Volume 3, No. 6, June 2005

News Flash - Any new solutions to Nausea and Vomiting in Pregnancy?

New Perinatology Corner Module - Nausea and Vomiting in Pregnancy
See What’s New on the MCH page below

CCC Corner Digest - Print friendly Digest of the CCC Corner 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:

Have you had your ‘morning after’ antiretroviral cocktail yet?

From Your Colleagues:

Burt Attico: Only Half of Women Requesting Postpartum Sterilization Undergo the Procedure
Carol Ballew: Community-Based Child Abuse Programs for Tribes and Migrant Workers, NCAST- AVENUW Institute 2005 - Fri/Sat August 5 & 6, 2005, Seattle, WA
Tammy Brown: Seeking Recipes Using Traditional Foods
Zelda Collett-Paule: Prozac is OK in pregnancy, but not for breastfeeding while Zoloft is
Terry Cullen: How to sign up for an Indian Health listserv? Share this with a colleague
George Gilson: Is Gestational Diabetes Mellitus Just a Diagnosis Waiting for a Disease?
Steve Holve: Funds for small projects - Community Access To Child Health (CATCH) Program, June 2005 Highlights: Indian Child Health
Chuck North: Perinatal study at Keams 1979: Not previously published
Phil Smith: Access to CDC's Guide to Community Preventive Services
Judy Thierry: Leading Causes of Death Charts / ICD codes: Enhancement to WISQARS; Ideal for a network supporting women's health
Alan Waxman: Covering Kids Act of 2005 - Bipartisan legislation

Hot Topics:

Obstetrics

-Slight delay in umbilical cord clamping better for preterm infants
-Public versus Private Umbilical Cord Blood Banking: Editorial Green Journal
-Pregnancy-Related Changes in Physical Activity, Fitness, and Strength
-Women with hypoglycemia during OGTT have lower incidence of GDM and neonatal BW
-Does the presence of a funnel increase the risk in a patient with a short cervix?
-And more…

Gynecology

-More effective than povidone iodine in vaginal hysterectomy: Chlorhexidine gluconate
-Transdermal contraceptive promising for reducing bleeding and delaying menses
-Collagen Injections May Be a Reasonable Option for Treating Female Stress Incontinence
-Menorrhagia and Screening for von Willebrand Disease
-Sexual functioning / quality-of-life outcomes similar in RCT of supracervical hysterectomy
-And more…

Child Health

-Risk of Autism: Parent, Pregnancy, and Birth Factors Found Possible Associations
-Screening for Idiopathic Scoliosis in Adolescents: Recommendation Statement, USPSTF

Chronic Illness and Disease

-Women with pregnancy-induced hypertension: Increased risk of metabolic syndrome later
-Improving Adherence to Treatment for Hypertension
-American Cancer Society Guidelines for Early Detection of Cancer Recommendations
-Cognitive Therapy May Be Effective for Moderate to Severe Major Depression
-Untreated Depression Common in Minority Women With Cancer

Features:

AFP

Pregnant Patients with Lupus Have High Rates of Fetal Loss

ACOG
-Urinary Incontinence in Women: Practice Bulletin
-Ob-Gyns Address Health Needs of Underserved Women With New Publication
-Latest ACOG News on Genetic Disorders, Prenatal Tests, DOs and DON'Ts, and Exercise

AHRQ

-Web M+M - Pregnant with Danger
-Most OB/GYNs reluctant to perform first-time cesarean without medical indications
-Caregiver characteristics influence the hospitalization / discharge of elderly women
-Sociodemographic factors affect receipt of preventive care services among women

Ask a Librarian
AskUs Live! Now Available to all Indian Health Staff

Breastfeeding
-Metformin: neither hypoglycemia nor other adverse effects were observed in 3 infants
-Exclusive breastfeeding may reduce postnatal HIV transmission

