The open-access journal PLoS Neglected Tropical Diseases is publishing an article emphasizing the rising burden of Neglected Tropical Diseases (NTDs) in Central Asia. According to the article's co-authors, Dr. Peter Hotez, President of the Sabin Vaccine Institute, and Dr. Ken Alibek of Nazarbayev University in Astana, Kazakhstan, the region continues to suffer from a post-Soviet economic breakdown that may have contributed to a re-emergence of several NTDs in the area, especially among its most economically disadvantaged groups. Specifically, the five mostly landlocked Central Asian countries created after the 1991 collapse of the Soviet Union -- Kazakhstan, Kyrgyzstan, Tajikistan, Turkmenistan and Uzbekistan -- became increasingly vulnerable to NTDs due to a deterioration of health care services and infrastructure. Among the prevalent diseases profiled in the article, the following was highlighted:
A study of rural primary schools in southwestern Kyrgyzstan found that many of the children had at least one soil-transmitted helminth infection. Developmental and cognitive delays have been associated in children with these infections, leading to decreased school attendance and low wages earned as adults. In Uzbekistan, and likely in other Central Asian countries, soil-transmitted helminth infections have been responsible for losses in economic productivity.
After the decentralization of farming and livestock production, small farms in Central Asia were left largely without veterinary inspection, leading to the deterioration of veterinary public health and the rise of zoonotic, or animal-borne, helminth infections. In four of the Central Asian nations, cystic echinococcosis -- a tapeworm infection spread by dogs and sheep -- has increased at least four-fold and is thought to be vastly under-reported. There has also been an alarming increase in pediatric cases of this and other zoonotic helminth infections.
Despite a considerable decrease in reported malaria cases as a result of indoor residual spraying and mass drug administration of anti-malaria drugs, a large portion of Kyrgyzstan and Tajikistan populations is still at risk for Plasmodium vivax malaria. In Tajikistan, the malaria epidemic is fueled by human migrations from Afghanistan, thwarting efforts to eliminate malaria in neighboring countries.
Dr. Hotez, who also serves as the director of the Sabin Vaccine Institute & Texas Children's Center for Vaccine Development and was recently named the founding dean of the first national school of tropical medicine, located at Baylor College of Medicine, said, "There appears to be an overall absence of detailed information on the prevalence of many of these neglected diseases in Central Asia."
Hotez and Alibek also suggest that the Global Fund to Fight AIDS, Tuberculosis, and Malaria should consider how to best integrate NTDs into their control and elimination programs in order to help ease the burden caused by NTDs.
**Source: Public Library of Science
28 September 2011
Una portada en EEUU reabre el debate de los embarazos tardíos
Madres casi a los 60 es el nuevo tema de debate que ha llegado a las primeras páginas de los periódicos estadounidenses. «¿Demasiado mayor para esto?», se pregunta el «New York Magazine» en un artículo de portada en el que aparece una mujer anciana simulando la célebre foto de Annie Leibovitz que en 1991 inmortalizó a Demi Moore desnuda, en su séptimo mes de embarazo.
En este reportaje de siete páginas, su autora Lisa Miller se introduce en el farragoso campo de los «prejuicios que estas madres coraje están obligadas a afrontar» y cuenta la historia de John Ross y Ann Maloney, quienes se conocieron cuando él tenía 54 años y ella 47 años.
La primera vez que tuvieron sexo, John le dijo a Ann que tenía el cuerpo de una chica, preparado para tener un hijo. Ann, que no tenía descendencia por un matrimonio anterior fracasado y una vida profesional ajetreada, se lanzó a la ardua carrera de ser madre no sin muchos obstáculos, no sólo físicos (tuvo que hormonarse para el tratamiento de reproducción asistida), sino también sociales.
«Si no entras en el estereotipo, te dejan de lado»«Si no entras en el estereotipo de cómo debería ser una madre, la gente te deja de lado», asegura Ann, quien con 60 años disfruta de una maternidad tardía junto a John, de 66 años y sus dos hijas Lily e Isabella de siete y 10 años.
