News flash: Sign up now

**NEONATAL RESUSCITATION PROGRAM**

**at the ACOG / IHS Postgraduate course in Denver**

This year a Neonatal Resuscitation Provider (NRP) course will be offered
in conjunction with the ACOG/IHS Postgraduate course in Denver. The
course will be held on Sunday morning June 13^th^ from 8 AM to 12 noon
at the Radisson Hotel. Class size for the NRP is limited so please
register early! The regular ACOG/IHS course begins at 1 PM that
afternoon. More information:
[**http://www.ihs.gov/MedicalPrograms/MCH/M/CN01.cfm#June2004**](http://www.ihs.gov/MedicalPrograms/MCH/M/CN01.cfm#June2004)

OB/GYN Chief Clinical Consultant's Corner

Volume 2, No. 2, February, 2004

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

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

Low-risk deliveries in a collaborative care birth center have outcomes
similar to hospital deliveries by obstetricians

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

From Donald Clark: Prevalence and correlates of mental disorders in AI
women in primary care

From Terry Cullen: Healthcare Disparities: Unequal Treatment, One Year
Later; Management of TB, STDs, HIV and Hepatitis C -- Strategies for
today's clinician

From Barbara Fine: Grant Writing Workshop: National Indian Women's
Health Resource Center;

"Falls During Pregnancy" March 12, Interactive Web Seminar

From Jim Galloway: Guidelines for Cardiovascular Disease Prevention in
Women; Disparities in Premature Deaths from Heart Disease, CDC; Coronary
Heart Disease in Women with Diabetes

From Sandra Haldane: Call for CNMs -- Needed in Afghanistan; SIDS
International Conference

From Howard Hays: Towards an Electronic Patient Record in Fort
Lauderdale FL

From Maria Martinez: Advances in cervical cancer prevention -- FREE CME

From Kelly Moore: Call to action for clinicians: The escalating
pandemics of obesity and lifestyle

From Chuck North: Strength of Recommendation Taxonomy (SORT): A
Patient-Centered Approach to Grading Evidence in the Medical Literature

From Jon Perez: Elder Care Resources from the Division's February 2004
Newsletter

From Sharon Phelan: Know any pregnant AI women interested in quitting
smoking or have quit?

From Jennifer Retsinas: American Indian, Alaska Native and Native
Hawaiian Caucus

**From Laura Shelby:** Do you have policies and procedures on treatment
of STDs?

Challenges faced in STD management in Indian County; Insurance coverage
among American Indians/Alaska Natives and Whites; Chlamydial Infections:
Primary Care Clinicians Guide

**From Arnold Sperling:** 4^th^ year students: Sub Internship in OB/GYN
available at Rosebud, S.D

**From Judy Thierry:** Do you want to impact Indian Health MCH for
decades to come? Office for Victims of Crime (OVC) Clearinghouse

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

##### Obstetrics: page 8

##### First-Trimester Screening Protocol for Trisomies 18 and 21; Maternal morbid obesity in early pregnancy is strongly associated with pregnancy complications; Management of Gestation Hypertension-Preeclampsia; Predicting failed trial of labor after primary cesarean delivery; Coverage for U urealyticum improves cesarean prophylaxis; Using Rectal Misoprostol in the Third Stage of Labor; SARS and Pregnancy: A Case Report; Health literacy and pregnancy preparedness in pregestational diabetes

Gynecology: page 9

Continuous combination oral contraceptive pills to eliminate withdrawal
bleeding; I just gained all this weight....I wonder if it was the
'Pill'; What is the best kind of dressing to use on a surgical wound? If
using HPV DNA testing, then consider this; New Contraceptive Options;
Increasing Adherence to Pap Screening Guidelines; Evaluation and
Management of Hirsutism in Women; **2004 National Women\'s Health Week
celebration: May 9-15, 2004**

Child Health: page 11

Infant physical abuse in Alaska higher than expected; Who are "Fragile
Families" and What Do We Know About Them? What is up with soft drinks
being sold in schools? What is up with soft drinks being sold in
schools? Child Passenger Deaths Involving Drinking Drivers; Low glycemic
index diet as practice-based treatment for overweight children; Reducing
the risk of SIDS in child care; Azithromycin for Persistent or Recurrent
Otitis Media; Prevention and Treatment of Type 2 Diabetes Mellitus in
Children

Chronic Illness and Disease: page 12

Screening for Type 2 Diabetes Mellitus in Adults; Strength Training
Among Adults Aged Greater Than or Equal to 65 Years; Moderate intensity
exercise works: RCT in overweight, sedentary women; Alaska Natives have
a disproportionately high percentage of HIV; Cognitive Behavior Therapy
vs. Relaxation Therapy for IBS; Do you have Medicaid patients who smoke?
**Prevalence of Diabetes and Impaired fasting glucose in Adults**

[Features:]{.underline} page 13

##### AFP: POEMS - First-Trimester Screening Protocol for Trisomies 18 and 21; Ultrasound Alone Does Not Diagnose PCOS

ACOG: Uterine artery embolization. ACOG Committee Opinion; Ethics of
Elective Primary Cesarean Delivery

**AHRQ:** Web M + M - A pregnant woman arrives at the ED with severe
abdominal pain; Total and supracervical hysterectomy: Surgical /
clinical outcomes are similar; More aggressive treatment recommendations
for women with diabetes; Reducing by at least half the incidence of
false-positive mammogram readings; Home visits by a nurse-health
advocate team can improve the outcomes

Breastfeeding: Lower rates of overweight among children who were
breastfed for longer duration; Easy Guide to Breastfeeding for American
Indian and Alaska Native Families

**Domestic Violence:** Screening for Partner Violence: Direct
Questioning or Self-Report?

**Elder Care News:** Routine screening for thyroid disease in adults?

Frequently asked questions: Are pharmacologic agents safe to use for
smoking cessation in pregnancy? Why do patients blood sugars go up so
high after certain meals? How does the intensity of the exercise affect
weight loss, etc?

**Hormone Replacement Update**: Nonhormonal alternatives for the
treatment of hot flashes; Understanding the Risks and Benefits of
Hormone Therapy

**Information Technology:** New Domestic Violence code for recording
GPRA information

International Health: Overseas contraceptives with no active
ingredients; Agencies Pledge to Cut Maternal Deaths; British Medical
Journal: Epidemiology for the Uninitiated

#### MCH Alert: Contraceptive use within adolescents' first sexual relationships; An argument for EC: Unintended pregnancy despite a family planning referral

#### Medscape: Efficacy and Tolerability of Oral Zolmitriptan in Menstrually Associated Migraine; Uterovaginal Packing With Rolled Gauze in Postpartum Hemorrhage;

#### Office of Women's Health, CDC: West Nile Virus During Pregnancy, Infant Guidelines

Osteoporosis: Relative value of heel Ultrasound in the diagnosis of
osteoporosis

Patient Education: Fiber: How to Increase Fiber in Your Diet; Nutrition:
Choosing Healthy, Low-Fat Foods; Nutrition: Tips for Improving Your
Health; Pelvic Inflammatory Disease: Updated Facts

Primary Care Discussion Forum: Ongoing now -- Bruce Finke Evidence based
periodic health screening for the elderly....."What is really necessary
in the "Annual Exam" for mature adults"

Osteoporosis screening? PSA screening? Lipid screening?

**Coming May 1, 2004** Donna Perry, Adolescent Medicine, Chinle

Topic: Adolescent risk taking behaviors.....a.k.a. "Sex drugs and rock
and roll"

#### What's new on the ITU MCH web pages: page 20

#### Who is Diane Jeanotte? Who is Mary Lynn Eaglestaff? Who is Diana Hu? and what they can do for you ?

###### Save the Dates: Upcoming events of interest page 21

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

# 

# [Abstract of the Month]{.underline}

Low-risk deliveries in a collaborative care birth center have outcomes
similar to hospital deliveries by obstetricians

Whether low-risk women give birth in collaborative care birth centers
that use certified nurse-midwife (CNM)/obstetrician management or in a
hospital where care is managed by an obstetrician, maternal and infant
outcomes are similar. However, the collaborative care birth centers have
fewer surgical deliveries and use fewer medical resources, according to
a study supported in part by the Agency for Healthcare Research and
Quality (HS07161).

William H. Swartz, M.D., of the University of California, San Diego,
Medical School and his colleagues studied the care and outcomes of 2,957
low-risk, low-income women from the time they began prenatal care to
discharge home from a collaborative care birth center or hospital. Of
these women, 1,801 received collaborative care, and 1,149 received
traditional hospital care.

Major antepartum, intrapartum, and neonatal complications were similar
in both groups, as were neonatal intensive care unit admissions.
However, women in collaborative care had 15 percent more normal
spontaneous vaginal deliveries, 23 percent fewer episiotomies, and 36
percent less use of epidural anesthesia.

Overall, more technical interventions (for example, induction and
augmentation of labor with oxytocin, episiotomies, and epidural use)
were more common in traditional care and less technical interventions
(walking, tub or shower use, and oral fluids) were more common in
collaborative care.

Also, collaborative care women had shorter lengths of stay in the birth
facility, with 28 percent more being discharged before 24 hours, and
almost 6 percent fewer having stays longer than 72 hours. Thus,
operative deliveries and hospital stays, major determinants of the cost
of perinatal care, were substantially reduced with collaborative care.
The researchers conclude that managed care organizations, local and
State governments, and obstetric providers may want to consider
inclusion of collaborative management/birth center programs in their
array of covered or offered services.

