In the last quarter of a century the prevalence of obesity in the United States has doubled. Officially one third of the US population is now obese being defined as having a Body Mass Index of greater than 30.
7% are morbidly obese with a BMI above 40. There seems little likelihood of the figures growing smaller in the immediate future as 17% of adolescents are overweight – a significant increase over the last 5 years (Ogden et al JAMA 2006;295:1549-55).
28 June, 2006
Over-assisted reproduction?
2% of babies born in Europe are the result of assisted reproduction. This has helped countries of the European Union raise their birth rates but these are still nowhere near population replacement levels (Int J Andr 2006;29:12-6).
Surely one of the most bizarre stories about assisted reproduction must be that of Mrs Z from Russia, reported by the appropriately named Mr Leidig in the BMJ (2006;332:627). She is a 55-year old headmistress whose son was dying of cancer, so she persuaded doctors to freeze some of his semen before treatment was started. This was done and two years after his eventual demise she requested his sperm be used to fertilise a donor egg and be implanted into a surrogate mother.
The child, Mrs Z’s grandson, was born alive and well but the Russian authorities say she is too old to adopt him. The situation is further complicated by the fact that the sperm donor died two years ago and cannot be legally registered as the father. Since the oocyte was donated, the baby doesn’t have a mother either, and since he has no parents he does not officially exist. The Registry Office wants to take him away from Mrs Z and place him in an orphanage. The case is going to court.
Surely one of the most bizarre stories about assisted reproduction must be that of Mrs Z from Russia, reported by the appropriately named Mr Leidig in the BMJ (2006;332:627). She is a 55-year old headmistress whose son was dying of cancer, so she persuaded doctors to freeze some of his semen before treatment was started. This was done and two years after his eventual demise she requested his sperm be used to fertilise a donor egg and be implanted into a surrogate mother.
The child, Mrs Z’s grandson, was born alive and well but the Russian authorities say she is too old to adopt him. The situation is further complicated by the fact that the sperm donor died two years ago and cannot be legally registered as the father. Since the oocyte was donated, the baby doesn’t have a mother either, and since he has no parents he does not officially exist. The Registry Office wants to take him away from Mrs Z and place him in an orphanage. The case is going to court.
25 June, 2006
24 June, 2006
UK statistics on O&G popularity
In the UK the popularity of our speciality is falling fast. Ten years ago 5% of all graduates wanted to specialise in O&G but this dropped to 3% in 2002 and is now estimated at 2%. This is way below the numbers required to maintain staffing levels, especially with consultants becoming increasingly required on labour wards.
Long hours and the exercising of “patients’ rights” in declining students’ presence are noted by the Royal College as disincentives to choosing O&G. Foreign doctors are being looked to as numbers dwindle (Brettingham BMJ 2006;332:323).
Long hours and the exercising of “patients’ rights” in declining students’ presence are noted by the Royal College as disincentives to choosing O&G. Foreign doctors are being looked to as numbers dwindle (Brettingham BMJ 2006;332:323).
Herbs for menopausal symptoms
Most herbal remedies for menopausal symptoms give under-whelming results – in fact, most research shows they are no better than placebo. There is always a placebo effect in these trials so any claims at improvements must show a reduction in symptoms well below possible “suggestion or Hawthorne” effects.
At last one such study has appeared (Uebelhack et al Obstet Gynecol 2006;107:247-55) from Germany using black cohosh plus St John’s wort. Black cohosh extract in the dosage of 1mg triterpene glycoside, the active ingredient, is said to relieve symptoms of hot flushes, night sweats and sleep disturbances without exerting oestrogenic effects. St John’s wort has proved effective in the treatment of depression and mood disorders at a dose of 0.25 mg hypericine, so the combination of the two herbs was tested against placebo in the hope of relieving menopausal physiological and psychological symptoms without the side effects of oestrogens or selective serotonin reuptake inhibitors.
Over a 16 week trial period, the women’s menopause rating scores were reduced by 50% in the active ingredient group and by 20% in the placebo group. In the depression rating scale treatment resulted in a 40% reduction in symptoms with a 12% placebo effect. The authors claim the relatively low placebo effect was due to a single investigator being employed who did not accentuate the psychotherapeutic approach.
The side effects were minimal and it appears that the combination of a fixed dose of black cohosh and St John’s wort has a place in the management of climacteric complaints with a pronounced psychological component.
