четверг, 29 сентября 2011 г.

RCOG Release: Ultrasound Training Programme For Obstetricians And Gynaecologists Launched

A new competence-based ultrasound training programme that is compulsory for doctors undergoing speciality training in obstetrics and gynaecology is now being implemented nationally.


It has been agreed that much of the training will be delivered by sonographers following discussions between the Royal College of Obstetricians and Gynaecologists (RCOG) and the Society and College of Radiographers (SCoR).


Mr Christoph Lees, RCOG national ultrasound training co-ordinator said, "The RCOG programme provides for 'deanery ultrasound co-ordinators' who will normally be obstetricians-gynaecologists and local 'ultrasound education supervisors' who may, for example, be ultrasound department managers or lead sonographers.


"The intention is that there are local discussions between these individuals as to how the RCOG training can be delivered, taking into account the number of potential trainees of all disciplines, the numbers already being trained within the department (including sonographer trainees), the available workforce and department capacity."


NHS trusts and boards will be expected to implement the training as part of the core syllabus requirements.
Audrey Paterson, Director of Professional Policy at the SCoR said, "The aim of the training is to improve maternal and women's healthcare, especially outside of normal hours when sonographer cover may not be available. Sonographers have traditionally played a major role in the training of doctors in obstetric and gynaecological ultrasound and their involvement is not new.


"Everyone recognises the need for an inter-professional approach to ensure the new training programme is delivered effectively."


Source:

Royal College of Obstetricians and Gynaecologists

четверг, 22 сентября 2011 г.

Link Discovered Between Hip Size Of Mothers And Breast Cancer Risk In Their Daughters

In a study of the maternity records of more than 6,000 women, David J.P. Barker, M.D., Ph.D., and Kent Thornburg, Ph.D., of Oregon Health & Science University discovered a strong correlation between the size and shape of a woman's hips and her daughter's risk of breast cancer. Wide, round hips, the researchers postulated, represent markers of high sex hormone concentrations in the mother, which increase her daughter's vulnerability to breast cancer.



A woman's hips are shaped at puberty when the growth of the hip bones is controlled by sex hormones but is also influenced by the level of nutrition. Every woman has a unique sex hormone profile which is established at puberty and persists through her reproductive life. The study's findings show for the first time that the pubertal growth spurt of girls is strongly associated with the risk of breast cancer in their daughters.



The study, carried out with colleagues in Finland and the United Kingdom., is described in an article just published online by the peer-reviewed American Journal of Human Biology. The authors followed up on 6,370 women born in Helsinki from 1934 to 1944 whose mothers' pelvic bones were measured during routine prenatal care. The study found that breast cancer rates were more than three times higher among the women in the cohort, born at or after term, whose mothers had wide hips. They were more than seven times higher if those mothers had already given birth to one or more children.



A woman's vulnerability to breast cancer, the study found, was greater if her mother's "intercristal diameter" -- the widest distance between the wing-like structures at the top of the hip bone -- was more than 30 centimeters, or 11.8 inches. The risk also was higher if these wing-like structures were round. The breast cancer risk was 2.5 times higher for the daughters of women in whom the widest distance was more than 3 centimeters greater than the distance at the front.



Barker, professor of medicine (cardiovascular medicine) in the OHSU School of Medicine as well as professor of clinical epidemiology at the University of Southampton in the U.K., is internationally known for discovering the relationship between low birth weight and the lifetime risk for coronary heart disease and other medical disorders, which the British Medical Journal has named the Barker Hypothesis. He has published more than 200 papers and written or edited five books about the developmental origins of chronic disease. He was honored in 2005 with the prestigious Danone International Prize for Nutrition for his pioneering research.



The OHSU study proposes that breast cancer is initiated in the first trimester of a pregnancy by exposure of the embryo's developing breast tissue to the mother's circulating sex hormones. The primary mammary cord, which gives rise to milk-producing breast lobules, develops in the fetus at 10 weeks. The fetal breast is known to be stimulated by circulating hormones; the intensity of the stimulation is such that half of all newborn babies have breast secretions.
















