**News Flash(s):**

**IHS Advanced Colposcopy course / Refresher Workshop**

-   March 30 - April 1, 2005

-   Albuquerque, New Mexico (see Save the Dates, below)

**The basics of all AI/AN women's health, plus a good update**

**I.H.S. / A.C.O.G. Postgraduate Course: Obstetric, Neonatal, and
Gynecologic Care Start planning now**

-   June 19 - 23, 2005

-   Denver, CO

-   Contact [Yvonne Malloy](mailto:YMalloy@acog.org) <YMalloy@acog.org>
    or 202-863-2580

-   Save the date info below and online

OB/GYN Chief Clinical Consultant's Corner

Volume 2, No. 12, December, 2004

# Contents: {#contents .Style-Style-Heading-1-+-Underline-+-Pattern:-Clear-(Gray-12.5%)}

#### Abstract of the Month: page 3 {#abstract-of-the-month-page-3 .Style-Heading-4-+-Arial-14-pt-Underline}

The tension free vaginal tape (TVT) procedure is 'coming of age'

#### From your colleagues: page 4 {#from-your-colleagues-page-4 .Style-Heading-4-+-Arial-14-pt-Underline}

**Katy Ciacco Palatianos:** Closing the Quality Gap

**James M. Galloway:** Prevention of Cardiovascular Disease & Diabetes
Among AI / AN

**Steve Holve:** Indian Child Health Notes -- December

**Carol Koeble:** New Perinatal HIV Hotline 1-800-933-3413

**Joan Koval:** You Will Love HypnoBirthing Clients

From Bob Laliberte: **Locum tenens availability**

**Marian Mehegan:** Region X Regional OWH Women\'s Health Meeting, Jan
24, 2005 Portland

**Chuck North:** Advances in Indian Health -- Save the dates

**Laura Shelby:** New HPV web page is now available on CDC web site

**Marsha Tahquechi:** How can I get ACOG materials when I am not a
member of ACOG?

**Judy Thierry:** Media: oral contraceptives protects against heart
disease, stroke, and other CVD

Preventive oral health supervision resource: maternal and child periods

Poison Control: Great parent / provider / community web site

New NCHS Reports: 2002 Lined Births/Infant Deaths and 2003 Births

HIV AIDS -- AI / AN data

-and more

**Alan Waxman:** Ideal course for og/gyns, FPs and APCs currently doing
colposcopy or in their preceptorships; Colposcopy \"certification" for
the non-OB/GYN provider?

#### Hot Topics:  {#hot-topics .Style-Heading-4-+-Arial-14-pt-Underline}

**Obstetrics page 8**

-Resources to help women make birth decisions: vaginal vs cesarean,
pelvic floor issues

-Fear of Childbirth Following Instrumental Vaginal Delivery

-IHS prenatal assessment form - ETOH, tobacco, substances, DV, other
home issues

-Vaginal Delivery After Prior Cesarean Delivery May Have Low Absolute
Risk 

-Multiple Prenatal Ultrasound Examinations Do Not Hinder Child
Development

-and more

**Gynecology page 10**

-Pelvic Floor Muscle Training Is Successful in Half of Patients Treated

## -Health Care Seeking Among Urban Minority Adolescent Girls: The Crisis at Sexual Debut 

-Local analgesia in laparoscopy: a randomized trial

\- Long-term treatment of menorrhagia with Mirena ™ versus endometrial
resection

\- Anal incontinence after vaginal delivery: a five-year prospective
cohort study

-and more

**Child Health page 11**

\- Parents may believe that they are not completely in control of their
children\'s television

\- Exposure to even one cigarette raised the odds of future smoking

\- Teen contraceptive use has become more effective since 1995

\- A Practical Guide to Infant Oral Health

\- Prevalence of Overweight Among Anchorage Children

-and more

**Chronic Illness and Disease page 11**

\- Getting Sufficient Sleep May Help Reduce Weight Gain

\- The Patient with Daily Headaches

\- Cranberry for Prevention of Urinary Tract Infections

\- Pharmacologic and Surgical Treatment of Obesity

\- Use of Traditional Foods in a Healthy Diet in Alaska

#### Features: page 12 {#features-page-12 .Style-Heading-4-+-Arial-14-pt-Underline}

##### AFP

-Is Exercise an Effective Therapy for Menopausal Hot Flushes?

-MRI vs. Mammography in High-Risk Patients

-Calcium and Prevention of Colorectal Cancer

-Link Between Metformin and Lactic Acidosis?

-Obsessive-Compulsive Disorder

-and more

ACOG

**-**Ultrasonography in Pregnancy

-Informed Refusal

-The Uninsured

-Partner Consent for Participation in Women\'s Reproductive Health
Research

**AHRQ**

\- Prehypertension is a considerable health risk, particularly in people
aged 45 and older

**Ask a Librarian**

-Children Having Children

**Breastfeeding**

-Breastfeeding Practices: Results from the Immunization Survey

**Domestic Violence**

**-**Washington Post Three-Day Series Examines Homicide of Pregnant
Women, New Mothers

-Sexual Violence: CDC Activities

**Elder Care News**

-Prevent falls and prevent injuries from falls that occur: VA Toolkit

**Family Planning**

-Do Combination Contraceptives Cause Weight Gain?

-Advanced provision of emergency contraception did not reduce abortion
rates

**Frequently asked questions**

-What is the best screening cut-off for gestational diabetes mellitus?

-Does tubal ligation reduce the risk of ovarian cancer?

-Do we have an Indian health policy on positive skin tests in pregnancy
for TB?

-Should INH therapy be withheld in women, or men, over 35 years old?

-Should breastfeeding be discouraged during antituberculosis therapy?

**Hormone Replacement Update**

-Effects of Hormone Therapy on Urinary Incontinence

-NAMS Issues Statement on Treatment of Hot Flashes

**Information Technology**

-Internet Med: Walter Reed Army Medical Center (WRAMC) Reference Desk

International Health

-International Conference on Women and Infectious Diseases, Conference
Papers

-Eliminating Racial Disparities in US Could Save More Lives Than Medical
Advances

#### MCH Alert

-Adolescent pregnancy intentions and pregnancy outcomes

Medscape

-Iraq War Is Public Health Disaster, Report Finds

-Individualizing Hormone Therapy for the Surgically Menopausal Woman

**Midwives Corner**

-New avenue to share midwifery ideas and resources: Starting January
2005

#### Office of Women's Health, CDC

-Infant Mortality Statistics from the 2002 Period Linked Birth/Infant
Death Data Set

Osteoporosis

-Bed Rest During Pregnancy Associated With Bone Loss

Patient Education

-Your Baby\'s Teeth

-Vaginitis

-Rebound Headaches

-What You Should Know About Genital Warts

Primary Care Discussion Forum

\- February 1, 2005:  Surgery for obesity? Moderator: Hope Baluh

#### Barbara Stillwater, Alaska Diabetes Prevention and Control

-Preemies Prone to \'Pre-Diabetes

-AHA Updates Guidelines for Cardiovascular Disease Prevention in Women 

-Certificate in Public Health Via Partial Distance Accepting
Applications

-Ask Cosmo about the National Library of Medicine

#### What's new on the ITU MCH web pages page 19

###### Save the Dates: Upcoming events of interest page 20

**Did you miss something in the last OB/GYN Chief Clinical Consultant
(CCC) Corner?**

#  {#section .Style-Heading-1-+-Underline}

# Abstract of the Month {#abstract-of-the-month .Style-Style-Heading-1-+-Underline-+-Pattern:-Clear-(Gray-12.5%)}

**Tension-Free Vaginal Tape Procedure Effective Long-Term for Urinary
Incontinence**\
[OBJECTIVE:]{.underline} To evaluate the long-term cure rates and late
complication rates after treatment of female urinary stress incontinence
with the minimally invasive tension-free vaginal tape operation.

[METHODS:]{.underline} Prospective observational, 3-center cohort study
originally of 90 women requiring surgical treatment for primary urinary
stress incontinence. Assessment variables included a 24-hour pad
weighing test, a stress test, visual analog scale for assessing the
degree of bother, and a questionnaire assessing the subjective
perception of the women on their continence status.

[RESULTS:]{.underline} The follow-up time was a mean of 91 months (range
78-100 months). Both objective and subjective cure rates were 81.3% for
the 80 women available for follow-up. Asymptomatic pelvic organ prolapse
was found in 7.8%, de novo urge symptoms in 6.3%, and recurrent urinary
tract infection in 7.5% of the women. No other long-term adverse effects
of the procedure were detected.

[CONCLUSION:]{.underline} The tension-free vaginal tape procedure for
treatment of female urinary stress incontinence is effective over a
period of 7 years. LEVEL OF EVIDENCE: II-3.

Nilsson CG, Falconer C, Rezapour M. Seven-Year Follow-up of the
Tension-Free Vaginal Tape Procedure for Treatment of Urinary
Incontinence. Obstet Gynecol. 2004 Dec;104(6):1259-62.

<http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&list_uids=15572486&dopt=Abstract>

#### [OB/GYN CCC Editorial comment:]{.underline}

The Green Journal, Obstetrics and Gynecology, also presented 4 other
articles\* on tension free vaginal tape (TVT) this month as this
procedure is 'coming of age'. The Abstract above describes the 7 year
success rate in a prospective 3-center study in 2 Nordic countries. The
results were comparable to the Burch procedure. One other article
describes a comparison with the laparascopic Burch.

Of special note are the 3 articles on complications associated with the
TVT procedure. This procedure has a distinct learning curve. I suggest
that providers seeking to add this procedure to their therapeutic
armamentarium do so with a mentor, and follow their initial results in a
department quality assurance project.

There are other tape related incontinence procedures that a provider
might want to explore. . ANMC had been an early adapter to TVT in Indian
Health, plus has experience with other helpful new methods. Please
contact me directly for questions on the ANMC experience njm

\*-**Laparoscopic burch colposuspension versus TVT: a randomized
trial.**

CONCLUSION: The TVT procedure results in greater objective and
subjective cure rates for urodynamic stress incontinence than does
laparoscopic Burch colposuspension. LEVEL OF EVIDENCE: I. Paraiso MF, et
al. Laparoscopic burch colposuspension versus tension-free vaginal tape:
a randomized trial. Obstet Gynecol. 2004 Dec;104(6):1249-58.\
<http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&list_uids=15572485&dopt=Abstract>

**-Prevalence of persistent and de novo overactive bladder symptoms
after the TVT**.\
CONCLUSION: The proportion of patients in whom de novo overactive
bladder or urge incontinence symptoms developed postoperatively is low,
and approximately 57% of patients with preoperative overactive bladder
symptoms can expect resolution of these symptoms after a TVT.

