Acupuncture and chronic pain
Posted by on September 17, 2012 - 11:49am

Acupuncture provides more relief from various types of chronic pain than does usual care and should be considered a valid therapeutic option, according to Andrew J. Vickers, DPhil of Memorial Sloan Kettering in NYC and colleagues who conducted  a meta-analysis of raw data from 29 studies.

For back and neck pain, osteoarthritis, and chronic headache, pain scores among patients treated with acupuncture were  below the pain scores for patients receiving sham acupuncture. The pain score improvement was even larger when acupuncture was compared with no acupuncture, the researchers reported online in Archives of Internal Medicine.

Acupuncture is recognized as having certain physiologic effects that can contribute to pain relief, but no plausible mechanism has been identified that could lead to long-term benefits for chronic pain, with the result that the treatment remains "highly controversial," according to the researchers.   Many controlled studies of acupuncture for pain have been published, but quality has been inconsistent and reliability has been questioned.

To provide more clarity about the effects of acupuncture on pain, Vickers and colleagues conducted an individual patient data meta-analysis based exclusively on high quality randomized trials.  Included trials required pain of at least a month's duration, with the primary endpoint being assessed at least a month after acupuncture treatment began.

This is "of major importance for clinical practice," meaning that acupuncture should be considered "a reasonable referral option for patients with chronic pain," they stated.

In an invited commentary accompanying the meta-analysis, Andrew L. Avins, MD, of Kaiser-Permanente in Oakland, Calif., argued that the benefits indeed were primarily those associated with the placebo effect, because the pain relief was so much greater when acupuncture was compared with usual care than when compared with the sham procedure.

But whether that should mean acupuncture has no value for patients, largely because of uncertainty as to its mechanisms of action, is a crucial concern, he pointed out.

"The ultimate question is: does this intervention work (or, more completely, do its benefits outweigh its risks and justify its cost)?" Avins wrote.

For acupuncture, the current meta-analysis offers "some robust evidence" that acupuncture does provide greater chronic pain relief than usual care, mechanisms of effect aside.

"Perhaps a more productive strategy at this point would be to provide whatever benefits we can for our patients, while we continue to explore more carefully all mechanisms of healing," Avins concluded.

Primary source: Archives of Internal Medicine
Vickers A, et al "Acupuncture for chronic pain: individual patient data meta-analysis" Arch Intern Med 2012; DOI: 10.1001/archinternmed.2012.3654.

More women needed in clinical trials
Posted by on September 14, 2012 - 11:42am

In the past, researchers excluded women from many studies and applied information based only on male participants to the experience of both men and women. Researchers did not design research to specifically investigate the differences between males and females because many people did not believe such differences existed. We now know many differences do exist and play a major role in the biological and physiological experiences of women and men.

To learn more about clinical trials and learn if we are making progress in the inclusion of women by reading our latest e-newsletter on the topic by clicking HERE.

Essential Health Benefits Discussed This Week In Chicago
Posted by on September 13, 2012 - 7:56am

This week a public meeting will be held in Chicago to determine which Essential Health Benefits (EHB) Illinois will cover in future health insurance plans. The Affordable Care Act has tasked each state with creating a set of EHB, which are a comprehensive package of health benefits.

Beginning in 2014, all health plans are required to begin offering the EHB to beneficiaries in the individual and small group markets. These state-based benchmark decisions are due by September 30, 2012, and could eventually affect nearly 70 million Americans, many of whom are women. The law mandates that 10 basic categories must be covered. These inlcude:

1. Ambulatory Patient Services

2. Emergency Services

3. Hospitalization

4. Maternity and Newborn Care

5. Mental Health and Substance Use Disorder Services

6. Prescription Drugs

7. Rehabilitive and Habilitive Services

8. Laboratory Services

9. Preventative and Wellness Services and Chronic Disease Management

10. Pediatric Services

Governor Pat Quinn will choose a benchmark plan that will then serve as the mandatory minimum for insurance plans in the state. The greatest importance of these EHB decisions will be the amount of coverage required in each category and the costs of insurance due to those new requirements. At first glance, it might seem the package of services related to maternity and new born care will have the most impact on women, however, it is likely that the mental health and substance use disorders services may be most needed given that women are far more likely to suffer from a wide range of anxiety disorders and depression. Despite enthusiasm for more even coverage and plan equality, the minimum categories will require that almost all insurance plans offer more than they do at present, certainly impacting the cost of health insurance.

