Women’s health-what’s new worldwide

This strategy, published by the United Nations, is a call to action for all countries and partners to work together to scale up and prioritise successful interventions, strengthen health systems and coordinate work across sectors to ensure that progress is made in improving the health of women and children around the world. The strategy outlines six essential areas that must be addressed if success is to be achieved: country-led health plans; a comprehensive, integrated package of essential interventions and services; integrated care; health-system strengthening; health workforce capacity building; coordinated research and innovation. The strategy states that if all the areas outlined in the document are addressed then between 2011 and 2015 an estimated 15 million child deaths (including three million newborn deaths) and the deaths of 570 000 women from complications of pregnancy could be prevented. The major barrier to implementation is not a lack of knowledge, as the great majority of these deaths are preventable, but a lack of resources to provide basic perinatal care and to deliver it in suburban–rural areas. A modest investment from wealthier nations and health systems could have a substantial impact, as has been the case with AIDs and the provision of antiretrovirals. http://www.who.int/pmnch/topics/maternal/20100914_gswch_en.pdf Published in November 2010 in the Morbidity and Mortality Weekly Report, the US Center for Disease Control (CDC) has issued revised and updated guidelines regarding the prevention of perinatal group B streptococcal disease (GBS). The guideline provides the latest evidence for the prevention of early-onset GBS, identification of women requiring intrapartum antibiotic prophylaxis, specimen collection and processing for GBS screening and secondary prevention of early-onset GBS among infants. The guideline also encourages both US local and state public health agencies and hospitals to develop robust surveillance mechanisms and to monitor the impact of prevention and education programmes. In addition to the guideline, the CDC has also developed a very informative GBS website (http://www.cdc.gov/groupbstrep/index.html) for obstetric and neonatal care providers and laboratory staff. The guidelines emphasise the US approach to GBS, which is based on a universal screening and intrapartum treatment strategy. Other countries have chosen different approaches with the most popular alternative being a risk-based approach, which was used in the UK. http://www.cdc.gov/mmwr/pdf/rr/rr5910.pdf This comprehensive report, produced annually by the Institute for Health Metrics and Evaluation at the University of Washington, provides an overview of the state of global health financing over the past year. The report focuses on two key elements, development assistance for health and government health expenditure. Key findings include: donor governments have continued to increase development assistance while private funding has declined; tracking health aid spending by individual governments has improved as a result of increased transparency; HIV/AIDS programmes are the most funded health area with maternal, newborn and child health receiving half the amount of funding that HIV/AIDS programmes received; 11 of the 30 countries with the highest disease burden are not listed among the 30 countries receiving the most development assistance; governments in developing countries have increased their commitment to health dramatically over the past two decades. The report highlights uncertainty around the future provision of development assistance as a result of the current economic climate and states that tracking global health spending is crucial in ensuring that what finance is available is directed appropriately to tackle the most important health needs around the world. This report is directly applicable to the global strategy for women’s health mentioned above. A commitment from wealthy nations and individuals to improve women’s health in the developing world, as was made with the HIV epidemic, would save countless lives. http://www.healthmetricsandevaluation.org/print/reports/2010/financing/financing_global_health_report_FullReport_IHME_1110.pdf This policy brief prepared by the Uganda country node of the Regional East African Community Health (REACH) Policy Initiative outlines the best available evidence regarding extending the use of non medically trained primary healthcare workers to deliver cost-effective maternal and child health services. The policy brief aims to inform policy-makers and stakeholders developing the Ugandan national policy for task shifting by providing an evidence-base for developing a range of task shifting options that could be adopted by the Ugandan Government to improve access to maternal and child health services. Traditional physician-based care will not be able to address the health of women and children in the developing world. The populace is geographically dispersed with long distances between villages. Training