- Email: [email protected]
Contemporary issues in women's health
International Journal of Gynecology and Obstetrics 104 (2009) 180–181
Contents lists available at ScienceDirect
International Journal of Gynecology and Obstetrics j o u r n a l h o m e p a g e : w w w. e l s ev i e r. c o m / l o c a t e / i j g o
CONTEMPORARY ISSUES IN WOMEN'S HEALTH Richard M.K. Adanu a,⁎,1, Maya M. Hammoud b,⁎,2 a b
Department of Obstetrics and Gynecology, University of Ghana Medical School, Korle Bu Hospital, Accra, Ghana Weill Cornell Medical College in Qatar, Doha, Qatar
The editors of Contemporary Issues in Women's Health solicit reporters and correspondents from throughout the world to make contributions to this section. Please feel free to email or otherwise contact Doctor Richard Adanu at [email protected] or Doctor Maya Hammoud at [email protected] if you have reports or items that you would like to have included. We would be happy to attribute the items to those reporters and correspondents who give permission in their transmittal. Otherwise, we will share those reports that we think are of the greatest interest to our readership without attribution. Depression increases the risk of preterm delivery Depression affects about 15% of women, and pregnant women face the same risk as nonpregnant women. A recent study published in the journal, Human Reproduction, reported that if a woman suffers from severe depression during her pregnancy, she is two times more likely to suffer from preterm delivery compared with women in “normal” mood. The study was conducted with 791 pregnant women of the Kaiser Permanente Medical Care Program in California to examine the impact of prenatal depression on the risk of preterm delivery after controlling for potential confounders. This risk is exacerbated by educational level, a history of fertility problems, and the presence of obesity and stressful events. The study attempted to look at whether the observed associations were confounded by the use of antidepressants, and this did not seem to be the case, although some of the associations in the study did not reach statistical significance. About 12% of babies are born premature. The reasons are not entirely known, but the burden of preterm delivery is enormous. Depression seems to be a contributing factor in those women who are depressed. It is important for women to seek help for depression in the prenatal period, during pregnancy, and post partum.
⁎ Corresponding authors. E-mail addresses: [email protected] (R.M.K. Adanu), [email protected] (M.M. Hammoud). 1 Senior Lecturer, Department of Obstetrics and Gynecology, University of Ghana Medical School, PO Box 4236, Accra, Ghana. 2 Senior Associate Dean for Education, Associate Professor of Obstetrics and Gynecology, Weill Cornell Medical College in Qatar, PO Box 24144, Doha, Qatar.
doi:10.1016/j.ijgo.2008.11.012
Reference Li D, Liu L, Odouli R. Presence of depressive symptoms during early pregnancy and the risk of preterm delivery: a prospective cohort study. Hum Reprod. 2008; 24(1):146–53.
International implementation of breast health guidelines for low-resource countries The Breast Health Global Initiative (BHCI), which represents a mix of internationally focused health care organizations, published a special supplement to the journal Cancer covering breast cancer guidelines for low- and middle-income countries in October 2008. The guidelines detail how to implement breast cancer programs from early detection, to diagnosis and treatment, to developing an overall breast health program within the resources available in these countries. “Guidelines for International Breast Health and Cancer ControlImplementation” outlines a tiered system of resource allocation based on countries' overall economic status and availability of resources. Considering that breast cancer comprises 23% of all female cancers and is a leading cause of mortality, developing practical guidelines that can be implemented in countries with limited resources is crucial. Breast cancer morbidity and mortality varies by geographic location and is highest in low-income countries. Women often present with more advanced cancer due to lack of programs and resources for early detection. Using the best standard of care that is practical in a given setting to implement programs for earlier detection and costeffective diagnosis and treatment of breast cancer should lead to measurable improvement in breast cancer outcomes. The implementation of the guidelines will begin with the creation of “learning laboratories” which will be locations to test programs that can later be expanded to other countries. The first laboratory will be set up in Kumasi, Ghana, later this year and the second will be in South America in 2009. Reference http://www.fhcrc.org/science/phs/bhgi/guidelines/.