Segal JL, et al. Prevalence of persistent and de novo overactive bladder
symptoms after the tension-free vaginal tape. Obstet Gynecol. 2004
Dec;104(6):1263-9.

<http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&list_uids=15572487&dopt=Abstract>

\-**Lateral excision of TVT for the treatment of iatrogenic urethral
obstruction**\
CONCLUSION: Urethral obstruction after TVT is a relatively uncommon
condition. It can be effectively treated with transvaginal lateral
excision of the tape. Recurrent stress incontinence seems to be less
likely to occur when the takedown procedure occurs beyond 14 days after
the initial TVT operation. LEVEL OF EVIDENCE: III.

Long CY, et al . Lateral excision of tension-free vaginal tape for the
treatment of iatrogenic urethral obstruction**.** Obstet Gynecol. 2004
Dec;104(6):1270-4.

<http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&list_uids=15572488&dopt=Abstract>

**-Necrotizing surgical site infection after tension-free vaginal
tape.**

CONCLUSION: This is the first case of necrotizing surgical site
infection after TVT placement. Infectious morbidity risks need to be
considered in these procedures.

Connolly TP. Necrotizing surgical site infection after tension-free
vaginal tape. Obstet Gynecol. 2004 Dec;104(6):1275-6.\
<http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&list_uids=15572489&dopt=Abstract>

# From your colleagues: {#from-your-colleagues .Style-Style-Heading-1-+-Underline-+-Pattern:-Clear-(Gray-12.5%)}

**Katy Ciacco Palatianos, HQE**

**Second Volume of \"Closing the Quality Gap\" Is Available**

#### The second volume in the series of AHRQ Evidence-based Practice Center Technical Reviews, titled *Closing the Quality Gap: A Critical Analysis of Quality Improvement Strategies, Volume 2: Diabetes Mellitus Care*, is now available. The reports explore the human and organizational factors influencing quality improvement strategies and evaluate nine quality improvement strategies, tools, or processes aimed at reducing the quality gap. Volume 2 examines strategies for improving the quality of care for adults with type 2 diabetes through changes in provider behavior, patient behavior, and modifications to the organization of care. Outpatient care for diabetes exemplifies the challenges of, and opportunities for, chronic disease management. Select to download [**Volume 2**](http://www.ahrq.gov/clinic/evrptpdfs.htm#qualgap2), or send an e-mail to [**ahrqpubs@ahrq.gov**](mailto:ahrqpubs@ahrq.gov) for a print copy. Select to download [**Volume 1**](http://www.ahrq.gov/clinic/evrptpdfs.htm#qualgap1); Volume 3, which will focus on improving the treatment of patients suffering {#the-second-volume-in-the-series-of-ahrq-evidence-based-practice-center-technical-reviews-titled-closing-the-quality-gap-a-critical-analysis-of-quality-improvement-strategies-volume-2-diabetes-mellitus-care-is-now-available.-the-reports-explore-the-human-and-organizational-factors-influencing-quality-improvement-strategies-and-evaluate-nine-quality-improvement-strategies-tools-or-processes-aimed-at-reducing-the-quality-gap.-volume-2-examines-strategies-for-improving-the-quality-of-care-for-adults-with-type-2-diabetes-through-changes-in-provider-behavior-patient-behavior-and-modifications-to-the-organization-of-care.-outpatient-care-for-diabetes-exemplifies-the-challenges-of-and-opportunities-for-chronic-disease-management.-select-to-download-volume-2-or-send-an-e-mail-to-ahrqpubsahrq.gov-for-a-print-copy.-select-to-download-volume-1-volume-3-which-will-focus-on-improving-the-treatment-of-patients-suffering .Style-Heading-4-+-Arial-14-pt-Underline}

James M. Galloway, IHS Cardiology Program

**Prevention of Cardiovascular Disease & Diabetes Among** **AI / AN**

-   May 16 - 19, 2005

-   Denver, CO

-   Co-sponsored by IHS, Joslin, ADA, NIH

-   <http://professionaled.joslin.org/CourseListing/CourseDesc.asp?intCourseTypeId=4&intCourseID=1269&strFullInd=Y>

Steve Holve, Tuba City

**Indian Child Health Notes -- December**

-Clinical advice from English novelist Jane Austen

-Steroids really do work for everything - proven in the New England
Journal

-Early childhood caries are bad in Canadian aboriginals - but not nearly
as bad as in Native American children in the US

-Great meeting in Telluride, CO in February 2005

<http://www.ihs.gov/MedicalPrograms/MCH/C/documents/PedNotes1204.doc>

**Carol Koeble, Anchorage**

**New Perinatal HIV Hotline 1-800-933-3413\
**The National Perinatal HIV Consultation and Referral service also
offers a Warmline and National Clinicians\' Post-Exposure Prophylaxis
Hotline. The National Clinicians Consultation Center is a component of
the [AIDS Education and Training Centers (AETCs)](http://hab.hrsa.gov/)
program. The AIDS Education and Training Centers is a clinical resource
for health care professionals, from the University of California, San
Francisco at San Francisco General Hospital in partnership with [Health
Resources and Services Administration (HRSA)](http://hab.hrsa.gov/) ,
HIV/AIDS Bureau, and the [Centers for Disease Control and Prevention
(CDC)](http://www.cdc.gov/). <http://www.ucsf.edu/hivcntr/>

**Joan Koval, Anchorage**

**You Will Love HypnoBirthing Clients**

 If anything, they may make your work easier as they focus in on deep
relaxation, visualizations, slow breathing and may have little need for
medication.  Their babies may be more alert, calm and take to
breastfeeding more easily and quickly.

You will not disturb a mom if you need to take vital signs, etc.  She
practices with distractions and those distractions may make her go even
deeper into relaxation.   Some ideas you may consider:

 -During labor, moms are having "surges" or "uterine waves" instead of
contractions.

-Words have powerful effects on our minds thus affecting our body's
response

-We try to use terms that have a gentle feel.

-Body sensations may be described as pressure or tightness.  It is the
change in that sensation and regularity of it that will bring them to
call the Birth Unit.

-We use the word "birthing" instead of delivering.

-Most importantly HypnoBirthing moms Breath Their Babies Down the birth
path until crowning and "go with " their body's cues.

-There is really no need to encourage "purple pushing" as soon as they
are complete.

-Even thought I recognize that this is an exciting time for staff and
all involved.

-When the baby crowns, if more power behind the breath is needed the
moms understand that pushing may happen then. Go here for more on
HypnoBirthing [www.hypnobirthing.com](http://www.hypnobirthing.com/)

From Bob Laliberte, Phoenix

**Locum tenens availablity**

Dr. Robert Laliberte is a board certified obstetrician/gynecologist
currently stationed at Phoenix Indian Medical Center (PIMC).  He will be
retiring from the Commissioned Corps of the Public Health Service and
from PIMC on January 1, 2005 after more than 20 years service.  He plans
to do locum tenens work and plans to work 6 months a year.  His history
with the IHS began at Crow Agency, Montana and is concluding at PIMC; he
would like to continue working in IHS facilities with Native patients. 
Should any facilities want or need a locum Ob/Gyn for a one time
assignment or for a recurring assignment, Dr. Laliberte would like to
speak with you and can be reached at the numbers or e-mail that follow.

 Robert C. Laliberte, MD, FACOG

W (602) 263-1550 H (480) 987-0938 <LBLALIB@AOL.COM>

**Marian Mehegan, Seattle Region X, OWH**

**Region X OWH Regional and State Women\'s Health Meeting, Jan 24, 2005
Portland**

Good opportunity for networking on programs and research in Region X
OWH, Portland, OR

Contact: mmehegan@osophs.dhhs.gov

**Chuck North, Albuquerque**

**Advances in Indian Health** **-- Save the dates**

-   May 11-13, 2005

-   Albuquerque, NM

-   2004 Brochure below (2005 brochure pending)

-   [http://hsc.unm.edu/cme/2004%20Web%20Info/AIH2004/AIHIndex.shtml](http://hsc.unm.edu/cme/2004 Web Info/AIH2004/AIHIndex.shtml)

-   Questions <CNorth@abq.ihs.gov>

**Laura Shelby, Albuquerque**

**New HPV web page is now available on CDC web site**

The website contains information targeted to the general public,
including an HPV Fact Sheet available in both English and Spanish and
links to scientifically accurate HPV information on other credible
websites.  The web address is:  http://www.cdc.gov/std/hpv/

**Marsha Tahquechi, Gallup**

**How can I get those great ACOG materials when I am not a member of
ACOG?**

ACOG has a special classification, Educational Affiliate Non-Physician,
for any individual with an advanced degree who through professional
training and/or experience in women\'s health care is able to further
the missions of the College. [Online Educational Affiliate Non-Physician
Application](https://www.acog.com/from_home/eanondocapp.pdf)

<https://www.acog.com/from_home/eanondocapp.pdf>

Here are the requirements <https://www.acog.com/from_home/educatreq.cfm>
or

contact Bernice Rose <brose@acog.org> (202) 863-2408 Fax: 202/479/0054

Information on other types of ACOG memberships

<https://www.acog.com/from_home/departments/dept_notice.cfm?recno=22&bulletin=2635>

## Judy Thierry, HQE

**Media: oral contraceptives protects against heart disease, stroke, and
other CVD**

A few weeks ago a report on oral contraceptive use and cardiovascular
disease was presented by Dr. Rahi Victory at a meeting of the American
Society for Reproductive Medicine, and an associated abstract was
published in the journal Fertility and Sterility by Dr. Victory and
Wayne State University colleagues. This presentation and abstract have
been quoted in the popular media worldwide as providing evidence that
oral contraceptive use protects against subsequent heart disease,
stroke, and other cardiovascular diseases. This statement will clarify
the implications of the Women's Health Initiative data that were used in
this study.

