Volume 3, No. 2, February 2005

News Flash(s) Plan now

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

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

-17th Annual IHS Research Conference and International 

Meeting on Inuit and Native American Child Health:  April 29-May 1, 2005

New Feature: 

CCC Corner Digest - A print friendly digest of the CCC Corner that can be mailed to you, or 

your colleagues. Just send your address to nmurphy@scf.cc

Direct Links to Topic Content: Abstract of the Month | From Your Colleagues | Hot Topics | Features

Links to Topic Summaries:

Topic Summaries Abstract of the Month From Your Colleagues Hot Topics Features Miss Something?

Contents:

Abstract of the Month:

LEEP Treatment Increases Risk of Preterm Delivery in Future Pregnancies 

From Your Colleagues:

Elaine Locke: Free Job Postings for Indian Facilities on ACOG Career Connection

Sandra Haldane: Web portal linking all HHS.gov sites to breast cancer information 

-Women and Medication Safety: Special Journal Issue Is Available Online 

Steve Holve How common is Methamphetamine use in your area? Feb ’05 ICHN available

Jean Howe: Announcing the new Deputy Chief Clinical Consultant

Yolanda Meza: Routine suctioning of meconium-stained before delivery of the shoulders?

Suzan Murphy: Methamphetamine abuse and breastfeeding

Chuck North: Patients with more than one medical condition: How can guidelines help? 

-Single digit need to treat (NNT) obesity are remarkable statistics - should spur us on 

Lori de Ravello: Contraceptive Methods Among Women: Quickstats

Judy Thierry: Discourage use of infant car seats as long term sleep environments

-Training for Nursery Room Nurses on Back to Sleep

-Tony Dekker, M.D. New Addiction Medicine Chief Clinical Consultant (CCC)

-The Chief Clinical consultants - are available for your consultation

-What is the definition of ‘preventable or avoidable maternal death?

Judy Whitecrane: It makes it easy for moms to remember:  2 days, 2 weeks, and 2 months

Hot Topics:

Obstetrics:

-Severe Preeclampsia and Eclampsia: Systolic Hypertension Is Also Important

-Progesterone Treatment Decreases Preterm Birth Rate

-Ripening of the Cervix and Risk for Later Preterm Birth

-Ginger May Relieve Nausea During Early Pregnancy

-Effect of Episiotomy on Pelvic Floor Weakness

Gynecology:

-Sexual Function After Hysterectomy

-Screening for Ovarian Cancer: Recommendation Statement

-Limitations of Screening Tests for Asymptomatic Chlamydia

-Abnormal Uterine Bleeding: Surgical or Medical Therapy?

-Endometriosis and Subfertility: Is the Relationship Resolved?

Child Health:

-Gender bias in child growth evaluations may miss disease in girls

-Recommended Childhood and Adolescent Immunization Schedule, United States, 2005

-Protective effects of firearm storage practices for children

-Dramatic decline in varicella related mortality: Impact of vaccine

-Oral health is looking to better capture the topical fluoride applications

Chronic Illness and Disease:

-Quality of Care May Decline as Physicians Age

-Chronic disease antecedents arise in utero and infancy

-JAMA Editorialist recommends the "low fad" approach

-Diabetes Mellitus in Women: Adolescence Through Pregnancy and Menopause

-Irritable Bowel Syndrome: Clinical Evidence Concise - BMJ

Features:

AFP:
-Radio-Frequency Endometrial Ablation for Menorrhagia

-Esterified Estrogen and Venous Thrombotic Risk

-Physical Therapy and Stress Urinary Incontinence

-Lactobacillus Does Not Prevent Post-Antibiotic Vaginitis

-Antidepressants and Smoking Cessation 

ACOG:
- Coping With the Stress of Medical Professional Liability Litigation 

AHRQ:
- Computerized Order Entry Leads to Unwanted Testing- Web M + M
- Clinical Ethics

-Women who have given birth only via cesarean are less likely than those with vaginal -deliveries to report stress incontinence

Ask a Librarian
-Infant Mortality:  Bad News, Good News

Breastfeeding:
- American Academy of Pediatrics Revised policy on Breastfeeding

CCC Corner Digest: A compact digest of last month’s CCC Corner - Highlights include: 

Depo Provera and bone loss

Oral rehydration solution – reverse transfer of technology

What maneuver is in best in shoulder dystocia?

Midwives serving in Indian Country

Marriage may be good for you
Consumer Reports evaluates condoms, and 16 other contraceptive methods

Bariatric surgery may be a viable treatment option in severe obesity, etc… 

Domestic Violence:

-Intimate Partner Violence During Pregnancy APRIL 2005 MCH EPI GRAND ROUNDS

-Primary Care Discussion Forum: Domestic Violence in AI/AN - Just finished

-Assaults during pregnancy: both immediate and long-term adverse neonatal outcomes

Elder Care News:

-Caring for elders at home: what is the best bath strategy?

