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March 2005 CCC Corner
> Features
Features
American
Family Physician**
Patient-Oriented Evidence that Matters (POEMS)*
Does Melatonin Improve Sleep in Asthmatic Women?
Clinical Question: Does melatonin improve sleep in women with asthma?
Bottom Line: Melatonin improves sleep quality in women with asthma, but not in a clinically meaningful way. (Level of Evidence: 2b)
http://www.aafp.org/afp/20050315/tips/22.html
*POEM Rating system: http://www.infopoems.com/levels.html POEM Definition: http://www.aafp.org/x19976.xml
** The AFP sites will sometimes ask for a username and password. Instead just ‘hit; cancel on the pop up password screen, and the page you are requesting will come up without having to enter a username and password.
ACOG
Pregestational diabetes mellitus.
ACOG Practice Bulletin No. 60
Summary of Recommendations and Conclusions
The following recommendations are based on limited or inconsistent scientific evidence (Level B):
- Suspected fetal macrosomia is not an indication for induction of labor because induction does not improve maternal or fetal outcomes.
- Antepartum fetal monitoring, including fetal movement counting, the nonstress test, the biophysical profile, and the contraction stress test when performed at appropriate intervals, is a valuable approach and can be used to monitor the pregnancies of women with pregestational diabetes mellitus.
- Adequate maternal glucose control should be maintained near physiologic levels before conception and throughout pregnancy to decrease the likelihood of spontaneous abortion, fetal malformation, fetal macrosomia, intrauterine fetal death, and neonatal morbidity.
- Patients and their families should be taught how to respond quickly and appropriately to hypoglycemia.
- Preconceptional counseling for women with pre-gestational diabetes mellitus has been reported to be beneficial and cost-effective and should be encouraged.
- The use of oral agents for control of type 2 diabetes mellitus during pregnancy should be limited and individualized until data regarding the safety and efficacy of these drugs become available.
- To prevent traumatic birth injury, cesarean delivery may be considered if the estimated fetal weight is greater than 4,500 g in women with diabetes.
Pregestational diabetes mellitus. ACOG Practice Bulletin No. 60. American College of Obstetricians and Gynecologists. Obstet Gynecol 2005;105:675–85.
Non-ACOG members
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15738045
ACOG Members
http://www.acog.org/publications/educational_bulletins/pb060.cfm
AHRQ
First-week followup of newborns after hospital discharge is critical to prevent severe jaundice and other problems
http://www.ahrq.gov/research/jan05/0105RA24.htm#head2
Ask A Librarian : Diane Cooper, M.S.L.S. / NIH
Salmonella from Pet Turtles-Again
Although banned by the FDA, pet turtles have emerged as a source of salmonella disease in children in Wisconsin and Wyoming recently. In some cases, the turtles were given away with purchases in a souvenir shop. Apparently the shop owner thought the FDA ban applied only to selling, but that's not a loophole. In another case, the turtle was sold "for educational purposes," again, not a loophole. Health departments can issue orders to stop distribution in both cases. "Salmonella infections usually (are) mild but can lead to...septicemia or meningitis (especially in infants and immunocompromised persons" the CDC warns. MMWR March 11, 2005;54:9
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5409a3.htm
Breastfeeding
Resurgence of kernicterus attributed primarily to early discharge of newborns
Neonatal Jaundice: Clinical Evidence Concise - BMJ
What are the effects of treatments for unconjugated hyperbilirubinemia in term and preterm infants?
BENEFICIAL
Exchange Transfusion. We found no randomized controlled trials (RCTs) on the effects of exchange transfusion versus no treatment or versus phototherapy. There is general consensus that exchange transfusion is effective in reducing serum bilirubin levels and in preventing neurodevelopmental sequelae. In most of the RCTs comparing other interventions, exchange transfusion was used successfully to reduce serum bilirubin levels when those interventions failed to control the rise of serum bilirubin.
