U.S. FDA Approves Second Bayer Oral Contraceptive That Also Raises Folate Levels

Bayer HealthCare Pharmaceuticals, Inc. announced the U.S. Food and Drug Administration (FDA) has approved a new oral contraceptive (OC), SAFYRAL™ (drospirenone 3 mg/ ethinyl estradiol 30 mcg/ levomefolate calcium 451 mcg tablets and levomefolate calcium 451 mcg tablets). In women who choose an OC for birth control, SAFYRAL raises folate levels for the purpose of reducing the risk of rare neural tube defects (NTDs) in a pregnancy conceived while taking SAFYRAL or shortly after discontinuing it. SAFYRAL provides the birth control YASMIN® (drospirenone 3 mg/ ethinyl estradiol 30 mcg) with 451 mcg levomefolate calcium, which is a B vitamin.


SAFYRAL is the second Bayer OC which contains folate. In September, the FDA approved Beyaz™ (drospirenone 3 mg/ ethinyl estradiol 20 mcg/ levomefolate calcium 451 mcg tablets and levomefolate calcium 451 mcg tablets), the first OC approved by the FDA to raise folate levels in women who choose an OC for birth control.


"With the FDA approval of Safyral, Bayer now offers two oral contraceptives that contain folate," said Leslie North, Vice President of Marketing, Women's HealthCare, Bayer HealthCare Pharmaceuticals. "SAFYRAL and Beyaz are part of Bayer's growing women's health franchise, and these new products reinforce our commitment to providing women various contraceptive options."


The Centers for Disease Control and Prevention, the U.S. Preventive Services Task Force, the March of Dimes and other leading health authorities recommend that all women of childbearing age supplement their diet with at least 400 mcg of folic acid daily.(1),(2),(3) A well-established body of evidence supports folate supplementation as a means to reduce the incidence of neural tube defects rare birth defects of the brain and spinal cord.(2),(3),(4) These rare birth defects happen in the first few weeks of pregnancy often before a woman finds out she is pregnant. As a result, daily folate supplementation is particularly important at least one month before and three months after conception.(2)


"Combining an oral contraceptive with folate is important, because women may become pregnant during OC use or shortly after discontinuation, possibly before seeking preconception counseling from their healthcare providers," said Dr. Anita Nelson, Professor of Obstetrics and Gynecology at the Harbor-UCLA Medical Center, Torrance, California. "For women who already use YASMIN for contraception, SAFYRAL offers these women a new option to receive daily folate supplementation as part of their OC routine."


Women should not use SAFYRAL if they smoke and are over age 35. Smoking increases the risk of serious side effects from the Pill, which can be life-threatening, including blood clots, stroke or heart attack. This risk increases with age and number of cigarettes smoked.















Patients are advised to alert their healthcare provider if they are taking folate supplements. SAFYRAL is not indicated during pregnancy. SAFYRAL has 99 percent contraceptive efficacy when used as directed. If pregnancy occurs during treatment with SAFYRAL, further intake must be stopped. If a woman discontinues use of SAFYRAL either with the intention of becoming pregnant or if she discontinues due to pregnancy while on the product, she is strongly encouraged to speak with her healthcare provider about taking a multivitamin with folic acid or another folate to maintain recommended folate intake.


SAFYRAL is in a 21/7 day regimen consisting of 21 days of drospirenone 3 mg/ethinyl estradiol 30 mcg with levomefolate calcium 451 mcg (Metafolin®*) followed by seven days of Metafolin only. SAFYRAL is expected to be available in mid-January 2011 by prescription only.


Women should not use SAFYRAL if they have kidney, liver, or adrenal disease because this could cause serious heart and health problems, or if they have or have had blood clots, certain cancers, history of heart attack or stroke, or if they are or may be pregnant. SAFYRAL increases the risk of serious conditions including blood clots, stroke and heart attack. Smoking increases these risks, especially in women over 35. The risk of blood clots is highest during the first year of use.


In addition, SAFYRAL contains drospirenone, a different kind of hormone that for some may increase potassium too much. Women should consult with their healthcare provider if they are on daily long-term treatment for a chronic condition with medications that may also increase potassium, as they should have a blood test to check their potassium level during the first month of taking SAFYRAL.


About the Clinical Development Program for SAFYRAL


The FDA approval of SAFYRAL to raise folate levels in women who choose an OC for contraception is based on two clinical trials. The first trial was a pivotal 24-week clinical trial involving 379 healthy women aged 18-40 years, which found that YAZ® (drospirenone 3 mg/ ethinyl estradiol 20 mcg) in combination with 451 mcg of Metafolin increased folate levels from baseline. This multicenter, randomized, double-blind, parallel group study conducted in a U.S. population with folate fortified food evaluated the effect of YAZ in combination with 451 mcg of Metafolin on red blood cell (RBC) folate and plasma folate levels compared to YAZ alone during 24 weeks of treatment. At week 24, the mean changes from baseline were significantly (p

Giuliani Says He Would Appoint 'Strict Constructionist' Judges To Supreme Court

Former New York City Mayor and possible Republican presidential candidate Rudolph Giuliani in recent weeks has "distanc[ed] himself from a position favoring abortion rights that he espoused" during his mayoral campaigns and "highlighted a different element of his thinking on the abortion debate," the New York Times reports. Giuliani in recent talks with conservative media outlets and voters in South Carolina said he would appoint "strict constructionist" judges to the Supreme Court -- a term that abortion-rights advocates say is "code among conservatives for those who seek to overturn or limit" Roe v. Wade, the 1973 Supreme Court decision that effectively barred state abortion bans -- the Times reports. Giuliani said he would nominate judges like Chief Justice John Roberts and Justices Antonin Scalia and Samuel Alito, who he believes would restrict Roe. In a recent interview with Sean Hannity of Fox News, Giuliani said that a law (S 3) being reviewed by the Supreme Court that bans so-called "partial-birth abortion" should be upheld. Giuliani in 2000 when asked by NBC News' "Meet the Press" host Tim Russert if he supported President Clinton's veto of a law that would have banned partial-birth abortion said, "I would vote to preserve the option for women. I think the better thing for America to do is to leave that choice to the woman because it affects her probably more than anyone else." Giuliani also told Hannity that he supports parental notification requirements for minors seeking abortion with a judicial bypass provision. On a 1997 candidate questionnaire from the National Abortion and Reproductive Rights Action League of New York he answered "yes" to the question: Would you oppose legislation "requiring a minor to obtain permission from a parent or from a court before obtaining an abortion." Giuliani's campaign aides say that he has not changed his position on abortion and that his stance on partial-birth abortion has been mischaracterized. "[A]bortion is something that, as a personal matter, I would advise somebody against," Giuliani said during the Hannity interview, adding, "I believe in a woman's right to choose. I think you have to ultimately not put a woman in jail for that" (Rivera, New York Times, 2/10).

Romney Comments on Abortion Rights
Possible Republican presidential candidate and former Massachusetts Gov. Mitt Romney on Friday during a visit to South Carolina "sought to dispel doubts" about his views against abortion rights, the AP/Boston Globe reports. "I am firmly pro-life," Romney told about 100 Republicans at a local restaurant, adding, "Every act I've taken as governor has been in favor of life," (Davenport, AP/Boston Globe, 2/9). Since Romney first ran for U.S. Senate in 1994, he has acknowledged that his position on abortion has changed from "proudly" supporting abortion rights to saying that he would "like to see" Roe overturned. When Romney ran for governor in 2002, he promised to "preserve the status quo" on abortion rights in the state and oppose any changes to state laws that restricted or increased access to abortion. However, Romney in 2004 said when he studied human embryonic stem cell research, he experienced an "awakening that led him to the conclusion that 'the sanctity of life had been cheapened' by the Roe decision" (Kaiser Daily Women's Health Policy Report, 12/21/06). According to the AP/Globe, abortion is a major issue among South Carolina's conservative voters (AP/Boston Globe, 2/9).

Opinion Piece
Romney, Giuliani and other political candidates might be "thoroughly sincere in rethinking their old positions" on abortion and other issues, but they also are part of a political system that "has created strong incentives for candidates to be less than candid about what they really think," Washington Post columnist E.J. Dionne writes in an opinion piece. Candidates are "rarely willing to say ... that they do not consider abortion the most important issue in politics," and "we don't make it easy" for them to "admit, as most voters do, that abortion is an agonizing question," according to Dionne. Giuliani's support for abortion rights will test whether presidential candidates have to "hold to each party's version of political correctness" in regard to abortion rights in order to receive primary votes, Dionne writes. He concludes that "we have created a system" that encourages many politicians "to adjust their convictions to their political needs," adding, "And then we denounce them" (Dionne, Washington Post, 2/13).

Broadcast Coverage
In an interview on ABC's "This Week," Arkansas Gov. Mike Huckabee (R) -- who is seeking the Republican presidential nomination -- addressed Giuliani's position on abortion rights and other issues. In response to a question about whether Giuliani's position on abortion rights would be "a game-ender in the Republican primaries," Huckabee said, "We'll find out in this election, it looks like, because it's going to be an issue that will clearly separate some of the candidates." He added, "But I'm pro-life because I think it's consistent with who we are as an American people. We are a culture and civilization that celebrates life" (Stephanopoulos, "This Week," ABC, 2/11). Video and a transcript of the segment are available online.














