stupak's (D-Mich.) continued opposition to the Senate health reform bill's abortion language, despite support for the bill from Catholic nuns and some antiabortion-right lawmakers. Maddow also included a discussion with Tracy Weitz of the Bixby Center for Global Reproductive Health about current restrictions on abortion access and how the Senate bill would affect insurance coverage for abortion (Maddow, "The Rachel Maddow Show, MSNBC, 3/17). On Friday, Maddow featured a commentary on Stupak's efforts, as well as an interview with Melanie Sloan of CREW about the lawmaker's ties to a Christian group called The Family (Maddow, "The Rachel Maddow Show," MSNBC, 3/12).

 Clinton Discusses Global Maternal Health: In an interview with MSNBC's Andrea Mitchell about women's rights, Secretary of State Hillary Rodham Clinton called attention to the Obama administration's focus on maternal and child health in its global health initiatives. Clinton said, "If women are able to survive, if they have access to family planning, they have fewer children, they take better care of those children, it's more likely those children will go to school" (Mitchell, "Andrea Mitchell Reports," MSNBC, 3/15).

 Planned Parenthood Looks at Private Abortion Coverage: A YouTube video from the Planned Parenthood Federation of America describes the emotional and financial challenges a South Dakota woman faced in obtaining a selective reduction after a medical diagnosis threatened her twin fetuses. The woman's husband said the costs related to the procedure would have been thousands of dollars if the couple did not have insurance to cover abortion services (Planned Parenthood Federation of America, 3/16).


Reprinted with kind permission from nationalpartnership. 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.


© 2010 The Advisory Board Company. All rights reserved.

Federal Judge Extends Temporary Restraining Order Blocking Missouri Law That Would Require Abortion Clinics To Upgrade Facilities

U.S. District Judge Ortrie Smith on Monday extended a temporary restraining order blocking a Missouri law (SB 370) that would designate facilities performing second- or third-trimester abortions or more than five first-trimester abortions each month as "ambulatory surgical centers," the St. Louis Post-Dispatch reports. Smith at a hearing said he is extending the order to allow more time for evidence and testimony to be submitted (St. Louis Post-Dispatch, 9/11).

Ambulatory surgical centers are subject to increased regulation from the state Department of Health and Senior Services. The law would require hallways at the facilities to be at least six feet wide and doors at least 44 inches wide. The clinics must also have separate male and female changing rooms for staff and a recovery room with space for a minimum of four beds with three feet of clearance around each bed. The health department has said the law requires that three clinics in the state be licensed.

Planned Parenthood of Kansas and Mid-Missouri last month filed a federal lawsuit alleging that the new regulations are unnecessary and are not meant to improve safety, but rather to interfere with a woman's constitutional right to abortion. Smith last month issued a temporary restraining order blocking implementation of the law, which was scheduled to take effect Aug. 28. Last week, Smith ruled that physician Allen Palmer -- who operates the Women's Care Gynecology clinic in Bridgeton, Mo. -- can join the lawsuit (Kaiser Daily Women's Health Policy Report, 9/10). Smith on Monday said he would rule on issuing a preliminary injunction on the law by Sept. 24.

Hearing Comments
Donna Harrison, a gynecologist and president-elect of the American Association of Pro Life Obstetricians and Gynecologists, at the hearing said the regulations were reasonable steps to protect women from complications of medical and surgical abortions, the Kansas City Star reports. Paul Blumenthal, a gynecologist and professor at Stanford University's School of Medicine, said the regulations are unnecessary (Morris, Kansas City Star, 9/10). Palmer in court documents argued that the same restrictions do not apply to other private physicians who performed minor surgeries in the offices. In addition, Palmer said he performed only early-term abortions at his office (St. Louis Post-Dispatch, 9/11).

Architects at the hearing testified that the three clinics would incur substantial costs to comply with the new law, but they said they did not estimate the cost of renovations if the state were to waive some of the requirements. Dean Linneman, an administrator for DHSS, said it is possible the department would permit waivers (Kansas City Star, 9/10).

Reprinted with kind permission from kaisernetwork. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at kaisernetwork/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork, a free service of The Henry J. Kaiser Family Foundation© 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

Low-Income, Minority Women Face Health Disparities In California, Report Finds

Low-income and minority women in California are more likely to be in poor health, obese and uninsured than whites and higher-income women, according to a University of California Center for Health Policy Research report released on Thursday, the Fresno Bee reports. The report, "Women's Health in California," is based on more than 50,000 telephone interviews conducted in 2001 and 2005.