Phototherapy. Two RCTs found that conventional phototherapy and fiberoptic phototherapy reduced neonatal jaundice more effectively than no treatment. One systematic review (which included quasirandomized and randomized controlled trials) and one subsequent RCT found that conventional phototherapy was more effective than fiberoptic phototherapy, although subgroup analysis in the systematic review found no significant difference between groups in preterm infants. No trials included in the review evaluated the impact of either phototherapy method on parent-infant bonding. One RCT found a greater effect with double-conventional compared with single-conventional phototherapy, but another RCT found no significant difference between double-fiberoptic and single-conventional phototherapy. One systematic review (which included quasirandomized and randomized controlled trials) found no significant difference between fiberoptic plus conventional and conventional phototherapy alone in additional phototherapy, exchange transfusion, or percentage change in bilirubin after 24 hours, although it noted a trend favoring the fiberoptic plus conventional group. Most trials did not report kernicterus as an outcome. We found insufficient evidence on the adverse effects of phototherapy.
UNKNOWN EFFECTIVENESS
Albumin Infusion. We found no RCTs on the effects of albumin infusion versus no treatment or versus other treatment.
Home Versus Hospital Phototherapy. We found no RCTs on the effects of home phototherapy versus no treatment or versus hospital phototherapy.
Definition
Neonatal jaundice refers to the yellow coloration of the skin and sclera of newborn infants that results from hyperbilirubinemia.
Incidence/Prevalence
Jaundice is the most common condition requiring medical attention in newborn infants. About 50 percent of term and 80 percent of preterm infants develop jaundice in the first week of life.1 Jaundice also is a common cause of readmission to the hospital after early discharge of newborn infants.2 Jaundice usually appears two to four days after birth and disappears one to two weeks later, usually without the need for treatment.
Etiology/Risk Factors
In most infants with jaundice, there is no underlying disease and the jaundice is termed physiologic. Physiologic jaundice occurs when there is accumulation of unconjugated bilirubin in the skin and mucous membranes. It typically presents on the second or third day of life and results from the increased production of bilirubin (caused by increased circulating red cell mass and a shortened red cell lifespan) and the decreased excretion of bilirubin (caused by low concentrations of the hepatocyte binding protein, low activity of glucuronyl transferase, and increased enterohepatic circulation) that normally occur in newborn infants. In some infants, unconjugated hyperbilirubinemia may be associated with breastfeeding (breast milk jaundice), and this typically occurs after the third day of life. Although the exact cause of breast milk jaundice is not clear, it is believed to be caused by an unidentified factor in breast milk. Nonphysiologic causes include blood group incompatibility (Rhesus or ABO problems), other causes of hemolysis, sepsis, bruising, and metabolic disorders. Gilbert's and Crigler-Najjar syndromes are rare causes of neonatal jaundice.
Prognosis
In the newborn infant, unconjugated bilirubin can penetrate the blood-brain barrier and is potentially neurotoxic. Unconjugated hyperbilirubinemia can, therefore, result in neurodevelopmental sequelae including the development of kernicterus. Kernicterus is brain damage arising from the deposition of bilirubin in brain tissue. However, the exact level of bilirubin that is neurotoxic is unclear, and kernicterus at autopsy has been reported in infants in the absence of markedly elevated levels of bilirubin.3 Recent reports suggest a resurgence of kernicterus in countries in which this complication had virtually disappeared.4 This has been attributed primarily to early discharge of newborns from the hospital.
