Doctors explore the latest advances in contraception

MORNING-AFTER PILL’CDC report: More teen girls use best birth controlBirth control method gainsResearchers at the University of Edinburgh say they’ve found a gene that plays a key role in male fertility, suggesting it could be exploited to develop hormone-free birth control for men.

Until that happens, though, the responsibility for contraception seems likely to remain primarily with women. (A recent University of North Carolina survey, for example, polled 326 female students between the ages of 18 and 45. More than 89 percent said contraceptive responsibility should be shared, but just 51 percent said it actually was in their relationships.)

The search for better, more effective methods of birth control never ends. Tweaking the gene that helps make sperm viable is one of the newer approaches, but older methods (beyond the pill) are constantly revised to improve their safety and efficacy

We asked Dr. Sheila Mody, a contraceptive specialist in the University of California San Diego School of Medicine’s Department of Reproductive Medicine, to review the latest developments.

Q: There has been considerable media coverage recently of newer contraceptive methods, such as hysteroscopic sterilization (Essure), contraceptive implants (Implanon) and the intrauterine device (IUD). Can you explain how these contraceptives work and relative advantages?

A: Essure is a no-incision permanent sterilization method. A small camera is used to go through the vagina and the cervix to visualize the openings of the fallopian tubes in the uterus. Then very small nickel coils are placed in the tubes, which causes scar tissue to form and block them. The scarring process takes three months. This is an outpatient procedure and avoids general anesthesia. It is highly effective with a failure rate comparable to other sterilization methods.

Implanon is a contraceptive implant containing a hormone called progestin. It’s placed under the skin in the upper arm. An Implanon insertion can be done in a clinic and the implant works for up to three years. It’s very effective and completely reversible.

The IUD is a contraceptive method that is becoming increasingly popular. It is a small T-shaped device that’s placed in the uterus. An IUD placement can be done in the clinic. The IUD works up to five or 10 years, depending on the type. Women who have not had children are still eligible to use this method. It does not impact future fertility. It’s a nice alternative to birth control pills because you don’t have to remember to take a pill every day. One type of IUD

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U.S. women in 20s less likely to get pregnant or have abortion

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CDC recommends expanded use of Pfizer vaccine

Reuters – Wed, Jun 20, 2012 (Reuters) - An advisory committee for the Centers for Disease Control and Prevention voted on Wednesday to recommended expanded use of Pfizer Inc's Prevnar 13 vaccine to include adults 19 and older with compromised immune systems due to conditions such as HIV infection, cancer and advanced kidney disease.

The Advisory Committee on Immunization Practices (ACIP)favored the expanded use by a vote of 14-0 with one abstention, the CDC said.

Prevnar 13, one of Pfizer's most important products, prevents pneumococcal pneumonia or invasive disease. Wall Street analysts, on average, have forecast Prevnar 13 sales will reach $6.75 billion by 2016. The company reported sales of $941 million in the first quarter.

"While we view this (recommendation) as an incremental positive, we think the Street expected a positive outcome," ISI Group analyst Mark Schoenebaum said in a research note.

Pfizer shares were off 9 cents at $22.62 in midday trading on the New York Stock Exchange.

Prevnar 13 was initially approved by the U.S. Food and Drug Administration in 2010 for the prevention of invasive pneumococcal disease caused by the 13 serotypes included in the vaccine in infants and children from 6 weeks through 5 years old.

The FDA in December approved Prevnar 13 for adults age 50 and older. ACIP has not yet recommended the vaccine for that patient population.

"We are committed to continuing discussions with the ACIP with the aim of expanding the recommendations to include all adults 50 years of age and older - a population rapidly increasing in the United States and at risk for developing vaccine-type pneumococcal pneumonia and invasive disease," Pfizer said in a statement.

Pfizer is expecting data next year from a Prevnar 13 trial of more than 84,000 subjects 65 and older to determine if the vaccine is effective in preventing the first episode of community-acquired pneumonia caused by the 13 pneumococcal serotypes in the vaccine.

ACIP is likely awaiting results from that trial, called CAPITA, before making a recommendation for the vaccine's use in older adults.

"The key event for Prevnar 13 remains the data readout in 2013 from the CAPITA adult outcomes study," Schoenebaum said.

The vaccine is not approved for those between the ages of 6 and 49.

(Reporting By Bill Berkrot; editing by Maureen Bavdek and Andre Grenon)

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U.S. Teen Pregnancy Rate Continues to Fall

HealthDay – 23 hrs ago WEDNESDAY, June 20 (HealthDay News) -- The teen pregnancy rate in the United States dipped to its lowest recorded level since 1976, a new government report shows.

