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
суббота, 31 декабря 2011 г.
суббота, 24 декабря 2011 г.
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.
"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.
суббота, 17 декабря 2011 г.
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)
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)
суббота, 10 декабря 2011 г.
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
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
суббота, 3 декабря 2011 г.
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.
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