Two government ministers and other Uruguayan public figures recently joined an Internet-based campaign to legalize abortion in the country, Reuters reports (Avila, Reuters, 6/11). Women who undergo abortion in Uruguay can face a three- to nine-month prison sentence, and anyone who is convicted of performing an abortion can face six to 24 months in prison. Abortion has been illegal in Uruguay since 1938 (Kaiser Daily Women's Health Policy Report, 5/10/04). About 30,000 illegal abortions are performed annually in the country, which has a population of about 3.3 million, according to nongovernmental organizations.
According to Reuters, about 3,500 people have signed a petition at despenalizar.blogspot since June 1, including the interior and social development ministers, writers and artists. The Web site says, "Those of us signing this have violated the law ... either by having an abortion or financing one, by accompanying a woman to have one, (or) knowing the identity of many women who have had one and keeping quiet. Either we are criminals or the law is unjust."
According to a recent poll, 61% of the country's population support legalizing abortion. A bill that would ease restrictions on the procedure was recently introduced in Congress, but Uruguayan President Tabare Vazquez has said he will veto any such legislation. The Senate defeated a similar bill in 2004 after the lower chamber passed it (Reuters, 6/11).
"Reprinted with permission from kaisernetwork. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at kaisernetwork/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork, a free service of The Henry J. Kaiser Family Foundation . © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.
суббота, 24 сентября 2011 г.
суббота, 17 сентября 2011 г.
Primate Ovaries Shielded From Radiation-Therapy-Induced Damage
A strategy developed by Massachusetts General Hospital (MGH) researchers to shield the ovaries of female mammals from the damaging effects of radiation and chemotherapy has passed an important milestone. A collaborative study with investigators from Oregon Health and Sciences University (OHSU), published online in the journal Fertility and Sterility, reports that brief preexposure of the ovaries to an FDA-approved agent called FTY720 preserved the fertility of female rhesus monkeys exposed to potentially lethal doses of radiation. All of the treated animals have had successful pregancies and delivered healthy offspring.
"When we started working on this project in the mid-1990s, the only strategy available to preserve the fertility of cancer patients was collecting and freezing eggs or ovarian tissue for assisted reproduction, neither of which offered much in terms of successful pregnancies," explains Jonathan Tilly, PhD, director of the Vincent Center for Reproductive Biology in the MGH Department of Obstetrics and Gynecology, senior author of the Fertility and Sterility article. "Since then we have brought the concept of protecting the ovaries from damage caused by anticancer treatments all the way from an idea on paper, through a decade of mouse studies, to a proof of concept in living primates."
In 1997 Tilly and collaborators at the MGH and other research centers discovered that treatment with chemotherapy drugs led to the death of egg cells in mice through a process known as apoptosis - used naturally by the body to delete unwanted or damaged cells - and also identified the specific cell-death pathway involved. A follow-up 2000 study from Tilly's group showed that blocking that pathway with a compound called sphingosine-1-phosphate (S1P) preserved the egg cells (oocytes) of mice exposed to radiation therapy, which activates the same cell-death pathway as chemotherapy; and that those oocytes could be fertilized. A third study from Tilly and colleagues at Memorial Sloan-Kettering Cancer Institute reported in 2002 that S1P-pretreated female mice that were mated two months after receiving radiotherapy successfully delivered litters of healthy offspring.
Testing this approach in primates presented several challenges, so before attempting a trial in monkeys, the researchers wanted to be sure that S1P would also protect human oocytes. Ovarian tissue from human patients was grafted into immunodeficient mice, and some of the animals were treated with S1P for an hour before the tissue was exposed to radiation. The experiment showed that the resting pool of follicles from which oocytes develop into mature eggs was protected in the S1P-treated animals but was largely depleted in the human grafts not protected with S1P.
Another potential obstacle to bringing this approach from mice to primates is the fact that rodent ovaries are enclosed in a membrane sac, confining any drug injected into the sac to the ovary. Primate ovaries are free of any such enclosure, presenting the risk that any protective agent applied to the ovary might escape and protect tumor cells as well. Fortunately, investigators at the Oregon National Primate Research Center based at OHSU had already developed an implantable miniature pump that could deliver a drug to the ovaries alone.
In the current study, the OHSU team, led by Mary Zelinski, PhD, conducted a series of experiments, the first of which confirmed that delivering S1P directly to the ovaries of rhesus monkeys provided the same sort of protection from radiation effects seen in the earlier mouse studies. Since S1P is a rather unstable molecule that is broken down quickly, the researchers then tried using FTY720, a long-acting S1P-like agent with similar effects that also is approved for the treatment of multiple sclerosis. Treatment with FTY720, also called fingolimod, was even more successful than S1P in protecting monkey ovarian follicles from radiation-induced cell death.
