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| Sunday 05 September 2010 |
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| News in Brief - Spring 2010 Brief items of the latest industry news... |
| Readers Comments Unedited readers comments about Orthopaedic Product News ... |
| New poster displays high quality clinical images of fetal anatomy - Spring 2010 A fetal imaging poster that illustrates highly detailed clinical images of fetal... |
| Beta-blockers help reduce metastasis and improve survival in breast cancer patients - Spring 2010 Treatment with beta-blockers can help reduce the spread of cancer in... |
| Fibromyalgia symptoms improved by lifestyle adjustments, reports study - Spring 2010 Short bursts of physical activity can ease fibromyalgia symptoms. Researchers... |
| Zapping uterine fibroids with heat from high-energy sound waves - Spring 2010 A new interventional radiology tool shows promise in the treatment of... |
| Trans fats linked to increased endometriosis risk and omega-3-rich food linked to lower risk - Spring 2010 Women whose diets are rich in foods containing Omega-3 oils might be... |
| Emergency contraception: Advance provision does not reduce pregnancy rates - Spring 2010 Providing emergency contraception to women in advance of need does not... |
| Pregnant women can receive breast cancer chemotherapy without endangering health of their babies - Spring 2010 Women who discover they have breast cancer while they are pregnant can be... |
| Child sexual abuse: A risk factor for pregnancy - Spring 2010 A new study carried out by Prof. Rachel Lev-Wiesel and Dr. Tzachi Ben Zion has... |
| Women’s support groups make dramatic improvements on neonatal survival rates - Spring 2010 Women’s community groups have had a dramatic effect on reducing neonatal... |
| HPV vaccine protects from cancer recurrence, suggests oncology study - Spring 2010 A vaccine designed to prevent cervical cancer also may protect females from... |
| Exposure to nitrogen dioxide lowers in vitro fertilisation success - Spring 2010 Exposure to an increased level of air pollutants, especially ... |
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News In Brief
 Possible ‘superbug’ status for STI
The rise of multi-drug resistance in gonorrhoea-causing bacteria is threatening to make the sexually-transmitted infection extremely difficult to treat. Professor Catherine Ison, speaking at the Society for General Microbiology’s spring meeting in Edinburgh, highlighted the very real possibility that strains of Neisseria gonorrhoeae resistant to all current treatment options could emerge in the near future.
Professor Ison, from the Health Protection Agency (HPA) in London, described how some strains of the gonococcal bacteria that cause the disease are now showing decreased sensitivity to the current antibiotics used to treat them - ceftriaxone and cefixime.
“Choosing an effective antibiotic can be a challenge because the organism that causes gonorrhoea is very versatile and develops resistance to antibiotics very quickly,” explained Professor Ison. “Penicillin was used for many years until it was no longer effective and a number of other agents have been used since. The current drugs of choice, ceftriaxone and cefixime, are still very effective but there are signs that resistance particularly to cefixime is emerging and soon these drugs may not be a good choice,” she said.
Bacteria isolated from patients diagnosed with gonorrhoea are tested for their susceptibility to various antibiotics to monitor patterns of resistance at a local and national level. Ongoing monitoring of antimicrobial resistance is critical to ensure that first-line treatments for gonorrhoea remain effective. “There are few new drugs available and so it is probable that the current use of a single dose may soon need to be revised and treatment over several days or with more than one antibiotic will need to be considered,” Professor Ison warned. “If this problem isn’t addressed then there is a real possibility that gonorrhoea will become a very difficult infection to treat,” she said. New Chief Executive for HFEA
Prof Lisa Jardine, Chair of the Human Fertilisation and Embryology Authority announced that the Authority had appointed Alan Doran CB as its Chief Executive. Mr Doran has been interim Chief Executive since October 2007, on secondment from Department of Health.
Lisa Jardine said: “It is great news that we have continuity of leadership at the Authority as we go into the first full year of our new legislation. There are challenging times ahead for all arms length bodies. I look forward enormously to working alongside Alan Doran, making sure that the HFEA goes on improving the quality of provision it gives to the sector.”