Teen pregnancy rates fell 40 percent from 1990 to 2008, the latest year for which complete data are available, according to the U.S. National Center for Health Statistics.

The report, which details pregnancy rates for 2006 to 2008 for U.S. women aged 15 to 44, also found pregnancy rates were declining among women in their 20s and increasing among women in their 30s and 40s.

Overall, there was a total of 4,248,000 live births, 1,212,000 induced abortions and 1,118,000 fetal losses in 2008. The estimated pregnancy rate for 2008 was 105.5 pregnancies per 1,000 women aged 15 to 44, which is about 9 percent below the 1990 peak, the new report showed.

The U.S. teen pregnancy rate declined continuously during this time period, except for a brief upturn from 2005 to 2006. This decline was more pronounced in younger teens. The pregnancy rate for teens aged 15 to 17 declined by almost one-half from 1990 to 2008, while the rate for older teenagers declined by about one-third over this time period.

Some racial and ethnic gaps in teen pregnancy rates exist. In 2008, pregnancy rates for black and Hispanic teenagers aged 15 to 19 were two to three times higher than the rates for white teenagers.

The overall decline in teen pregnancy seems to be continuing. The researchers report that more recent birth data for teenagers show that the birth rate has continued to fall from 2008 through 2010.

So what is driving these trends? "The overall fertility has dropped a good bit in this country, and pregnancy rates are also going down, presumably because people are more careful about contraception," said Dr. John Santelli, a pediatrician and adolescent medicine specialist who is the chair of the Heilbrunn Department of Population and Family Health at Columbia University's College of Physicians and Surgeons, in New York City.

"Women are increasingly delaying childbearing into their late 20s, 30s and sometime even their 40s, which will lower the rates right there," he said. The reasons are twofold: Some women are pursuing careers and the contraceptive use has also improved.

There have been pretty consistent declines in the teen birth rate and teen pregnancy rates since 1990. "This is good news," Santelli said.

Media coverage of pregnant teens such as Bristol Palin and the advent of reality shows focusing on teen moms had left many public health experts concerned about the glamorization of teen pregnancy and its potential implications. But these events have had little bearing on the trends so far, he said.

"Bristol Palin standing up for abstinence is not what is going on here," Santelli said. Instead, "this is probably related to better contraceptive use, including some of these newer methods such as long-acting reversible contraceptive methods and access to care."

While 2008 data might already seem outdated in 2012, Santelli explained that it takes a while for states to accrue the information needed to analyze these trends. "Birth rates are pretty fast these days, but abortion reporting can be sluggish, which is why this 2008 data just became available."

The decline in teen pregnancy rates overall is impressive, but gaps by race remain, said Dr. Jill Maura Rabin, an obstetrician/gynecologist at Long Island Jewish Medical Center-North Shore-LIJ Health System in Manhasset, N.Y.

"We know that support is what works best for teens -- especially when they are pregnant," she said. A support network made up of a nurse or other health care provider and a social worker is the best way to prevent a second pregnancy among teens. "It may be that certain teens need more support. We still have a lot of work to do."

Rabin said that pregnancy and birth rates are declining among women in their 20s because of access to emergency contraception and more contraceptive choices including long-acting reversible contraception. "We have better education about these options," she said. "Women are postponing starting a family because of the economy, they want to get their degrees and life expectancy is increasing."

These same women may be more likely to consider getting pregnant in their 30s and 40s due to advances in reproductive endocrinology. "Our toolbox and skills have increased, and we are helping them get pregnant into their 40s," she said. While some older women may have a difficult time getting pregnant, unplanned pregnancy can, and does, occur in this age group, she said.

"Women in the 40s think they can't get pregnant anymore and have unprotected intercourse, but they can," Rabin said. "If you are having intercourse and don't want to be pregnant, use contraception."

There are risks associated with pregnancy at older ages, she added. "Genetic issues increase as eggs age, but we have better testing for genetic disorders today," Rabin said. "Older women are also more likely to develop pregnancy-related complications, but good prenatal care can help identify these conditions early and monitor women so that they have a healthy pregnancy."

More information

Learn about teen pregnancy, contraception and sexual health at the Guttmacher Institute.