"Our findings support the hypothesis that wide round hips reflect high levels of sex hormone production at puberty, which persist after puberty and adversely affect breast development of the daughters in early gestation," the authors commented. They could only speculate, they said, on the exact nature of this adverse effect but pointed out: "Catechol estrogen, a metabolite or estradiol, is thought to cause chromosomal instability by breaking DNA strands. High catechol estrogen concentrations in the maternal circulation could produce genetic instability in differentiating breast epithelial cells, which would make the breast vulnerable to cancer in later life."



"Epidemiological findings of this kind aren't designed to define precise biological or molecular mechanisms," said Grover Bagby, M.D., deputy director of the OHSU Cancer Institute. "However, for those of us involved in identifying the earliest molecular causes of cancer, these fascinating results define the types of questions we need to ask. This is a wake-up call telling us to pay attention to stem cell populations at the time of birth ??¦ a good deal earlier than we might have otherwise done. It is important to consider these cell populations because only by understanding the initial cause can we begin to develop rational strategies to prevent this very common cancer."



The daughters who were the subjects of the study were all born during 1934-1944 at either Helsinki University Central Hospital or City Maternity Hospital, the two maternity hospitals in Finland's capital. The occurrence of breast cancer among them was ascertained from national registers of all hospital admissions and deaths in Finland. Three hundred of them had had breast cancer of whom 48 died from the disease. Their mean age when they were diagnosed was 54.



The findings shed new light on the link between breast cancer and nutrition. "Mothers whose daughters developed breast cancer were of similar height to the other mothers," Barker and Thornburg reported. "This suggests that they had similar nutrition through childhood. Our findings do not therefore indicate that good nutrition through childhood is linked to breast cancer in the next generation. But they do show that the pubertal growth spurt of girls, which reflects the level of nutrition, is strongly associated with the risk of breast cancer in their daughters."







The authors of the journal article besides Barker and Thornburg, who is director of the OHSU Heart Research Center and professor of cardiovascular medicine in the OHSU School of Medicine, were Clive Osmond, senior scientist at the Medical Research Council Epidemiology Resource Center at the University of Southampton; Eero Kajantie and Tom J. Forsen, both of Finland's National Public Health Institute; and Johan G. Eriksson, who holds positions at both the National Public Health Institute as well as with the University of Helsinki's Department of Public Health. Barker and Osmond have collaborated with Eriksson and his Finnish colleagues for the past 12 years tracing some 20,000 men and women in the Helsinki Birth Cohort Study.



The American Journal of Human Biology is published by Wiley-Liss, Inc., a subsidiary of John Wiley & Sons, Inc. The full text of the study, entitled "A possible link between the pubertal growth of girls and breast cancer in their daughters," is available in "Early View".



Click here for access to the abstract.



Source: Harry Lenhart


Oregon Health & Science University




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четверг, 15 сентября 2011 г.

Women's Heart Health Takes Center Stage In February

Despite strides in raising awareness of cardiovascular disease as the leading cause of death and illness among women, heart disease is still under-recognized, under-treated, and under-diagnosed in women. During American Heart Month, The American College of Obstetricians and Gynecologists encourages women to learn how they can protect their heart health.


Heart disease killed more than 432,000 US women in 2006-roughly one woman per minute. Women over age 20 have more than a one in three chance of dying from cardiovascular disease.


Long considered a man's disease, awareness efforts have helped many people understand that heart disease is very much a women's disease. It often manifests differently in men and women making the signs harder to recognize and delaying diagnosis in women. And while heart disease kills more women than men in the US, vast disparities still exist in the care of women with heart disease, their treatment after cardiac events such as heart attack, and their representation in clinical trials.