Analyses of these data must be regarded as exploratory since the Women's
Health Initiative was not designed to answer these important questions.
Specifically, the data used were collected at enrollment into the
Women's Health Initiative program, when women in the age range 50-79
were asked to recall oral contraceptive use patterns and cardiovascular
disease occurrences many years in the past.

Furthermore, we have found that analyses of these data don't support
inferences of either cardiovascular disease benefit or risk when
additional account is taken of the complex relationships between the
ages of participating women and both oral contraceptive use patterns and
cardiovascular disease. Analyses continue and we pledge to publish the
details of our subsequent more detailed analyses in the near future. We
regret any confusion caused by our preliminary report

Clarification by the authors
[[http://www.whi.org/news/press_oral_contraceptives.php]{.underline}](http://www.whi.org/news/press_oral_contraceptives.php)

FAQs on the topic
[[http://www.whi.org/news/faq_oral_contraceptives.php]{.underline}](http://www.whi.org/news/faq_oral_contraceptives.php)

WHI News Home Page
[[http://www.whi.org/news/]{.underline}](http://www.whi.org/news/)

#### [OB/GYN CCC Editorial comment:]{.underline}

**From William Haffner, Rockville - OB/GYN CCC, retired**

The WHI / NHLBI response is very clear in its message - that there is no
established CVD health benefit and there continues to be an increased
risk for CVD (MI, DVT and stroke) in older women and in smokers.

The IHS / ACOG Postgraduate Course has been teaching for a number of
years the importance for screening for risk factors, especially in women
over 35, generally recommending that Oral Contraceptives not be used in
such women when they have additional risks such as uncontrolled HTN,
diabetes with vascular disease, etc. The ACOG position has been that
Oral Contraceptives are OK for women over 35 who are otherwise healthy.
The whole issue of Oral Contraceptives use by women with medical
conditions is being revisited over the next year or so by the ACOG
Committee on Practice Bulletins - Gynecology. The current ACOG Practice
Bulletin will then be re-issued. njm

**Preventive oral health supervision resource: maternal and child
periods**\
Bright Futures in Practice: Oral Health---Pocket Guide is a resource to
assist health professionals in providing oral health care for infants,
children, adolescents, and pregnant and postpartum women. The pocket
guide was developed by the National Maternal and Child Oral Health
Resource Center working in collaboration with the Bright Futures
Education Center at the American Academy of Pediatrics, with support
from the Maternal and Child Health Bureau. The pocket guide offers
health professionals an overview of preventive oral health supervision
for five developmental periods---pregnancy and postpartum, infancy,
early childhood, middle childhood, and adolescence. It is designed to be
a useful tool for a wide array of health professionals including
dentists, dental hygienists, physicians, physician assistants, nurses,
dietitians, and others.
<http://www.mchoralhealth.org/Toolbox/professionals.html>.

**Poison Control: Great parent / provider / community web site**

This Minnesota website is very comprehensive:
 <http://www.mnpoison.org/index.asp>

1 800-222-1222 Phone stickers and magnets available

**New NCHS Reports: 2002 Lined Births/Infant Deaths and 2003 Births**

These reports are now out to the public if you have not seen them.  They
are posted on: <http://www.cdc.gov/nchs/births.htm>.  A special
supplemental report on infant mortality will be out before the end of
the calendar year.

**HIV AIDS -- AI / AN data**

Diagnoses of HIV/AIDS \-\-- 32 States, 2000\--2003

<http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5347a3.htm>

**Children\'s Health, the Nation\'s Wealth: Assessing and Improving
Child Health**

The AMCHP report offers a new comprehensive framework for measuring the
health of children.

<http://www.nap.edu/catalog/10886.html>

**Alan Waxman** **Retired IHS OB/GYN CCC**

**Ideal course for og/gyns, FPs and APCs doing colposcopy or in their
preceptorships**

This year is a review and update ideal for og/gyns, FPs and APCs
currently doing colposcopy or in their preceptorships. March 30 - April
1, 2005 respectively, Albuquerque, New Mexico (see Save the Dates,
below) <http://www.ihs.gov/MedicalPrograms/MCH/M/CN01.cfm#Mar2005>

**Colposcopy \"certification" for the non-OB/GYN provider**

**Q.** How many colposcopies in a year does a non-OB/GYN provider need
to perform to maintain their \"certification"?

Are there standards established, or are there criteria with regards to
credentials? 

If not, how would you recommend verification of a non-OB/GYN provider
continued competency in this procedure? 

 **A.** First there is no \"certification\" for colposcopy.  The IHS has
recommendations for initial colposcopy privileges (50 supervised exams)
and ASCCP has its Mentorship program (25 exams - at least 3 high grade)
with written examination. The ASCCP program is a training program that
many practices use as de facto certification.  No one has established
criteria for maintenance of privileges.  When we set up the IHS program,
we established 60 exams a year as a \"reasonable\" number to stay
competent.  Some providers can do fewer and remain competent, some would
need to do more, but an average of 5 a month sounded reasonable.

There is no data to support one volume of experience over another.  
Because many ITU settings have a low volume of abnormal Paps, but
geographic isolation justifies an on-site colposcopist, the IHS
epidemiology program with support from the CDE has established a program
of annual continuing colposcopy education with emphasis on small group
case reviews and lots of images of high grade lesions.

I\'d suggest that unless there is a question of competence with any
non-OB/GYN provider that he/she should plan to come to the IHS Refresher
course this year and at least every other year.  That\'s a good way to
document that he/she has maintained their competence.

 In alternating years there are

#1 Basic IHS Colposcopy Workshops alternating with

#2 IHS Advanced Colposcopy course / Refresher Workshops

These workshops recur in March and April of each year. Check in the
Conference Archives for past information
<http://www.ihs.gov/MedicalPrograms/MCH/M/ConfArch.asp>

 Other resources

IHS Women's Health Cancer page

<http://www.ihs.gov/MedicalPrograms/MCH/W/WHcancer.asp>

 ASCCP Home page (with conferences and courses)

<http://www.asccp.org/index.html>

 

# Hot Topics: {#hot-topics-1 .Style-Style-Heading-1-+-Underline-+-Pattern:-Clear-(Gray-12.5%)}

#### Obstetrics {#obstetrics .Style-Heading-4-+-Arial-14-pt-Underline}

**Resources to help women make birth decisions: vaginal vs cesarean,
pelvic floor issues**

The Maternity Center Association (MCA) Web site contains three new
resources to help women make informed decisions about cesarean and
vaginal birth. The new Maternity Topics were developed as part of MCA\'s
Maternity Wise program to promote evidence-based maternity care. The new
topics include in-depth information and resources on cesarean section,
vaginal birth after cesarean section, and pelvic floor health.
[[http://www.maternitywise.org/mw/topics]{.underline}](http://www.maternitywise.org/mw/topics)

**Fear of Childbirth Following Instrumental Vaginal Delivery**

CONCLUSION: Instrumental vaginal delivery offers advantages over
caesarean section for future delivery outcomes. The psychological impact
of operative delivery requires urgent attention.

Bahl R, Strachan B, Murphy DJ.Outcome of subsequent pregnancy three
years after previous operative delivery in the second stage of labour:
cohort study. BMJ. 2004 Feb 7;328(7435):311

<http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=14724128>

**IHS prenatal assessment form - ETOH, tobacco, substances, DV, other
home issues**

This IHS form (for identifying potentially at risk women of childbearing
age) is far superior to any form that is currently being used (e.g.
CAGE) for this purpose. Aberdeen Area is implementing the form area
wide.  Assess - ETOH, tobacco, substances, DV, other home issues. This
may be a good activity for an FAS/D initiative -- to go with the new
GPRA indicator 11.

<http://www.psc.gov/forms/IHS/ihs-866.pdf>

**Vaginal Delivery After Prior Cesarean Delivery May Have Low Absolute
Risk** \
CONCLUSIONS: A trial of labor after prior cesarean delivery is
associated with a greater perinatal risk than is elective repeated
cesarean delivery without labor, although absolute risks are low. This
information is relevant for counseling women about their choices after a
cesarean section. Landon MB, et al Maternal and perinatal outcomes
associated with a trial of labor after prior cesarean delivery. N Engl J
Med. 2004 Dec 16;351(25):2581-9.

<http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15598960>

**Multiple Prenatal Ultrasound Examinations Do Not Hinder Child
Development**\
INTERPRETATION: Exposure to multiple prenatal ultrasound examinations
from 18 weeks\' gestation onwards might be associated with a small
effect on fetal growth but is followed in childhood by growth and
measures of developmental outcome similar to those in children who had
received a single prenatal scan. Newnham JP, et al Effects of repeated
prenatal ultrasound examinations on childhood outcome up to 8 years of
age: follow-up of a randomised controlled trial. Lancet. 2004 Dec
4;364(9450):2038-44.\
<http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15582061>

**Update on nonpharmacologic approaches to relieve labor pain and
prevent suffering**

Suffering, which is different from pain, is not an outcome that is
usually measured after childbirth. We assumed that suffering is unlikely
if indicators of satisfaction were positive after childbirth. Adequate
evidence of benefit in reducing pain exists for continuous labor
support, baths, intradermal water blocks, and maternal movement and
positioning. Acupuncture, massage, transcutaneous electrical nerve
stimulation, and hypnosis are promising, but they require further study.
The effectiveness of childbirth education, relaxation and breathing,
heat and cold, acupressure, hypnosis, aromatherapy, music, and
audioanalgesia are either inadequately studied or findings are too
variable to draw conclusions on effectiveness.

Simkin P, Bolding A. Update on nonpharmacologic approaches to relieve
labor pain and prevent suffering. J Midwifery Womens Health. 2004
Nov-Dec;49(6):489-504.\
<http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15544978>

**Cesarean Risk and Labor Duration in Obese Mothers**\
CONCLUSION: In nulliparous women undergoing labor induction, maternal
weight was associated with a higher cesarean risk and longer labor and
was inversely proportional to the cervical dilation rate. LEVEL OF
EVIDENCE: II-2 Nuthalapaty FS, Rouse DJ, Owen J.The association of
maternal weight with cesarean risk, labor duration, and cervical
dilation rate during labor induction. Obstet Gynecol. 2004
Mar;103(3):452-6.\
<http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=14990405>

**Fetal hyperinsulinism and maternal one-hour postload glucose level**

CONCLUSION: Children whose mothers had a 1-hour value between 160 and
179 mg/dL had significantly higher cord blood insulin values than
offspring of women with a 1-hour value below 160 mg/dL. LEVEL OF
EVIDENCE: II-2.

