News Flash(s)

Plan now

ACOG / IHS -- Total Women's Health and Neonatal Course: June 19-23, 2005

**IHS Advanced Colposcopy course / Refresher Workshop: March 30 -- April
1, 2005**

New Features:

Ask a Librarian: Diane Cooper

Midwives Corner: Marsha Tahquechi

What's new in STDs?: Laura Shelby

OB/GYN Chief Clinical Consultant's Corner

Volume 3, No. 1, January, 2005

# 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}

**Limit use of Depo Provera to 2 consecutive years only: Black Box
Warning from the FDA**

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

Burt Attico: Smoking During Pregnancy Tied to Gestational Diabetes Risk

**Donna Brown**: Hand foot and mouth disease in pregnancy

**Terry Cullen:** IHS prenatal assessment form - ETOH, tobacco,
substances, DV, other issues

**George Gilson**: Which fetal heart rate / contraction patterns are
worrisome with misoprostol use**?**

Steve Holve: Oral Rehydration Solution: 5 articles -- January Indian
Child Health Notes

## Chuck North: Serving Native American Communities 

Lori de Ravello: **National Summit on Preconception**

**Judy Thierry**: Birth Simulator for Shoulder Dystocia - Rubin\'s
maneuver requires least traction

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

##### Obstetrics: page 7

-Highest percentage ever reported in the United States: Cesarean
Delivery

-Alcohol Consumption Among Women Who Are Pregnant, or Who Might Become
Pregnant

-Normalizing blood pressure rapidly and reducing the need for
antihypertensive therapy

-Preterm premature rupture of membranes: Optimal gestational age for
delivery?

-Factor V Leiden polymorphism is associated with an increased risk of
preeclampsia

**Gynecology: page 8**

-Passive smoking increases the risk of cervical neoplasia

-Consumer Reports Magazine Rates Condoms, Reviews 16 Other Contraceptive
Methods

**Child Health: page 8**

-Social Norms and Friends' Influences on weight control behavior:
Adolescent girls

-Teenagers in the United States: Sexual Activity, Contraceptive Use, and
Childbearing

**Chronic Illness and Disease: page 8**

-Bariatric Surgery May Be a Viable Treatment Option for Severe Obesity:
2 articles

-The Recognition of Depression: The Primary Care Clinician\'s
Perspective

-High Folate Intake May Reduce Risk of Hypertension in Women

-Women With Diabetes Do Worse After Stenting

-Premature birth and later insulin resistance

#### Features: page 9 {#features-page-9 .Style-Heading-4-+-Arial-14-pt-Underline}

**American Family Physician**

\-[Imaging for Suspected
Appendicitis](http://lyris.aafp.org/t/132975/5913807/251197/0/)

ACOG

\- Intrauterine Device - ACOG Practice Bulletin NUMBER 59

-EC does not increase promiscuity or unprotected sex among women, nor
does it cause women to abandon their regular birth control methods

**AHRQ**

-Wrong Site \"Near Miss\" -- Web M+M -Surgery

**Ask a Librarian**

\- Great New Resource: MD Consult available: Many journals at your
fingertips

**Breastfeeding**

\- Free website for medications and breastfeeding that is useful and
credible

\- State Legislation on Breastfeeding    

**Domestic Violence**

-Sexual assault is associated with significantly higher levels of PTSD

-Just finished..... Domestic Violence in Native Women -- Primary Care
Forum Summary

**Elder Care News**

-Co-incidence of Alzheimer's and cerebrovascular disease accelerates
cognitive decline

-Native Americans Social and Economic Development Strategies (SEDS)
Grants

-Palliative Care resource for hospitals and clinics

**Family Planning**

-Being overweight may increase the risk of becoming pregnant while using
OCs

-EC does not cause women to abandon their regular birth control methods

**Frequently asked questions**

-The 'quad' second trimester screening test is expensive. Is it worth
it?

-What are the best cut-offs to use while monitoring diabetes in
pregnancy therapy?

-How does birth interval affect the repeat cesarean vs. vaginal delivery
decision?

-Are there alternatives to insulin / diet in diabetes and pregnancy?
Glyburide? Others?

-How many colposcopies in a year does a non-OB/GYN provider need to
perform?

**Hormone Replacement Update**

-Venlafaxine significantly decreases postmenopausal patient-perceived
hot flush score

**Information Technology**

\- Electronic Health Record: Overview, Implementation & Lessons
Learned - Courses

International Health

-Lifelong accumulated racial discrimination by African American: Preterm
delivery

#### MCH Alert

-National Birth Defects Prevention Month

#### Medscape

######### -Are Vaginal Symptoms Ever Normal? A Review of the Literature

**Midwives Corner**

-Midwives Serving Indian Country

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

-Marriage may be good for you

-Explaining the 2001-02 Infant Mortality Increase: Linked Birth/Infant
Death Data Set

Osteoporosis

-Alendronate is safe and effective: Can carry treatment out ten years
without concern

\-[Effect of Vitamin D on falls: a
meta-analysis](http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15113819)

Patient Education

-Maternal Child Health Patient Education: new web page envisioned

Primary Care Discussion Forum

-Surgery for obesity? February 2005

-Just finished..... Domestic Violence in Native Women -- Primary Care
Forum Summary

**What's new in Sexually Transmitted Diseases?**

-Preventive Health Care Seeking Among Adolescents: The Gonorrhea
Community Action Project

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

-The \'Polymeal\' Cuts Heart Disease by 76% - Recipe for Life**\
-** Depression Increases Insulin Resistance, Diabetes in Middle-Aged
Women

## -Dietary Guidelines for Americans 2005

#### What's new on the ITU MCH web pages page 17

###### Save the Dates: Upcoming events of interest page 18

**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%)}

**Limit use of Depo Provera to 2 consecutive years only**

**Black Box Warning from the FDA**

**Substantial Bone Loss Seen with Depo-Provera Use**

FDA: "Women who use Depo Provera Contraceptive Injection (CI) may lose
significant bone mineral density (BMD). Bone loss is greater with
increasing duration of use and may not be completely reversible. It is
unknown if use Depo Provera CI during adolescence or early adulthood, a
critical time of bone accretion, will reduce peak bone mass and increase
the risk for osteoporotic fracture in later life. Depo Provera CI should
be used as a long term birth control method (e.g., longer than 2 years)
only if other birth control methods are inadequate."

<http://www.fda.gov/medwatch/SAFETY/2004/DepoProvera_Label.pdf>
<http://www.fda.gov/>

OBJECTIVE: To compare longitudinal changes in bone mineral density (BMD)
among first-time depot medroxyprogesterone acetate (DMPA) users to women
using no hormonal contraception, and evaluate user characteristics
associated with that BMD change.

DESIGN: Prospective longitudinal study.

PATIENT(S): Women, aged 18 to 35, choosing DMPA for contraception (n =
178) and women using no hormonal contraception (n = 145).

MAIN OUTCOME MEASURE(S): Hip and spine BMD measured, at three-month
intervals for 24 months, by dual energy x-ray absorptiometry. RESULT(S):
Mean hip BMD declined 2.8% (SE = 0.034) 12 months following DMPA
initiation and 5.8% (SE = 0.096) after 24 months. Mean spine (L1-L3) BMD
declined 3.5% (SE = 0.022) and 5.7% (SE = 0.034), respectively, after
one and two years of DMPA use. Mean hip and spine BMD of control
participants changed less than 0.9% over the same period. Among DMPA
users, body mass index (BMI) change was inversely associated with BMD
change at the hip, but not at the spine. Calcium intake, physical
activity, and smoking did not influence BMD change in either group.