Los numerosos estudios y estadísticas usadas por Lisa Miller no dejan lugar a dudas: los hijos de padres ancianos son sanos y felices tanto o más que los de padres jóvenes. Las críticas más duras contra las madres mayores argumentan que «no es estética» la imagen de una mujer de 60 años amamantando a un niño.
En este reportaje de siete páginas, su autora Lisa Miller se introduce en el farragoso campo de los «prejuicios que estas madres coraje están obligadas a afrontar» y cuenta la historia de John Ross y Ann Maloney, quienes se conocieron cuando él tenía 54 años y ella 47 años.
La primera vez que tuvieron sexo, John le dijo a Ann que tenía el cuerpo de una chica, preparado para tener un hijo. Ann, que no tenía descendencia por un matrimonio anterior fracasado y una vida profesional ajetreada, se lanzó a la ardua carrera de ser madre no sin muchos obstáculos, no sólo físicos (tuvo que hormonarse para el tratamiento de reproducción asistida), sino también sociales.
«Si no entras en el estereotipo, te dejan de lado»«Si no entras en el estereotipo de cómo debería ser una madre, la gente te deja de lado», asegura Ann, quien con 60 años disfruta de una maternidad tardía junto a John, de 66 años y sus dos hijas Lily e Isabella de siete y 10 años.
Los numerosos estudios y estadísticas usadas por Lisa Miller no dejan lugar a dudas: los hijos de padres ancianos son sanos y felices tanto o más que los de padres jóvenes. Las críticas más duras contra las madres mayores argumentan que «no es estética» la imagen de una mujer de 60 años amamantando a un niño.
-Madres mayores, madres ricas
Pero en los Estados Unidos de la recesión económica, los movimientos contra las madres mayores de 50 años tienen otras motivaciones. «Sólo los ricos», señala el progresista Slate «pueden permitirse invertir centenares de miles de dólares en técnicas de fecundación asistida para invetir su reloj biológico».
«Cuando vives en un país de 51 millones que casi no tienen ni derecho a asistencia médica», advierte el «New York Magazine», «el privilegio de estas madres aparece como una gran injusticia digna de la frívola y extravagate María Antonieta».
Pero en los Estados Unidos de la recesión económica, los movimientos contra las madres mayores de 50 años tienen otras motivaciones. «Sólo los ricos», señala el progresista Slate «pueden permitirse invertir centenares de miles de dólares en técnicas de fecundación asistida para invetir su reloj biológico».
«Cuando vives en un país de 51 millones que casi no tienen ni derecho a asistencia médica», advierte el «New York Magazine», «el privilegio de estas madres aparece como una gran injusticia digna de la frívola y extravagate María Antonieta».
**Publicado en "VOCENTO"
Public ignorant about key messages concerning diet and cancer
New research on public perceptions about cancer reveals that 50-year-old ideas still hold sway while many current lifestyle messages are not getting through. On the positive side, however, the vast majority of people now believe cancer is curable. Experts at the University of Leicester and Leicester's Hospitals carried out the research to assess patients' beliefs about the causes of cancer, which was funded by the Leicestershire-based charity Hope Against Cancer.
The study, published online in the journal Clinical Oncology, aimed to compare knowledge about the outcome of cancer treatment and beliefs about the causes of cancer among British South Asian cancer patients and beliefs held by British White cancer patients and the impact of these beliefs upon the patients' mental health.
Between September 2007 and January 2010, 279 patients, who were aware they had cancer, entered the study, funded by Leicestershire-based charity Hope Against Cancer, at the Leicestershire Cancer Centre. Researchers found that:
Across both groups there was an over emphasis on pollution, stress and injury as causes of cancer
Almost one quarter of the group believed cancer was caused by injury, reflecting research carried out over half a century ago
20% believed that surgery could cause cancer to spread
Both cohorts believed religion/fate played a part in cancer
30% of the group gave credence to alternative medicine being as effective as current clinical procedures
It was generally accepted that smoking can cause cancer
There was widespread lack of awareness about the roles diet, obesity and lack of exercise play in the development of the disease.
The vast majority believed cancer to be curable, with only 10.6% of the British South Asian group and 2.7% of the British White group thinking it was incurable. Out of the total sample, 93% understood the advantages of early screening.