Alan Doran said: “I could not be more delighted. The HFEA plays a truly singular role in society in regulating assisted conception services. Our members are a joy to work with and our staff are capable, talented and forgiving of their elders. I am looking forward to building on the enormous changes of the past few years with them all.” Midwives welcome donor breast milk bank guidance
Commenting on the National Institute for Health and Clinical Excellence (NICE) guidance, ‘Donor breast milk banks: the operation of donor breast milk bank services’, Janet Fyle, Professional Policy Advisor at the Royal College of Midwives, said: “Donor breast milk is a very important for sick babies who need the super-nutrients that breast milk offers. This is why we welcome the very high standards set by NICE for obtaining and storing donor breast milk.
“This will encourage and give confidence to those mothers who donate their milk and mothers whose infants receive the donated breast milk.” New poster displays high quality clinical images of fetal anatomy A fetal imaging poster that illustrates highly detailed clinical images of fetal anatomy is available for gynaecology, maternity and fetal medicine departments. It displays pictures obtained using a 9L4 transducer, which integrates with the ACUSON S2000™ diagnostic ultrasound system from Siemens Healthcare. The 9L4 transducer uses a revised linear format to deliver high frequency imaging resolution for an unprecedented level of anatomical clarity. This is particularly beneficial for target scanning of congenital abnormalities in obstetrics. The poster illustrates anomalies from 20 week referral scans picked up by the linear probe. This includes unilateral cleft lip and palate, plus Agenesis of the Corpus Callosum and Dandy-Walker malformation.
Beta-blockers help reduce metastasis and improve survival in breast cancer patients Treatment with beta-blockers can help reduce the spread of cancer in patients with breast tumours, a researcher will tell the seventh European Breast Cancer Conference (EBCC7) in Barcelona. In a controlled study, Dr. Des Powe, a senior healthcare research scientist at Queen’s Medical Centre, Nottingham University Hospital NHS Trust, Nottingham, UK, and his team found that the group of patients treated with beta-blockers showed a significant reduction in metastasis and better survival. The scientists believe that they are the first in the world to have investigated the effect of beta-blockers in breast cancer patients. In collaboration with Professor Frank Entschladen’s group at Witten University, Germany, Dr. Powe looked at three groups of breast cancer patients: those who were already being treated for hypertension by beta-blockers, those whose hypertension was treated by other medications, and those who did not suffer from hypertension and were therefore not taking any treatment for it. Forty-three of the 466 patients were already taking beta-blockers and, in this group, there were significant reductions in both distant metastasis and local recurrence. They also had a 71% reduced risk of dying from breast cancer compared with the other groups. “We were also able to study the presence of one receptor for beta-blockers 2AR, as a potential biomarker for predicting clinical response to beta-blocker treatment,” says Dr. Powe, “but we did not find that this correlated directly to the outcome of treatment. We are currently looking at other target receptors as predictors of clinical outcome.” Previous cell line laboratory studies have shown that beta-blockers work against various types of cancer because high levels of stress hormones in the tumour increase cell proliferation and migration (the movement of cells to other locations). “These effects are induced by the stress hormones norepinephrine and epinephrine acting on specific target receptors in a kind of lock and key fashion,” says Dr. Powe. “We sought to translate these laboratory findings into clinical research.” Beta-blocker drugs bind to a specific kind of receptor to prevent the stress hormones from reaching their target; in cancer cells this prevents the hormones from stimulating and activating them. The researchers say that they are sure that their results are due to the effect of beta-blockers rather than a protective effect of hypertension per se. “If that had been the case, we would have seen similar survival benefits in patients receiving other forms of treatment for hypertension,” says Dr. Powe, “but we did not. It is reasonable to speculate, therefore, that some non-hypertensive women with breast cancer will respond favourably to beta-blocker treatment, though doses and side effects would need to be investigated in clinical trials. We also need to look at whether beta-blockers could be given as a supplementary therapy with existing breast cancer treatment.” This finding may assist treatment in two ways, say the researchers: it appears to slow down tumour growth and could