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Norway men asked to don condoms for "Sex Hour"

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No link seen between contraceptives and higher HIV risk: CDC

Reuters – 6 hrs ago ATLANTA (Reuters) - There is no clear link between the use of contraceptives such as the birth control pill or Depo-Provera shots and an increased risk that a woman will contract HIV, the U.S. Centers for Disease Control and Prevention said on Thursday.

But the CDC also said it was "strongly" encouraging the use of condoms as a precaution against the virus that causes AIDS.

Recent studies have suggested that the use of hormonal contraceptives could increase the risk of women contracting HIV. But after reviewing the studies, the Atlanta-based CDC said, "the evidence does not suggest" a link between oral contraceptives such as the birth control pill and increased HIV risk.

For injectable forms of birth control such as Depo-Provera the evidence is inconclusive, but in the absence of more definitive research it too is considered safe, CDC officials said.

Women at risk for HIV infection or who already have the virus "can continue to use all hormonal contraceptive methods without restriction," the CDC said.

The World Health Organization reached a similar conclusion last February.

"It's hard to conclusively say whether or not there is an increased risk," from hormonal contraceptives, Dr. Naomi Tepper, a CDC medical officer, told Reuters.

"Because we can't say from the evidence that there is an increased risk, they are all still considered safe, including the injectables."

The studies are particularly confusing with women who use progesterone-only injectables, which in the United States is sold under the brand named Depo-Provera, Tepper said.

A study published last October in The Lancet Infectious Diseases journal suggested that hormonal contraceptives, primarily the injectable forms, could double the risk of women contracting HIV.

For women who already have the disease, hormonal contraceptives could double the risk of transmitting the virus to a partner, according to the study. But Tepper said it was unclear why the contraceptives could increase risk of HIV infection.

The CDC said Thursday that all women at risk of contracting HIV and particularly those using the injectable forms of hormonal birth control, should make sure their partners use condoms as a safeguard against HIV infection.

"All women, if they don't want to become pregnant should be using an effective method of contraception," Tepper said. "And they also should be using something to protect against HIV or sexually-transmitted infections."

In 2010, 10,000 women in the United States were infected with HIV, the CDC said.

Pregnancy can also be medically risky for women with HIV and the disease can be transmitted to the unborn child, the CDC said.

(Editing by Tom Brown and Paul Simao)

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No money for sterilization victims in North Carolina budget

Reuters – 4 hrs ago WINSTON-SALEM, North Carolina (Reuters) - North Carolina's effort to become the first state to compensate people subjected to involuntary sterilizations failed when legislators passed a $20.2 billion budget on Thursday that does not include proposed $50,000 payments for each victim still alive.

The news came as a blow for the 146 verified living victims of a decades-long, state-sanctioned eugenics program that forced sterilizations and castrations on citizens deemed unfit to bear children.

"Many are angry, many of them are just distraught and devastated," said Charmaine Fuller Cooper, executive director of the state-funded N.C. Justice for Sterilization Victims Foundation. "Everyone had gotten their hopes up."

From 1929 to 1974, nearly 7,600 people, mostly women, were sterilized in North Carolina, where the eugenics program endured longer than similar programs in more than 30 U.S. states.

Records indicate that as many as 1,800 victims are still living in North Carolina.

The lump-sum payments for the survivors received support from the Republican-led state House of Representatives and Democratic Governor Beverly Perdue. But the plan did not get the backing of Senate Republicans during budget negotiations.

Critics cited concerns about the costs and said no amount of money would fix the wrongs committed by the eugenics program.

"We all agree with the fact that an apology is certainly appropriate," said Republican state Senator Chris Carney. "But I don't think that makes us any more sorry because we attach a dollar figure to it."

Earlier this year, a state eugenics compensation task force appointed by Perdue recommended awarding $50,000 to each of the living victims of the sterilization program, along with a package of mental health services.

Many of the people targeted by the program were poor, undereducated and institutionalized. While most other states' programs ended after World War Two, the peak years of North Carolina's program were from 1946 to 1968, leaving the state with more living victims as a result.

As part of a campaign in recent years to identify victims for compensation and educate the public about the former program, some of the people who were sterilized came forward and told their stories.

The collapse of efforts to compensate them has left some victims feeling re-victimized, Fuller Cooper said.

"It was never about money," she said. "It was about restoring dignity to people who had that dignity stripped away at a very young age."

The state budget is set to go in effect on July 1. Perdue has 10 days to decide whether she will veto it.