CCC Corner Digest

-Should we counsel pregnant patients on storage of umbilical cord stem cells?
-Medical Mystery Tour - Mystery Question Asked During Post partum Hemorrhage
-To VBAC, or not to VBAC, that is the question…
-Using the quad screen? (New CME Module) Prenatal Genetic Screening – Serum and US
-Pelvic Floor Muscle Function and Urinary Incontinence: Role for Physical Therapy
-Good Screening Tools for Substance Use: 5 P’s or 4 P’s
-Negative LEEP Is Not Reassuring
-To eat fruit and vegetables or not? Factors in consumers’ decisions
-What are the best ways to quit smoking?
-Intrapartum fetal heart rate monitoring, ACOG Practice Bulletin
-Vitamin C reduced premature rupture of the membranes (PROM)
-Antibiotic Tx for Bacterial Vaginosis Does Not Prevent Preterm Birth
-Young age at first sexual intercourse and STIs in adolescents
-There are 1440 minutes in a day. Make 30 of them active

Domestic Violence

-McCain introduces safety to Indian Women Act
-PREVENT WORKSHOP: Moving Towards Violence Prevention

Elder Care News

-Is your patient with chronic somatic symptoms just depressed?

Family Planning

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

Frequently asked questions

-Is it standard of care to obtain a 2nd ultrasound on low risk patients for a fetal survey?
-What is the Indian Health procedure for HIV screening in pregnancy?
-If a pregnant woman is dependent on opiates, can I treat her addiction?

Hormone Replacement Update

-Use of Soy Not effective for Menopausal Symptoms
-Management of postmenopausal hot flushes with venlafaxine hydrochloride: a RCT
-USPSTF Makes Recommendation Against Routine Use of Estrogen

Information Technology

-Tribal access to NIH library services

International Health

-Considerable evidence to support reinstatement of symphysiotomy, for obstructed labour
-International Electives: Maximizing the Opportunity to Learn and Contribute

MCH Alert
-Summer Fun: Surgeon General issues healthy dozen tips for toddlers
-Follow-up testing among children with elevated screening blood lead levels
-Effectiveness of school based programs to reduce drinking and driving

Medical Myster Tour

-Follow-up: The Case of the Mystery Question

Medscape
-The Prevention and Treatment of Osteoporosis: A Review

Midwives Corner

-Primary Care for Midwives: Two Resources
-Screening for Genital Herpes: USPSTF

Office of Women’s Health, CDC

-Atlas of Heart Disease and Stroke Among American Indians and Alaska Natives 2005
-WISEWOMAN Works, Vol 2: Success Stories on Empowering Women to Stop Smoking

Oklahoma Perspective

-West Nile Virus in Women

Osteoporosis:

-Limitations of Bone Mineral Density Measurements in the Management of Osteoporosis
-What are the effects of treatments to prevent fractures in postmenopausal women?

Patient Education:

-Post-term Pregnancy: What You Should Know
-Wild is better: Farmed Atlantic and wild Pacific salmon contaminated with dioxins

Primary Care Discussion Forum:

-August 1, 2005: Appropriate use of narcotics for chronic non-cancer pain
-Fall 2005: Web based Indian Health M + M

STD Corner

-The National STD-related Infertility Prevention Program
-Ectopic Pregnancy / Reproductive Capacity After Chlamydia Positive and Negative Results
-Chlamydia Screening: Characteristics of Top-Performing Primary Care Offices
-Screening for Gonorrhea: USPSTF Recommendation Statement

Barbara Stillwater, Alaska Dibaetes Prevention and Control

There are 1440 minutes in a day. Make 30 of them active
-Study Links Daily Steps to Specific Health Gains, Costs Saved

What’s new on the ITU MCH web pages:

New Perinatology Corner Module: Nausea and Vomiting in Pregnancy

Any new solutions to Nausea and Vomiting in Pregnancy?

