Articles Posted in Gynecology

http://www.protectpatientsblog.com/wp-content/uploads/sites/69/2017/04/hpv-vaccine-uptake-infographic.__v100248120-216x300.jpgMore Americans ages 18 to 59 may be infected with the human papilloma virus (HPV) than previously had been known, with 1 in 4 men and 1 in 5 women carrying high-risk strains, federal experts say.

The new findings from the Centers for Disease Control and Prevention may become a key part of campaigns to get more parents to vaccinate youngsters against HPV infections. They have been found to cause cervical cancer and have been tied to cancers of the throat, anus, and male and female reproductive organs.

HPV-related cancers are on the rise, and it is concerning that the CDC found that almost half of Americans’ are infected. But public health leaders have confronted ignorance and adult prudery—by physicians, public officials, and parents—as they try to get boys and girls, ages 11 and 12, inoculated and protected against the virus.

marijuana-smoking-131013-300x200Although marijuana is marching toward legalization across the United States, expectant moms may wish to think long and hard still about smoking or ingesting a substance that has become as ubiquitous in some households as aspirin or a bottle of chardonnay. The New York Times has delved into this discussion, even as other news outlets recently have provided parental warnings about hype over apps for baby care and tossing some toxic homeopathic teething remedies.

Pot? Not for expectant moms

Let’s turn first, and not be blue noses about it, to why moms would consider pot while pregnant. Data show that few do (an estimated 4 percent of more than 200,000 women in one 12-year sample — though the number had doubled in recent time). For younger women, the answer may be, just because. They don’t equate it with risk but with recreation. They say they try to be cautious with it, just as they might curtail their alcohol consumption but still have a rare drink. Older and expectant moms may use pot, as many women do, because they find it helps with depression, anxiety, stress, pain, nausea and vomiting.

breastIt’s described as an “aggressive, costly, morbid, and burdensome” surgery that often lacks “compelling evidence” that it contributes to patients’ “survival advantage.” So why are increasing numbers of women  deciding to have both their breasts removed when doctors detect early stage cancer in one breast?

New research, based on a questionnaire and follow-up with more than 2,400 women, recommends that surgeons be clearer and more direct about treatment options and outcomes with breast cancer patients. That’s because 17% of respondents said, incorrectly, that they think that removing the other healthy breast in a woman with cancer in one breast helps prevent the disease’s recurrence, while almost 40 percent said they didn’t know this procedure’s effects.

Researchers found that many women—including more than 40 percent of their respondents—with breast cancer contemplate the surgery known as contralateral prophylactic mastectomy (CPM), and that sufficient numbers of surgeons may not explain why it may be inappropriate for them. Their study has been published in the peer-reviewed Journal of the American Medical Association Surgery. As the Los Angeles Times reported:

Facts line up in some challenging ways:

Cranberries20101210Cranberry juice doesn’t work on urinary tract infections

Despite longtime belief in its potency, cranberry juice doesn’t help women with urinary tract infections (UTIs), new research confirms. Experts administered cranberry capsules to 185 female nursing home patients for a year. The standardized doses were equal to  drinking 20 ounces of juice daily. They fared no better with UTIs. That led the peer-reviewed Journal of the American Medical Association to editorialize that, “The continuing promotion of cranberry use to prevent recurrent UTI in the popular press or online advice seems inconsistent with the reality of repeated negative studies or positive studies compromised by methodological shortcomings. Any continued promotion of the use of cranberry products seems to go beyond available scientific evidence and rational reasoning.” JAMA says it is time not only to bust this myth but for proponents, including those who have a well-intentioned wish to find antibiotic alternatives, to “move on.”

spermeggjpgA reported rash of new lawsuits offers a poignant, sadly recurrent reminder: Aspiring parents who rely on commercial sperm banks for critical reproductive tissues must heed an ancient consumer prescription: caveat emptor. The New York Times says litigation, from Florida to California, Canada to the UK, all raises serious questions about the light or nonexistent regulation of assisted reproduction centers and the materials and services they tout. As the Times describes it, the latest suits highlight “claims of deception and negligence, and [add to] an array of challenges beyond the longstanding issue of undetected genetic problems,” in donor sperm.

The sperm banks, the paper notes, stand accused of “careless record-keeping, or mishandling or misappropriation of sperm banked for a client’s personal use. Others say the banks use hyped, misleading descriptions to market their donors.” The Times reports on cases in which banks have given out wrong tissues that may lead to offspring with serious genetic-related conditions, and from donors with bad or difficult histories, including cases in which mothers assert they have learned, post hoc, that they will bear children of a different race.

