Presentation is key in antenatal information, research suggests

The font type of written text and how easy it is to read can be influential when it comes to engaging people with important health information and recruiting them for potentially beneficial programmes, new research by The University of Manchester and Leeds Beckett University has found.Led by Dr Andrew Manley, a Chartered Sport and Exercise Psychologist and Senior Lecturer in Sport and Exercise Psychology at Leeds Beckett, the study – published in the latest issue of Patient Education and Counseling journal – assessed the extent to which the title and font of participant information sheets can influence a person’s perception of written information.Thirty-five pregnant women and 36 trainee midwives took part in the research and were randomly presented with one of four participant information sheets describing an antenatal programme.

Read the rest of the article at http://www.medicalnewstoday.com/releases/290920.php.

Studies show young people ‘wish they were better informed about sex’

Researchers investigating how young men and women learn about sex found that a gap exists between the type of sex education young people want and what they receive.The researchers also identified differences between how men and women learn about sex and relationships. The two studies, published in BMJ Open, utilized data from the third National Survey of Sexual Attitudes and Lifestyles (Natsal-3) – the largest scientific study of its kind in the UK.”The terrain young people have to navigate as they are growing up has changed considerably over the past 20 years and it will inevitably continue to do so,” says study author Dr. Clare Tanton. “This means that while we need a more structured approach towards sex and relationships education, we must also be able to adapt to these changing needs.”In one of the two studies, data from Natsal-3 for 3,869 participants, conducted between 2010 and 2012, was compared with data from surveys conducted in 1990-1991 and 1999-2001, in order to assess how sources of information about sex may have changed over time.

Read the rest of the article at http://www.medicalnewstoday.com/articles/290528.php.

IUDs and hormonal implants have become ‘five times as popular’ over past decade

A new Centers for Disease Control and Prevention report finds a shift in preferences for birth control among American women, who are increasingly opting for long-lasting reversible contraceptives.Long-acting reversible contraceptives (LARCs) include intrauterine devices (IUDs) and subdermal hormonal implants. Although IUDs were used more commonly in the US during the 1970s, concerns over their safety prompted a decline in use of these devices.Since then, however, IUDs have been redesigned with safety in mind, and the Centers for Disease Control and Prevention (CDC) report shows that there has been growing interest in IUDs and 5-year contraceptive implants – which were approved in 1990 – because these contraceptive methods are highly effective at preventing unintended pregnancies.IUDs are placed inside the uterus, where they release hormones or copper to prevent pregnancies. The CDC say that the failure rate for IUDs is below 1%, making them more effective than the birth control pill, which – partly due to users sometimes forgetting to take the pill – has a failure rate of about 9%.

Read the rest of the article at http://www.medicalnewstoday.com/articles/289874.php.

New pathway for stalling BRCA tumor growth revealed

Findings could lead to new therapies for breast, ovarian, and other cancers

Inhibiting the action of a particular enzyme dramatically slows the growth of tumor cells tied to BRCA1 and BRCA2 genetic mutations which, in turn, are closely tied to breast and ovarian cancers, according to researchers at NYU Langone Medical Center.Senior investigator and NYU Langone cell biologist Agnel Sfeir, PhD, says that if further experiments prove successful, these findings could lead to a new class of targeted therapies against cancers with BRCA1 and BRCA2 mutations. The researchers’ findings in experiments in mice and human cells are described in the journal Nature online.Dr. Sfeir and her collaborators say their discovery about the enzyme — called polymerase theta, or PolQ — resulted from efforts to answer a fundamental biological question: How do cells prevent the telomere ends of linear chromosomes, which house our genetic material, from sticking together? Cell DNA repair mechanisms can stitch together telomeres broken as part of cell metabolism. But such fusions, the researchers say, compromise normal cell growth and survival.”In the purest biological sense, our findings show how this particular enzyme, which we know is active in several tumors, promotes unwanted telomere fusions by inserting whole segments of DNA via a disruptive DNA repair pathway termed alt-NHEJ,” says Dr. Sfeir, an assistant professor at NYU Langone and its Skirball Institute for Biomolecular Medicine and a member of NYU’s Laura and Isaac Perlmutter Cancer Center. “It was quite remarkable to find that by blocking PolQ action, cancer cell growth was cut by more than half.”