\"Outcomes, safety, and resource utilization in a collaborative care
birth center program compared with traditional physician-based perinatal
care,\" by Debra J. Jackson, R.N., M.P.H., D.Sc., Janet M. Lang, Ph.D.,
Sc.D., Dr. Swartz, and others, in the June 2003 *American Journal of
Public Health* 93(6), pp. 999-1006.

PubMed

<http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12773368&dopt=Abstract>

AHRQ

[http://www.ahrq.gov/research/dec03/1203RA15.htm#head5]{.underline}

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

As we deliver maternity care to the Indian Health community similar
question arises frequently.

[At my facility or at the facilities which send patients to my
facility...]{.underline}

-How few infants can a facility safely deliver per year?

-How few deliveries can individual providers and nurses provide safely
on an ongoing basis?

-Do 'birthing centers' need to maintain the same credentials and
regulatory criteria as a Level I maternity center?

This article confirms previous literature that has shown that low risk
maternity care can be provided safely in a collaborative manner using
careful triage guidelines while being willing to transport appropriate
patients.

See the June OB/GYN CCC Corner for a recent example in Indian Country,
Leeman et al,

which was the June Abstract of the Month, OB/GYN CCC Corner

<http://www.ihs.gov/medicalprograms/mch/m/mchdownloads/ccccorner61903.doc>

As to the other questions.....those and other similar questions are
actively addressed in the IHS Biennial Women's Health and Maternal Child
Health Meeting on an ongoing basis. This year the Biennial meeting will
be held in Albuquerque, NM, August 4-6, 2004. I encourage all providers
and staff who provide care to female American Indian and Alaska Natives
to attend to help us sort those issues out. This year's theme is
'**[Prevention in American Indian and Alaska Native
Women']{.underline}** and has remarkable nationally recognized experts
on the agenda.

Here is more information on the Biennial meeting

<http://www.ihs.gov/MedicalPrograms/MCH/M/CN01.cfm#August2004> njm

## From your colleagues:

##### From Donald Clark, Albuquerque

Prevalence and correlates of mental disorders in Native American women
in primary care.

OBJECTIVES: We examined the lifetime and the past-year prevalence and
correlates of common mental disorders among American Indian and Alaska
Native women who presented for primary care. METHODS: We screened 489
consecutively presenting female primary care patients aged 18 through 45
years with the General Health Questionnaire, 12-item version. A
subsample (n = 234) completed the Composite International Diagnostic
Interview. We examined associations between psychiatric disorders and
sociodemographic variables, boarding school attendance, and
psychopathology in the family of origin. RESULTS: The study participants
had high rates of alcohol use disorders, anxiety disorders, and
anxiety/depression comorbidity compared with other samples of
non-American Indian/Alaska Native women in primary care settings.
CONCLUSIONS: There is a need for culturally appropriate mental health
treatments and preventive services.

Duran B, Sanders M, Skipper B, Waitzkin H, Malcoe LH, Paine S, Yager J.
Prevalence and correlates of mental disorders among Native American
women in primary care. Am J Public Health. 2004 Jan;94(1):71-7.

<http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=14713701&dopt=Abstract>

Department of Family and Community Medicine, University of New Mexico
School of Medicine, Albuquerque, NM 87131-0001, USA. bonduran@unm.edu

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

In many cases adult mental disorders in Native women start with
traumatic experiences in childhood and young adulthood related to child
sexual abuse and domestic violence.

As noted above we hope to address many of those issues in the Violence
Against Native Women track of the 2004 Women's Health and MCH Indian
Health Conference, August 4-6, 2004 in Albuquerque, NM. Specifically,
Dr. Duran will be discussing the above finding at the Biennial meeting.

The 2004 meeting's theme is '**[Prevention in American Indian and Alaska
Native Women']{.underline}** and has remarkable nationally recognized
experts on the agenda. . I encourage all providers and staff who provide
care to female American Indian and Alaska Natives to attend to help us
sort those issues out. Here is more information on this biennial
meeting. njm

<http://www.ihs.gov/MedicalPrograms/MCH/M/CN01.cfm#August2004>

##### From Terry Cullen, Tucson

###### Healthcare Disparities: Unequal Treatment, One Year Later

Addressing Healthcare Disparities and Health Communications Needs of
Racial and Ethnic Minority Communities. View this webcast

<http://www.kaisernetwork.org/health_cast/hcast_index.cfm?display=detail&hc=808>

> **Management of TB, STDs, HIV and Hepatitis C - STRATEGIES FOR
> TODAY\'S CLINICIAN**
>
> Friday -- Saturday March 26 -- 27, 2004 Yuma, Arizona *CA STD/HIV
> Prevention Training Center Sharon Adler MD, MPH* *Clinical Instructor
> [www.ucsf.edu/paetc](http://www.ucsf.edu/paetc)*

##### From Ruth Etzel, Anchorage

**AAP - Pediatric Environmental Health: Second Edition**\
Premier resource on identification, prevention, and treatment of
environmental health problems

<http://www.ihs.gov/MedicalPrograms/MCH/C/CHprogram.asp#aap>

##### From Barbara Fine, HQE

Grant Writing Workshop: National Indian Women's Health Resource Center

"Grant Writing Made Easy" April 5 & 6, 2004 San Diego, California

Registration is FREE.  Space is limited to 25 participants

Contact NIWHRC, Toll Free, 1-866-464-9472 or 918-456-6094

Register with Kim or Mary Helen. 

**Falls During Pregnancy: Friday, March 12, Interactive Web Seminar**

The Center for Injury Research and Control at the University of
Pittsburgh will be presenting a live, interactive web seminar. Please
note, you must RSVP before March 12^th\
^by sending a brief email to <circl@pitt.edu> Web site:
<http://www.circl.pitt.edu/home/seminars.htm>

##### From Jim Galloway, IHS Cardiology Program, Flagstaff

###### Guidelines for Cardiovascular Disease Prevention in Women, Evidence-Based

As part of the American Heart Association\'s Heart Month activities,
which include the Go Red for Women Campaign, the AHA has released the
\"Evidence-Based Guidelines for Cardiovascular Disease Prevention in
Women\" in Circulation (Feb, 2004: 109:672-693).

<http://circ.ahajournals.org/cgi/reprint/01.CIR.0000114834.85476.81v1.pdf>

###### Disparities in Premature Deaths from Heart Disease, CDC 

American Indians and Alaska Natives are significantly over-represented
in premature deaths

<http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5306a2.htm>

**Coronary Heart Disease in Women with Diabetes**\
\"Diabetes and Cardiovascular Disease Review\" features guidelines,
research, patient education

<http://www.ihs.gov/MedicalPrograms/MCH/W/WHcvd.asp#heartDiab>

##### From Sandra Haldane, HQE

##### Call for Certified Nurse Midwives (CNMs)

A call has been extended and will come out soon over the PHS list serv
for Certified Nurse Midwives to assist with teaching as well as L & D
management at the Rabia Balkhi Hospital in Kabul, Afghanistan.  This is
joint effort under the DHHS including CDC, IHS and other organizations,
public and private.  This opportunity is open to COs and Civilians.  If
you are able to assist in this effort, please contact Dr. Chan at
[pchan@osophs.dhhs.gov]{.underline}  Thanks for your support in this
effort. 

**8th SIDS International Conference July 2-6, 2004, in Edmonton,
Canada**

On-line registration is now open ( reduced fees for early registration
are available until April 16th)

Visit to the conference website
[http://www.sidsi-canada2004.org](http://www.sidsi-canada2004.org/)

##### From Howard Hays, Anchorage

###### Towards an Electronic Patient Record (TEPR) in Fort Lauderdale FL, May 17-22, 2004

I wanted to make you aware of an EHR-related educational opportunity.
The Medical Records Institute (MRI), based in Boston, hosts an annual
conference called Towards an Electronic Patient Record (TEPR). This is a
very large conference with a great many sessions that are relevant to
our facilities as you plan for EHR implementation.

<http://www.medrecinst.com/conferences/tepr/index.asp>

**[From Maria Martinez, Anchorage]{.underline}**

**Advances in cervical cancer prevention: January 22, 2004 until
February 29, 2004.**

Association of Reproductive Health Professionals published clinical
proceedings. In recognition of Cervical Cancer Awareness Month, the
Association of Reproductive Health Professionals (ARHP), a Washington,
DC-based professional education organization, is offering free
continuing medical education (CME) credits from January 22, 2004 until
February 29, 2004.

<http://www.arhp.org/healthcareproviders/cme/onlinecme/hpvcp/TOC.cfm?ID=334>

**[From Kelly Moore, National Diabetes Program, ABQ]{.underline}**

**A call to action for clinicians: The escalating pandemics of obesity
and sedentary lifestyle**

This report provides a \"call to action\" with step-by-step guidelines
specifically directed at the pivotal role of physicians and other health
care professionals in curbing these dangerous epidemics. This blueprint
for action, which requires only a few minutes of a clinician\'s time to
implement, will facilitate more effective intervention related to
obesity and inactivity and should favorably impact public health.

Manson JE, Skerrett PJ, Greenland P, VanItallie TB. The escalating
pandemics of obesity and sedentary lifestyle: a call to action for
clinicians. Arch Intern Med. 2004 Feb 9;164(3):249-58.