In the final experiment, radiation was delivered directly to the ovaries of three female monkeys that had been pretreated with FTY720. A control group of three underwent a sham radiation treatment after receiving an inert infusion. Both groups resumed normal menstrual cycles, were successfully mated, and all have delivered offspring that appear normal and healthy. Two of the three radioprotected females have become pregnant a second time and delivered two more healthy offspring. Because female monkeys without normal ovarian function will not mate, there was no mating test of irradiation without FTY720 protection, since those animals would have complete ovarian destruction.
"This first generation of offspring born to FTY720-protected mothers have been assessed anatomically and behaviorally, as well as with the most sensitive assay we have for propagated genetic damage, and everything looks fine," says Tilly. "They are now about 2 years old and approaching sexual maturation, so we want to make sure they are reproductively normal and that the second-generation offspring will also be normal."
Tilly stresses, "The damage that anticancer treatments inflict on women's ovaries not only destroys their fertility, it also exposes them to the health risks of premature ovarian failure. The animals in this study have maintained ovarian function - they are still having normal menstrual cycles - several years after they were treated, which is critical. There are a handful of approaches out there that might give cancer patients a shot at preserving fertility, but this is currently the only option on the table for preventing premature menopause."
The current study, Tilly adds, is also an illustration of the power of collaboration. "This work could not have been done without the vast experience in primate ovarian biology of Mary Zelinski and her team at OHSU. We brought the science developed from more than a decade of mouse studies and, by working together with Mary's team, successfully translated that work from mice to primates, enabling us now to say with confidence that this approach has a good chance of succeeding in human pateents." A professor of Obstetrics, Gynecology and Reproductive Biology at Harvard Medical School, Tilly hopes to next plan a clinical trial in human cancer patients, in collaboration with colleagues from the MGH Cancer Center.
Notes:
In addition to Zelinski, who is lead author, co-authors of the of the Fertility and Sterility paper are Maralee Lawson, Francis Pau, PhD, Natalia Toscano, Darla Jacob and John Fanton, DVM, Oregon Health and Sciences University; Mark Murphy, Battelle Pacific Northwest Division; Andrea Jurisicova, PhD, and Robert Casper, MD, University of Toronto; and Steven Dertinger, PhD, Litron Laboratories. The study was supported by grants from the National Institutes of Health, the Canada Research Chair Program, the Canadian Institutes of Health Research, and Vincent Memorial Hospital Research Funds. The MGH holds patents on the use of S1P and its analogs for protection of oocytes from the side effects of anticancer therapies.
Source:
Sue McGreevey
Massachusetts General Hospital
"When we started working on this project in the mid-1990s, the only strategy available to preserve the fertility of cancer patients was collecting and freezing eggs or ovarian tissue for assisted reproduction, neither of which offered much in terms of successful pregnancies," explains Jonathan Tilly, PhD, director of the Vincent Center for Reproductive Biology in the MGH Department of Obstetrics and Gynecology, senior author of the Fertility and Sterility article. "Since then we have brought the concept of protecting the ovaries from damage caused by anticancer treatments all the way from an idea on paper, through a decade of mouse studies, to a proof of concept in living primates."
In 1997 Tilly and collaborators at the MGH and other research centers discovered that treatment with chemotherapy drugs led to the death of egg cells in mice through a process known as apoptosis - used naturally by the body to delete unwanted or damaged cells - and also identified the specific cell-death pathway involved. A follow-up 2000 study from Tilly's group showed that blocking that pathway with a compound called sphingosine-1-phosphate (S1P) preserved the egg cells (oocytes) of mice exposed to radiation therapy, which activates the same cell-death pathway as chemotherapy; and that those oocytes could be fertilized. A third study from Tilly and colleagues at Memorial Sloan-Kettering Cancer Institute reported in 2002 that S1P-pretreated female mice that were mated two months after receiving radiotherapy successfully delivered litters of healthy offspring.
Testing this approach in primates presented several challenges, so before attempting a trial in monkeys, the researchers wanted to be sure that S1P would also protect human oocytes. Ovarian tissue from human patients was grafted into immunodeficient mice, and some of the animals were treated with S1P for an hour before the tissue was exposed to radiation. The experiment showed that the resting pool of follicles from which oocytes develop into mature eggs was protected in the S1P-treated animals but was largely depleted in the human grafts not protected with S1P.
Another potential obstacle to bringing this approach from mice to primates is the fact that rodent ovaries are enclosed in a membrane sac, confining any drug injected into the sac to the ovary. Primate ovaries are free of any such enclosure, presenting the risk that any protective agent applied to the ovary might escape and protect tumor cells as well. Fortunately, investigators at the Oregon National Primate Research Center based at OHSU had already developed an implantable miniature pump that could deliver a drug to the ovaries alone.