Read the rest of the article at http://www.medicalnewstoday.com/releases/288900.php.

Mode of delivery in childbirth associated with pain during or after sexual intercourse

Operative birth is associated with persisting pain during or after sexual intercourse, known as dyspareunia, suggests a new study published in BJOG: An International Journal of Obstetrics and Gynaecology (BJOG).

The study aimed to investigate the contribution of obstetric risk factors, including mode of delivery and perineal trauma to postpartum dyspareunia. It also examined the influences of other risk factors, including breastfeeding, maternal fatigue, maternal depression and intimate partner abuse.

A cohort of 1244 first time mothers across six maternity hospitals in Melbourne, Australia was used. Data were taken from baseline and postnatal questionnaires at 3, 6, 12 and 18 months. The mean gestational age of the study participants at the time of enrolment was 15 weeks.

Of the women sampled, 49% had a spontaneous vaginal birth, two thirds of whom sustained a sutured tear and/or episiotomy, 10.8% had an operative vaginal birth assisted by vacuum extraction and 10.7% gave birth assisted by forceps. Additionally, 9.7% were delivered by elective caesarean section and 19.9% were delivered by emergency caesarean section.

Results showed that 78% of the study population had resumed sexual intercourse by 3 months, 94% by 6 months, 97% by 12 months and 98% by 18 months postpartum.

With regards to dyspareunia following childbirth, most of the women (85.7%) who had resumed sex by 12 months postpartum experienced pain during first vaginal sex after childbirth. Dyspareunia was reported by 44.7% of women at 3 months postpartum, 43.4% at 6 months, 28.1% at 12 months and 23.4% at 18 months postpartum. Of the women who reported dyspareunia at 6 months postpartum, a third (32.7%) reported persisting dyspareunia at 18 months postpartum.

Compared to women who had a spontaneous vaginal delivery with intact perineum or unsutured tear, women who had an emergency caesarean section, vacuum extraction or elective caesarean section had double the risk of reporting dyspareunia at 18 months postpartum, adjusting for maternal age and other risk factors.

Other factors associated with dyspareunia at 18 months postpartum include pre-pregnancy dyspareunia, intimate partner abuse and maternal fatigue. One in six women (16%) in the study experienced abuse by an intimate partner in the first 12 months postpartum. One third of these women (32.4%) reported dyspareunia at 18 months postpartum, compared with 20.7% of women who did not experience intimate partner abuse. The authors of the study highlight that these results suggest that clinicians should be alert to the possibility that intimate partner abuse is a potential underlying factor in persisting dyspareunia.

The authors conclude that greater recognition and understanding of the role of mode of delivery and perineal trauma in contributing to postpartum maternal morbidities is needed. Additionally, ways to prevent postpartum dyspareunia should be explored.

Ellie McDonald from the Murdoch Childrens Research Institute, Victoria, Australia and co-author of the study said:

“Almost all women experience some pain during first sexual intercourse following childbirth.

“However, our findings show the extent to which women report persisting dyspareunia at 6 and 18 months postpartum is influenced by events during labour and birth, in particular caesarean section and vacuum extraction delivery.

“Not enough is known about the longer term impact of obstetric procedures on maternal health. The fact that dyspareunia is more common among women experiencing operative procedures points to the need for focusing clinical attention on ways to help women experiencing ongoing morbidity, and increased efforts to prevent postpartum morbidity where possible.”

Patrick Chien, BJOG Deputy Editor-in-chief added:

“This is the first study with detailed, frequent and long-term follow-up to assess associations of dyspareunia with obstetric risk factors.

“This study provides us with robust evidence about the extent and persistence of postpartum dyspareunia and associations with mode of delivery and perineal trauma. Future research could look into ways of preventing dyspareunia.”

Adapted by MNT from original media release

http://www.medicalnewstoday.com/releases/288323.php

 

Mobility disabilities can contribute to complications during pregnancy

A new study indicates that women with mobility disabilities often experience problems during pregnancy related to their functional impairments.