Many of the two groups' assumptions about cancer were held in common. There was widespread over-emphasis on environmental pollution, stress and injury as triggers for cancer. Environmental pollution is a relatively minor cause of cancer, while there is no evidence that stress or injury can cause cancer.
Twenty per cent of the sample believed wrongly that treatment, in particular surgery, caused the cancer to spread and this was a cause of significant depression among British South Asians and anxiety across both groups.
The perceived role of religion in the cause of and recovery from cancer was more prevalent among the British South Asians, though a small cohort of the British White patients had some belief in Fate.
Nearly 30% of the total sample thought alternative treatments could be as effective as surgery, radiotherapy and chemotherapy. This view was held by almost twice as many British South Asian patients as British White patients.
The way patients understand cancer can have a major impact on how they cope with it psychologically. This study is part of a wider investigation with the long-term aim of improving psychological support of cancer patients.
Professor Paul Symonds, of the Department for Cancer Studies and Molecular Medicine at the University of Leicester, commented: "It is clear that there is a continual need for education into the causes of cancer. The good news is that the majority of the sample believed that cancer was curable and screening effective, while 84% appreciated that smoking could cause cancer.
**Source: University of Leicester
The study, published online in the journal Clinical Oncology, aimed to compare knowledge about the outcome of cancer treatment and beliefs about the causes of cancer among British South Asian cancer patients and beliefs held by British White cancer patients and the impact of these beliefs upon the patients' mental health.
Between September 2007 and January 2010, 279 patients, who were aware they had cancer, entered the study, funded by Leicestershire-based charity Hope Against Cancer, at the Leicestershire Cancer Centre. Researchers found that:
Across both groups there was an over emphasis on pollution, stress and injury as causes of cancer
Almost one quarter of the group believed cancer was caused by injury, reflecting research carried out over half a century ago
20% believed that surgery could cause cancer to spread
Both cohorts believed religion/fate played a part in cancer
30% of the group gave credence to alternative medicine being as effective as current clinical procedures
It was generally accepted that smoking can cause cancer
There was widespread lack of awareness about the roles diet, obesity and lack of exercise play in the development of the disease.
The vast majority believed cancer to be curable, with only 10.6% of the British South Asian group and 2.7% of the British White group thinking it was incurable. Out of the total sample, 93% understood the advantages of early screening.
Many of the two groups' assumptions about cancer were held in common. There was widespread over-emphasis on environmental pollution, stress and injury as triggers for cancer. Environmental pollution is a relatively minor cause of cancer, while there is no evidence that stress or injury can cause cancer.
Twenty per cent of the sample believed wrongly that treatment, in particular surgery, caused the cancer to spread and this was a cause of significant depression among British South Asians and anxiety across both groups.
The perceived role of religion in the cause of and recovery from cancer was more prevalent among the British South Asians, though a small cohort of the British White patients had some belief in Fate.
Nearly 30% of the total sample thought alternative treatments could be as effective as surgery, radiotherapy and chemotherapy. This view was held by almost twice as many British South Asian patients as British White patients.
The way patients understand cancer can have a major impact on how they cope with it psychologically. This study is part of a wider investigation with the long-term aim of improving psychological support of cancer patients.
Professor Paul Symonds, of the Department for Cancer Studies and Molecular Medicine at the University of Leicester, commented: "It is clear that there is a continual need for education into the causes of cancer. The good news is that the majority of the sample believed that cancer was curable and screening effective, while 84% appreciated that smoking could cause cancer.
**Source: University of Leicester
La web “medico.com” permite intercambiar opiniones y experiencias a usuarios y profesionales sanitarios
El Dr. Julian Fisher, neurólogo, pediatra y profesor de la Universidad de Harvard en Boston (Estados Unidos) y director médico del portal internacional http://www.medico.com/, ha presentado en Madrid al recién nombrado asesor médico en España de este proyecto, el doctor Jesús Sánchez Martos, catedrático de Educación para la Salud de la Universidad Complutense de Madrid. Como expertos en acercar el conocimiento médico a la población, pretenden que el nuevo espacio de Internet medico.com permita a los usuarios (sanitarios y pacientes) una comunicación bidireccional para intercambiar experiencias y aportar ideas en beneficio de la salud. La supervisión por parte de los expertos de todos los contenidos garantiza la credibilidad y el rigor de la información que se transmite a través de este nuevo medio.
