Women’s health—what’s new worldwide

Authors

  • Shona Kirtley,

  • Bryn Kemp,

  • Stephen Kennedy


International guidelines/reports

Teenagers in the United States: sexual activity, contraceptive use and childbearing, National Survey of Family Growth 2006–8

This report from the US Department of Health and Human Services presents national estimates of sexual activity, contraceptive use and births among young men and women aged between 15 and 19 years in the USA in 2006–8. The data were collected during the National Survey of Family Growth, carried out during that time period by the National Center for Health Statistics. This report tracks changes in factors related to birth and pregnancy rates and sexually transmitted diseases in US teenagers and assesses the impact of various federal, state and local programmes implemented to tackle the previously high rates of teenage pregnancy in the USA.

http://www.cdc.gov/nchs/data/series/sr_23/sr23_030.pdf

Safer pregnancy in Tamil Nadu

This report, published by the World Health Organization (WHO), outlines the experiences, achievements and lessons learned from the Family Welfare Programme of the state of Tamil Nadu, in southern India. The Government of Tamil Nadu introduced a number of programmes to try to improve maternal and child health using three strategies: 1. prevention and termination of unwanted pregnancies; 2. accessible, high-quality antenatal care and institutional delivery, with routine essential obstetric care and emergency obstetric first aid at the primary level, and 3. accessible, high-quality emergency obstetric care at the first referral level. The actions taken by the Tamil Nadu Government have been largely successful with the maternal mortality ratio falling from 450 per 100 000 live births in 1980 to 90 per 100 000 live births in 2006. The child mortality rate (stated as death before the first birthday) has also fallen from 113 per 1000 children born in 1971 to 37 per 1000 children born in 2005.

http://whqlibdoc.who.int/searo/2009/9789290223566.pdf

Promoting sexual and reproductive health for persons with disabilities

The Convention on the rights of persons with disabilities came into force in May 2008 and is the first legally binding international treaty on disability. Five articles of the Convention have direct relevance to sexual and reproductive health, reproductive rights and gender-based violence. This guidance note, published by WHO and the United Nations Population Fund, addresses issues regarding the provision of sexual and reproductive health services to people with disabilities, focusing specifically on programming. The guidance highlights five keys areas for targeting action: 1. establish partnerships with organisations representing people with disabilities; 2. raise awareness and increase accessibility within existing programmes; 3. ensure that all programmes addressing sexual and reproductive health reach out to and serve all people with disabilities; 4. include disability issues in all national policy, laws and budgets for sexual and reproductive health provision, and 5. encourage and promote research on the sexual and reproductive health of people with disabilities.

http://whqlibdoc.who.int/publications/2009/9789241598682_eng.pdf

A reproductive health communication model that helps to improve young women’s reproductive life and reduce population growth: the case of PRACHAR from Bihar, India

This report from Pathfinder International discusses the success of a reproductive health communication model, called PRACHAR, developed and tested in Bihar, India. The PRACHAR model provides a way to tackle persistently high fertility rates by providing reproductive health information to adolescents, young couples, parents and influential community members so as to create an atmosphere that encourages the uptake of new ideas that can improve health and quality of life. The report states that, given the current level of success, projections for 2025 suggest that the population of Bihar state would increase by 23 million fewer people if the PRACHAR model continues to be implemented. The report highlights the fact that the tool has been successful in delaying age at marriage and early childbearing, encouraging spacing of pregnancies by increasing contraceptive use, and increasing awareness/use of contraceptives among the most socioeconomically disadvantaged members of Bihar.

http://www.pathfind.org/site/DocServer/PRACHAR_Impact_-_Pathfinder_WP_Jan_2010.pdf?docID=18181

Clinical trial recruitment

Clinicians keen to keep up-to-date regarding clinical trials that are currently recruiting may find the following informative.

Trial of use of injectable progestin (DMPA) injection and high-dose oral progestin (MPA) tablets in outpatient treatment of acute excessive vaginal bleeding

http://clinicaltrials.gov/ct2/show/NCT01148420

This pilot clinical trial of 50 women aims to investigate the effectiveness of short-term administration of 20-mg medroxyprogesterone acetate (MPA) tablets three times a day for 3 days combined with the injectable progestin (depot MPA; DMPA) that lasts for 3 months. Women will be followed up at 24 and 48 hours to report bleeding status, their use of medication and any side effects. On day 3, women will return to the clinic for a repeat haemoglobin and interval test. Women who continue to bleed on day 3 will be contacted again on day 5.