CONCLUSION(S): Hip and spine BMD declined after one DMPA injection and
this decline continued with each subsequent injection for 24 months.
With the exception of increasing BMI among DMPA users, no user
characteristics offered protection against DMPA-related BMD loss.

Clark MK, et al Bone mineral density changes over two years in
first-time users of depot medroxyprogesterone acetate. Fertil Steril.
2004 Dec;82(6):1580-6.\
<http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15589863>

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

The FDA Black Box warning was based on one controlled clinical trial in
adults and one ongoing open label, non-randomized clinical trial in
adolescent females. The loss increases with duration of use and may not
be completely reversible. There is evidence, in both adults and
adolescents, that the decrease in BMD is at least partially reversible
after Depo Provera CI is discontinued and ovarian estrogen production
increases. Long term studies on BMD loss in adolescents are not
available at this time, but are ongoing.

Please note the FDA does not have data to address whether calcium or
Vitamin D may lessen BMD loss in women using Depo Provera CI. All
patients should have adequate calcium or Vitamin D intake. There is also
randomized clinical data that estrogen supplementation is protective in
adolescent girls. (See below)

Another approach, if long term Depo Provera CI is deemed essential, is
to measure BMD. In adolescents, interpretation of BMD results should
take into account patient age and skeletal maturity. Also see other
citations below

[Bottom-line]{.underline}: Until further data is available, use of Depo
Provera CI for longer than 2 years should be limited, while adequate
intake of calcium and Vitamin D should be encouraged. If other forms of
birth control are inadequate, then BMD should be measured and should
take into account patient age and skeletal maturity. Estrogen
supplementation can also be considered.

**For more information:**

[Conclusion]{.underline} Our results suggest that estrogen
supplementation is protective of bone in adolescent girls who receive
depot medroxyprogesterone acetate injections.

Cromer BA et al Double-blinded randomized controlled trial of estrogen
supplementation in adolescent girls who receive depot
medroxyprogesterone acetate for contraception. Am J Obstet Gynecol 2005
Jan;192(1):42-7     

<http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15672001>

[CONCLUSIONS:]{.underline} Depot medroxyprogesterone contraception was
associated with a greater risk of diabetes compared with combination
oral contraceptive use only. Risk was associated with length of use and
persisted after adjustment for body mass index. Additional research is
needed for confirmation, but this risk should be considered in
contraceptive choice for women at high risk for diabetes.

Kim C; Seidel KW; Begier EA; Kwok YS Diabetes and depot
medroxyprogesterone contraception in Navajo women. Arch Intern Med 2001
Jul 23;161(14):1766-71 

<http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=11485510>

CONCLUSION: Women who use depot medroxyprogesterone acetate through to
menopause have attenuated rates of bone loss from the lumbar spine and
femoral neck, presumably because they have already lost the
estrogen-sensitive component of bone.

Cundy T; Cornish J; Roberts H; Reid IR Menopausal bone loss in long-term
users of depot medroxyprogesterone acetate contraception. Am J Obstet
Gynecol 2002 May;186(5):978-83    

<http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=12015524>

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

#### Burt Attico, Phoenix {#burt-attico-phoenix .Style-Heading-4-+-Arial-14-pt-Underline}

**Smoking During Pregnancy Tied to Gestational Diabetes Risk**\
Mean plasma glucose concentrations increased by 0.5 mg/dL for each
cigarette smoked per day.

Previous studies have linked smoking to the risk of type 2 diabetes, but
the relationship between smoking and diabetes remains unclear. If the
association between smoking and gestational diabetes mellitus is causal,
the researchers write, \"then 47% of gestational diabetes mellitus in
smokers and 10% in all women in our study population could potentially
be attributed to tobacco exposure.\"...\"smoking may be an important
modifiable risk factor for gestational diabetes mellitus.\" England LJ,
et al. Glucose tolerance and risk of gestational diabetes mellitus in
nulliparous women who smoke during pregnancy. Am J Epidemiol. 2004 Dec
15;160(12):1205-13.
<http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15583373>

**VBAC Backlash: Why are hospitals forbidding women who have had
C-sections the right** to have vaginal births? By David Dobbs
<http://slate.msn.com/id/2111499/>

#### Donna Brown, Anchorage {#donna-brown-anchorage .Style-Heading-4-+-Arial-14-pt-Underline}

**Hand foot and mouth disease in pregnancy**

Q. How does one manage possible exposure to hand foot and mouth disease
in pregnancy?

A. With reassurance, unless the mother has a febrile illness during the
last week of pregnancy.

**Hand, foot, and mouth syndrome** --- The hand, foot, mouth syndrome
(HFM) is a common acute illness, affecting mostly children, which is
characterized by fever, oral vesicles on the buccal mucosa and tongue,
and peripherally distributed small, tender cutaneous lesions on the
hands, feet, buttocks and (less commonly) genitalia. The group A
coxsackieviruses are recovered most often from hand-foot-mouth syndrome
patients.

The illness usually resolves in two to three days without complication.
Concomitant central nervous system (CNS) disease may occur when HFM
syndrome is caused by enterovirus 71.

**Pregnancy** --- Enterovirus infections in pregnant women do not
readily cross the placenta and cause fetal disease, nor is there an
association with miscarriage or preterm birth. However, rare cases of
intrauterine fetal death (from echoviruses or coxsackieviruses) and
severe maternal abdominal pain suggestive of abruption have been
reported. Vertical transmission is much more likely to occur in the
perinatal period. There is no strong evidence that maternal enterovirus
infections cause congenital malformation even though a few reports have
suggested a possible relationship with certain anomalies.

**Neonatal infections** --- Most newborns with life-threatening
enterovirus disease acquire the infection from a symptomatic mother in
the perinatal period; approximately 60 to 70 percent of women who bear
infected infants have a febrile illness during the last week of
pregnancy. Ample experimental evidence indicates that the fetus is
relatively protected during maternal infection by the placenta, but the
newborn has a high risk of infection, perhaps as a result of exposure to
either virus-positive cervical secretions or viremic maternal blood.

**UpToDate**

**Clinical manifestations and diagnosis of enterovirus infections**

<http://www.uptodateonline.com/application/topic.asp?file=viral_in/13577&type=A&selectedTitle=1~4>

**Editorial Comment: George Gilson**

That\'s as much info as is available to my knowledge, really just case
reports mostly, and maternal reassurance is best.