<http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=14769621&dopt=Abstract>

**[From Chuck North, Albuquerque]{.underline}**

Strength of Recommendation Taxonomy (SORT): A Patient-Centered Approach
to Grading Evidence in the Medical Literature

The SORT is a comprehensive taxonomy for evaluating the strength of a
recommendation based on a body of evidence and the quality of an
individual study. If applied consistently by authors and editors in the
family medicine literature, it has the potential to make it easier for
physicians to apply the results of research in their practice through
the information mastery approach and to incorporate evidence-based
medicine into their patient care.

**NB:** Includes "walkovers" between the various grading methods: BMJ,
USPSTF, Cochrane, CEBM <http://www.aafp.org/afp/20040201/548.html>

**[From Jon Perez, Division of Behavioral Health, HQE]{.underline}**

###### Dr. Perez wanted to share these resources from the Division's February 2004 Newsletter

Long term care, IHS

<http://www.ihs.gov/medicalprograms/eldercare/Long_Term_Care.asp>

Resources for Professionals: Elder care, IHS

<http://www.ihs.gov/medicalprograms/eldercare/Resources_For_Professionals.asp>

Medicaid Home Care for Tribal Health Services: A Tool Kit for Developing
New Programs

<http://www.healthpolicy.ucla.edu/pubs/publication.asp?pubID=79>

DHHS Resources for aging

<http://www.os.dhhs.gov/aging/index.shtml>

**[From Sharon Phelan, Albuquerque]{.underline}**

**Do you know any pregnant Native women interested in quitting smoking
or have quit?**

Dartmouth University and ACOG Smoking Cessation in Pregnancy Program are
interested in contacting pregnant Native women interested in quitting
smoking, or who have quit, for possible interviews about their success
and challenges with quitting. Stipend available

Contact Sharon Phelan <stphelan@salud.unm.edu>

**[From Jennifer Retsinas, Anchorage]{.underline}**

**American Indian, Alaska Native and Native Hawaiian (AIANNH) Caucus
Nov. 6-10, 2004**

invites abstracts for papers that address the theme of the 2004 American
Public Health Association (APHA) Annual Meeting, \"Public Health and the
Environment\" and general topics addressing AIANNH populations. The 2004
APHA conference will take place in Washington, DC from November 6-10,
2004.

The Caucus also invites papers that specifically address the following:
Best Practices:

Diabetes and American Indians, Alaska Natives, Native Hawaiians;
Environmental Health and Native Communities; Healing Mind, Body, and
Spirit; Health Disparities that affect Native Communities; Impact of
Cancer on Native Health
[http://apha.confex.com/apha/132am/aiannhc.htm]{.underline}

**[From Laura Shelby, STD Program, ABQ]{.underline}**

###### Do you have policies and procedures on treatment of STDs?

Laura Shelby is collating as many of policies and procedures on STDs as
possible to improve the care of STDs in Indian Country. The goal is to
develop screening policies for high-risk population, based on U.S.
Preventive Guidelines. Sent your policies and procedures to Laura K.
Shelby <laura.shelby@mail.ihs.gov>

###### 

###### Challenges faced in Indian County: STD management

Laura is interested in putting together a document to identify
challenges and barriers in addressing STD and HIV faced in Indian
County. This experience is not unique, as many of the same challenges
that providers face in Indian County have been experienced elsewhere,
e.g., Southern states -- Southern States Manifesto: A call to action.
Some challenges include: lack of access to healthcare, problems related
to socioeconomic status, staffing shortages, etc. The CDC has approved
some staff time to pursue a similar document for Indian Country.

Contact Laura K. Shelby <laura.shelby@mail.ihs.gov>

Health service access, use, and insurance coverage among American
Indians/Alaska Natives and Whites: what role does the Indian Health
Service play?

[OBJECTIVES:]{.underline} We compared access and utilization of health
services among American Indians/Alaska Natives (AIANs) with that among
non-Hispanic Whites.

[METHODS:]{.underline} We used data from the 1997 and 1999 National
Survey of America\'s Families to estimate odds ratios for several
measures of access and utilization and the effects of Indian Health
Service (IHS) coverage.

[RESULTS:]{.underline} AIANs had less insurance coverage and worse
access and utilization than Whites. Over half of low-income uninsured
AIANs did not have access to the IHS. However, among the low-income
population, AIANs with only IHS access fared better than uninsured AIANs
and as well as insured Whites for key measures but received less
preventive care.

[CONCLUSIONS:]{.underline} The IHS partially offsets lack of insurance
for some uninsured AIANs, but important needs were potentially unmet.

Zuckerman S, Haley J, Roubideaux Y, Lillie-Blanton M. Health service
access, use, and insurance coverage among American Indians/Alaska
Natives and Whites: what role does the Indian Health Service play? Am J
Public Health. 2004 Jan;94(1):53-9.

<http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=14713698&dopt=Abstract>

**Sexually Transmitted Chlamydial Infections: Primary Care Clinicians
Guide**\
Diagnosis, Treatment, and Prevention - California STD / HIV Prevention
Training Center

<http://www.ihs.gov/MedicalPrograms/MCH/M/PROG01.cfm#SexuallyTransmittedDisease>

**[From Arnold Sperling, Rosebud]{.underline}**

**4^th^ year students welcome: Sub Internship in OB/GYN now available at
Rosebud, S.D.**

4^th^ year medical students welcome for clinical supervised patient
contact in all areas of women's health care. Case presentation at
completion of rotation. Course description:

<http://www.ihs.gov/MedicalPrograms/MCH/M/MCHdownloads/OB501courseelective.doc>

Contact Arnold Sperling, M.D. <sperlingfamily@comcast.net>

##### From Judy Thierry, HQE

###### Do you want to impact Indian Health MCH for DECADES TO COME?

###### Chapter 13, the MCH Chapter of the IHS Manual, is being revised. The last revision was in 1992, so your input could last decades till the next update. Dr. Thierry has set up a WebBoard for the revision process at [**http://forum.ihs.gov:80/\~mch**](http://forum.ihs.gov:80/~mch)

Please contact Dr. Thierry to let her subscribe you to this WebBoard
<thierry@hqe.ihs.gov>

###### 

###### Office for Victims of Crime (OVC) Clearinghouse

I encourage you to use this clearing house - resource for Office for
Victims of Crime (OVC) publications consider ordering these for your
libraries, let your respective programs know that they are available, to
have at local service areas 

<http://www.ojp.usdoj.gov/ovc/publications/infores/other.htm>

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

**[Obstetrics]{.underline}**

###### First-Trimester Screening Protocol for Trisomies 18 and 21 AFP - POEM

**Bottom Line**: A first-trimester protocol involving maternal age, two
biochemical markers, and ultrasonographic measurement of fetal nuchal
translucency is at least as accurate as standard second-trimester
screening. (Level of Evidence: 1b)

<http://www.aafp.org/afp/20040215/tips/28.html>

**Maternal morbid obesity in early pregnancy is strongly associated with
pregnancy complications**

CONCLUSION: Maternal morbid obesity in early pregnancy is strongly
associated with a number of pregnancy complications and perinatal
conditions. LEVEL OF EVIDENCE: II-2

Cedergren MI. Maternal morbid obesity and the risk of adverse pregnancy
outcome. Obstet Gynecol. 2004 Feb;103(2):219-24.

######### [http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&list_uids=14754687&dopt=Abstract]{.underline}

######### 

###### Management of Gestation Hypertension-Preeclampsia

Algorithm for the management of mild gestational hypertension or
preeclampsia

<http://www.aafp.org/afp/20040215/tips/32.html>

**Predicting failed trial of labor after primary cesarean delivery**

CONCLUSIONS: An unfavorable score predicting a high rate of
complications and more failed trials of labor may help in counseling
patients considering trial of labor. A better system to predict the
success or failure of trial of labor is needed. LEVEL OF EVIDENCE: III

######### Dinsmoor MJ, Brock EL. Predicting failed trial of labor after primary cesarean delivery. Obstet Gynecol. 2004 Feb;103(2):282-6.

######### [**http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&list_uids=14754696&dopt=Abstract**](http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&list_uids=14754696&dopt=Abstract)

######### 

###### Coverage for U urealyticum improves cesarean prophylaxis

CONCLUSION: Extended spectrum prophylactic antibiotic treatment (with
presumed efficacy against U urealyticum) given to women undergoing
cesarean delivery at term shortens hospital stay and reduces the
frequency of post-cesarean delivery endometritis and wound infections.

Andrews WW, et al. Randomized clinical trial of extended spectrum
antibiotic prophylaxis with coverage for Ureaplasma urealyticum to
reduce post-cesarean delivery endometritis. Obstet Gynecol June
2003;101:1183-9.

<http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12798523&dopt=Abstract>

or

<http://www.aafp.org/afp/20040201/tips/58.html>

**Using Rectal Misoprostol in the Third Stage of Labor**

Khan RU, El-Refaey H. Pharmacokinetics and adverse-effect profile of
rectally administered misoprostol in the third stage of labor. Obstet
Gynecol May 2003;101:968-74.

<http://www.aafp.org/afp/20040115/tips/14.html>

###### SARS and Pregnancy: A Case Report

A laboratory-confirmed case of severe acute respiratory syndrome (SARS)
is reported in a pregnant woman. Although the patient had respiratory
failure, a healthy infant was subsequently delivered, and the mother is
now well. There was no evidence of viral shedding at delivery.
Antibodies to SARS virus were detected in cord blood and breast milk.