More women today know about the factors that increase their risk of heart disease, including diabetes, obesity, high cholesterol, and high blood pressure. Unfortunately, these conditions are on the rise among American women. According to the American Heart Association, an estimated 11.5 million women in the US are diabetic; more than half of white, black, and Hispanic women (58%, 80% and 78% respectively) are overweight or obese; 48% of women have borderline high cholesterol; 39% of women have high blood pressure; and many women (50% white, 64% black, and 60% Hispanic) are sedentary and get no physical activity.


Heart disease is largely preventable and individual efforts can make a difference. Ob-gyns are encouraged to discuss heart disease with their patients, the health problems that may contribute to it, and steps to improve their heart health. Women who know their health indicator numbers-such as body mass index (BMI), waist circumference, blood pressure, and blood cholesterol and sugar levels-are better equipped to tackle personal risk factors and work with their doctors to improve them.


Healthy lifestyle habits play an important role in reducing the risk of heart disease. Women should aim to consume a diet high in fiber and low in saturated fats, cholesterol, and refined carbohydrates. They should also get 30 to 90 minutes of exercise on most days of the week and quit smoking.


For more information on heart disease, go to americanheart.


Source

American College of Obstetricians and Gynecologists

четверг, 8 сентября 2011 г.

Home Visits, Classes And Emotional Support From Therapists Improve Parenting Of Abusive Mothers

Mothers who live in poverty and who have abused their children can stop if they are taught parenting skills and given emotional support.



A new study has found that mothers in families in which there is a history of child abuse and neglect were able to reduce how much they cursed at, yelled at, slapped, spanked, hit or rejected their children after a series of home visits from therapists who taught them parenting skills.



There were large improvements in mothers' parenting in families that received the intensive services, compared to families that did not receive the services, according to SMU psychologists Ernest Jouriles and Renee McDonald at Southern Methodist University in Dallas, two of the study's eight authors.



As a result of the intensive, hands-on training, the women in the study said they felt they did a better job managing their children's behavior, said Jouriles and McDonald. The mothers also were observed to use better parenting strategies, and the families were less likely to be reported again for child abuse.



"Although there are many types of services for addressing child maltreatment, there is very little scientific data about whether the services actually work," said McDonald. "This study adds to our scientific knowledge and shows that this type of service can actually work."



Help for violent families



The parenting training is part of a program called Project Support, developed at the Family Research Center at SMU and designed to help children in severely violent families.



The study appears in the current issue of the quarterly Journal of Family Psychology. The article is titled "Improving Parenting in Families Referred for Child Maltreatment: A Randomized Controlled Trial Examining Effects of Project Support." SMU psychologist David Rosenfield also authored the study.



The research was funded by the federal Interagency Consortium on Violence Against Women and Violence Within the Family, along with the Texas-based Hogg Foundation for Mental Health.



"Child maltreatment is such an important and costly problem in our society that it seems imperative to make sure that our efforts - and the tax dollars that pay for them - are actually solving the problem," said Jouriles. He and McDonald are co-founders and co-directors of the SMU Family Research Center.



In 2007, U.S. child welfare agencies received more than 3 million reports of child abuse and neglect, totaling almost 6 million children, according to the U.S. Department of Health and Human Services.



Poor and single with children



The study worked with 35 families screened through the Texas child welfare agency Child Protective Services, CPS. The parents had abused or neglected their children at least once, but CPS determined it best the family stay together and receive services to improve parenting and end the maltreatment.



In all the families, the mother was legal guardian and primary caregiver and typically had three children. On average she was 28, single and had an annual income of $10,300. Children in the study ranged from 3 to 8 years old.
















Half the families in the study received Project Support parenting education and support. The other half received CPS's conventional services.



New parenting skills + help



Mental health service providers met with the 17 Project Support families weekly in their homes for up to 6 months.



During that time, mothers, and often their husbands or partners, were taught 12 specific skills, including how to pay attention and play with their children, how to listen and comfort them, how to offer praise and positive attention, how to give appropriate instructions and commands, and how to respond to misbehavior.