(Editing by Greg McCune and Xavier Briand)

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As Heat Builds, Take Steps to Protect Yourself

HealthDay – 4 hrs ago WEDNESDAY, June 20 (HealthDay News) -- As the first major heat wave of the summer engulfs the continental United States, health experts are urging people to take special precautions when dealing with scorching temperatures and oppressive humidity.

One of the most important things to do is to drink plenty of water throughout the day to avoid dehydration, said Dr. Robert Glatter, an emergency physician at Lenox Hill Hospital in New York City.

Sports drinks that contain electrolytes such as sodium and potassium with small amounts of glucose may help to combat dehydration, Glatter noted, but caffeinated beverages and products with high amounts of sugar can worsen dehydration.

Because children and the elderly are particularly vulnerable to dehydration, they should be checked on often and encouraged to drink lots of fluids, he added.

Many seniors take medications, including diuretics and some blood pressure drugs, that hamper the body's ability to cool itself through sweating, and people who are overweight may also be prone to heat sickness because of their tendency to retain more body heat, according to the U.S. Centers for Disease Control and Prevention.

Along with consuming lots of fluids, try not to stay outside any longer than necessary, Glatter added.

"Stay indoors if possible, preferably in an air-conditioned space," he said. "If only a fan is available, misting with cool water may help to cool you by evaporation."

If you do have to spend time outdoors, wear loose, light-colored clothing and a wide-brimmed hat, to shield yourself from the sun's rays, Glatter noted.

The CDC recommends a "buddy system" when working in the heat, to monitor the health of your co-workers and have them do the same for you. Heat-induced illness can cause a person to become confused or lose consciousness, and you should call 911 immediately if you see this happening.

Even short periods of searing temperatures can cause serious health problems, so the CDC recommends that you listen to local media reports or contact local health departments for safety updates. Overexerting yourself on a hot day, spending too much time in the sun or staying too long in an overheated place can all cause heat-related illnesses.

According to the CDC, there are several types of heat illnesses that you need to watch out for, both in yourself and among others:

Heat stroke happens when the body can't regulate its own temperature. Your ability to sweat stops, and your body is unable to cool down. Your body temperature may rise to 106 degrees Fahrenheit or higher in the space of 10 to 15 minutes. Heat stroke can cause death or permanent disability if emergency treatment is not given. Some of the symptoms include red, hot, dry skin, a rapid and strong pulse, a throbbing headache, dizziness, nausea and confusion. Once these symptoms occur, the victim has to be cooled rapidly using whatever methods you have, which include putting the person in a cool tub of water or a cool shower, spraying the person with a hose or wrapping the victim in a cool sheet. Do not give the victim fluids to drink, and get medical help as soon as possible.Heat exhaustion is a milder form of heat illness that can develop after several days of exposure to high temperatures and lack of fluids. Those most prone to heat exhaustion are elderly people, those with high blood pressure and people working or exercising in a hot environment. Symptoms include heavy sweating, paleness, muscle cramps, fatigue, dizziness, headache, nausea, vomiting or fainting. The skin may be cool and moist, and the pulse rate fast and weak while breathing may be fast and shallow. Help the victim to cool off, and seek medical attention if symptoms worsen or last longer than an hour.Heat cramps typically happen after you sweat a lot during strenuous activity. The low salt level in the muscles may be the cause of heat cramps. Heat cramps may also be a symptom of heat exhaustion. Symptoms include muscle pains or spasms, usually in the stomach, arms or legs. You should stop all activity immediately and sit down in a cool place. Drink clear liquids or sports drinks, and do not return to strenuous activity for a few hours. Seek medical attention if the cramps do not stop within an hour.

More information

For more on heat waves, go to the U.S. Centers for Disease Control and Prevention.

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Health Tip: Take Care of Yourself, Too

HealthDay – 4 hrs ago (HealthDay News) -- People who constantly care for others with emotional and physical problems often become stressed themselves.

Signs of caregiver stress may include weight changes, problems sleeping, depression or frequent bouts of anger.

The Womenshealth.gov website offers these suggestions to help relieve caregiver stress:

Seek help from friends and loved ones, and local community caregiving resources and support groups.Don't be afraid to say "no" to requests that will require too much of your energy and time. Be realistic when setting your goals.Know and accept that you cannot change everything, and recognize that there is no such thing as a perfect caregiver.Stay organized by keeping lists, and prioritizing your responsibilities.Maintain relationships with friends and family, and take time each week to do something that you enjoy.Do your best to maintain a sense of humor.Find time for daily exercise, and keep regular checkups with your doctor.