The report found that:
Statewide, low-income Hispanic women are three times more likely to be uninsured than whites;

Low-income women are four times more likely than higher-income women to be uninsured;

Low-income women between ages 18 and 64 are three times more likely than higher-income women to report that they are in fair to poor health;

Low-income women are more likely to have health conditions such as arthritis, high blood pressure, heart disease and diabetes, which affect their quality of life, compared with higher-income women; and

More than 20% of low-income women statewide are obese and 25.5% are overweight.
Erin Peckham, a researcher at the center and author of the report, said, "People might want to do better with their health, but the lack of money, the lack of medical care and the lack of access in low-income neighborhoods to healthy foods and safe physical activity are the things that low-income people in Fresno and the Valley areas face." She added, "Bottom line, if you're poor or a minority, you are potentially in trouble health-wise. California needs to renew its efforts at seeking a solution to our lack of health insurance overall" (Anderson, Fresno Bee, 8/7).

The report is available online.


Reprinted with kind permission from kaisernetwork. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at kaisernetwork/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork, a free service of The Henry J. Kaiser Family Foundation.

© 2008 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

Concurrent Sexual Relationships Not Uncommon Among U.S. Men, Contributing To Spread Of HIV, Study Says

Eleven percent of men in the U.S. report that they have conducted multiple sexual relationships at the same time during the past year -- a behavior that could be contributing to the spread of HIV in the country -- according to a study published online on Tuesday in the American Journal of Public Health, Reuters Health reports. For the study, Adaora Adimora of the University of North Carolina-Chapel Hill and colleagues examined data from a 2002 federal survey that included 4,928 men between ages 15 and 44. The study showed that 11% of the men said they had at least two concurrent sexual relationships during the previous year. Among this group, most said they had only female partners.

The study found that the men were more likely to report that they drank and used drugs during sex and that their female partners also were involved in other sexual relationships, Reuters Health reports. In addition, men with more than one female partner were more likely than monogamous men to have sex with another man, according to the study. Black and Hispanic men were two to three times more likely than white men to have concurrent sex partners, the study found (Norton, Reuters Health, 10/30).

"The higher concurrency prevalence in various groups, dense sexual networks, and mixing between high-risk subpopulations and the general population may be important factors in the U.S. epidemic of heterosexual HIV infection," the authors concluded (Adimora et al., American Journal of Public Health, 10/30). "This study sheds light on the epidemic of heterosexually transmitted HIV in the U.S.," particularly among blacks and Hispanics, Adimora said, adding, "People, especially women, need to avoid partnerships with people who have other partners" (Reuters, 10/30).


The study is available online.

Reprinted with kind permission from kaisernetwork. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at kaisernetwork/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork, a free service of The Henry J. Kaiser Family Foundation© 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

Perinatal And Postpartum Depression A Top Priority At Annual Conference Of Ob-Gyns

Depression during and after pregnancy is prevalent among women, and, if left untreated, can have serious health consequences for both women and their babies, according to a trio of speakers at today's opening ceremonies of The American College of Obstetricians and Gynecologists' 58th Annual Clinical Meeting (ACM). The President's Program featured two of the country's leading experts on women's mental health and a former First Lady of New Jersey, who suffered postpartum depression (PPD) with both of her pregnancies.


"As ob-gyns, if we can focus more of our attention on the emotional and psychological health of our patients during pregnancy and postpartum, I believe our specialty can have a positive and significant impact on the overall health and well-being of women everywhere," said Gerald F. Joseph, Jr, MD, president of The American College of Obstetricians and Gynecologists. "I'm so passionate about postpartum depression that I've made it the theme of my presidential initiative and a major focus of the ACM's scientific program this year.


"Our message today to ob-gyns is one of awareness," added Dr. Joseph. "In essence, we may be the first to make a diagnosis of depression or to observe depressive symptoms getting worse. It's especially important to identify depression during pregnancy so that we can help prevent the condition from worsening after delivery."


The peak prevalence of major depressive disorders is during the childbearing years, and depression is one of the most common complications of pregnancy. Between 14%-23% of women will experience depression during pregnancy, and an estimated 5%-25% of women will have postpartum depression.


"Perinatal depression causes suffering in women; it compromises a mother's ability to parent effectively; and it can have negative consequences for the child and the family over the long term," said Michael W. O'Hara, PhD, who delivered the Samuel A. Cosgrove Memorial Lecture, "Perinatal Depression: Screening, Diagnosis, and Treatment." Dr. O'Hara, a professor of psychology at the University of Iowa in Iowa City, is a widely recognized authority in the field of mood disorders and depression in women. He specializes in perinatal depression, which refers to depression that occurs at any time during pregnancy or throughout the first year after giving birth.


