Reproductive Health News
STATE POLITICS & POLICY | Arizona Nursing Board Committee Recommends Allowing Nurses To Perform First-Trimester Abortions [May 12, 2008] The Arizona Board of Nursing's Advance Practice Committee has voted unanimously to recommend that nurse practitioners be allowed to perform first-trimester abortions in the state, the Arizona Daily Star reports. The full nursing board is scheduled to vote on the recommendation on Wednesday. According to the Star, the recommendation "will only add fuel" to legislative efforts aimed at overriding the nursing board and permitting only doctors to perform abortions in the state. The House recently voted 32-28 to pass a bill (HB 2269) that would prohibit all nurses from performing surgical abortions (Fischer, Arizona Daily Star, 5/9). Although state law regulates nursing, there are no rules specifically addressing which types of practitioners can perform abortions. Rules state that nurse practitioners are entitled to perform therapeutic procedures that they are qualified to conduct. The bill was spurred by a complaint filed in June 2007 with the Board of Nursing against Mary Andrews, a nurse practitioner with Planned Parenthood Arizona. The board considered the issue in November 2007 but did not reach a decision. Michelle Steinberg, a spokesperson for PPAZ, said her organization has been using a nurse practitioner to conduct abortions for eight years "with fewer complications than the national average" (Daily Women's Health Policy Report, 3/7). Steinberg said, "There are a large number of women in Tucson who need to access services," adding, "That doesn't necessarily mean it has to be a physician." PPAZ attorney Lawrence Rosenfeld told the nursing board committee that Arizona law does not prohibit nurse practitioners from handling first-trimester abortions. Pam Lotke, a physician and professor at the University of Arizona, last week at a Advance Practices Committee hearing testified that the procedure used in first-term abortion -- which essentially vacuums out the fetus -- is considered extremely safe with few complications and that there is no reason that cannot be done by a properly trained nurse practitioner. However, Cathi Herrod -- president of the Center for Arizona Policy, which has lobbied to ban all abortions -- said the current legislative proposal is about safety rather than restricting access to legal abortions. In a letter to the nursing board, she wrote that current abortion regulations in Arizona specifically refer to the procedure being performed by doctors and that nothing specifically permits nurse practitioners to perform the procedure (Arizona Daily Star, 5/9). [READ MORE...]
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NATIONAL POLITICS & POLICY | Senate GOP Seeks to Remove Provisions To Delay Medicaid Regulations From War Spending Bill [May 12, 2008] Some Senate Republicans are pushing to remove provisions in the supplemental war spending measure that would prevent seven new Medicaid regulations from taking effect until April 1, 2009, CQ Today reports. Republicans also are attempting to remove a provision in the bill that would ban physician-owned specialty hospitals from receiving Medicare payments. The House approved the delay in Medicaid legislation (HR 5613) approved last month. Sen. Charles Grassley (R-Iowa), ranking Republican on the Senate Finance Committee, on Thursday sent a letter to Senate appropriators asking that the two provisions be removed from the measure. Grassley in the letter said that Medicare and Medicaid are a "basic part of the jurisdiction of the Finance Committee." Grassley sent copies of the letter to Finance Committee Chair Max Baucus (D-Mont.); Senate Appropriations Committee Chair Robert Byrd (D-W.Va.); and Sen. Thad Cochran (R-Miss.), ranking member of the Appropriations Committee. Baucus spokesperson Carol Guthrie said, "Sen. Baucus has said that in light of the fact that efforts to move legislation stopping these bad Medicaid (regulations) from being implemented have been blocked, the supplemental funding bill is a viable vehicle for moving them forward." Byrd had not responded to the letter as of Friday, but Byrd spokesperson Jesse Jacobs said the provisions have support from Democratic leaders in the Senate. Jacobs added that the provisions are expected to be included in the House version of the war funding bill. Cochran spokesperson Margaret McPhillips said the senator is supporting Grassley, adding that Cochran "was certainly not consulted" when the provisions were added to the spending bill. McPhillips said that the provisions "don't belong on a supplemental appropriations bill, particularly if there is to be no opportunity for amendments on the House or Senate floor, and no conference committee" (Armstrong, CQ Today, 5/9). The seven rule changes at issue aim to restrict services covered by some states' case management plans; limit Medicaid reimbursement to public hospitals; narrow federal Medicaid reimbursement eligibility for outpatient hospital services; bar federal reimbursement for transportation to school and school-based care for Medicaid-eligible children; restrict the types of "rehabilitative" services covered by federal funding; reduce federal Medicaid reimbursement for students at teaching hospitals; and limit taxes some states charge health providers. HHS Secretary Mike Leavitt has said that if Congress allows the rules on reimbursement to public hospitals and the reduction of reimbursement to teaching hospitals, the Bush administration would be willing to postpone implementation of the other five rules (Daily Women's Health Policy Report, 5/7). [READ MORE...]