NPR's "Morning Edition" on Tuesday reported Romney's potential presidential campaign. Romney's past positions on abortion and other issues could negatively affect his support among social conservatives, NPR reports (Inskeep/Gonyea, "Morning Edition," NPR, 2/13). Audio of the segment is available online.

"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.

Fractures Significantly Reduce Quality Of Life In Women With Osteoporosis

Researchers seeking to understand the impact of osteoporosis and fractures on various aspects of health have found that women who had previous fractures experienced a significant reduction in health-related quality of life similar to or worse than that experienced by patients with diabetes, arthritis, lung disease and other chronic illnesses. This latest study from the Global Longitudinal Study of Osteoporosis in Women (GLOW), which is based at the Center for Outcomes Research at the University of Massachusetts Medical School, was published online in the Mayo Clinic Proceedings.



Approximately 40 percent of women over 50 will suffer a fracture; the most common sites of fracture are the hip, spine and wrist. These fractures often carry with them chronic pain, reduced mobility, loss of independence, and especially in the case of hip fracture, an increased risk of death. Because the likelihood of fractures increases substantially with older age, fracture numbers are projected to rise as the population ages.



Using a standardized index measuring five dimensions of health (mobility, self-care, usual activities, pain or discomfort, and anxiety or depression), the study authors administered health surveys to nearly 60,000 postmenopausal women in 10 countries. The surveys were used to compare the overall health status, physical function and vitality of participants and assess health-related quality of life. The study found that spine, hip and upper leg fractures resulted in the greatest decrease in quality of life.



"Our study shows that the effects of fractures result in significant reductions in quality of life that are as lasting and as disabling as other chronic conditions. As important, the greater the number of fractures, the greater the disability," said the lead author of the paper, Jonathan D. Adachi, MD, GLOW investigator and the Alliance for Better Bone Health Chair in Rheumatology at St. Joseph's Healthcare and McMaster University in Ontario. "This suggests that efforts are needed to prevent fractures from occurring."



Study Details:


GLOW is a prospective, international cohort study of women 55 years of age and older who visited their primary care physician during the 2 years prior to enrollment in the study. Over 60,000 women were recruited by more than 700 primary care physicians in 17 cities in 10 countries (Australia, Belgium, Canada, France, Germany, Italy, Netherlands, Spain, United Kingdom and United States). In GLOW, information is being gathered on fracture risk factors, treatments, patient behaviors, and fracture outcomes over a 5-year period.



GLOW in Worcester, Massachusetts:


28,000 US women are participating in GLOW. Dr. Stephen Gehlbach from the School of Public Health and Health Sciences, University of Massachusetts and co author of the article enrolled 5,091 women through the University of Massachusetts Memorial Health Care system and area physician practices. Of these participants, 23% had a previous fracture.



Sponsors:


Financial support for the GLOW study is provided by Warner Chilcott Company, LLC and sanofi-aventis to the Center for Outcomes Research, University of Massachusetts Medical School.



Source:

Alison Duffy

University of Massachusetts Medical School

Minster Unveils 'Linda's Pregnancy' at Maternity Conference, UK

UK Health Minister Stephen Ladyman will today announce an Exemplar
showing a woman's journey through pregnancy and birth and
illustrating how Government standards can be put into practice to
provide greater choice and flexibility for women using maternity
services.


'Linda's pregnancy' follows the journey of a young African Caribbean
woman and her partner as they progress through her second pregnancy.
Covering issues such as smoking during pregnancy, healthy eating and
concerns over maternal mental health, the story is taken from Linda's
realisation that she is pregnant through to 6 weeks after the birth
of her child.


Health Minister Stephen Ladyman said


"Maternity services already represent one of the many success stories
of the NHS and the exemplar illustrates some of the ways in which
professionals can work together to place the needs of women and their
babies at the centre of their care using the Children's and Maternity
National Service Framework (NSF).


"The NSF will encourage choice in maternity services so that,
whenever possible, women can decide where they give birth and the
type of care they receive. I am pleased to be working with our
partners at the Royal Colleges to take this work forward."


The Exemplar will be unveiled at 'Maternity Services for the 21st
Century', a conference which is a collaboration between the
Department of Health, the Royal College of Obstetricians and
Gynaecologists, the Royal College of Paediatrics and Child Health and
the Royal College of Midwives. It will focus on professionals
working in partnership to achieve the best outcomes and experiences
for women using maternity services.


The Royal College of Obstetricians & Gynaecologists said
"Today is all about teamwork to support one another in the
implementation of the National Service Framework and to find the best
way forward so that we can all make real and lasting improvements for
women and their babies.


"It is important to remember that this is a ten year plan for
improving care and the Colleges will now encourage the dissemination
of the Framework down to a local level so that it can be implemented
to best support the needs of local populations.


"The RCOG looks forward to continuing our close working relationship
with our colleagues at the Royal College of Midwives and the Royal
College of Paediatrics and Child Health in using this Framework to
deliver high quality maternity and neonatal services to all women in
England and Wales. The College believes that the multi-disciplinary
approach emphasised in the Framework will give us a real opportunity
to change and improve maternity services over the next decade."


The Royal College of Midwives said


"Today provides us all with the opportunity to discuss the first
steps in implementing the new NSF. We look forward to working with
our partners in providing maternity services that are user led, with
an emphasis on fulfilling health and social care needs and
priorities, as we move into the 21st Century."


Achieving the standards set out in the NSF will be challenging and in
recognition of this it has been developed as a ten-year strategy,
with services expected to meet the standards by 2014.


The NSF presents a real opportunity for the NHS to target resources
more effectively and utilising new ways of working. It aims to
ensure that Primary Care Trusts and maternity service providers
design, review and improve maternity services through a programme of
consultation, building on the work of existing local groups.



'Maternity Services for the 21st Century' will be held on 14 March
2005 at the Royal College of Obstetricians and Gynaecologists, London


The Maternity services exemplar can be found at

dh/assetRoot/04/10/60/49/04106049


The National Framework for children, young people and maternity
services was published on 15th September 2004 and is the biggest
national initiative to improve health and social services and can be
found
if you CLICK HERE.


For media enquiries, please contact: Michelle Hinds at the Department
of Health Media Centre on tel: 020 7210 5375, Marie Sterry at the
Royal College of Obstetricians and Gynaecologists on 0207 772 6357 or
Jonathan Andrews at the Royal College of Midwives on 0207 312 3432


For public enquiries, please contact the Department of Health Public
Enquiries Department on tel: 020 7210 4850


GNNREF: 112523

Issued by : DOH Press Office

Proponents Of Female Genital Cutting In Kenya Promoting It As HIV Prevention Method

Some proponents of female genital cutting in Kisii, Kenya, are claiming that the practice will reduce a woman's risk of contracting HIV, IRIN/PlusNews reports. These proponents say FGC prevents HIV because women will have reduced sexual desire after it is performed, resulting in fewer sexual partners and a decreased risk for contracting the virus. Researchers have challenged the notion that there is a difference sexual desire among women who have undergone FGC with those who have not, IRIN/PlusNews reports. After FGC was outlawed for girls younger than age 18, local residents say that proponents of the procedure have become "even more aggressive in their efforts to keep [FGC] alive." Jacqueline Mogaka, a local advocate against FGC, said, "I do not know where this idea of female genital mutilation being a remedy for HIV infection originated, but it is a strong belief" in Kisii, adding, "Young girls are now even voluntarily turning up for the cut because of this belief."

Despite being against Ministry of Health policy, FGC still is widespread in Kisii, with 97% of girls undergoing the procedure, most commonly when they are teenagers, IRIN/PlusNews reports. Grace Kemunto, a traditional circumciser said, "When you are cut as a woman, you do not become promiscuous and it means you cannot get infected by HIV." Opponents of FGC say the assumption that women and girls are always in control of their sexual practices is false and can be harmful, according to IRIN/PlusNews. In the Nyanza province, where Kisii is located, an estimated 9% of girls are married by age 15, and 53% are married by age 19, according to data from a 2003 Kenya Demographic and Health Survey. IRIN/PlusNews reports that efforts against FGC pointed out the increased HIV risk with traditional methods such as a single cutting device used on multiple women. However, this lead to an increase in nurses and midwives performing the procedure, which opponents indicate is "holding back the fight against FGC because the practice was no longer associated with a fear of HIV," IRIN/PlusNews reports. The practice also poses a risk of hemorrhaging -- during the procedure or childbirth, as well as from vaginal tearing during sexual intercourse -- that could lead to a need for blood transfusions in regions where a safe blood supply is not guaranteed, according to IRIN/PlusNews (IRIN/PlusNews, 1/27).


Reprinted with kind 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.