"Although depression is the leading cause of disability for women throughout the world, it continues to be associated with stigma in our society," according to Katherine L. Wisner, MD, MS, who also spoke at the opening session. "Stigma contributes to the perception that antidepressant drug therapy is less justifiable for pregnant women with depression than, for example, antibiotics or drugs used to treat gastric ailments." Dr. Wisner is a professor of psychiatry, obstetrics-gynecology and reproductive sciences, epidemiology and women's studies at the University of Pittsburgh School of Medicine and director of the Women's Behavioral HealthCARE program at the Western Psychiatric Institute and Clinic at the University of Pittsburgh Medical Center.















"Ob-gyns, as primary care providers for women and especially in the context of pregnancy care, are in a perfect position to identify women who are depressed and to provide or facilitate access to treatments," said Dr. O'Hara. The American College of Obstetricians and Gynecologists encourages ob-gyns to strongly consider screening for depression during and after pregnancy. "What matters is that ob-gyns initiate the discussion of depression with their pregnant patients and new mothers and this can be accomplished by asking good, sensitive questions. This step is critical-you can't tell by looking at a woman whether or not she is depressed.


"One big misconception is that there is little risk to not treating," noted Dr. O'Hara. "We know very clearly that women who are depressed are more likely to smoke and take drugs. In addition, the presence of major depression during pregnancy is associated with preeclampsia, preterm birth, and low birth weight. The implications for not treating the depression are both real and severe." Studies have shown that untreated maternal depression negatively affects an infant's cognitive, neurologic, and motor skill development, and it can also negatively impact mental health and behavior of older children.


"Evidence-based treatment for depression includes psychotherapy and antidepressant medication, and other treatments such as bright morning light therapy, acupuncture, and exercise are being studied for use in pregnancy to expand therapeutic options," said Dr. Wisner. Although non-drug treatments are preferred by many pregnant women, the fact is, "the availability of accessible, acceptable, and affordable mental health intervention of any type is limited," she added. "A comprehensive disease management strategy holds the potential to reduce maternal disability and avert a new generation at risk."


Former First Lady of New Jersey, Mary Jo Codey presented the Anna Marie D'Amico Lecture, "Recognizing Postpartum Depression: Speak Up When You're Down," named after the statewide campaign put in place during Governor Richard Codey's term in office to raise awareness about PPD and offer education and resources to women, their families, and health care professionals. Mrs. Codey, who suffered PPD with both of her pregnancies, resolved to speak out so that other struggling mothers would know that they are not alone and need not feel ashamed.


"Too many women with depression are slipping through the cracks and going untreated," Mrs. Codey said. "This is deeply concerning to me because the health and well-being of women are at risk. We owe it to women and their families to provide more education, screening, treatment, and support." She was active in helping to secure passage of the Melanie Blocker-Stokes MOTHERS Act, which will increase funding for research, education, and awareness of postpartum mood disorders. The provisions were included in the final federal health care reform legislation.


Source

American College of Obstetricians and Gynecologists

Some Conservatives Criticize Giuliani Judicial Appointments

Some prominent conservatives have criticized former New York City Mayor Rudolph Giuliani's (R) judicial appointments and have said his record undermines his promise that he would appoint "strict constructionists" to the Supreme Court if elected president, the Los Angeles Times reports (Hamburger/Schreck, Los Angeles Times, 3/12). Giuliani, who has formed a presidential exploratory committee, supports abortion rights. Giuliani in recent talks with conservative media outlets and voters in South Carolina said he would appoint "strict constructionist" judges to the Supreme Court. In a recent interview with Sean Hannity of Fox News, he also said that a law (S 3) being reviewed by the Supreme Court that bans so-called "partial-birth abortion" should be upheld and that he supports parental notification requirements with a judicial bypass provision for minors seeking abortions (Kaiser Daily Women's Health Policy Report, 3/5). In his eight years as mayor, Giuliani appointed or reappointed 127 municipal judges -- who preside over family courts, criminal misdemeanor cases and civil claims of less than $25,000 -- the Times reports. Connie Mackey, vice president of the Family Research Council's political and legislative division FRC action, said Giuliani's appointments "were mostly liberal," adding, "Any pro-lifer who believes they are going to get the kind of judge out of Rudy Giuliani that we see in either [Supreme Court Chief Justice John] Roberts or [Supreme Court Justice Samuel] Alito is probably going to be disappointed." Some constitutional law experts disagree with Mackey's conclusion, the Times reports. Stephen Gillers, a law professor at New York University, called it "nonsense" to cite municipal judges as an indication of how a candidate might appoint Supreme Court justices. He added that Giuliani as mayor was "guided by concerns of competence" when making judicial appointments (Los Angeles Times, 3/12).

