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	<title>Birth Story &#187; Journal of the American Medical Association</title>
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	<description>The people, the science and the culture that saved our lives.</description>
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		<title>The art and science of women&#8217;s health</title>
		<link>http://birthstory.net/gynecology/the-art-and-science-of-womens-health/</link>
		<comments>http://birthstory.net/gynecology/the-art-and-science-of-womens-health/#comments</comments>
		<pubDate>Thu, 14 Apr 2011 03:23:12 +0000</pubDate>
		<dc:creator>Delia</dc:creator>
				<category><![CDATA[Gynecology]]></category>
		<category><![CDATA[Public health]]></category>
		<category><![CDATA[breast cancer]]></category>
		<category><![CDATA[Brigham and Women's Hospital]]></category>
		<category><![CDATA[estrogen]]></category>
		<category><![CDATA[heart disease]]></category>
		<category><![CDATA[hormone replacement therapy]]></category>
		<category><![CDATA[HRT]]></category>
		<category><![CDATA[JoAnn E. Manson MD]]></category>
		<category><![CDATA[Journal of the American Medical Association]]></category>
		<category><![CDATA[New York Times]]></category>
		<category><![CDATA[progesterone]]></category>
		<category><![CDATA[Susan Love MD]]></category>
		<category><![CDATA[Tara Parker-Pope]]></category>
		<category><![CDATA[The Women's Health Initiative]]></category>

		<guid isPermaLink="false">http://birthstory.net/?p=5578</guid>
		<description><![CDATA[The Women's Health Initiative, a series of randomized controlled trials begun in 1991, was supposed to be definitive in terms of the role hormone-replacement theory would play in managing the health of post-menopausal women. However, the WHI has yielded unexpected and sometimes apparently inconsistent results. The medical establishment expected the WHI to show that HRT, [...]]]></description>
			<content:encoded><![CDATA[<p><a title="Women's Health Initiative" href="http://www.nhlbi.nih.gov/whi/" target="_blank">The Women's Health Initiative,</a> a series of randomized controlled trials begun in 1991, was supposed to be definitive in terms of the role hormone-replacement theory would play in managing the health of post-menopausal women. However, the WHI has yielded unexpected and sometimes apparently inconsistent results.</p>
<p>The medical establishment expected the WHI to show that HRT, which had been popular for years, helped prevent cancer, heart disease and osteoporosis in older women.</p>
<div>
<dl id="attachment_5562" class="wp-caption alignleft" style="width: 272px;">
<dt class="wp-caption-dt"><img class="size-full wp-image-5562    " title="L'Arlesienne" src="http://birthstory.net/wp-content/uploads/2011/04/LArlesienne.jpg" alt="L'Arlesienne / Vincent van Gogh" width="262" height="362" /></dt>
<dd class="wp-caption-dd">"Sheesh"</dd>
</dl>
</div>
<p>Instead, in 2002 researchers announced in the<a title="JAMA 2002; 288:321-333" href="http://jama.ama-assn.org/content/288/3/321.full" target="_blank"> Journal of the American Medical Association</a> that they had stopped the trials, which involved more than 160,000 women, because participants receiving estrogen combined with progesterone were developing invasive breast cancer at substantially higher rates than were women receiving a placebo, and their rates of heart disease were also high.</p>
<p>HRT, which to that point had been prescribed liberally for post-menopausal women, virtually disappeared as a therapy, in spite of the fact that <a title="Medscape article" href="http://www.medscape.com/viewarticle/442877_4" target="_blank">it did seem to be helping women</a> avoid hip fractures and colon cancer.</p>
<p>Just last week, though,<a title="New study " href="http://jama.ama-assn.org/content/305/13/1305.abstract" target="_blank"> again in JAMA,</a> a group of WHI researchers reported that a smaller study of women who have had a hysterectomy, who were treated with estrogen alone for a median of 10.7 years, showed a <em>decreased</em> breast cancer risk with the treatment, with no significant increase in heart disease.</p>
<p>Well, that's disconcerting. Should post-menopausal women be asking their doctors about HRT after all? Probably not most of them.</p>
<p>“Women are different — it’s relevant to almost every medication and almost every intervention,” Joann E. Manson MD told Tara Parker-Pope in <a title="NYT story on WHI" href="http://www.nytimes.com/2011/04/10/weekinreview/10estrogen.html?sq=body%20politic&amp;st=cse&amp;scp=1&amp;pagewanted=all" target="_blank">a story in last Sunday's New York Times.</a></p>
<p>“With this study, in many ways, science worked the way it’s supposed to work. It’s a little like watching sausage being made. It may seem on the surface that the study was a real problem and had many, many flaws, but in reality, it ended up giving invaluable information,” said Dr. Manson, a WHI investigator who is also chief of preventive medicine at<a title="Brigham and Women's Hospital" href="http://www.brighamandwomens.org/" target="_blank"> Brigham and Women’s Hospital</a> in Boston.</p>
<p>Adds Pope, "The most compelling lesson of the research should be that science is always worth the wait. Consumers should insist that doctors make recommendations based on scientific evidence, say investigators, rather than allowing drug companies or marketing hype to dictate patients’ health care choices."</p>
<p>That's true for middle-aged women, pregnant women, men and parents as well.</p>
<p><em>Image: Vincent Van Gogh's "L'Arlesienne"</em></p>
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		<item>
		<title>Bank on it</title>
		<link>http://birthstory.net/history/bank-on-it/</link>
		<comments>http://birthstory.net/history/bank-on-it/#comments</comments>
		<pubDate>Fri, 30 Jul 2010 16:42:11 +0000</pubDate>
		<dc:creator>Delia</dc:creator>
				<category><![CDATA[Blood]]></category>
		<category><![CDATA[History]]></category>
		<category><![CDATA[People]]></category>
		<category><![CDATA[Bernard Fantus]]></category>
		<category><![CDATA[blood banks]]></category>
		<category><![CDATA[Chicago]]></category>
		<category><![CDATA[Cook County Hospital]]></category>
		<category><![CDATA[Journal of the American Medical Association]]></category>

