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or teardrop-shaped pieces of skin and
acanthosis nigricans or patches of
rough brown to black skin. For more
information, visit http://www.asrm.
org/ or http://www.pcostrategies.org/.
Women Want AdviceRegarding AlterativeMenopause Therapies
Women want information from
their health care providers
about menopause alternatives but per-
ceive their providers as unwilling to
talk about alternatives with them,
according to a study conducted by
researchers at Stanford University and
presented at the 15th Annual Meeting
of the North American Menopause
Society (NAMS) in Washington, DC.
The survey gathered information
about women’s experiences with
menopause symptoms, familiarity with
research developments such as the
Women’s Health Initiative (WHI)
results, use and perceptions of pre-
scription and alternative treatment
options and interactions with health
professionals around these issues. The
WHI results initiated a 74 percent
decrease in prescriptions for Prempro
and other forms of estrogen in 2003,
leaving many women looking for alter-
natives for symptom relief. The survey
yielded rich insight into what women
are currently using to relieve
menopause symptoms and the factors
that influence treatment decisions. The
survey found:
• Nearly as many women (29 percent)
have taken herbal or soy remedies as
those taking hormone therapy (HT)
(35 percent), and almost half of HT
users have tried alternative
supplements to ease their
menopause symptoms
• Of the women surveyed, 43 percent
either consider herbal and soy
products helpful or are increasingly
curious about their use for relieving
menopause symptoms
• A vast majority of premenopausal
(91 percent) and peri-/
postmenopausal women (80
percent) had not discussed herbal
products with their health care
providers
• Only half (53 percent) of peri-/
postmenopausal women taking
December 2004 | January 2005 AWHONN Lifelines 501
Scare Tactics Harmful in Violence Prevention
Programs that rely on “scare tactics” to prevent children and adolescents
from engaging in violent behavior are not only ineffective, but may
actually make the problem worse, according to an independent state-of-the-
science panel convened this week by the National Institutes of Health (NIH).
The panel found that group detention centers, boot camps and other “get
tough” programs often exacerbate problems by grouping young people with
delinquent tendencies, where the more sophisticated instruct the more naive.
Similarly, the practice of transferring juveniles to the adult judicial system can
be counterproductive, resulting in greater violence among incarcerated youth.
The panel highlighted two programs that are clearly effective in reducing
arrests and out-of-home placements:
• Functional Family Therapy
• Multisystemic Therapy
Among the important characteristics that these programs have in common
are a focus on developing social competency skills, a long-term approach and
family involvement.
herbal supplements had disclosed
their use to their health care
providers
• Approximately 30 percent of past
and current HT users were
frustrated that their health care
providers didn’t provide enough
information about herbal and
dietary supplements to relieve
menopause symptoms
The findings related to safety percep-
tions about herbal products amplified
the lack of provider-patient communi-
cation. While proven safety was the
most important factor when women
consider herbal products, more than
70 percent of women expressed at least
some concern or uncertainty about the
safety of these products. In addition,
women aware of the Women’s Health
Initiative were much more likely to
have stopped taking estrogen.
The survey reflects the increasing
number of women who are using
alternative medicine to relieve
menopause symptoms but doing so
without professional guidance. The
authors call for more education for
women about menopause symptom
treatments, including herbal therapies
and HT risks.
Actonel ReducesFracture Risk inOsteopenia
Anew analysis shows that
Actonel (risedronate sodium
tablets) treatment up to three years
significantly reduces the risk of verte-
bral and nonvertebral fragility fracture
by 75 percent in postmenopausal
women with osteopenia. These data
were presented recently at The NAMS
annual meeting.
“Postmenopausal women with a
bone mineral density (BMD) score
above the osteoporosis threshold could
still be at risk of fracture since other
factors besides low BMD contribute to
fracture risk,” said Dr. James A. Simon,
502 AWHONN Lifelines Volume 8 Issue 6
Reducing Maternal Death Worldwide
Every minute of every day, at least one woman in a developing country
dies in childbirth—more than half a million each year. To reduce
maternal deaths, the World Health Organization and the Partnership for
Safe Motherhood and Newborn Health are intensifying support to countries
around the world to ensure that a woman does not die while giving birth to
her child.
The needs are wide ranging—from training skilled birth attendants who
can help a woman give birth safely, to the very basic issue of recording the
cause of a woman’s death. WHO estimates that maternal deaths are underre-
ported by as much as 50 percent because deaths are not classified correctly,
or more often, not counted at all. In 62 countries of the world, there are no
maternal mortality data whatsoever.
Calling the maternal deaths an invisible epidemic, experts affirmed that
pregnancy is a normal state of health and that women should not die giving
birth.
While the main causes of maternal deaths are hemorrhage, infection,
hypertensive disorders, obstructed labor and unsafe abortion, the funda-
mental reasons for the continuing crisis are unavailable, inaccessible or
poor-quality care. The effects are tragically amplified, as some 1 million chil-
dren are left motherless each year. These children are 10 times more likely to
die in childhood than children whose mothers have not died.
Maternal mortality shows a stark divide between rich and poor countries.
In some developing regions, a woman has a 1 in 16 chance of dying in preg-
nancy and childbirth. This compares with a 1 in 2,800 risk for a woman
from a developed region. Sub-Saharan Africa and central south Asia, in par-
ticular, suffer high rates of maternal death. The risk of dying in pregnancy in
the world’s poorest countries is over a hundred times higher than in the
richest ones.
“Beyond the Numbers—Reviewing Maternal Deaths and Complications
to Make Pregnancy Safer” is the new focus for WHO regional and country
offices and partners from more than 20 regional and international agencies,
including UNFPA, UNICEF and the World Bank. This program includes
training health planners and providers in high-risk countries and regions in
the use of six methods to gather information upon which to base actions:
verbal autopsies, reviewing deaths in the community, health facility–based
reviews, confidential inquiries, near-miss case reviews and clinical audit.