and placing healthcare workers who can take an evidence-based approach to common problems, such as the use of misoprostol for postpartum atony, is a strategy that merits careful consideration and testing in clinical trials versus usual care. http://www.who.int/rpc/evipnet/Taskshiftingfullreport.pdf Clinicians keen to keep up-to-date regarding clinical trials that are currently recruiting may find the following informative. http://clinicaltrials.gov/ct2/show/NCT01256671 This phase III trial aims to investigate the long-term safety of intravaginal dehydroepiandrosterone (DHEA) in postmenopausal women with vaginal atrophy who have not had a hysterectomy. Women aged between 40 and 75 years of age will be recruited and will receive a daily dose of 0.5% DHEA intravaginally for 52 weeks. Inclusion criteria: Postmenopausal women (non hysterectomised); women between 40 and 75 years of age; willing to participate in the study and sign an informed consent; women who have self-identified symptom(s) of vaginal atrophy; willing to have endometrial biopsy at screening and end of study (week 52). Primary outcome measures: Change from baseline over time of clinical safety data (adverse event reporting, vital signs, physical examination findings, gynaecological examination findings, clinical laboratory tests, endometrial biopsy, mammography and Papanicolaou smear). Secondary outcome measures: Change from baseline over time of vaginal cell maturation (percentage of parabasal and superficial cells); change from baseline over time of vaginal pH; change from baseline over time of self-assessment of symptoms of vulvar/vaginal atrophy. Trial site: Various locations in the USA and Canada. Anticipated trial end date: June 2012. http://clinicaltrials.gov/ct2/show/NCT01256346 This observational study aims to compare the time required, using either pulse oximetry or electrocardiography leads, to obtain an accurate heart-rate measurement of a preterm newborn (24–32 weeks of gestation). Each baby will be fitted with both pulse oximetry leads (Massimo Radical 7) and electrocardiography leads (3M™ Red Dot™ Neonatal Limb Band Monitoring Electrodes, Pre-wired). The time required for each to register a heart rate will be compared. Inclusion criteria: Gestational age of 24–32 weeks. Primary outcome measure: Time until accurate heart rate. Secondary outcome measures: Intermeasurement accuracy. Trial site: Oklahoma, USA. Anticipated trial end date: December 2011. http://clinicaltrials.gov/ct2/show/NCT01251263 This prospective, randomised trial aims to determine the combined effects of a continuous oral contraceptive (OC) regimen with additional oral estradiol therapy on the occurrence and severity of headaches in women with menstrually associated migraines (MAMs). Inclusion criteria: Women using the birth control pill (OC), patch or vaginal ring taken in the traditional 21/7 or 24/4 manner; if women are not on OCs, patch or vaginal ring participants must have a period every 21–40 days; women must not want to get pregnant for 12 months; women who have headaches around the time of their period. Primary outcome measure: Comparing baseline MAMs with headache occurrence and severity after the implementation of continuous OC therapy. Secondary outcome measures: Compare effect of estradiol versus placebo on MAMs severity and duration. Trial site: Texas, USA. Anticipated trial end date: October 2012. http://clinicaltrials.gov/ct2/show/NCT01255189 This randomised, controlled phase IV trial aims to assess the effects of positional changes in preterm infants on cerebral oxygenation levels using near infrared spectroscopy. Inclusion criteria: <32 weeks of gestation and/or <1500 g; >30th day preterm infants. Primary outcome measure: The effect of positional changes on cerebral oxygenation in preterm infants. Trial site: Ankara, Turkey. Anticipated trial end date: June 2011. US 7846680 Detection of the nucleolar channel system of human endometrium and uses thereof. This granted patent describes methods whereby assays can be used to detect the presence or absence of nucleolar channel systems (NCSs) in endometrial tissue samples. Specifically, an agent that is specific for a protein (selected from the group consisting of one or more of Nup153, Nup62, Tpr, Lamin A/C, Lamin A, Lamin B2, Emerin, Calnexin, BiP, PDI, CLIMP63, Karyopherin β1, Ran and γ-tubulin) is applied to the tissue sample. The presence of the protein within the nuclei of the endometrial epithelial cells signifies the presence of NCSs in the tissue sample. Additionally, this patent outlines methods using NCSs for determining the implantation receptiveness of a postovulatory endometrium and in determining the effectiveness of contraception. This application claims the benefit of US Provisional Patent Application No. 61/062,827, filed on 29 January 2008, the content of which is hereby incorporated by reference. Meier, U. Detection of the nucleolar channel system of human endometrium and uses thereof. 