© 2009 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

Women's Risk Of Developing Schizophrenia Increased By Genetic Variant

A complete scan of the human genome has revealed that a genetic variant in the Reelin gene increases the risk of developing schizophrenia in women only. Researchers from the Hebrew University of Jerusalem and the University of Oxford, who conducted the study in the Ashkenazi Jewish population, confirmed their findings by establishing a multinational collaboration that included populations and researchers from the United Kingdom, Ireland, United States, and China. Their research is published in the February issue of the open-access journal PLoS Genetics.



Heritability of schizophrenia has been well established through epidemiological studies in past years. However, efforts to identify the genes associated with this devastating disease, which affects about 1% of the human population, have encountered significant difficulties. Technological advances that allow the complete and efficient scanning of the entire genome present a new opportunity to address this challenge.



The authors analyzed 500,000 genetic variants distributed across the whole human genome in DNA from patients with schizophrenia and control subjects. By comparing the genomes of hundreds of patients with schizophrenia with those of healthy controls across several human populations, the researchers identified a gene that significantly increases the risk of developing the disease, but interestingly in women only.



This study represents significant progress in the study of schizophrenia with possible practical implications in the areas of disease diagnosis and drug discovery. Nevertheless, it is important to stress that these possibilities will require many years of additional research, and even then, success cannot be guaranteed.







Link to the published article



CITATION: Shifman S, Johannesson M, Bronstein M, Chen SX, Collier DA, et al. (2008) Genome-wide association identifies a common variant in the reelin gene that increases the risk of schizophrenia only in women. PLoS Genet 4(2): e28. doi:10.1371/journal.pgen.0040028



CONTACT:


Dr. Sagiv Shifman

University of Oxford

Wellcome Trust Centre for Human Genetics


Dr. Ariel Darvasi

Hebrew University

Center for Research on Pain



Disclaimer


This press release refers to an upcoming article in PLoS Genetics. The release is provided by the article authors and/or their institutions. Any opinions expressed in this release or article are the personal views of the journal staff and/or article contributors, and do not necessarily represent the views or policies of PLoS. PLoS expressly disclaims any and all warranties and liability in connection with the information found in the releases and articles and your use of such information.



About PLoS Genetics


PLoS Genetics (plosgenetics/) reflects the full breadth and interdisciplinary nature of genetics and genomics research by publishing outstanding original contributions in all areas of biology. All works published in PLoS Genetics are open access. Everything is immediately and freely available online throughout the world subject only to the condition that the original authorship and source are properly attributed. Copyright is retained by the authors. The Public Library of Science uses the Creative Commons Attribution License.



About the Public Library of Science


The Public Library of Science (PLoS) is a non-profit organization of scientists and physicians committed to making the world's scientific and medical literature a freely available public resource. For more information, visit plos/.



Source: Mary Kohut


Public Library of Science

Study Finds Health Care Disparities For Female Veterans

Female veterans do not receive the same quality of outpatient care as male veterans at about one-third of the 139 Department of Veterans Affairs facilities that offer it, according to a report released on Friday by VA, the AP/Philadelphia Inquirer reports. Women account for about 14% of the U.S. Armed Forces and about 5% of VA's population, but that number is expected to nearly double in the next two years. The VA's review found the health care disparity even as women are serving on the front lines at historic levels.

The review found a need for more physicians trained to address the health care needs of women, as well as more equipment for women's health. The report noted that other studies had found better surgical outcomes and decreased mortality for women at VA hospitals compared with women enrolled in Medicare Advantage plans or those receiving private care. Other studies also have shown better performance of breast and cervical cancer screenings among women receiving care through VA than those enrolled in private or other government-sponsored health plans.

William Duncan, associate deputy undersecretary at VA, said the disparity between men and women's health is unacceptable and the department is working to address the issue. He said, "We're striving to understand the reason for these health disparities in veterans health care based on personal characteristics." The report states that VA has made some progress, such as creating on-site mammography services and women's clinics at most VA facilities. VA also is trying to recruit more clinicians with training in women's care, according to the report (Hefling, AP/Philadelphia Inquirer, 6/16).


Reprinted with kind 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.

© 2008 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

Government Calls For Conference To Look At Bacterium That Caused Deaths Of Four California Women Who Took Mifeprex

The federal government has called for a conference to look at the Clostridium sordellii bacterium, which caused the deaths of four California women who were taking Danco Laboratories' Mifeprex, the New York Times reports (Harris, New York Times, 2/11). Mifeprex -- which is known generically as mifepristone -- when taken with misoprostol, can cause a medical abortion. FDA in July 2005 issued a public health advisory warning for physicians to watch for any signs of sepsis or other infections among women taking the drug, which the agency approved in 2000 for the termination of pregnancies of 49 days or less. FDA officials on Nov. 4, 2005 updated the advisory after they discovered that the deaths of four California women who took the drug all were caused by C. sordellii, a rare and deadly bacterium. According to a report published in December 2005 in the New England Journal of Medicine, the deaths of the women were linked to toxic shock caused by the bacterium, but the researchers found no direct link among the deaths of the four women and concluded that the risk of infection in conjunction with taking the drug is "low." CDC has said the one factor that ties the four cases together is that misoprostol was administered vaginally instead of orally, which is considered "off-label use" (Kaiser Daily Women's Health Policy Report, 12/8/05). According to the Times, "another intriguing mystery" is that all four cases happened in California. An FDA official speaking on the condition of anonymity said 15 to 20 scientists have been asked to present their research on the bacterium at a May 11 conference at CDC in Atlanta. "We hope to keep the focus on the science," the official said, adding that officials are worried the debate over medical abortion might hinder the scientific discussion. He said, "We're holding this in a secure government facility for a reason" (New York Times, 2/11).


"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.

Vitamin D2 Supplements Might Lower Risk Of Some Older Women Falling Down

High-risk older women, especially those from sunny climates, and especially during the winter, may benefit from a reduced risk of falls if they take Vitamin D2 supplements, according to an article in Archives of Internal Medicine (JAMA/Archives), January 14th edition.


The researchers explain "Approximately one-third of women older than 65 years fall each year, and 6% sustain a fracture as a result of the fall. In addition, fear of falling is a major problem in older people."


Richard L. Prince, M.D., Sir Charles Gairdner Hospital, Nedlands, Australia, and team carried out a year-long clinical trial involving 302 women aged 70-90 years - they all lived in Perth, Australia. As vitamin D is produced as a response to exposure to sunlight and the study was carried out in a sunny place, the scientists selected women whose blood vitamin D levels for below 24 nanograms per milliliter, the median for the area.


All the women in the study had a history of falls in the previous year. They were given 1,000 milligrams of calcium citrate per day. 50% of them were then randomly selected to receive either 1,000 international units of vitamin D2 (ergocalciferol) while the other 50% received an identical placebo. The researchers gathered data on falls every six weeks.


During the study period 53% of the vitamin D2 women and 62.9% of the placebo women had at least one fall. They found that vitamin D2 therapy reduced the risk of having at least one fall by 19%, even after factoring in such variables as height.


The researchers wrote "When those who fell were grouped by the season of first fall or the number of falls they had, ergocalciferol treatment reduced the risk of having the first fall in winter and spring but not in summer and autumn, and reduced the risk of having one fall but not multiple falls."


They also wrote "It is interesting that the ergocalciferol therapy effect was confined to those who were to sustain one fall but not those destined to have more than one fall. Older people who fall frequently tend to have more risk factors for falling, including greater degrees of disability and poorer levels of physical function."


Perhaps chemically correcting vitamin D levels in the blood in these women is insufficient to prevent falls, they noted.


The authors concluded "Ergocalciferol, 1,000 international units per day, added to a high calcium intake is associated with 23 percent reduction of the risk of falling in winter/spring to the same level as in summer/autumn."


"Effects of Ergocalciferol Added to Calcium on the Risk of Falls in Elderly High-Risk Women"

Richard L. Prince; Nicole Austin; Amanda Devine; Ian M. Dick; David Bruce; Kun Zhu

Arch Intern Med. 2008;168(1):103-108

Click here to view abstract online

U.N. Officials Call For Increased Action To Prevent Spread Of HIV Among Women, Children In Asia-Pacific Region

More needs to be done to prevent and treat HIV/AIDS among pregnant women and infants in the Asia-Pacific region, U.N. officials said on Monday at the opening of the first Asia-Pacific Joint Forum, the AP/International Herald Tribune reports. At the five-day conference, health experts, nongovernmental organizations and HIV-positive people from 22 countries plan to promote a strategy to prevent HIV transmission among pregnant women and children, with a focus on improved integration of HIV/AIDS and maternal health services. "Linking HIV prevention efforts with reproductive health care can strengthen and improve access to both," Chaiyos Kunanusont, an adviser to the U.N. Population Fund, said. Delegates plan to establish a framework that aims to strengthen links between counseling and testing for HIV and other sexually transmitted infections and maternal and child health, family planning and sexual health. The United Nations estimates that the number of HIV-positive women in the Asia-Pacific region from 2001 through 2004 increased by 16% to more than two million, compared with the global increase of 8%. In addition, roughly 90% of the 411,000 HIV-positive children in the region contracted the virus as a result of mother-to-child transmission, according to the AP/Herald Tribune (AP/International Herald Tribune, 11/6).