El doctor Fisher ha anunciado que el proyecto tiene previsto un gran crecimiento con el próximo lanzamiento dos nuevas versiones además de la ya existente en español para España y Latinoamérica; será en portugués para Brasil y Portugal y la versión en inglés para la India.
“Hace años que lo tenía en mi mente, pero la tecnología no permitía desarrollar este tipo de plataformas. Ahora con Internet sí y por eso aquí estamos. Actualmente hay muchos pacientes y enfermedades y éstas son muy complejas. ¿Cómo podemos manejar estos datos con rigor y ayudar a los pacientes? En medico.com hemos creado un recurso flexible de información: más de 4.000 enfermedades descritas con bibliografía de expertos de todo el mundo”, explicó.
El creador de esta iniciativa comenta que existe un foro en el que los propios pacientes, especialmente los crónicos, hablan entre sí contando las experiencias de su enfermedad, haciendo recomendaciones. Sin embargo aclara que, puesto que eso puede dar lugar a inexactitudes, imprecisiones e incluso errores, el equipo médico lo revisa, aclara y aporta su punto de vista científico.
“Queremos dar una información clara para el paciente y fidedigna, para que además pierda el miedo a la enfermedad. Todos nuestros contenidos son revisados por los asesores médicos y sus equipos. Esto hace que nos distingamos de la mayoría de la información de salud que hay en Internet”, agrega el doctor Fisher. Por ello esta iniciativa no es “una más” a las tantas que hay en la Red con el fin de conseguir información sobre salud.
El portal contiene información de consulta sobre decenas de disciplinas, además de un blog para la comunidad de usuarios y una potente plataforma de preguntas y respuestas con herramientas de búsquedas. Se trata de una web abierta y gratuita donde poder consultar, compartir información y realizar preguntas en las distintas especialidades médicas.
El doctor Fisher ha anunciado que el proyecto tiene previsto un gran crecimiento con el próximo lanzamiento dos nuevas versiones además de la ya existente en español para España y Latinoamérica; será en portugués para Brasil y Portugal y la versión en inglés para la India.
“Hace años que lo tenía en mi mente, pero la tecnología no permitía desarrollar este tipo de plataformas. Ahora con Internet sí y por eso aquí estamos. Actualmente hay muchos pacientes y enfermedades y éstas son muy complejas. ¿Cómo podemos manejar estos datos con rigor y ayudar a los pacientes? En medico.com hemos creado un recurso flexible de información: más de 4.000 enfermedades descritas con bibliografía de expertos de todo el mundo”, explicó.
El creador de esta iniciativa comenta que existe un foro en el que los propios pacientes, especialmente los crónicos, hablan entre sí contando las experiencias de su enfermedad, haciendo recomendaciones. Sin embargo aclara que, puesto que eso puede dar lugar a inexactitudes, imprecisiones e incluso errores, el equipo médico lo revisa, aclara y aporta su punto de vista científico.
“Queremos dar una información clara para el paciente y fidedigna, para que además pierda el miedo a la enfermedad. Todos nuestros contenidos son revisados por los asesores médicos y sus equipos. Esto hace que nos distingamos de la mayoría de la información de salud que hay en Internet”, agrega el doctor Fisher. Por ello esta iniciativa no es “una más” a las tantas que hay en la Red con el fin de conseguir información sobre salud.
El portal contiene información de consulta sobre decenas de disciplinas, además de un blog para la comunidad de usuarios y una potente plataforma de preguntas y respuestas con herramientas de búsquedas. Se trata de una web abierta y gratuita donde poder consultar, compartir información y realizar preguntas en las distintas especialidades médicas.
**Publicado en "MEDICOS Y PACIENTES"
NACE E-MINTZA, UNA APLICACIÓN PARA PERSONAS CON GRAVES BARRERAS COMUNICATIVAS
La Fundación Orange y la Fundación Dr. Carlos Elosegui de Policlínica Gipuzkoa ha presentado la aplicación gratuita e-Mintza, un sistema personalizable y dinámico de comunicación diseñado para personas con autismo o con severas barreras de comunicación oral o escrita, cuya creación contó con el apoyo del Plan Avanza2 del Ministerio de Industria, Turismo y Comercio.