also be used to target those patients who have an increased risk of developing secondary cancers. “Our first study is relatively small, and we now intend to validate it in a larger group,” says Dr. Powe. “We will be looking for funding and collaborators to test the effectiveness of beta-blocker treatment on patients diagnosed with breast cancer. We are very encouraged by these first results which have already shown that by using a well-established, safe, and cost-effective drug, we can take another step on the road to targeted therapy in breast cancer.” Fibromyalgia symptoms improved by lifestyle adjustments, reports study Short bursts of physical activity can ease fibromyalgia symptoms. Researchers writing in the journal Arthritis Research & Therapy have shown that encouraging patients to undertake ‘Lifestyle Physical Activity’ (LPA) can markedly increase the average number of steps taken per day and produce clinically relevant reductions in perceived disability and pain.  Kevin Fontaine, from Johns Hopkins University School of Medicine, worked with a team of researchers at the Johns Hopkins Bayview Medical Center campus to investigate the effects of 30 minutes of LPA, five to seven days a week, on physical function, pain and other measures of disability in 84 fibromyalgia patients. He said: “Fibromyalgia is estimated to occur in 2% of the U.S. general population, affecting about eight times more women than men. Although exercise has been shown to be beneficial, the symptoms often create obstacles that deter many from exercising consistently enough to derive benefits.”
LPA involves moderate-intensity physical activity based around everyday life such as taking the stairs instead of using an elevator, gardening and walking. In this study, participants were taught to perform LPA intense enough to cause heavy breathing, but not so heavily that they could not hold a conversation. During subsequent sessions participants were taught self-monitoring of LPA, goal setting, dealing with symptom flares, problem solving strategies to overcome barriers to being more physically active, as well as instruction in finding new ways to integrate short bouts of LPA into their daily lives.
At the end of the study, the participants randomized to LPA increased their average daily steps by 54%. Compared to the controls, the LPA group also reported significantly less perceived functional deficits and less pain. Speaking about these results, Fontaine said: “The nature of fibromyalgia’s symptoms, the body pain and fatigue, make it hard for people with this malady to participate in traditional exercise. We’ve shown that LPA can help them to get at least a little more physically active, and that this seems to help improve their symptoms.”
Zapping uterine fibroids with heat from high-energy sound waves A new interventional radiology tool shows promise in the treatment of uterine fibroids. Magnetic resonance-guided focused ultrasound (MRgFUS), a minimally invasive treatment, uses high-energy ultrasound waves to generate heat at a specific point to destroy uterine fibroid tissue and relieve symptoms. A study of more than 100 patients shows that women can get lasting relief from uterine fibroid-related symptoms with MRgFUS—thus avoiding myomectomy, the surgical removal of uterine fibroids, or hysterectomy, major abdominal surgery to remove the uterus, say researchers at the Society of Interventional Radiology’s 35th Annual Scientific Meeting in Tampa, Florida, US. “Our 119-patient study shows that magnetic resonance-guided focused ultrasound is highly effective and can provide lasting relief from uterine fibroid-related symptoms,” said Gina Hesley, M.D., Mayo Clinic in Rochester, Minn. In the 12 months following MRgFUS treatment, 97 percent of the women reported improvement of their symptoms, with 90 percent of women rating their improvement as either considerable or excellent. “MRgFUS is newer than another interventional radiology fibroid treatment—uterine fibroid embolization or UFE—a widely available treatment that blocks blood flow to fibroid tumors. Our results with effectiveness of MRgFUS technology are promising and comparable with that of UFE, but its longer-term effectiveness needs continued study,” said Hesley. “Today, women have interventional radiology options that do not involve the use of a scalpel incision. Women should ask for a consult with an interventional radiologist who can determine from MR imaging whether they are candidates for either procedure,” she added. MRgFUS is performed as an outpatient procedure; it uses high-intensity focused ultrasound waves—that can pass through skin, muscle, fat and other soft tissues—to destroy (ablate) fibroid tissue. During treatment, the physician uses magnetic resonance imaging (MRI) to see inside the body to deliver the treatment directly to the fibroid. MRI scans identify the tissue in the body to treat and are used to plan each patient’s procedure. MRI provides