####  {#section-1 .Style-Heading-4-+-Arial-14-pt-Underline}

#### Terry Cullen, Tucson {#terry-cullen-tucson .Style-Heading-4-+-Arial-14-pt-Underline}

**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.ihs.gov/MedicalPrograms/MCH/M/PROG01.cfm#ETOH**](http://www.ihs.gov/MedicalPrograms/MCH/M/PROG01.cfm#ETOH) {#httpwww.ihs.govmedicalprogramsmchmprog01.cfmetoh .Style-Heading-4-+-Arial-14-pt-Underline}

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

#### George Gilson, Anchorage {#george-gilson-anchorage .Style-Heading-4-+-Arial-14-pt-Underline}

**Q. Which fetal heart rate and contraction patterns are worrisome**
**with misoprostol use?**

**A.** The hyperstimulation syndrome is worrisome and contraindicates
further use of the drug.

See Below

There are 3 types of uterine contraction patterns associated with
misoprostol use, only one of which is worrisome:

1\) tachysystole refers to the occurrence of more than 7 uterine
contractions in any 15 minute monitoring window,

2\) hypertonus refers to 2 or more uterine contractions lasting more
than 120 seconds in any 15 minute monitoring window,  

3\) the hyperstimulation syndrome refers to any instance of 1) or 2)
accompanied by a nonreassuring fetal heart tracing (i.e., tachycardia,
decreased variability, repetitive variables or lates).

Only the hyperstimulation syndrome is worrisome and contraindicates use
of the drug for further attempts at ripening or induction. It\'s
incidence in most studies is usually under 5%. Tachysystole in early
labor after use of misoprostol is a common finding and is usually not a
cause of either maternal discomfort or fetal intolerance of the process,
and does not contraindicate further usage. See also:

**UpToDate: Induction of labor: Indications, techniques, and
complications**

<http://www.uptodateonline.com/application/topic.asp?file=labordel/8409&type=A&selectedTitle=4~32>

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

#### Steve Holve, Tuba City  {#steve-holve-tuba-city .Style-Heading-4-+-Arial-14-pt-Underline}

# Oral Rehydration Solution: 5 articles -- January Indian Child Health Notes

The development of ORS has probably saved more lives worldwide than any
other medical device in the past 30 years. It was rapidly adopted
overseas but there was initial resistance to its use in the United
States. Much of the resistance was based on the assumption that
intravenous fluid (more sophisticated and intensive technology) must be
better than something so simple as drinking salt and sugar water.
Numerous studies in the past thirty years have shown not only the
safety, but the superiority of ORS over intravenous therapy except in
cases of severe diarrhea or children with decreased levels of
consciousness.

The CDC article is a great summary for anyone not familiar with ORS; its
development, scientific rationale and clinical use. I would like to
point out that much of the early work on the use of ORS in this country
was done by Dr. Matu Santosham of Johns Hopkins University. Much of his
work was done with the Indian Health Service on the Whiteriver Apache
reservation in Arizona. Dr. Santosham has also done many other studies
of tremendous benefit to American Indians and Alaskan Natives through
his work on development of vaccines against Hemophilus influenza type B
and pneumococcus
[[http://www.ihs.gov/MedicalPrograms/MCH/C/documents/PedNotes0105.doc]{.underline}](http://www.ihs.gov/MedicalPrograms/MCH/C/documents/PedNotes0105.doc)

#### Chuck North, Albuquerque {#chuck-north-albuquerque .Style-Heading-4-+-Arial-14-pt-Underline}

## Serving Native American Communities 

....the University of South Dakota School of Medicine and University of
New Mexico Health Sciences Department of Family Medicine have a central
focus of reducing health disparities, especially for the American Indian
population. This work is done through medical student rotations in
preventive medicine, obstetrics-gynecology, and community health at IHS
clinics and hospitals, medical student research projects addressing
tribal and IHS priorities, faculty research and service grants/contracts
with tribes, and an epidemiology contract through the Center for Rural
Health Improvement with the Aberdeen Area IHS. Medical student projects
include helping a tribe develop its own cancer plan, conducting a
research survey of IHS provider screening habits and training needs for
domestic violence, and a follow-up project the next year that provides
ACOG domestic violence screening training CME to IHS providers.
Department faculty and residents provide community lectures on
educational opportunities in medicine and the health sciences to
students in the communities where they work.

Like politics, health care is inherently a local issue, and the needs
and concerns of local groups are as varied as the groups themselves.
Academic departments must adapt to the local environment, build on local
strengths, and respond to local needs. The programs described here
represent only a small part of the diversity of departmental programs,
but they are models of how departments have responded to their local
conditions and built programs and systems that reach out to, collaborate
with, and help those we seek to serve.

### Burns, EA, North, C, Patrick, S. Serving Native American Communities *Annals of Family Medicine* 3:93- (2005) <http://www.annfammed.org/cgi/content/full/3/1/93>

#### Lori de Ravello, Albuquerque {#lori-de-ravello-albuquerque .Style-Heading-4-+-Arial-14-pt-Underline}

**National Summit on Preconception Care**

JUNE 21-22, 2005, Atlanta, Georgia, Mark your calendar!

Centers for Disease Control and Prevention (CDC)/Agency for Toxic
Substances and Disease Registry (ATSDR), the March of Dimes, and others
<http://www.signup4.net/Public/ap.aspx?EID=NATI14E>

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

#### Summer Institute in Reproductive and Perinatal Epidemiology, July 10-16, 2005 {#summer-institute-in-reproductive-and-perinatal-epidemiology-july-10-16-2005 .Style-Heading-4-+-Arial-14-pt-Underline}

Participants will be given a travel stipend (up to \$1,500 provided by
IHDCYH); room and board also will be covered. Subjects to availability,
up to 20 qualified students will be selected. Graduate students,
postdoctoral and clinical fellows interested in a research career in
reproductive or perinatal epidemiology are invited to apply. All
documents must be received by March 1, 2005.

Gwendoline Simard, course coordinator, <gsimard@cihr-irsc.gc.ca> or
Phone 613-941-0424

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

#### Judy Thierry, HQE {#judy-thierry-hqe .Style-Heading-4-+-Arial-14-pt-Underline}

**Birth Simulator for Shoulder Dystocia - Rubin\'s maneuver requires the
least traction**

Without expeditious and appropriate management, both mother and fetus
are at risk for injury, even death. Up to 27% of shoulder dystocia
deliveries are associated with brachial plexus palsy, of which 10% are
permanent. A novel birth simulator designed by biomedical engineers at
Johns Hopkins University in Baltimore, Maryland, helps identify the
least traumatic delivery procedure for shoulder dystocia and other
problem deliveries and assists in physician training. See details below
[Conclusion]{.underline}: In a laboratory model of initial maneuvers for
shoulder dystocia, anterior Rubin\'s maneuver requires the least
traction for delivery and produces the least amount of brachial plexus
tension. Further study is needed to validate these results clinically.

Gurewitsch ED et al Comparing McRoberts\' and Rubin\'s maneuvers for
initial management of shoulder dystocia: An objective evaluation. Am J
Obstet Gynecol. 2005 Jan;192(1):153-60.

<http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15672018>

or <http://www.medscape.com/viewarticle/496721?src=search>

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

Shoulder dystocia is rare, but can be a devastating problem. Timely
application of known maneuvers can reverse the problem instantly. I
recommend everyone who provides obstetric care, directly or indirectly,
complete the Advanced Life Support in Obstetrics Course (ALSO) at least
every 5 years.
<http://www.ihs.gov/MedicalPrograms/MCH/M/PR01.cfm#AdvancedLifeSupport>

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

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

**Highest percentage ever reported in the United States: Cesarean
Delivery**

Preliminary data for 2003 indicated that 27.6% of all births in the
United States resulted from cesarean deliveries, an increase of 6% from
2002 and the highest percentage ever reported in the United States.
After declines during 1989-1996, the total cesarean rate and the primary
cesarean rate (i.e., percentage of cesareans among women with no
previous cesarean delivery; 19.1% in 2003) have increased each year.