New York Times Examines Romney Contributions to Conservative Groups
Contributions made by Massachusetts Gov. Mitt Romney (R) to several "conservative groups" in the months preceding his announcement that he is running for the Republican presidential nomination might "create the appearance of a conflict of interest for groups often asked to evaluate him," the New York Times reports. According to the New York Times, a foundation controlled by Romney in December 2006 made contributions of $10,000 to $15,000 to organizations associated with major national conservative groups, including Massachusetts Citizens for Life, Massachusetts Citizens for Limited Taxation and the Massachusetts Family Institute. Romney has contributed $35,000 in the last two years to the Federalist Society, a conservative legal group, and he contributed $25,000 to the conservative Heritage Foundation in December 2005. He and a group of his supporters also contributed about $10,000 to a not-for-profit group affiliated with National Review. All the groups have said Romney had never contributed before, and his public tax filings show no previous gifts to similar groups. According to the New York Times, the support of leading conservative organizations in Massachusetts has become important to Romney's campaign due to doubts from some conservatives over his past support for abortion rights. Romney's contributions demonstrate his convictions, his spokesperson, Kevin Madden, said, adding, "He has donated his time and his effort and whatever resources he can to help advance their causes" (Kirkpatrick, New York Times, 3/11). According to the Los Angeles Times, Romney has spent more "time and energy" addressing his position on abortion rights than any other presidential candidate (Hook, Los Angeles Times, 3/11). Romney's foundation's 2006 contributions will become public with its tax filings later this year (New York Times, 3/11).














"Reprinted with permission from kaisernetwork. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at kaisernetwork/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork, a free service of The Henry J. Kaiser Family Foundation . © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

Chlamydia Vaccine A Step Closer To Reality

Scientists at Queensland University of Technology are one step closer to developing a world-first vaccine to protect women against contracting the most common sexually-transmitted disease, Chlamydia.


International vaccine company Sanofi-Pasteur has awarded QUT a funding boost of more than $300,000 to continue its research into Chlamydia and work towards developing a vaccine specifically targeting adolescent women.


Professor Peter Timms, from QUT's Institute of Health and Biomedical Innovation (IHBI), said a team of researchers had already identified certain proteins that were able to protect against Chlamydia infection.


"We've been testing these proteins as part of animal trials...and we think we've got the answer. It is possible that within three to five years we'll be finished the animal trials and be looking at clinical trials in humans."


Professor Timms said Sanofi-Pasteur's funding would allow QUT to evaluate the effectiveness of Chlamydia prevention methods developed at the university, as well as compare and test possible prevention methods being developed by Sanofi-Pasteur.


He said once a vaccine had been developed it could be administered via a patch, similar to ones used by smokers for nicotine.


"Patches are a good way to deliver proteins to a part of the body's immune system and they are also easy and user-friendly."


He said with rates of Chlamydia infection in some Australian communities as high as 12 per cent of the female population, there was a "real need" to develop a vaccine.


"Chlamydia is the most common infectious disease in the world and results in infertility in women and long-term chronic pelvic pain," he said.


"There are antibiotics to treat Chlamydia, but there's no vaccine to prevent it. In many cases women don't know they are infected because there are not really any physical signs or symptoms, so by and large they don't get treatment."


Professor Timms said Sanofi-Pasteur was one of the world's largest companies devoted to the development of human vaccines.


"The fact that such a large vaccine company as Sanofi-Pasteur has selected QUT to help develop Chlamydia vaccines points to the value of the work being done here," he said.
"Despite this current injection of funds, further work and funding is still needed to take this current research through to a vaccine product."


QUT researchers working on the project are part of IHBI's Cells and Tissue Domain and include Professors Peter Timms, Ken Beagley, Associate Professor Louise Hafner, Celia Berry and Chris Barker.


qut.edu.au

Clinton Replacement In Senate Must Uphold Her Legacy As 'Champion For Women,' Opinion Piece Says

Although President-elect Barack Obama's nomination of Sen. HilLary Clinton (D-N.Y.) for secretary of state is an "unprecedented opportunity to bring her unique leadership, advocacy and diplomacy skills to the world's stage," it is important to "make sure that our gain is not simultaneously our loss," Kelli Conlin, president of NARAL Pro-Choice New York, writes in a Albany Times Union opinion piece. Clinton as a senator has been a "singular champion for all the women of the United States," Conlin writes, adding, "Clinton led the way for progressive, pro-choice legislation in the Senate and, because she represents New York, our state's priorities helped push the rest of the nation forward."