<http://www.cdc.gov/ncidod/EID/vol10no2/03-0736.htm>

###### Health literacy and pregnancy preparedness in pregestational diabetes

**Objective:** We investigated the association between functional health
literacy and markers of pregnancy preparedness in women with
pregestational diabetes.\
**Conclusions:** The results of this study suggest that low functional
health literacy among women with pregestational diabetes is associated
with several factors that may adversely impact birth outcomes.

Endres LK, Sharp LK, Haney E, Dooley SL. Health literacy and pregnancy
preparedness in pregestational diabetes. Diabetes Care. 2004
Feb;27(2):331-4.

<http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=14747209&dopt=Abstract>

###### Ethics of Elective Primary Cesarean Delivery

Cesarean deliveries are among the most common surgical procedures
performed in the United States. Recent publications demonstrate the
reduced risks of these operations and describe their potential benefits
to both mothers and children. Recent surveys show that a substantial
minority of obstetricians would accede to patients\' requests for
elective primary cesarean delivery, and some of these professionals
would prefer that mode of delivery for themselves or their partners.
However, scant attention has been paid to the ethical underpinnings of
surgery by choice in these circumstances or ethically justified criteria
for determining the role of patient choice in elective surgery
generally. We define and elaborate upon the role of beneficence-,
autonomy-, and justice-based considerations in these deliberations. We
conclude that beneficence-based clinical judgment still favors vaginal
delivery. Additionally, we have no confidence that either offering or
performing elective cesarean delivery is consistent with
substantive-justice-based considerations and conclude that there is no
autonomy-based obligation to offer cesarean delivery in an ethically and
legally appropriate informed consent process. Physicians should respond
to patient-initiated requests for such procedures with a thorough
informed consent process and request that the woman reconsider to ensure
that her autonomy is being meaningfully exercised. In such cases,
implementing a woman\'s request is ethically permissible.

Minkoff H, Powderly KR, Chervenak F, McCullough LB. Ethical dimensions
of elective primary cesarean delivery. Obstet Gynecol. 2004
Feb;103(2):387-92\
<http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&list_uids=14754712&dopt=Abstract>

**[Gynecology]{.underline}**

**Continuous combination oral contraceptive pills to eliminate
withdrawal bleeding:**

A randomized trial.

CONCLUSION: Extension of the 28-day oral contraceptive cycle to
continuous use with a low-estrogen dose combination oral birth control
pill resulted in significantly fewer bleeding days.

Miller L, Hughes JP. Continuous combination oral contraceptive pills to
eliminate withdrawal bleeding: a randomized trial. Obstet Gynecol. 2003
Apr;101(4):653-61.

<http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12681866&dopt=Abstract>

or

[http://www.ihs.gov/MedicalPrograms/MCH/M/MCHfamPlng.asp]{.underline}

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

While the practice of continuous OCPs is now receiving a great deal more
attention in the literature, and from your pharmaceutical
representatives, gynecologists have used continuous OCPs for many, many
years successfully for treatment of various conditions, e.g.,
endometriosis.

As the old editions of the Williams textbook correctly pointed out,
monthly menses are actually somewhat of a modern contrivance. Not all
that long ago many of our Native patients were often either lactating or
childbearing for the majority of their reproductive years, so menses
were much less frequent until the latter part of the 20th century.

Please recall as various vendors vie for your pharmaceutical budget,
that you can easily explain to your patient how to use a series standard
28 day OCPs packages on a continuous basis for 3-4 cycles and then have
a menses. You can also use it as a good opportunity to reinforce basic
patient education about other aspect of the use of OCPs, as well. njm

######### I just gained all this weight....I wonder if it was the 'Pill'....

Systematic Review of Randomized Controlled Trials

CONCLUSION: Available evidence is insufficient to determine the effect
of combination contraceptives on weight, but no large effect is evident.

Trials Maria F. Gallo, David A. Grimes, Kenneth F. Schulz, Frans M.
Helmerhorst\
Combination Estrogen-Progestin Contraceptives and Body Weight:
Systematic Review of Randomized Controlled Obstet Gynecol 2004 103:
359-373.

Non-ACOG Members

[http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&list_uids=14754709&dopt=Abstract]{.underline}

ACOG Members

[http://www.greenjournal.org/cgi/content/abstract/103/2/359]{.underline}

######### What is the best kind of dressing to use on a surgical wound?

Were you taught to always take the dressing off by 24 hours to keep the
wound dry?

Perhaps an occlusive dressing is better for those longer-term GYN
wounds, e.g., midline

[Conclusion]{.underline}

During an eight-year period, the author used a semiocclusive,
transparent film surgical dressing as a protective cover for 3637
surgical incisions. The wet environment facilitated healing, and no
patient exhibited any symptoms of wound infection. Compared with
traditional methods, the semiocclusive dressing resulted in faster wound
healing, decreased pain, and less scarring. It also permitted visual
assessment of wound healing, as well as promoting patient mobility and
hygiene.

Rubio PA. Use of semiocclusive, transparent film dressings for surgical
wound protection: experience in 3637 cases. Int Surg. 1991
Oct-Dec;76(4):253-4.\
[http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=1778724&dopt=Abstract]{.underline}

CONCLUSIONS: In the context of no additional benefit for the prevention
of wound infection or the rate of wound healing for any of the three
dressing products examined, dry absorbent dressings are the most
comfortable and cost-effective products for sternotomy wounds following
cardiac surgery

Wynne R, Botti M, Stedman H, Holsworth L, Harinos M, Flavell O,
Manterfield C. Effect of three wound dressings on infection, healing
comfort, and cost in patients with sternotomy wounds: a randomized
trial. Chest. 2004 Jan;125(1):43-9.\
[http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=14718419&dopt=Abstract]{.underline}

Eaglstein WH. Occlusive dressings. J Dermatol Surg Oncol. 1993
Aug;19(8):716-20.

[http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8349911&dopt=Abstract]{.underline}

Eaglstein WH, Mertz PM, Falanga V Occlusive dressings. Am Fam Physician.
1987 Mar;35(3):211-6.

[http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=3825848&dopt=Abstract]{.underline}

## If using HPV DNA testing, then consider this....

## Human papillomavirus DNA-positive women with negative cervical cytology results should be retested in 6 to 12 months rather than referred for colposcopy.

Wright TC Jr, Schiffman M, Solomon D, Cox JT, Garcia F, Goldie S, Hatch
K, Noller KL, Roach N, Runowicz C, Saslow D. Interim guidance for the
use of human papillomavirus DNA testing as an adjunct to cervical
cytology for screening. Obstet Gynecol. 2004 Feb;103(2):304-9.

<http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&list_uids=14754700&dopt=Abstract>

###### New Contraceptive Options 

Primary reasons for the high rate of unplanned pregnancy include
dissatisfaction with or underuse of effective contraceptive methods and
poor compliance with contraceptive methods that require daily adherence.
Several effective forms of contraception have become available in the
United States within the past four years.
<http://www.aafp.org/afp/20040215/853.html>

Editorial: <http://www.aafp.org/afp/20040215/editorials.html>

**Increasing Adherence to Pap Screening Guidelines**

Yabroff KR, et al. Effectiveness of interventions to increase
Papanicolaou smear use. J Am Board Fam Pract May-June 2003;16:188-203.

<http://www.aafp.org/afp/20040115/tips/15.html>

**Evaluation and Management of Hirsutism in Women**

<http://www.aafp.org/afp/20040115/tips/17.html>

**2004 National Women\'s Health Week celebration: May 9-15, 2004**

<http://www.ihs.gov/MedicalPrograms/MCH/W/WHgen.asp#womenweek>

**[Child Health]{.underline}**

###### Infant physical abuse in Alaska higher than expected

The rate of fatal infant physical abuse in Alaska during the 7-year
study period was 0.20 per 1,000 (or 20 per 100,000). In comparison, the
National Center on Child Fatality Review data indicate that the rate for
Alaska during the period 1993-1997 was 11.71 per 100,000, while the
National Center for Injury Prevention and Control data indicate that the
rate for the U.S. as a whole in the year 2000 was 9.07 per 100,000.

Gessner BD, Moore M, Hamilton B, et al. 2004. The incidence of infant
physical abuse in Alaska. Child Abuse & Neglect 28(1):9-23.

More information about child abuse, injury prevention, and infant
mortality prevention is available from the MCH Library\'s organizations
lists at <http://www.mchlibrary.info/databases/orgmenu.html>

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

Infant and child abuse may have sequelae long past the childhood years.
Dr. Duran at the University of New Mexico has quantified some of the
long-term effects on AI/AN later in life. (See Prevalence and correlates
of mental disorders in Native American women in primary care above). Dr.
Duran and others will discuss these and other issues related to domestic
violence at the 2004 Womens's Health and MCH Biennial meeting. I
encourage all providers (Family Physicians, OB/GYNs, CNMs, APNs, and
staff who provide care to female American Indian and Alaska Natives to
attend to help us sort those issues out. Here is more information on
this biennial meeting.
<http://www.ihs.gov/MedicalPrograms/MCH/M/CN01.cfm#August2004>

###### Who are "Fragile Families" and What Do We Know About Them? 

This summarizes findings from a national, longitudinal study of
unmarried parents, their relationships to each other, and the well-being
of their children. The policy brief is one in a series of briefs about
couples and marriage published by the Center for Law and Social Policy.
Researchers are in the process of interviewing mothers and fathers at
the time of their child\'s birth, 1 year later, 3 years later, and 5
years later. In-home assessments of the children will also be conducted
in 3- and 5-year interviews. The policy brief is available at
<http://www.clasp.org/DMS/Documents/1073679033.53/Marriage_Brief4.pdf>

More information about both studies is available at
<http://crcw.princeton.edu/fragilefamilies>

###### What is up with soft drinks being sold in schools?

The AAP notes that decisions about which foods will be sold in schools
is often made by school-district business officers alone, rather than
with input from local health professionals. The policy statement is
intended to inform pediatricians and other health professionals,
parents, superintendents, and school board members about nutritional
concerns related to soft drink consumption in schools.