-Cultural Diversity at the End of Life: Issues and Guidelines

-Management of Hypertension in Older Persons

-White House Conference on Aging

Family Planning:

-Do combination hormonal contraceptives cause weight gain?

-Availability and Use of Publicly Funded Family Planning Clinics

Frequently asked questions:

What is the Indian Health policy on use of chaperones?

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

The ‘quad’ second trimester screening test is expensive. Is it worth it?

How can you predict if a placenta previa will persist based on US at 15-24 weeks?

Hormone Replacement Update:

Benefits and Risks of Estrogen in Postmenopausal Women

Information Technology:

Free CME from Harvard to 60 of our providers

International Health:

Institute for OneWorld Health -- A Not-for-Profit Pharmaceutical Company

MCH Alert

Medscape

Midwives Corner

Office of Women’s Health, CDC:

-Cesarean Rate Highest Ever

Osteoporosis:

-“Uncertain Role” of Biochemical Markers Use in Osteoporosis Therapy

-Fracture Protection Lost Five Years After Stopping Hormone Replacement Therapy

-Impact of Intense Exercise on Early Osteopenia in Women

Patient Education:

-Painful Menstrual Periods

-Urinary Tract Infections

-Pelvic Floor Muscle Exercises

-Microscopic Hematuria

-Heart Palpitations

Primary Care Discussion Forum:

-April 1, 2005: Methamphetamine use in Indian Country

Barbara Stillwater, Alaska Diabetes Prevention and Control:

-Walk 2000 More Steps a Day and Never Gain Another Pound

-Fit And Fat Not Good Enough

-15-Year Study Shows Link Between Fast Food, Obesity and Insulin Resistance

-How Well Do Adults Follow Prescriptions for insulin?

What’s new on the ITU MCH web pages:

Save the Dates: Upcoming events of interest                

Did you miss something in the last OB/GYN

Chief Clinical Consultant Corner?

The January 2005 OB/GYN CCC Corner is available at:

http://www.ihs.gov/MedicalPrograms/MCH/M/obgyn0105.cfm

Volume 3, No. 1, January, 2005

Abstract of the Month:        page 3

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

From your colleagues:       page 4

Burt Attico: Smoking During Pregnancy Tied to Gestational Diabetes Risk

Donna Brown: Hand foot and mouth disease in pregnancy

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

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

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

Chuck North: Serving Native American Communities 

Lori de Ravello: National Summit on Preconception

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

Hot Topics:          

Obstetrics:          page 7

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

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

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

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

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

Gynecology:          page 8

-Passive smoking increases the risk of cervical neoplasia

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

Child Health:          page 8

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

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

Chronic Illness and Disease:        page 8

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

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

-High Folate Intake May Reduce Risk of Hypertension in Women

-Women With Diabetes Do Worse After Stenting

-Premature birth and later insulin resistance

Features:          page 9

American Family Physician

-Imaging for Suspected Appendicitis

ACOG

- Intrauterine Device - ACOG Practice Bulletin NUMBER 59

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

AHRQ

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

Ask a Librarian

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

Breastfeeding

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

- State Legislation on Breastfeeding     

Domestic Violence

-Sexual assault is associated with significantly higher levels of PTSD

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

Elder Care News

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

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

-Palliative Care resource for hospitals and clinics

Family Planning

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

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

Frequently asked questions

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

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

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

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

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

Hormone Replacement Update

-Venlafaxine significantly decreases postmenopausal patient-perceived hot flush score

Information Technology

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

International Health

-Lifelong accumulated racial discrimination by African American: Preterm delivery

MCH Alert

-National Birth Defects Prevention Month

Medscape

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

Midwives Corner

-Midwives Serving Indian Country

Office of Women’s Health, CDC

-Marriage may be good for you

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

Osteoporosis

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

-Effect of Vitamin D on falls: a meta-analysis

Patient Education

-Maternal Child Health Patient Education: new web page envisioned

Primary Care Discussion Forum

-Surgery for obesity? February 2005

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

What’s new in Sexually Transmitted Diseases?

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

Barbara Stillwater, Alaska Diabetes Prevention and Control

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

-Dietary Guidelines for Americans 2005

What’s new on the ITU MCH web pages     page 17

Save the Dates: Upcoming events of interest     page 18

The past CCC Corners are archived at:

http://www.ihs.gov/MedicalPrograms/M C H/M/OBGYN02.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@SouthCentralFoundation.com

or 907 729 3154 (with voicemail)

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

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OB/GYN

Dr. Neil Murphy is the Obstetrics and Gynecology Chief Clinical Consultant (OB/GYN C.C.C.). Dr. Murphy is very interested in establishing a dialogue and/or networking with anyone involved in women's health or maternal child health, especially as it applies to Native or indigenous peoples around the world. Please don't hesitate to contact him by e-mail or phone at 907-729-3154.