<http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5402a5.htm>

**Alcohol Consumption Among Women Who Are Pregnant, or Who Might Become
Pregnant**

Approximately 10% of pregnant women used alcohol, and approximately 2%
engaged in binge drinking or frequent use of alcohol. The results
further indicated that more than half of women who did not use birth
control (and therefore might become pregnant) reported alcohol use and
12.4% reported binge drinking.
<http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5350a4.htm>

<http://www.cdc.gov/mmwr/PDF/wk/mm5350.pdf> PDF version (p. 1178)

**Normalizing blood pressure rapidly and reducing the need for
antihypertensive therapy**

CONCLUSION: Brief postpartum furosemide therapy for patients with severe
preeclampsia seems to enhance recovery by normalizing blood pressure
more rapidly and reducing the need for antihypertensive therapy.
Shortening of hospitalization and reduction of delayed postpartum
complications were not benefited. Ascarelli MH et al. Postpartum
preeclampsia management with furosemide: a randomized clinical trial.
Obstet Gynecol. 2005 Jan;105(1):29-33.\
<http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&list_uids=15625138&dopt=Abstract>

**Preterm premature rupture of membranes: is there an optimal
gestational age for delivery?**

CONCLUSION: Our findings suggest that expectant management of women at
34 weeks and beyond is of limited benefit.

Lieman JM, Brumfield CG, Carlo W, Ramsey PS. Preterm premature rupture
of membranes: is there an optimal gestational age for delivery? Obstet
Gynecol. 2005 Jan;105(1):12-7.\
<http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&list_uids=15625135&dopt=Abstract>

**Factor V Leiden polymorphism is associated with an increased risk of
preeclampsia**

CONCLUSION: This meta-analysis suggests that the factor V Leiden SNP is
associated with an increased risk of preeclampsia. Further studies are
warranted to determine whether subgroups of high-risk women should be
screened for this mutation.

Lin J, August P. Genetic thrombophilias and preeclampsia: a
meta-analysis. Obstet Gynecol. 2005 Jan;105(1):182-92.

<http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&list_uids=15625161&dopt=Abstract>

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

**Passive smoking increases the risk of cervical neoplasia**

CONCLUSION: The associations were in the direction of increased risk for
both passive smoking and current active smoking in both the 1963 and
1975 cohorts, but were stronger in the 1963 cohort. The results of this
long-term, prospective cohort study corroborate the association between
active cigarette smoking and cervical neoplasia and provide evidence
that passive smoking is a risk factor for cervical neoplasia. Trimble CL
et al Active and passive cigarette smoking and the risk of cervical
neoplasia. Obstet Gynecol. 2005 Jan;105(1):174-81.

<http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&list_uids=15625160&dopt=Abstract>

**Consumer Reports Magazine Rates Condoms, Reviews 16 Other
Contraceptive Methods**

The group used \"standardized tests\", including filling condoms with
air, to rate the products it examined. *Consumer Reports* also included
a \"[Guide to
Contraceptives](http://www.consumerreports.org/main/content/display_report.jsp?WebLogicSession=Qdv21LPEXbIOzaTPr3CjAXoNA7mzRSuKNNambjrQJa86jDPjqPTD|-7713857185340821589/169937909/6/7005/7005/7002/7002/7005/-1|-7976650973904308052/169937904/6/7005/7005/7002/7002/7005/-1&FOLDER<>folder_id=551087&ASSORTMENT<>ast_id=333141&bmUID=1104934613044),\"
which discusses and charts 16 other contraceptive choices, including
birth control pills, intrauterine devices and vasectomy (*Consumer
Reports*, February 2005). The report says that IUDs, oral contraceptives
and emergency contraception have become \"safer than in previous years.
However, Consumers Union said in a statement that \"\[c\]ondoms remain
the only family planning and pregnancy prevention method that can help
prevent sexually transmitted diseases, including HIV, which causes
AIDS\"
<http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=27482>

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

**Role of Social Norms and Friends' Influences on weight control
behavior: Adolescent girls**

Social influences \-- perceptions of friends dieting and, to a lesser
extent, the prevalence of trying to lose weight throughout a school \--
are associated with UWCBs \[unhealthy weight-control behaviors\] for a
large group of adolescent girls. Dieting is common among adolescent
girls, and many practice UWCBs such as fasting, using diet
pills/powders/liquids, and vomiting or taking laxatives. School-wide
prevalence of girls trying to lose weight was significantly, although
modestly, related to UWCBs for normal-weight and moderately overweight
girls.

Friends\' dieting was significantly related to UWCBs among normal-weight
and moderately overweight girls. Eisenberg ME, Neumark-Sztainer D, Story
M. 2005. The role of social norms and friends\' influences on unhealthy
weight-control behaviors among adolescent girls. Social Science &
Medicine 60(6):1165-1173.

<http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15626514>

**Teenagers in the United States: Sexual Activity, Contraceptive Use,
and Childbearing, 2002**

In 2002, about 47 percent of female teenagers (4.6 million), and about
46 percent of male teenagers (4.7 million) had had sexual intercourse at
least once. Teenagers showed increases in the use of contraceptives.
About 3 out of 4 teens used a method of contraception at their first
intercourse. About 91 percent of males and 83 percent of females used a
method at their last (most recent) sex.
<http://www.cdc.gov/od/oc/media/pressrel/r041210.htm>

<http://www.cdc.gov/nchs/data/series/sr_23/sr23_024FactSheet.pdf> Fact
Sheet

<http://www.cdc.gov/nchs/data/series/sr_23/sr23_024.pdf> Report (550 KB)

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

**Bariatric surgery: 2 articles (See also Primary Care Discussion Forum,
below)**

**Bariatric Surgery May Be a Viable Treatment Option for Severe
Obesity**

CONCLUSIONS: As compared with conventional therapy, bariatric surgery
appears to be a viable option for the treatment of severe obesity,
resulting in long-term weight loss, improved lifestyle, and, except for
hypercholesterolemia, amelioration in risk factors that were elevated at
baseline.

Sjostrom L, et al. Lifestyle, diabetes, and cardiovascular risk factors
10 years after bariatric surgery. N Engl J Med. 2004 Dec
23;351(26):2683-93.

[[http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15616203]{.underline}](http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15616203)

**Bariatric surgery: majority had complete resolution or improvement of
co-morbidities**

CONCLUSIONS: Effective weight loss was achieved in morbidly obese
patients after undergoing bariatric surgery. A substantial majority of
patients with diabetes, hyperlipidemia, hypertension, and obstructive
sleep apnea experienced complete resolution or improvement.

Buchwald H, et al Bariatric surgery: a systematic review and
meta-analysis. JAMA. 2004 Oct 13;292(14):1724-37.

<http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15479938>

**The Recognition of Depression: The Primary Care Clinician\'s
Perspective**\
CONCLUSIONS: The likelihood of accurately diagnosing depression and the
timeliness of the diagnosis are highly influenced by the conditions
within which clinicians practice. Productivity expectations in primary
care will continue to undermine the identification and treatment of
depression if they fail to take into consideration the factors that
influence such care.