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CONTRACEPTION & FAMILY PLANNING | Pope Praises 1968 Document Condemning Contraception [May 12, 2008] Pope Benedict XVI on Saturday said that the Roman Catholic Church's teachings on birth control are complicated but that the church's 1968 document that condemned contraception use is laudable, the AP/International Herald Tribune reports. Benedict was giving a speech to mark the 40th anniversary of Pope Paul VI's 1968 "Humanae vitae," which translates to "On Human Life" -- a document that prohibits Catholics from using "artificial birth control" -- according to the AP/Herald Tribune. Benedict said that teaching Catholics about the document "isn't easy" but added, "The truth expressed in 'Humanae vitae' doesn't change; on the contrary, in the light of new scientific discoveries it is ever more up to date." He said, "No mechanical technique can substitute for the act of love that two married people exchange as a sign of greater mystery" (D'Emilio, AP/International Herald Tribune, 5/10). The pope said he hopes young people will be "able to learn the true meaning of love and prepare for it with proper sex education." Benedict also warned against sex becoming a drug and the human body being seen only as an object, Agence France-Presse reports. Losing sight of the connection between body and soul could mean "losing the value of a person and falling prey to the serious danger of seeing the body as an object that can be bought and sold," the pope said (Agence France-Presse, 5/10). Kan. Bishop Urges Gov. Sebelius To Stop Receiving Communion In related news, Archbishop Joseph Naumann, head of the Archdiocese of Kansas City, recently said that Kansas Gov. Kathleen Sebelius (D) should not receive Holy Communion because of her support for abortion rights, the Kansas City Star reports. Naumann in a column in the Catholic newspaper Leaven called on Sebelius to take the "necessary steps for amendment of her life," including a confession, a public apology and a promise to "undo the damage" from her support of abortion rights. Sebelius spokesperson Nicole Corcoran said that the governor had not seen Naumann's column but noted that "receiving Communion has not been a problem in the past for" the governor (Bullers, Kansas City Star, 5/10). Naumann said he wrote to Sebelius in August 2007 asking her to not receive Communion. Naumann said that he recently learned Sebelius had received Communion, so he wrote to her again and asked her to respect his original request and "not require from me any additional pastoral actions." Naumann wrote that the "spiritually lethal message, communicated by [Sebelius], as well as many other high-profile Catholics in public life, has been in effect: 'The church's teaching on abortion is optional.'" According to Naumann, Sebelius' veto last month of an abortion-related bill showed a lack of respect to Kansas lawmakers and residents, who are embarrassed that Kansas "has become infamous for being the late-term abortion center for the Midwest" (Hanna, AP/Topeka Capital-Journal, 5/10). According to the Star, Naumann could prohibit priests from allowing Sebelius to receive Communion, but he is not considering that option. Instead, Naumann said he hopes Sebelius will do the "right thing." The U.S. Conference of Catholic Bishops in 2004 said that Catholic lawmakers who support abortion rights were "cooperating in evil" and that their bishops could decide whether to deny them Communion, the Star reports (Kansas City Star, 5/10). [READ MORE...]