http://www.aafp.org/afp/20050301/bmj.html
CCC Corner Digest
Nicely laid out hard copy of a compact digest of last month’s CCC Corner
Highlights include:
LEEP Treatment Increases Risk of Preterm Delivery in Future Pregnancies
Announcing the new OB/GYN Deputy Chief Clinical Consultant IHS
It makes it easy for moms to remember: 2 days, 2 weeks, and 2 months
Severe Preeclampsia and Eclampsia: Systolic Hypertension Is Also Important
Progesterone Treatment Decreases Preterm Birth Rate
Sexual Function After Hysterectomy
Screening for Ovarian Cancer: Not Recommended
Gender bias in child growth evaluations may miss disease in girls
Chronic disease antecedents arise in utero and infancy: The Barker Hypothesis
Radio-Frequency Endometrial Ablation for Menorrhagia
Esterified Estrogen and Venous Thrombotic Risk
Infant Mortality: Bad News, Good News
Hormonal Contraceptives and Weight Gain
Men have often been overlooked for routine chlamydia screening
Walk 2000 More Steps a Day and Never Gain Another Pound
http://www.ihs.gov/MedicalPrograms/MCH/M/documents/050307_OL.pdf
If you want a copy of the CCC Digest mailed to you each month, please contact nmurphy@scf.cc
Domestic
Violence
Intimate Partner Violence During Pregnancy APRIL 2005 MCH EPI GRAND ROUNDS
PRESENTER: Kenneth D. Rosenberg, MD, MPH
WHEN: Wednesday, April 6, 2005 at 2:00-3:00 pm EDT
WEBCAST REQUIREMENTS: To join the webcast, you must register at least a day ahead of time at http://www.uic.edu/sph/cade/mchepi/
Homicide is the 2nd leading cause of injury-related deaths among pregnant and women
"For every 100,000 live births in the United States during 1991 through 1999, there were at least 2 women who died as a result of homicide during pregnancy or within 1 year after pregnancy,"
Chang J, Berg CJ, Saltzman LE, et al. 2005. Homicide: A leading cause of injury deaths among pregnant and postpartum women in the United States, 1991-1999. American Journal of Public Health 95(3):471-477.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15727979
An easy palm-based downloadable domestic violence assessment tool
In an effort to reach health practitioners and health professional students who rely on palm-based electronic tools for quick reference, the Family Violence Prevention Fund, in collaboration with Denise Bilbao, MD and Leigh Kimberg, MD, recently created a new assessment tool for domestic violence. Complete with tips on how to conduct inquiry, assessment, intervention, documentation, and follow-up for domestic violence, along with facts and web links, this palm ready tool is available in two formats, for either the iSilo or Documents to Go text readers. http://endabuse.org/health/ipv/
Elder
Care News
Palliative care and hospice training in Anchorage, Alaska - May 10-12, 2005
We have funds to support travel, per diem, and registration for three persons from each Area. This can be in the form of an interdisciplinary team or individuals from different sites. They can be tribal or IHS. This is an interdisciplinary training, targeted toward physicians, NPs, PAs, nurses, pharmacists, and behavioral health clinicians.
Federal travelers will be asked to generate their own travel orders and arrangements and the costs will reimbursed directly from HQE.
Nonfederal travelers will have their travel arrangements made by ANTHC, the conference contractor and reimbursement will be made by ANTHC to the traveler.
There is room for as many additional individuals from each Area as you can send, with travel, per diem and registration costs ($300) borne by the Area, SU, or Tribe. The registration cost is significantly less than what it is actually costing for the conference and also includes a toolkit including state-of-the art reference materials.
As in the past, we are asking that the CMO from each Area "nominate" the team that will be supported from the Area. CDs and DONs are asked to send their nominations to their Area CMO.
Please send Dr. Finke the names and contact information for all individuals traveling through the Area, indicating those "nominated" for complete cost coverage and those additional folks whose programs will be covering the costs. We will register all of them directly. If there are additional funds available, we can, perhaps, help defray the cost of additional trainees.
The absolute deadline for nominations is Friday, April 1
Contact Bruce.Finke@ihs.gov or http://www.ihs.gov/MedicalPrograms/ElderCare/Index.asp
Family
Planning
Women continue to die from unintended pregnancy
…despite all that is known about them, nearly half of U.S. pregnancies continue to be unintended, women continue to die from unintended pregnancy, and adverse consequences of unintended pregnancy can be felt throughout families, communities, and the larger society
Gardner J, Miller L. 2005. Promoting the safety and use of hormonal contraceptives. Journal of Women's Health 14(1):53-60
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15692278
Effects of Contraception on Bone Mineral Density
Women using depot medroxyprogesterone acetate contraception lost approximately 3 percent in bone mineral density per year. Because this form of contraception is intended for long-term use, they call for additional studies to determine if the loss continues linearly and to identify strategies to counteract the effect. Berenson AB, et al. Effects of hormonal contraception on bone mineral density after 24 months of use. Obstet Gynecol May 2004;103:899-906.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15121563
OB/GYN CCC Editorial comment:
Please see the January CCC Corner commentary on caution in use of DMPA for greater than 2 years after the FDA Black Box Warning.