Addressing fertility preservation for young cancer patients
Posted by on September 11, 2012 - 8:59am

Oncofertility is an interdisciplinary field at the intersection of oncology and reproductive medicine that expands fertility options for young cancer survivors. Experts in this field identify which cancer treatments are likely to damage later reproductive ability for men, women, and children and develop new fertility preservation methods. In addition, these scientists are also identifying cancer treatments that may be “fertoprotective” and prevent damage to the reproductive organs during cancer treatment. Every year, experts in this field meet to discuss the recent advances in oncofertility scientific and medical treatment. The sixth annual conference is September 27 - 28, 2012 in Chicago, IL.

The program for this two-day conference on fertility after cancer features translational and clinical research on fertility preservation, lessons learned from individual fertility preservation programs, a speech and special performance by the founder of the adolescent and young adult cancer advocacy group, Stupid Cancer, and a Keynote Symposium by Hamish Wallace, MD (Royal Hospital for Sick Children, Edinburgh). During the two days of the conference, more than 20 invited speakers from across the globe will present cutting-edge information to attendees.

Health care providers will be provided with CME or nursing contact hours at no additional cost. For more information or to register for the conference, visit the website at http://bit.ly/oncofert12 or email oncofertility@northwestern.edu. The 2012 Oncofertility Conference is funded by the NIH (Grant 5R13HD063248-03), and an unrestricted educational grant from Ferring Pharmaceuticals, Inc.

To learn more about fertility and cancer, visit SaveMyFertility.org and download the free iPhone app.

 

Women fare poorer in Alzheimer's progression
Posted by on September 10, 2012 - 9:04am

New research shows that women with Alzheimer’s disease show worse mental deterioration than men, even when at the same stage of the the disease.

According to researchers at the University of Hertfordshire, men with Alzheimer’s consistently performed better than women across the five cognitive areas they examined.

Most remarkably, the verbal skills of women with Alzheimer’s are worse when compared to men with the disease.   This finding is a striking difference to the profile for the healthy population where females have a distinct advantage.

Led by Keith Laws, Ph.D., the research team completed a meta-analysis of neurocognitive data from 15 published studies, which revealed a consistent male advantage on verbal and visuospatial tasks, as well as on tests of both episodic memory and semantic memory.

Episodic memory describes our ability to recall specific events of our own past, accompanied by the feeling of remembering. Semantic memory is knowledge that we acquire that is purely factual without any personal feeling or history attached.

“Unlike mental decline associated with normal aging, something about Alzheimer’s specifically disadvantages women,” said Laws, a psychology professor.

The influence of hormones might be a possible explanation, he said, pointing to a loss of estrogen in women. Another theory is that men have a “greater cognitive reserve” that protects against the disease, he said.  Further analysis of the data showed that age, education level and dementia severity did not explain the advantage that men with the disease have over women, he added.

Alzheimer’s disease, a progressive condition affecting memory, thinking, behavior and emotion, is the most common form of dementia.

Alzheimer’s Disease International estimates that there are currently 30 million people in the world with dementia, with 4.6 million new cases every year. The incidence of Alzheimer’s is greater among women than men, with the difference increasing with age, researchers note.

The new study was published in the Journal of Clinical and Experimental Neuropsychology.

Source: University of Hertfordshire

Vitamin D may not impact heart risk in older women
Posted by on September 8, 2012 - 9:03am

According to a new study, vitamin D supplements may not reduce heart risks in older women as previously suggested. At total of 305 healthy postmenopausal women aged 60-70 yr were recruited and received a daily capsule of 400 or 1000 IU vitamin D3 or placebo.  Investigators found that the supplements did not have much of an impact on cholesterol, blood pressure and blood sugar.

Source:  Wood et.al.  J of Cl Endo & Metabolism, Aug 3, 2012.

