Researchers from the US and the UK who analysed health data on over 17,000 women from midlife to old age found that being overweight or obese in middle age was linked to a significantly lower chance of enjoying good health in old age, with obese middle aged women having a 79 per cent lower chance.

The study was the work of researchers from the Harvard School of Public Health (HSPH) and Brigham and Womens Hospital in Boston, Massachusetts, USA, and the University of Warwick in the UK, and is published online in the 29 September issue of the BMJ.

For the study the researchers used data from over 17,000 participants of the Nurses Health Study, United States, one of the largest and longest running investigations of factors that influence womens health.

All the participants lived at least until the age of 70 and were free from major chronic diseases at midlife (their mean age was 50 in 1976, the baseline date of the study). They continued to give information on physical function, chronic diseases, cognitive function, and mental health as they approached 70 and over.

The researchers defined “healthy survival” as living to 70 and beyond while at the same time having (1) no history of 11 major chronic diseases, and (2) having “no substantial cognitive, physical, or mental limitations”. Thus not only being free of disease, but also having all ones faculties and enough physical and mental ability to go shopping, go up and down stairs and take care of oneself.

“Usual survival” was living to 70 and over but with no particular health status.

After analysing the data the researchers found that9.9 per cent of the women who lived to the age of 70 and over met the criteria for “healthy survival”.
After taking into account lifestyle and diet, the higher a womans BMI at baseline, the lower her odds of healthy survival, compared to “usual survival” (this was a linear relationship with P

An article published Online First and in a future edition of The Lancet reports that hormone replacement therapy (HRT) using oestrogen and progestin increases the risk of death from lung cancer. This finding should be included into riskbenefit consideration for women considering HRT. It is especially essential for women at high risk of lung cancer. The article is the work of Professor Rowan Chlebowski, of the Los Angeles Biomedical Research Institute at HarbourUCLA Medical Center, Torrance, CA, USA, and colleagues.

Data from the Womens Health Initiative (WHI) trial was studied. This large trial, of HRT (oestrogen plus progestin) in postmenopausal women, was stopped prematurely when health risks were found to outweigh benefits. Followup after an average of 5.6 years showed that participants assigned to HRT had higher risks of cardiovascular disease, coronary heart disease, stroke, venous thromboembolism, and breast cancer, and lower risks of fractures and colorectal cancers than did women assigned to placebo. Between study groups, allcause mortality did not fluctuate. In addition, results from further followup of an additional 2.4 years (totalling 8 years of monitoring) suggested that the combined hormone therapy might increase mortality from lung cancer. In order to corroborate this association, the authors evaluated the number of lung cancers diagnosed in the trial over the whole followup period.

The WHI study involved 16,608 postmenopausal women aged 50 to 79 years with an intact uterus. It was a randomised controlled trial that took place in 40 centres in the USA. A group of 8,506 women received a oncedaily tablet of 0.625 mg conjugated equine oestrogen plus 2.5 mg medroxyprogesterone acetate. The other group of 8,102 women received matching placebo. After the 8 years total followup the researchers found that more women died from lung cancer in the combined hormone therapy group than in the placebo group (73 compared to 40 deaths). In other words, women in the HRT group were 71 percent more likely to die. This was mostly as a result of a higher number of deaths from nonsmallcell lung cancer (NSCLC) in the combined therapy group (62 compared to 31 deaths). Women in the HRT group were 87 percent more likely to die particularly of NSCLC. In addition, women in the HRT group were 28 percent more likely to be diagnosed with lung cancer than those given placebo, although this finding was not statistically significant. Between groups, incidence and mortality rates of smallcell lung cancer were comparable.

Dr. Rowan T. Chlebowski, MD, PhD, Los Angeles Biomedical Research Institute (LA BioMed) chief of oncology and author of the study comments”Postmenopausal women, especially current smokers or longterm past smokers, should carefully consider these new lung cancer findings before initiating or continuing combined estrogen plus progestin use.”

The authors write in conclusion “Treatment with oestrogen plus progestin in postmenopausal women…increased the number of deaths from lung cancer, in particular deaths from nonsmallcell lung cancer. These findings should be incorporated into riskbenefit discussions with women considering combined hormone therapy, especially those with a high risk of lung cancer…such as current smokers or longterm past smokers.”