American Academy of Pediatrics, Committee on School Health. 2004. Soft
drinks in schools. Pediatrics 113(1):152-154.

<http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=14702469&dopt=Abstract>

**Child Passenger Deaths Involving Drinking Drivers \-\--United States,
1997\--2002**\
<http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5304a2.htm>

###### Low glycemic index diet as practice-based treatment for overweight children

Many parents were able to lower the GI of their child\'s diet, after
hearing a brief description of the LGI \[low glycemic index\] diet and
receiving a handout. This dietary approach emphasizing the glycemic
index rather than the fat or caloric content of foods has shown promise
in treating overweight children. (The glycemic index measures how much
one\'s blood sugar increases over a period of 2 or 3 hours after a meal.
Carbohydrate foods that break down quickly during digestion have the
highest glycemic index.)

Young PC, West SA, Ortiz K, et al. 2004. A pilot study to determine the
feasibility of the low glycemic diet as a treatment for overweight
children in primary care practice. Ambulatory Pediatrics 4(1):28-33.

The script and a sample of the diet are available from the authors.
Address correspondence to <paul.young@hsc.utah.edu> More information
about child and adolescent nutrition is available from the MCH Library
knowledge path at
<http://www.mchlibrary.info/KnowledgePaths/kp_childnutr.html> and the
Bright Futures Web site at
<http://www.brightfutures.org/nutrition/about.html>

###### Reducing the risk of SIDS in child care

Nearly 20 percent of babies who die of sudden infant death syndrome
(SIDS) do so in child care settings. In an effort to reduce this death
rate, the Healthy Child Care America Back to Sleep Campaign has created
a speaker\'s kit, \"Reducing the Risk of SIDS in Child Care.\" It
contains many teaching tools and free resources from the National
Institute of Child Health and Human Development\'s Back to Sleep
Campaign and other SIDS organizations. Visit
[http://www.healthychildcare.org](http://www.healthychildcare.org/)

**Azithromycin for Persistent or Recurrent Otitis Media, AFP - POEM**

[Bottom Line:]{.underline} For every 10 children with persistent or
recurrent otitis media who receive high-dose azithromycin for three days
instead of high-dose amoxicillin-clavulanate for 10 days, there is one
additional clinical cure at one month and one fewer episode of diarrhea.
However, clinical success at two weeks does not differ. (Level of
Evidence: 1b)

<http://www.aafp.org/afp/20040201/tips/50.html>

**Prevention and Treatment of Type 2 Diabetes Mellitus in Children\
**Special Emphasis on American Indian and Alaska Native Children

<http://www.ihs.gov/MedicalPrograms/MCH/W/WHdm.asp#prevention>

**[Chronic disease and Illness]{.underline}**

###### Screening for Type 2 Diabetes Mellitus in Adults

Case study based on U.S. Preventive Services Task Force (USPSTF)
recommendations on screening for type 2 diabetes mellitus.

###### [**http://www.aafp.org/afp/20040201/putting.html**](http://www.aafp.org/afp/20040201/putting.html)

###### 

###### Strength Training Among Adults Aged Greater Than or Equal to 65 Years \-\-- 2001

The majority of older adults, including even those physically active,
are missing opportunities to improve their overall health and fitness
through regular strength training.

<http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5302a1.htm>

###### Moderate intensity exercise works: RCT in overweight, sedentary women

\"Participants randomized to vigorous exercise intensity did not have
greater weight loss than those randomized to a similar dose of exercise
performed at a moderate intensity. The authors conclude that
\"interventions should initially target the adoption and maintenance of
at least 150 min/wk of moderate intensity exercise, and when
appropriate, eventually progress to exercise levels . . . of 60 min/d.\"

Jakicic JM, Marcus BH, Gallagher KI, et al. Effect of exercise duration
and intensity on weight loss in overweight, sedentary women. 2003. JAMA,
The Journal of the American Medical Association 290(10):1323-1330.

<http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12966123&dopt=Abstract>

######### Alaska Natives have a disproportionately high percentage of HIV

17% of the population, but 21% of the HIV cases

<http://www.epi.hss.state.ak.us/bulletins/docs/rr2004_01.pdf>

###### Cognitive Behavior Therapy vs. Relaxation Therapy for IBS 

**Clinical Question:** How effective are psychological interventions in
patients with irritable bowel syndrome (IBS)?

**Bottom Line:** There is no good evidence that cognitive behavior
therapy or relaxation therapy is any more helpful than usual treatment
in patients with IBS. (Level of Evidence: 1b­)

<http://www.aafp.org/afp/20040215/tips/22.html>

**Do you have Medicaid patients who smoke?**\
State Medicaid Coverage for Tobacco-Dependence Treatments: Reimbursement
for treatment

<http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5303a3.htm>

**Prevalence of Diabetes and Impaired Fasting Glucose in Adults**

<http://www.ihs.gov/MedicalPrograms/MCH/W/WHdm.asp#PhysAct>

##### Features

## American Family Physician

###### 

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

###### First-Trimester Screening Protocol for Trisomies 18 and 21 

**Bottom Line**: A first-trimester protocol involving maternal age, two
biochemical markers, and ultrasonographic measurement of fetal nuchal
translucency is at least as accurate as standard second-trimester
screening. (Level of Evidence: 1b)

###### [**http://www.aafp.org/afp/20040215/tips/28.html**](http://www.aafp.org/afp/20040215/tips/28.html)

###### Ultrasound Alone Does Not Diagnose PCOS 

**Bottom Line:** A polycystic appearance of the ovaries on
ultrasonography is common in women of reproductive age. Women have
normal fertility if they have polycystic ovaries on ultrasound
examination and no other characteristics of PCOS, including menstrual
disturbance, obesity, acne, and hirsutism. (Level of Evidence: 2b+)

<http://www.aafp.org/afp/20040215/tips/29.html>

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

##### ACOG

**Uterine artery embolization. ACOG Committee Opinion.**

###### Uterine artery embolization for the treatment of symptomatic uterine leiomyomata has become increasingly popular. Based on current evidence, it appears that uterine artery embolization, when performed by experienced physicians, provides good short-term relief of bulk-related symptoms and a reduction in menstrual flow. Complication rates associated with the procedure are low, but in rare cases can include hysterectomy and death. There is insufficient evidence to ensure its safety in women desiring to retain their fertility, and pregnancy-related outcomes remain understudied. The American College of Obstetricians and Gynecologists\' Committee on Gynecologic Practice considers the procedure investigational or relatively contra-indicated in women wishing to retain fertility. The use of uterine artery embolization in postmenopausal women is rarely, if ever, indicated. The Committee strongly recommends that women who wish to undergo uterine artery embolization have a thorough evaluation with an obstetrician-gynecologist to help facilitate optimal collaboration with interventional radiologists and to ensure the appropriateness of this therapy, taking into account the reproductive wishes of the patient. It is also recommended that all patients considering uterine artery embolization be adequately informed about potential complications.

Uterine artery embolization. ACOG Committee Opinion. Committee on
Gynecologic Practice, American College of Obstetricians and
Gynecologists. Obstet Gynecol. 2004 Feb;103(2):403-4.

Non-ACOG Members

<http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&list_uids=14754718&dopt=Abstract>

ACOG members

[http://www.greenjournal.org/cgi/reprint/103/2/403.pdf]{.underline}

##### AHRQ

**A pregnant woman arrives at the ED with severe abdominal pain: Web M +
M**

A pregnant woman arrives at the ED with severe abdominal pain. Concerned
about a ruptured appendix, the ED physicians send her for CT scan. The
obstetrics resident examines her there and is concerned about a ruptured
tubal pregnancy.

<http://www.webmm.ahrq.gov/cases.aspx?ic=43>

**Total and supracervical hysterectomy: Surgical / clinical outcomes are
similar**

[http://www.ahrq.gov/research/dec03/1203RA12.htm#head2]{.underline}

**More aggressive treatment recommendations for women with diabetes** -

may be needed to reduce their risk of heart disease-related death

[http://www.ahrq.gov/research/dec03/1203RA11.htm#head1]{.underline}

######### Reducing by at least half the incidence of false-positive mammogram readings:

Radiologists\' access to women\'s previous mammograms

[http://www.ahrq.gov/research/dec03/1203RA14.htm#head4]{.underline}

**Home visits by a nurse-health advocate team can improve the outcomes**

of low-income, minority mothers and their infants

<http://www.ahrq.gov/research/dec03/1203RA16.htm#head6>

##### Breastfeeding

###### Lower rates of overweight among children who were breastfed for longer duration

This study highlights 1 consequence of prolonged breastfeeding and
reinforces the rationale for recommendations to breastfeed an infant for
at least a full year

Grummer-Strawn LM, Mei Z. 2004. Does breastfeeding protect against
pediatric overweight? Analysis of longitudinal data from the Centers for
Disease Control and Prevention Pediatric Nutrition Surveillance System.
Pediatrics Electronic Pages 113(2):e81-e86.