CONTEMPORARY ISSUES IN WOMEN'S HEALTH
Accelerating efforts to save the lives of women and newborns In September 2000, the United Nations Millennium Declaration was endorsed by 189 countries and was translated into 8 Millennium Development Goals (MDGs) to be achieved by 2015. Progress toward achieving the MDGs is monitored with a framework of measurable targets and indicators for each MDG that was defined in 2001. MDG 5 focuses on improving maternal health. The situation on the range of indicators defined to monitor progress shows that accelerated action is needed to achieve MDG 5. In September 2008, Dr Margaret Chan, Director General of the World Health Organization, decided to convene a number of women leaders to examine the issues of maternal mortality and universal access to reproductive health, and see what could be done in the most affected countries. Key messages included worldwide statistics on maternal health, the correlation between newborn survival to maternal health and survival, the fact that most maternal and newborn deaths and illnesses can be prevented by access to qualified skilled care during pregnancy and childbirth including timely access to emergency obstetric care and newborn care, and the urgent need to address a well-functioning and responsive system to improve maternal and newborn health. A joint statement regarding increasing efforts to save the lives of women and newborns was released in September 2008 on behalf of UNICEF, the United Nations Population Fund, the World Bank, and the World Health Organization. The statement commits to enhancing support to the countries with the highest maternal mortality and to support countries in strengthening their health systems to achieve the two MDG 5 targets of reducing the maternal mortality ratio by 75% and achieving universal access to reproductive health by 2015. Those efforts will also contribute to achieving MDG 4, “to reduce child mortality.” Maternal mortality is the largest health inequity in the world, with 99% of maternal deaths occurring in low-income countries—half of them in Africa. Each year, over 500 000 women die in pregnancy or childbirth and every year one million newborns die within the first 24 hours of life owing to lack of quality care. Since the vast majority of maternal and newborn deaths can be prevented with proven interventions, strengthening national capacity to tackle the root causes of maternal mortality and morbidity and scaling up quality health services to ensure universal access to reproductive health should help achieve MDG 5. Reference http://www.who.int/making_pregnancy_safer/events/2008/mdg5/ en/.
Successful delivery after entire ovary transplant The world's first transplant of an entire ovary has resulted in the delivery of a healthy baby girl. The 39-year-old mother received the ovary transplant from her twin sister. The transplant was performed to relieve the symptoms of early menopause and to restore menses. The woman had become infertile at the age of 15 when her own ovaries
181
failed. She conceived naturally after the transplant and delivered a 3.6 kg baby, although she did not actually intend to become pregnant. Dr Sherman Silber announced the postovarian transplant delivery at the American Society of Reproductive Medicine Conference in San Francisco, USA. Although there have been deliveries after transplant of strips of ovarian tissue, this was the first time a complete ovary was transplanted. Dr Silber suggested that the full ovary transplant was likely to last longer than strips of ovarian tissue. The procedure might also allow a woman's ovary to be removed and put back after extended storage. This could be needed when a woman of reproductive age undergoes cancer treatment. The transplant was performed using delicate microsurgical techniques to reattach the ovary's blood supply and to keep it in place alongside the fallopian tube, thereby ensuring that ova expelled would be able to travel down the tube. A spokesman for the British Fertility Society stated that the society supports the use of ovary transplant but only when fertility is threatened by impending radiotherapy or chemotherapy. Reference http://news.bbc.co.uk/2/hi/health/7724212.stm.
Women's health: Useful sources of information BioMed Central is a publisher of open access journals which publishes BMC Women's Health. It is possible to download full text versions of all articles from the website: http://www.biomedcentral. com/bmcwomenshealth/. The World Health Organization has released The Reproductive Health Library (RHL) No.11. The latest volume contains 137 Cochrane reviews on: sexual and reproductive health of adolescents; fertility regulation; gynecology and related cancers; HIV and AIDS; infertility; newborn health; pregnancy and childbirth; and reproductive tract and sexually transmitted infections. In addition, for each Cochrane review there is at least one expert, peer-reviewed commentary, which includes a supplementary section entitled “Practical aspects.” RHL commentaries evaluate the findings of the Cochrane review, especially with regard to their significance for under-resourced settings. The practical aspects section presents the evidence in the form of concrete actions for implementation. To help clinicians master specific details of complex interventions, RHL also includes short training videos. These and other contents make RHL one of the largest and most widely available sources of evidence-based clinical information on sexual and reproductive health for both low-income and high-income countries. The RHL is available at: http://www.who.int/rhl/en/. It is also possible to order a CD of RHL No 11 from the site. The Women's Health Specialist Library at http://www.library.nhs. uk/womenshealth/ provides links to a wealth of information on various areas of women's health. Some of the areas covered are sexual health, fertility control, infertility, menopause, prolapse, and urinary problems. There are links to download current guidelines from the Royal College of Obstetricians and Gynaecologists (RCOG).