In the current study, the OHSU team, led by Mary Zelinski, PhD, conducted a series of experiments, the first of which confirmed that delivering S1P directly to the ovaries of rhesus monkeys provided the same sort of protection from radiation effects seen in the earlier mouse studies. Since S1P is a rather unstable molecule that is broken down quickly, the researchers then tried using FTY720, a long-acting S1P-like agent with similar effects that also is approved for the treatment of multiple sclerosis. Treatment with FTY720, also called fingolimod, was even more successful than S1P in protecting monkey ovarian follicles from radiation-induced cell death.
In the final experiment, radiation was delivered directly to the ovaries of three female monkeys that had been pretreated with FTY720. A control group of three underwent a sham radiation treatment after receiving an inert infusion. Both groups resumed normal menstrual cycles, were successfully mated, and all have delivered offspring that appear normal and healthy. Two of the three radioprotected females have become pregnant a second time and delivered two more healthy offspring. Because female monkeys without normal ovarian function will not mate, there was no mating test of irradiation without FTY720 protection, since those animals would have complete ovarian destruction.
"This first generation of offspring born to FTY720-protected mothers have been assessed anatomically and behaviorally, as well as with the most sensitive assay we have for propagated genetic damage, and everything looks fine," says Tilly. "They are now about 2 years old and approaching sexual maturation, so we want to make sure they are reproductively normal and that the second-generation offspring will also be normal."
Tilly stresses, "The damage that anticancer treatments inflict on women's ovaries not only destroys their fertility, it also exposes them to the health risks of premature ovarian failure. The animals in this study have maintained ovarian function - they are still having normal menstrual cycles - several years after they were treated, which is critical. There are a handful of approaches out there that might give cancer patients a shot at preserving fertility, but this is currently the only option on the table for preventing premature menopause."
The current study, Tilly adds, is also an illustration of the power of collaboration. "This work could not have been done without the vast experience in primate ovarian biology of Mary Zelinski and her team at OHSU. We brought the science developed from more than a decade of mouse studies and, by working together with Mary's team, successfully translated that work from mice to primates, enabling us now to say with confidence that this approach has a good chance of succeeding in human pateents." A professor of Obstetrics, Gynecology and Reproductive Biology at Harvard Medical School, Tilly hopes to next plan a clinical trial in human cancer patients, in collaboration with colleagues from the MGH Cancer Center.
Notes:
In addition to Zelinski, who is lead author, co-authors of the of the Fertility and Sterility paper are Maralee Lawson, Francis Pau, PhD, Natalia Toscano, Darla Jacob and John Fanton, DVM, Oregon Health and Sciences University; Mark Murphy, Battelle Pacific Northwest Division; Andrea Jurisicova, PhD, and Robert Casper, MD, University of Toronto; and Steven Dertinger, PhD, Litron Laboratories. The study was supported by grants from the National Institutes of Health, the Canada Research Chair Program, the Canadian Institutes of Health Research, and Vincent Memorial Hospital Research Funds. The MGH holds patents on the use of S1P and its analogs for protection of oocytes from the side effects of anticancer therapies.
Source:
Sue McGreevey
Massachusetts General Hospital
суббота, 10 сентября 2011 г.
Maternal Mortality Rate In U.S. Highest In Decades, Experts Say
The maternal mortality rate in the U.S. is the highest it has been in decades, according to statistics released this week by CDC's National Center for Health Statistics, the AP/Washington Post reports. According to the figures, the U.S. maternal mortality rate was 13 deaths per 100,000 live births in 2004. The rate was 12 deaths per 100,000 live births in 2003 -- the first year the maternal death rate was more than 10 since 1977 (Stobbe, AP/Washington Post, 8/24). A total of 540 women were reported to have died of maternal causes in 2004, 45 more than were reported in 2003, according to the report (NCHS report, 8/21).
Reasons for Increase
A rise in the number of caesarean sections -- which now account for 29% of all births -- could be a factor in the increased maternal mortality rate, some experts said. According to a review of maternal deaths in New York, excessive bleeding is one of the primary causes of pregnancy-related death, and women who have undergone several previous c-sections are at particularly high risk of death.
Some studies have found that race and quality of care also factor into the maternal mortality rate. The maternal mortality rate among black women is at least three times higher than among white women. Black women also are more susceptible to hypertension and other complications, and they tend to receive inadequate prenatal care. Three studies have shown that at least 40% of maternal deaths could have been prevented with improved quality of care.