Breast cancer, HRT, and Alcohol
Posted by on September 7, 2012 - 8:02am

An analysis among more than 40,000 postmenopausal women who were in the California Teachers Study was carried out to determine if there were differences in risk of breast cancer among women consuming alcohol according to their previous or current use of hormone therapy (HT).  In the cohort, 660 women were diagnosed with invasive breast cancer during follow up.

Results showed an increase in risk of breast cancer among alcohol consumers of more than 20 grams of alcohol per day (about 1 ½ to 2 typical drinks) who were current users of HT but not among those who were ex-users of HT.  The authors conclude: “Following the cessation of HT use, alcohol consumption is not significantly associated with breast cancer risk, although a non-significant increased risk was observed among women who never used HT.  Our findings confirm that concurrent exposure to HT and alcohol has a substantial adverse impact on breast cancer risk.  However, after HT cessation, this risk is reduced.”

Forum reviewers considered this to be a very well done analysis on a large group of post-menopausal women with repeated assessments of alcohol consumption and HT use.  However, results from even very large studies on the relation between alcohol, HT, and breast cancer risk have often been conflicting.  Even with numerous studies on this topic, we still have very poor predictors of which women will develop breast cancer.  There is some increase in risk for women with a family history of such cancers and those who are obese.  However, the percentage increases in risk associated with HT, alcohol consumption, and other environmental factors are generally small (unlike the many-fold increase in the risk of lung cancer among smokers in comparison with never smokers).  This may explain why the results of individual studies may reach apparently conflicting conclusions.  While the present study suggests that women who consume alcohol may have a decrease in their risk of breast cancer if they stop taking hormone replacement therapy, our current understanding of factors affecting breast cancer risk remains quite inadequate.

Reference:  Horn-Ross PL, Canchola AJ, Bernstein L, Clarke CA, Lacey JV, Neuhausen SL, Reynolds P, Ursin G.  Alcohol consumption and breast cancer risk among postmenopausal women following the cessation of hormone therapy use: the California Teachers Study.  Cancer Epidemiol Biomarkers Prev 2012. [Epub ahead of print]

More women choosing IUDs
Posted by on September 4, 2012 - 1:50pm

A growing number of U.S. women may be opting for intrauterine devices (IUDs) as their birth control method, a national survey finds.  That's good news, researchers say, since IUDs and contraceptive implants are the most effective forms of reversible birth control.

In the U.S., though, they are still far from the most popular, with use lagging well behind birth control pills and condoms.   In the new study, researchers found that in 2009, 8.5 percent of U.S. women using birth control chose an IUD or implant - with the large majority going with the IUD.

That was up from just under four percent in 2007, according to findings published in the journal Fertility and Sterility.

"We saw some pretty notable growth," said lead researcher Lawrence B. Finer of the Guttmacher Institute in New York, a sexual and reproductive health organization.  Some of the possible reasons given:    medical societies, like the American College of Obstetricians and Gynecologists (ACOG), have endorsed IUDs and implants; and an increase in advertisements for IUDs.

ACOG says the devices should be offered as "first-line" options for most women, because of their effectiveness and safety.

IUDs are implanted in the uterus, where they release small amounts of either copper or the hormone progestin to prevent pregnancy.   It is estimated that with IUDs, between 0.2 - 0.8 % of women will have an unplanned pregnancy.  It is effective for 5-10 years depending on the device.   The contraceptive implant, about the size of a matchstick, is inserted under the skin of the arm, where it releases controlled amounts of progestin.  The rate for unplanned pregnancy with implants is 0.05% and it works for 3 years.

"They are basically ‘set and forget' methods," Finer said.

In contrast, the Pill and condoms must be used perfectly to be most effective. And with the way people typically use them, the unintended pregnancy rate is about 9.0%  per year.    With condoms alone, it's between 18 and 21 percent.

More could be done to encourage U.S. women to opt for IUDs and implants, according to Finer.    In some other countries, the devices are much more popular: in France and Norway, for example, about one-quarter of women on birth control use IUDs or implants. And in China, a full 41 percent do, Finer's team says in its report.