Contents lists available at ScienceDirect
International Journal of Gynecology and Obstetrics j o u r n a l h o m e p a g e : w w w. e l s ev i e r. c o m / l o c a t e / i j g o
CONTEMPORARY ISSUES IN WOMEN'S HEALTH Richard M.K. Adanu a,⁎,1, Maya M. Hammoud b,⁎,2 a b
Department of Obstetrics and Gynecology, University of Ghana Medical School, Korle Bu Hospital, Accra, Ghana Weill Cornell Medical College in Qatar, Doha, Qatar
The editors of Contemporary Issues in Women's Health solicit reporters and correspondents from throughout the world to make contributions to this section. Please feel free to email or otherwise contact Doctor Richard Adanu at [email protected] or Doctor Maya Hammoud at [email protected] if you have reports or items that you would like to have included. We would be happy to attribute the items to those reporters and correspondents who give permission in their transmittal. Otherwise, we will share those reports that we think are of the greatest interest to our readership without attribution. Depression increases the risk of preterm delivery Depression affects about 15% of women, and pregnant women face the same risk as nonpregnant women. A recent study published in the journal, Human Reproduction, reported that if a woman suffers from severe depression during her pregnancy, she is two times more likely to suffer from preterm delivery compared with women in “normal” mood. The study was conducted with 791 pregnant women of the Kaiser Permanente Medical Care Program in California to examine the impact of prenatal depression on the risk of preterm delivery after controlling for potential confounders. This risk is exacerbated by educational level, a history of fertility problems, and the presence of obesity and stressful events. The study attempted to look at whether the observed associations were confounded by the use of antidepressants, and this did not seem to be the case, although some of the associations in the study did not reach statistical significance. About 12% of babies are born premature. The reasons are not entirely known, but the burden of preterm delivery is enormous. Depression seems to be a contributing factor in those women who are depressed. It is important for women to seek help for depression in the prenatal period, during pregnancy, and post partum.
⁎ Corresponding authors. E-mail addresses: [email protected] (R.M.K. Adanu), [email protected] (M.M. Hammoud). 1 Senior Lecturer, Department of Obstetrics and Gynecology, University of Ghana Medical School, PO Box 4236, Accra, Ghana. 2 Senior Associate Dean for Education, Associate Professor of Obstetrics and Gynecology, Weill Cornell Medical College in Qatar, PO Box 24144, Doha, Qatar.
doi:10.1016/j.ijgo.2008.11.012
Reference Li D, Liu L, Odouli R. Presence of depressive symptoms during early pregnancy and the risk of preterm delivery: a prospective cohort study. Hum Reprod. 2008; 24(1):146–53.
International implementation of breast health guidelines for low-resource countries The Breast Health Global Initiative (BHCI), which represents a mix of internationally focused health care organizations, published a special supplement to the journal Cancer covering breast cancer guidelines for low- and middle-income countries in October 2008. The guidelines detail how to implement breast cancer programs from early detection, to diagnosis and treatment, to developing an overall breast health program within the resources available in these countries. “Guidelines for International Breast Health and Cancer ControlImplementation” outlines a tiered system of resource allocation based on countries' overall economic status and availability of resources. Considering that breast cancer comprises 23% of all female cancers and is a leading cause of mortality, developing practical guidelines that can be implemented in countries with limited resources is crucial. Breast cancer morbidity and mortality varies by geographic location and is highest in low-income countries. Women often present with more advanced cancer due to lack of programs and resources for early detection. Using the best standard of care that is practical in a given setting to implement programs for earlier detection and costeffective diagnosis and treatment of breast cancer should lead to measurable improvement in breast cancer outcomes. The implementation of the guidelines will begin with the creation of “learning laboratories” which will be locations to test programs that can later be expanded to other countries. The first laboratory will be set up in Kumasi, Ghana, later this year and the second will be in South America in 2009. Reference http://www.fhcrc.org/science/phs/bhgi/guidelines/.