"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.

Genes Are An Important Factor In Urinary Incontinence

Much of the risk of developing incontinence before middle age is determined by our genes. Genetic factors can explain half of people's susceptibility to urinary incontinence, a study of twins at the University of Gothenburg and Karolinska Institutet (Sweden) reveals.



Urinary incontinence is very common, especially among women, with around one in three affected at some point in life. Incontinence, overactive bladder and other lower urinary tract symptoms can be caused by factors such as old age, excess weight, pregnancy and childbirth, as well as stroke and other neurological disorders.



"Incontinence is caused by a combination of factors," says gynaecologist Anna Lena Wennberg, one of the researchers behind the study. "We already knew that there are hereditary factors, but now we've been able to show for the first time how important the genetic component is for various types of urinary tract disorder."



Conducted in collaboration with the Swedish Twin Registry at Karolinska Institutet in Stockholm, the study looked at just over 25,000 Swedish twins aged 20 to 46. Information about urinary incontinence, overactive bladder and other lower urinary tract symptoms were analysed using a statistical method which measures how much of the difference between people is due to genetic variation. By comparing the prevalence of these symptoms in identical twins, who have identical genes, and non-identical twins, who share half of their genetic material, the researchers were able to draw conclusions about the relative significance of genetic and environmental factors.



"With urinary incontinence, we saw that just over half of the variation (51%) can be explained by genetic factors," says Wennberg. "This doesn't mean that half of all people with urinary incontinence inherit it from their parents, but that around 50% of people's susceptibility to urinary incontinence can be explained by their genes."



Genes also turned out to be significant for nocturia - the need to get up in the night to urinate. In this case, around a third (34%) of the variation has a genetic explanation.



Wennberg does not believe that there is a single incontinence gene, rather that a number of different genes play a role. These genes combine with various environmental factors or cause disorders which, in turn, increase the risk of urinary incontinence.



"Urinary incontinence is a multifactorial condition, and while we now know that much of the variation between people is down to their genes, treatment will continue to focus on environmental factors which are easier to influence, such as smoking and excess weight."


Notes:


The study was published recently in the online version of the journal European Urology.



URINARY INCONTINENCE: There are several different forms of urinary incontinence. Stress incontinence is where the sphincter between the bladder and the urethra leaks under pressure from the abdomen when coughing, lifting or exercising. Urge incontinence is where the bladder contracts abnormally, resulting in an urge to urinate even when the bladder is not full. Overflow incontinence is where the bladder does not empty as it should, with the result that urine escapes when the bladder is full. Urinary incontinence can also be caused by various neurological disorders or as a side-effect of some medicines.



Source:

Anna-Lena Wennberg


University of Gothenburg

Gene Linked To Preterm Birth Among Hispanic Women

Researchers at Yale School of Medicine have found that the gene ENPP1 is linked to preterm birth and low birth weight among Hispanic women.



Errol Norwitz, M.D., associate professor in the Department of Obstetrics, Gynecology & Reproductive Sciences at Yale, presented preliminary results from this research at the Society for Maternal Fetal Medicine Annual Meeting on February 2 in Dallas, Texas.



One out of eight babies in the United States is born prematurely - delivery prior to 37 weeks gestation. These babies don't fare as well as their full-term counterparts, especially if they are born prior to 28 weeks gestation. In many cases, it is still unclear why preterm births occur, but Norwitz said that both the genetic make-up of the mother and the genetic make-up of the baby play a role.



Norwitz and his collaborators sought to understand the mechanisms responsible for the onset of labor at term and how these mechanisms are either overwhelmed or short-circuited, leading to preterm birth. Some women, especially African-American women, are genetically pre-disposed to preterm births, even after taking into account socioeconomic status, demographics, underlying medical conditions and multiple pregnancies. Norwitz said that multiple genes or a single particular genetic variant - single nucleotide polymorphism - may be involved.



In his study, Norwitz and colleagues tried to tease out some of the genetic factors that are important for preterm birth. They isolated DNA in blood samples from a largely Hispanic population of mothers with a history of preterm birth and compared them to the DNA of women who had only had full-term pregnancies. They then screened the DNA for 128 different genetic variations in 77 candidate genes. While these genetic variants have been known to cause clinical disorders, no one had ever investigated them in the context of preterm birth before.



Four polymorphisms were associated with premature birth, but - to the team's surprise - a variant of the ENPP1 gene was the one most closely linked. ENPP1 has been associated with insulin resistance, glucose intolerance and a risk of developing type-2 diabetes. In certain people, it is associated with hardening of the arteries and high blood pressure. In the context of prematurity, say the researchers, it is possible that the variant form of ENPP1 is associated with deranged energy metabolism.



"In our original study, 85 percent of the population was Hispanic," said Norwitz. "It appears that there are genetic variations unique to each ethnic population. We are now in the process of validating our findings in African-American, Caucasian and Native-American populations."







Other authors on the study included Victoria Snegovskikh, Charles Lockwood, Edward Kuczynski, Louis Muglia, Daniel Robert Tilden, Beth Ann Kozel, Edmund Funai, Mert Ozan Bahtiyar, Guoyang Luo, Stephen Thung and Thomas Morgan.



A discussion on this topic is available on Yale University iTunes U, "Health and Medicine" section.



Source: Karen N. Peart


Yale University

Amnesty International Affirms New Abortion Policy Despite Opposition From Catholic, Conservative Leaders

Amnesty International on Friday affirmed a policy that supports a woman's right to have an abortion under certain circumstances despite opposition from Roman Catholic and conservative leaders worldwide, BBC News reports (Pigott, BBC News, 8/18). The organization at the end of its biennial meeting in Mexico City said it would work to "support the decriminalization of abortion, to ensure women have access to health care when complications arise from abortion and to defend women's access to abortion ... when their health or human rights are in danger" (Reuters, 8/17). According to London's Times, the new policy is automatically binding for Amnesty's members in each member country, including where abortion is illegal (Caldwell/Syal, Times, 8/21).

According to the policy, safe abortions should be available to women in cases of rape or incest, or when the health or life of a pregnant woman is at risk. Amnesty Senior Policy and Campaigns Director Widney Brown has said the policy is part of the group's global campaign to stop violence against women. The policy does not acknowledge abortion as a "fundamental right" for women, and the organization supports the right of states to put "reasonable limitations" on abortion providers and to prosecute those who risk women's lives by performing unsafe abortions, according to Brown.

Reaction
Critics have said that Amnesty has abandoned its principles by changing its previously neutral position on abortion (Kaiser Daily Women's Health Policy Report, 7/30). Cardinal Renato Martino, head of the Vatican's justice and peace department, in June called on Roman Catholics and Catholic organizations to withhold contributions to Amnesty because of the policy. Noeleen Hartigan, program director for Amnesty International Irish Section, said the affiliate recently decided to effectively opt out of the policy and will not participate in Amnesty's abortion-related campaigns (Kaiser Daily Women's Health Policy Report, 7/30).

Michael Evans, Roman Catholic bishop of East Anglia in England, has ended his membership with Amnesty after the group affirmed its support for the new policy, his office confirmed Tuesday, AFP/Yahoo! News reports (AFP/Yahoo! News, 8/21). Evans, who wrote a prayer for the Amnesty's "protect the human" campaign, in a statement on his Web site said, "Very regretfully, I will be ending my 31-year membership of Amnesty International" (Kelland, Reuters, 8/21). "Appalling violence must not be answered by violence against the most vulnerable and defenseless form of human life in a woman's womb," Evans said, adding, "There is no human right to access to abortion, and Amnesty should not involve itself even in such extreme cases."














Kate Gilmore, Amnesty's executive deputy secretary-general, said the group simply supports "women's human rights to be free of fear, threat and coercion as they manage all consequences of rape and other grave human rights violations" (Times, 8/21). Suzanne Trimmel, spokesperson for Amnesty International USA, said that a "handful" -- probably fewer than 200 -- of the chapter's 400,000 members have quit because of the policy change (Kaiser Daily Women's Health Policy Report, 7/30). According to BBC News, Amnesty's international council "overwhelmingly" supported the policy change (BBC News, 8/18).

"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.

GOP Chair Steele Calls Abortion An 'Individual Choice,' Says He Disagrees With Roe V. Wade

Republican National Committee Chair Michael Steele in an interview this week with GQ magazine said that abortion is an "individual choice" and that decisions regarding the procedure should be left to the states, the Washington Times reports. In the interview, which was posted on the magazine's Web site on Wednesday, Steele said his background as an adopted child showed him "the power of life … and the power of choice." Steele continued, "The choice issue cuts two ways. You can choose life or you can choose abortion. You know, my mother chose life. So, you know, I think the power of the argument of choice boils down to stating a case for one or the other." When asked whether he thinks women have the right to choose an abortion, Steele replied, "Yeah. Absolutely," adding, "I think that's an individual choice."

During the interview, Steele also said he disagrees with the Supreme Court's 1973 decision in Roe v. Wade. Steele said that "as a legal matter, Roe v. Wade was a wrongly decided matter." When asked how women would have the ability to choose abortion if Roe were overturned, Steele responded that "states should make that choice." He elaborated, "That's what the choice is. The individual choice rests in the states. Let them decide."