Esta nueva herramienta permite que el usuario pueda comunicarse con otras personas mediante el uso de tecnología táctil y multimedia. Asimismo promueve su autonomía a través de una agenda personalizada. 'e-Mintza', que en euskera se traduce como "habla electrónica", es un programa de descarga gratuita que está diseñado para cualquier tableta habitual del mercado. Es fácilmente personalizable en cuanto a la lengua utilizada, características, textos, imágenes, vídeos o sonidos, en función de las necesidades o intereses del usuario, quien podrá interactuar a través de una pantalla táctil en un dispositivo tipo tableta, pero también a través del ratón en el caso de una pantalla de ordenador no táctil.
Esta nueva herramienta permite que el usuario pueda comunicarse con otras personas mediante el uso de tecnología táctil y multimedia. Asimismo promueve su autonomía a través de una agenda personalizada. 'e-Mintza', que en euskera se traduce como "habla electrónica", es un programa de descarga gratuita que está diseñado para cualquier tableta habitual del mercado. Es fácilmente personalizable en cuanto a la lengua utilizada, características, textos, imágenes, vídeos o sonidos, en función de las necesidades o intereses del usuario, quien podrá interactuar a través de una pantalla táctil en un dispositivo tipo tableta, pero también a través del ratón en el caso de una pantalla de ordenador no táctil.
La herramienta, inicialmente pensada para facilitar la comunicación de las personas con autismo puede ser usada por otras muchas personas, dada su alta capacidad de personalización. Así, por ejemplo, puede ser útil para niños con sordera que aún no han adquirido un lenguaje; parálisis cerebral, personas con discapacidad intelectual grave; pacientes con daño cerebral adquirido por traumatismos o accidentes; personas mayores con enfermedades neurodegenerativas; personas que no pueden expresarse por requerir intubación o ventilación asistida durante su estancia hospitalaria, etc.
El proyecto e-Mintza se inició en 2009, involucrando a los usuarios finales desde las fases iniciales, para que el proyecto respondiera realmente a sus necesidades. La evaluación con los usuarios reales se mantuvo durante un período de nueve meses teniendo en cuenta parámetros como la adecuación de los pictogramas, el tamaño de las fotos, la capacidad motriz del usuario, la utilidad comunicativa real y no tanto lúdica de la herramienta, la manejabilidad y la funcionalidad educativa, entre otros aspectos.
Entre las novedades incorporadas tras la evaluación con los usuarios, destaca la agenda, en la que el usuario puede ubicar el plan temporal secuenciado hasta seis actividades por día o espacio temporal. Se identificó la importancia de incluir la agenda considerando que la anticipación y planificación es esencial a la hora de apoyar a personas con autismo o con discapacidad intelectual. Una de las características del software e-Mintza es la posibilidad de personalizarlo con fotos personales en vez de pictogramas o letras. Además, se incluye la opción de añadir vídeos. El desarrollo técnico de e-Mintza fue realizado por Nesplora, empresa del Parque Tecnológico de San Sebastián, y contó con la esencial participación de personas y familiares de la Asociación de Autismo GAUTENA en las distintas fases del proyecto.
**Publicado en "ACTA SANITARIA"
27 September 2011
Removal of fibroids that distort the womb cavity may prevent recurrent miscarriages
Researchers have found the first, firm evidence that fibroids are associated with recurrent miscarriages. They have also discovered that if they removed the fibroids that distorted the inside of the womb, the risk of miscarriage in the second trimester of pregnancy was reduced dramatically – to zero. The study, which is published online in Europe’s leading reproductive medicine journal Human Reproduction today Wednesday, is the culmination of 20 years of investigation into recurrent miscarriage by Professor Tin-Chiu Li and his team at the recurrent miscarriage clinic at the University of Sheffield and Sheffield Teaching Hospitals (Sheffield, UK).