New Perinatology Corner Module: Nausea and Vomiting in Pregnancy

http://www.ihs.gov/MedicalPrograms/MCH/M/NVP01.cfm

Prenatal HIV Screen and Consent Procedures, IHS

http://www.ihs.gov/MedicalPrograms/MCH/M/PROG01.cfm#prenatalHIV

There are several upcoming Conferences

../F/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/perCrnr.cfm

…or just take a look at the What’s New page

wNew.cfm#top

Save the Dates: Upcoming events of interest                

National Summit on Preconception Care

• JUNE 21-22, 2005
• Atlanta, Georgia
• Catalyst for national recommendations for preconception care, CDC
• http://www.signup4.net/Public/ap.aspx?EID=NATI14E

Comprehensive Colposcopy course, ASCCP

• August 4-7, 2005
• San Francisco
• 29 credits, American Society for Colposcopy and Cervical Pathology

Primary Care Provider Training in Addictions

• August 8 - 12, 2005
• Tacoma, WA
• Alcoholism and Substance Abuse Program Branch (ASAPB), IHS
  Clinical Training in American Indian/Alaska Native Alcohol and Other Drug Abuse
  Contact Teresa Sappier, Behavioral Health HQE Teresa.Sappier@ihs.gov

Native Peoples of North America HIV/AIDS Conference

• May 3–6, 2006
• Anchorage, Alaska
• Embracing Our Traditions, Values, and Teachings
• National Institutes of Health (NIH), DHHS

Did you miss something in the last OB/GYN

Chief Clinical Consultant Corner?

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

http://www.ihs.gov/MedicalPrograms/MCH/M/obgyn0505.cfm

Volume 3, No. 5, May, 2005

From Your Colleagues:
Terry Cullen: What is GPRA?
James Galloway: School junk food ban law in Arizona - How about our IHS facilities next?
George Gilson: AI/AN Premature Delivery Rate Higher than the National Average
Sandy Haldane: ACOG / IHS Course - DISREGARD $50.00 fee for late registration
Steve Holve: May 2005 Indian Child Health Notes; Methamphetamine in Indian Country
Ted Mala: American Indian/Alaska Native Health Policy Monograph
Chuck North: Loss of bone mass reversed: Significant gains post DMPA discontinuation
Robert Pittman: Use lindane products as second-line only
Phil Smith: Quality Through Collaboration: The Future of Rural Health Care
Judy Thierry:
-Good Screening Tools for Substance Use: 5 P’s or 4 P’s
-Post GDM care at your site: Anything interesting? What more could be done?
-Feature Highlight: 2005 Prematurity Profile – March of Dimes
-CDC web site with Repro health and SIDS and SUID
-Infant mortality (SIDS/SUIDI) in AIAN and structure of IHS health care
-Federal Registry HP/DP Grant Announcement
-Child abuse prevention Funding
Judy Whitecrane:
-APN / PA Meeting: June 6-10, 2005
-Primary Care Provider Training in Addictions
-Do you want to learn more about VRE, MRSA, and Influenza? Other topics?

Hot Topics:

Obstetrics
-Should we help patients decide on storage of umbilical cord stem cells? Yes
-Brief interventions for prenatal alcohol use reduce subsequent consumption the most
-Time has come to take on the professional responsibility of reducing episiotomy use
-Subcutaneous drain is ineffective in preventing wound complications in obese women
-Cesarean and Vaginal Birth After Previous Cesarean Delivery
-Epidural Analgesia During Labor Increases Risk of Abnormal Fetal Head Position
-Evidence-Based Prenatal Care: Part II. 3rd Trimester Care, Infectious Disease Screening
-Perinatal Depression: Prevalence, Screening Accuracy, and Screening Outcomes: AHRQ

Gynecology
-Testosterone patch effective in hypoactive sexual desire in surgically menopausal
-Negative LEEP Is Not Reassuring
-Human Papillomavirus Quadrivalent Vaccine May Be Effective
-Oophorectomy and Hysterectomy No Curb on Sexuality
-Randomised comparison of microwave endometrial ablation with transcervical resection
-The physiologic effects of pneumoperitoneum in the morbidly obese
-Hypertension Boosts Uterine Fibroid Risk
-Failure to simply get a Pap test often to blame for cervical cancer diagnosis