The Times reports that although Steele has always categorized himself as "pro-life" and received an endorsement from the antiabortion-rights group National Right to Life Committee when he ran for the Senate in 2006, he "often has been viewed with suspicion" by conservatives who oppose abortion rights. For example, Steele worked with Christine Todd Whitman, a Republican abortion-rights supporter, to form the Republican Leadership Council. During a 2006 interview on NBC's "Meet the Press," Steele said that he thought Roe should be followed as a settled law. Steele during the 2006 interview also would not say that he would support a constitutional amendment to ban abortion (Morton, Washington Times, 3/12).


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.

Study Examines The Mechanisms That Silence The Estrogen Receptor Gene Alpha During Breast Cancer

The mechanisms that silences the estrogen receptor gene alpha (ER-?±) in certain breast cancer cell lines may be closer to being unlocked, according to a study by researchers at Temple University's Sbarro Institute for Cancer Research and Molecular Medicine.


The researchers reported their findings, "Epigenetic Modulation of Estrogen Receptor-?± by pRb Family Proteins: A Novel Mechanism in Breast Cancer," in the Aug. 15 issue of the journal Cancer Research


In a previous study, the researchers found that in estrogen receptor-positive and estrogen receptor-negative mammary cell lines of women who have been affected with breast cancer, the tumor-suppressing gene pRb2/p130 binds to a specific region of the estrogen receptor gene alpha and forms molecular complexes recruiting and/or interacting with several proteins. They discovered that in estrogen receptor-negative cells which are able to silence the expression of the estrogen receptor pRb2/p130 forms a specific molecular complex recruiting a different sequence of proteins than in the estrogen receptor positive cells.


In the current study, lead by Antonio Giordano, M.D., Ph.D., director of the Sbarro Institute (shro), the researchers showed that the presence of specific pRb2/p130 multimolecular complexes bound to the estrogen receptor gene strongly correlates with the methylation (chemical modification) of the gene.


"Our hypothesis is that the sequence of epigenetic events for establishing and maintaining the silenced state of the estrogen receptor gene alpha during the breast cancer progression is mediated by pRb2/p130 in association with specific proteins that modified the DNA structure through specific mechanisms," said Giordano, who discovered the Rb2 gene while working at Temple's Fels Cancer Institute in the early 1990s.


"In other words, the presence of a specific pRb2/p130 multimolecular complex may dictate a local change of the DNA structure of the estrogen receptor alpha gene and influence its susceptibility to chemical modification (DNA methylation), as well as to different epigenetic alterations leading to estrogen receptor alpha silencing," added Marcella Macaluso, research assistant professor at the Sbarro Institute and the study's lead author.


Giordano says this study provides a basis for understanding how the complex pattern of estrogen receptor gene alpha methylation and transcriptional silencing is generated, as well as for understanding the relationship between this pattern and its function during breast cancer progression.


By understanding this mechanism of how pRb2/p130 recruits molecules, he says, researchers will be able to design therapies and drugs that are very precise in the target they recognize.


"One gene on its own doesn't mean anything," he explains. "It's the dialogue among the genes that are writing the sentences, and this finding really writes a very important sentence in the book that we are authoring on uncovering the understanding of how a normal cell functions and why some therapies work or some therapies don't work. It also clearly shows that cancer is not the event of one gene, but an army of genes and it looks like pRb2/p130 is one of the generals."


Giordano and Macaluso were joined in this study by research fellow Micaela Montanari and doctoral students Paul Bart Noto and Valter Gregorio from the Sbarro Institute, and Professor Christian Bronner from the Centre National de la Recherche Scientifique/Universit?© Louis Pasteur in France.


The study was coordinated by Giordano and carried out at Temple's Sbarro Institute and the Department of Human Pathology and Oncology at the University of Siena in Italy. It was funded by the National Institutes of Health, the U.S. Army Medical Research and Material Command and the Sbarro Health Research Organization.


Temple University

301 University Services Bldg.1601 North Broad St.

Philadelphia, PA 19122

United States

temple.edu

For Breast Cancer Patients Early Switch To An Aromatase Inhibitor Increases Survival

For breast cancer patients taking tamoxifen, switching to an aromatase inhibitor within three years significantly improves survival rates, according to a new study. Published in the March 15, 2007 issue of CANCER, a peer-reviewed journal of the American Cancer Society, the study reveals that the clear survival benefit was also achieved without an increased risk of death from other causes - a significant risk associated with tamoxifen.



Hormone modulating therapies have made a significant impact on the survival rates of women with estrogen-sensitive breast cancer over the last two decades. The drugs are used as adjuvant to primary surgical treatment for a period of five years.



Tamoxifen was the first estrogen modulator shown to increase survival and reduce the risk of breast cancer recurrence. However, tamoxifen is associated with increased risk of death from other causes, such as strokes and endometrial cancer. Despite this risk, tamoxifen and another drug in this class, raloxifene, remain an extensively used and popular treatment.



Aromatase inhibitors, such as aminoglutethimide and anastrozole, work in a different way to lower estrogen levels. Recent evidence shows aromatase inhibitors used alone or in follow-up after two years of tamoxifen therapy demonstrates clear and, in some cases, improved reduction of recurrence risk. However, there is conflicting evidence about mortality benefits.



Led by Professor Francesco Boccardo, M.D. of the National Cancer Research Institute and the University of Genoa in Italy, researchers pooled data from two studies (828 women) comparing five year treatment with tamoxifen alone (415 women) or tamoxifen for two to three years followed by an aromatase inhibitor for the remaining treatment period (413 women).



Dr. Boccardo and his colleagues found that compared to treatment with tamoxifen alone, all cause mortality risk and breast cancer-related mortality risk both fell significantly for women switching to an aromatase inhibitor. In addition, there was no increased risk of death from other causes in women who were prescribed the aromatase inhibitor.



"This pooled analysis provides solid evidence that switching to an aromatase inhibitor following a few years of tamoxifen treatment, implies a mortality benefit over continued tamoxifen and that the benefit on breast cancer-related mortality is mainly due to the effect of switching," conclude the authors.







Article: "Switching to an Aromatase Inhibitor Provides Mortality Benefit in Early Breast Carcinoma. Pooled Analysis of 2 Consecutive Trials," F. Boccardo, A. Rubagotti, D. Aldrighetti, F. Buzzi, G. Cruciani, A. Farris, G. Mustacchi, M. Porpiglia, G. Schieppati, P. Sismondi, CANCER; Published Online: February 12, 2007 (DOI: 10.1002.cncr.22513); Print Issue Date: March 15, 2007.



Contact: David Greenberg


John Wiley & Sons, Inc.

Blogs Comment On Obama Faith-Based Initiatives, State Reproductive Health Developments

The following summarizes women's health-related blog entries.

~ "Faith-Based Initiatives Office To 'Address' Teen Pregnancy? Let's Reduce It," Frances Kissling, RH Reality Check: Last week, President Obama "unveiled his plans for the new White House Office on Faith-Based and Neighborhood Partnerships and signed an executive order authorizing it and naming the first 15 of the eventual 25 council members who will advise him," Kissling writes in a blog entry. There was "little change in the council's core mission -- helping faith groups get government funding for social services, education and humanitarian efforts," Kissling writes, adding, "More alarming was the planned incursion of the Faith based Office into reproductive health and rights. Suddenly, one of the four top priorities for the office is to examine 'ways to support women and children, address teen pregnancy and reduce the need for abortion.'" According to Kissling, the "very wording of the mandate makes clear the conservative bias of the office." She adds that although the "goal is clear" in terms of abortion, where "teen pregnancy is concerned, we have no idea if addressing teen pregnancy means more abstinence-only programming or high schools in which teens who carry pregnancies to term get day care." This is "one of those issues the women's movement and the reproductive health movement cannot ignore," Kissling writes, adding that there are "10 seats left on this committee, and we need to insist that those seats be held by religious and secular leaders ... who are both anti-poverty and pro-choice." She concludes, "After we get those names to the president, we need to let the president know that it is the women's movement and the reproductive health movement that he needs to look to on our issues. When we are ignored on these issues, the president is not on common ground, he is on shaky ground and is bound to stumble" (Kissling, RH Reality Check, 2/9).