In addition, for the first time it has given a reliable estimate of the prevalence of fibroids in women who have recurrent miscarriages. Fibroids in or around the womb (uterus) are benign tumours composed of muscle and fibrous tissue. Although they have been associated with spontaneous miscarriage, until now there has been no evidence of their role in recurrent miscarriages (RM). The prevalence of fibroids has been estimated to be between 3-10% in women of reproductive age, but the prevalence is unknown in women who experience RM, which is defined as three or more consecutive miscarriages. The researchers analysed data from 966 women who attended the Sheffield RM clinic.
The women were scanned for uterine anomalies, including fibroids, via transvaginal ultrasound and radiology, and 79 were found to have fibroids. “This enabled us to calculate that the prevalence of fibroids was 8.2% among women with recurrent miscarriages; this has never been accurately reported before,” said one of the researchers, Dr Sotirios Saravelos, who is a clinical research Fellow at the University of Sheffield.
Fibroids were diagnosed and grouped into three classifications: · Submucosal – these grow in the muscle beneath the inner lining of the womb wall and grow into the middle of the womb, distorting the cavity· Intramural – these develop in the muscle wall of the womb and are the most common type of fibroid. They do not distort the cavity and have less than 50% protrusion into the serosal surface – the outer membrane lining the womb · Subserosal – these grow outside the wall of the womb into the pelvis, do not distort the womb cavity, and have a greater than 50% protrusion out of the serosal surface. Prof Li used minimally invasive surgery (hysteroscopy) to remove cavity-distorting (submucosal) fibroids from 25 women; 54 women with fibroids that did not distort the cavity had no surgery and they were matched with a control group of 285 women whose recurrent miscarriages were still unexplained after all investigations found nothing abnormal; these women also had no intervention. In the 25 women who had undergone surgery, miscarriage rates in subsequent pregnancies during the second trimester fell from 21.7% to 0%. This translated to an increase in the live birth rate from 23.3% to 52%. Dr Saravelos said: “This is the first time that it has been shown that removing fibroids that distort the uterine cavity may increase the chances of a subsequent live birth in women with recurrent miscarriages.” The 54 women with fibroids not distorting the uterine cavity and who had had no surgery also did better after referral to the RM clinic. Pre-referral, the miscarriage rate during the second trimester was 17.6% and this fell to 0% after referral. Live birth rates went up from 20.6% to 70.4% in subsequent pregnancies. This was similar to results from the 285 women with unexplained RM; the second trimester miscarriage rate was 8% pre-referral to the clinic, falling to 1.8% post-referral, while live birth rates increased from 20.6% to 71.9% after referral. Dr Saravelos said: “These results are interesting because they suggest that the finding of fibroids in women with recurrent miscarriage does not necessarily imply that the fibroids are the only cause of the miscarriage. In addition, they suggest that surgical intervention is not the only means whereby patients with recurrent miscarriage benefit from attending a specialised, dedicated clinic. However, for women with fibroids that distort the uterine cavity, our work shows that removing the fibroids can eliminate miscarriage during the second trimester and double the live birth rate in subsequent pregnancies. "It has been recognised since the 1980s that women with unexplained recurrent miscarriage have very good pregnancy outcomes following referral to a dedicated clinic without the need for any intervention, and with psychological supportive care, i.e. tender loving care, alone. This usually takes the form of regular visits to a dedicated recurrent miscarriage clinic, regular antenatal scans to check the condition of the baby, reassurance to the mother from the specialist that everything is progressing well and specialist antenatal counselling throughout the pregnancy.
“Interestingly, although women may increase their live birth rate by up to 50% after psychological supportive care, the exact underlying mechanisms involved in this process are not entirely understood. In the present study, the fact that women with fibroids not distorting the uterine cavity do so well, suggests that they also do not have an underlying cause for recurrent miscarriage. As a result, they can also be considered as having ‘unexplained recurrent miscarriage’, and should be counselled that they have very good chances of a successful pregnancy without the need for any intervention or surgery and with the psychological supportive care offered by a dedicated recurrent miscarriage clinic.
" The main limitation of the study is that there was no control group for the women who had their fibroids removed and so it is not possible to tell whether they would have done better without surgery, after referral to the RM clinic. The researchers say that their work highlights the need to perform a randomised controlled trial to investigate this. “The definitive study requires the recruitment of a rather large number of patients to be randomised between intervention and no intervention. This would require the input of several clinics in a multi-centre randomised controlled trial and its success would depend on the support of all clinics along with that of Sheffield,” said Dr Saravelos.