Regulators exercise minimal oversight over these operations, often mostly to ensure sanitary conditions in storage facilities and steps to try to curb transmission of disease.

stirrupsThere’s insufficient evidence of the health benefits for millions of women who aren’t pregnant and who aren’t experiencing problems to undergo regular pelvic exams, a top federal task force on preventive care says.

Tens of millions of women get the exams each year, even though they are intrusive and uncomfortable. More important, research has failed to demonstrate that the procedure prolongs women’s lives or decreases their chances of developing illnesses like ovarian cancer, the influential U.S. Preventive Services Task Force has advised.

The group and other medical organizations in recent years have applied rigorous, evidence-based research to common, and seemingly common-sense tests and exams. They have found, as the online news site Stat says, that regular screening mammograms, annual PSA prostate tests, and yearly physicals “have little basis in science and fewer benefits that once thought.”

hpvWhen it comes to inoculations for kids, cancer doctors want more preteens to get the vaccine against the human papilloma virus (HPV), while public health officials are encouraging shots and discouraging the use of a nasal mist to protect children against seasonal flu.

The campaign for HPV shots has shifted among medical experts, the Washington Post reported, moving from pediatricians to cancer specialists. Oncologists are pushing this vaccine, citing its effectiveness in curbing cervical cancer in girls and young women, and in helping to reduce throat cancers in men.

I’ve written before about studies showing the vaccine’s effectiveness, and the reluctance of pediatricians, in particular, to recommend this therapy robustly because that would mean talking to young patients, ages 10 to 12, about sex and sexuality.

mergerFew states are monitoring, much less acting to protect, patient-consumers from one of the hot trends in today’s health care: the mergers, acquisitions, consolidations─and yes, closings─that are creating super-sized hospital organizations, chain-institutions that for business reasons seek greater efficiencies but also may be lessening access to care, sometimes as a result of religious reasons.

That’s the contention of a group called mergerwatch.org, which arose from a group of New York state family planning advocates who reacted when two hospitals, one Catholic and the other secular, merged, and reproductive services became a contentious issue in the new institution.

The group since has scrutinized hospital mergers, consolidations, and closings nationally, issuing a new study from its “When Hospitals Merge” project─an initiative that has been foundation supported and has published in peer-reviewed, respected medical journals like the AMA Journal of Ethics.

With the presidential campaigns under way and some partisans playing crazy with health care issues, it’s refreshing to find some good news to report about women’s reproductive issues, specifically, increases in early diagnoses in young women of treatable cervical cancer and calm, quiet efforts in two states to empower pharmacists to prescribe birth control medications.

Researchers from the American Cancer Society attribute the favorable finding on cervical cancer diagnoses to an aspect of the Affordable Care Act, aka Obamacare — more young women stayed on their parents’ insurance coverage and benefited from detection programs, the New York Times has reported.

This matters because the research shows that women with insurance are more likely to get screenings that identify the cancer early and: “Early diagnosis improves the prospects for survival because treatment is more effective and the chance of remission is higher. It also bolsters women’s chances for preserving their fertility during treatment.”

For a nation that’s 238 years old, America can be remarkably immature in certain ways — take, for example, in its thinking about sex. Maybe if we weren’t so adolescent about this life-giving topic, we wouldn’t have been subjected to some of the recent, tawdry, and distressing reports from yes, both celebrities and scientists.

HIV-AIDS persists as one of the nation’s major public health challenges, as the U.S. Office for Disease Prevention and Health Promotion points out, noting: An estimated 1.1 million Americans are living with HIV, and 1 out of 5 people with HIV do not know they have it.HIV continues to spread, leading to about 56,000 new HIV infections each year.” Retrovirals have allowed millions to live and live better with HIV as a serious, chronic disease.

But surely the public discourse on HIV should not be dominated by the sad hijinks of the likes of television star Charlie Sheen, who took to the airwaves, along with tut-tut commentaries that followed, to disclose his HIV-positive status and the wealth-soaked lifestyle that contributed to it. His ostensible reason for his broadcast appearance, he said, was to encourage others’ greater HIV awareness and to urge the sexually active to get tested regularly for the disease. Of course he also said that his new-found candor will allow him to cut off the millions of dollars he has paid to keep his status secret.

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