The women's health initiative reports in perspective: facts or fallacies?

There are no new data in the Women's Health Initiative. The Collaborative Study of Hormone Factors in breast cancer showed a non-significant increased risk after 5 years. HERS showed an increased risk of cardiovascular disease in HT users with previous heart disease. The Cache County study indicated that estrogen therapy initiated after age 60 increased the incidence of Alzheimer's disease. The daily progestogen in the HT users decreased the estrogen receptors in the coronary arteries and minimized the beneficial direct effect of estrogen. It also decreased progesterone receptors in the endometrium, thus making it less endometrial-protective. The WHI was contrary to previous studies of estrogen therapy because women with specific menopausal symptoms were excluded, were older, had never used estrogen and had long-term estrogen deficiency. It takes healthy tissue to allow an effective response to estrogen and maintenance of health. Maximal benefit of HT may require early onset of treatment, near the time of menopause. However, it is never too late to arrest the progression of osteoporosis and decrease the risk of fracture.     

Safe motherhood: the FIGO initiative.

Over the last twenty years the international community-realizing that the tragedy of women dying during pregnancy and in childbirth could no longer be tolerated-launched a series of initiatives aimed at making safe motherhood a cornerstone of health services in all countries. Making pregnancy and delivery safe events is particularly complex, as it involves infrastructural and logistic, as well as technical, issues. Women die because they have no access to skilled personnel during pregnancy and at the time of delivery and because--if an emergency situation arises--they cannot reach a facility where emergency obstetric services are available. FIGO, the International Federation of Obstetrics and Gynecology-as the only global organization representing the Obstetricians of the world-decided some time ago that it could not limit its activities to proposing technical guidelines and debating scientific issues. It had to move into the field and, through its affiliated societies, help change the ability of the multitude of women in the developing world to obtain skilled attendance at birth. In 1997, plans were made to launch activities in five areas where maternal mortality was particularly high: Central America (Guatemala, Honduras, Nicaragua and El Salvador), Ethiopia, Mozambique, Pakistan, and Uganda. Five member societies from the developed world (the American College of Obstetricians and Gynecologists, the Society of Obstetricians and Gynecologists of Canada, the Italian Society of Obstetrics and Gynecology, the Royal College of Obstetricians and Gynecologists of the United Kingdom; and the Swedish Society of Obstetrics and Gynecology) agreed to provide support to their counterparts in these five selected areas. The project is now in its final stage. Results are, by and large, positive, demonstrating that, by motivating health professionals in the field and for a relatively modest financial outlay, more efficient use of existing services could be made in a sustainable fashion to save lives.     

The baby-friendly hospital initiative increases breastfeeding rates in a US neonatal intensive care unit.

This study evaluated the impact of a Baby-Friendly designation on breastfeeding rates in a US neonatal intensive care unit (NICU). The medical records of all surviving infants directly admitted to the Boston Medical Center's level III, 15-bed NICU in 1995 (before Baby-Friendly policies were implemented) and 1999 (when Baby-Friendly status was granted) were reviewed. Infants receiving any breast milk by any means during the first week of enteral feeds were considered to have initiated breastfeeding. Maternal and infant demographics for 1995 and 1999 were comparable. The NICU breastfeeding initiation rate increased from 34.6% (1995) to 74.4% (1999) (P < .001). Among 2-week-old infants, the proportion receiving any breast milk rose from 27.9% (1995) to 65.9% (1999) (P < .001), and the proportion receiving breast milk exclusively rose from 9.3% (1995) to 39% (1999) (P = .002). The implementation of Baby-Friendly policies leading to a Baby-Friendly designation was associated with increased breastfeeding initiation and duration rates.     

The baby-friendly hospital initiative and breastfeeding at birth in Brazil: a cross sectional study

Background

Breastfeeding in the first hour after birth is important for the success of breastfeeding and in reducing neonatal mortality. Government policies are being developed in this direction, highlighting the accreditation of hospitals in the Baby-Friendly Hospital (BFH) initiative. The aim of this study was to analyze the association between delivery in a BFH (main exposure), compared to non BFH, and timely initiation of breastfeeding (outcome).

Methods

Data came from the “Birth in Brazil” survey, a nationwide hospital-based study of postpartum women and their newborns, coordinated by the Oswaldo Cruz Foundation. A sample of 22,035 mothers/babies was analyzed through a hierarchical theoretical model on three levels, and all analyzes considered the complex sample design. Odds ratios were obtained by logistic regression, with a 99 % CI.