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PREGNANCY & CHILDBIRTH | Pew Report Finds Higher Fertility Rates Among Hispanic Women Than Among Non-Hispanics [May 12, 2008] The Pew Hispanic Center on Thursday released an analysis that found that Hispanic women in the U.S. -- whether they are U.S. born or immigrants -- have higher fertility rates than non-Hispanic women, the AP/Hartford Courant reports (Gamboa, AP/Hartford Courant, 5/8). The analysis found that there were 84 births per every 1,000 Hispanic women, compared with 63 births per 1,000 non-Hispanic women. There were 73 births per 1,000 Hispanic women born in the U.S., compared with 96 births per 1,000 immigrant Hispanic women. The report found that unmarried Hispanic women born in the U.S. are more likely to have children than single immigrant Hispanic and non-Hispanic women. About 50% of Hispanic children were born to unmarried women. The percentage of single immigrant Hispanics who gave birth -- about 35% -- was nearly the same as for non-Hispanic women, the report found. Census Bureau data released last week state that Hispanics account for about 15.1% of the U.S. population and one out of every four children in the U.S. under age five. The nation's Hispanic population is expected to grow as new births outnumber new immigrants, the AP/Courant reports (AP/Hartford Courant, 5/8). The report is available online. [READ MORE...]
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INTERNATIONAL NEWS | Survival Rates for Infants Born Before 24 Weeks' Gestation in U.K. Unchanged, Study Finds [May 12, 2008] The survival rate of infants born before 24 weeks' gestation in the United Kingdom did not change from 1994 to 2005, according to a study published Friday in the journal BMJ, Reuters UK reports. According to Reuters UK, the research came as British Members of Parliament prepare to debate whether to reduce the time during which women can legally receive an abortion in the country from 24 weeks' gestation to 20 weeks' gestation (Castle, Reuters UK, 5/9). For the study, David Field, professor of neonatal medicine at the University of Leicester, and colleagues compared survival rates during two time periods among infants born between 22 and 26 weeks' gestation in 16 hospitals in England's Trent region. About 500 infants were born in both the 1994 to 1999 time period and the 2000 to 2005 period (BBC News, 5/9). The study found that there was no improvement in survival between the two periods for infants born at 23 weeks' gestation, which remained at 18%. Of the 150 infants born at 22 weeks' gestation, none survived, the study found (Moss, Scotsman, 5/9). There was significant improvement in the survival rates of infants born at 24 and 25 weeks' gestation. The survival rate of infants born at 24 weeks' gestation increased from 24% to 41%, and the rate for infants born at 25 weeks' gestation increased from 52% to 63%. According to BBC News, the study supports preliminary findings from national research published last month (BBC News, 5/9). According to Field, medical advances that had aided older infants failed to assist younger ones. "Doing exactly the same thing for these more immature babies doesn't seem to have made any difference at all," Field said, adding, "It's as if there is some maturity effect that kicks in around 23 and 24 weeks" (Reuters UK, 5/9). Reaction Tony Calland, chair of the British Medical Association's ethics committee, said the research gave further weight to the agency's view that there is no scientific justification for lowering the abortion time limit. "Although the vast majority of abortions take place in the first trimester, there are still women who need abortion services later on in their pregnancy," Calland said, adding, "To lower the abortion limit would leave a number of women in dire circumstances." Andrew Ferguson of the Christian Medical Fellowship, said, "Two-thirds of the public, two-thirds of [general practitioners] and three-quarters of all women want the upper limit (for abortion) reduced significantly." He added, "These findings will not alter their views, and we urge Parliament to take public opinion into consideration" (Scotsman, 5/9). MP Nadine Dorries of the Conservative Party on her Web site said the "report is the most desperate piece of tosh produced by the pro-choice lobby, and it smells of one thing -- desperation" (BBC News, 5/9). David Cameron, head of the Conservative Party, has said he would support further reduction in the time limit. A spokesperson for Prime Minister Gordon Brown of the Labour Party has said the prime minister would not vote for a change in the limit (Reuters UK, 5/9). [READ MORE...]
