May 5th, 2008 by Dr. Val Jones in Health Policy, Health Tips
1 Comment »
Do you know your state’s momScore? Revolution Health and I have teamed up with leading medical experts and mommy bloggers to create a new health index just in time for Mother’s Day: the momScore.
Check out this fun interactive map that ranks states by 10 key maternal health variables*:
- Access to prenatal care
- Availability of childcare services
- Number of insured moms
- Maternal mortality
- Affordability of childrens’ health insurance
- Air quality
- Family paid leave policy
- Infant mortality
- Risk of pregnancy complications
- Violent crime rate
We also created a combined average of these variables (weighted according to expert perceived importance) to get an overall ranking. So, do you know where it’s best to be a mom in the United States?
Apparently, Vermont ranks most favorably (on average) in all of these variables. Don’t live in Vermont? Check out how your state compares.
Would you like to discuss your state’s rankings with others or debate the momScore? You can post your comments in our interactive momScore community. This is a really exciting opportunity to discuss women’s health issues in a fresh new way. I hope that the momScore will challenge states to strengthen their efforts to keep moms and babies healthy. At the very least, we’ve made a lot of Vermonters quite smug.
*Variables are based on state reporting to the Environmental Protection Agency (EPA), the Centers for Disease Control and Prevention (CDC), and the United States Census Bureau, as well as leading non-profit organizations such as the Kaiser Family Foundation and the American College of Obstetricians and Gynecologists. For more information about momScore methodology, click here.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
March 11th, 2008 by Dr. Val Jones in News
1 Comment »
I was surprised by recent recent findings from the CDC’s National Health and Nutrition Examination Survey– one in four teenage girls (ages 14-19, chosen at random in the US) tested positive for some sort of sexually transmitted disease, most commonly HPV (human papilloma virus) (18%), followed by chlamydia (4%), trichomonas (2.5 %), and herpes (2%).
I asked Revolution Health expert, Dr. Iffath Hoskins, (Senior Vice President, Chairman and Residency Director in the Department of Obstetrics and Gynecology at Lutheran Medical Center in Brooklyn, N.Y.) what she thought of this news.
“This relatively high infection rate is cause for concern. We need to increase our education efforts so that teenagers are more aware of the risks of sexually transmitted diseases, especially since women’s reproductive futures are at stake. Chlamydia infections can substantially decrease fertility rates, long after the infection has been fully treated with antibiotics.
As far as the high HPV rates are concerned, I’m not surprised since previous research has estimated that 80-90% of adults have been infected with at least one of 80 subtypes of this very common virus. Only 6 of these 80 are known to predispose women towards cervical cancer. But the HPV vaccine can substantially reduce the risk for contracting those 6, so it’s important to vaccinate young girls against this virus.
No teenage girl should be walking around with chlamydia or trichomonas. They are treatable with antibiotics.”
The study also found racial differences between STD infection rates in teenage girls, with blacks being infected at twice the rate of white or Hispanic girls. The CDC is calling for educational outreach to at-risk groups, and the American Academy of Pediatrics supports confidential teen screening.
I hope that these staggering statistics act as a wake up call to health care providers who may not have thought to screen their teen patients for STDs. Apparently, these infections are more common than we realized.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
March 6th, 2008 by Dr. Val Jones in Expert Interviews
3 Comments »
I must admit that I was a bit skeptical of the conclusions drawn by the media about the latest analysis of the Women’s Health Initiative (WHI) data. The WHI study has generated many different spin-off articles about hormone replacement therapy and its potential link to breast cancer. This latest review suggests that the increased risk for cancer persists up to five years after stopping HRT treatment for menopausal symptoms. I asked Revolution Health expert and past president of the American College of Obstetricians and Gynecologists, Dr. Vivian Dickerson, to help us put this new article into context.
Dr. Val: What does this new study contribute to our understanding of the risks of HRT?
Dr. Dickerson: First of all the women in this study were not on estrogen alone (the usual treatment for women who have had hysterectomies). Their HRT consisted of a combination of Premarin (estrogen) and Provera (progesterone). The original study indicated a slightly higher (barely statistically significant) increased risk for cardiovascular disease (CVD) and a statistically significant increased risk in breast cancer (but relative risks were less than 1.5 for both, which is very small).