Baik SY, et al The Recognition of Depression: The Primary Care
Clinician\'s Perspective. Ann Fam Med. 2005 Jan-Feb;3(1):31-7.

<http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&list_uids=15671188&dopt=Abstract>

**High Folate Intake May Reduce Risk of Hypertension in Women\
**Women consuming at least 1,000 µg per day of total folate had a 46%
reduction in the risk of incident hypertension. High folate intake from
dietary and supplemental sources significantly decreases the risk of
incident hypertension in women, especially younger women.

Forman JP et al Folate intake and the risk of incident hypertension
among US women. JAMA. 2005 Jan 19;293(3):320-9.\
<http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15657325>

**Women With Diabetes Do Worse After Stenting**

CONCLUSION: In patients who underwent coronary artery stenting, the
increased risk of adverse cardiac events associated with diabetes was
more pronounced in women than in men.

Ndrepepa G et al Sex-associated differences in clinical outcomes after
coronary stenting in patients with diabetes mellitus. Am J Med. 2004 Dec
1;117(11):830-6.

<http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15589486>

**Premature birth and later insulin resistance**\
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>

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

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

[**Imaging for Suspected
Appendicitis**](http://lyris.aafp.org/t/132975/5913807/251197/0/)

Overall diagnostic accuracy achieved by traditional history and physical
examination is only about 80 percent. Imaging techniques such as
ultrasonography and computed tomography can improve diagnostic accuracy
and patient outcomes.

<http://lyris.aafp.org/t/132975/5913807/251197/0/>

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

**Intrauterine Device**

**ACOG Practice Bulletin NUMBER 59**

**Conclusions**

-   Pelvic inflammatory disease complicating IUD insertion is uncommon,
    and the risk of PID decreases to the background risk after the first
    20 days after insertion.

-   Nulligravid and multiparous women at low risk of STDs who desire
    long-term reversible contraception are good candidates for IUDs.

**Summary of Recommendations**

***The following recommendations are based on good and consistent
scientific evidence (Level A):***

-   Routine use of prophylactic antibiotics at the time of IUD insertion
    confers little benefit.

-   The copper T380A is very effective for postcoital emergency
    contraception and is most effective if inserted within 5 days after
    unprotected intercourse.

***The following recommendations are based on limited or inconsistent
scientific evidence (Level B):***

-   Intrauterine devices may be offered to women with a history of
    ectopic pregnancy.

-   The levonorgestrel intrauterine system may be an acceptable
    alternative to hysterectomy in women with menorrhagia.

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

-   The FDA recommends that IUDs be removed from pregnant women when
    possible without an invasive procedure.

-   An IUD placed for contraception should be removed in a woman who has
    become menopausal.

-   Contraception counseling should include information about risk
    factors for STDs and PID.

Intrauterine device. ACOG Practice Bulletin No. 59. American College of
Obstetricians and Gynecologists. Obstet Gynecol 2005;105:223--32.

Non-ACOG Members

<http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15625179>

ACOG Members

<http://www.acog.org/publications/educational_bulletins/pb059.cfm>

**EC does not increase promiscuity or unprotected sex among women, nor
does it cause women to abandon their regular birth control methods.**

Statement of Vivian M. Dickerson, MD, President, The American College of
Obstetricians and Gynecologists on *JAMA* Emergency Contraception Study

<http://www.acog.org/from_home/publications/press_releases/nr01-05-05.cfm>

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

**Wrong Site \"Near Miss\"**

A patient went to the operating room (OR) for surgery on the lower leg.
Per the Universal Protocol, the surgeon marked the proper leg prior to
bringing the patient to the OR. The patient was placed in the prone
position and anesthesia was administered. A \"Time Out\" was performed,
during which all the team members met and confirmed the procedure. The
nurse began to prep the patient\'s lower leg, but the anesthesiologist
felt that something wasn\'t right. After stabilizing the patient, he
checked the chart and discovered that the nurse had scrubbed the wrong
extremity. He notified the team members and stopped the procedure. The
patient had come just minutes away from having surgery on the wrong leg,
but no harm occurred. The correct leg was then prepared, and the patient
underwent successful surgery.

<http://www.webmm.ahrq.gov/> (click on Surgery M + M)

#### Ask a Librarian: Diane Cooper, M.S.L.S. / NIH {#ask-a-librarian-diane-cooper-m.s.l.s.-nih .Style-Heading-4-+-Arial-14-pt-Underline}

**Great New Resource: MD Consult available: Many journals at your
fingertips**

You now have access to journals and also electronic medical reference
textbooks in MD Consult. 

If you haven\'t tried MD Consult, here is how:

-Go to HSRL site:  <http://hsrl.nihlibrary.nih.gov/>

·Next go to the menu bar across the top of the page and hold your cursor
on:  RESEARCH TOOLS

·A drop down box will show ACCESSING BOOKS AND JOURNALS (click this)

·Next click on CONNECT TO MD CONSULT

·You can use either the generic account which does not give you
everything OR you can set up an individual account. Questions?
<cooperd@mail.nih.gov>

##### 

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

**Free website for medications and breastfeeding that is useful and
credible**

From Diane Cooper, NIH

<http://www.perinatology.com/exposures/druglist.htm>

**State Legislation on Breastfeeding    **

State Legislation that Protects, Promotes, and Supports Breastfeeding.
An inventory and analysis of state breastfeeding and maternity leave
legislation. (2004) Project for United States Breastfeeding Committee. 
Darleen Chien and Kathleen Rasmussen. Cornell University.  Department of
Nutritional Sciences
<http://www.usbreastfeeding.org/Issue-Papers/State-Legislation-2004.pdf>

####  {#section-7 .Style-Heading-4-+-Arial-14-pt-Underline}

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

**Sexual assault is associated with significantly higher levels of
PTSD**

CONCLUSION: Sexual assault is experienced by most physically abused
women and associated with significantly higher levels of PTSD compared
with women physically abused only. The risk of re-assault is decreased
if contact is made with health or justice agencies.

McFarlane J, et al Intimate partner sexual assault against women:
frequency, health consequences, and treatment outcomes. Obstet Gynecol.
2005 Jan;105(1):99-108.\
<http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&list_uids=15625149&dopt=Abstract>

**Just finished..... Domestic Violence in Native Women -- Primary Card
Forum**

**Summary**

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

**Full Discussion**

<http://www.ihs.gov/MedicalPrograms/MCH/M/documents/DVDisc1405.doc>

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

**Co-incidence of Alzheimer's and cerebrovascular disease accelerates
cognitive decline**

In the first study below in which 2257 men aged 71 to 93 were followed
for up to 8 years, walking was associated with a decreased risk of
dementia. The study uses a variety of mechanisms to address the
possibility that pre-clinical dementia could be a cause of reduced
walking.

The second study below evaluates cognitive function by telephone
interview in the women of the Nurses Health Study, followed by
questionnaires and telephone interview from 1986 to 1995-2001. In 18,766
women aged 70-91 at the time of final evaluation (1995-2001), "long term
physical activity, including walking, is associated with better
cognitive function and less cognitive decline."