		<guid isPermaLink="false">http://birthstory.net/?p=3957</guid>
		<description><![CDATA[Bernard Fantus, the Hungarian-born physician who was the director of "therapeutics" at Cook County Hospital in Chicago, Ill., established the first "blood bank" in 1937. Until then, a donor had to be on-site at the time of a blood transfusion. Dr. Fantus also coined the term "blood bank," in an article in the Journal of [...]]]></description>
			<content:encoded><![CDATA[<p><a title="Bernard Fantus" href="http://www.myhero.com/go/hero.asp?hero=Bernard_Fantus_2008" target="_blank">Bernard Fantus,</a> the Hungarian-born physician who was the director of "therapeutics" at <a title="Cook County Hospital" href="http://www.johnstrogerhospital.org/dom/cook.html" target="_blank">Cook County Hospital</a> in Chicago, Ill., established the first "blood bank" in 1937.</p>
<p>Until then, a donor had to be on-site at the time of a blood transfusion.</p>
<p><div id="attachment_3961" class="wp-caption alignright" style="width: 194px"><a href="http://birthstory.net/wp-content/uploads/2010/07/Fantus.3.jpg"><img class="size-full wp-image-3961" title="Bernard Fantus" src="http://birthstory.net/wp-content/uploads/2010/07/Fantus.3.jpg" alt="Bernard Fantus" width="184" height="211" /></a><p class="wp-caption-text">Bernard Fantus</p></div></p>
<p>Dr. Fantus also coined the term "blood bank," in an <a title="JAMA article" href="http://jama.ama-assn.org/cgi/content/summary/109/2/128" target="_blank">article</a> in the<em><a title="JAMA" href="http://jama.ama-assn.org/" target="_blank"> Journal of the American Medical Association</a></em> that year that set out the hospital's methodology in clear, understandable terms.</p>
<p>Other institutions swiftly developed their own blood-storage facilities, and helped themselves to Fantus's catchy term as well.</p>
<p>Cook County's blood-storage innovation came at a critical time, just a few years before the start of <a title="World War II" href="http://history.amedd.army.mil/booksdocs/wwii/blood/default.htm" target="_blank">World War II,</a> when blood donated by people thousands of miles from the battlefronts would make the difference between life and death for a great many injured Allied soldiers.</p>
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		</item>
		<item>
		<title>Swine flu more deadly to pregnant women</title>
		<link>http://birthstory.net/history/swine-flu-deadly-to-pregnant-women/</link>
		<comments>http://birthstory.net/history/swine-flu-deadly-to-pregnant-women/#comments</comments>
		<pubDate>Wed, 21 Apr 2010 11:35:20 +0000</pubDate>
		<dc:creator>Delia</dc:creator>
				<category><![CDATA[History]]></category>
		<category><![CDATA[Maternal mortality]]></category>
		<category><![CDATA[Public health]]></category>
		<category><![CDATA[Alicia M. Siston]]></category>
		<category><![CDATA[antiviral drugs]]></category>
		<category><![CDATA[Centers of Disease Control]]></category>
		<category><![CDATA[H1N1]]></category>
		<category><![CDATA[Hospitals]]></category>
		<category><![CDATA[influenza]]></category>
		<category><![CDATA[intensive care units]]></category>
		<category><![CDATA[Journal of the American Medical Association]]></category>
		<category><![CDATA[pregnancy]]></category>
		<category><![CDATA[seasonal flu]]></category>
		<category><![CDATA[swine flu]]></category>

		<guid isPermaLink="false">http://birthstory.net/?p=3110</guid>
		<description><![CDATA[Pregnant women were more likely to die in last year&#8217;s outbreak of the so-called swine flu than other people were, the Journal of the American Medical Association reports in the issue published today. Pregnant women represent only about 1 percent of the population of the United States, yet they accounted for 5 percent of deaths [...]]]></description>
			<content:encoded><![CDATA[<p>Pregnant women were more likely to die in last year&#8217;s outbreak of the so-called swine flu than other people were, the <em><a title="Journal of the American Medical Assn." href="http://jama.ama-assn.org/cgi/content/abstract/303/15/1517" target="_blank">Journal of the American Medical Association</a></em> reports in the issue published today.</p>
<p>Pregnant women represent only about 1 percent of the population of the United States, yet they accounted for 5 percent of deaths from the H1N1 flu between April and August of 2009, according to an analysis of data from the Centers of Disease Control in Atlanta, Georgia, by Alicia M. Siston, Ph.D., of the CDC, and colleagues.</p>
<p>Taking antiviral drugs soon after they became ill greatly helped pregnant women who were hospitalized.</p>
<p>Of 788 pregnant women who were reported to the CDC to have become ill with H1N1 virus between April and August, 30 died. That was 5 percent of all swine flu deaths for the period. Of 509 women who were hospitalized, 115 were so sick they were admitted to intensive care units.</p>
<p>If they had waited four days after the onset of symptoms to go to a doctor, pregnant women were six times more likely to wind up in an ICU than if they sought treatment after only two days.</p>
<p>Pregnant women should be vaccinated against H1N1, and should be treated quickly with antiviral drugs if they do become sick, the authors recommended.</p>
<p>Two-thirds of the women who died in the final tally for the year were in their final trimester of pregnancy. &#8220;Changes in the immune, cardiac, and respiratory systems are likely  reasons that pregnant women are at increased risk for severe illness  with influenza,&#8221; the authors wrote.</p>
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