a three-dimensional view of the targeted tissue, allowing for precise focusing and delivery of the ultrasound energy. MRI also enables the physician to monitor tissue temperature in real-time to ensure adequate—but safe—heating of the target. Immediate imaging of the treated area following MRgFUS helps the physician determine the success of the treatment. The procedure was approved by the Food and Drug Administration for treating uterine fibroids in October 2004; however, it is still considered new, is not widely available and not all insurance carriers cover it. In the nearly three-year study, 119 women completed MRgFUS treatment at the Mayo Clinic and were followed for 12 months using phone interviews to assess fibroid-related symptoms and symptomatic relief. Of the 89 patients who were available for phone interviews at 12 months, 69 indicated they received from the following relief from symptoms: excellent (74 percent), considerable (16 percent), moderate (9 percent) and insignificant (1 percent). The rate of additional treatments needed post-MRgFUS was 8 percent, which is within values reported for myomectomy and uterine fibroid embolization, said Hesley. The Mayo researchers will continue to study two-year and three-year results of symptom relief. They will also compare their current results with those reported for myomectomy and uterine artery embolization and investigate the efficacy of MRgFUS in treating other uterine conditions, such as adenomyosis, a condition in which tissue that normally lines the uterus also grows within the muscular walls of the uterus, said Hesley. Trans fats linked to increased endometriosis risk and omega-3-rich food linked to lower risk Women whose diets are rich in foods containing Omega-3 oils might be less likely to develop endometriosis, while those whose diets are heavily laden with trans fats might be more likely to develop the debilitating condition, according to new a published study. The experiment - which is the largest to have investigated the link between diet and endometriosis risk and the first prospective study to identify a modifiable risk factor for the condition - found that while the total amount of fat in the diet did not matter, the type of fat did. Women who ate the highest amount of long-chain Omega-3 fatty acids were 22% less likely to be diagnosed with endometriosis than those who ate the least and that those who ate the most trans fats had a 48% increased risk, compared with those who ate the least.  The findings from 70,709 American nurses followed for 12 years, published online in Europe’s leading reproductive medicine journal Human Reproduction, not only suggest that diet may be important in the development of endometriosis, but they also provide more evidence that a low fat diet is not necessarily the healthiest and further bolster the case for eliminating trans fats from the food supply, said the study’s leader, Dr. Stacey Missmer, an assistant professor of obstetrics, gynaecology and reproductive biology at Brigham and Women’s Hospital and Harvard Medical School in Boston, Massachusetts, USA.
“Millions of women worldwide suffer from endometriosis. Many women have been searching for something they can actually do for themselves, or their daughters, to reduce the risk of developing the disease, and these findings suggest that dietary changes may be something they can do. The results need to be confirmed by further research, but this study gives us a strong indication that we’re on the right track in identifying food rich in Omega-3 oils as protective for endometriosis and trans fats as detrimental,” Dr. Missmer added.
In the study, the researchers collected information from 1989 to 2001 on 70,709 women enrolled in the U.S. Nurses Health Study cohort. They used three food-frequency questionnaires spaced at four-year intervals to record the women’s usual dietary habits over the preceding year. They categorised consumption of the various types of dietary fat into five levels and related that information to later confirmed diagnoses of endometriosis. A total of 1,199 women were diagnosed with the disease by the end of the study. The results were adjusted to eliminate any influence on the findings from factors such as total calorie intake, body mass index, number of children borne and race.
Long-chain Omega-3 fatty acids are found mostly in oily fish. They have been linked to reduced heart disease risk. In the study, the highest contributor was mayonnaise and full-fat salad dressing, followed by fatty fish such as tuna, salmon and mackerel.
Trans fats are artificially produced through hydrogenation, which turns liquid vegetable oil into solid fat. Used in thousands of processed foods, from snacks to ready-meals, they have already been linked to increased heart disease risk. Some countries and municipalities have banned them. The major sources of trans fats in this study were fried restaurant foods, margarine and crackers.