Leipold H, Kautzky-Willer A, Ozbal A, Bancher-Todesca D, Worda C. Fetal
hyperinsulinism and maternal one-hour postload plasma glucose level.
Obstet Gynecol. 2004 Dec;104(6):1301-6.\
<http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&list_uids=15572494&dopt=Abstract>

**What You Need to Know About Mercury in Fish and Shellfish: 2004 EPA
and FDA Advice**

Women Who Might Become Pregnant, Women Who are Pregnant, Nursing
Mothers, and\
Young Children <http://www.cfsan.fda.gov/~dms/admehg3.html>

Seafood Information and Resources
<http://www.cfsan.fda.gov/seafood1.html>

**ACOG Releases Guidelines on Management of Post-term Pregnancy**

<http://www.aafp.org/afp/20041201/practice.html>

**Diagnosis and Management of Preeclampsia**

<http://www.aafp.org/afp/20041215/2317.html>

#### Gynecology {#gynecology .Style-Heading-4-+-Arial-14-pt-Underline}

**Pelvic Floor Muscle Training Is Successful in Half of Patients
Treated**

## Pelvic floor muscle training is beneficial in one half of the patients who are treated in this manner. Two or more leakages per day at baseline and the chronic use of psychotropic medication significantly predicted therapy failure Cammu H, et al Who will benefit from pelvic floor muscle training for stress urinary incontinence? Am J Obstet Gynecol. 2004 Oct;191(4):1152-7. [**http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15507935**](http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15507935)

## Health Care Seeking Among Urban Minority Adolescent Girls: The Crisis at Sexual Debut 

Adolescent girls attempt to meet reproductive health needs within a
context shaped by values of privacy and close mother-daughter
relationships. Difficulty balancing these values often results in
inadequate support and care. McKee DA et al Health Care Seeking Among
Urban Minority Adolescent Girls: The Crisis at Sexual Debut *Annals of
Family Medicine* 2:549-554 (2004)

<http://www.annfammed.org/cgi/content/full/2/6/549>

**Local analgesia in laparoscopy: a randomized trial\
**CONCLUSION: Infiltration of bupivacaine at completion of gynecologic
laparoscopic surgery decreases pain at trocar sites in the immediate
postoperative period. LEVEL OF EVIDENCE: I.

Einarsson JI, Sun J, Orav J, Young AE. Local analgesia in laparoscopy: a
randomized trial. Obstet Gynecol. 2004 Dec;104(6):1335-9.\
<http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&list_uids=15572499&dopt=Abstract>

**Anal incontinence after vaginal delivery: a five-year prospective
cohort study**\
CONCLUSION: Anal incontinence among primiparous women increases over
time and is affected by further childbirth. Anal incontinence at 9
months postpartum is an important predictor of persisting symptoms.
Pollack J, Nordenstam J, Brismar S, Lopez A, Altman D, Zetterstrom
J.Anal incontinence after vaginal delivery: a five-year prospective
cohort study. Obstet Gynecol. 2004 Dec;104(6):1397-402.\
<http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&list_uids=15572505&dopt=Abstract>

**Long-term treatment of menorrhagia with Mirena ™ versus endometrial
resection**\
CONCLUSION: Both treatments efficiently reduced menstrual bleeding. The
high continuation rate suggests that the levonorgestrel intrauterine
system is comparable with transcervical resection of the endometrium.
LEVEL OF EVIDENCE: I.

Rauramo I, Elo I, Istre O. Long-term treatment of menorrhagia with
levonorgestrel intrauterine system versus endometrial resection. Obstet
Gynecol. 2004 Dec;104(6):1314-21.

<http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&list_uids=15572496&dopt=Abstract>

**Add-Back Therapy May Be Helpful for Endometriosis**

CONCLUSION(S): Add-back therapy allows the treatment of women with
relapse of endometriosis-associated pain for a longer period, with
reduced bone mineral density loss, good control of pain symptoms, and
better patient quality of life compared with GnRH analogue alone or oral
contraceptive. Zupi E, et al Add-back therapy in the treatment of
endometriosis-associated pain. Fertil Steril. 2004 Nov;82(5):1303-8.\
Marconi D, Sbracia M, Zullo F, De Vivo B, Exacustos C, Sorrenti G.\
<http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15533351>

**New Women's Health data released**

Women\'s Health USA 2004 presents current and historical data on some of
the most pressing health challenges facing women, their families, and
their communities, including health care quality, women in clinical
trials, organ donation, and hormone therapy. The 2004 data book, the
third in a series of annual reports on women\'s health published by the
Maternal and Child Health Bureau, provides a profile of women\'s health
from a variety of data sources and highlights racial and ethnic
disparities as well as sex disparities
[[http://mchb.hrsa.gov/whusa04]{.underline}](http://mchb.hrsa.gov/whusa04)

**Management of Genital Warts (also see Patient Education)**

<http://www.aafp.org/afp/20041215/2335.html>

**Management of Vaginitis (also see Patient Education)**

<http://www.aafp.org/afp/20041201/2125.html>

#### Child Health {#child-health .Style-Heading-4-+-Arial-14-pt-Underline}

**Parents may believe that they are not completely in control of their
children\'s television**

If this is correct, parents would both welcome and benefit from tools
and strategies that would help them exert more control over their
children\'s television habits and reduce their hours of viewing.
Christakis DA, Ebel BE, Rivara FP, et al. 2004. Television, video, and
computer game usage in children under 11 years of age. Journal of
Pediatrics 145(5):652-656.

<http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15520768>

**Exposure to even one cigarette raised the odds of future smoking**

Relatively small increases in the number of cigarettes consumed during
childhood are associated with significantly higher odds of current,
established, and daily smoking in adolescence. Jackson C, Dickinson D.
2004. Cigarette consumption during childhood and persistence of smoking
through adolescence. Archives of Pediatrics and Adolescent Medicine
158(11):1050-1056.

<http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15520342>

**Teen contraceptive use has become more effective since 1995**

NCHS Fact sheets available

Adolescents in 2002 delayed first intercourse for longer than
adolescents in 1995.

Adolescents in 2002 used contraceptives more often than adolescents in
1995.

Trends in sexual activity and contraceptive use as measured from 1995
through 2002 are consistent with the downward trend in pregnancies and
births to adolescents that has been observed since 1991. Available at
<http://www.cdc.gov/nchs/nsfg.htm>

**A Practical Guide to Infant Oral Health (also see Patient Education)**

<http://www.aafp.org/afp/20041201/2113.html>

Editorial Oral Health in Primary Care Medicine: Practice and Policy
Challenges

<http://www.aafp.org/afp/20041201/editorials.html>

**Prevalence of Overweight Among Anchorage Children**

A Study of Anchorage School District Data: 1998-2003 November 10, 2004

[[http://epi.alaska.gov/bulletins/docs/rr2004_09.pdf]{.underline}](http://epi.alaska.gov/bulletins/docs/rr2004_09.pdf)

[[http://www.adobe.com/products/acrobat/readstep2.html]{.underline}](http://www.adobe.com/products/acrobat/readstep2.html)

#### Chronic disease and Illness {#chronic-disease-and-illness .Style-Heading-4-+-Arial-14-pt-Underline}

**Getting Sufficient Sleep May Help Reduce Weight Gain**

Sleep deprivation alters hormones and increases appetite, according to
the results of a brief randomized study. The editorialists suggest that
getting enough sleep may help reduce weight gain. Spiegel K, et al Brief
communication: Sleep curtailment in healthy young men is associated with
decreased leptin levels, elevated ghrelin levels, and increased hunger
and appetite. Ann Intern Med. 2004 Dec 7;141(11):846-50.\
<http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15583226>

**The Patient with Daily Headaches (also see Patient Education)**

<http://www.aafp.org/afp/20041215/2299.html>

**Cranberry for Prevention of Urinary Tract Infections**

<http://www.aafp.org/afp/20041201/2175.html>

**Pharmacologic and Surgical Treatment of Obesity**

<http://www.aafp.org/afp/20041201/practice.html> (Scroll down page)

**Use of Traditional Foods in a Healthy Diet in Alaska**

Risks in Perspective Second Edition: Volume 2. Mercury, December 1, 2004

[[http://epi.alaska.gov/bulletins/docs/rr2004_10.pdf]{.underline}](http://epi.alaska.gov/bulletins/docs/rr2004_10.pdf)

[http://epi.alaska.gov/bulletins/docs/rr2004_11.pdf]{.underline}

# Features {#features .Style-Style-Heading-1-+-Underline-+-Pattern:-Clear-(Gray-12.5%)}

## American Family Physician\*\* {#american-family-physician .Style-Heading-2-+-14-pt}

###### Patient-Oriented Evidence that Matters (POEMS)\*

Is Exercise an Effective Therapy for Menopausal Hot Flushes?

[Clinical Question:]{.underline} Is exercise an effective therapy for
vasomotor symptoms in postmenopausal women?

**[Bottom Line]{.underline}:** Exercise does not decrease vasomotor
symptoms in postmenopausal women. Women should be encouraged to
exercise, but not with the expectation that it will alleviate their hot
flushes. (Level of Evidence: 1b)
[**http://www.aafp.org/afp/20041215/tips/7.html**](http://www.aafp.org/afp/20041215/tips/7.html)

MRI vs. Mammography in High-Risk Patients

[Clinical Question:]{.underline} Is magnetic resonance imaging (MRI)
more accurate than mammography in women who are at high risk of
developing breast cancer?