In a supplementary note, Dr Apar Kishor Ganti, University of Nebraska Medical Center, Omaha, NE, USA, remarks “Because the optimum safe duration of hormonereplacement therapy in terms of lungcancer survival is unclear, such therapy should probably be avoided in women at a high risk of developing lung cancer, especially those with a history of smoking. These results, along with the findings showing no protection against coronary heart disease, seriously question whether hormonereplacement therapy has any role in medicine today. It is difficult to presume that the benefits of routine use of such therapy for menopausal symptoms outweigh the increased risks of mortality, especially in the absence of improvement in the quality of life.”

“Oestrogen plus progestin and lung cancer in postmenopausal women (Womens Health Initiative trial) a posthoc analysis of a randomised controlled trial”
Rowan T Chlebowski, Ann G Schwartz, Heather Wakelee, Garnet L Anderson, Marcia L Stefanick, JoAnn E Manson, Rebecca J Rodabough, Jason W Chien, Jean WactawskiWende, Margery Gass, Jane Morley Kotchen, Karen C Johnson, Mary Jo OSullivan, Judith K Ockene, Chu Chen, F Allan Hubbell, for the Womens Health Initiative Investigators
DOI 10.1016/S01406736(09)615269
The Lancet

More than 200 million women worldwide want contraceptives, but currently have no access to them. Addressing this unmet need, and the 76 million unintended pregnancies globally each year, would slow population growth. This in turn would reduce demographic pressure on the environment. Those issues are discussed in the lead editorial in this week´s edition of The Lancet.

The editorial says “Countries in the developing world least responsible for the growing emissions are likely to experience the heaviest impact of climate change, with women bearing the greatest toll. In tandem with other factors, rapid population growth in these regions increases the scale of vulnerability to the consequences of climate change, for example, food and water scarcity, environmental degradation, and human displacement.”

The editorial mentions the recent International Conference on Population and Development (ICPD) meeting in Berlin and observes “Many of the NGOs still seem to be working in silos, avoiding the multisectoral engagement required to change societal attitudes.” It qualifies of disappointing the remaining tensions between various groups in these communities, but continues to remark “However, the discussions on how the sexual and reproductive health community are grappling with the emergent environmental crises that now shadow the landscape of womens health drew much attention at the Berlin meeting.”

A study of the first 40 National Adaptation Programmes of Action (NAPAs) is soon to be published by the WHO. It is submitted by the least developed countries to the UN Framework Convention on Climate Change. The study shows that 37 of these countries made the association between population growth and climate change. However, only six of them identified family planning as an element of their adaptation strategy. This is because family planning falls under the responsibility of the Ministries of Health rather than Environment, who are responsible for the NAPA documents. Also, only 7 percent of the 448 projects across the 40 NAPAs were in the health sector.

According to the editorial, the health response is not part of the current approaches to combat climate change. There is reference to a case study in Ethiopia, where people were trained in sustainable land management practices.At the same time the availability of family planning was increased. The programme resulted in a direct improvement to the environment with better agricultural practices. This outcome will be sustained in the longterm and will not be deteriorated by a rapidly increasing population.

The editorial says in closing “With less than three months to go, the UN Copenhagen conference on climate change provides an opportunity to draw attention to the centrality of women. The sexual and reproductive health and rights community should challenge the global architecture of climate change, and its technology focus, and shift the discussion to a more humanbased, rightsbased adaptation approach. Such a strategy would better serve the range of issues pivotal to improving the health of women worldwide.”

“Sexual and reproductive health and climate change”
The Lancet

Sales of Mercks HPV vaccine, Gardasil, declined by a third this year, and three years after the FDA approved the drug an estimated three out of four women remain unvaccinated despite millions spent on advertising and lobbying for government mandates. A recent marketing study offers a reason.

Michelle Steward, assistant professor of marketing at Wake Forest University, and several colleagues conducted an experiment with women, ages 18 to 30, and found that they were more likely to consider being vaccinated for HPV after participating in a survey than as a result of commercial advertising or a government mandate.

“The educational cues in the survey are the least coercive and appear to prompt more thinking about the risks of not being vaccinated than laws, which may produce a negative backlash or advertisements, of which consumers might be skeptical,” said Steward.