“Women tend to go to the Internet in particular to look for something they can do. The majority of the dietary recommendations they find there are the ones prescribed for heart health, but until now, those had not been evaluated specifically for endometriosis,” Dr. Missmer said. “This gives them information that is more tailored and provides evidence for another disease where it is the type of fat in the diet, rather than the total amount, that is important.”
Besides confirming the finding, a next step could be to investigate whether dietary intervention that reduces trans fats and increases Omega-3 oils can alleviate symptoms in women who already have endometriosis, Dr. Missmer added.
Emergency contraception: Advance provision does not reduce pregnancy rates Providing emergency contraception to women in advance of need does not reduce pregnancy rates, despite increased use and faster use after unprotected sexual intercourse. These are the findings according to a new review published recently in The Cochrane Library. Women who take emergency contraception up to five days after unprotected sex are less likely to become pregnant. But there are many reasons why women may not be able to access emergency contraception within this time frame. In some countries, for instance, emergency contraceptives are not available over the counter and it can be difficult to arrange an appointment with a doctor on public holidays or weekends. One proposed solution is to provide women with a set of emergency contraceptive pills to keep for immediate use, should it be needed. The review included 11 trials and involved a total of 7,695 women from the US, China, India and Sweden. The researchers looked at the effect of advance provision of emergency contraception on rates of pregnancy and sexually transmitted infections (STIs), as well as on sexual behaviour and contraceptive use. They found that women with advance access to emergency contraception had similar rates of pregnancy as women who did not receive the medication in advance. Women given emergency contraception in advance were no more likely to have unprotected sex, to contract STIs, or to change their use of other contraceptive methods. However, women with advance provision did take the medication an average of 13 hours sooner after sex, and were more likely to use emergency contraception at all. “Our review suggests that strategies for advance provision of emergency contraception which have been tested to date do not appear to reduce unintended pregnancy at the population level,” says lead researcher Chelsea Polis of the Johns Hopkins Bloomberg School of Public Health. “At the same time, advance provision does not appear to increase the risk of unprotected sex or sexually transmitted infections, and does not change use of other contraceptive methods.” “Some women may not use emergency contraception when needed, even if they have it in advance. Like condoms, emergency contraception will not work if it is not used,” says Polis. “Women should still be given information about and easy access to emergency contraception, because it is a safe and effective way to prevent unintended pregnancies for individual women who will use it when needed.” Pregnant women can receive breast cancer chemotherapy without endangering health of their babies Women who discover they have breast cancer while they are pregnant can be treated with chemotherapy without endangering the health of their unborn baby, according to research to be presented at the seventh European Breast Cancer Conference (EBCC7) in Barcelona. Dr Sibylle Loibl, Assistant Professor in Obstetrics and Gynaecology at the University of Frankfurt, Germany, and a member of the German Breast Group, will tell the conference that pregnant breast cancer patients can be treated as close as possible to standard recommendations because chemotherapy delivered while babies were in the womb did not appear to cause the babies significant problems at or after birth. “Until now, the evidence upon which we based our decisions about how to treat pregnant women with breast cancer has been largely limited to case studies and retrospective investigations. For this reason doctors have tended to be cautious in their approach to treatment because of fears about the effect it might have on the foetus, even though it meant that women did not necessarily receive the best treatment for their cancer,” said Dr Loibl. “Therefore, the German Breast Group set up a registry to collect data both retrospectively and prospectively from patients who have been diagnosed with breast cancer during pregnancy. It is the only international registry to focus on the outcomes of both the mother and the baby.”  The researchers entered details of 235 patients prospectively (119) and retrospectively (116) to the registry between April 2003 and October 2009. The ages of the women ranged between 23 and 46 with an average (median) age of 33. Breast cancer was diagnosed, on average, at 23 weeks into the pregnancy. Not all the data are complete yet, but out of 151 women, 91 received an average of two cycles of chemotherapy while they were pregnant.
The average gestational age of the babies at the time of delivery was 36 weeks, ranging between 28 and 42 weeks. Babies that were exposed to chemotherapy during pregnancy were born slightly lighter than babies who were not: an average of 2636mg, compared to 2791mg.