http://www.ihs.gov/MedicalPrograms/MCH/M/OBGYN0105_AOM.cfm
Frequently
asked questions
Q. What is the Indian Health policy for HIV screening in pregnancy?
A. Our goal is to maximize our care by using ‘opt out’ HIV screening.
http://www.ihs.gov/MedicalPrograms/MCH/M/documents/HIVscreen52005.doc
Q. Should I prescribe Depo Provera as a long term agent for more than 2 years?
A. There is concern about bone loss if used > 2 yrs. Here are some alternative strategies
http://www.ihs.gov/MedicalPrograms/MCH/M/documents/Depo21205.doc
Q. What preventive therapy is recommended for patients at high risk for pre-eclampsia?
A. Low dose aspirin is recommended for selected high risk patients. Calcium is less certain.
http://www.ihs.gov/MedicalPrograms/MCH/m/documents/AspirPreec21405.doc
Q. My patient is not doing too well with her hormone replacement therapy. Options?
A. There are many options: pharmacologic, behavioral, dietary, and cultural.
http://www.ihs.gov/MedicalPrograms/MCH/M/documents/HRT21405.doc
Q. What are the best staffing ratios for my clinic and / or my hospital?
A. The best ratios provide effective care with dignity for your patients. See below
http://www.ihs.gov/MedicalPrograms/MCH/M/documents/Staffing21205.doc
Q. What are some of the opportunities to provide care in Indian women’s health?
A. Working in Indian Health can be a rewarding health care avenue. See below
http://www.ihs.gov/MedicalPrograms/MCH/m/documents/Recruit21305.doc
Q. Is Depo Provera associated with weight gain or diabetes in American Indians and Alaska Natives?
A. Use of depot medroxyprogesterone acetate (DMPA) has commonly been associated with weight gain, but not as much as you may expect.
http://www.ihs.gov/MedicalPrograms/MCH/M/documents/DepoWeight22805.doc
Hormone
Replacement Update
Estrogen with or without progestin should not be prescribed for relief of incontinence
CONCLUSIONS: Conjugated equine estrogen alone and CEE + MPA increased the risk of UI among continent women and worsened the characteristics of UI among symptomatic women after 1 year. Conjugated equine estrogen with or without progestin should not be prescribed for the prevention or relief of UI. Hendrix SL et al. Effects of estrogen with and without progestin on urinary incontinence. JAMA. 2005 Feb 23;293(8):935-48.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&list_uids=15728164&dopt=Abstract
Information
Technology
Computerized order entry system may increase risk of medication errors
CONCLUSIONS: In this study, we found that a leading CPOE system often facilitated medication error risks, with many reported to occur frequently. As CPOE systems are implemented, clinicians and hospitals must attend to errors that these systems cause in addition to errors that they prevent. Koppel R et al. Role of computerized physician order entry systems in facilitating medication errors. JAMA. 2005 Mar 9;293(10):1197-203.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15755942
and
CONCLUSIONS: Many CDSSs improve practitioner performance. To date, the effects on patient outcomes remain understudied and, when studied, inconsistent
Garg AX et al Effects of computerized clinical decision support systems on practitioner performance and patient outcomes: a systematic review. JAMA. 2005 Mar 9;293(10):1223-38.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15755945
and
Editorial: Wears RL, Berg M. Computer technology and clinical work: still waiting for Godot. JAMA. 2005 Mar 9;293(10):1261-3.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15755949
The use of an intranet-based prenatal record improves communication among the outpatient office, the antepartum testing unit, and the labor floor.
CONCLUSION: The use of a paperless, hospital intranet-based prenatal chart significantly improves communication among providers. LEVEL OF EVIDENCE: II-3.