SAFETY MISCONCEPTIONS

When IUDs first came out, there were concerns that they might raise the risk of pelvic infection and jeopardize women's future fertility. So the original IUD labeling said the devices were contraindicated for women who'd never had children.   But it's now known that IUDs do not carry those risks.     "Many doctors continue to have outdated ideas about who can and cannot use an IUD," Finer said.

Cost may be another issue keeping women from using IUDs and implants.   The devices have a big upfront cost: the price of an IUD is $500-900 which does not include the doctor's charges for putting them in.    The Implanon implant costs between $400 and $800, with all charges considered.

Since the devices last for years, they are cost-effective in the long run, Finer said.

Birth control pills, for instance, cost anywhere from about $10 to $50 per month, depending on whether a woman uses generic or brand-name pills.   Finer said that may change, though, with healthcare reform. The new law considers birth control part of preventive healthcare, and most health plans must cover it without co-pays and deductibles.

IUDs and implants can have unwanted side effects, however. With the implant, irregular menstrual bleeding is most common; some women stop having their periods altogether.

"There's no one best birth control method for all couples," Finer said.    But he added that now that many couples are putting off having children until their 30s, more women may want to consider long-acting birth control options.

SOURCE: http://bit.ly/MRSbZO Fertility and Sterility, online July 13, 2012.

Reuters Health
Women's Access To Health Care: 2012 State Analysis
Posted by on September 1, 2012 - 1:15pm

Each year the Kaiser Family Foundation and the National Women’s Law Center release a Women’s Access To Care: State By State Analysis. This report highlights many of the key issues pertaining to women’s health and health policy. Given the vast amount of decision-making and funding that take place at the state level, this analysis is a yearly must read.

Here are the highlights for 2012:

General Notes of Importance

  • A total of 13 states have Offices of Women’s Health that develop agendas on women’s health issues and provide policy guidance to the governor’s office, state legislature and the state department of health.
  • Few states require special training and service protocols for health care providers and law enforcement personnel that serve victims of violence. Most states do, however, have laws prohibiting discrimination against victims of violence seeking health insurance.
  • Women now account for 30% of new HIV infections in the United States. To prevent vertical transmission of HIV, the majority of states have implemented the Centers for Disease Control and Prevention’s 1995 guidelines for HIV testing of pregnant women, which call for voluntary testing for all pregnant women.

Private Insurance Coverage

  • Most states mandate that insurers cover some screening tests important to women’s health. 49 states and DC have mammography mandates, while only 25 states and DC have cervical cancer screening mandates.
  • Some states have taken major steps in increasing access to reproductive health care for women by mandating insurance coverage for key services. Half the states have adopted contraceptive coverage mandates, which require insurers to cover contraceptives to the same extent as other prescription medications, although 14 states include an exemption for employers and/or insurers with moral or religious objections to contraception.
  • About two-thirds of states have addressed mental health parity in an attempt to increase access to mental health services. Access to mental health care is particularly important for women, who are twice as likely as men to suffer from certain mental health conditions.

Medicaid

  • Most states have made significant expansions in Medicaid eligibility. Women comprise the majority of adult Medicaid recipients and nearly one in five women ages 18 to 64 living below 200% of the federal poverty level are enrolled in Medicaid.
  • States have taken steps to expand Medicaid coverage and income protections for low-income seniors and people with disabilities. Medicaid is an important source of coverage for low-income seniors (who disproportionately tend to be women) and people with disabilities.
IWHR Blog recognized for offering quality editorial on women's health
Posted by on August 31, 2012 - 6:07am

The Institute for Women's Health Research blog was recently recognized  for its excellence in editorial content to the health student world by KwikMed, one of two fully licensed online pharmacies in the USA. A panel of judges reviewed hundreds of different sites from across the internet before hand picking the best 18.   According to the panel:   The aim of this blog is to make some of the biggest issues in women's health research more accessible in the modern world and speed up the time it takes for scientific research discoveries to impact women's health and well being in everyday life.   Based at Northwestern University, hot topics include breast cancer, pregnancy, sex differences and weight managment.  This blog brings to light important pieces of legislation that relate to women's health such as aspects of the Affordable Care Act.  A great blog for women's health medical practitioners and interested students across America.  To view the other winners, click HERE.

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