Of the 91 babies exposed to chemotherapy, three were born bald (alopecia), one was small for gestational age, one had trisomia 18 (a chromosomal disorder) and died one week after birth, one had necrotic enterocolitis (a severe bacterial infection of the intestine) and died three weeks after birth, one developed sepsis (blood infection), one developed neutropenia (low white blood cell count) and two had anaemia. Of the 60 babies who were not exposed to chemotherapy, one had temporary apnoea (breathing interruption), one had an increase in C reactive protein (a protein that appears in response to inflammation or infection) and one had gastroenteritis.
Dr Loibl said: “Most of the problems described in the babies exposed to chemotherapy were not related to the treatment but were most probably due to other circumstances (for instance, necrotic enterocolitis due to preterm delivery or trisomia 18). Normally, in nature, there is a risk of malformations of between one and two percent, and other problems such as infection can happen. The foetal outcomes of these babies that received chemotherapy were not significantly different from those who did not.
“Therefore, this study suggests that pregnant breast cancer patients can be treated as close as possible to standard recommendations and receive chemotherapy, if it is indicated, while they are pregnant. Ideally, this should take place in the care of specialised, multidisciplinary teams. We would like to generate more robust data to confirm this and so the registry is continuing and we are updating and completing the data.”
In addition to the data on outcomes for mothers and babies, Dr Loibl and her colleagues are also collecting tumour specimens and placenta material from the women who are being followed prospectively, and these are sent to the German Breast Group’s biomaterial bank. The researchers hope that this will give them important information in the future about the effects of pregnancy and chemotherapy on outcomes for mothers and babies.
Child sexual abuse: A risk factor for pregnancy A new study carried out by Prof. Rachel Lev-Wiesel and Dr. Tzachi Ben Zion has found that women who were victims of sexual abuse in childhood reported higher levels of depression and symptoms of post-trauma during pregnancy. Sexual abuse in childhood increases the chances of high-risk pregnancy, shows a new study conducted by Prof. Rachel Lev-Wiesel, Head of the Graduate School of Creative Arts Therapies at the University of Haifa, Lee Yampolsky and Dr. Tzachi Ben Zion, Deputy Director of Soroka Hospital. “Even when a woman willingly and happily commences a pregnancy, it seems that the body relates the sexual act that created the pregnancy with the abuse trauma, evoking negative feelings which can then be expressed in physical and gynecological problems,” Prof. Lev-Wiesel explains. The current study examined the possibility of sexual abuse experienced in childhood triggering retraumatisation during wanted pregnancy. A group of 1,830 pregnant women participating in the study were divided into high- and low-risk groups, which were further divided into three subgroups: those who were victims of child sexual abuse, those who experienced other types of trauma in childhood, and those who had experienced no notable trauma. Compared with women who had not endured any notable trauma before, those who had been sexually abused in childhood, the study shows, suffered higher levels of depression and more post-traumatic symptoms. According to Prof. Lev-Wiesel, the main post-traumatic symptoms that these women reported were detachment and avoidance. The study also found that the more severe the child sexual abuse, the stronger the correlation between the PTS symptoms and poor physical health during pregnancy. “Gynecological problems might be the body’s manifestation of the child sexual abuse trauma,” Prof. Lev-Wiesel explains. “The current study’s findings have important practical implications for health care providers, practitioners and obstetrical gynecologists. There is a need to to recognise and address the psychological state of pregnant child sexual abuse survivors,” Prof. Lev-Wiesel says. “It is also important to remember that since the screening process itself may serve as a trigger to retraumatisation, a specially trained team should provide a safe environment and psychological assistance.” Women’s support groups make dramatic improvements on neonatal survival rates Women’s community groups have had a dramatic effect on reducing neonatal mortality rates in some of the poorest areas on India, according to a study published in the journal the Lancet. The groups provide a cost-effective intervention with added benefits such as reducing significantly maternal depression and improving decision-making amongst the women. Every year, an estimated four million children worldwide die within the first month of their lives. Less than a quarter of the sixty-eight countries targeted by the Millennium Development Goal 4 (reduction of mortality rate in children less than five years old by two-thirds by 