“The results would suggest that Mercks money may be best spent engaging people through a survey on relevant health topics to get the consumer to think about their own risks. Theres nothing to suggest that there would be any difference in males reactions. If Merck gains FDA approval to market Gardasil for boys, the advantages of surveys versus mandates or advertising would remain the same.

“Determining how best to move consumers from hearing about a drug or vaccination to actually using the product should rival R&D in importance to a firm,” Steward said.

The study, “The Influence of Different Types of CuestoAction on Vaccination Behavior An Exploratory Study,” will be published in the spring edition of the Journal of Marketing Theory and Practice.

Steward is available to discuss the study and its implications for the marketing of healthrelated products.

Hundreds of nongovernmental organizations from around the world gathered for a threeday conference in Berlin last week, where they emphasized the need for broader international support for improving womens health worldwide “15 years after the International Conference on Population and Development in Cairo, where a similar group set goals to improve the sexual health and rights for women, particularly in the developing world,” the Associated Press reports.

Gill Greer, a conference organizer and director general of the International Planned Parenthood Federation, said, “Funding for the delivery of the programs that came out of (the Cairo conference) has not kept pace with the promises, but nevertheless there have been some dramatic changes and improvements and advances.” Greer added, “If we invest in women, they will drive development” (McGroarty, 8/5).

Speakers “called upon the 400 delegates from 131 countries to mount public demonstrations to command attention, to promote open discussion of sexual behaviour, and to insist upon scaling up successful programmes of voluntary family planning, comprehensive sex education and maternal and newborn health care,” afrol News reports.

The U.S. plans to increase its support in international programs for women, according to Scott Radloff of USAID, the AP reports. “Were likely to be witnessing about a 50 percent increase in funding for both family planning, reproductive health and for maternal/child health over a twoyear period, Radloff said, without specifying exactly how much money would be allocated,” the AP writes (8/5).

DAWN.com examines the goals that came from the Cairo conference and why international “successes in the arena of sexual and reproductive health” have been “slow coming” (Ebrahim, 9/4).

This information was reprinted from globalhealth.kff.org with kind permission from the Henry J. Kaiser Family Foundation. You can view the entire Kaiser Daily Global Health Policy Report, search the archives and sign up for email delivery at globalhealth.kff.org.

© Henry J. Kaiser Family Foundation. All rights reserved.

Critical Outcome Technologies Inc. (COTI) (TSX VENTURECOT) announced important positive results today from a series of experiments carried out at a prominent American cancer research facility. The experiments were designed; first, to estimate the oral maximum tolerated dose (MTD) for COTI2; second, to evaluate the effectiveness of oral COTI2 alone and third, to compare the effectiveness of oral COTI2 plus Doxil® (doxorubicin HCl) to that of Doxil alone. The experiments showed that

The MTD from these experiments is 100125 mg/kg when COTI2 is given once daily for 5 days/week for up to three consecutive weeks.

The maximum tumor growth inhibition was 62.8% (p less than 0.05) at day 19 in animals treated with COTI2 at or below the MTD compared with animals receiving no drug treatment.

The maximum tumor growth inhibition was 79.2% (p less than 0.05) at day 19 in animals treated with COTI2 at or below the MTD plus Doxil compared with animals receiving no drug treatment.

The maximum tumor growth inhibition was 80.2% (p less than 0.05) at day 19 in animals treated with COTI2 at or below the MTD plus Doxil compared with animals treated with Doxil alone.

Treatment with the combination of COTI2 and Doxil was well tolerated.

These results confirm and extend results from previous animal experiments where COTI2 was given intravenously and provide strong supportive evidence for the continued development of oral COTI2 in combination with conventional single agent therapy for the treatment of human ovarian cancer.

“COTI2 was originally designed to be an oral agent for the out patient treatment of multiple cancers and we are delighted to see that oral COTI2 alone, and in combination with Doxil, showed superior treatment results compared to Doxil alone as measured by significant tumor growth inhibition in an animal model of an aggressive human ovarian cancer (A2780). These results are significant because they add to the impressive data set of COTI2, showing effectiveness, particularly in combination with first and second line agents, against multiple cancers while also exhibiting low toxicity,” said Dr. Wayne R. Danter, President and Chief Scientific Officer of COTI.