Inclusion criteria: women aged 18–50 years; candidates for outpatient management; vital signs stable; no severe anaemia; no medical conditions requiring transfusion.

Primary outcome measure: slowing of acute bleeding.

Secondary outcome measures: complete cessation of bleeding; compliance with study medication.

Trial site: California, USA.

Anticipated trial end date: October 2010.

The biomarker study

http://clinicaltrials.gov/ct2/show/NCT01148654

This cohort study will assess women at risk for preterm birth secondary to preterm labour, preterm prelabour rupture of membranes (PPROM) and cervical insufficiency. A medical/obstetric history will be obtained as well as four samples of maternal blood (collected on separate occasions), samples of placental cord blood, maternal saliva and an infant buccal swab. Each woman’s pregnancy outcome will be followed to identify correlations between biomarker levels, latency to delivery and adverse neonatal outcomes.

Inclusion criteria: women with singleton pregnancies (22+0 to 33+6 weeks) who present to the Hospital of the University of Pennsylvania (HUP) ‘Perinatal Evaluation Center’ with preterm labour, PPROM or cervical insufficiency; women who present in labour and deliver (or have just delivered) a single preterm infant (22+0 to 33+6 weeks) at HUP.

Trial site: Pennsylvania, USA.

Anticipated trial end date: June 2012.

Effects of exercise for overweight women with polycystic ovary syndrome (POLY)

http://clinicaltrials.gov/ct2/show/NCT01150539

This interventional, non-randomised trial aims to assess the effects of a 16-week exercise training programme on insulin resistance and adiposity in overweight/obese women with polycystic ovary syndrome (PCOS). A number of baseline assessments will be performed: the control group will undergo these assessments once and the PCOS group will undergo them twice, once at baseline and once after 16 weeks. During the 16-week exercise programme, body weight will be measured weekly and menstrual cycle frequency will be documented.

Inclusion criteria: women aged 18–30 years; BMI ≥ 25; sedentary lifestyle, not currently exercising >60 minutes/week; medical diagnosis of PCOS; non-PCOS controls are required to have regular menstrual cycles (one per month).

Primary outcome measure: change in insulin sensitivity measured by the euglycaemic–hyperinsulinaemic clamp.

Secondary outcome measures: change in visceral fat, body lipolysis and menstrual cyclicity.

Trial site: Louisiana, USA.

Anticipated trial end date: June 2011.

Postoperative belladonna and opium suppositories in vaginal surgery

http://clinicaltrials.gov/ct2/show/NCT01150474

This randomised, interventional trial aims to determine the effectiveness of belladonna and opium suppositories in improving pain control following vaginal surgery. Treatment will be administered immediately after surgery and will continue every 8 hours for 24 hours.

Inclusion criteria: scheduled for elective vaginal surgery requiring general anaesthesia at the Mayo Clinic Hospital.

Primary outcome measure: pain at hour 4 (linear analogue scale score for pain at 4 hours after surgery).

Secondary outcome measures: pain at hours 12 and 20 (linear analogue scale score for pain at hours 12 and 20 after surgery).

Trial site: Arizona, USA

Anticipated trial end date: June 2012.

Patent news

Granted patents

US 7740849 Use of compounds that bind soluble endoglin and SFLT-1 for the treatment of pregnancy-related hypertensive disorders. This US granted patent is for treating pregnancy-related hypertensive disorders. The inventors have discovered that both soluble endoglin levels in placental tissue samples and soluble endoglin protein levels in serum are elevated in women with a pregnancy-associated hypertensive disorder. This invention proposes that compounds that bind to or neutralise soluble endoglin can be used to reduce the elevated levels of soluble endoglin and treat pregnancy-associated hypertension, including pre-eclampsia and eclampsia. See Annu Rev Pathol 2010;5:173–92 for an excellent review by the same group of authors on placental antiangiogenic factors in pre-eclampsia.