<http://www.brightfutures.org/nutrition/about.html>

###### Easy Guide to Breastfeeding for American Indian and Alaska Native Families

This excellent resource is temporary out of stock. Try here for details:

[http://www.4woman.gov/search/Doclist.CFM?DetailType=Pub&start_r=1&page_start=1&AR=Text&inputkey=native%20breast%20feeding&lg2=AND](http://www.4woman.gov/search/Doclist.CFM?DetailType=Pub&start_r=1&page_start=1&AR=Text&inputkey=native breast feeding&lg2=AND)

Contact for questions: 1-800 Information and Referral Service with new
[Breastfeeding]{.underline}

[Helpline]{.underline} at 1-800-994-9662 or
[http://www.4woman.gov](http://www.4woman.gov/)

## Domestic Violence

## Screening for Partner Violence: Direct Questioning or Self-Report?

CONCLUSION: A self-report checklist is an effective alternative to
direct questioning in detecting women who are experiencing partner
violence and is acceptable to women. LEVEL OF EVIDENCE: II-3

## Joan Webster, RN and Victoria Holt Screening for Partner Violence: Direct Questioning or Self-Report? Obstet Gynecol. 2004 Feb;103(2):299-303. 

## http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&list_uids=14754699&dopt=Abstract

**[Elder Care News, Bruce Finke]{.underline}**

**Routine screening for thyroid disease in adults?**

The U.S. Preventive Services Task Force (USPSTF) concludes the evidence
is insufficient to recommend for or against routine screening for
thyroid disease in adults.

**Rating: [I
Recommendation](http://www.ahrq.gov/clinic/3rduspstf/ratings.htm#irec).**

*Rationale:* The USPSTF found fair evidence that the thyroid stimulating
hormone (TSH) test can detect subclinical thyroid disease in people
without symptoms of thyroid dysfunction, but poor evidence that
treatment improves clinically important outcomes in adults with
screen-detected thyroid disease. Although the yield of screening is
greater in certain high-risk groups (e.g., postpartum women, people with
Down syndrome, and the elderly), the USPSTF found poor evidence that
screening these groups leads to clinically important benefits. There is
the potential for harm caused by false positive screening tests;
however, the magnitude of harm is not known. There is good evidence that
over-treatment with levothyroxine occurs in a substantial proportion of
patients, but the long-term harmful effects of over-treatment are not
known. As a result, the USPSTF could not determine the balance of
benefits and harms of screening asymptomatic adults for thyroid disease.

Overtreatment with levothyroxine increases the risk of osteoporosis and
atrial fibrillation in the elderly; this relationship is seen even
within the normal range (lower TSH, higher rates of osteoporosis and
a-fib. The literature supports targeting the TSH at high normal in the
elderly on replacement therapy.

For updates on USPSTF recommendations, go to:
<http://www.ahcpr.gov/clinic/gcpspu.htm>

**[Frequently asked questions]{.underline}**

**Why do patients blood sugars go up so high after certain meals?**

Q.Have you ever wondered why your GDM or DM patient's blood sugars go
really high only after certain meals?

A. Yes portion size is an issue, but it may have a lot to do with the
Glycemic Index of the foods in that meal

**High:**

Potatoes, Bananas, White bread, White rice, French fries, Refined
breakfast cereals, White spaghetti, Soft drinks, Sugar

**Low:**

Most Legumes, Whole fruits, Whole Wheat, Oats, Bran, Brown rice, Bulgar,
Barley, Whole grain breakfast cereals, Couscous

Here are some resources

<http://www.hsph.harvard.edu/nutritionsource/carbohydrates.html>

<http://www.glycemicindex.com/>

<http://vanderbiltowc.wellsource.com/dh/content.asp?ID=620>

Brand-Miller J, Hayne S, Petocz P, Colagiuri S. Low-glycemic index diets
in the management of diabetes: a meta-analysis of randomized controlled
trials. Diabetes Care. 2003 Aug;26(8):2261-7.

**CONCLUSIONS:** Choosing low-GI foods in place of conventional or
high-GI foods has a small but clinically useful effect on medium-term
glycemic control in patients with diabetes. The incremental benefit is
similar to that offered by pharmacological agents that also target
postprandial hyperglycemia

<http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=12882846>

**How does the intensity of the exercise affect weight loss,
etc\....?**\
Participants randomized to vigorous exercise intensity did not have
greater weight loss than those randomized to a similar dose of exercise
performed at a moderate intensity

CONCLUSIONS: Significant weight loss and improved cardiorespiratory
fitness were achieved through the combination of exercise and diet
during 12 months, although [no differences were found based on different
exercise durations and intensities in]{.underline} this group of
sedentary, overweight women. Jakicic JM, Marcus BH, Gallagher KI, et al.
Effect of exercise duration and intensity on weight loss in overweight,
sedentary women. 2003. JAMA, The Journal of the American Medical
Association 290(10):1323-1330.\
<http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12966123&dopt=Abstract>

###### Q. Are pharmacologic agents safe to use for smoking cessation in pregnancy? 

A. Pharmacologic intervention should be the third choice after
exhausting all behavioral approaches. See smoking in pregnancy at this
site:

<http://www.ihs.gov/MedicalPrograms/MCH/M/MCHfaq.asp#S>

**[Hormone Replacement Update]{.underline}**

###### Nonhormonal alternatives for the treatment of hot flashes

**Objective:** To review the literature on clonidine, venlafaxine,
selective serotonin reuptake inhibitors, and gabapentin for the
treatment of hot flashes.\
**Conclusions:** Clonidine, venlafaxine, paroxetine, fluoxetine, and
gabapentin are nonhormonal agents that have demonstrated efficacy in
small controlled and uncontrolled trials in reducing hot flashes and
should be considered in patients unwilling or unable to take hormonal
therapies.

Sicat BL, Brokaw DK. Nonhormonal alternatives for the treatment of hot
flashes. Pharmacotherapy. 2004 Jan;24(1):79-93.

<http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=14740790&dopt=Abstract>

**Understanding the Risks and Benefits of Hormone Therapy**

Multiple physician groups and the U.S. Preventive Services Task Force
recommend that physicians counsel postmenopausal patients about the
individual risks and benefits of using hormone therapy. The authors
conclude that women overestimate the risk of the four diseases studied
regardless of their current hormone therapy status. Women who use
hormone therapy believe these medications convey a greater reduction in
risks for osteoporosis and myocardial infarction, with a smaller
increase in the risk of developing breast and uterine cancers.
Continuing efforts to assist women in understanding the risks and
benefits of hormone therapy would be helpful.
<http://www.aafp.org/afp/20040215/tips/31.html>

# [Information Technology]{.underline}

###### New Domestic Violence code for recording valuable GPRA information --Terry Cullen

The percentage of women screened for domestic violence is a FY 2004 GPRA
indicator. This is to remind you that the new RPMS code for recording of
domestic violence screening was released to the field on November 25,
2003. Please contact your site manager and/ or data entry personnel if
you have been unable to record screening for domestic violence in your\
RPMS system. Ask your site manager if they have installed the following
patch:

aum_0410.01k released on November 25, 2003\
aum_0410.01n

EXAM NAME: INT PARTNER VIOLENCE SCREEN CODE: 34

Please contact Terry Cullen <Theresa.Cullen@IHS.GOV> if you have any
questions about this indicator and/or recording the results within the
RPMS system

# [International Health Update]{.underline}

###### Overseas contraceptives with no active ingredients

FDA and Johnson and Johnson Co. of Raritan, NJ are warning the public
about an overseas Internet site selling counterfeit contraceptive
patches that contain no active ingredients.

<http://www.fda.gov/medwatch/SAFETY/2004/safety04.htm#cpatch>

###### 

###### Agencies Pledge to Cut Maternal Deaths

Eight international agencies pledged their support today to a new
strategy designed to prevent deaths of women from pregnancy and
childbirth complications, a number that reaches 23,000 in Latin America
and the Caribbean each year. Nearly all of these deaths can be prevented
with adequate care. <http://www.paho.org/English/DD/PIN/pr040220.htm>

###### British Medical Journal: Epidemiology for the Uninitiated

Want to know the difference between case control and cohort studies? And
much more.....

<http://bmj.bmjjournals.com/epidem/epid.html>

#### [MCH Alert]{.underline}

###### Contraceptive use within adolescents' first sexual relationships

This article examines the link between partner and relationship
characteristics and contraceptive use within adolescents\' first sexual
relationships. The analyses build upon previous research that highlights
the importance of understanding sexual, contraceptive, and birth
outcomes within the context of sexual relationships. They conclude that
\"parents, educators and service providers should be particularly aware
of relationships that teenagers are engaged in to help reduce early
sexual activity, contraceptive inconsistency, unintended pregnancy and
STDs.

Manlove J, Ryan S, Franzetta K. 2003. Patterns of contraceptive use
within teenagers\' first sexual relationships. Perspectives on Sexual
and Reproductive Health 35(6):246-255.

<http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=14744656&dopt=Abstract>

###### An argument for EC: Unintended pregnancy despite a family planning referral

We found that women contacted for purposes of STD partner notification
reported very high rates of past unintended pregnancy and that an
important minority were at risk for unintended pregnancy in the future,
but that providing these women with referral for FP \[family planning\]
services was ineffective.