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ELECTION 2008 | Newark Star-Ledger Examines Abortion Positions of Republican Candidates for U.S. Senate [May 12, 2008] The Newark Star-Ledger on Friday examined the views on abortion of the three Republican candidates for an open New Jersey U.S. Senate seat. According to the Star-Ledger, former U.S. Rep. Dick Zimmer, state Sen. Joseph Pennacchio and Murray Sabrin, a professor at Ramapo College who ran for governor as a Libertarian in 1997, all oppose so-called "partial-birth" abortion but their views on other abortion restrictions vary. Zimmer said that he had voted against a federal ban on partial-birth abortion while in Congress but has since changed his position. Zimmer said his support for abortion rights is based on his belief in "limited government." He added, "Government should play a minimal part in people's private lives. As a general rule, the government should not interfere in a decision that should be made by a woman and her doctor and her spiritual adviser and her family." Zimmer added that he supports "reasonable restrictions" on abortion, such as parental notification. Sabrin, during a debate at Fairleigh Dickinson University in late April, said he is "pro-life" but opposes national mandates related to abortion. "Roe v. Wade was an inappropriate decision, and I've always believed this should be handled at the state level, as it was prior to Roe," Sabin said, adding, "Being pro-life does not mean you want one-size-fits-all for the country. I believe that would be a mistake." Pennacchio said Sabin "punted" during the debate. He added, "People want to know where you stand. They don't want you to go to Washington and punt [the issue] back to the states." Pennacchio said that his views on abortion have "evolved," adding that he now wants to amend the U.S. Constitution to state that life begins at conception. Richard Collier -- president of the Morristown, N.J.-based Legal Center for the Defense of Life -- said the difference between Pennacchio and Sabrin come down mainly to "tactics." According to the Star-Ledger, the Legal Center for the Defense of Life does not make political endorsements. Marie Tasy, executive director of New Jersey Right to Life, said it expects to make an endorsement in the Senate primary "soon," adding that the group has sent questionnaires to Sabrin and Pennacchio. Tasy said the group knows where Zimmer "stands." Peter Wooley, executive director of Fairleigh Dickinson University's Public Mind poll, said abortion is "problematic for Republicans in New Jersey." He added that opposing abortion rights can be an advantage in the primary but that "it would be very difficult to win a statewide race in New Jersey as a pro-life candidate" (Schwaneberg, Newark Star-Ledger, 5/9). [READ MORE...]
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RESEARCH | Study Finds Carcinogenic HPV Infections Often Clear Within One Year [April 24, 2008] Summary of "Rapid Clearance of Human Papillomavirus and Implications for Clinical Focus on Persistent Infections," Rodriguez et al., Journal of the National Cancer Institute, April 2, 2008. Researchers examined the outcomes of 800 carcinogenic human papillomavirus infections among 599 women enrolled in a population-based cohort in Guanacaste, Costa Rica, in order to better understand the natural history of human papillomavirus, or HPV, and to gauge the extent of treatment that women with HPV infections should receive. The study found that detection of carcinogenic HPV infections is "extremely common" on a cross-sectional screening but that the majority of infections clear quickly. Ana Cecilia Rodriguez of the National Cancer Institute and colleagues enrolled women ages 18 and older for the study. The study found a 13.7% prevalence of carcinogenic HPV among women in the study, with the highest prevalence (24.4%) among women ages 18 to 24. According to Rodriguez and colleagues, studies have found similar HPV prevalence in the U.S. The study found that 55% of the 800 infections cleared within six months and that 67% cleared within 12 months. In addition, persistence of carcinogenic HPV infections was less common in women younger than age 30. Researchers focused on the first 30 months of follow-up. According to the researchers, it is important for health care providers during that time frame to decide whether to treat HPV and to weigh the chance of clearance against the possibility that the patient will develop cervical intraepithelial neoplasia grade 2 or worse (CIN2+), which can lead to cervical cancer. The women in the study were screened regularly for HPV, cervical cytology and viral clearance, and women who developed CIN2+ were treated appropriately. Only 4% of the HPV infections were linked to newly diagnosed CIN2+ 30 months after detection. If the virus had not cleared after 12 months, the study found a 21% risk of a CIN2+ diagnosis by 30 months. According to the researchers, the findings indicate that some patients with normal cytology and an initial positive HPV result could be carefully watched instead of treated because a 12-month follow-up can safely determine more than 50% of such infections as transient. The findings suggest that health care providers should focus on the persistence of an HPV infection rather than only on an initial screening in order to effectively treat the virus and cervical cancer. [READ MORE...]