In addition, for the first time it has given a reliable estimate of the prevalence of fibroids in women who have recurrent miscarriages. Fibroids in or around the womb (uterus) are benign tumours composed of muscle and fibrous tissue. Although they have been associated with spontaneous miscarriage, until now there has been no evidence of their role in recurrent miscarriages (RM). The prevalence of fibroids has been estimated to be between 3-10% in women of reproductive age, but the prevalence is unknown in women who experience RM, which is defined as three or more consecutive miscarriages. The researchers analysed data from 966 women who attended the Sheffield RM clinic.
The women were scanned for uterine anomalies, including fibroids, via transvaginal ultrasound and radiology, and 79 were found to have fibroids. “This enabled us to calculate that the prevalence of fibroids was 8.2% among women with recurrent miscarriages; this has never been accurately reported before,” said one of the researchers, Dr Sotirios Saravelos, who is a clinical research Fellow at the University of Sheffield.
Fibroids were diagnosed and grouped into three classifications: · Submucosal – these grow in the muscle beneath the inner lining of the womb wall and grow into the middle of the womb, distorting the cavity· Intramural – these develop in the muscle wall of the womb and are the most common type of fibroid. They do not distort the cavity and have less than 50% protrusion into the serosal surface – the outer membrane lining the womb · Subserosal – these grow outside the wall of the womb into the pelvis, do not distort the womb cavity, and have a greater than 50% protrusion out of the serosal surface. Prof Li used minimally invasive surgery (hysteroscopy) to remove cavity-distorting (submucosal) fibroids from 25 women; 54 women with fibroids that did not distort the cavity had no surgery and they were matched with a control group of 285 women whose recurrent miscarriages were still unexplained after all investigations found nothing abnormal; these women also had no intervention. In the 25 women who had undergone surgery, miscarriage rates in subsequent pregnancies during the second trimester fell from 21.7% to 0%. This translated to an increase in the live birth rate from 23.3% to 52%. Dr Saravelos said: “This is the first time that it has been shown that removing fibroids that distort the uterine cavity may increase the chances of a subsequent live birth in women with recurrent miscarriages.” The 54 women with fibroids not distorting the uterine cavity and who had had no surgery also did better after referral to the RM clinic. Pre-referral, the miscarriage rate during the second trimester was 17.6% and this fell to 0% after referral. Live birth rates went up from 20.6% to 70.4% in subsequent pregnancies. This was similar to results from the 285 women with unexplained RM; the second trimester miscarriage rate was 8% pre-referral to the clinic, falling to 1.8% post-referral, while live birth rates increased from 20.6% to 71.9% after referral. Dr Saravelos said: “These results are interesting because they suggest that the finding of fibroids in women with recurrent miscarriage does not necessarily imply that the fibroids are the only cause of the miscarriage. In addition, they suggest that surgical intervention is not the only means whereby patients with recurrent miscarriage benefit from attending a specialised, dedicated clinic. However, for women with fibroids that distort the uterine cavity, our work shows that removing the fibroids can eliminate miscarriage during the second trimester and double the live birth rate in subsequent pregnancies. "It has been recognised since the 1980s that women with unexplained recurrent miscarriage have very good pregnancy outcomes following referral to a dedicated clinic without the need for any intervention, and with psychological supportive care, i.e. tender loving care, alone. This usually takes the form of regular visits to a dedicated recurrent miscarriage clinic, regular antenatal scans to check the condition of the baby, reassurance to the mother from the specialist that everything is progressing well and specialist antenatal counselling throughout the pregnancy.
“Interestingly, although women may increase their live birth rate by up to 50% after psychological supportive care, the exact underlying mechanisms involved in this process are not entirely understood. In the present study, the fact that women with fibroids not distorting the uterine cavity do so well, suggests that they also do not have an underlying cause for recurrent miscarriage. As a result, they can also be considered as having ‘unexplained recurrent miscarriage’, and should be counselled that they have very good chances of a successful pregnancy without the need for any intervention or surgery and with the psychological supportive care offered by a dedicated recurrent miscarriage clinic.