[**Bruce Finke**:]{.underline} *Neither of these studies is able to show
a causal relationship between physical activity and reduction of risk
for dementia since both are, essentially, epidemiologic studies. But
both clearly indicate that an association exists. This makes sense in
the context of a large body of research which suggests that the
co-incidence of Alzheimer's dementia and cerebrovascular disease
accelerates cognitive decline.*

*Another reason to encourage physical activity at any and all ages and
to work at the community level to increase opportunities for walking and
other forms of exercise for the elderly.*

[Abbott RD, White LR, Ross GW, Masaki KH, Curb JD, Petrovitch
H.](http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15383515)
Walking and dementia in physically capable elderly men. JAMA. 2004 Sep
22;292(12):1447-53

<http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15383515>

[Weuve J, Kang JH, Manson JE, Breteler MM, Ware JH, Grodstein
F.](http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15383516)
Physical activity, including walking, and cognitive function in older
women. JAMA. 2004 Sep 22;292(12):1454-61.

<http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15383516>

Administration for Native Americans (ANA) Social and Economic
Development Strategies (SEDS) Grants -- an opportunity to develop long
term care programs.

The ANA SEDS program is a competitive grant program whose goal is to
strengthen children, families, and communities through community-based
organizations, Tribes, and Village governments. The program announcement
emphasizes community-based partnerships and projects which develop
independence for tribal communities and support and strengthen the
family and culture. The focus is on economic development and cultural
preservation.

Tribal programs looking for funding to develop long term care services
payable through Medicaid or other reimbursement should look into the ANA
SEDS program as a potential source of start-up funding. The FY 05
announcement should be coming in October 2004.
[**http://www.acf.dhhs.gov/programs/ana/**](http://www.acf.dhhs.gov/programs/ana/)

**Palliative Care resource for hospitals and clinics**

The **Center to Advance Palliative Care (CAPC)** is dedicated to
increasing the availability of quality palliative care services in
hospitals and other health care settings for people with
life-threatening illnesses, their families, and caregivers. There are
tools, training, and technical assistance necessary to start and sustain
successful palliative care programs.

At their website [ww.capc.org](http://www.capc.org/) you will find,
among other valuable information, the **2004 Crosswalk of JCAHO
Standards and Palliative Care,** developed to provide hospitals with the
policy and administrative foundation for delivering palliative care
services that are consistent with JCAHO standards.

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

**Being overweight may increase the risk of becoming pregnant while
using OCs**

CONCLUSION: Our results suggest that being overweight may increase the
risk of becoming pregnant while using OCs. If causal, this association
translates to an additional 2-4 pregnancies per 100 woman-years of use
among overweight women, for whom consideration of additional or
effective alternative contraceptive\
Holt VL, et al Body mass index, weight, and oral contraceptive failure
risk. Obstet Gynecol. 2005 Jan;105(1):46-52.

<http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&list_uids=15625141&dopt=Abstract>

**EC does not increase promiscuity or unprotected sex among women, nor
does it cause women to abandon their regular birth control methods.**

CONCLUSIONS: While removing the requirement to go through pharmacists or
clinics to obtain EC increases use, the public health impact may be
negligible because of high rates of unprotected intercourse and relative
underutilization of the method. Given that there is clear evidence that
neither pharmacy access nor advance provision compromises contraceptive
or sexual behavior, it seems unreasonable to restrict access to EC to
clinics.

Raine TR, et al Direct access to emergency contraception through
pharmacies and effect on unintended pregnancy and STIs: a randomized
controlled trial. JAMA. 2005 Jan 5;293(1):54-62

<http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15632336>

[**Insertion and Removal of Intrauterine
Devices**](http://lyris.aafp.org/t/132975/5913807/251199/0/)

Parous women in stable, mutually monogamous relationships who seek
contraception are ideal candidates for the intrauterine device (IUD).
Two IUDs are available: a copper-releasing device and a
hormone-releasing device. Family physicians should counsel their
patients about which contraceptive is best for them and can insert the
device during a normal office visit using individual IUD protocols.
<http://lyris.aafp.org/t/132975/5913807/251199/0/>

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

**Q. The 'quad' second trimester screening test is expensive. Is it
worth it?**

A. The 'quad' screen is more cost effective and patient friendly. See
details below

<http://www.ihs.gov/MedicalPrograms/MCH/M/documents/QuadScr122304>

**Q. What are the best cut-offs to use while monitoring diabetes in
pregnancy therapy?**

A. Ideally: FBS \< 95 mg/dL, 1 hr. \< 130 mg/dL and 2 hr \< 120 mg/dL.
See the details below

<http://www.ihs.gov/MedicalPrograms/MCH/M/documents/GDMmonit122404.doc>

**Q. How does birth interval affect the repeat cesarean vs. vaginal
delivery decision?**

A. Intervals \< 18-24 months slightly increase risk, but it is something
the patient can control.

<http://www.ihs.gov/MedicalPrograms/MCH/M/documents/cesInterv122604.doc>

**Q. Are there alternatives to insulin** **/** **diet in** **diabetes**
**and** **pregnancy? Glyburide? Others?**

A. Yes, we have successfully used glyburide, and other agents, with
caution.

[[http://www.ihs.gov/MedicalPrograms/MCH/M/documents/Glyb122404.doc]{.underline}](http://www.ihs.gov/MedicalPrograms/MCH/M/documents/Glyb122404.doc)

**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. See below for the
rest of the details, though

<http://www.ihs.gov/MedicalPrograms/MCH/M/documents/colpCertFAQ122304.doc>

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

**Venlafaxine significantly decreases postmenopausal patient-perceived
hot flush score**

CONCLUSION: Extended-release venlafaxine, 75 mg per day, is an effective
treatment for postmenopausal hot flushes in otherwise healthy women,
based on a significant decrease in patient-perceived hot flush score.

Evans ML et al Management of postmenopausal hot flushes with venlafaxine
hydrochloride: a randomized, controlled trial. Obstet Gynecol. 2005
Jan;105(1):161-6.\
<http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&list_uids=15625158&dopt=Abstract>

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

**Electronic Health Record: Overview, Implementation & Lessons Learned**

This class is ideal for sites that are getting ready for the EHR and
want to see it in the clinical practice setting. Clinical staff will
demonstrate a patient visit from start to finish.

EHR Course Dates: Contact Carolyn Johnson
<cjohnson@wsp.Portland.ihs.gov>

2/16/2005 or go here

3/30/2005
<http://www.ihs.gov/Cio/RPMS/index.cfm?module=Training&option=Index>

5/4/2005

6/15/2005

Many more dates, Cherokee, North Carolina and Warm Springs, Oregon

**Release of BUD Uniform Data System, Version 2.0. **

This software has the following functionality:

-passive extraction of patient and

-visit data from the IHS Resource and Patient Management System (RPMS)
to produce four UDS reports. (UDS reports are due to BPHC on or before
February 15, 2005)

Please contact your site manager for further information.
[Theresa.Cullen@IHS.GOV]{.underline}

####  {#section-8 .Style-Heading-4-+-Arial-14-pt-Underline}

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

**Lifelong accumulated racial discrimination by African American:
Preterm delivery**

CONCLUSIONS: The lifelong accumulated experiences of racial
discrimination by African American women constitute an independent risk
factor for preterm delivery.