2015) are on track to achieve that goal. A previous study conducted in Nepal and published by the Lancet in 2004 suggested that participatory women’s groups could achieve a significant impact on neonatal health in poorer countries, far more than one-to-one contact with a health worker. To see if these findings could be applied in other countries, the researchers repeated the exercise in Jharkhand and Orissa, two of the poorest states in eastern India. Neonatal mortality rates in the two regions are 49 and 45 per 1000 live births respectively, disproportionately higher than India’s national estimates of 39 per 1000. By comparison, in the UK the figures are 4 per 1000. Between 2005 and 2008, a team of researchers led by Professor Anthony Costello from the Institute of Child Health, UCL (University College London), and Dr Prasanta Tripathy, from the Indian voluntary organisation Ekjut, evaluated how women’s groups affected neonatal mortality and maternal depression in intervention areas as compared to areas where no participatory groups were set up. The groups were evaluated using a cluster-randomised controlled trial, which was funded by the Health Foundation, the UK Department for International Development, the Wellcome Trust and the UK Big Lottery Fund. The groups were facilitated by women recruited in the local area, non-healthcare professionals who tended to be married, with some schooling, and a respected member of the community. The number of women taking part of in the groups increased from one in six women (17%) of childbearing age in the first year to over a half (55%) in the third year. The women worked through a ‘community action cycle’ involving four stages: identifying the problems associated with pregnancy, childbirth and care of newborns; developing strategies to tackle these problems, such as improving hygiene, raising emergency funds and producing their own birthing kits; working with local community leaders, teachers, politicians and others to implement these strategies, and; evaluating their success. “It was crucial that the women were allowed to think thought through the issues and implement their own strategies to tackle them, rather than us telling them what to do,” says .. Dr Nirmala Nair of Ekjut. “We believe that a trained facilitator who supports informed peer learning is more effective for lasting behaviour change than a traditional instructor/learner approach.” The effects of the interventions were dramatic: by the second and third years of the trial, the neonatal mortality rate in the areas where the participatory women’s groups existed had fallen by 45%. These areas also saw a significant fall (57%) in moderate depression amongst mothers by the third year of the trial. “What we were seeing was a change in behaviour towards better hygiene practices and improved care for newborns,” explains Professor Costello. “There was a move away from harmful practices such as giving birth in unclean environments and delaying breastfeeding. We saw significant improvements in areas such as basic hygiene by birth attendants, clean cord care and women responding earlier to care needs.” The researchers believe that improved social capital – the access the group gave women to a wider support network of peers – was potentially the most valuable aspect of the groups and would have contributed towards the improved childbirth and childcare practices and the reduction in maternal depression. It may also explain why such groups have had much greater success than direct – even one-to-one – interventions with healthcare workers. “Many of the women in these groups would have been relatively young, living in arranged marriages with only their mother-in-law or a very limited network of friends for support,” explains Dr Audrey Prost from UCL. “The groups empower the women to take preventive measures and to deal with problems more effectively when they arise. If you’ve been to a group and a problem arises, you’ve got a ready-made network that you can go to for help and support.” The researchers estimate that the additional cost on introducing support to these groups per newborn life saved was around US$910. However, this raises questions over who would pay for supporting these groups: federal or state government, non-governmental organisations, or a combination of the two. HPV vaccine protects from cancer recurrence, suggests oncology study A vaccine designed to prevent cervical cancer also may protect females from post-surgical recurrence of the disease, according to researchers at the University of Alabama at Birmingham (UAB), US. A new study shows that the Gardasil vaccine reduces the likelihood of human papillomavirus (HPV)-related disease recurring after teen and adult women already have had surgery to remove cancer or certain pre-cancerous changes, said Warner Huh, M.D., an associate professor in the UAB Division of Gynecologic Oncology and lead presenter on the study. The findings were announced March 15 at the annual meeting of the Society of Gynecological Oncologists in Chicago. The study shows that Gardasil