Conlin continues, "So when we think about appointing her replacement, we must ask what it truly means to replace" a senator "who nearly single-handedly ended [FDA's] foot-dragging on approving emergency contraception for over-the-counter access" and worked with Sen. Charles Schumer (D-N.Y.) "to oppose the [Bush] administration's plan to reduce federal reimbursement to health clinics (including family planning clinics, substance abuse counseling and mental health clinics)." Since July, Clinton and Sen. Patty Murray (D-Wash.) "have been leading the opposition" to the "misguided" proposed HHS conscience rule that would allow many health care workers to decline to participate in care because of their moral or religious beliefs, Conlin writes. She also notes that Clinton sponsored the Lily Ledbetter Fair Pay Act, which would have "helped close the pay gap and end the inequities that have shortchanged women and families for far too long." In addition, Clinton cosponsored legislation to repeal the "Mexico City" policy -- also known as the "global gag rule" -- as well as bills to fund comprehensive sex education, to expand access to contraception and to codify Roe v. Wade, Conlin writes.

"Simply put, there is no other senator who has shown such commitment, dedication and leadership when it has come to standing up for women's health and rights," Conlin says. She adds that although "[s]ome may argue that, with the election of a pro-choice president and additional pro-choice senators and Congress members, we no longer need an advocate like Clinton," the truth is "that we need someone like her even more. Not just to defend against regressive legislation, but to push forward a proactive, pro-choice agenda." Conlin continues, "We need someone who not only represents New York's pro-choice values, but has the political acumen and ability to confront the entrenched power structures in the Senate. We need someone who has the same willingness to be an ally and advocate for New York and women across the country." She concludes, "We hope that as Gov. David Paterson (D) considers the appointment of Clinton's successor, he will choose someone who will commit to upholding this legacy" (Conlin, Albany Times Union, 12/2).


Reprinted with kind permission from nationalpartnership. 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.

Obama Defends Decision To Ease Federal Restrictions On Embryonic Stem Cell Research

In a White House press conference on Tuesday, President Obama said his decision to ease some of former President George W. Bush's restrictions on federal funding of embryonic stem cell research was the "right thing to do and the ethical thing to do," the AP/Google reports. Obama's March 9 executive order on embryonic stem cell research allows federally funded scientists to access hundreds of new lines created since Bush's 2001 order restricting the research to 21 lines in existence at the time (AP/Google[1], 3/25). At Tuesday's press conference, a reporter asked Obama how much he "personally wrestled with the morality or ethics of federally funding this kind of research, especially given the fact that science so far has shown a lot of progress with adult stem cells, but not a lot with embryonic." Obama said, "I believe that it is very important for us to have strong moral guidelines, ethical guidelines, when it comes to stem cell research or anything that touches on ... the issues of possible cloning or issues related to ... the human life sciences." He continued that "those issues are all critical," adding, "I wrestle with it on stem cell[s]; I wrestle with it on issues like abortion." Obama said that "the guidelines that we provided meet that ethical test" and that "for embryos that are typically about to be discarded, for us to be able to use those in order to find cures for Parkinson's or for Alzheimer's or ... all sorts of other debilitating diseases ... that is the right thing to do." He added that his opinion is shared by "a number of people who are also against abortion" (Press conference transcript, AP/Google [2], 3/25). Obama said that he has "no investment in causing controversy" and that he is "happy to avoid it if that's where the science leads us." However, he added that he does not want to "predetermine this based on a very rigid ideological approach, and that's what I think is reflected in the executive order" (AP/Google [1], 3/25).

Obama Signals 'Flexibility' in Embryonic Stem Cell Research Debate, Editorial Says

A Washington Post editorial addressing Obama's apparent "flexibility" in his budget request notes that Obama also "appeared to signal flexibility" on the issue of embryonic stem cell research in his remarks on Tuesday. The editorial notes that Obama in his executive order "said he would approve federal funding on stem cells derived from embryos, with no mention of limitations or restrictions," and he would direct NIH to draft the regulations. "Last night, unlike in his original announcement, he referred to 'embryos that are typically about to be discarded,' of which many thousands exist in fertility clinics," the editorial says, adding, "Does that mean he might draw a line at the creation of embryos for the purpose of research?" The answer is "unclear, but it would be a positive step if his comment means he will decide, rather than leaving to scientists, the question of whether to limit the research to embryos already slated for destruction," according to the editorial (Washington Post, 3/25).


Reprinted with kind permission from nationalpartnership. 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.


© 2009 The Advisory Board Company. All rights reserved.

Women Twice As Likely As Men To Seek Treatment For Hyperhidrosis

Whether it's sweaty palms causing embarrassment when shaking hands on a job interview or unsightly underarm stains that could make anyone think twice about wearing a white shirt, the excessive sweating disorder known as hyperhidrosis can impact all facets of a person's personal and professional life. Although the prevalence of this chronic medical condition is the same for men and women, a new study examining hyperhidrosis patients finds that women sought treatment much more frequently than men.