Collins JW et al. Very low birth weight in African American infants: the
role of maternal exposure to interpersonal racial discrimination. Am J
Public Health. 2004 Dec;94(12):2132-8.\
<http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15569965>

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

**National Birth Defects Prevention Month**

the MCH Library has released a new edition of the knowledge path,
Prenatal Care. The knowledge path is an electronic resource guide on
recent, high-quality resources that analyze perinatal health statistics,
describe effective prenatal care programs, and report on research aimed
at improving access to and the quality of prenatal care and improving
perinatal health outcomes.
[[http://www.mchlibrary.info/KnowledgePaths/kp_prenatalcare.html]{.underline}](http://www.mchlibrary.info/KnowledgePaths/kp_prenatalcare.html).

#### Medscape\* {#medscape-1 .Style-Heading-4-+-Arial-14-pt-Underline}

######### Are Vaginal Symptoms Ever Normal? A Review of the Literature

<http://www.medscape.com/viewarticle/490226?src=top10>

######### 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: Marsha Tahquechi, CNM, GIMC {#midwives-corner-marsha-tahquechi-cnm-gimc .Style-Heading-4-+-Arial-14-pt-Underline}

**Midwives Serving Indian Country**

The American College on Nurse Midwives (ACNM) has profiled Native
American midwives and nurse midwives serving Indian Country. In
September of 2004 in conjunction with the opening of the Museum of the
American Indian and the 2004 Indian Health Summit the ACNM set up an
exhibit at the summit highlighting the work of midwives serving Indian
Country. They also provided a booklet profiling some of the Indian
Health Service midwifery practices across the country. Booklet and other
information: <http://www.midwife.org/prof/display.cfm?id=457>

Relevant links that address some of the health concerns and initiatives
to eliminate health disparities among Native Peoples:
[[http://www.acnm.org/prof/midwivesindians.cfm]{.underline}](http://www.acnm.org/prof/midwivesindians.cfm)

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

**Marriage may be good for you**

Regardless of population subgroup or health indictor, married adults
were generally found to be healthier than adults in other marital status
categories. Never married adults were among the least likely to be
overweight or obese. Marital Status and Health: United States, 1999-2002
presents prevalence estimates by marital status for selected health
status and limitations, health conditions, and health risk behaviors
among U.S. adults, using data from the 1999--2002 National Health
Interview Surveys.
<http://www.cdc.gov/nchs/pressroom/04facts/marriedadults.htm>

<http://www.cdc.gov/nchs/data/ad/ad351.pdf> Report (620 KB)

**Explaining the 2001-02 Infant Mortality Increase: Linked Birth/Infant
Death Data Set**

The U.S. infant mortality rate increased from 6.8 infant deaths per
1,000 live births in 2001 to 7.0 in 2002, the first increase in more
than 40 years. From 2001 to 2002 infant mortality rates increased for
very low birth weight infants as well as for preterm and very preterm
infants. Although infant mortality rates for very low birth weight
infants increased, most of the increase in the infant mortality rate
from 2001 to 2002 was due to a change in the *distribution* of births by
birth weight and, more specifically, to an increase in infants born
weighing less than 750 grams.

<http://www.cdc.gov/nchs/pressroom/05news/lowbirthwt.htm>

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

**Alendronate is safe and effective: Can carry treatment out ten years
without concern**

This study reports on the ten year follow-up of 247 postmenopausal women
with osteoporosis treated with the bisphosphonate agent alendronate
(Fosamax). They were initially part of a larger cohort in a placebo
controlled treatment trial reported at 3 years. This group of women has
been followed to evaluate for continued response to alendronate and
adverse effects. Women were divided into three branches, those who had 5
years of treatment and discontinued, those treated with 5mg a day for 10
years, and those treated for 10mg a day for 10 years.

-   Bone mineral density (BMD) increased in a dose-dependent fashion
    throughout the treatment period for those treated for 10 years,
    remaining within the normal range.

-   Those women treated for 5 years and discontinued preserved some of
    their BMD gains after discontinuation but did not further increase.

-   No insufficiency fractures or fracture malunions were reported,
    indicating that the bone developed in the presence of the
    bisphosphonate was functioning normally.

-   Adverse effects attributable to the medication were minimal and did
    not differ between the three groups.

**Bruce Finke:** *We already know from a number of studies that
bisphosphonate treatment for women with low BMD (T-score of less than
2.5 or two standard deviations below the mean for healthy young women)
is effective in preventing fracture. This descriptive study suggests
that long term treatment with alendronate is safe and effective and that
we can carry treatment out at least ten years without concern.*

[Bone HG et al. Ten years' experience with alendronate for osteoporosis
in postmenopausal women. N Engl J Med 2004 Mar 18,
350:1189-99.](http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15028823)

[*http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15028823*](http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15028823)

[**Effect of Vitamin D on falls: a
meta-analysis**](http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15113819)

This paper presents a meta analysis of studies looking at the effect of
Vitamin D supplementation on falls in ambulatory, stable elders. Based
on 5 randomized controlled studies involving 1237 persons, vitamin D
supplementation reduced the risk of fall by 22% when compared to calcium
alone or placebo. The number needed to treat was 15 (15 persons would
need to take Vitamin D supplementation to prevent one person from
falling). There was inadequate data to test the best dose, but the
strongest effect seemed to be at the 800 mIU dose. The authors suggest
that this may be because of the effect of vitamin D on improving muscle
strength.

**Bruce Finke:** *We tend to think of the role of Vitamin D in reducing
fracture risk because of its impact on bone health when taken with
calcium. This study indicates that there is a direct effect in reducing
falls. 800 mIU vitamin D is easy to get while also supplementing calcium
and trace minerals through a combination of multivit (400 mIU) and
calcium/vitamin D tablet (typically 500mg elemental calcium and 200 mIU
Vitamin D).*

[Bischoff-Ferrari HA, Dawson-Hughes B, Willett WC, Staehelin HB,
Bazemore MG, Zee RY, Wong
JB.](http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15113819)
[Effect of Vitamin D on falls: a meta-analysis. JAMA. 2004 Apr
28;291(16):1999-2006.](http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15113819)

<http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15113819>

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

**Maternal Child Health Patient Education: new web page envisioned**

Would like an easy to find comprehensive resource for MCH Patient
Education? If so, contact Neil Murphy
<nmurphy@southcentralfoundation.com> Let's chat

**Current Maternal Child Health Patient Education web site**

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

**IHS Patient Education Home page**

<http://www.ihs.gov/NonMedicalPrograms/HealthEd/index.cfm?module=initiative&option=protocols&newquery=dsp_NatlPatientEd_Protocols.cfm>

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

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

-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?

Moderator: Hope Baluh

Should the majority of your obese patients receive bariatric surgery
now, before they develop diabetes complications, or arthritis and
require multiple joint replacements?

-How is your facility going to be able to pay for all these bariatric
surgery procedures, and their complications?

Here are some examples:

32 yo mother of twins 10 days s/p Gastric bypass presents to her Primary
Care Provider complaining of hiccups, feeling anxious, heart rate 105,
history of anxiety attacks and depression, has been unable to swallow
her Zoloft.

**How do we help her?**

 

You referred a 27 yo hypertensive diabetic male with a BMI of 41for
obesity surgery which he successfully underwent 7 months ago. He returns
to you having lost over 80 lbs. but now can hardly eat; he has daily
bouts of epigastric pain that can last for hours.