Bernstein PS, Farinelli C, Merkatz IR. Using an electronic medical record to improve communication within a prenatal care network. Obstet Gynecol. 2005 Mar;105(3):607-12.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&list_uids=15738032&dopt=Abstract
UpToDate Version 13.1 Now Available; Includes Pediatrics
Since our last release, our editors have updated more than 40% of our topic reviews with new information. We encourage you to check out the "What's New" section in the "Table of Contents" to access the updates considered to be of particular interest by our editors.
http://www.ihs.gov/MedicalPrograms/CIR/index.cfm?module=cir_answering_clinical_questions
Tribal Connections
The website is an important outreach tool to the American Indian/Alaska Native (AI/AN) communities and for promoting National Library of Medicine (NLM) online resources like MedlinePlus. What we have begun in our new phase is to provide editorial content in the form of news articles and features about health and wellness issues. http://www.tribalconnections.org/
Native Web.org: Resource Database / Health
http://www.nativeweb.org/resources/health/
International
Health Update
Women, inequality, and the burden of HIV
Driving through KwaZulu-Natal, South Africa, one is struck by the lush farmland and beautiful coast. Beyond this panorama, however, lie rural communities such as Umbumbulu, with its unemployment rate of 60 percent and rampant violence, where 40 percent of women seeking prenatal care are positive for the human immunodeficiency virus (HIV). Thandi Dlamini (not her real name) grew up in a crowded four-room house in Umbumbulu with 13 family members. As the youngest girl, she was charged with cooking, cleaning, and caring for her elders. At 19 years of age, she met her first boyfriend. From the perspective of….
Ojikutu BO, Stone VE. Women, inequality, and the burden of HIV. N Engl J Med. 2005 Feb 17;352(7):649-52. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&list_uids=15716557&dopt=Abstract
Physician Missions With Doctors Without Borders: A Newsmaker Interview With Christophe Fournier, MD http://www.medscape.com/viewarticle/497076?src=nlpromo
UN Predicts Global Population of 9.1 Billion by 2050
http://www.medscape.com/viewarticle/500236?src=mp
MCH
Alert
Task Force presents recommendations for reducing violence
Given that violence, particularly violence by and against juveniles, is widespread and causes considerable morbidity and mortality in the United States, the findings and recommendations in this report should be relevant to most communities. Task Force on Community Preventive Services. 2005. Recommendations to reduce violence through early childhood home visitation, therapeutic foster care, and firearm laws. American Journal of Preventive Medicine 28(2S1):6-10
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15698745
Medscape*
Genital Herpes and Pregnancy: Preventing Neonatal Transmission (Archived Web Conference)
http://www.medscape.com/viewprogram/3772?src=mp
Ask the Experts topics in Women's Health and OB/GYN Index, by specialty, Medscape
http://www.medscape.com/pages/editorial/public/ate/index-womenshealth
OB GYN & Women's Health Clinical Discussion Board Index, Medscape
http://boards.medscape.com/forums?14@@.ee6e57b
Clinical Discussion Board Index, Medscape
Hundreds of ongoing clinical discussions available
http://boards.medscape.com/forums?14@@.ee6e57b
Free CME: MedScape CME Index by specialty
http://www.medscape.com/cmecenterdirectory/Default
*NB: Medscape is free to all, but registration is required. It can be accessed from anywhere with Internet access. You just need to create a personal username and password.
Midwives Corner: Marsha Tahquechi, CNM, GIMC
Emergency OB Drills: The Phoenix Indian Medical Center Experience
After attending the American Native Women’s Health & Maternity Care Conference in Albuquerque last August, the Phoenix Indian Medical Center Midwifery Services created an Emergency OB Drill team, which includes CNMs and RNs from the obstetrical services. The team has been holding emergency OB drills in the areas of emergency cesarean section and post-partum hemorrhage, with future plans to add eclamptic events and shoulder dystocia. The drills have been quite successful with participation from the OB/GYN providers, CNMs, RNs, and most ancillary services, such as, anesthesia, laboratory, radiology, and respiratory therapy. They have been instrumental in discovering areas to improved and well received by staff.
OB/GYN CCC Editorial comment:
Thanks very much to Tami McBride, RNC; Karen Carey, CNM of PIMC for that posting
This is exactly what we all need to continue to do to keep up our skills as a team.