Speaking today at the 65th Annual Meeting of the American Academy of Dermatology, dermatologist Dee Anna Glaser, MD, FAAD, professor and vice chairman of dermatology at Saint Louis University School of Medicine in St. Louis, Mo., discussed how a patient's age, gender and the site of the excessive sweating affected diagnosis and treatment.


Hyperhidrosis is categorized as either primary hyperhidrosis (no known cause) or secondary hyperhidrosis (known cause) and can be limited to certain areas of the body or throughout the body. Primary hyperhidrosis affects nearly 3 percent of the U.S. population, or an estimated 7.8 million people, and most commonly affects the palms, soles, underarms, face and scalp. Secondary hyperhidrosis is due to an underlying condition, such as an infection, a medical disorder, anxiety or certain medications.


"While there have been a number of studies focusing on the treatment of hyperhidrosis, few studies have described the patient population impacted by this condition," explained Dr. Glaser. "Our study set out to identify common trends and associations of patients with primary hyperhidrosis in order to better understand the patients affected by this common condition."


Dr. Glaser and a team of researchers examined the medical records of 515 patients evaluated and treated for hyperhidrosis at their university-based dermatology practice. Of the total number of patients who sought treatment for hyperhidrosis, more than two-thirds (67.2 percent) were female and one-third (32.8 percent) were male. Interestingly, men were significantly more likely to seek treatment for facial hyperhidrosis, while women were much more likely to seek treatment for hyperhidrosis limited to the underarm area. The average age of the onset of hyperhidrosis for patients was 14.


When patients were asked to rate their condition on the Hyperhidrosis Disease Severity Scale which rates sweating from 1 (mild) to 4 (severe) Dr. Glaser reported that an overwhelming majority of patients rated their condition a 4, describing it as intolerable and always interfering with their daily activities. In addition, patients reported that stress, anxiety, heat and exercise were the most common aggravating factors.















The study also found that the patient's family history, age and site of hyperhidrosis affected diagnosis. "We have known for some time that a genetic component may contribute to primary hyperhidrosis, as 30 percent to 65 percent of patients have a family history of the condition," said Dr. Glaser. "Our study showed that patients who reported the onset of hyperhidrosis prior to age 20 were more likely to have a family history of the condition."


While hyperhidrosis commonly first occurs during puberty or early adolescence, some of the study patients developed hyperhidrosis at a much younger age than other patients. For example, 55 percent of patients affected by hyperhidrosis on the palms of their hands or the soles of their feet developed the condition before age 11. However, the vast majority of patients with hyperhidrosis of the underarm area were more likely to develop their first symptoms after puberty 68 percent developed the condition between the ages of 12 and 19.


"If left untreated, hyperhidrosis can really inhibit the way people live their lives," added Dr. Glaser. "Fortunately, dermatologists now have a number of newer therapies, as well as tried-and-true treatments, available to help patients with hyperhidrosis. Patients should consult their dermatologist if they experience unusual amounts of sweating over a prolonged period of time or perspiration that is not triggered by obvious factors. As this study suggests, not all hyperhidrosis patients are affected equally by this condition, and we're hopeful that future treatments will address the differences we found between genders and age groups."


Headquartered in Schaumburg, Ill., the American Academy of Dermatology (Academy), founded in 1938, is the largest, most influential, and most representative of all dermatologic associations. With a membership of more than 15,000 physicians worldwide, the Academy is committed to: advancing the diagnosis and medical, surgical and cosmetic treatment of the skin, hair and nails; advocating high standards in clinical practice, education, and research in dermatology; and supporting and enhancing patient care for a lifetime of healthier skin, hair and nails. For more information, contact the Academy at 1-888-462-DERM (3376) or aad.


American Academy of Dermatology

930 E. Woodfield Rd.

Schaumburg, IL 60173-4927

United States

aad

Are Cities Designed For Women? Penn-ICOWHI Conference Examines Urban Women's Health

Women comprise more than half the population of the nation's cities, are three times as likely as their male counterparts to live alone after the age of 65, and are primary caregivers for their families at all ages and stages of life. The University of Pennsylvania School of Nursing, with the International Congress of Women's Health Issues, will host "Cities and Women's Health: Global Perspectives," Wednesday, April 7, through Saturday, April 10, on Penn's campus to examine how urban environments affect their health.


The Penn-ICOWHI conference will bring experts in city planning, health policy, public policy, education, sociology, and others from across the globe together to address how health issues facing women are exacerbated by city living. This includes environmental pollution, sedentary lifestyles, diminished space and opportunity for exercise, traffic accidents, exposure to stress and violence, and limited access to healthy and fresh foods.