Golden MR, Whittington WLH, Handsfield HH, et al. 2004. Failure of
family-planning referral and high interest in advanced provision
emergency contraception among women contacted for STD partner
notification. Contraception 69:141-146.

<http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=14969673&dopt=Abstract>

#### [Medscape\*]{.underline}

###### Uterovaginal Packing With Rolled Gauze in Postpartum Hemorrhage

Uterovaginal packing to treat cases of primary and secondary postpartum
hemorrhage is described. The method is simple and quick to perform and
requires no special equipment.

Rashmi Bagga, MD; Vanita Jain, MD; Seema Chopra, MD; Jasvinder Kalra,
MD; Sarala Gopalan, PhD, FRCOG Medscape General Medicine 9(1), 2004
<http://www.medscape.com/viewarticle/468090?mpid=25197>

Efficacy and Tolerability of Oral Zolmitriptan in Menstrually Associated
Migraine: A Randomized, Prospective, Parallel-Group, Double-Blind,
Placebo-Controlled Study

**Background:** Approximately 60% of female migraineurs report
experiencing migraine in association with menstruation, while 7% to 25%
experience attacks almost exclusively with menstruation.\
**Conclusion:** Oral zolmitriptan exhibits efficacy and good
tolerability in the treatment of menstrually associated migraine.
Improvement over placebo was observed as early as 30 minutes following
treatment.

Elizabeth Loder, MD, FACP; Stephen D. Silberstein, MD, FACP; Susan
Abu-Shakra, MD; Loretta Mueller, DO; Timothy Smith, MD, RPh Headache
44(2):120-130, 2004.
<http://www.medscape.com/viewarticle/468714?mpid=25197>

######### 

###### Emergency Contraceptive Pills and Adolescents (Live Web Conference) Free CME/CEUs

######### [**http://www.medscape.com/viewprogram/2904**](http://www.medscape.com/viewprogram/2904)

######### 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 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@@.eeab9d1>

**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.

**[Office of Women's Health, CDC]{.underline}**

###### West Nile Virus During Pregnancy, Infant Guidelines

Guidelines for Infants Born to Mothers Infected with West Nile Virus
During Pregnancy

<http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5307a4.htm>

**[Osteoporosis]{.underline}**

###### Osteoporosis -- significant part of Primary Care Listserv discussion this month

One of the issues that came out of this month's discussion is question
of the relative value of heel Ultrasound in the diagnosis of
osteoporosis

[From Charles Rhodes, PIMC, 2/23/2004 9:07 AM]{.underline}\
I\'m not sure I would agree that Ultrasound (US) is \"inferior\" to
p-DXA. US is a newer approach, so the data base is less robust. Most of
the items I have seen lately describing femur-and-lumbar (\"axial\") DXA
as the \"gold standard\" are written by people who have a financial
interest in \"axial\" DXA units. Axial DXA IS the \"gold standard\" in
one sense: it was the method used in the large clinical trials of
bisphosphonates. However, it was also used in trials of high-dose
fluoride, in which setting it gave misleading results. (High dose
fluoride -\> increased BMD by DXA, but also increased fracture rate.)
The fracture rate is the REAL gold standard.

Because it gives mineral content in three dimensions, instead of a
two-dimensional projection of a three-dimensional object, qCT should be
superior to DXA, but the data base is thinner and the radiation dose
higher (although still low.)

Some people believe that US will ultimately prove superior to all three
radiation methods (DXA, pDXA, qCT). Besides the absence of ionizing
radiation, they feel US can give information about continuity of
trabeculae \-- an aspect missed totally by all the other methods. For
now, the US folks are still working on optimizing the software to
interpret the information available from US. What we need are studies
following a tested but untreated population long enough for them to
develop enough fractures to plot the predictive value of the testing
method. We have that for DXA and pDXA, not for US and I\'m not sure
about qCT.

Another comment:

N. Burton Attico, MD 2/18/2004 7:53 PM\
In some way, a positive screen should have a formal \"test\" using DEXA,
so that you could also determine hip and the spine, and complete the
diagnostic w/u. With the recent articles, diabetes should be an
automatic \"trigger\" to screen.

Brown, SA, Sharpless JL. Osteoporosis: An under-appreciated complication
of diabetes mellitus. Clinical Diabetes 2004 22(1):10-20

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

**[Please note]{.underline}** the above comments were responses to a
question about the relative utility of heel US vs DEXA and other
modalities for the evaluation of osteoporosis. They may be taken
somewhat out context. If you have questions, please contact the two
authors directly

In the meantime. DEXA is the gold standard at this time. Ultrasound
technology does have the utility of the relative small size of the
device. A number of ITU facilities utilize US now, but if at all
feasible, a DEXA is preferred. I really suggest you either join the
Primary Care Listserv to become part of this discussion, to get complete
ideas being communicated and the entire context.

Another alternative is to view the discussion after it is completed. It
will be captured and posted on the MCH web site at:
<http://www.ihs.gov/MedicalPrograms/MCH/M/PCdiscForum.asp>

##### Patient Information

###### Fiber: How to Increase Fiber in Your Diet 

<http://www.aafp.org/afp/20040215/927ph.html>

###### Nutrition: Choosing Healthy, Low-Fat Foods 

<http://www.aafp.org/afp/20040215/925ph.html>

###### Nutrition: Tips for Improving Your Health

<http://www.aafp.org/afp/20040215/923ph.html>

###### Pelvic Inflammatory Disease -- Updated Fact Sheet, CDC

<http://www.cdc.gov/std/PID/STDFact-PID.htm>

**[Primary Care Listserv]{.underline}**

The Primary Care Discussion Forum is one way to learn about / discuss
best practice clinical care with national experts in an e-mail format.

Our first discussion was a success. It included a short primer on "New
cervical cancer screening guidelines and technologies" by Alan Waxman,
MD. Dr. Waxman then facilitated an e-mail based discussion. Upcoming
discussions include:

###### February 1, 2004 DISCUSSION ONGOING RIGHT NOW

[Discussion facilitator:]{.underline} Bruce Finke, IHS Elder Care
Initiative

Topic: Evidence based periodic health screening for the
elderly....."What is really necessary in the "Annual Exam" for mature
adults"

This will also include a discussion of rpms based solutions to better
documentation

Issues to be addressed:

\- Do the guidelines make sense as a framework for providing high
quality care for our older

patients?

\- Can we do this in our hospitals and clinics?

\- Is an annual preventive care visit the way to ensure access to
preventive services for our older

patients?

-Osteoporosis screening? PSA screening?

###### May 1, 2004

[Discussion facilitator:]{.underline} Donna Perry, Adolescent Medicine,
Chinle

Topic: Adolescent risk taking behaviors.....a.k.a. "Sex drugs and rock
and roll"

This will include discussion of methamphetamine (up to 15% AI youth in
some IHS Areas have tried it), alcohol and marijuana, driving while
"high" or riding with someone who it, and not wearing seatbelts.

**[Please note:]{.underline}**

You can expect 20-30 total e-mail messages per topic, 4 times a year.
Each discussion will last approximately 4-6 weeks.

If that is too much e-mail for you, then don't subscribe, or just
subscribe for those topics of special interest to your practice and then
unsubscribe after that topic is closed out.

When finished, the full discussions and a summary will be posted on the
Primary Care Discussion Forum web page:

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

It is easy to subscribe. Go to this page and fill in your name, then hit
search, then follow the instructions:

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

It is also easy to unsubscribe: go to this page and fill in your name,
then follow the instructions:

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

Or contact Jason Crim at
[jason.crim@mail.ihs.gov](mailto:jason.crim@mail.his.gov) to join the
Primary Care listserv.

##### What's new on the ITU MCH web pages?

###### Mary Lynn Eaglestaff: MCH Coordinator Aberdeen Area

[**http://www.ihs.gov/MedicalPrograms/MCH/M/MCHC12.cfm**](http://www.ihs.gov/MedicalPrograms/MCH/M/MCHC12.cfm)

About Diana Hu: MCH Coordinator Navajo Area

###### [**http://www.ihs.gov/MedicalPrograms/MCH/M/MCHC14.cfm**](http://www.ihs.gov/MedicalPrograms/MCH/M/MCHC14.cfm)

###### 

###### About Diane Jeanotte: MCH Coordinator Billings Area

<http://www.ihs.gov/MedicalPrograms/MCH/M/MCHC11.cfm>

###### 

###### MCH Genetics page updated, IHS

<http://www.ihs.gov/NonMedicalPrograms/nc4/Genetics.cfm>

###### 

###### New PCC+ form: Well women's exam

<http://www.ihs.gov/MedicalPrograms/MCH/M/mchdownloads/wh_template.doc>

###### Need some statistics on Women\'s Health in Indian Country?

<http://www.ihs.gov/MedicalPrograms/MCH/M/PROG02.cfm#ihsstat>

or nationally scroll down to.....