7 December 2010. http://www.patentlens.net/patentlens/patents.html?patnums=US_7846680 US 7842464 Use of ADAM 12 for diagnosis and therapy of preeclampsia. This granted patent outlines the use of the gene ADAM 12 as a valuable diagnostic marker in diagnosing pre-eclampsia and related syndromes. Previous research has shown that transcription of ADAM 12, present in many bodily fluids including blood, is strongly upregulated in women with pre-eclampsia. This patent therefore proposes that routine blood samples taken during most antenatal visits can additionally be tested for the presence of an up-regulation of ADAM 12-S allowing for regular monitoring and early detection of pre-eclampsia. Gack S, Schorpp-Kistner M, Angel P, Wrobel G, Lichter P, Marme A, Stumm S. Use of ADAM 12 for diagnosis and therapy of preeclampsia. 30 November 2010. http://www.patentlens.net/patentlens/patents.html?patnums=US_7842464 US 2010/0311190 A1 Devices and methods for detecting amniotic fluid in vaginal secretions. This patent application discusses a method for diagnosing premature rupture of the fetal membranes (PROM) by detecting whether amniotic fluid is present in the vagina. Specifically, the patent relates to the detection of placental α-microglobulin-1 (PAMG-1) above the minimal background concentration of amniotic protein PAMG-1 in the vaginal secretion of pregnant women which is proposed to indicate that amniotic fluid is present and that PROM may have occurred. Fuks B, Petrunin D, Zaraisky E, Boltovskaya M, Nazimova S, Starosvetskaya N, Konstantinov A, Marshiskaia M. Devices and methods for detecting amniotic fluid in vaginal secretions. 9 December 2010. http://www.patentlens.net/patentlens/patents.html?patnums=US_2010_0311190_A1 US 2010/0305210 A1 S-Alkylisothiouronium derivatives for treating abnormal uterine bleeding disorders. This patent application outlines methods for treating uterine hypercontractility disorders, in particular abnormal uterine bleeding and dysmenorrhoea. The application discloses that the administration of a composition comprising the active ingredient S-ethylisothiouronium diethylphosphate to women with abnormal uterine bleeding can reduce bleeding or even eradicate it. The authors state that the beneficial effects may continue for a few months after cessation of treatment and may additionally reduce menstrual-related pain. This compound, if effective, would provide a novel molecular pathway to relieve the burden of dysmenorrhea and abnormal uterine bleeding. Barkan R, Ghicavii V. S-Alkylisothiouronium derivatives for treating abnormal uterine bleeding disorders. 2 December 2010. http://www.patentlens.net/patentlens/patents.html?patnums=US_2010_0305210_A1 US 2010/0304993 A1 Biomarkers for the detection of early stage ovarian cancer. This patent application outlines methods and kits for determining the presence of ovarian cancer by measuring biomarkers present in a sample provided by a woman. Specifically, two panels of biomarkers for ovarian cancer have been identified. The first comprising (i) apolipoprotein A1, (ii) transthyretin, (iii) inter-α (globulin) inhibitor H4 (plasma Kallikrein-sensitive glycoprotein), (iv) transferrin and (v) CA125 and the second panel comprising (i) apolipoprotein A1, (ii) transthyretin, (iii) connective tissue activating peptide III, and (iv) CA125. The panels have been shown to be sensitive in detecting early-stage (stage I or stage II) ovarian cancer. Fung E.T, Clarke C, Bast RC Jr, Coombes KR. Biomarkers for the detection of early stage ovarian cancer. 2 December 2010. http://www.patentlens.net/patentlens/patents.html?patnums=US_2010_0304993_A1 The Australian states of Western Australia and New South Wales have followed the state of Victoria in removing the rights of gamete and embryo donors to remain anonymous. This change has been made as a result of the 2010 Assisted Reproductive Technology Treatment Regulations coming into force. Consequently, almost all donor conception procedures carried out in Australia will now operate on a non anonymous basis with donor-conceived people having the right to learn the identity of their donor. This reflects the shift, internationally, towards using identifiable donors in assisted reproductive treatments. http://www.bionews.org.uk/page_81599.asp?dinfo=00sSl5l9D7OY8tgvvgYy03gJ A case brought before the European Court of Human Rights by three women who suffered serious health consequences after not being granted access to abortion services in Ireland, has ruled that Ireland has violated its human rights obligations. In Ireland access to abortion is restricted in almost all cases and women are only granted access to abortion services if their pregnancies are life threatening. The Irish government now need to implement a number of changes to ensure that they comply with the European Court’s judgement. The only alternative is for them to appeal the decision and assert that their national sovereignty trumps EU decisions to the contrary. http://www.hrw.org/en/news/2010/12/16/ireland-european-court-says-abortion-rights-issue

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