Health scientists will join urban planners to analyze the specific effects that the layouts and design of streets, houses, and transportation systems have on women in cities. For the first time in history, more than half of the world's population lives in urban environments, and the Penn-ICOWHI 18th Conference will explore redesigning cities for active living, increasing access to health care, treating adolescent girls in high-risk environments, eliminating policy gaps that undermine women's health, and curbing intimate-partner violence.


Speakers include:



-- President Obama's Ambassador-at-Large for Global Women's Health, Melanne Verveer, who will discuss the progress that has been made in women's health since the United Nation's 1995 conference on women



-- Mamphela Ramphele, MD, an authority on socioeconomic issues and leader in spearheading projects for disadvantaged persons throughout South Africa



-- Sheela Patel, founder and director of a Mumbai-based NGO designed to address the needs of "slumdog's mother" women living on pavements and in slums in different parts of India


"When women are healthy, their communities are healthy and vice versa. We need to understand the challenges we face," said Afaf I. Meleis, dean of Penn Nursing.


Source: University of Pennsylvania School of Nursing

Women, Water and Hygiene Are Key to Change in Africa

Women, water and basic hygiene are the key to creating lasting change in Africa, but national water and sanitation plans are still leaving women out, leaders in development said today.


UNICEF Executive Director Ann M. Veneman joined other prominent women, including Hilde Frafjord Johnson, Norway's Minister for International Development, to call for more attention and funds to help the millions of African women and girls suffering disproportionately for lack of these basic services.


"Unsafe water, inadequate sanitation and poor hygiene habits play a major role in child mortality," said UNICEF Executive Director Ann M. Veneman. "Bringing basic services to Africa's women and girls could transform their lives and boost child survival in the region."


Veneman said she is joining Minister Johnson and Minister Maria Mutagamba, Uganda's Minister of State for Water, in the Women Leaders for Water, Sanitation and Hygiene (WASH) initiative. Launched last year by the Water Supply and Sanitation Collaborative Council (WSSCC), Women Leaders in WASH helps governments to link women with sanitation and hygiene programmes, and supports the UNICEF drive to put safe water and basic sanitation into all primary schools by 2015. The group is meeting at UNICEF today to set out a plan of action for Africa.


Lack of safe water and sanitation remains one of the world's most urgent health issues. Some 1.1 billion people worldwide still lack safe water and 2.6 billion have no sanitation, according to a UNICEF and World Health Organization 2005 report Water for Life.


Sub-Saharan Africa is the only region likely to miss Millennium Development Goal (MDG) targets on both safe water and basic sanitation, unless the world acts quickly to turn this around. MDG 7 calls on countries to reduce by half the number of people living without these basic services. But despite good progress in some countries, currently only 58 per cent of Africans live within 30 minutes walk of an improved water source and only 36 percent have even a basic toilet.


The consequences are particularly severe for African women and children, condemning millions to a life of illness, lost opportunities and virtual slavery.


In rural Africa, 19 per cent of women spend more than one hour on each trip to fetch water, an exhausting and often dangerous chore that robs them of the chance to work and learn. Women without toilets are forced to defecate in the open, risking their dignity and personal safety. Education suffers too: more than half of all girls who drop out of primary school do so for lack of separate toilets and easy access to safe water.


Unsafe water, inadequate sanitation and poor hygiene habits play a major role in Africa's high child mortality rate. Diarrhoea is the third-biggest child killer in Africa after pneumonia and malaria, accounting for 701,000 child deaths out of 4.4 million on the continent every year. It also leaves millions of children with a legacy of chronic malnutrition, the underlying cause of over half of all child mortality. The burden of caring for sick relatives inevitably falls to women and girls, keeping them at home and shutting them out of economic development.


Bringing relief to women and girls will result in better services for all and benefit entire communities, said Minister Johnson and Minister Mutagamba.


"Women can be key agents of change if they are empowered and involved," said Minister Johnson. "Since they are the primary victims of unsafe water and poor sanitation, we must start with them if we are to liberate Africa from cycles of illness, child mortality and low productivity."


"In Uganda, we saw how rapidly school attendance can rise and illness fall when schools have safe water and separate toilets for boys and girls," said Minister Mutagamba. "There is no excuse not to put these effective and sustainable interventions into practice everywhere."