~ "Faith-Based Teen Pregnancy and Abortion Reduction?" Amie Newman, RH Reality Check: It was "startling" that Obama decided to "maintain the Office of Faith-Based and Neighborhood Initiatives," Newman writes, adding, "Reducing teen pregnancy is a virtuous and appropriate goal for the federal administration -- as is reducing unintended pregnancies." However, it is "unclear ... why these issues are being placed under the Office of Faith-Based Initiatives, or how faith-based organizations that receive federal funds will use said funds to 'reduce the need for abortion' or reduce teen pregnancy," according to Newman. She adds that when Obama "declares that the Office of Faith-Based Initiatives is going to take on the reduction of teen pregnancy and the need for abortion, one has to ask, how exactly? With such a mission at the heart of an office expressly formed to funnel federal funds to faith- and neighborhood-based programs, there is cause for concern. This office could very well continue to support abstinence-only programs via faith-based organizations that make a case for the continued funding." In addition, "'abortion reduction' or 'reducing the need for abortion' is a poor excuse for a goal," Newman writes, adding, "For one thing, most women do not 'need' an abortion -- they decide to have an abortion based on a variety of personal and private factors." According to Newman, the goals should be to improve "women's access to health services, including family planning for women and their partners, contraception and overall sexual and reproductive health services; and to improve "every young person's sexual and reproductive health and well-being by providing comprehensive sexual health education that teaches them how to protect and care for their health, how to navigate their own sexuality, ... and how to engage in healthy relationships." Newman adds that she is "cautious about the ways in which the Office of Faith-Based Initiatives is going to tackle critical health care issues like the reduction of teen pregnancy and the need for abortion, considering the larger issues of access to family planning, contraception, comprehensive sexual education and more that have yet to be addressed" (Newman, RH Reality Check, 2/6).














~ "Abortion, Contraception and Sex Ed in the States in 2008," Rachel Gold/Elizabeth Nash, RH Reality Check: Although social issues such as reproductive health were not the "top priority" for state legislators in 2008, there were 1,001 measures introduced in 44 states and Washington, D.C., related to reproductive health and rights, resulting in 33 new laws in 20 states, Gold and Nash write in a blog entry that examines several of the new laws. They write that none of the 17 abortion-related laws expand access, but a few states passed laws that "promote reproductive health by requiring hospitals to provide information on emergency contraception" to victims of sexual assault, lay the "groundwork" for expanding Medicaid coverage of family planning services and require insurance coverage of the human papillomavirus vaccine. Gold and Nash continue that Ohio, South Carolina, South Dakota and Oklahoma passed laws requiring abortion providers to perform or offer to perform an ultrasound, bringing the total number of states with ultrasound laws to 16. According to Gold and Nash, Oklahoma's new law requires abortion providers to "verbally describe the image to the woman and position the monitor so she is able to see it" but is not yet " in effect pending the outcome of a legal challenge." They continue that Oklahoma and Idaho passed laws that address "coerced abortion," which "are the result of efforts by [abortion-rights] opponents to characterize abortion providers as often being complicit in forcing women to have abortions, despite the absence of data to substantiate their claims." Six states, including Maryland and Iowa, addressed funding for abortion or abortion alternatives. According to Gold and Nash, Oklahoma's omnibus abortion law contains two provisions not found in any abortion-related measure enacted in 2008, including one that "prohibits a woman from suing a medical provider who does not give full and accurate information about her pregnancy if the misinformation results in her carrying the pregnancy to term" and a second that "greatly expands the ability of health care professionals and facilities in the state to refuse to provide or refer for abortion." Gold and Nash write that three new laws in Wisconsin, Colorado and Iowa "were designed to improve access to contraception and other preventive services," while a second law in Colorado and a similar one in Michigan "continued existing restrictions on state family planning funds." According to the authors, the issue of sexual education "did not elicit significant attention in 2008," with the only related measure enacted in New Hampshire to permit "a student to be excused from health or sex education for religious reasons" (Gold/Nash, RH Reality Check, 2/10).

Antiabortion-Rights Blog

~ "Obama, Stem Cells, Mexico City and More," National Right to Life blog: According to an antiabortion-rights National Right to Life blog entry, President Obama's remarks at the National Prayer Breakfast last week was an example of "unintentionally inclusionary language." NRLC reports that Obama said, "'There is no God who condones taking the life of an innocent human being. This much we know.'" The blog entry continues, "Still another batch of good news on the alternative-to-embryonic stem cell front" is the news that Northwestern University researcher Richard Burt is publishing a study that "showed improvement in four in five multiple sclerosis patients by using bone marrow stem cell transplants to 'reset' their immune system," in the journal Lancet-Neurology. The blog entry continues that Bishop Joseph Francis Martino of the Scranton, Pa., diocese wrote an open letter to Sen. Robert Casey (D-Pa.) that "criticized the freshman senator for failing to vote in favor of an amendment that would have made the 'Mexico City' policy permanent." According to NRLC Legislative Director Douglas Johnson, the effect of reversing the Mexico City policy is "to put hundreds of millions of taxpayer dollars into the hands of organizations that aggressively promote abortion as a population-control tool in the developing world" (National Right to Life blog, 2/9).


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.

Elsevier Announces The 2008 Supplement Of Reproductive Health Matters

Elsevier has announced the publication of Reproductive Health Matters 2008 Supplement on the theme of "Second trimester abortion: women's health and public policy". Second trimester abortion raises complex issues regarding methods, values, stigma, the burden on providers of service delivery and the sometimes complicated reality of women's lives and decisions. This issue of Reproductive Health Matters grew out of a conference on second trimester abortion convened in London in 2007 by the International Consortium on Medical Abortion and attended by 90 expert clinicians and advocates from all over the world.



In many countries, legislation prohibits or restricts the grounds for second trimester abortions. Instead of preventing women from having abortions, these laws often force them to risk their lives doing so. There will always be women who need abortions after 12 weeks of pregnancy, but the numbers diminish greatly by 20 weeks, and become rare after 24 weeks.



Abortion-related deaths have been declining globally in the past three decades because many more countries now have safe, legal abortion. Methods have become substantially safer and simpler, more providers have been trained, and women with complications are more likely to seek and to receive medical help, even where abortion is still legally restricted.



This issue calls for the need for second trimester abortion to be met in a safe, timely and sympathetic manner In-depth, country-based research is needed, to bring out the facts on second trimester abortion, as evidence of why it should be treated as a legitimate form of women's health care and supported in public health policy. Papers in this supplement cover the law and safety of second trimester abortion; women's and providers' perspectives; policy, politics and values; moving from unsafe to safe service delivery; currently recommended methods; methods that should go out of use; and recommendations for advocacy and action from the ICMA conference.



Titles include:
A critical appraisal of laws on second trimester abortion


Reasons for second trimester abortions in England and Wales


A week in the life of an abortion doctor, Western Cape Province, South Africa


Decision-making after ultrasound diagnosis of fetal abnormality


Fetal pain: do we know enough to do the right thing?

Among papers on the law and safety of second trimester abortion; women's and providers' perspectives; policy, politics and values; service delivery; and recommended methods and methods that should go out of use. Other articles focus on countries such as Cuba, India, Mongolia, Mozambique, Nepal, the Netherlands, USA and Vietnam.







About Reproductive Health Matters (RHM)



Reproductive Health Matters is published twice a year, in May and November in English, with editions in translation in Arabic, Chinese, French, Hindi, Portuguese, Russian and Spanish. RHM covers laws, policies, research and services that meet women's reproductive health needs. Each issue focuses on a main theme and includes feature papers, topical papers on other subjects and a round-up of information from published literature.
















About Elsevier



Elsevier is a world-leading publisher of scientific, technical and medical information products and services. Working in partnership with the global science and health communities, Elsevier's 7,000 employees in over 70 offices worldwide publish more than 2,000 journals and 1,900 new books per year, in addition to offering a suite of innovative electronic products, such as ScienceDirect (sciencedirect/), MD Consult (mdconsult/), Scopus (info.scopus/), bibliographic databases, and online reference works.



Elsevier (elsevier/) is a global business headquartered in Amsterdam, The Netherlands and has offices worldwide. Elsevier is part of Reed Elsevier Group plc (reedelsevier/), a world-leading publisher and information provider. Operating in the science and medical, legal, education and business-to-business sectors, Reed Elsevier provides high-quality and flexible information solutions to users, with increasing emphasis on the Internet as a means of delivery. Reed Elsevier's ticker symbols are REN (Euronext Amsterdam), REL (London Stock Exchange), RUK and ENL (New York Stock Exchange).



Source: Minke Havelaar


Elsevier

Women Smokers' Longevity Cut By 14.5 Years Because Of Smoking

One in every five adult women in the United States still smokes, even though smoking takes an average of 14.5 years off their lives, says the American College of Obstetricians and Gynecologists (ACOG).


ACOG said that approximately 438,000 men and women in the USA die prematurely as a result of smoking directly or passively - add to this total about 8.6 million people who have developed serious, preventable illnesses as a result of smoking.


ACOG urges all women smokers to do everything they can to give up. Women should take advantage of every resource available, choose a day when to quit, and take steps now towards giving up tobacco.


ACOG Fellow Sharon Phelan, MD, who helped develop ACOG's smoking cessation materials for health care providers, said "Smoking shaves an average of 14.5 years off the lives of female smokers, yet nearly one in five women 18 and older still light up. "The damaging effects of smoking on women are extensive, well-documented, and can be observed from the cradle to the premature grave. Smoking is a harmful habit that negatively affects nearly every organ in the body. There's just no good reason not to quit."


More women die from lung cancer than from any other cancer, informs ACOG. The number of annual lung cancer deaths of women in the USA has increased six-fold since the middle of the last century. Several other cancer risks are increased if you smoke, such as oral cancer, and cancers of the breast, larynx, esophagus, pancreas, kidney, bladder, uterus, and cervix.