" The main limitation of the study is that there was no control group for the women who had their fibroids removed and so it is not possible to tell whether they would have done better without surgery, after referral to the RM clinic. The researchers say that their work highlights the need to perform a randomised controlled trial to investigate this. “The definitive study requires the recruitment of a rather large number of patients to be randomised between intervention and no intervention. This would require the input of several clinics in a multi-centre randomised controlled trial and its success would depend on the support of all clinics along with that of Sheffield,” said Dr Saravelos.
Endocrinology media release: Clinical research needs to be more attuned to the needs of patients and clinicians
Sir Iain Chalmers, coordinator of The James Lind Initiative, will use his plenary lecture at the European Society for Paediatric Endocrinology meeting to highlight the need for the research community to be more effective in serving the information needs of patients and professionals. He will state there are currently large inefficiencies in the way health research is carried out, with the result that the needs of consumers of research results - patients and clinicians - are not being met effectively.
Over US$100 billion is put towards supporting biomedical research worldwide every year, resulting in an estimated 1 million research publications1. However, Sir Iain’s presentation will argue that there are currently inefficiencies in the research system which could be reduced. Recommendations for improving productivity include:
· New research should only be supported if it has been demonstrated in systematic reviews of existing evidence that it will address important uncertainties. Only against that background can proposed new research be ethical and likely to be worthwhile.
· New clinical research should address unanswered questions that are of relevance to patients and clinicians.
· When new results are reported, the impact they have on the totality of evidence relevant to the question addressed should be made clear.
· The scientific community needs to ensure that well conducted studies addressing important uncertainties are all published, regardless of the direction and strength of the results. Biased under-reporting of research is unacceptable, both on scientific and ethical grounds.
· Research needs to be made more available to people working within the healthcare system and greater efforts made to ensure that patients and clinicians have readier access to research findings relevant to the treatment and other choices they have to make.
Sir Iain Chalmers from The James Lind Initiative said:
“The ultimate outcome of all health research should be to improve patient health and wellbeing. When carrying out new research, resources should be allocated as effectively as possible to projects that will reduce important uncertainties and offer the public good returns on its investments.
“Our work has shown that this is not the case currently and that there is still a large waste of resources in the way that health research is carried out and reported. There are a number of areas we have identified where this waste can be cut, including ensuring that patients and clinicians are consulted about their research priorities and that all findings of well conducted research are published, regardless of direction and strength of results. Although there are admirable exceptions, the research community as a whole needs to examine the way it functions and move towards making research more accessible and accountable to the end-users - patients, clinicians and the general public".
Over US$100 billion is put towards supporting biomedical research worldwide every year, resulting in an estimated 1 million research publications1. However, Sir Iain’s presentation will argue that there are currently inefficiencies in the research system which could be reduced. Recommendations for improving productivity include:
· New research should only be supported if it has been demonstrated in systematic reviews of existing evidence that it will address important uncertainties. Only against that background can proposed new research be ethical and likely to be worthwhile.
· New clinical research should address unanswered questions that are of relevance to patients and clinicians.
· When new results are reported, the impact they have on the totality of evidence relevant to the question addressed should be made clear.
· The scientific community needs to ensure that well conducted studies addressing important uncertainties are all published, regardless of the direction and strength of the results. Biased under-reporting of research is unacceptable, both on scientific and ethical grounds.
· Research needs to be made more available to people working within the healthcare system and greater efforts made to ensure that patients and clinicians have readier access to research findings relevant to the treatment and other choices they have to make.
Sir Iain Chalmers from The James Lind Initiative said:
“The ultimate outcome of all health research should be to improve patient health and wellbeing. When carrying out new research, resources should be allocated as effectively as possible to projects that will reduce important uncertainties and offer the public good returns on its investments.
“Our work has shown that this is not the case currently and that there is still a large waste of resources in the way that health research is carried out and reported. There are a number of areas we have identified where this waste can be cut, including ensuring that patients and clinicians are consulted about their research priorities and that all findings of well conducted research are published, regardless of direction and strength of results. Although there are admirable exceptions, the research community as a whole needs to examine the way it functions and move towards making research more accessible and accountable to the end-users - patients, clinicians and the general public".
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