###### Women\'s Health USA 2003, Maternal and Child Health Bureau

<http://www.ihs.gov/MedicalPrograms/MCH/M/PROG02.cfm#DatabaseAndReference>

###### Prevention and treatment of Type 2 diabetes mellitus in children

<http://pediatrics.aappublications.org/cgi/reprint/112/4/e328.pdf>

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]{.underline}**

**Basic IHS Colposcopy Course April 26-29, 2004**

Albuquerque, New Mexico

[http://www.ihs.gov/MedicalPrograms/MCH/M/CN01.cfm#April2004]{.underline}

For more information, contact:
[roberta.paisano@mail.ihs.gov]{.underline}

FYI: 2002 brochure

[http://www.ihs.gov/MedicalPrograms/MCH/M/ArchDownloads/2002_colposcopy.pdf]{.underline}

**Refresher IHS Course April 27-29, 2004**

Albuquerque, New Mexico

[http://www.ihs.gov/MedicalPrograms/MCH/M/CN01.cfm#April2004]{.underline}

For more information, contact:
[roberta.paisano@mail.ihs.gov]{.underline}

FYI: 2002 brochure

[http://www.ihs.gov/MedicalPrograms/MCH/M/ArchDownloads/2002_colposcopy.pdf]{.underline}

###### 

###### 2004 National Women\'s Health Week celebration, May 9-15, 2004

Many resources to help with local activities

<http://www.4woman.gov/whw/2004/>

###### Learn more about National Women\'s Check-Up Day: May 10, 2004

<http://www.4woman.gov/whw/2004/Join-the-fun/check-up-day.html>

**3rd National Sexual Violence Prevention Conference, CDC **

May 25 - 28, 2004 

Los Angeles, California 

 <http://www.cdc.gov/ncipc/2004nsvpc.htm> 

#### National IHS PA / APN Annual Meeting

June 7-11, 2004

Scottsdale, Arizona

[**http://www.ihs.gov/MedicalPrograms/MCH/M/CN01.cfm#June2004**](http://www.ihs.gov/MedicalPrograms/MCH/M/CN01.cfm#June2004)

Contact Judy Whitecrane for questions <judy.whitecrane@mail.ihs.gov>

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

-   June 13-17, 2004 **with separate NRP Course on first morning
    session, 6/13/04**

-   Denver, CO

-   Contact Teddra Penland at 301 443 1840

-   <http://www.ihs.gov/MedicalPrograms/MCH/M/CN01.cfm#June2004>

-   2004 brochure
    <http://www.ihs.gov/MedicalPrograms/MCH/M/ConfDnlds/Brochure2004.doc>

-   June 13th at 8:00 am: Separate NEONATAL RESUSCITATION PROGRAM

-   NRP Class size limited. Sign up now

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

**2004 Biennial OB/GYN meeting: Prevention in Women's Health**

August 4-6, 2004

Albuquerque, New Mexico

Great CEU /CME, plus good networking for leaders of Women's Health / MCH

Contact Neil Murphy for questions <nmurphy@anmc.org>

<http://www.ihs.gov/MedicalPrograms/MCH/M/CN01.cfm#August2004>

Did you miss something in the last OB/GYN Chief Clinical Consultant
Corner?

###### January 2004

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

Health Status of American Indians Compared with Other Racial/Ethnic
Minority Populations

[From your colleagues:]{.underline} page 5

From Burt Attico: Sick of Lawsuits Campaign

From Jean Charles-Azure: **Assessment and Management of Adult Obesity:
Case Studies**

From Katy Ciacco Palatianos: How does your facility's UTI resistance
compare to your region?

From Terry Cullen: Online learning opportunity: Violence against Native
Women; How do Consumers Search for and Appraise Information on Medicines
on the Internet?

From Mary Helen Deer: Funding available: Colorectal cancer screening in
primary care

From Terry Friend: BTLs in non-Native women with Native partners

From James Galloway: Coronary Heart Disease in Women with Diabetes

From Lindley Gifford: When is best to screen for Chlamydia in
asymptomatic women?

From Joan Koval: Does Folate intake affect cervical dysplasia?

From Bill Lubke, Ken Moore: Clinical Guidelines for Common Genitourinary
Disorders

From Chuck North: Evidence Based Practice Resources

From Suzanne Schwendenman: Tobacco cessation in pregnancy:
Pharmacological methods?

From Ros Singleton: Pregnant women in their second or third trimester
should get flu vaccine

From Judy Thierry: Breast and cervical changes that are non-cancerous,
and abnormal Pap or mammogram; Should we start using progesterone to
treat preterm labor now?

From Alan Waxman: Summary of New Cervical Cancer Screening Guidelines
and New Technology Forum

**[Hot Topics:]{.underline}** **page 12**

##### Obstetrics: Persistent Fetal Occiput Posterior Position; Maternal Behaviors and Experiences Before, During, and After Pregnancy; Prenatal HIV Testing and Antiretroviral Prophylaxis at an Urban Hospital, 1997---2000; Does Assisted Reproduction Cause Spontaneous Abortion? 2003 Obstetrics Year in Review, Medscape; Postpartum Depression Treatments and the Impact of Antidepressant Drugs on Nursing; Spinal Anesthesia in Obstetrics \-- New Concepts and Developments; Cesarean Delivery Linked to Subsequent Stillbirths

Gynecology: Diaphragm Fitting; 2003 GYN Year in Review, Medscape;
Pharmacologic Treatment of Polycystic Ovary Syndrome; Chaperone Use
During Pap Smears

Child Health: Influenza-Associated Deaths Reported Among Children Aged
\<18 Years; 2004 CATCH Implementation Funds available;

Chronic Illness and Disease: The USPSTF recommendations on Obesity; Use
of Botanicals by Women: Toward Optimal Health; Lipid Changes on Hormone
Therapy and Coronary Heart Disease Events in the Heart and
Estrogen/Progestin Replacement Study (HERS); Dietary Fiber Decreases
Risk for Colorectal Cancer; Diagnosis of Systemic Lupus Erythematosus;
Hepatitis B; Bovine Spongiform Encephalopathy in a Dairy Cow \-\--
Washington State, 2003; What are some of the surgical options for the
morbidly obese?

[Features:]{.underline} page 15

AFP: [Cochrane for Clinicians]{.underline}: Does Metformin Improve
Clinical Features of Polycystic Ovary Syndrome? Thromboembolism;
[POEMS:]{.underline} Aspirin Prevents Preeclampsia and Complications;
Spinal Manipulation for Low Back Pain; Glucosamine and Chondroitin for
Osteoarthritis; Other: Hypertension in Pregnancy Signals Hypertension
Later; Omega-3 Fatty Acid and Heart Disease in Diabetic Women;
Anticholinergic Therapy for Overactive Bladder Symptoms

ACOG: ACOG Endorses JCAHO\'s Universal Protocol for Preventing Wrong
Site, Wrong Procedure, Wrong Person Surgery

**AHRQ:** A higher rate of cesarean delivery does not necessarily
correspond with better perinatal outcomes; Use of tocolytic therapy to
stop uterine contractions can prolong pregnancy and prevent preterm
birth; Personalized form letters may improve breast and cervical cancer
screening among low-income and minority women; Age, fertility status,
and other factors influence satisfaction with progestin treatment for
abnormal uterine bleeding; Benefits of adding radiation therapy to
tamoxifen after breast conserving surgery diminish with increasing age

**Breastfeeding:** Returning to Work While Breastfeeding; Breastfeeding
and Returning to Work in the Physician\'s Office; Revised American
Cancer Society Guidelines for Breast Cancer Screening, 5/2003

**Elder Care News:** February 1, 2004 Discussion facilitator: Bruce
Finke, IHS Elder Care Initiative Evidence based periodic health
screening for the elderly

**Frequently asked questions:** Should you give prophylaxis for GBS when
performing a scheduled cesarean delivery?

**Hormone Replacement Update**: HRT improves sleep; Thoughts on
individualizing hormone replacement therapy

**Information Technology:** Affordable electronic health record systems

International Health: Low Rate of Mother-to-Child Transmission of HIV-1
After Nevirapine Intervention

#### MCH Alert: Health care quality and disparities in access to services

#### Medscape: Ask the Experts topics in Women\'s Health and OB/GYN; OB GYN & Women\'s Health Discussion Board; Clinical Discussion Board; Free CME

#### Office of Women's Health, CDC: Interested in Federal funding? You may be interested in this web site; Centers for Disease Control and Prevention 2004 Program Announcements

Osteoporosis: **New Guidelines from ACOG: Osteoporosis;** Evidence Based
Practice: Screening for Osteoporosis in Postmenopausal Women; Vertebral
Compression Fractures in the Elderly; Osteoporosis and Health-Related
Quality-of-Life Outcomes; How important is calcium intake to bone health
for postmenopausal women?

Patient Education: Hepatitis B; Birth Control Using a Diaphragm; Using
Your Diaphragm; Returning to Work While Breastfeeding; Painful
Urination; Urinary Tract Infections During Pregnancy; Urinary Tract
Infections in Adults; Urinary Reflux; Urinary Tract Infections in
Children; Osteoporosis

###### Primary Care Discussion Forum: February 1, 2004 Discussion facilitator: Bruce Finke, IHS Elder Care Initiative Evidence based periodic health screening for the elderly

**Violence against women**: General Epidemiology; Improving Screening of
Women for Violence - Basic Guidelines for Physicians; Factors in
Perpetration; Sexual Violence Against Girls; Consequences of Child
Abuse; Substance Abuse in Women Who Have Been Exposed to Violence;
Pregnancy; General Physical and Mental Consequences; Effects on the
Brain; Screening Protocols; Professional Issues Related to Screening;
Intervention; Around the World

The **January 2004 OB/GYN CCC Corner** is available at:\
<http://www.ihs.gov/MedicalPrograms/MCH/M/MCHdownloads/CCCCorner1504.doc>

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, contact Jason
Crim at: [jason.crim@mail.ihs.gov](mailto:jason.crim@mail.his.gov)

2/29/04

Revised 5/4/04njm