CONTEMPORARY ISSUES IN WOMEN'S HEALTH
Accelerating efforts to save the lives of women and newborns In September 2000, the United Nations Millennium Declaration was endorsed by 189 countries and was translated into 8 Millennium Development Goals (MDGs) to be achieved by 2015. Progress toward achieving the MDGs is monitored with a framework of measurable targets and indicators for each MDG that was defined in 2001. MDG 5 focuses on improving maternal health. The situation on the range of indicators defined to monitor progress shows that accelerated action is needed to achieve MDG 5. In September 2008, Dr Margaret Chan, Director General of the World Health Organization, decided to convene a number of women leaders to examine the issues of maternal mortality and universal access to reproductive health, and see what could be done in the most affected countries. Key messages included worldwide statistics on maternal health, the correlation between newborn survival to maternal health and survival, the fact that most maternal and newborn deaths and illnesses can be prevented by access to qualified skilled care during pregnancy and childbirth including timely access to emergency obstetric care and newborn care, and the urgent need to address a well-functioning and responsive system to improve maternal and newborn health. A joint statement regarding increasing efforts to save the lives of women and newborns was released in September 2008 on behalf of UNICEF, the United Nations Population Fund, the World Bank, and the World Health Organization. The statement commits to enhancing support to the countries with the highest maternal mortality and to support countries in strengthening their health systems to achieve the two MDG 5 targets of reducing the maternal mortality ratio by 75% and achieving universal access to reproductive health by 2015. Those efforts will also contribute to achieving MDG 4, “to reduce child mortality.” Maternal mortality is the largest health inequity in the world, with 99% of maternal deaths occurring in low-income countries—half of them in Africa. Each year, over 500 000 women die in pregnancy or childbirth and every year one million newborns die within the first 24 hours of life owing to lack of quality care. Since the vast majority of maternal and newborn deaths can be prevented with proven interventions, strengthening national capacity to tackle the root causes of maternal mortality and morbidity and scaling up quality health services to ensure universal access to reproductive health should help achieve MDG 5. Reference http://www.who.int/making_pregnancy_safer/events/2008/mdg5/ en/.
Successful delivery after entire ovary transplant The world's first transplant of an entire ovary has resulted in the delivery of a healthy baby girl. The 39-year-old mother received the ovary transplant from her twin sister. The transplant was performed to relieve the symptoms of early menopause and to restore menses. The woman had become infertile at the age of 15 when her own ovaries
181
failed. She conceived naturally after the transplant and delivered a 3.6 kg baby, although she did not actually intend to become pregnant. Dr Sherman Silber announced the postovarian transplant delivery at the American Society of Reproductive Medicine Conference in San Francisco, USA. Although there have been deliveries after transplant of strips of ovarian tissue, this was the first time a complete ovary was transplanted. Dr Silber suggested that the full ovary transplant was likely to last longer than strips of ovarian tissue. The procedure might also allow a woman's ovary to be removed and put back after extended storage. This could be needed when a woman of reproductive age undergoes cancer treatment. The transplant was performed using delicate microsurgical techniques to reattach the ovary's blood supply and to keep it in place alongside the fallopian tube, thereby ensuring that ova expelled would be able to travel down the tube. A spokesman for the British Fertility Society stated that the society supports the use of ovary transplant but only when fertility is threatened by impending radiotherapy or chemotherapy. Reference http://news.bbc.co.uk/2/hi/health/7724212.stm.
Women's health: Useful sources of information BioMed Central is a publisher of open access journals which publishes BMC Women's Health. It is possible to download full text versions of all articles from the website: http://www.biomedcentral. com/bmcwomenshealth/. The World Health Organization has released The Reproductive Health Library (RHL) No.11. The latest volume contains 137 Cochrane reviews on: sexual and reproductive health of adolescents; fertility regulation; gynecology and related cancers; HIV and AIDS; infertility; newborn health; pregnancy and childbirth; and reproductive tract and sexually transmitted infections. In addition, for each Cochrane review there is at least one expert, peer-reviewed commentary, which includes a supplementary section entitled “Practical aspects.” RHL commentaries evaluate the findings of the Cochrane review, especially with regard to their significance for under-resourced settings. The practical aspects section presents the evidence in the form of concrete actions for implementation. To help clinicians master specific details of complex interventions, RHL also includes short training videos. These and other contents make RHL one of the largest and most widely available sources of evidence-based clinical information on sexual and reproductive health for both low-income and high-income countries. The RHL is available at: http://www.who.int/rhl/en/. It is also possible to order a CD of RHL No 11 from the site. The Women's Health Specialist Library at http://www.library.nhs. uk/womenshealth/ provides links to a wealth of information on various areas of women's health. Some of the areas covered are sexual health, fertility control, infertility, menopause, prolapse, and urinary problems. There are links to download current guidelines from the Royal College of Obstetricians and Gynaecologists (RCOG).