[Bottom Line:]{.underline} MRI is better than mammography at ruling out
breast cancer (i.e., more sensitive), but it is more likely to produce
false-positive results (i.e., less specific). It also is more expensive
and leads to more unnecessary biopsies and follow-up studies. This makes
it inappropriate in women at low or average risk, but it may be a good
option in women at high risk who understand the limitations. (Level of
Evidence: 2b) <http://www.aafp.org/afp/20041201/tips/6.html>

Cochrane Briefs

Calcium and Prevention of Colorectal Cancer

[Clinical Question]{.underline}

Do calcium supplements prevent colorectal cancer and adenomatous polyps?

Evidence-Based Answer

Combined evidence from two clinical trials of calcium supplementation
lasting for several years revealed a reduced rate of recurrent
colorectal adenoma. However, evidence is insufficient to recommend
supplementation with dietary calcium for patients who have never had an
adenoma.

<http://www.aafp.org/afp/20041201/cochrane.html> (scroll down page)

Link Between Metformin and Lactic Acidosis?

[Clinical Question]{.underline}

Does metformin cause lactic acidosis?

[Evidence-Based Answer]{.underline}

There is no evidence that metformin causes lactic acidosis, even in
patients with renal insufficiency or other comorbidities. Although
caution is still indicated in patients with multiple or severe
comorbidities, it appears that the initial concern about lactic acidosis
with this drug was misplaced.
<http://www.aafp.org/afp/20041201/cochrane.html> (scroll down page)

Clinical Evidence Concise A Publication of BMJ Publishing Group

Obsessive-Compulsive Disorder

<http://www.aafp.org/afp/20041201/bmj.html>

USPSTF Putting Prevention into Practice, An Evidence-Based Approach

**Screening for Suicide Risk**

<http://www.aafp.org/afp/20041201/putting.html>

and

<http://www.aafp.org/afp/20041201/us.html>

**\*POEM Rating system**: <http://www.infopoems.com/levels.html> **POEM
Definition:** <http://www.aafp.org/x19976.xml>

\*\* The AFP sites will sometimes ask for a username and password.
Instead just 'hit; cancel on the pop up password screen, and the page
you are requesting will come up without having to enter a username and
password.

#### ACOG {#acog .Style-Heading-4-+-Arial-14-pt-Underline}

**Ultrasonography in Pregnancy**

NUMBER 58, DECEMBER 2004 ACOG Practice Bulletin

[Conclusions]{.underline}

-   Ultrasound examination is an accurate method of determining
    gestational age, fetal number, viability, and placental location.
    Gestational age is most accurately determined in the first half of
    pregnancy.

-   The ability of ultrasonography to diagnose major fetal anomalies is
    well established.

-   The diagnosis of fetal growth abnormalities with ultrasonography is
    not precise.

-   Ultrasonography is safe for the fetus when used appropriately.

-   Specific indications are the best basis for the use of
    ultrasonography in pregnancy.

-   The optimal timing for a single ultrasound examination in the
    absence of specific indications for a first-trimester examination is
    at 16--20 weeks of gestation.

[Summary of Recommendations]{.underline}

*The following recommendation is based on limited or inconsistent
scientific evidence (Level B):*

-   Serial ultrasonograms to determine the rate of growth should be
    obtained approximately every 2--4 weeks.

*The following recommendations are based primarily on consensus and
expert opinion (Level C):*

-   Casual use of ultrasonography, especially during pregnancy, should
    be avoided.

-   Before an ultrasound examination is performed, patients should be
    counseled about the limitations of ultrasonography for diagnosis.

Ultrasonography in pregnancy. ACOG Practice Bulletin No. 58. American
College of Obstetricians and Gynecologists. Obstet Gynecol
2004;104:1449--58.

Non-ACOG Members

<http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15572512>

ACOG Members

<http://www.acog.org/publications/educational_bulletins/pb058.cfm>

**Informed Refusal**

ACOG Committee Opinion Number 306, December 2004

ABSTRACT: Informed refusal is a fundamental component of the informed
consent process. Informed consent laws have evolved to the \"materiality
or patient viewpoint\" standard. A physician must disclose to the
patient the risks, benefits, and alternatives that a reasonable person
in the patient\'s position would want to know to make an informed
decision. Throughout this process, the patient\'s autonomy, level of
health literacy, and cultural background should be respected. The
subsequent election by the patient to forgo an intervention that has
been recommended by the physician constitutes informed refusal.
Documentation of the informed refusal process is essential. It should
include a notation that the need for the intervention, as well as risks,
benefits, and alternatives to the intervention, and possible
consequences of refusal, have been explained. The patient\'s reason for
refusal also should be documented.

Informed refusal. ACOG Committee Opinion No. 306. American College of
Obstetricians and Gynecologists. Obstet Gynecol 2004;104:1465--6.

Non-ACOG Members

<http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15572515>

ACOG Members

<http://www.acog.org/publications/committee_opinions/co306.cfm>

#### [OB/GYN CCC Editorial comment:]{.underline}

Every Indian Health and tribal facility should have a vigorous program
to document Informed Refusal with their patients. The document above
outlines excellent basic tenets. njm

**The Uninsured**

ACOG Committee Opinion Number 308, December 2004

ABSTRACT: The United States is one of the few industrialized nations in
the world that does not guarantee access to health care for its
population. Access to health care for all women is a paramount concern
of obstetrician--gynecologists and the American College of Obstetricians
and Gynecologists. Lack of health care coverage creates access issues
that affect women, practitioners, and the health care system as a whole.
The number of women in the United States without health care coverage
grew 3 times faster than the number of men without such coverage during
the late 1990s and early 2000s. A change in our currently fragmented
health care system is warranted because the lack of coverage clearly
matters to the millions of uninsured Americans. Pregnant women and
infants are among the most vulnerable populations in the country and the
American College of Obstetricians and Gynecologists believes that
providing them with full insurance coverage must be a primary step in
the process of providing coverage for all Americans. However, it is only
the first step; it is critical to expand coverage for all Americans.
Health professionals can play a pivotal role in improving access to
needed health care by helping society understand the importance of
broadening health insurance coverage.

The uninsured. ACOG Committee Opinion No. 308. American College of
Obstetricians and Gynecologists. Obstet Gynecol 2004;104:1471--4.

Non-ACOG Members

<http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15572517>

ACOG Members

<http://www.acog.org/publications/committee_opinions/co308.cfm>

**Partner Consent for Participation in Women\'s Reproductive Health
Research**

ACOG Committee Opinion Number 307, December 2004

ABSTRACT: Recent advances in reproductive medicine include treatment of
subfertility as well as investigation of agents that may serve as both
contraceptives and potential prophylaxis against sexually transmitted
diseases, including potential protection from human immunodeficiency
virus (HIV). Although there is no doubt regarding the need for informed
consent by women participating in trials evaluating the safety and
effectiveness of these novel agents and treatments, there has been some
debate regarding the necessity and propriety of requiring consent from
the partners of women involved in certain types of clinical trials
involving reproductive health. Issues of partner consent are unique to
research surrounding women\'s reproductive health as opposed to research
pertaining to women\'s health, in general. This is due, in part, to a
valid concern about a potential effect of the research on the partner.
There are, therefore, legitimate reasons to obtain partner consent for a
woman\'s participation in a clinical trial. In the absence of such
reason, partner consent should not be mandated.

Partner consent for participation in women's reproductive health
research. ACOG Committee Opinion No. 307. American College of
Obstetricians and Gynecologists. Obstet Gynecol 2004;104:1467--9.

Non-ACOG Members

<http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15572516>

ACOG Members

<http://www.acog.org/publications/committee_opinions/co307.cfm>

#### AHRQ {#ahrq .Style-Heading-4-+-Arial-14-pt-Underline}

**Prehypertension is a considerable health risk, particularly in people
aged 45 and older**

<http://www.ahrq.gov/research/nov04/1104RA1.htm>

##### Ask a Librarian Clinical Informationist - IHS, Diane Cooper

**Children Having Children**

The rate of 10-14 year old mothers has decreased again for American
Indians according to the National Center for Health Statistics. For the
latest recorded year, 2002, the rate was 2.1 per 1,000 females in that
age group. In 2000, it was 2.7 and in 1999, it was 4.1. These rates are
lower than for Hispanics (3.6 in 2002) and non-Hispanic black (4.7 in
2002). For all races the 2002 rate was 1.7. "American Indian" includes
Aleuts and Eskimos. ***(National Vital Statistics Reports November 15,
2004)*** <http://www.cdc.gov/nchs/pressroom/04news/lowbirths.htm>

For copies contact your Clinical Informationist - IHS, Diane Cooper
<cooperd@mail.nih.gov>

##### 

#### Breastfeeding {#breastfeeding .Style-Heading-4-+-Arial-14-pt-Underline}

**Breastfeeding Practices: Results from the Immunization Survey**

<http://www.cdc.gov/breastfeeding/NIS_data/index.htm>

####  {#section-2 .Style-Heading-4-+-Arial-14-pt-Underline}

#### Domestic Violence {#domestic-violence .Style-Heading-4-+-Arial-14-pt-Underline}

**Washington Post Three-Day Series Examines Homicide of Pregnant Women,
New Mothers**\
<http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=27336>

**Sexual Violence: CDC Activities**

<http://www.cdc.gov/ncipc/factsheets/svactivities.htm>

####  {#section-3 .Style-Heading-4-+-Arial-14-pt-Underline}

#### Elder Care News {#elder-care-news .Style-Heading-4-+-Arial-14-pt-Underline}

**Prevent falls and prevent injuries from falls that occur: VA Toolkit**

[[http://www.va.gov/ncps/fallstoolkit/index.html]{.underline}](http://www.va.gov/ncps/fallstoolkit/index.html)

#### Family Planning {#family-planning .Style-Heading-4-+-Arial-14-pt-Underline}

**Do Combination Contraceptives Cause Weight Gain?**\
CONCLUSION: Available evidence is insufficient to determine the effect
of combination contraceptives on weight, but no large effect is evident.
Gallo MF, Grimes DA, Schulz KF, Helmerhorst FM.Combination
estrogen-progestin contraceptives and body weight: systematic review of
randomized controlled trials. Obstet Gynecol. 2004 Feb;103(2):359-73.\
<http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=14754709>

#### [OB/GYN CCC Editorial comment:]{.underline}

The worry about possible significant weight gain with combination oral
contraceptives (OCP) use is a commonly articulated reason for patients
not to use OCPs. The results can be associated with subsequent
unintended pregnancy. Please share the above information from systematic
review of randomized controlled trials with your patients. njm

**Advanced provision of emergency contraception did not reduce abortion
rates**\
A number of small studies have demonstrated increased use of emergency
contraception (EC) when women have a supply available at home. It has
been suggested that widespread use of EC could reduce abortion rates.
The results of this study suggest that widespread distribution of
advanced supplies of EC through health services may not be an effective
way to reduce the incidence of unintended pregnancy in the UK. Glasier
A, et al Advanced provision of emergency contraception does not reduce
abortion rates. Contraception. 2004 May;69(5):361-6.