“We are very pleased to receive this important new scientific data providing powerful evidence supporting the commercial potential of our pipeline,” said Mr. Michael Cloutier, Chief Executive Officer of COTI.

Source

Almost half of Bangladeshi women with young children experience violence from their husbands, and their children appear to have a higher risk of recent respiratory infections and diarrhea, according to a report in the August issue of Archives of Pediatrics & Adolescent Medicine, one of the JAMA/Archives journals.

Despite substantial improvements in childhood survival in the previous decade, 77 per 1,000 children born in Bangladesh die before age 5, according to background information in the article. Diarrhea and acute respiratory infections are the leading causes of early childhood deaths. “Violence against mothers by their husbands is a factor hypothesized to relate directly and indirectly to the poor health of young children via exposure to violence, the incapacitation of mothers and direct mistreatment and neglect of children,” the authors write.

Jay G. Silverman, Ph.D., of the Harvard School of Public Health, Boston, and colleagues studied 1,592 married Bangladeshi women with at least one child age 5 years or younger who participated in the 2004 Bangladesh Demographic Health Survey. Intimate partner violence was assessed on surveys given to the men, whereas women reported information about their childrens health.

More than two of every five (42.4 percent) of the mothers had experienced intimate partner violence from their husband within the past year. Those who did were more likely to report that their children had acute respiratory infections (19.2 percent vs. 13.7 percent) or diarrhea (11.6 percent vs. 7.6 percent) within the past two weeks. “Importantly, because the present analyses were adjusted for potential confounders, these effects persist after consideration of socioeconomic status (e.g., poverty), household characteristics and environmental factors (e.g., sanitation),” the authors write.

Both direct and indirect mechanisms may be responsible for the elevated risk of illness among children exposed to intimate partner violence, they note. Trauma and anxiety are more common among children in violent households and could lead to suppression of the immune system over time. The children could also be experiencing direct physical harm from their fathers. “A growing body of work demonstrates that intimate partner violence occurs within a context of malepartner control, which can include interference in the ability of women to meet basic health needs for themselves and their children,” the authors write. For example, women who are being abused may be less likely to have their children immunized or to breastfeed, both of which can compromise child health.

“Associations of maternal experiences of intimate partner violence with two leading causes of childhood mortality strongly suggest that such abuse threatens not only the health of women but also that of their children,” the authors conclude. “Prevention of intimate partner violence perpetration by men may be critical to the improvement of maternal and child health.”

Arch Pediatr Adolesc Med. 2009;163[8]700705.

Source
Archives of Pediatrics & Adolescent Medicine

UroToday.com Pelvic floor muscle exercise (PFME) is most appropriate for patients with mildtomoderate stress urinary incontinence (SUI). To obtain therapeutic efficacy, it is crucial that PFME be performed correctly and consistently. Without appropriate training; however, up to 30% of patients are not aware of how to perform PFME.

This was a randomized clinical trial, PretestPosttest Control Group Design. The subjects totaled 108. Half were randomly assigned to the experimental group, and the other half were randomized to the control group. The objective of this study is to investigate the relative effects of interpersonal support and digital vaginal palpation (DVP) as part of PFME training as compared to PFME with a printed handout instruction, in a 12week, individualized training program. To reflect the efficacy of DVP, a 1h pad test was employed as the primary outcome measure. The decrease in the weight of the 1h pad test from baseline was significant (p < 0.001) in the experimental group but not in the control group (p = 0.514).

The results serve to support the notion that modification of PFME techniques may lead to significant improvements in outcome. Interpersonal support and PFME, performed correctly, increase the effectiveness of PFME in reducing urine leakage, even in patients who have very few symptoms of SUI. This study was performed by a very skilled physician who had good rapport with his patients. But if the doctor is busy or his female patient with mild SUI is shy, her condition may go undiagnosed. If the nurse, however, is familiar with DVP as part of the PFME training technique, and can provide interpersonal support, more female patients with mild to moderate SUI will be helped and progression of this disease will be prevented.