Veneman, Johnson and Mutagamba hailed the great progress made by many poor countries as proof that water and sanitation goals are achievable everywhere. They called on Millennium Summit leaders to commit to a strong action plan for the next decade.


unicef/media/media_28260.html

Pope Warns Against Discrimination Through Genetic Screening

During a Vatican conference titled "New Frontiers of Genetics and the Risk of Eugenics," Pope Benedict XVI said that there are "worrisome displays" of discrimination resulting from advancements in diagnosing genetic illnesses and the development of therapies to treat them, the AP/Washington Post reports. According to the Post, the pope's comments were an "apparent reference to pre-implantation genetic diagnosis for embryos," which allows embryos created for in vitro fertilization to be tested for genetic conditions and diseases prior to implantation. The Vatican opposes PGD because embryos are often destroyed as a result. Benedict also is opposed to the technology because "it means that medical biotechnology has given way to being the judge of the strongest." He is concerned that genetic screening can lead to discrimination because it prizes "efficiency, perfection and physical beauty at the expense of other forms of existence that are deemed unworthy."

Proponents of the genetic testing and PGD argue that the technology can help prevent parents from passing on hereditary diseases to their children. Many countries either ban the procedure or restrict it to the detection of serious diseases, in part to curb selective screening of factors like eye color or gender, the AP/Post reports. The pope said, "What we must repeat with force is the equal dignity of every human being, for the sole fact of having been brought to life. One's biological, psychological and cultural development and health can never become an element for discrimination" (Winfield, AP/Washington Post, 2/21).


Reprinted with kind permission from nationalpartnership. 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.


© 2009 The Advisory Board Company. All rights reserved.

Teen Girls Report Barriers To Physical Activity

Teenage girls perceive lack of time as the number one barrier to physical activity, according to a new study published in the March issue of Medicine & Science in Sports & Exercise®, the official journal of the American College of Sports Medicine (ACSM). The three-year survey assessing black and white adolescent girls reveals sedentary habits are mostly linked to internal barriers (interest, motivation), which were unrelated to external factors (jobs, recreation).


More than half of approximately 2,000 girls surveyed from ages 16 or 17 to 18 or 19 were identified as being sedentary. Of those classified as sedentary (about 1,000 girls), the majority (65 percent for black girls and 80 percent for white girls) claimed lack of time was their primary barrier to activity. They also frequently said they were too tired or uninterested in participating in physical activities. Other commonly reported barriers, such as safety and body image concerns, came from the 10-item questionnaire developed to assess the girls' perceptions of barriers to activity participation.


With the identification of these barriers, researchers corroborated with other information about the girls to understand whether barriers were simply perceived or were related to external circumstances. For instance, while the majority of girls felt lack of time prevented their pursuit of activity, researchers found no difference in hours at work or in household chores when compared to girls who did not report time as a barrier. Further, girls who said they were too tired had about the same amount of sleep per night as those who did not report fatigue.


"Overall activity levels have declined by 83 percent in these age groups," said Sue Y.S. Kimm, M.D., M.P.H., lead author of the study. "These girls are definitely at risk for becoming overweight or obese, if they are not already, because of this steep decline. Recognizing what these girls perceive as barriers to their health and wellness can help us motivate them to find balance in their life that includes an increase in energy expenditure."


Other findings from the study showed habitual physical activity was significantly lower among black girls; these girls spent twice as much time watching television or videos and were significantly heavier than white girls. More white girls reported lack of time, and also were significantly more likely to indicate fatigue and self-consciousness as a barrier to exercise. Black girls were more than twice as likely to cite safety as a concern, although this was not one of the leading barriers to activity participation. Researchers were interested to find that black girls cited fewer barriers overall, and suggested the greater decline in activity participation may reflect cultural differences and attitudes about exercise.


"We don't know as much as we'd like about why girls become particularly inactive during adolescence," said Kimm. "Our evidence suggests the two most commonly cited reasons - lack of time and fatigue - are probably not actual barriers because these girls did not work more hours after school or have less sleep than others. However, it's the perception of a barrier we must overcome in order to help these girls find the time and energy it takes to get moving."















ACSM and the U.S. Centers for Disease Control and Prevention recommend 30 minutes of physical activity on most, if not all, days of the week. For those who perceive lack of time as a major barrier, health and fitness experts agree physical activity can be accumulated during the day in shorter periods of activity, such as 10- or 15-minute bouts.


The American College of Sports Medicine is the largest sports medicine and exercise science organization in the world. More than 20,000 international, national, and regional members are dedicated to advancing and integrating scientific research to provide educational and practical applications of exercise science and sports medicine.


Medicine & Science in Sports & Exercise® is the official journal of the American College of Sports Medicine , and is available from Lippincott Williams & Wilkins at 1-800-638-6423. For a complete copy of the research paper (Vol. 38, No. 3, pages 536-542) or to speak with a leading sports medicine expert on the topic, contact the Department of Communications and Public Information at 317-637-9200 ext. 127 or 117. Visit ACSM online at acsm. The conclusions outlined in this news release are those of the researchers only, and should not be construed as an official statement of the American College of Sports Medicine.


acsm