See the previous comments on TOLAC in From Your Colleagues: Scott Sunde
Here are other resources
Michele Lauria, M.D.: Emergency Delivery Simulations: How to Develop Teamwork (PPT 728k)
http://www.ihs.gov/MedicalPrograms/MCH/M/MCHdownloads/Talk.ppt
or for all the lecture notes and slides
http://www.ihs.gov/MedicalPrograms/MCH/M/PROG01.cfm#MeetingLecNotes
Other Midwives Corner items:
Concern over rising cesarean delivery rate: ACNM approaches Congress
The American College of Nurse Midwives in February sent a letter to Congress expressing concern over the rising cesarean delivery rate (27% in 2003) and the declining VBAC rate (10.6% in 2003) in this country. They have asked Congress to explore these issues from a public health perspective. http://www.midwife.org/press/display.cfm?id=461
Ice Massage for the Reduction of Labor Pain
Two recent studies have explored the use of ice message for the reduction of pain in early labor. This technique may be added to the armamentarium of providers for some patients seeking pain relief in early labor.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=14526344
Alternative Medicines' Popularity Prompts Concern
Use of Alternative and Complementary Remedies on the Rise - Midwives and Ob-Gyn providers are not strangers to the use of traditional and alternative medicine in native populations. The Center for Complementary and Alternative Medicine at NIH released a survey in May 2004 demonstrating the widespread use of CAM’s across the nation. The need for careful screening of ob-gyn patients in the use of CAM’s at entry into care is essential in safely and effectively treating patients. The "WHO Guidelines: Developing Information on Proper Use of Traditional, Complementary and Alternative Medicine" can be found online at www.who.int/medicines/library/trm/consumer.pdf Other resources
http://nccam.nih.gov http://www.medscape.com/viewarticle/484309?src=search
Office
of Women's Health, CDC
Spread the Word - National Women's Health Week, May 8-14, 2005
Whether you are an individual, organization, health professional, or other, you can participate. Host an event, spread the word or do what you can to help women get the health screenings or information they need http://www.4woman.gov/whw/
Osteoporosis
How best to start good bone health?
CONCLUSION: Scant evidence supports nutrition guidelines focused specifically on increasing milk or other dairy product intake for promoting child and adolescent bone mineralization.
Lanou AJ, Berkow SE, Barnard ND. Calcium, dairy products, and bone health in children and young adults: a reevaluation of the evidence. Pediatrics. 2005 Mar;115(3):736-43.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15741380
Commentary
Greer FR Bone Health: It's More Than Calcium Intake Pediatrics. 2005 Mar;115(3):792-4.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15741386
Clinical Rules Don't Predict Osteoporosis in Women
CONCLUSIONS: Our results suggest that these clinical prediction rules do not perform well as a general screening method to identify postmenopausal women who are more likely to have osteoporosis; however, the Osteoporosis Risk Assessment Instrument and Simple Calculated Osteoporosis Risk Estimation may be useful in identifying some women who need not undergo testing, especially younger postmenopausal women.
Mauck KF et al. Use of clinical prediction rules in detecting osteoporosis in a population-based sample of postmenopausal women. Arch Intern Med. 2005 Mar 14;165(5):530-6.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&list_uids=15767529&dopt=Abstract
Patient
Information
Consumer Health: Indian Health
http://www.ihs.gov/MedicalPrograms/consumer-health/
What Should I Know About Cholesterol?
http://www.aafp.org/afp/20050315/1147ph.html
Vertigo-A Type of Dizziness
http://www.aafp.org/afp/20050315/1129ph.html
Primary
Care Discussion Forum
April 1, 2005: Methamphetamine use in Indian Country
Moderator: Steve Holve
-How common is Methamphetamine use in your area?
-Should all mothers be screened at delivery for Methamphetamine use or only if medically indicated?
-What resources are available in your community if a pregnant mother is found to be using Methamphetamine?
-What resources are available for teenagers and adults who are Methamphetamine users?
-What programs have shown success in treating Methamphetamine addiction?
How to subscribe / unsubscribe to the Primary Care Discussion Forum?