A female smoker runs double the risk of developing coronary heart disease, compared to a non smoker - the chance of developing COPD (chronic obstructive pulmonary disease) is ten times bigger.


More Risks


Compared to somebody who does not smoke, a woman's risk of developing the following diseases, conditions and unpleasant events is significantly higher??


-- Bronchitis

-- Cataracts

-- Early Menopause

-- Emphysema

-- Gum Disease

-- Lower Bone Density after Menopause

-- Osteoporosis

-- Premature Skin Aging

-- Rheumatoid Arthritis

-- Tooth Loss


Risks During Pregnancy And Risks For Babies/Children


The percentage of smoking women who have problems conceiving when they want to have a baby is much higher than for non-smoking women. When a female smoker does get pregnant, she runs a significantly higher risk of delivering a premature baby, a low-weight full-term baby, a baby with poor lung function, bronchitis or asthma. Breastfeeding smoking mothers pass on the harmful chemicals they have consumed from smoking onto their offspring through breast milk.















A woman who takes birth control pills, smokes, and is older than 35 years of age runs a much higher than normal risk of developing lethal blood clots.


Dr. Phelan emphasized "Pregnant women should absolutely not smoke, and smoking should not be allowed in the home after a baby is born. Unfortunately, we know that infants and young children are more heavily exposed to secondhand smoke than adults, and parents, guardians, or other members of the household often smoke around them."


A baby whose mother smoked during pregnancy runs a higher risk of SIDS (sudden infant death syndrome - known in the UK as Cot Death), as does an infant who is exposed to secondhand smoke.


The CDC (Centers for Disease Control and Prevention) estimates that there could be as many as 300,000 children in the USA under the age of 18 months who get lower respiratory tract infections because of their exposure to secondhand smoke. Exposure to secondhand smoke can raise a baby's risk of having asthma attacks, ear problems and respiratory infections.


One quarter of current teenage smokers go on to become regular adult smokers.


Out of the estimated 4,000 American teenagers who take up smoking each day in the USA, about 1,100 will become people who smoke every day for many years. Just under one quarter of high school girls and one tenth of middle school girls smoke regularly in America.


The lower down the socioeconomic ladder a child is in America, the more likely he/she is to take up smoking. The likelihood of a child taking up smoking is much greater if he/she has parents who smoke - healthcare professionals believe this is partly because children have more access to tobacco at home, while at the same time they see smoking as something acceptable if it occurs normally in the house. ACOG also informs that research has shown that teenagers who smoke are more likely to engage in higher-risk sexual activities, and to consume alcohol and illegal drugs.


Hope for those who quit


Dr. Phelan said "Soon after a woman stops smoking, her heart rate and blood pressure drop to healthier levels, and breathing, circulation, and sense of smell and taste may improve. Heart attack risk decreases by 50% within the first year of quitting, and the risk of developing some cancers, heart disease, and other ailments falls to nearly that of a nonsmoker within the first few years."


Dr. Phelan added "It takes most smokers several attempts to kick cigarettes for good. Going cold turkey can be extremely difficult because of nicotine withdrawal and cravings. Physicians can suggest nicotine replacement products - patches, gums, nasal sprays, etc. - to help with cravings. They can also prescribe medications such as bupropion or varenicline, which in combination with nicotine replacement, can double the chances of quitting."


Source - American College of Obstetricians and Gynecologists.


- Christian

Pope Benedict XVI Says Abortion Could Threaten Future Of Europe, New York Times Reports

Pope Benedict XVI on Friday during a visit to Vienna, Austria, said abortion could threaten the future of Europe, the New York Times reports. The pope urged European governments "not to allow children to be considered as a form of illness" and to provide incentives to couples who have children in an effort to reverse the continent's declining fertility rate (Fisher, New York Times, 9/8). According to Reuters, the average total fertility rate in European Union countries is about 1.5 children per woman (Pullella, Reuters, 9/7).

Benedict said that the "fundamental human right ... is the right to life itself," adding, "This is true of life from the moment of conception until its natural end. Abortion, consequently, cannot be a human right -- it is the very opposite." The pope proposed that rather than legalize abortion, governments create a "climate of joy and confidence in life ... in which children are not seen as a burden, but rather as a gift for all" (AFP/Yahoo! News, 9/7).

According to Reuters, Benedict's speech could have implications in the 2008 U.S. presidential election, in which abortion is expected to become a major campaign issue. In addition, the speech put the pope on a "collision course" with Amnesty International, which recently affirmed a new policy on abortion that supports a woman's right to the procedure under certain circumstances, Reuters reports (Reuters, 9/7).

Reprinted with kind 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.

Kaiser Daily Women's Health Policy Report Highlights Recently Released Journal Articles

The following highlights recently released journal articles on women's health issues.

Pregnancy & Childbirth
"Gestational Weight Gain and Adverse Neonatal Outcome Among Term Infants," Obstetrics and Gynecology: Naomi Stotland of the University of California-San Francisco and colleagues looked at the link between weight gain during pregnancy and adverse outcomes among 20,465 full-term, single-birth infants. Weight gain among women was categorized under Institute of Medicine guidelines and by weight gain extremes -- either a gain of fewer than 15.4 pounds or a gain of more than 39.6 pounds. The researchers found that 29% of the participants gained more than 39.6 pounds during their pregnancies, while 4.8% gained less than 15.4 pounds. According to the researchers, infants born to women who gained weight above recommended levels had poor Apgar scores -- a measurement of how well infants look and respond immediately following birth. Excessive weight gain also was associated with infant seizures, low blood sugar and meconium aspiration -- a potentially serious breathing condition. In addition, women who gained weight above recommended levels had a decreased risk of delivering small infants, while weight gain below recommended levels was associated with an increased risk of delivering a small infant. The study's findings indicate that increased efforts need to be made to prevent excessive weight gain during pregnancy, the researchers said (Reuters Health, 9/11).
"The Infant Development, Environment and Lifestyle Study: Effects of Prenatal Methamphetamine Exposure, Polydrug Exposure and Poverty on Intrauterine Growth," Pediatrics: Lynne Smith, associate professor of pediatrics at the University of California-Los Angeles' David Geffen School of Medicine, and colleagues analyzed the stools of 1,618 newborns for presence of methamphetamines in four medical centers in Honolulu, Los Angeles, Iowa and Oklahoma and asked their mothers if they had used meth during pregnancy. The researchers found that 84 of the infants had been exposed to meth in utero. After taking into account such factors as socioeconomic status, smoking and alcohol intake, the researchers found that the infants whose mothers had used meth during pregnancy were 3.5 times as likely to be underweight -- which is classified as weighing fewer than five pounds -- as those who were not exposed to the drug. The researchers said the drug might have hampered the flow of nutrients from the pregnant women to the womb (BBC News, 9/6).

Public Health
"Recreational Physical Activity and Survival Among Young Women With Breast Cancer," Cancer: Page Abrahamson of the Fred Hutchinson Cancer Research Center and colleagues examined the link between physical activity before cancer diagnosis and survival rates among 1,264 women ages 20 to 54 who were diagnosed with breast cancer between 1990 and 1992. Within several months of breast cancer diagnosis, the researchers asked the women how often, on average, they participated in moderate and vigorous physical activity at ages 13, 20 and during the 12 months before diagnosis. According to the researchers, 290 women died during the study participants were followed, and women who reported the lowest activity levels had consistently lower survival rates. After accounting for cancer stage and income level, the researchers recorded a 22% reduction in the risk of death among the women with the highest level of activity in the year before their cancer diagnosis, compared with women who had the lowest activity levels. High levels of physical activity also were associated with a 30% decrease in the risk of death among women who were overweight or obese at diagnosis, according to the study. The researchers did not observe a correlation between risk of death and physical activity among women who were underweight or at their ideal weight when they were diagnosed with cancer. They also found that physical activity at ages 13 and 20 had no effect on survival rates among study participants. The study's findings are promising because not many adjustable lifestyle behaviors have been identified for improving breast cancer survival rates, according to the researchers (Rauscher, Reuters Health, 9/11).















"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.

Patient-Centered Health Care for Muslim Women in the USA

"Patient-centered Health Care for Muslim Women in the United States" is the topic of a conference March 4 and 5 at the
University of Illinois at Chicago that brings together consumers, providers and national experts to discuss culturally
appropriate health care for Muslim women.


Dr. Memoona Hasnain, director of research and assistant professor of public health in family medicine at UIC, is the
principal conference organizer.


From her own experiences as a Muslim woman and a physician, as well as from published studies and an informal survey of
female Muslim students and family medicine providers at UIC, Hasnain concluded that there is a need for ongoing discussion
and additional research on the subject.


"The religious and cultural beliefs of Muslim women impact their health care needs, and they face major barriers while
seeking health care that the rest of the population, particularly health care providers, often are unaware of," she said.



Modesty, for example, is a key concept in Muslim women's lives. Observant Muslim women prefer to avoid unnecessary close
contact with men, and most choose to wear clothing that covers their bodies. They need female health care providers and have
dietary restrictions, special needs during fasting, and personal hygiene needs related to daily prayers, Hasnain said.