The study included 8 women with spinal cord injuries, 4 with cerebral palsy, and 10 with other conditions. Impairment-related complications during pregnancy included falls, urinary tract and bladder problems, wheelchair fit and stability problems, significant shortness of breath, increased spasticity, bowel management difficulties, and skin integrity problems.

“Relatively little information is available about the pregnancy experiences of women with physical disabilities, which hampers preconception planning and helping women know what to expect as their pregnancies progress,” said Dr. Lisa Iezzoni, lead author of the Acta Obstetricia et Gynecologica Scandinavica article. “Our findings from 22 interviewees with physical disabilities who described their pregnancies provide insights, albeit preliminary, that could inform both women and their obstetrical practitioners about possible complications so they can plan ahead.”

Adapted by MNT from original media release

http://www.medicalnewstoday.com/releases/287082.php

 

 

Positive acceptability for investigational contraceptive ring reported by Population Council

The Population Council published new research in the November issue of the journal Contraception demonstrating that an investigational one-year contraceptive vaginal ring containing Nestorone® and ethinyl estradiol was found to be highly acceptable among women enrolled in a Phase 3 clinical trial. Because the perspectives of women are critical for defining acceptability, researchers developed a theoretical model based on women’s actual experiences with this contraceptive vaginal ring, and assessed their overall satisfaction and adherence to instructions for ring use. In this trial, researchers also measured continuation of ring use for up to one year.

“Understanding the factors that influence women’s satisfaction with and acceptability of a contraceptive method helps researchers and product developers design and test products that better meet their health and family planning needs,” said Ruth Merkatz, Director, Clinical Development, Center for Biomedical Research at the Population Council. “Our results add to the growing body of evidence documenting the acceptability of our investigational contraceptive vaginal ring. With the development of this model, we can continue studying women’s preferences for this and other vaginal rings to ensure that introductory and educational efforts are user-centric and responsive to women’s needs.”

Designing and Testing the Acceptability Model

The acceptability model was developed based on four objective domains of contraceptive vaginal ring use: ease of use (e.g., ease of inserting and removing the ring, remembering the schedule); side effects; expulsion of the ring and feeling the ring while wearing it (including awareness of the ring during sexual intercourse); and changes to sexual activity, frequency, or pleasure. A questionnaire was developed to assess these domains as well as overall satisfaction and adherence to instructions for use. Continuation of ring use was also evaluated.

The model was tested among 1,036 women enrolled in a Phase 3 clinical trial of the Council’s investigational one-year contraceptive vaginal ring. They were given a questionnaire that measured the domains of ring use, overall satisfaction, and adherence to the regimen. The acceptability questionnaire was integrated into a study protocol across 12 trial sites in Latin America, the United States, Europe, and Australia over three years.

The study protocol was approved by the Council’s Institutional Review Board and each site’s ethical committee. All women provided informed consent. The questionnaires were translated into each site’s local language, and were administered at the beginning of each woman’s third monthly cycle of use, and again after one year (or at the time of study discontinuation).

Findings from the Acceptability Study and Recommendations for Providers and Researchers

Eighty-nine percent of women were satisfied with the one-year ring. Women who reported being satisfied found the ring easy to insert and remove, and did not experience changes in sexual pleasure or frequency of intercourse. Additionally, women who reported satisfaction with the ring were twice as likely to use the method correctly compared to women who reported dissatisfaction and 5 times as likely to use the ring for a full year. Women who reported dissatisfaction (11%) were more likely to report feeling the ring while wearing it and during intercourse, and to experience side effects associated with use.

The researchers made three recommendations for healthcare professionals, clinical trial leaders, and community healthcare workers (e.g., community health extension workers, nurses, and midwives) who counsel women considering or using a contraceptive vaginal ring method:

• Practitioners are strongly encouraged to inform women about the possibility of experiencing hormonal and non-hormonal side effects, and counsel on managing side effects;
• Comfort with inserting and removing the ring should be addressed during personal counseling with women, regardless of prior experiences with other vaginal ring products; and
• Guidance about feeling the ring or possibly expelling it is also necessary. With support from informed providers or experienced users, women can practice insertion to make sure they are inserting the ring correctly.