Results

Among all births, 40 % occurred in hospitals accredited or in accreditation process for the BFHI and 52 % of women underwent caesarean section. In the final model, at the distal level, mothers less than 35 years old, and those who lived in the North Region, had a higher chance of timely initiation of breastfeeding. At the intermediate level, prenatal care in the public sector and advice on breastfeeding during pregnancy were directly associated with the outcome. At the proximal level, being born in a Baby-Friendly Hospital and vaginal delivery increased the chance of timely initiation of breastfeeding, while prematurity and low birth weight reduced the chance of the outcome.

Conclusions

The chance of being breastfed in the first hour after birth in Baby-Friendly hospitals was twice as high as at non-accredited hospitals, which shows the importance of this initiative for timely initiation of breastfeeding.

     

The award winning "Completing the circle" complementary therapy service initiative at Christie NHS Hospital Manchester

The complementary therapy team at the Christie Hospital has won a highly prestigious national Prince of Wales award. The award is for "Good Practice in Integrated Healthcare" and applauds the hospital for including complementary therapies as part of patient care at the Christie. His Royal Highness, The Prince of Wales presented The Prince of Wales Foundation for Integrated Healthcare Award to Christie staff at Lambeth Hospital in London on the 11th December 2003 (see picture). The Gateway Clinic at Lambeth Hospital jointly won the award (reference here to a future publication). The Christie Hospital started providing complementary therapies 7 years ago, and the service has greatly expanded in the last 3 years. Patients can choose a complementary therapy treatment in addition to their medical treatment. A 15-strong complementary therapy team provides back and head massages, reflexology and other treatments. The paper reports on the various aspects of the project, identifying who leads each part and how it is being developed and evaluated.     

CEU:Managing menopausal symptoms after the women's health initiative

Until the results of the Women's Health Initiative (WHI) were released in July 2002, hormone replacement therapy (HRT) had been thought to be the most effective way to manage unwanted menopausal symptoms and to prevent long-term health problems associated with aging. The results of the WHI, showing that HRT is less beneficial and associated with more risks than previously thought, has complicated the management of unwanted menopausal symptoms. This article discusses the effectiveness of HRT and other modalities used to relieve menopausal symptoms and discusses how to choose an HRT product to match specific menopausal complaints and provide maximum safety.     

Prophylactic antibiotic administration prior to hysterectomy: a quality improvement initiative

OBJECTIVE: To determine whether institution of a preoperative antibiotic policy could increase the use of prophylactic antibiotics prior to hysterectomy. STUDY DESIGN: A retrospective cohort study of 400 women who underwent abdominal, vaginal or laparoscopic hysterectomy for benign indications at Women and Infants Hospital was performed. Rates and timing of prophylactic preoperative antibiotic administration were determined, as were the rates of postoperative febrile morbidity. These data were compared to data collected in a medical record review of 686 hysterectomies performed prior to institution of the antibiotic policy. RESULTS: Prior to the institution of the antibiotic policy, 50% of patients (342/686, 95% CI 46.0, 53.7) received prophylactic preoperative antibiotics. After introduction of the antibiotic policy, 91.2% (95% CI 88.0, 93.8) of patients received prophylactic preoperative antibiotics. Approximately 66% of the antibiotics were administered within the 60 minutes preceding the surgical incision. Postoperative febrile morbidity was noted in 14% of patients prior to the antibiotic policy as compared to 11% of patients after the policy was instituted. Abdominal surgical approach was found to be a clinically and statistically significant risk factor for febrile morbidity (OR = 7.0; 95% CI 2.3, 20.9). CONCLUSION: Rates of prophylactic preoperative antibiotic administration significantly increased after institution of a hospital policy advocating routine antibiotic prophylaxis prior to hysterectomy. Additional steps must be taken to ensure more routine and appropriately timed administration of antibiotics prior to hysterectomy and to continuously monitor the use of prophylactic antibiotics.     

Preventing unsafe abortion: Achievements and challenges of a global FIGO initiative

FIGO established a Working Group on the Prevention of Unsafe Abortion in 2007 and a parallel program or “Initiative” with the same name. The initiative involved 46 FIGO member societies from seven regions: South-Southeast Asia, Eastern-Central Europe and Central Asia, North Africa and Eastern Mediterranean, Eastern-Central-Southern Africa, Western-Central Africa, Central America and Caribbean, and South America. Each society working in collaboration with the corresponding Ministry of Health and other agencies conducted a situational analysis and prepared a plan of action based on the findings. Such plans of action are continuously monitored by annual evaluation of the progress in the implementation at regional workshops. A substantial progress has been achieved in providing legal and safe abortion services, replacing curettage for manual vacuum aspiration or misoprostol and introducing and expanding postabortion contraception with emphasis on long-acting methods, such as IUDs and contraceptive implants.