At last one such study has appeared (Uebelhack et al Obstet Gynecol 2006;107:247-55) from Germany using black cohosh plus St John’s wort. Black cohosh extract in the dosage of 1mg triterpene glycoside, the active ingredient, is said to relieve symptoms of hot flushes, night sweats and sleep disturbances without exerting oestrogenic effects. St John’s wort has proved effective in the treatment of depression and mood disorders at a dose of 0.25 mg hypericine, so the combination of the two herbs was tested against placebo in the hope of relieving menopausal physiological and psychological symptoms without the side effects of oestrogens or selective serotonin reuptake inhibitors.
Over a 16 week trial period, the women’s menopause rating scores were reduced by 50% in the active ingredient group and by 20% in the placebo group. In the depression rating scale treatment resulted in a 40% reduction in symptoms with a 12% placebo effect. The authors claim the relatively low placebo effect was due to a single investigator being employed who did not accentuate the psychotherapeutic approach.
The side effects were minimal and it appears that the combination of a fixed dose of black cohosh and St John’s wort has a place in the management of climacteric complaints with a pronounced psychological component.
Fibroid embolisation outcomes
The long-term outcomes of fibroid embolisation look promising. The FIBROID Registry in the US is a voluntary multi-centre database that chronicles the results of fibroid embolisation. There are records of over 2000 women and they have a unique symptom score method which allows quality-of-life measurements to be made and compared prospectively.
The results are available for the first year after embolisation and 95% of patients had significantly improved symptoms and quality-of-life scores. Only 3% underwent hysterectomy within a year of treatment. The results are remarkable with the best outcomes being achieved when the fibroids were small, submucosal and presented with heavy menstrual loss (Spies et al Obstets Gynecol 2005;106:1309-18).
The results are available for the first year after embolisation and 95% of patients had significantly improved symptoms and quality-of-life scores. Only 3% underwent hysterectomy within a year of treatment. The results are remarkable with the best outcomes being achieved when the fibroids were small, submucosal and presented with heavy menstrual loss (Spies et al Obstets Gynecol 2005;106:1309-18).
Ultimate sex discrimination
There are more boys than girls born in India. The discrepancy is becoming more marked with every census, and is greater in urban than rural areas and amongst higher socio-economic groups. It is not a natural process as there are more male than female stillbirths and infant mortality ratios are equal.
The situation is even more apparent in households where the first-born is a girl – the next child is much more likely to be a boy – rather than another girl. In other words, the sex of the existing child or children affects the sex of the next born.
Jha et al (Lancet 2006;367:211-8) traced these trends by conducting interviews in over one million households. They postulate that prenatal sex testing with abortion of female fetuses is the most likely explanation which fits with India’s common ideology. Although illegal and officially condemned (Sheth pp 135-6) the practice of ultrasonic or amniocentesis sex determination is widespread and it is calculated that in that country alone 10 million female fetuses have been aborted in the last two decades. China is also suspected of having a similarly discriminatory attitude, and the world figure of “missing presumed dead” female babies is estimated at 100 million.
The situation is even more apparent in households where the first-born is a girl – the next child is much more likely to be a boy – rather than another girl. In other words, the sex of the existing child or children affects the sex of the next born.
Jha et al (Lancet 2006;367:211-8) traced these trends by conducting interviews in over one million households. They postulate that prenatal sex testing with abortion of female fetuses is the most likely explanation which fits with India’s common ideology. Although illegal and officially condemned (Sheth pp 135-6) the practice of ultrasonic or amniocentesis sex determination is widespread and it is calculated that in that country alone 10 million female fetuses have been aborted in the last two decades. China is also suspected of having a similarly discriminatory attitude, and the world figure of “missing presumed dead” female babies is estimated at 100 million.
Oestrogens only and breast cancer
Part of the Women’s Health Initiative study of hormonal replacement therapy in the late 1990s included a group of hysterectomised women who received oestrogen alone. Over 10 000 post-menopausal women were randomised to 0.625mg of conjugated equine oestrogen (CEE) daily or placebo over a period of seven years before the trial was stopped because of an increase in stroke incidence without cardiovascular benefit.
14 June, 2006
Some interesting links
This is an interesting link of a journal-club search.
The Public Library of Science has an open-access medical journal.
The Cochrane Centre for evidence-based medicine
Center for Evidence-based medicine at Oxford.
The Public Library of Science has an open-access medical journal.
The Cochrane Centre for evidence-based medicine
Center for Evidence-based medicine at Oxford.
06 June, 2006
Welcome
Welcome to the JASS blog. This is where the editor-in-chief of the Journal Article Summary Service will be recording his thoughts on state of the art in obstetrics and gynaecology research. Posts will include opinion on the latest research and practice, as well as what is happening in the leading journals.
Your feedback is always welcome.
Subscribe to:
Posts (Atom)