**What diagnostic test might be helpful?**

AG is a 39 y.o. American Indian diabetic female who weighed 450 lbs.
.....after bariatric surgery she developed chronic diarrhea and is now
taking several oral mineral supplements a day...

How do we help her?

Here is the Obesity therapy primer

[**http://www.ihs.gov/MedicalPrograms/MCH/M/PCdiscForumMod.asp#SurgObes**](http://www.ihs.gov/MedicalPrograms/MCH/M/PCdiscForumMod.asp#SurgObes)

**Just finished..... Domestic Violence in Native Women**

**Summary**

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

**Full Discussion**

<http://www.ihs.gov/MedicalPrograms/MCH/M/documents/DVDisc1405.doc>

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

Subscribe to the Primary Care listserv

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

Unsubscribe from the Primary Care listserv

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

Questions on how to subscribe, contact <nmurphy@scf.cc> directly

**What's New in STDs? Laura** **Shelby, Albuquerque**

**A Community-Based Intervention Designed to Increase Preventive Health
Care Seeking Among Adolescents: The Gonorrhea Community Action Project**

-This intervention is noteworthy because the researchers employed a
different approach to STD control by embedding STD prevention within a
larger message about the importance of comprehensive
prevention/reproductive health among adolescents and young adults.

-The goal of the intervention was to increased preventive health care
seeking among female adolescents.

-Females participants were more likely to make an appointment for a
check-up, to have undergone a check-up, and discuss the importance of
having a check-up with family and friends.

-The intervention, however, was less successful on male participants.
Vandevanter NL et al A community-based intervention designed to increase
preventive health care seeking among adolescents: the gonorrhea
community action project. Am J Public Health. 2005 Feb;95(2):331-7.

<http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&list_uids=15671472&dopt=Abstract>

#### For full text, contact Laura Shelby [**laura.shelby@mail.ihs.gov**](mailto:laura.shelby@mail.ihs.gov) {#for-full-text-contact-laura-shelby-laura.shelbymail.ihs.gov .Style-Heading-4-+-Arial-14-pt-Underline}

####  {#section-10 .Style-Heading-4-+-Arial-14-pt-Underline}

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

#### The \'Polymeal\' Cuts Heart Disease by 76% - Recipe for Life CONCLUSION: The Polymeal promises to be an effective, non-pharmacological, safe, cheap, and tasty alternative to reduce cardiovascular morbidity and increase life expectancy in the general population. Franco OH et al. The Polymeal: a more natural, safer, and probably tastier (than the Polypill) strategy to reduce cardiovascular disease by more than 75%. BMJ. 2004 Dec 18;329(7480):1447-50. {#the-polymeal-cuts-heart-disease-by-76---recipe-for-life-conclusion-the-polymeal-promises-to-be-an-effective-non-pharmacological-safe-cheap-and-tasty-alternative-to-reduce-cardiovascular-morbidity-and-increase-life-expectancy-in-the-general-population.-franco-oh-et-al.-the-polymeal-a-more-natural-safer-and-probably-tastier-than-the-polypill-strategy-to-reduce-cardiovascular-disease-by-more-than-75.-bmj.-2004-dec-1832974801447-50. .Style-Heading-4-+-Arial-14-pt-Underline}

#### [**http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&list_uids=15604180&dopt=Abstract**](http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&list_uids=15604180&dopt=Abstract) {#httpwww.ncbi.nlm.nih.goventrezquery.fcgicmdretrievedbpubmedlist_uids15604180doptabstract .Style-Heading-4-+-Arial-14-pt-Underline}

####  {#section-11 .Style-Heading-4-+-Arial-14-pt-Underline}

#### Depression Increases Insulin Resistance, Diabetes in Middle-Aged Women CONCLUSIONS: Depression is associated with higher HOMA-IR values and incident diabetes in middle-aged women. These associations are mediated largely through central adiposity. However, African-American women with depression experience increased risk of diabetes independent of central adiposity and other risk factors. {#depression-increases-insulin-resistance-diabetes-in-middle-aged-women-conclusions-depression-is-associated-with-higher-homa-ir-values-and-incident-diabetes-in-middle-aged-women.-these-associations-are-mediated-largely-through-central-adiposity.-however-african-american-women-with-depression-experience-increased-risk-of-diabetes-independent-of-central-adiposity-and-other-risk-factors. .Style-Heading-4-+-Arial-14-pt-Underline}

#### Everson-Rose SA et al. Depressive symptoms, insulin resistance, and risk of diabetes in women at midlife. Diabetes Care. 2004 Dec;27(12):2856-62. {#everson-rose-sa-et-al.-depressive-symptoms-insulin-resistance-and-risk-of-diabetes-in-women-at-midlife.-diabetes-care.-2004-dec27122856-62. .Style-Heading-4-+-Arial-14-pt-Underline}

#### [**http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15562197**](http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15562197) {#httpwww.ncbi.nlm.nih.goventrezquery.fcgicmdretrievedbpubmeddoptabstractlist_uids15562197 .Style-Heading-4-+-Arial-14-pt-Underline}

####  {#section-12 .Style-Heading-4-+-Arial-14-pt-Underline}

## Dietary Guidelines for Americans 2005

*Dietary Guidelines for Americans* is published jointly every 5 years by
the Department of Health and Human Services (HHS) and the Department of
Agriculture (USDA). The *Guidelines* provide authoritative advice for
people two years and older about how good dietary habits can promote
health and reduce risk for major chronic diseases.

#### [**http://www.healthierus.gov/dietaryguidelines/**](http://www.healthierus.gov/dietaryguidelines/) {#httpwww.healthierus.govdietaryguidelines .Style-Heading-4-+-Arial-14-pt-Underline}

####  {#section-13 .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%)}

[**Health Affairs, Vol. 24, No. 1 devoted to Evidence Based Medicine,
February
2005**](http://www.ihs.gov/MedicalPrograms/MCH/m/mchebp.asp#healthAffairs)

<http://www.ihs.gov/MedicalPrograms/MCH/m/mchebp.asp#healthAffairs>

[**Pitfalls in Disease Specific Guidelines in multiple
conditions**](http://www.ihs.gov/MedicalPrograms/MCH/m/documents/guidelinepitfallsnejm.pdf)

<http://www.ihs.gov/MedicalPrograms/MCH/m/mchebp.asp#pitfalls>

[**Cochrane Library, clinically applied topics,
A-Z**](http://www.informedhealthonline.org/item.aspx?tabid=3)

<http://www.ihs.gov/MedicalPrograms/MCH/m/mchebp.asp#az>

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>

-   2005 Brochure

```{=html}
<!-- -->
```
-   <http://www.ihs.gov/MedicalPrograms/MCH/M/Documents/Brochure2005EL.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>

**National Summit on Preconception Care**

-   JUNE 21-22, 2005

-   Atlanta, Georgia

-   Catalyst for national recommendations for preconception care, CDC

-   <http://www.signup4.net/Public/ap.aspx?EID=NATI14E>

# 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 **December 2004 OB/GYN CCC Corner** is available at:

<http://www.ihs.gov/MedicalPrograms/MCH/M/obgyn1204.cfm>

#### Abstract of the Month: page 3 {#abstract-of-the-month-page-3-1 .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-4-1 .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-2 .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

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@scf.cc>

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>

njm1/31/05c