The researchers recommended continued research to broaden the evidence supporting the use of the model. Additional studies in other geographic regions are recommended, such as sub-Saharan Africa, where a long-acting, reversible method under the woman’s control has the potential to be an important new contraceptive option.

About the Investigational Nestorone® and Ethinyl Estradiol Contraceptive Vaginal Ring

The investigational one-year contraceptive vaginal ring is a long-acting, reversible contraceptive designed to provide protection against pregnancy for up to one year. It is currently in the late stages of clinical development.

The ring contains the progestin Nestorone®, an investigational new chemical entity that has been shown to be effective in preventing ovulation, as well as ethinyl estradiol, an FDA-approved, marketed estrogen product. Roughly 2¼ inches in diameter, the investigational one-year ring is soft and flexible, and women can easily insert and remove the ring without the assistance of a healthcare professional.

As demonstrated in clinical trials, the investigational one-year ring is designed to prevent ovulation by releasing a low dose of hormones through the vaginal walls and into the bloodstream. It is left in place for 21 days and removed for 7 days. A single ring can be used for up to 13 cycles (one year). Because it is designed to be effective for 13 cycles and designed so that refrigeration is not required, the investigational one-year ring may be a suitable option for women in developing countries who lack convenient access to a health care facility or pharmacy, and in areas where regular electricity outages – or lack of electricity – are a fact of life.

Adapted by MNT from original media release

 

Clinical consultations for fertility problems no greater for women with celiac disease

Women with celiac disease present with fertility problems no more often than women in the general population, according to a new study in Gastroenterology1 , the official journal of the American Gastroenterological Association.

“Despite inconsistent findings from small studies, concern has been raised that celiac disease may cause infertility,” said lead study author Nafeesa N. Dhalwani, PhD, from the University of Nottingham, United Kingdom. “Celiac patients should rest assured; our findings indicate that women with celiac disease do not report fertility problems more often than women without celiac disease.”

Researchers conducted a large population-based cohort study, analyzing more than 2 million women of childbearing age in the United Kingdom, to compare the rates of new clinically recorded fertility problems in groups of women with and without celiac disease. The findings show women with celiac disease do not have a greater likelihood of fertility problems, either before or after diagnosis of celiac disease.

However, rates of infertility were 41 percent higher among women diagnosed with celiac disease when they were 25-29 years old, compared to women in the same age group without the disease. Dr. Dhalwani provides guidance on these findings: “It is important to recognize that this represented only a very small increase in the number of women consulting with fertility problems — if we followed women between ages 25-29 years over a one-year period, presentation with fertility problems would occur in one of every 100 women without celiac disease, but in 1.5 of every 100 women with celiac disease. The fact that this increase was not seen in women of the same age with undiagnosed celiac disease indicates that it is unlikely to represent a biological impact of the condition on fertility. It may instead be related to heightened concern that may prompt earlier consultation if women experience delays in conception. This does, however, warrant further assessment.”

While undiagnosed celiac disease is likely to be an underlying cause of unexplained infertility for some women, these findings indicate that most women with celiac disease, either undiagnosed or diagnosed, do not have a substantially greater likelihood of clinically recorded fertility problems than women without celiac. Therefore, screening when women initially present with fertility problems may not identify a significant number of women with celiac disease, beyond the general population prevalence.

Previous studies associating infertility with celiac disease included small numbers of women attending infertility specialist services and subsequently screened for celiac disease, so they may not be representative of the general population. This is the largest study to assess the association between celiac disease and fertility problems to date with data on more than 2 million women over a period of 20 years.

Celiac disease affects about 1 percent of the population in North America and Western Europe, with women constituting about 60 to 70 percent of the clinically diagnosed population. Celiac disease is an autoimmune condition which can result in intestinal malabsorption and prevents the body from collecting nutrients as food passes through the small intestine. The primary treatment for celiac disease is the strict following of a gluten-free diet.

http://www.medicalnewstoday.com/releases/286421.php

 

 

Some women who consume soy experience fewer hot flashes

Does soy in the diet help with hot flashes? It does, but only for women whose bodies can produce the soy metabolite equol, reports a study of American women just published online in Menopause, the journal of The North American Menopause Society. About 20% to 50% of North American and European women have this ability.