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RESEARCH | Study Examines Delivery of Preventive Services From Gynecologists, General Medical Physicians [April 24, 2008] Summary of "Preventive Services Use Among Women Seen by Gynecologists, General Medical Physicians or Both," Lewis et al., Obstetrics & Gynecology, April 2008. Beth Lewis of the Department of Medicine at Saint Peters University Hospital and colleagues examined data from the 2000 National Health Interview Survey. The study looked at women ages 18 to 64 who were under the care of a general medical physician or gynecologist, or both. The researchers studied the association of provider type with Pap tests, tobacco-use screening, and exercise and dieting counseling among women ages 18 to 64, as well as provision of the above services and clinical breast examinations, mammograms and colon cancer screening among women ages 50 to 64. These services were further divided into gender-specific services -- Pap tests, mammograms and clinical breast examinations -- and gender-neutral services -- diet and exercise counseling, and screening for tobacco use and colorectal cancer. The study also accounted for such variables as age, race, education, income, insurance status, census region, urban residence and immigration status. Researchers also considered measures of health, such as self-reported health status, hospitalization in the past year, number of physician visits in the past year and smoking. Results Of the 7,317 women studied, 5,766, or 78.8%, were between ages 18 and 49, and 1,551, or 21.2%, were ages 50 to 64. Fifteen percent were seen by general medical physicians, 62.2% by gynecologists and 22.9% by both. Women who visited only a gynecologist or both types of providers were typically younger and of higher socioeconomic status than the women who saw only a general medical physician. The women who visited only a gynecologist or both types of providers also tended to have better health in terms of self-rated general health and chronic diseases. For all of the services examined, women seeing gynecologists alone reported receiving preventive care as frequently or more frequently than women seeing only a general medical physician. In addition, women seeing gynecologists and women seeing both providers were more likely to receive gender-specific care. With the exception of tobacco screening -- which occurred more often among women who went to gynecologists -- there were no differences across provider groups for gender-neutral services. In addition, the combination of receiving care from both types of providers significantly increased the chance that women would receive diet and exercise counseling, as well as colorectal cancer screening. Overall, patients of both gynecologists and general medical physicians had low rates of gender-neutral care; only about half of women in the study had colorectal cancer and tobacco screening, and about one-fourth had diet and exercise counseling. Discussion The results indicate that “gynecologists perform as well as or better than general medical physicians” in the delivery of the services studied. According to the researchers, the findings validate policy decisions that increase women's access to gynecologists, such as identifying gynecologists as primary care providers in managed care plans. The results add credibility to some women's decisions to rely on gynecologists for basic health care screening and counseling, according to the authors. However, because patients of both general medical physicians and gynecologists had overall low rates of gender-neutral care, "comprehensive preventive health care remains suboptimal for women seeing either type of provider," the researchers write, adding that gynecologists and general medical physicians "must remain vigilant about the prevention of diseases in women for which good screening measures exist." [READ MORE...]
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RESEARCH | Researchers Examine Effect of Sex Education on Risk of Pregnancy, STIs Among Teens [April 24, 2008] Summary of "Abstinence-Only and Comprehensive Sex Education and the Initiation of Sexual Activity and Teen Pregnancy," Kohler et al., Journal of Adolescent Health, April 2008. Pamela Kohler and Lisa Manhart of the University of Washington's Center for AIDS and STD and William Lafferty of UW's Department of Health Services examined the effect of formal sex education programs on the risk of pregnancy and sexually transmitted infections by analyzing data from 1,150 teenage girls and 1,121 teenage boys ages 15 to 19 who responded to the National Survey of Family Growth's general questionnaire and special adolescent interview. The sample was restricted to participants who were heterosexual and had never been married. To determine what type of education the participants received, the researchers asked whether the teens ever received "any formal instruction at school, church, a community center or some other place about how to say no to sex" before age 18. A follow-up question asked about receiving instruction on birth control methods. Those who reported receiving both education about birth control and education that emphasized a "say no to sex" approach were classified as having participated in comprehensive sex education. Those who reported only receiving sex education about how to say no to sex were classified as having received abstinence-only sex education. The researchers excluded respondents who reported exposure to sex education that taught only birth control without discussing abstinence, those who did not answer sex education questions or those who reported an age of first intercourse younger than 10. They also excluded those who reported having had sex before they received formal sex education. Characteristics associated with risky behavior among teens -- including age, household income, race or ethnicity, geographical residence and "intactness" of the family unit -- were assessed as potential variables. Findings Of the 