Now all this new analysis tells me is that the CVD risk appears to extinguish or become negligible after three years though there is still an increase in breast cancers (compared to placebo) but the difference was not statistically significant. This is interesting in that it does add some plausibility to the claim that the reason breast cancer rates declined so significantly in the year(s) after WHI is because of all the women who quit taking HRT. It doesn’t prove anything, but just more grist for the mill. (Unfortunately I don’t see sub-group analyses of the women who chose to continue HRT after the end of WHI and those who quit from the treatment group.)
The study authors used some fancy math to demonstrate that there was a statistically significant increase in all-cause mortality (including breast cancer) for the women in the HRT group. Since the relative risk is so low, all they can say is that there is no reason to use HRT as a protective or primary preventive measure against heart disease, which we’ve known for many years now.
Dr. Val: Would you change your HRT recommendations based on this new analysis of the WHI data?
Dr. Dickerson: I wouldn’t change a thing that I am doing or counseling. These data are weak and the differences are not robust in any parameter.
***
So there you have it, ladies. No need for heightened alarm based on this analysis of the WHI data, especially if you have never been on the Premarin/Provera cocktail. It would be really helpful to compare breast cancer rates in women who stopped HRT versus those who continued it after the initial WHI data were released. Let’s keep our fingers crossed that this subgroup analysis is next up for publication.
Addendum: My friend and HRT expert, Dr. Avrum Bluming, kindly wrote me an email to further underscore the dubious nature of this study’s findings. Here’s what he said:
“The paper reads more like a lawyer’s presentation then a scientific article (i.e. it makes points followed by the disclaimer that the findings represented are not statistically significant—but the points have been registered). Instead of concluding that the very small increased risk of harm associated with estrogen and progesterone combination therapy (reported in the original studies, which were of questionable significance in the first place) are not found 2+ years after HRT was stopped, they find new risks (lung cancer) to allow them to conclude that administration of HRT results in delayed increased risks.”This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
March 5th, 2008 by Dr. Val Jones in Expert Interviews, News
2 Comments »
This is a cute story that caught my eye – a couple used in-vitro fertilization (IVF) to become pregnant, and they specifically asked their doctor to implant only one embryo to make sure that they did not have multiple births. In the end, that one embryo split twice, causing identical triplets to grow inside the uterus. All three baby boys were born healthy at 35 weeks gestation.
I asked Revolution Health fertility expert, Dr. Rani Abbasi, to help me to understand if there was any greater risk of twinning in the IVF process. Interestingly, there are some new techniques used to help insure implantation of embryos that can also increase the chances of identical twins forming. I don’t know if this couple’s doctor used either technique, but I thought I’d explain them to you because the MSNBC report might lead you to believe that this event was extremely rare (they quote 200 million to one) when in fact it may not be quite THAT rare.
There are two methods that fertility specialists can use to increase the chances of implantation for a single embryo. First, incubating the embryo in an extended culture (for 5 days rather than the usual 3) makes it more likely that the transfer will implant in the uterus. However, since the embryo is two days older at the time of transfer, it has a higher likelihood of splitting into two, causing identical twins.
Second, some fertility experts use a technique called “assisted hatching” which also improves the likelihood of implantation of an embryo. This involves making a small nick in the embryo’s outer zone (I think of it as an egg shell) to facilitate the cells breaking out of the protective outer coating and implanting in the uterine wall. When the nick is made, it is also possible for a single cell to fall out (rather than the group of cells, called a blastocyst, exiting together) and become its own fetus.
So ultimately, it’s possible that the techniques used by this couple’s doctor to insure a successful implantation of one embryo increased the chance of splitting of that same embryo, resulting in triplets. Granted, the chance of this happening is still rare – and it’s ironic since the couple was doing all they could to avoid twins or triplets – but it’s not nearly as rare as the chance of a random woman having identical triplets outside of IVF.
For more information about twins and triplets, check out my recent podcast interview with pregnancy expert Dr. Mary D’Alton. And for those of you who believe that you can control your destiny, this story should give you pause!This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
March 1st, 2008 by Dr. Val Jones in Humor
2 Comments »
This is one of the funniest SNL skits I’ve seen in a long time (hat tip to KevinMD). It’s a spoof drug commercial about a birth control pill that allows women to have their period once a year. Enjoy!This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