Karumanchi S, Sukhatme VP, Toporsian M, Letarte MV. Use of compounds that bind soluble endoglin and SFLT-1 for the treatment of pregnancy-related hypertensive disorders. 22 June 2010.

http://www.patentlens.net/patentlens/patents.html?patnums=US_7740849

EP 1677875 B1 A protein involved in ovarian cancer. This European granted patent claims an anti-CDCP1 antibody for use in the treatment, prophylaxis, screening or diagnosis of ovarian cancer. CDCP1 is a transmembrane protein with intracellular tyrosine residues that are phosphorylated upon activation; it is supposed to be engaged in proliferative activities and resistance to apoptosis of cancer cells.

Burgess NA. A protein involved in ovarian cancer. 9 June 2010.

http://www.patentlens.net/patentlens/patents.html?patnums=EP_1677875_B1

Patent applications

US 2010/0150862 A1 Methods of modulating maternal–fetal tolerance. This application provides cytokines and methods of modulating maternal tolerance and implantation of a fetus using interleukin-27, a heterodimeric cytokine involved in cell-mediated immunity. A method of determining whether an individual is suffering from immune-mediated spontaneous abortion is also claimed.

Devergne, O. Methods of modulating maternal–fetal tolerance. 17 June 2010.

http://www.patentlens.net/patentlens/patents.html?patnums=US_2010_0150862_A1

US 2010/0152102 A1 Use of somatostatin or one of its analogues for preparing a medicament intended to regulate the ovarian follicular reserve in nonmenopausal women. This patent application relates to the use of somatostatin agonist analogues to produce a treatment to regulate ovarian follicular reserve in nonmenopausal women by reducing the depletion of the reserve over time or by using such compounds to accelerate the start of the growth of quiescent follicles. In a recent publication, the same group shows that, in the mammalian ovary, kit ligand, coded by a cAMP-stimulatable gene, is a protein that promotes initiation of follicle growth. The neuropeptide somatostatin is a small peptide that inhibits cAMP generation in many cell types. Consequently, somatostatin receptor agonists might alter kit ligand production and subsequent follicle growth (Endocrinology 2010;151:1299–309).

Gougeon, A., Loumaye, E. Use of somatostatin or one of its analogues for preparing a medicament intended to regulate the ovarian follicular reserve in nonmenopausal women. 17 June 2010.

http://www.patentlens.net/patentlens/patents.html?patnums=US_2010_0152102_A1

US 2010/0154801 A1 Method of surgical repair if vagina damaged by pelvic organ prolapse and prosthetic materials and devices suitable for use therein. This patent application relates to a method, using various prosthetic materials and devices, for surgical repair of the vaginal wall that has been damaged by the prolapse of any of the pelvic organs. Specifically, the vaginal wall can be repaired by first mobilising the vaginal epithelium off the underlying fascia of at least part of the vaginal wall, then positioning a prosthetic material over the exposed fascia, followed by re-fixing the vaginal epithelium over the prosthetic material and fascia, and finally inserting an intravaginal splint in the vagina.

Carey, M. Method of surgical repair if vagina damaged by pelvic organ prolapse and prosthetic materials and devices suitable for use therein. 24 June 2010.

http://www.patentlens.net/patentlens/patents.html?patnums=US_2010_0154801_A1

Legal matters

Ohio senate bill proposes ‘hybrid’ ban

The Ohio State Senate in the USA has recently passed Bill 243, banning the creation of any embryo that would contain both human and animal DNA or tissues. The bill lists eight different ‘human–animal hybrids’, used in stem cell research, that would become illegal. The bill has now been sent to the State House of Representatives for deliberation.

http://www.bionews.org.uk/page_62581.asp?dinfo=00sSl5l9D7OY8tgvvgYy03gJ

African women still not getting justice in National Courts

A new report, published in June, highlights the fact that women in African Commonwealth countries are not receiving adequate protection from national courts. The report analyses African Commonwealth court cases over the past decade and concludes that the courts have failed to protect women, particularly in cases of sexual violence, child custody and marital disputes, despite guaranteeing those rights in local egislation and within regional and international agreements.

http://reproductiverights.org/en/press-room/african-women-still-not-getting-justice-in-national-courts-new-report-finds

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