<http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15105057>

#### Frequently asked questions {#frequently-asked-questions .Style-Heading-4-+-Arial-14-pt-Underline}

**Q. What is the best screening cut-off for gestational diabetes
mellitus?**

A. A cut-off of 140 mg/dL has 10% less sensitivity than a threshold of
130 mg/dL but fewer false-positive results; either threshold is
acceptable. See this discussion

<http://www.ihs.gov/MedicalPrograms/MCH/M/documents/GDMScr112804.doc>

**Q. Does tubal ligation reduce the risk of ovarian cancer?**

A. Yes, tubal ligation has reduced the risk of ovarian cancer in several
case control studies.

<http://www.ihs.gov/MedicalPrograms/MCH/M/documents/BTLovarCaRsk112804.doc>

**Q. Do we have an Indian health policy on positive skin tests in
pregnancy for TB?**

A. Yes, we have brief policy in Chapter 13 of the IHS Manual. Here is an
expanded discussion.

<http://www.ihs.gov/MedicalPrograms/MCH/M/documents/TB112604.doc>

**Q. Should INH therapy be withheld in women, or men, over 35 years
old?**

A. The decision about PPD testing and INH therapy of LTBI are not based
on age, but on risk.

<http://www.ihs.gov/MedicalPrograms/MCH/M/documents/TB112604.doc>

**Q. Should breastfeeding be discouraged during antituberculosis
therapy?**

A. Breastfeeding should **not** be discouraged with first-line
antituberculosis agents.

<http://www.ihs.gov/MedicalPrograms/MCH/M/documents/TB112604.doc>

#### Hormone Replacement Update {#hormone-replacement-update .Style-Heading-4-+-Arial-14-pt-Underline}

**Effects of Hormone Therapy on Urinary Incontinence**

CONCLUSION: Postmenopausal hormone therapy appears to increase risk of
developing urinary incontinence. This risk does not vary by route of
administration, type of hormones, or dose taken, but is diminished upon
cessation of use. LEVEL OF EVIDENCE: II-2

Grodstein F, Lifford K, Resnick NM, Curhan GC. Postmenopausal hormone
therapy and risk of developing urinary incontinence. Obstet Gynecol.
2004 Feb;103(2):254-60.\
<http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=14754692>

**NAMS Issues Statement on Treatment of Hot Flashes**

In women who need relief for mild vasomotor symptoms, NAMS recommends
first considering lifestyle changes, either alone or combined with a
nonprescription remedy, such as dietary isoflavones, black cohosh, or
vitamin E. Prescription systemic estrogen-containing products remain the
therapeutic standard for moderate to severe menopause-related hot
flashes. Recommended options for women with concerns or
contraindications relating to estrogen-containing treatments include
prescription progestogens, venlafaxine, paroxetine, fluoxetine, or
gabapentin. North American Menopause Society. Treatment of
menopause-associated vasomotor symptoms: position statement of The North
American Menopause Society. Menopause. 2004 Jan-Feb;11(1):11-33.\
<http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=14716179>

**The role of complementary and alternative medicine in menopausal
symptoms**

<http://home.mdconsult.com/das/journal/view/43477565-2/N/15122963?ja=446016&PAGE=1.html&ANCHOR=top&source>=

(from MD Consult -- free, but just need to register)

#### Information Technology {#information-technology .Style-Heading-4-+-Arial-14-pt-Underline}

#### Internet Med: Walter Reed Army Medical Center (WRAMC) Reference Desk {#internet-med-walter-reed-army-medical-center-wramc-reference-desk .Style-Heading-4-+-Arial-14-pt-Underline}

Medical Informatics Links For Physicians, Nurses and Allied Health
Professionals

<http://www.wramc.amedd.army.mil/departments/library/InterMedLibrary.htm>

#### International Health Update {#international-health-update .Style-Heading-4-+-Arial-14-pt-Underline}

**International Conference on Women and Infectious Diseases, Conference
Papers**

<http://www.cdc.gov/ncidod/EID/vol10no11/contents_v10n11.htm>

**Eliminating Racial Disparities in US Could Save More Lives Than
Medical Advances**\
The US health system spends far more on the \"technology\" of care
(e.g., drugs, devices) than on achieving equity in its delivery. For
1991 to 2000, we contrasted the number of lives saved by medical
advances with the number of deaths attributable to excess mortality
among African Americans. Medical advances averted 176,633 deaths, but
equalizing the mortality rates of Whites and African Americans would
have averted 886,202 deaths. Achieving equity may do more for health
than perfecting the technology of care.

Woolf SH, et al The health impact of resolving racial disparities: an
analysis of US mortality data**.** Am J Public Health. 2004
Dec;94(12):2078-81.

<http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15569956>

#### MCH Alert {#mch-alert-1 .Style-Heading-4-+-Arial-14-pt-Underline}

**Adolescent pregnancy intentions and pregnancy outcomes**

Despite a majority of the teens expressing no plans to become pregnant
in the next 6 months, there was tremendous variability in their
assessments of the likelihood that they would become pregnant in the
next 6 months. The authors, suggest that a counseling intervention
focused on adolescents\' perceptions of the life circumstances that
influence conception and contraceptive use may be beneficial.\
Rosengard C, Phipps MG, Adler NE, Ellen JM. Adolescent pregnancy
intentions and pregnancy outcomes: A longitudinal examination. : J
Adolesc Health. 2004 Dec;35(6):453-61.

<http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15581524>

#### Medscape\* {#medscape .Style-Heading-4-+-Arial-14-pt-Underline}

######### Iraq War Is Public Health Disaster, Report Finds

War in Iraq has caused a public health disaster that has left the
country\'s medical system in tatters and increased the risk of disease
and death, according to a report released Tuesday.

Medact, a British-based charity that examines the impact of war on
health, said cases of vaccine-preventable diseases were rising and
relief and reconstruction work had been mismanaged.

\"The health of the Iraqi people has deteriorated since the 2003
invasion,\" Gill Reeve, the deputy director of Medact, told a news
conference to launch the report. \"Immediate action is needed to halt
this health disaster.\"

<http://www.medscape.com/viewarticle/494929?src=mp>

**Individualizing Hormone Therapy for the Surgically Menopausal Woman**

**CME: Archived Web Conference**
<http://www.medscape.com/viewprogram/3504>

######### Ask the Experts topics in Women\'s Health and OB/GYN Index, by specialty, Medscape

######### [**http://www.medscape.com/pages/editorial/public/ate/index-womenshealth**](http://www.medscape.com/pages/editorial/public/ate/index-womenshealth)

######### 

######### OB GYN & Women\'s Health Clinical Discussion Board Index, Medscape

<http://boards.medscape.com/forums?14@@.ee6e57b>

**Clinical Discussion Board Index, Medscape**

Hundreds of ongoing clinical discussions available

<http://boards.medscape.com/forums?14@@.ee6e57b>

**Free CME: MedScape CME Index by specialty**

<http://www.medscape.com/cmecenterdirectory/Default>

\*NB: Medscape is free to all, but registration is required. It can be
accessed from anywhere with Internet access. You just need to create a
personal username and password.

#### Midwives Corner {#midwives-corner .Style-Heading-4-+-Arial-14-pt-Underline}

**New avenue to share midwifery ideas and resources: Starting January
2005**

This new feature will begin in January 2005. The Midwives Corner will be
a venue to share patient education resources, clinical guidelines, and
midwifery ideas. Marsha Tahquechi at GIMC will coordinate regular
midwifery input to the CCCC.

Please contact Marsha Tahquechi at <Marsha.Tahquechi@ihs.gov>

#### Office of Women's Health, CDC {#office-of-womens-health-cdc-1 .Style-Heading-4-+-Arial-14-pt-Underline}

**Infant Mortality Statistics from the 2002 Period Linked Birth/Infant
Death Data Set**

A new report confirms that the 2002 infant mortality rate in the United
States increased to 7.0 from the record low in 2001 of 6.8 per 1,000
live births. Overall, 27,970 infants died in the first year of life in
2002, compared with 27,523 in 2001. The three leading causes of infant
death were congenital malformations, low birthweight, and sudden infant
death syndrome, which together accounted for 45 percent of all infant
deaths. Infant mortality rates were higher for infants whose mothers had
no prenatal care, were teenagers, had less education, or were unmarried.
Between 2001 and 2002 the infant mortality rate among mothers who smoked
during pregnancy increased by 6 percent. In 2002 the rate among smokers
was 68 percent higher than for mothers who did not smoke during
pregnancy. <http://www.cdc.gov/nchs/pressroom/04facts/infant.htm>

#### Osteoporosis {#osteoporosis .Style-Heading-4-+-Arial-14-pt-Underline}

**Bed Rest During Pregnancy Associated With Bone Loss**

CONCLUSION: Substantial trabecular bone loss may occur during pregnancy,
particularly in women prescribed bed rest. Study of postpartum bone
recovery in such women is needed.\
Promislow JH et al Bed rest and other determinants of bone loss during
pregnancy**.** Am J Obstet Gynecol. 2004 Oct;191(4):1077-83.\
<http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15507924>

#### Patient Information {#patient-information .Style-Heading-4-+-Arial-14-pt-Underline}

**Your Baby\'s Teeth**

<http://www.aafp.org/afp/20041201/2121ph.html>

**Vaginitis**

<http://www.aafp.org/afp/20041201/2139ph.html>

**Rebound Headaches**

<http://www.aafp.org/afp/20041215/2313ph.html>

**What You Should Know About Genital Warts**

<http://www.aafp.org/afp/20041215/2345ph.html>

#### Primary Care Discussion Forum {#primary-care-discussion-forum .Style-Heading-4-+-Arial-14-pt-Underline}

**February 1, 2005:  Surgery for obesity?**

Moderator: Hope Baluh

This discussion will include:

-Is it time for Obesity Surgery in the IHS?