1,719 teens included in the study, 47.4% were female respondents, and the median age was 17. In addition, 76.7% of the participants were classified as white, and 14% were classified as black. About half of household incomes reported were less than $40,000 annually, and a little more than half of the participants resided in a central city. About 41.3% of the participants reported a "nonintact" family unit. Overall, 9.4% reported not having received any formal sex education, 23.8% reported abstinence-only sex education, and 66.8% said they had received comprehensive sex education. Those who had not received formal sex education tended to be black, from rural areas and from low-income, nonintact families. Participants receiving abstinence-only education were typically younger and from low- to moderate-income, intact families. Those who reported having received comprehensive sex education were somewhat older, white and from higher-income families in more urban areas. Almost half of the respondents reported having engaged in sex by the time of the survey. After adjusting for other predictors, the researchers found that abstinence-only sex education was not significantly associated with a teenager ever engaging in intercourse. However, comprehensive sex education was associated with slightly reduced reports of engaging in intercourse. Among all the respondents, 7.3% reported a pregnancy. After adjusting for other variables, abstinence-only sex education was not significantly associated with reported teen pregnancy, compared with those who had received no formal sex education. Teenagers who reported having had comprehensive sex education were significantly less likely to report a teen pregnancy, compared with those who had not received sex education. In addition, comprehensive sex education was associated with a 50% lower risk of teen pregnancy compared with abstinence-only education. The study also found that neither abstinence-only nor comprehensive sex education programs were significantly associated with risk of STIs, compared with no sex education. Conclusions The researchers noted that abstinence-only programs have no significant effect on "delaying the initiation of sexual activity or in reducing the risk for teen pregnancy" and STIs. They added that when compared with no sex education or abstinence-only education, comprehensive sex education programs were associated with a significantly reduced risk of pregnancy. Comprehensive sex education also was associated with a marginally reduced likelihood of a teen becoming sexually active, when compared with no sex education. In addition, the report showed a "strong relationship" between a family's "intactness" and whether teens' received sex education. Teenagers from intact families were more likely to have received formal sex education, compared with those from nonintact families. The researchers noted that because the findings indicated a decreased likelihood of pregnancy among teens who received comprehensive sex education, adolescents who received abstinence-only education might "engage in higher-risk behaviors once they initiate sexual activity." Although further research is needed to examine the effects of formal sex education, the study's findings "suggest that formal comprehensive sex education programs reduce the risk for teen pregnancy without increasing the likelihood that adolescents will engage in sexual activity," the researchers write, adding that the findings "confirm results from randomized controlled trials that abstinence-only programs have minimal effect on sexual risk behavior." [READ MORE...]
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RESEARCH | Researchers Examine Hormonal Contraception Prescription Patterns Among Adolescents [April 24, 2008] Summary of "Trends in Prescribing Patterns of Hormonal Contraceptives for Adolescents," O'Brien et al., Contraception, April 2008. Researchers in the April issue of Contraception examined whether there was a drop in prescriptions given to adolescents for oral contraceptives that contain the hormone desogestrel, after it was found that the hormone increased the risk of deep vein thrombosis. Researchers from the Center for Innovation in Pediatric Practice looked at the patterns of hormonal contraceptive prescriptions given to young women between 1993 and 2004. The researchers hypothesized that prescriptions for contraceptives that contain the hormone desogestrel would decline after 1995, when a higher risk of deep vein thrombosis was first linked to desogestrel and other types of progestin. After this 1995 "scare," fewer clinicians in Europe prescribed contraceptives that contained progestin, particularly to adolescents; however, little was known about whether prescribing patterns of hormonal contraceptives in the U.S. had changed over time. Methods and Findings Sarah O'Brien of the Center for Innovation in Pediatric Practice at the Research Institute at Nationwide Children's Hospital and colleagues analyzed data from the National Ambulatory Medical Care Survey. They looked at 1,672 outpatient visits among girls and women ages 11 to 21 that included a prescription for hormonal contraception. The researchers classified data according to the type of contraceptive prescribed in two ways. The first method classified the contraceptives according to estrogen dose, with ultra-low doses defined as 20 micrograms to 25 mcg, low doses as 30 mcg to 40 mcg and high doses as 50 mcg or greater. The second method looked at the type of progestin prescribed: nondesogestrel, desogestrel and drospirenone. The researchers also classified data on provider specialty, including general practice, pediatrics and adolescent medicine, obstetrics and gynecology, or another specialty. Variables included age; race; expected source of payment; and whether the primary reason for the visit was general care, menstrual problems or other reasons. The study found that 4.6% of visits for female patients ages 11 to 21 included a prescription for contraception