Child Health
-To eat fruit and vegetables or not? Factors that influence consumers’ decisions
-School nutrition resources
Chronic Illness and Disease
-What are the best ways to quit smoking?
-Screening for Asymptomatic Bacteriuria: Recommendation Statement: USPSTF
-The Living to 100 Life Expectancy Calculator
-Improving the Quality of Care for Adults with Type 2 Diabetes Mellitus
-Acupuncture: a clinical review
-Benefits of Omega-3 Fatty Acids
-One size doesn't fit all
-Evidence-Based Guidelines for Cardiovascular Disease Prevention in Women
-Evaluation of Palpable Breast Masses
-AHRQ Recent Findings: Cardiovascular Disease

Features:

AFP
-Does Lipid Lowering Decrease Stroke Risk?
-Hyperbaric Oxygen Therapy in Patients with Chronic Wounds
-Mammography Screening Intervals Questioned
-Estrogen Increases the Risk of Gallbladder Disease
-Fibroids (Uterine Myomatosis, Leiomyomas) BMJ Clinical Evidence Concise
-Anticonvulsant Medications for Migraine Prevention: Cochrane for Clinicians

ACOG
Intrapartum fetal heart rate monitoring. ACOG Practice Bulletin

AHRQ
-Recent findings
-AHRQ Patient Safety Network (PSNet), the new "one-stop" patient safety portal

Ask a Librarian
Vitamin C reduced premature rupture of the membranes (PROM)

Breastfeeding
-Making Every Mother and Child Count - Through Breastfeeding, One Baby at a Time
-Breast-feeding initiation in low-income women
-Interested in the US Breastfeeding Committee Task Force and Coalition Conference?
-AAP Releases Updated Breastfeeding Recommendations
-Exclusive Breast-feeding May Reduce Risk of Postnatal HIV Transmission

CCC Corner Digest

Highlights include
-Human Papillomavirus ACOG Practice Bulletin
-Burt Attico, Phoenix: DMPA / BMD, and Teens: Recent and Reassuring Data
-Tx for BV or T. vaginalis does not reduce Preterm birth or adverse outcome
-Antibiotics for Recurrent Urinary Tract Infections: Cochrane for Clinicians
-FASlink: The approach is directed at maternal drinking behavior and dose
-Can Patients with Cancer Postpone Death for Important Events?
-Access to the NIH Library web resources being explored - Indian Health Tribal staff
-‘The patch’: Trouble getting it on your formulary?
-Midwifery care of poor and vulnerable women, 1925-2003
-Natural mentoring relationships and adolescent health: evidence from a national study
-A Decline in Life Expectancy in the US
-Should you be using the quad screen?
-Prenatal Genetic Screening – Serum and Ultrasound - New Perinatology Corner Module

Domestic Violence
-Intimate Partner Violence using PRAMS data - group studied age 20+
-AHRQ Recent Findings: Violence Against Women
-McCain introduces safety to Indian Women Act
-PREVENT WORKSHOP: Moving Towards Violence Prevention
-Preventing Sexual and Intimate Partner Violence Within Racial/Ethnic Minorities
-Injury Prevention Fact Sheet Focuses on Child Maltreatment
-Hidden Problem of Child Abuse

Elder Care News
-Funding available to engage elders in service and mentor youth

Family Planning
Oral Contraceptives: Their Mode of Action and Dermatologic Applications

Frequently asked questions
-What types of drug testing are indicated in pregnancy?
-Is it standard of care to obtain a 2nd ultrasound on low risk patients for a fetal survey?
-What kind of availability is necessary for vaginal birth after cesarean? and
-Does there have to be Pediatrician at all emergency deliveries?
-Does the active management of the third stage of labor really work?
-What is the significance of ultrasound (US) ‘soft markers’ for Down Syndrome?
-What are the main risks for expectant mothers in day care settings?
-Do you need help documenting Patient Education or GPRA items?