-How are primary care providers addressing the obesity epidemic now?

-Would non-surgical programs to address this issue be safer? easier?
more effective?

-Cost effectiveness\... what\'s cheaper? What about results?

### How to subscribe / unsubscribe to the Primary Care Discussion Forum?

Subscribe to the Primary Care listserv

<http://www.ihs.gov/generalweb/helpcenter/ihshelpdesk/index.cfm?module=listserv&option=subscribe&newquery=1>

Unsubscribe from the Primary Care listserv

<http://www.ihs.gov/generalweb/helpcenter/ihshelpdesk/index.cfm?module=listserv&option=unsubscribe&newquery=1>

Questions on how to subscribe, contact <nmurphy@anmc.org> directly

#### Barbara Stillwater, Alaska State Diabetes Program  {#barbara-stillwater-alaska-state-diabetes-program .Style-Heading-4-+-Arial-14-pt-Underline}

#### Preemies Prone to \'Pre-Diabetes {#preemies-prone-to-pre-diabetes .Style-Heading-4-+-Arial-14-pt-Underline}

#### CONCLUSIONS: Like children who were born at term but who were small for gestational age, children who were born prematurely have an isolated reduction in insulin sensitivity, which may be a risk factor for type 2 diabetes mellitus Hofman PL, et al Premature birth and later insulin resistance: N Engl J Med. 2004 Nov 18;351(21):2179-86. [**http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15548778**](http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15548778) {#conclusions-like-children-who-were-born-at-term-but-who-were-small-for-gestational-age-children-who-were-born-prematurely-have-an-isolated-reduction-in-insulin-sensitivity-which-may-be-a-risk-factor-for-type-2-diabetes-mellitus-hofman-pl-et-al-premature-birth-and-later-insulin-resistance-n-engl-j-med.-2004-nov-18351212179-86.-httpwww.ncbi.nlm.nih.goventrezquery.fcgicmdretrievedbpubmeddoptabstractlist_uids15548778 .Style-Heading-4-+-Arial-14-pt-Underline}

####  {#section-5 .Style-Heading-4-+-Arial-14-pt-Underline}

**AHA Updates Guidelines for Cardiovascular Disease Prevention in
Women **

High-risk conditions in women associated with a greater than 20% risk of
a cardiovascular event within 10 years include peripheral arterial
disease, abdominal aortic aneurysm, diabetes mellitus, and chronic renal
disease. The authors of the current guidelines summarize means to
minimize risks for CVD, some of which will also decrease the risk of
developing these other significant risk factors. *Circulation.*
2004;109:558-560, 672-692

<http://www.ihs.gov/NonMedicalPrograms/nc4/Documents/WomensPreventionGuidelines.pdf>

**Certificate in Public Health Via Partial Distance Accepting
Applications**

The 26-29 credits earned through this program earned may be transferred
into the Extended MPH Degree Program if a Certificate student later
applies and is admitted as an MPH degree student.

The Certificate in Public Health through the Extended MPH Degree Program
at the University of Washington spans a 12-month timeframe and covers
important public health topics in biostatistics, epidemiology, local
public health practice, health services, and general public health
management. Students may choose from several pathway options: Community
Practice, Health Education, or Maternal and Child Health. Applicants
should have at least three years of experience related to public health.

Applications are available for the UW\'s Certificate in Public Health
that starts during Summer 2005 at:
[[http://depts.washington.edu/hsedp/]{.underline}](http://depts.washington.edu/hsedp/).

**ADA Current Grant Opportunities**

#### [**http://diabetes.org/diabetes-research/research-grant-application-forms/ADA-grant-opportunities/ADA-current-grant-opportunities.jsp**](http://diabetes.org/diabetes-research/research-grant-application-forms/ADA-grant-opportunities/ADA-current-grant-opportunities.jsp) {#httpdiabetes.orgdiabetes-researchresearch-grant-application-formsada-grant-opportunitiesada-current-grant-opportunities.jsp .Style-Heading-4-+-Arial-14-pt-Underline}

####  {#section-6 .Style-Heading-4-+-Arial-14-pt-Underline}

#### Ask Cosmo about the National Library of Medicine {#ask-cosmo-about-the-national-library-of-medicine .Style-Heading-4-+-Arial-14-pt-Underline}

#### Cosmo says: Hello. Ask me one question in a short sentence and I will link you to information about the National Library of Medicine (NLM). [**http://wwwns.nlm.nih.gov/NLM/Connect**](http://wwwns.nlm.nih.gov/NLM/Connect) {#cosmo-says-hello.-ask-me-one-question-in-a-short-sentence-and-i-will-link-you-to-information-about-the-national-library-of-medicine-nlm.-httpwwwns.nlm.nih.govnlmconnect .Style-Heading-4-+-Arial-14-pt-Underline}

#### If you need more help, use the link below to send an e-mail to NLM Customer Service.  {#if-you-need-more-help-use-the-link-below-to-send-an-e-mail-to-nlm-customer-service. .Style-Heading-4-+-Arial-14-pt-Underline}

#### [**http://www.nlm.nih.gov/cgi/nmemail.pl**](http://www.nlm.nih.gov/cgi/nmemail.pl) {#httpwww.nlm.nih.govcginmemail.pl .Style-Heading-4-+-Arial-14-pt-Underline}

# What's new on the ITU MCH web pages? {#whats-new-on-the-itu-mch-web-pages .Style-Style-Heading-1-+-Underline-+-Pattern:-Clear-(Gray-12.5%)}

**Q. What is the best screening cut-off for gestational diabetes
mellitus**?

<http://www.ihs.gov/MedicalPrograms/MCH/M/documents/GDMScr112804.doc>

There are several upcoming **Conferences**

<http://www.ihs.gov/MedicalPrograms/MCH/M/CN01.cfm#top>

and **Online CME/CEU resources**, etc....

<http://www.ihs.gov/MedicalPrograms/MCH/M/CN13.cfm>

and the latest **Perinatology Corners** (free online CME from IHS) are
at

<http://www.ihs.gov/MedicalPrograms/MCH/M/MCHpericrnr.asp>

...or just take a look at the **What's New** page

<http://www.ihs.gov/MedicalPrograms/MCH/W/WN00.asp#top>

# Save the dates {#save-the-dates .Style-Style-Heading-1-+-Underline-+-Pattern:-Clear-(Gray-12.5%)}

**20th Annual Conference on Women's and Children's Healthcare**

-   For providers caring for Native women and children

-   February 25 - 27, 2005

-   First announcement details
    <http://www.ihs.gov/MedicalPrograms/MCH/M/documents/tldr20051stnotice.doc>

-   Telluride, CO
    <http://www.ihs.gov/MedicalPrograms/MCH/M/ConfDnlds/Tellurideagenda10-2004.doc>

-   Contact Alan Waxman <awaxman@salud.unm.edu>

**\
IHS Advanced Colposcopy course / Refresher Workshop**

-   March 30 - April 1, 2005 respectively

-   Albuquerque, New Mexico

-   Brochure
    <http://www.ihs.gov/MedicalPrograms/MCH/M/documents/Colpo05mailoutbrochure.pdf>

-   Or contact [Roberta Paisano](mailto:Roberta Paisano)
    <Roberta.Paisano@na.ihs.gov> (505) 248-4431

**17th Annual IHS Research Conference: International Meeting on Inuit
and Native American Child Health: Innovations in clinical care and
research**

> April 29-May 1, 2005, Seattle, WA

<http://www.aap.org/nach/InternationalMeeting.htm>

**3rd Western MCH Epidemiology**

-   May 12-13, 2005

-   Portland, OR

-   <http://sphcm.washington.edu/mchepi2005/>

**American College of Obstetricians and Gynecologists Annual Clinical
Meeting**

-   May 7-11, 2005

-   San Francisco , California

-   53rd Annual ACOG ACM <http://www.acog.org/ACM2005/>

**Advances in Indian Health**

-   May 11-13, 2005

-   Albuquerque, NM

-   2004 Brochure (2005 pending)

-   [http://hsc.unm.edu/cme/2004%20Web%20Info/AIH2004/AIHIndex.shtml](http://hsc.unm.edu/cme/2004 Web Info/AIH2004/AIHIndex.shtml)

-   Contact <CNorth@abq.ihs.gov>

**Prevention of Cardiovascular Disease & Diabetes Among** **AI / AN**

-   May 16 - 19, 2005

-   Denver, CO

-   Co-sponsored by IHS, Joslin, ADA, NIH

-   <http://professionaled.joslin.org/CourseListing/CourseDesc.asp?intCourseTypeId=4&intCourseID=1269&strFullInd=Y>

**2005 U.S. Public Health Conference/Global Health Summit**

-   June 5-9, 2005

-   Philadelphia, PA, Development of the Report on Global Health

-   40^th^ Annual U.S. Public Health Professional Conference, June 6-9,
    2005

-   [www.coausphsconference.org](../../../../../../../../exchweb/bin/redir.asp%3FURL=http://www.coausphsconference.org/)

**I.H.S. / A.C.O.G. Postgraduate Course: Obstetric, Neonatal, and
Gynecologic Care**

-   June 19 - 23, 2005

-   Denver, CO

-   Contact [Yvonne Malloy](mailto:YMalloy@acog.org) <YMalloy@acog.org>
    202-863-2580

-   Save the date info
    <http://www.ihs.gov/MedicalPrograms/MCH/M/documents/pgcoursesavethedate.doc>

-   [2004
    Brochure](http://www.ihs.gov/MedicalPrograms/MCH/M/ConfDnlds/Brochure2004.doc)
    (WORD 252k) NB: 2005 brochure is coming soon

> <http://www.ihs.gov/MedicalPrograms/MCH/M/ConfDnlds/Brochure2004.doc>

-   June 19th at 8:00 am: NEONATAL RESUSCITATION PROGRAM

```{=html}
<!-- -->
```
-   NRP Class size limited. Sign up now
    <http://www.ihs.gov/MedicalPrograms/MCH/M/documents/NeonatalResuscitationProvider2.doc>

```{=html}
<!-- -->
```
-   Meeting Website
    <http://www.ihs.gov/MedicalPrograms/MCH/M/CN01.cfm#June05>