Subscribe to the Primary Care listserv
http://www.ihs.gov/generalweb/helpcenter/helpdesk/index.cfm?module=listserv&option=subscribe&newquery=1
Unsubscribe from the Primary Care listserv
http://www.ihs.gov/generalweb/helpcenter/helpdesk/index.cfm?module=listserv&option=unsubscribe&newquery=1
Questions on how to subscribe, contact nmurphy@scf.cc directly
STD Corner - Laura Shelby,
STD Director, IHS
Women's Sexual Health and Sexually Transmitted Diseases – Advances in the Field
May 13, 2005 San Francisco
Current advances in the intersecting fields of women’s sexual health and STDs. The conference proposes a sexual health agenda for the 21st century. 7.25 CMEs; 8.7 CEUs
(916) 443-0218 or Alex@RDLent.com
www.rdlent.com or http://www.rdlent.com/index.cfm?fuseaction=agenda&cid=61
Other:
Expedited treatment of sex partners on persistent gonorrhea or chlamydial infection
Providing medication for the sexual partners of patients with gonorrhea or chlamydial infection without requiring the partners' prior medical evaluation significantly reduced persistent or recurrent infections among participants
Golden MR, Whittington WLH, Handsfield HH, et al. 2005. Effect of expedited treatment of sex partners on recurrent or persistent gonorrhea or chlamydial infection. The New England Journal of Medicine, 352(7):676-685.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15716561
Barbara
Stillwater, Alaska State Diabetes Program
Postmenopausal Women and Visceral Fat Loss through Exercise
Women with diabetes cannot rely on diet alone to get rid of the stomach bulge
When a woman with type 2 diabetes wants to lose her belly, exercise is her best friend. Even if she diets perfectly, eating all the right foods in ideal amounts, her waistline may not budge unless she works out. Exercise is required to lose excess fat deep in the abdomen, says a new study. Diet alone did not reduce visceral fat. Only exercise alone or exercise plus dieting reduced visceral fat. The researchers say their study demonstrates the importance of exercise in reducing visceral fat in the treatment of women with type 2 diabetes.
In conclusion, modest weight loss, through either D or D+E, resulted in similar improvements in total abdominal fat, SAT, and glycemic status in postmenopausal women with type 2 diabetes; however, the addition of exercise to diet is necessary for VAT loss. These data demonstrate the importance of exercise in the treatment of women with type 2 diabetes.
Giannopoulou I, et al. Excercise is required for visceral fat loss in postmenopausal women with type 2 diabetes. J Clin Endocrinol Metab. 2005 Mar;90(3):1511-8
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15598677
Minding the gender gap: The divergence between men's and women's health research
Men and women are different -- in ways beyond anatomy. A push to explore the chasm that separates research could give primary care more insight into the variations.
The NIH didn't require that women be included in clinical trials until 1993.
Here is just one example of the downstream result of these trends:
Women's hearts at risk
Women are still less likely than men to receive recommendations from their physicians for preventive therapies such as cholesterol-lowering drugs, aspirin therapy and cardiac rehabilitation to protect them from heart disease and death, according to a new study.
Mieres JH et al. Role of noninvasive testing in the clinical evaluation of women with suspected coronary artery disease: consensus statement from the Cardiac Imaging Committee, Council on Clinical Cardiology, and the Cardiovascular Imaging and Intervention Committee, Council on Cardiovascular Radiology and Intervention, American Heart Association. Circulation. 2005 Feb 8;111(5):682-96
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15687114
Omitting breakfast on insulin sensitivity and fasting lipid: Deleterious effects
Conclusion: Omitting breakfast impairs fasting lipids and postprandial insulin sensitivity and could lead to weight gain if the observed higher energy intake was sustained
Farshchi HR et al Deleterious effects of omitting breakfast on insulin sensitivity and fasting lipid profiles in healthy lean women. Am J Clin Nutr. 2005 Feb;81(2):388-96
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15699226
Waist circumference cutoffs for identifying cardiovascular disease risk factors
Conclusions: WC is a better indicator of CVD risk than is BMI in the 3 race-ethnicity groups studied. The proposed WC cutoffs are more sensitive than are BMI cutoffs in predicting CVD risk.