Hormone Replacement Update
-Estrogen plus progestin: WHI showed relief of menopausal symptoms but adverse effects
-Exercise: Alternative to estrogen for endothelial dysfunction in postmenopausal women
-Black cohosh extract is more effective than placebo in treating climacteric symptoms
-Does Beginning HT Earlier Decrease Mortality?
-The Impact of Comorbidities on Hormone Use

Information Technology
IHS Office of Information Technology (OIT) latest edition of the IT News:

International Health
-10.6 million children die before age five, and half a million women die in childbirth
-Neonatal survival: a call for action
-Make Every Mother and Child Count: The World Health Report 2005
-Some countries will not achieve millennium development goals for health by 2015
-Children having children: The state of the World’s mothers 2004
-Improving Aboriginal Health: First Ministers’ and Aboriginal Leaders’ Meeting

MCH Alert
-Randomized controlled trial: Risk of Adolescent Suicide Screening Programs
-Reduce the Risk of SIDS: New Tools from American Academy of Pediatrics
-Interventions to improve cultural competence among health professionals

Medical Myster Tour
-The Case of the Mystery Question
-Who prescribed that really potent clomiphene in 1978? March Medical Mystery follow-up

Medscape

Midwives Corner
-Antibiotic Treatment for Bacterial Vaginosis Does Not Prevent Preterm Birth
-Elective Cesarean Section; How informed is informed?
-Share These With Women – ACNM Patient/ client hand- outs
-New low and high – Tech calendar methods of family planning
-Herbs and the childbearing woman: Guidelines for midwives

Office of Women’s Health, CDC
Health Characteristics of the American Indian and Alaska Native Adult Population
Oklahoma Perspective
To VBAC, or not to VBAC, that is the question……

Osteoporosis:
-Statins and osteoporosis: a clinical review
-Guidelines Unclear on Screening for Osteoporosis
-AHRG Recent Findings: Osteoporosis

Patient Education:
-Infections During Pregnancy: What You Should Know?
-A Guide to Perimenopause: Patient FAQs - Cleveland Clinic

Primary Care Discussion Forum:
August 1, 2005 - Appropriate use of narcotics for chronic non-malignant (non-cancer) pain

STD Corner
-After the promise: The STD consequences of adolescent virginity promises
-2005 4-Corners STD/HIV Summit June 22 – 24, 2005, Farmington, NM
-Oral versus vaginal sex among adolescents: Perceptions, attitudes, and behavior
-Young age at first sexual intercourse and sexually transmitted infections in adolescents

Barbara Stillwater, Alaska Dibaetes Prevention and Control
-There are 1440 minutes in a day. Make 30 of them active
-Waistline of one meter or more are at serious risk of insulin resistance
-Rosiglitazone Crosses Placenta in First Trimester
-Happy People Are Healthier - Song "Don't Worry, Be Happy," - Sound medical advice
-Depressed diabetics die sooner than depressed non-diabetics
-Be surprised: Portion size, calories, amount of activity needed to expend those calories
-Step Counting Increases Exercise More Than Timed Walking
-Carrying weight around waist increases risk of metabolic syndrome even if BMI is normal
-Diabetes Increases Risk of Urinary Infection in Postmenopausal Women
-National Employee Health & Fitness Day: Wednesday, May 18, 2005

Any new solutions to Nausea and Vomiting in Pregnancy?
New Perinatology Corner Module: Nausea and Vomiting in Pregnancy
http://www.ihs.gov/MedicalPrograms/MCH/M/NVP01.cfm

Prenatal HIV Screen and Consent Procedures, IHS
http://www.ihs.gov/MedicalPrograms/MCH/M/PROG01.cfm#prenatalHIV

There are several upcoming Conferences
../F/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/perCrnr.cfm

…or just take a look at the What’s New page
wNew.cfm#top

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.