Also, therapists provided the mothers with emotional support and helped them access materials and resources through community agencies as needed, such as food banks and Medicaid. The therapists also helped mothers evaluate the adequacy and safety of the family's living arrangements, the quality of their child-care arrangements and how to provide enough food with so little money.



Services provided to families receiving traditional child welfare services varied widely. The range of services included parenting classes at a church or agency, family therapy or individual counseling, videotaped parenting instruction, anger-management help, GED classes and contact by social workers in person or by phone.



Fewer recurrences of abuse



Only 5.9 percent of the families trained through Project Support were later referred to CPS for abuse, compared with almost 28 percent of the control group, the researchers found.



"The results of this study have important implications for the field of child maltreatment," said SMU's Rosenfield.



Project Support was launched in 1996 to address the mental health problems of maltreated children and children exposed to domestic violence, both of which often lead to considerable problems for children later in life, such as substance abuse, interpersonal violence and criminal activity. Previous studies have shown the program can improve children's psychological adjustment as well as mothers' ability to parent their children appropriately and effectively, according to the researchers.



Project Support: A promising practice



With funding from the U.S. Department of Justice's Office of Juvenile Justice and Delinquency Prevention, Project Support has been included in a study evaluating 15 "promising practices" nationally for helping children who live in violent families.



Jouriles is professor and chairman of the SMU Psychology Department. McDonald and Rosenfield are associate professors.



Other researchers were William Norwood, University of Houston; Laura Spiller, Midwestern State University; Nanette Stephens, University of Texas; Deborah Corbitt-Shindler, SMU; and Miriam Ehrensaft, City University of New York.



Source:

Margaret Allen


Southern Methodist University

четверг, 1 сентября 2011 г.

Wyoming Lawyer Who Introduced Legislation To Restrict Access To Abortion Nominated For Federal Judgeship

Sens. Craig Thomas (R-Wyo.) and Mike Enzi (R-Wyo.) on Monday announced the nomination of lawyer Richard Honaker for a U.S. District Court judgeship, the AP/Billings Gazette reports. Honaker in 1991 while a member of the Wyoming Legislature introduced a bill -- called the Human Life Protection Act -- that would have banned abortion except in cases of rape or incest or if the pregnant woman's health was in jeopardy, according to the AP/Gazette. The legislation would have required survivors of rape and incest seeking an abortion to report the crime within five days. The state House Judiciary Committee in 1991 voted 5-4 against the bill. After the legislation failed, the political action committee Unseen Hands of Prayer Circle attempted to place the measure on a state ballot. Honaker represented Unseen Hands in an appeal to the Wyoming Supreme Court. Opponents of the measure said it violated the U.S. Constitution. The court allowed the measure to be placed on the ballot in 1994, but it was not approved by state voters. Honaker on Monday said, "As a state legislator, I took positions on a lot of legislative issues and public policy issues, and one of them was on the abortion issue." He added that his "role as a judge would be far different." Honaker said, "I am absolutely committed to approaching every case that I hear with an open mind and deciding every case that I hear fairly and impartially, based on the rule of law and the U.S. Constitution." Sharon Breitweiser, executive director of NARAL Pro-Choice Wyoming, said she is "horrified" at Honaker's nomination, adding that she "doubt[s] that his zeal for the anti-abortion movement has waned in any way." Cameron Hardy, a spokesperson for Thomas, said he was not aware of Honaker's stance on abortion rights (Neary, AP/Billings Gazette, 3/19). Thomas in a statement said that Honaker "has the right judicial philosophy; he knows the importance of interpreting the law while not legislating from the bench." Enzi in a statement said Honaker "has what it takes to provide an impartial hand in applying the laws of the land." Honaker has been nominated by President Bush to fill the U.S. District Court seat in Wyoming vacated by the retirement of Judge Clarence Brimmer, the Casper Star-Tribune reports (Barron, Casper Star-Tribune, 3/20).

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