The researchers surveyed women from age 45 to 55 in a Seattle, Washington-area healthcare system to find study participants who weren’t using hormone therapy and ate soy foods at least three times a week. The participants recorded how many and how severe and bothersome their hot flashes and night sweats were and also had their hot flashes measured with a skin monitor. Urine tests showed which women produced equol, which is metabolized from the soy isoflavone diazden by bacteria in the gut.

Of the 357 participants, 34% were equol producers. And among the equol producers, those who had the most soy in their diet were 76% less likely to report a higher than average number of hot flashes and night sweats than those who had the least soy in their diet. But for the women who did not produce equol, soy made no difference. Soy intake didn’t affect how severe or bothersome the hot flashes and night sweats were for either group.

Measuring equol in urine is a test that’s only done in research centers, so it’s not realistic for women who are not participating in studies to be tested. And the effect of soy for women who do produce equol needs to be confirmed in controlled, randomized studies, so making a definite recommendation to women on soy and hot flashes is premature, said the authors.

“Women who are interested in trying dietary soy for their hot flashes can do their own experiment by incorporating it as a healthy food in their diet. If it doesn’t help in four to six weeks, they can assume it probably won’t and can try other lifestyle or medical therapies for their hot flashes,” says NAMS Executive Director Margery Gass, MD, NCMP.

That may be what some women in this study did. The clue is that about the same proportion of Caucasian and Asian women in this study were equol producers (36% and 38%, respectively), although it’s known that a much higher proportion of Asian women can produce equol. So it may be that the Caucasian women who found soy foods helped regularly included these foods in their diet.

An approach that could help more women reduce hot flashes–whether they can produce equol or not–is to use supplemental equol. A supplement of equol for hot flashes and other menopausal symptoms is being studied now in the United States by Otsuka Pharmaceutical Company, Ltd, which sponsored this study, and its subsidiary Pharmavite LLC, the supplement manufacturer.

http://www.medicalnewstoday.com/releases/285686.php

 

 

For younger postmenopausal women, when bone density is good, no repeat tests needed

But when bone density tests do show osteoporosis, the risk of major fracture is high

After menopause and before age 65, women who have normal bone density have a very low risk of fracture, shows a new study from the Women’s Health Initiative (WHI) published online in Menopause, the journal of The North American Menopause Society. That means these women don’t need another bone mass density (BMD) test before age 65.

This study followed up 4,068 postmenopausal women ages 50 to 64 who had a BMD test, weren’t taking hormones orcalcium and vitamin D supplements in the trial, and didn’t already have an osteoporotic fracture.

Among the women who had no osteoporosis at the start of the study, it took from 12.8 years (for the youngest) to 7.6 years (for the oldest) for just 1% of them to sustain a vertebral fracture that caused problems or to sustain a hip fracture. And it took from 11.5 years to 8.6 years for 3% of the women without osteoporosis at the start to sustain a major osteoporotic fracture, that is, a vertebral fracture that caused problems or a fracture of the hip, wrist, or top of the upper arm.

Those who did have osteoporosis at the outset had a high fracture risk, with 1% of them sustaining a problematic vertebral fracture or a hip fracture within just 3 years, and 3% of them sustaining a major osteoporotic fracture in just 2.5 years.

The decision to do a BMD test or repeat it after menopause is based on a judgment of a woman’s risk of fracture, but research and debate on how to judge that risk are ongoing. Usually, a first test before age 65 is discouraged unless a woman has a medical condition where it or the treatment is associated with bone loss. What the risks are that can guide repeat testing have not been clear, and clinical practice varies widely.

“But the study just published online in the Society’s journal provides evidence that the young postmenopausal women without osteoporosis on their BMD test, if they happened to have one before age 65, are not likely to need a repeat BMD test before 10 to 15 years have elapsed, barring significant health developments,” says NAMS Executive Director and study coauthor Margery Gass, MD.

Adapted by MNT from original media release

http://www.medicalnewstoday.com/releases/285293.php