during the study period. The proportion of prescriptions for contraceptives containing desogestrel was lower in the U.S. than in Europe in 1995 and remained constant during the study period. Prescriptions for contraceptives containing ultra-low doses of estrogen increased, while prescriptions for those containing low doses decreased. Use of high-dose estrogen-containing contraceptives increased, mainly because of the introduction of the transdermal contraceptive patch Ortho Evra in 2001. The type of contraceptive prescribed in terms of progestin or estrogen did not vary by age, race, expected source of payment or reason for visit. Prescriptions of progestin-only birth control pills and the injectable contraceptive Depo-Provera accounted for 11.6% and 6.3% of all prescriptions, respectively. Prescriptions of intrauterine devices and vaginal rings were rare, accounting for approximately 1% of all prescriptions. Ob-gyn clinics and family medicine practices accounted for the majority of prescriptions, at 55% and 35%, respectively. Most prescriptions for adolescents age 14 and older were made at ob-gyn offices. Discussion According to the researchers, it is particularly concerning for adolescents that the risk of DVT "appears to be even higher among first-time users of oral contraception." Although prescription rates of such contraceptives were lower in the U.S. than in Europe during the "pill scare," U.S. prescribing patterns have not changed. In addition, FDA has not issued a warning about the increased risk of DVT associated with desogestrel-containing contraceptives despite concerns about the hormone and petitions from the consumer advocacy group Public Citizen to ban desogestrel-containing contraceptives. A "significant minority of adolescents are still prescribed desogestrel-containing oral contraceptives, and a greater number of adolescents are now exposed to higher doses of estrogen, due to the increasing prescribing of the transdermal contraceptive patch," the researchers write. The authors conclude that additional studies are needed to determine the absolute risk of DVT in adolescents taking contraceptives and to ensure that physicians have accurate safety information when prescribing contraceptives to adolescents. [READ MORE...]
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RESEARCH | HRT Increases Risk of Breast Cancer Recurrence Among Survivors of Disease, Study Finds [April 24, 2008] Summary of "Increased Risk of Recurrence After Hormone Replacement Therapy in Breast Cancer Survivors," Holmberg, Journal of the National Cancer Institute, April 2008. Hormone replacement therapy for menopausal symptoms is known to increase the risk of breast cancer in healthy women, but HRT's effect on breast cancer risk among breast cancer survivors has been unclear. A study -- called Hormonal Replacement After Breast Cancer: Is it Safe, or HABITS -- aimed to determine the risk of breast cancer among survivors of the disease who were taking HRT. The study was halted in December 2003 after two separate studies linked HRT use to an increased breast cancer risk in healthy women. The current study -- led by Lars Holmberg of the Department of Surgical Sciences at Uppsala University in Sweden -- followed up with 447 women who had participated in the HABITS study for a median of four years to determine whether breast cancer survivors taking HRT have an increased risk of their cancer coming back. The researchers followed up with women who had completed primary treatment of stage 0 to stage 2 breast cancer, including tumor removal and axillary surgery, radiotherapy and chemotherapy. The women were required to be free of breast cancer recurrence, have no other cancer or serious disease and have no contraindications to HRT. Women also were required to have menopausal symptoms that they and their physicians believed required treatment. Local networks of oncologists, surgeons and gynecologists recruited, assigned groups and followed the participants. The researchers recommended that women visit a breast cancer specialist twice annually for three years after the HABITS study ended and at least once annually for another two years. In addition, the researchers recommended that the women receive mammograms every 12 to 24 months or participate in routine mammography screening in intervals of 18 to 24 months. Participants also were required to visit a gynecologist annually. New breast cancer events, as well as other cancers, compliance and treatment side effects were recorded. Findings, Conclusions Participants were randomly assigned to take HRT or the best systematic management of menopausal symptoms. Women taking HRT were asked to stop taking the therapy after two years, and those experiencing serious withdrawal symptoms received gradually decreased dosages for six to 12 months. The researchers were able to follow 442 of the women for a median of four years. There were 39 breast cancer events in the HRT group and 17 in the non-HRT group. At the end of the follow-up period, six women in the HRT group had died of breast cancer, and six were living with distant metastases, compared with five deaths and four distant metastases in the non-HRT group. The researchers concluded that breast cancer survivors taking HRT had a "significantly increased risk of a new breast cancer event." Other observational studies and analyses had suggested breast cancer survivors did not have an increased risk of breast cancer recurrence when taking HRT. However, the researchers were not surprised their results deviated from those of earlier studies because they were not conducted formally and did not control for bias. The researchers added that the findings suggest HRT "induces and promotes" breast cancer in survivors of the disease and "may also stimulate" tumor growth. Further research is needed to determine the impact of specific HRT regimens on the risk of breast cancer recurrence following exposure to HRT among survivors of the disease, the researchers concluded. [READ MORE...]