reduces by approximately 40 percent the chances that more cancer or pre-cancerous changes will occur in the cervix, vagina and vulva up to 3.8 years after a female has surgery for one of those conditions. Huh said the findings are important because they answer a question many women and their doctors have been asking — does an HPV vaccine help prevent virus-related changes in the body after women have surgery to treat similar changes? “Based on this study, the data is compelling and suggests it does help to prevent virus-related changes,” Huh said. “Knowing that Gardasil also may offer postoperative protection from recurrent disease will be crucial in follow-up care and overall health planning for teens and women.” The vaccine is approved to fight the four HPV strains believed to cause 70 percent of cervical cancers and more than 90 percent of genital warts The study involved 17,622 women ages 15 to 26 from two clinical trials, some who were vaccinated and some who were not. Hundreds of study participants had surgery to remove cancer or certain pre-cancerous changes of the cervix, vagina and vulva and to remove genital warts. Huh said the results are encouraging because patients treated for HPV-related disease are known to be at higher risk for contracting the same disease post-operatively. Reducing the risk and need of a secondary procedure is an important step in improving women’s care, he said. Exposure to nitrogen dioxide lowers in vitro fertilisation success Exposure to an increased level of air pollutants, especially nitrogen dioxide, has been associated with lower likelihoods of successful pregnancy among women undergoing in vitro fertilisation, according to a team of fertility researchers. The team examined the outcomes of the first pregnancy attempt of 7,403 women undergoing IVF at Penn State Milton S. Hershey Medical Center, Hershey, Pa.; Shady Grove Fertility, Rockville, Md.; and Columbia University College of Physicians and Surgeons, New York, N.Y. They conducted their observations over a seven-year period from 2000 to 2007. “Numerous studies have consistently shown a relationship between air pollution and human health, ranging from mortality, cardiovascular disease and other chronic conditions,” said Duanping Liao, Ph.D., professor of epidemiology and vice chair department of public health sciences, Penn State College of Medicine. “In the process of searching for the mechanisms responsible for the above associations, we, and others, have reported significant links between air pollution and inflammation and increased blood clotting. These intermediate factors are also associated with reproductive health.” The IVF population was chosen, as it is a well-controlled and timed process to investigate the association of air pollution and human reproductive effects. Burning of fossil fuels and diesel engine combustion produces nitrogen dioxide and fine particles. Researchers looked at those pollutants along with ozone, the gas involved in smog formation. While the effects of declining air quality on IVF success are variable and pollutant-dependent, elevated exposures to nitrogen dioxide and fine particles were consistently associated with lower success rates of pregnancy.  Researchers looked at the effects of pollution particles both individually -- single pollutant model, and with other particles -- multi-pollutant model. For the single pollutant model, exposure to ozone appeared to have a positive association with a successful birth if the exposure was before the embryo culture or embryo transfer. Researchers theorise that higher ozone levels indicate lower nitrogen dioxide levels, which would show better pregnancy outcomes. In addition, for the multi-pollutant model, the “positive” effects of ozone were diminished with the addition of nitrogen dioxide. In contrast, after adjusting for ozone, higher nitrogen dioxide exposures consistently associated with the lower success rate, regardless of which indictor was used -- positive pregnancy test, clinically confirmed intrauterine pregnancy or live birth.
These findings may be useful in studying the adverse effects of air pollution on human reproduction in general.
“Since IVF is a well controlled and highly timed process, we have a much better handle on the assessment of the time of exposures to elevated air pollutants in relationship to fertilisation, pregnancy, and delivery,” Liao said. “Therefore, the IVF population coupled with detailed assessment of air pollution exposures may provide us an ideal situation to investigate the potential health effects of air quality on human reproduction.”
Air pollutant concentration data for the study period came from the U.S. Environmental Protection Agency. The researchers calculated daily pollution concentrations for each patient during the entire in vitro cycle and pregnancy. They calculated varying periods of air quality exposure for average daily concentrations at the patient’s home during four stages of IVF and at the IVF clinic during fertilisation and embryo transfer.
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