# Did you miss something in the last OB/GYN Chief Clinical Consultant Corner? {#did-you-miss-something-in-the-last-obgyn-chief-clinical-consultant-corner .Style-Style-Heading-1-+-Underline-+-Pattern:-Clear-(Gray-12.5%)}

The **November 2004 OB/GYN CCC Corner** is available at:\
<http://www.ihs.gov/MedicalPrograms/MCH/M/documents/CCC1104.doc>

**[Contents:]{.underline}**

**[Abstract of the Month]{.underline}:** **page 3**

## Results of the National Study of Vaginal Birth After Cesarean in Birth Centers 

[From your colleagues:]{.underline} page 4

**From Burt Attico:** Glycemic Control in Diabetic Women Fosters
Delivery of Normal Weight Infants; Health Disparities in Women's Health

From Bonnie Bishop-Stark: Total Cr/P useful for ruling out preeclampsia,
but not at diagnosing

**From Mark Carroll:** Opportunities for local/regional collaboration
between IHS and VA

**From Diane Cooper:** Ask a Medical Librarian - New service available
to all Indian Health Staff

**From Terry Cullen:** UpToDate Subscriber Newsletter - *UpToDate*
Version 12.3 Now Available

From Sandra Dodge: **Smoking During Pregnancy;** Trends in national
estimates of mean weight, height, and body mass index; **Access to
care**

**From Doug Eby:** Asthma prevalence, hospitalization, and
corticosteroid use: Alaska Natives

**From Kat Franklin:** Easy access to Patient Education materials

From Steve Holve: November Child Health Notes highlights

**From Bob Laliberte:** LOCUM TENENS AVAILABILITY

**From Kelly Moore**: Best practices for diabetes programs and care in
pregnancy

**From Kelton Oliver:** IHS Patient Education codes can make your life
easier

**From Ty Reidhead:** Easier access to Clinical Guidelines in Indian
Health

From Judy Thierry: Overweight and obese women had a significantly slower
labor ; 4 in 10 people who start drinking before age 15 eventually
become alcohol dependent

From Alan Waxman: Conference on Women's and Children's Healthcare-20th
Annual

**From Pat Yee-Spencer:** There is an OB/GYN physician interested in IHS

**[Hot Topics:]{.underline}**

**Obstetrics**: **page 10**

3 Articles on CenteringPregnancy; Fetal Manipulation Often Best for
Shoulder Dystocia; Data support the routine use of antibiotics for women
with PROM; AFI offers no advantage over single deepest pocket when
performed with the BPP; Mercury Levels in Young Children and
Childbearing-Aged Women; Vaginal-perianal compared with vaginal-rectal
cultures for group B; Perinatal infections due to group B streptococci;
Treatment of Bacterial Vaginosis in Pregnancy; Pregnancy Nutrition
Surveillance System / Pediatric Nutrition Surveillance websites; Blunt
Trauma in Pregnancy; Seat belt use during pregnancy; Pregnancy
Prevention in Adolescents; Teenage Pregnancy Prevention: What Can We Do?
Introduction of Routine HIV Testing in Prenatal Care

**Gynecology:** **page 13**

Colposcopy Possibly Unjustified for Screening Young Women for Cervical
Cancer; Women With Atypical Glandular Cells: A Long-Term Study in a
High-Risk Population; Pessary Test May Predict Urinary Incontinence
After Hysterectomy; Many older patients are bothered by night sweats,
day sweats, and hot flashes; Pelvic symptoms in women with pelvic organ
prolapse; Incontinence Products and Devices for the Elderly; Urinary
incontinence strategies for frail elderly women; Physiotherapy Helpful
for Persistent Postnatal Stress Urinary Incontinence; Laparoscopic vs.
Abdominal Hysterectomy: a Comparison; Add-back therapy plus GnRH-a
improves treatment of endometriosis pain; Cognitive Behavior Therapy
Should Be First-Line Therapy for Sleep-Onset Insomnia; Do your patients
complain of poor sleep? Is it hormonal? Or something else? Laparoscopic
Excision Often Helpful for Endometriosis; Ultrasound Therapy Effective
for Vulvar Dystrophy; Stress urinary incontinence -- An excellent review
of management; Management of Cervical Cytologic Abnormalities; The 2001
ASCCP Management Guidelines for Cervical Cytology, Editorial

**Child Health:** **page 15**

Cholestasis of pregnancy - Bile acid pneumonia: a \"new\" form of
neonatal respiratory distress syndrome? AHRQ and its partners launch new
tools to help combat childhood obesity; AAP to Issue Advisory to Help
Diagnose, Treat and Monitor Depressed Children; Childhood Bullying:
Implications for Physicians; Bullying: Patient Education

**Chronic Illness and Disease:** **page 16**

A novel specific prophylaxis for menstrual-associated migraine;
Identifying patients who require a change in their current acute
migraine treatment; National Diabetes Awareness Month; Acne patients
should include attention to anger and other chronic emotional states;
Prevalence of Overweight and Obesity Among Adults with Diagnosed
Diabetes; The colon is a pelvic organ too: taking the Couric challenge;
Aggressive statin strategy best for patients with heart disease; Is
Antibiotic Use Associated with Breast Cancer Risk? Caloric Restriction
Decreases Incidence of Breast Cancer; Vioxx Pulled From Global Market -
Potential Mechanisms for Cardiovascular Risk; Outcomes After Cardiac
Catheterization in Women; Common Dietary Supplements for Weight Loss

[Features:]{.underline} page 18

AFP: Isoflavones Do Not Reduce Menopausal Symptoms; Trial of Labor After
Cesarean Section Is Relatively Safe; Ultrapotent Topical Steroids for
Vulvar Lichen Sclerosus; Screening for Syphilis Infection:
Recommendation Statement;

**ACOG:** Gynecologic Herpes Simplex Virus Infections; Prenatal and
Perinatal Human Immunodeficiency Virus Testing: Expanded; Influenza
Vaccination and Treatment During Pregnancy; ACOG Issues State-of-the-Art
Guide to Hormone Therapy

**AHRQ:** Study finds that some pregnant women are prescribed drugs that
may be considered unsafe during pregnancy; Quality-of-life benefits of
short-term hormone therapy may outweigh the risks for some menopausal
women; After more than 20 years, quality of life is similar for women
who had a hysterectomy or went through natural menopause; Instruments
that measure the health status of children: Impact of race, ethnicity,
and income on health

**Breastfeeding:** Breastfeeding reduced risk of leukemia; New Brochure:
Nursing Mothers Room\'s

**Domestic Violence:** Intimate Partner Violence: What Are Physicians\'
Perceptions with older patients? Abuse in childhood and adolescence as
predictor of future victimization

**Elder Care News:** Use of Traditional Foods in a Healthy Diet in
Alaska: Risks in Perspective; Metabolic syndrome plus inflammation
increases risk of cognitive decline

**Family Planning:** Depo Provera: Loss of significant bone mineral
density; Effectiveness of Spermicides Containing Nonoxynol-9;
Contraception for Adolescents

**Frequently asked questions:** Does IHS have any policy on distribution
of the morning after pill? Is exercise actually recommended in
pregnancy? What do you use to treat pregnant women with migraines? Is
routine antenatal surveillance indicated with an elevated maternal serum
alpha-fetoprotein? Can we use misoprostol for labor induction in asthma
patients? Using weekly 17-OH-progesterone caproate in your patient
population for PTL? What are some of the issues involving rapid cesarean
delivery [+]{.underline} local anesthesia? What is the best antenatal
surveillance regimen for twin gestations?

**Hormone Replacement Update**: Effect of Hormone Therapy on Cognition
in Elderly Women

**Information Technology:** Prenatal care: a strategic first step toward
EMR acceptance; Designated provider management system, version 1.0
released

**International Health**: 100,000 Excess Civilian Iraqi Deaths Since
War; Health policy summer internship available to minority college
students; Applied Epidemiology Fellowship in Maternal and Child Health

**MCH Alert:** New Web site to support the education and training of
those working in the MCH; Economic factors explain weight outcomes

**Medscape**: Cultural Differences in Diet and Heart Health Among Women

**Office of Women's Health, CDC**: Intervention and Evaluation Trials to
Prevent Intimate Partner Violence: Funding

**Osteoporosis**: Pharmacologic Prevention of Osteoporotic Fractures;
Osteoporosis Management: Out of Subspecialty Practice and into Primary
Care

**Patient Education:** Timing of pregnancy, and pre-pregnancy health
habits and important issues; Seat Belt Use During Pregnancy; Bullying:
Patient Education

Primary Care Discussion Forum: Domestic violence -- now; Gastric
stapling surgery -- Feb. 05

#### Barbara Stillwater, Alaska Diabetes Prevention and Control: Obesity and Diabetes Independently Increase Cesarean Delivery Risk; Even Without Diabetes, High Blood Sugar Ups Death, Heart Disease Risk; Western\' Diet Linked to Type 2 Diabetes in Women; Average American is 1 Inch Taller, 25 Pounds Heavier Than 40 Years Ago; MAJOR GAINS IN HEALTH CARE QUALITY, BUT ONLY FOR 1/4th OF THE SYSTEM; Cultural Sensitivity and Its Impact on Care

The past CCC Corners are archived at:

<http://www.ihs.gov/MedicalPrograms/MCH/M/OBGYN01.cfm#top>

The CCC Corner is good way to inform ITU providers about recent updates,
while decreasing the number of e-mail messages.

Let me know if you want to add something to next month's CCC Corner at
<nmurphy@anmc.org>

or 907 729 3154 (with voicemail)

\*The opinions expressed in the OB/GYN CCC Corner are strictly those of
the authors, and not necessarily those of the Indian Health System, or
the author of this newsletter. If you have any comments, please share
them by joining the Primary Care Discussion Forum where this topic was
recently discussed. To join the Primary Care Listserv, click on
'Subscribe' here
<http://www.ihs.gov/MedicalPrograms/MCH/M/MCHdiscuss.asp>

12/27/04