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RESEARCH | Sexual Health Communication Between Parents, Children Lacking [April 24, 2008] Summary of "Communication Between Parents and Their Children About Sexual Health," Ogle, S., et. al., Contraception, April 2008. A questionnaire completed by students ages 13 to 15 in a public school in Edinburgh, Scotland, and their parents or guardians shows that there are barriers to communicating effectively about sexual health issues. The findings indicate that the lack of communication about sexual health issues between parents and their children stems mainly from the children's reluctance to talk about such issues rather than reluctance by parents. The study suggests adolescent children do not often seek out parents or guardians as sources of advice or information about sexual health and particularly about sexual intercourse. Questionnaires Given To Determine Comfort Levels Sharron Ogle and Simon Riley of the University of Edinburgh's Queen's Medical Research Institute and Anna Glasier of the Scottish group Family Planning and Well Women Services distributed a self-completed questionnaire to 317 teenagers in an Edinburgh public school and 575 of their parents. The questionnaire was designed to determine relative comfort levels about discussing six sexual health topics: girlfriends/boyfriends, homosexuality, sexual intercourse, contraception, sexually transmitted infections and abortion. Three hundred and forty-five parents, 162 female students and 155 male students completed the questionnaire. Parents were asked to provide information about their age, occupation, their child's age and gender, their relationship with their child, how comfortable they were discussing each of the topics and any other comments they wanted to share. The level of comfort was identified on a scale of one to four, where one was "very comfortable," two was "comfortable," three was "uncomfortable" and four was "very uncomfortable." A total "discomfort score" was derived by adding the responses to all six topics. The children were asked how likely they were to talk to their parents or guardians about various scenarios related to the six topics. Children who indicated they definitely would not speak to either parent for any topic were asked to provide an explanation. The study found that parents were most comfortable discussing girlfriends or boyfriends and least comfortable talking about sexual intercourse with their children. The children's surveys also revealed that they were least likely to discuss sexual intercourse with their parents and more likely to talk about girlfriends or boyfriends. The level of discomfort for fathers was significantly higher than for mothers, regardless of the gender of the child. The level of discomfort for fathers with daughters was higher, compared with all other groups. Girls were less likely to talk to fathers than mothers about the six topics, while boys were equally likely to talk to their mothers or fathers. According to the study, 57% of the children said the main reason for not talking to parents about the six topics was embarrassment, and 26% said they preferred using other sources of advice. Among girls, 42% said they discussed the issues with friends, 28% with their mothers and 5% with their fathers. These findings were similar for all topics except abortion, where friends and mothers equally accounted for 33%. The study found that for boys, 34% discussed sexual issues with friends, 20% with their mothers and 18% with their fathers. Parents Are Not 'Widely Used' The researchers noted that despite the parents' "overall high comfort levels," the children generally were unwilling to discuss sexual health with their parents. The findings suggest that parents and guardians are not "widely used" by their children as sources of advice and information concerning the six sexual health topics. In part because the questionnaire format could not delve deeper into the reasons parents are underutilized as resources on such topics, the researchers said further study is needed. [READ MORE...]
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