Written by ChiehHsing Liu as part of Beyond the Abstract on UroToday.com

UroToday the only urology website with original content written by global urology key opinion leaders actively engaged in clinical practice. To access the latest urology news releases from UroToday, go tourotoday.com

A federal vaccine advisory panel scheduled to meet Wednesday likely will recommend that pregnant women be among the first groups to receive the H1N1 influenza vaccine if a limited number of doses are available, the AP/Atlanta JournalConstitution reports. The Centers for Disease Control and Prevention usually accepts the recommendations of the panel, called the Advisory Committee on Immunization Practices. According to the AP/JournalConstitution, health care workers are expected to be the No. 1 priority for receiving the vaccine.

For more than 10 years, the panel has recommended that pregnant women get vaccinated for seasonal flu, which can be a threat even to those who are young and healthy. CDC data show that pregnant women, who make up 1% of the U.S. population, have accounted for 6% of H1N1 flu deaths in the country since April, when the pandemic began.

British and Swiss health officials have recommended that women consider delaying pregnancies if possible. Most health officials have said that advice oversteps the available evidence, but they have agreed that pregnant women face significant risk from the H1N1 flu. A recent World Health Organization report stated that pregnant women appear to be “at increased risk for severe [H1N1] disease, potentially resulting in spontaneous abortion and/or death, especially during the second and third trimesters of pregnancy.” However, WHO has not yet recommended that pregnant women get priority vaccinations. Kevin Ault, an obstetrician at Emory University, said that pregnant women are especially vulnerable because of changes in the lungs and immune system that make it more difficult to overcome respiratory infections (Stobbe, AP/Atlanta JournalConstitution, 7/28).

Reprinted with kind permission from nationalpartnership.org. You can view the entire Daily Womens Health Policy Report, search the archives, or sign up for email delivery here. The Daily Womens Health Policy Report is a free service of the National Partnership for Women & Families, published by The Advisory Board Company.

© 2009 The Advisory Board Company. All rights reserved.

Timeframe before conception may be linked to disease later in life

Mothers health in the days and weeks prior to becoming pregnant may determine the health of offspring much later in life, according to results of studies reported at the annual meeting of the Society for the Study of Reproduction, which is taking place July 18 to 22 at the David L. Lawrence Convention Center in Pittsburgh. These studies demonstrate that maternal nutrition, protein intake and level of fat in the diet may cause epigenetic changes in the developing fetus that can have longterm health consequences.

Summaries of their findings are as follows

Too Much of a Sweet Thing? Maternal Diabetes and Embryo Development

The time between ovulation and conception may be a critical one for maternal and fetal health, according to Kelle Moley, M.D., Washington University School of Medicine. In mouse studies, she found that subtle differences in maternal metabolism had longlasting effects. Indeed, when Dr. Moley transferred embryos from a diabetic mouse into a nondiabetic mouse shortly after egg implantation, she noted neural tube defects, heart defects, limb deformities and growth defects in offspring. These findings indicate that we may need to redirect our ideas about maternal health to the time prior to pregnancy, she says.

Take Your Vitamins Before Becoming Pregnant

Are we encouraging pregnant women to take vitamins when it may be too late to impact the health of a growing fetus? According to Kevin Sinclair, Ph.D., University of Nottingham, maternal nutrition even at the time of conception can alter fetal development. In studies with sheep and rodents, he found that offspring of mothers with vitamin B12 and folic acid deficiencies were fatter, became insulin resistant and had higher blood pressure by the time they reached middleage, demonstrating that early molecular changes may not manifest themselves for many years.

Low Protein Diet May Lead to “Jumpy” Offspring

Low protein levels in female mice during the first few moments of conception, when the egg is still dividing, caused abnormal growth, cardiovascular disease, high blood pressure and jumpy behavior in their offspring. According to Tom Fleming, Ph.D., University of Southampton, mice born to mothers with low protein grew bigger extracting as much nutrients as they could to compensate for poor nutrition while in the womb.

Beyond Genetics How Dormant Memories Can Impact LaterLife Events

According to epigenetic theory, changes in the genome can happen at any time through the impact of environmental factors on the expression of genes over time. One of the most critical periods is early life when epigenetic memories are created that may impact a persons susceptibility to disease later in life, says Shukmei Ho, Ph.D., University of Cincinnati Medical Center. According to her research, these “memories” may remain dormant until an environmental trigger brings them to the surface, modifying risk for disease.

Source
Clare Collins