Zhu S et al Race-ethnicity-specific waist circumference cutoffs for identifying cardiovascular disease risk factors. Am J Clin Nutr. 2005 Feb;81(2):409-15.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15699228
Beginning Exercise Routine Later in Life Still Reduces Heart Disease, Diabetes risk
CONCLUSIONS: Higher fitness achieved over 10 years of regular exercise training in older adults was associated with reduced development of metabolic risk factors for cardiovascular disease, fewer exercise-induced cardiac abnormalities, and reduced comorbidity.
Petrella RJ, et al Can adoption of regular exercise later in life prevent metabolic risk for cardiovascular disease? : Diabetes Care. 2005 Mar;28(3):694-701
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&list_uids=15735210&dopt=Abstract
Blood Pressure, Insulin Sensitivity Linked to Waist Circumference
These results suggest that the documented association between obesity, fasting insulin, insulin sensitivity, and blood pressure is largely explained by concomitant variation in WC.
Poirier P, et al Impact of waist circumference on the relationship between blood pressure and insulin: the Quebec Health Survey. Hypertension 2005;45:347-348,363-367.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15668356
Commentary: Dr. Ele Ferrannini, University of Pisa School of Medicine, Pisa, Italy
Hypertension 2005;45:347-348
VHA Health Foundation 2005 Call for Proposals
The VHA Health Foundation is challenging health care providers across the country to submit their best, most innovative programs for funding consideration. The Foundation will award grants ranging from $100,000 to $250,000 to support promising initiatives at the local level that represent a novel and/or significantly better approach to solving a problem or need related to health and/or health care. This program encourages creativity, innovation and the adoption and/or adaptation of new ideas and practices in the health care industry www.vhahf.org.
The Letter of Intent deadline: April 18, 2005 Full proposal: May 13, 2005
What's
new on the ITU MCH web pages?
Obesity: Surgical Treatment? Primary Care Forum Discussion Summary
http://www.ihs.gov/MedicalPrograms/MCH/M/documents/SumObe22805.doc
Obesity: Surgical Treatment? Primary Care Forum Discussion - Full
http://www.ihs.gov/MedicalPrograms/MCH/M/documents/ObesDisc31305.doc
Q. How many deliveries does a provider need to maintain active privileges?
A. Those numbers should be set by the local Medical Staff. Here are some examples
http://www.ihs.gov/MedicalPrograms/MCH/m/documents/Credent21905.doc
There are several upcoming Conferences
../F/CN01.cfm#top
and Online CME/CEU resources, etc….
http://www.ihs.gov/MedicalPrograms/MCH/M/CN13.cfm
and the latest Perinatology Corners (free online CME from IHS) are at
http://www.ihs.gov/MedicalPrograms/MCH/M/MCHpericrnr.asp
…or just take a look at the What’s New page
wNew.cfm#top
Save
the dates
IHS Domestic Violence Prevention / Intentional Injuries Course
17th Annual IHS Research Conference: International Meeting on Inuit and Native American Child Health: Innovations in clinical care and research
3rd Western MCH Epidemiology
American College of Obstetricians and Gynecologists Annual Clinical Meeting
Advances in Indian Health
Prevention of Cardiovascular Disease & Diabetes Among AI / AN
Native American Women’s Health: Leadership for Change Conference
- May 19 -20, 2005
- Denver, CO
- Office on Women’s Health, DHHS
- Invitation for Dialogue, Planning, and Commitment to Health
- ../F/CN01.cfm#May05
2005 U.S. Public Health Conference/Global Health Summit
- June 5-9, 2005
- Philadelphia, PA, Development of the Report on Global Health
- 40th Annual U.S. Public Health Professional Conference, June 6-9, 2005
- www.coausphsconference.org
I.H.S. / A.C.O.G. Postgraduate Course: Obstetric, Neonatal, and Gynecologic Care
National Summit on Preconception Care
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top
Dr.
Neil Murphy is the Obstetrics and Gynecology Chief Clinical Consultant
(OB/GYN C.C.C.).
Dr. Murphy is very interested in establishing a dialogue and/or
networking with anyone involved in women's health or maternal child
health, especially as it applies to Native or indigenous peoples
around the world. Please don't hesitate to contact him by e-mail
or phone at 907-729-3154.
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