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Health Tip: Warm Up Before You Exercise

HealthDay – 4 hrs ago (HealthDay News) -- Taking a few extra minutes to warm up before your workout can offer many health benefits.

The American Council on Exercise mentions these examples:

Increased core body temperature, which leads to more efficient calorie burning.Muscles are able to contract more quickly and forcefully.More oxygen is sent to the working muscles due to increased metabolic rate.Better elasticity in the muscles, which reduces the risk of injury.Improved muscle control and range of motion in the joints.More comfortable, longer workouts and improved psychological preparedness to exercise.

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Eating Disorders Hitting Women Over 50, Study Finds

HealthDay – 4 hrs ago THURSDAY, June 21 (HealthDay News) -- Although eating disorders are typically thought of as a problem among teenage girls, many women over 50 practice unhealthy eating behaviors, a new study indicates.

The researchers found that almost 4 percent report binge eating, nearly 8 percent report purging, more than 70 percent diet to lose weight and 62 percent say their weight or shape adversely impacts their lives, according to the report published June 21 in the International Journal of Eating Disorders.

"Everyone -- especially health-care providers -- needs to erase stereotypes about who experiences disordered eating. Women well into their 50s and beyond still report struggling with weight dissatisfaction and a palette of unhealthy behaviors aimed at weight control," said lead researcher Cynthia Bulik, director of the University of North Carolina Eating Disorders Program.

"Our '70 is the new 50' society may be placing additional appearance pressures on women that perpetuate disordered eating practices well into older adulthood," she added.

These messages cause dissatisfaction and lead women toward extreme measures to achieve these "societally concocted ideals," Bulik said.

For the study, Bulik's team collected data on more than 1,800 U.S. women who took part in the Gender and Body Image Study.

Among these women, about 27 percent were obese, 29 percent were overweight, 42 percent were normal weight and 2 percent were underweight, the study authors noted.

About 8 percent of women said they purged in the last five years and 3.5 percent said they had binged in the past month, the investigators found. Most of these women were in their early 50s, but there were also women over 75, the authors said.

In addition, 36 percent of the women said they spent at least half their time in the last five years dieting, 41 percent said they checked their body size or shape daily and 40 percent weighed themselves at least twice a week.

Moreover, 62 percent said their weight or shape had a negative impact on their life, 79 percent said it affected their image of themselves and 64 percent said they thought about it daily.

Many women resorted to unhealthy ways to lose weight, including diet pills (7.5 percent), excessive exercise (7 percent), diuretics (2.5 percent), laxatives (2 percent) and vomiting (1 percent), the researchers found.

In all, 66 percent didn't like their overall appearance. Their dissatisfaction was highest with their stomach (84 percent) and shape (73 percent).

"We simply cannot ignore disordered eating and weight dissatisfaction in women over 50," Bulik said.

"But, we have no idea how to tailor interventions for women over 50 so treatment can be appropriate to their developmental stage in life. That is a critical next step," she said.

Eating disorders can have dire consequences, Bulik noted.

"Anorexia nervosa has the highest mortality rate of any psychiatric illness. Although we do not have clear data on differences in mortality across the age spectrum, we do know that the body becomes less resilient to the physical insults from starvation, binge eating and purging as it ages. So these disorders in older women may lead to even more medical complications because the body bounces back less easily as it ages," she said.

Bulik said there are signs to look out for that may indicate someone has an eating disorder. These include: precipitous weight loss or low weight; withdrawing from family, partner and friends; evidence of binge eating or purging; extremely low self-esteem and body esteem; not eating with the family; avoiding events where there is food.

"Partners can be so helpful, but often do not know what to do. Inform yourself about eating disorders and don't expect the problem just to go away. These are not just passing phases, these are serious and potentially life-threatening disorders that require treatment," she said.

Commenting on the study, Dr. Edith Rubenstein, an attending psychiatrist at Lenox Hill Hospital in New York City, said: "This is an unrecognized problem. It had been thought the problem was much smaller."

But, she added, "All of these weight and shape concerns are taking up a lot of mental space in women in this age group, surprisingly."

There is a growing older population of women who are heavier, which may be contributing to this anxiety about weight and shape, Rubenstein said. These are serious problems that need attention, she explained.

"If you have excessive concerns about weight and shape, if you are obsessing about weight and shape, if you are engaging in unhealthy behaviors like bingeing and purging, you should seek medical attention," Rubenstein advised.

More information

For more on eating disorders, visit the U.S. National Library of Medicine.

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Cancer Survivors Call in Sick to Work More Often, Study Finds

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