Muslim practices and beliefs have implications for a variety of health care issues, she explained. Some are more obvious,
such as those related to sexual norms and obstetrical and gynecological care, including maternal and child health issues.
Less obvious ones include the stigma associated with mental health issues and HIV/AIDS.


"Providers' lack of attention to these needs may seriously compromise care," Hasnain said. "Due to the disconnect between
Muslim women's religious and cultural beliefs and providers' understanding and accommodation of those beliefs, some Muslim
women don't get the health care they need because it is not available in ways that are culturally appropriate. Belonging to a
particular religion or culture should never be the reason for receiving less than ideal health care."


The conference is sponsored by the department of family medicine of the UIC College of Medicine and funded by the Agency for
Healthcare Research and Quality of the U.S. Department of Health and Human Services. This collaborative project has support
from several UIC colleges and centers including the National Center of Excellence in Women's Health, Center for Research on
Women and Gender, School of Public Health, College of Nursing and the Great Cities Institute.


The conference will take place from 8 a.m. to 5 p.m. Friday and 8:30 a.m. to 1 p.m. Saturday in the UIC Student Center West,
828 S. Wolcott Ave.


The keynote address, "Women in Islam: Facts and Perceptions," by Asma Barlas, professor and chair of politics at Ithaca
College, will be from 9 to 9:40 a.m. Friday.















From 9:45 to 10:25 a.m., Dr. Rosaly Correa-de-Araujo, senior advisor on women's health at the Agency for Healthcare Research
and Quality, will present an interactive lecture on "Patient Centered Care: Relevance to Women's Health."


The remainder of Friday will be devoted to group work engaging participants in discussing priorities in health care for
Muslim women and developing an agenda for research, action and best practice.


Saturday highlights include, from 9 to 9:40 a.m., "Patient-Physician Communication: the Case of the Muslim Woman Patient," by
Dr. Elizabeth Burns, professor and chair, department of family medicine, University of North Dakota School of Medicine and
Health Sciences.


From 9:45 to 10:25 a.m., Dr. Fauzia Lodhi, director, Palliative Care and Hospice Program, Rush University Medical Center and
member of the board of directors of the Muslim Community Center in Chicago, will lead a discussion on "Culturally Appropriate
Health Care for Muslim Women."


From 10:45 to 11:25 a.m., Dr. Nawal Nour, assistant professor at Harvard Medical School and director of the African Women's
Health Center at Brigham and Women's Hospital, will lead a discussion on "Clinical Perspective: Female Genital Cutting."



From 11:30 a.m. to 12:30 p.m., a panel of Muslim women will discuss their health experience and an expert panel will respond
to them. This moderated panel discussion also will allow questions from other participants.


The conference is open to the public. Additional information is available at (312) 413-9118 and at uic.edu/depts/ci/mwhconf.


UIC ranks among the nation's top 50 universities in federal research funding and is Chicago's largest university with 25,000
students, 12,000 faculty and staff, 15 colleges and the state's major public medical center. A hallmark of the campus is the
Great Cities Commitment, through which UIC faculty, students and staff engage with community, corporate, foundation and
government partners in hundreds of programs to improve the quality of life in metropolitan areas around the world.


University of Illinois at Chicago

601 S. Morgan St. MC 288

Chicago, IL 60607-7113

United States

Phone 312-996-3456

Fax 312-996-3754

news.uic.edu

Risks Of Cesarean Delivery Are Underreported, Benefits Overstated - Media Briefing Highlights Concerns In Advance Of NIH Conference

Unnecessary cesarean delivery constitutes a threat to the future health of mothers and babies who undergo major surgery, according to experts who spoke at a media briefing hosted by the American College of Nurse-Midwives (ACNM), in Washington, D.C. today. According to these experts, the risks of cesarean delivery are largely misunderstood and underreported, and any benefits are often overstated. Women undergoing the procedure are doing so without being properly informed and are placing their future ability to have a normal delivery in serious jeopardy.


29% of all babies born in 2004 were delivered by cesarean and cesarean deliveries are the most often-performed surgical procedures in the United States, at a cost of $14 billion. The overall rate has increased an unexplainable 40% since 1996.


During the briefing, two women who underwent what they believe were preventable cesareans spoke about the complications they endured after their surgeries. Karen Salinetti of Falls Church, Virginia, underwent additional surgery to remove adhesions, a frequent complication of surgery, which developed after her cesarean. "I want women to know all the risks; too often, information about the surgery is glossed over, and in my case, had I been better informed, I might have made different decisions," Salinetti said. Barbara Stratton from Baltimore, Maryland, said, "I don't believe that any woman should go through this major surgery unnecessarily."


Also at the briefing, Peter Bernstein, MD, of Albert Einstein College of Medicine in New York, NY, presented an update of his article 'Complications of Cesarean Delivery,' which was published by Medscape in September 2005. Bernstein wrote, "With the increasing rate of cesarean deliveries, providers will see more and more of these complications. It is also critical for the provider and the patient to be aware of the risks for complications so that they can make informed decisions about the best mode of delivery given the individual clinical situation they face."


Maureen Corry, MPH, of Childbirth Connection, a national not-for-profit organization that works to improve maternity care quality, presented data from Listening to Mothers, a national survey of women's childbearing experiences. The new survey, conducted by Harris Interactive® among women who gave birth in 2005, offers the first national data collected from mothers themselves on many views and experiences with cesarean section. "Mothers have spoken: Contrary to common belief, they are not electing to plan primary cesarean sections without medical reason; and furthermore, many believe that the current malpractice environment leads providers to perform cesarean sections that are not really needed. It's time for policy makers, health professionals, and women themselves to confront the legal, financial, clinical and other factors that contribute to the escalating U.S. cesarean rate."


"Midwives, as specialists in women's health care, are very concerned that decisions to perform surgery are being made based on circumstantial evidence, misinterpretation of evidence and/or lack of respect for the short and long term risks of this major abdominal surgery," said Katherine Camacho Carr, CNM, PhD, president of the ACNM.















The briefing was part of the ongoing ACNM REDUCE Campaign, which was launched to raise public and policymaker awareness about the troubling rise in cesarean sections performed in the United States. REDUCE stands for 'Research and Education to Decrease Unnecessary Cesarean Sections.'


The following organizations have joined ACNM in the REDUCE Campaign: American Association of Birth Centers, Citizens for Midwifery, the Coalition for Improving Maternity Services, the International Cesarean Awareness Network, and Lamaze International. Leaders from those organizations offered these statements in support of the REDUCE Campaign briefing:


-- "It is imperative that we educate the public about cesarean births including the risks of cesarean birth, and risk factors for future pregnancies, which are largely unknown to the public, and how to prevent cesarean sections by choosing birth centers and the midwifery model of care," said Jill Alliman, CNM, MSN, president of the American Association of Birth Centers.


-- "Only women themselves can tell us if they are actually demanding cesarean section surgery. With what we are learning from Childbirth Connection today, we now know that women VERY rarely schedule first cesareans by choice without a medical reason," says Susan Hodges, president of Citizens for Midwifery. "Only women can tell us what kind of informed consent process was provided to them. Citizens for Midwifery believes that women are not being given adequate and unbiased information about all the risks and benefits of cesarean sections. Research is needed to understand who and what are now influencing decisions to perform major abdominal surgery 'for no medical reason' despite substantial evidence that all cesareans increase harmful risks for mothers and babies."


-- "Voluntary cesarean surgeries are being sold as a woman's right to choose," says Lamaze International President Raymond DeVries, Ph.D. "But for a woman to choose the best option for her and her baby, she must know all the risks of surgical delivery and the comparative risks of a well-managed vaginal birth. Health care providers have the ethical and legal responsibility to provide this information to the women they care for."


-- "While public health officials may capture the harms of cesarean in overall morbidity and mortality statistics, we see the harms of cesarean on a much more personal level," said Tonya Jamois, president of the International Cesarean Awareness Network. "Many of the women who come to our group are struggling with post-operative pain, infections, chronic pain, secondary infertility, miscarriages, and fears about what complications that scar might pose for their next pregnancy. Some women breeze through their cesareans, but many pay a high price, and it should never be done without a good medical reason."


The ACNM REDUCE Campaign - Research and Education to Decrease Unnecessary Cesarean Sections - is a public service campaign of the American College of Nurse-Midwives and its partners. For more information about the REDUCE Campaign, visit midwife


With roots dating to 1929, the American College of Nurse-Midwives is the oldest women's health care association in the U.S. ACNM's mission is to promote the health and well-being of women and newborns within their families and communities through the development and support of the profession of midwifery as practiced by certified nurse-midwives and certified midwives. Midwives believe every individual has the right to safe, satisfying health care with respect for human dignity and cultural variations. More information about ACNM can be found at midwife.




American College of Nurse-Midwives

8403 Colesville Road, Suite 1550

Silver Spring, MD 20910-6374

acnm



ACNM 51st Annual Meeting & Exhibit

May 26 - June 1, 2006 - Salt Lake City, Utah