The rise in obesity also might be a factor, some experts said. According to researchers, overweight women tend to have diabetes or experience other complications that could affect pregnancy outcomes. Overweight women also might have excessive tissue or larger infants, which could make a vaginal birth more difficult and lead to more c-sections. More women also are giving birth in their late 30s and 40s, when risks of pregnancy complications are higher, according to the AP/Post (AP/Washington Post, 8/24).
In addition, the report says the increase in maternal deaths "largely reflects" more states' use of a separate item on the death certificate indicating pregnancy status of the woman. According to the report, the number of maternal deaths does not include all deaths of pregnant women, but only those deaths reported on the death certificate that were assigned to causes related to or aggravated by pregnancy or pregnancy management (NCHS report, 8/21). California, Idaho and Montana in 2003 changed death certificate questions, the AP/Post reports (AP/Washington Post, 8/24).
The report is available online (.pdf).
"Reprinted with permission from kaisernetwork. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at kaisernetwork/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork, a free service of The Henry J. Kaiser Family Foundation . © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.
суббота, 3 сентября 2011 г.
Abstinence-Only Education 'Fails' Texas Children, Editorial Says
"Abstinence is a good message, but teens also must know the dangers of having sex without condoms and contraceptives," a Dallas Morning News editorial says. According to the editorial, Alaska Gov. Sarah Palin's (R) 18-year-old daughter Bristol, who gave birth in December after an unintended pregnancy, recently said on Fox News that abstinence-only education is "not realistic at all." Bristol Palin "knows from experience something that has yet to sink in among Texas education policymakers: An abstinence-only health curriculum fails our children," the editorial says.
Texas "consistently ranks among the top five states for teen pregnancies," the editorial continues, adding that the state was behind only Mississippi and New Mexico in recent federal statistics. A new study conducted by researchers at Texas State University and funded by the Texas Freedom Network, which favors a comprehensive sex education curriculum, found that up to 96% of Texas school districts either teach an abstinence-only curriculum or avoid discussing sex altogether. David Wiley, co-author of the study, wrote that the prevailing attitude among health teachers in the state is that "when it comes to sexuality education, it's best to keep your mouth shut." The editorial writes, "Adding to the fear was the Board of Education's decision in 2004 to adopt health textbooks that preached abstinence while downplaying the benefits of condoms and contraceptives." The editorial writes that Centers for Disease Control and Prevention data show that Texas teens have unprotected sex "far more often" than the national average and that states and cities using an "abstinence-plus" curriculum see rates of unprotected sex below the national average. "Statistics show that when students receive the complete message, they listen," the editorial writes.
The editorial writes that "one Texas teenager gets pregnant every 10 minutes, on average," according to the Texas Department of State Health Services. "In contrast to the Board of Education," the health department "specifically recommends a multifaceted approach including abstinence counseling and advice on the use of condoms and contraceptives," the editorial continues, adding, "That message clearly isn't getting through to the schools." The editorial concludes, "Texas, it's time to get real. It's time to talk to our teens about abstinence and protected sex" (Dallas Morning News, 3/1).
Reprinted with kind permission from nationalpartnership. You can view the entire Daily Women's Health Policy Report, search the archives, or sign up for email delivery here. The Daily Women's 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.
Texas "consistently ranks among the top five states for teen pregnancies," the editorial continues, adding that the state was behind only Mississippi and New Mexico in recent federal statistics. A new study conducted by researchers at Texas State University and funded by the Texas Freedom Network, which favors a comprehensive sex education curriculum, found that up to 96% of Texas school districts either teach an abstinence-only curriculum or avoid discussing sex altogether. David Wiley, co-author of the study, wrote that the prevailing attitude among health teachers in the state is that "when it comes to sexuality education, it's best to keep your mouth shut." The editorial writes, "Adding to the fear was the Board of Education's decision in 2004 to adopt health textbooks that preached abstinence while downplaying the benefits of condoms and contraceptives." The editorial writes that Centers for Disease Control and Prevention data show that Texas teens have unprotected sex "far more often" than the national average and that states and cities using an "abstinence-plus" curriculum see rates of unprotected sex below the national average. "Statistics show that when students receive the complete message, they listen," the editorial writes.
The editorial writes that "one Texas teenager gets pregnant every 10 minutes, on average," according to the Texas Department of State Health Services. "In contrast to the Board of Education," the health department "specifically recommends a multifaceted approach including abstinence counseling and advice on the use of condoms and contraceptives," the editorial continues, adding, "That message clearly isn't getting through to the schools." The editorial concludes, "Texas, it's time to get real. It's time to talk to our teens about abstinence and protected sex" (Dallas Morning News, 3/1).
Reprinted with kind permission from nationalpartnership. You can view the entire Daily Women's Health Policy Report, search the archives, or sign up for email delivery here. The Daily Women's 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.
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