Trial Proceedings
Chen's attorneys said that despite multiple setbacks local authorities prevented them from presenting a strong defense, the New York Times reports (Kahn, New York Times, 11/27). Chen's attorneys also said there were occasions for optimism during the 10-hour proceedings on Monday despite multiple setbacks, the Washington Post reports. "In the morning, the prosecutor interrupted us all the time, and the judge was always on the prosecutor's side," Li said, adding, "In the afternoon, the prosecutors tried to interrupt us about 20 to 30 times, but this time, the judge mostly denied their objections" (Fan, Washington Post, 11/28). According to the AP/ABC News, Li walked out of the courtroom midway through the proceedings to protest what he said was unfair treatment and interference by local authorities. Two of Li's witnesses could not be found before the trial, and Li said he saw a third, Chen Guanghe, being taken away on Sunday by eight men he believes were police officers in civilian clothing or men with ties to the police, the AP/ABC News reports. Li said he was prevented from collecting evidence and was assaulted on Sunday by a group of 30 people in Dongshigu, China (AP/ABC News, 11/27). Three witnesses -- including Chen's wife, Yuan Weijing, and brother, Chen Guangqing -- were allowed to testify for the defense, and Chen was allowed about 30 minutes to defend himself, the South China Morning News reports (Ma, South China Morning News, 11/28). Yuan said that she was questioned by police on Tuesday, the AP/International Herald Tribune reports (Ang, AP/International Herald Tribune, 11/28). Teng Biao, also one of Chen's attorneys, was detained by the police for about four hours for questioning during the trial. According to Reuters, an unnamed court official said the trial was an "ordinary case," but he declined to provide details (Kang Lim, Reuters, 11/27). A verdict is expected within a month, Li said, adding that he expects the court to uphold the charge of damaging public property, which carries a maximum sentence of seven months (AP/ABC News, 11/27).
"Reprinted with permission from kaisernetwork. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at kaisernetwork/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork, a free service of The Henry J. Kaiser Family Foundation . © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.
суббота, 30 июля 2011 г.
Retrial For Human Rights Advocate Chen Guangcheng Ends Without Verdict
The retrial for human rights advocate Chen Guangcheng -- who was arrested in China after attempting to bring a class-action lawsuit against the government for alleged human rights abuses associated with the enforcement of the country's one-child-per-family policy -- ended on Monday with no verdict, the AP/ABC News reports (Ang, AP/ABC News, 11/27). Chen has recorded testimony from men and women in communities in and around China's Linyi province who have experienced forced abortions and sterilizations. Chen in August was sentenced by a court in China's Shandong province to four years and three months in prison for allegedly "willfully damaging property" and "organizing a mob to disturb traffic." An appeals court in Shandong in October ordered the retrial. According to Li Jingsong, one of Chen's attorneys, the Linyi City Intermediate Court overturned the sentence "because the process of the first trial was unfair, and facts and evidence ... were not tenable and did not hold water" (Kaiser Daily Women's Health Policy Report, 11/1).
суббота, 23 июля 2011 г.
Is It All In The Head? - Understanding Psychosexual Disorders In Women, UK
A new paper to be published in The Obstetrician & Gynaecologist ( TOG ) reviews existing scientific knowledge of women's sexual dysfunction and examines the different types of recognised psychosexual disorders to increase awareness of these issues amongst doctors.
Sexual dysfunction has been reported in 43% of women and most of these difficulties focus around areas such as desire, arousal, orgasm and sexual pain. A review carried out by the American Psychiatric Association in 1999 expanded these fields to include physical and psychological causes. The existence of non-coital pain disorder was also noted.
It is now widely accepted that responsive desire, triggered by mental and physical arousal, occurs in the majority of women, rather than spontaneous desire, which is less common. These problems are a result of a combination of biological, interpersonal, environmental and psychological factors that impact on a woman's reaction to sex.
The authors recognise that gynaecological conditions and procedures can be distressing for some women. Although overall sexual wellbeing improves after some forms of gynaecological treatment such as a hysterectomy, some women miss the sensations felt before surgery. Negative obstetric experiences such as birth trauma are also known to affect women's sexual response to stimuli. Other forms of treatment, whether drug-based or in the form of radiotherapy, have also been known to affect women's desire.
The common sexual disorders are:
- Sexual desire disorder - usually a result of personal experiences and cultural programming. Depression can have an effect and hormonal treatment is usually used.
- Sexual arousal disorder - a combination of physical and psychological factors. Pre-existing conditions such as diabetes or previous injuries may have an impact. Pharmacological treatment is used alongside physical treatment such as the use of lubricants.
- Orgasmic disorder - more common among younger women. Cognitive behavioural therapy, sexual education and Kegel exercises often used as treatment.
- Sexual pain disorder - (Dyspareunia) a physical condition that occurs when pain is experienced during penetration, usually a result of muscle tension in the vulva or pelvis. It is sometimes associated with dermatological conditions such as psoriasis and sometimes misdiagnosed as recurrent thrush. Vaginismus is also a physical condition but often a result of phobias caused typically by childhood sexual trauma or a background of severely oppressive religious orthodoxy. A combination of counselling and physical treatment such as the use of vaginal trainers has been known to help patients.
The authors recommend that doctors should be sympathetic to the sensitive nature of these sexual problems. They must have detailed notes of the woman's medical, pain, psychological and sexual history and need to have an understanding of the psychosexual function and the ability to communicate about these matters in a non-judgemental, non-intrusive manner.
Clinicians should also have some understanding of non-verbal communications in order to identify when women are feeling tense and anxious, and if they are displaying behaviours (such as complaining about pelvic pain, distress about having periods or disassociation during the time of genital examination) that reveal an underlying problem. A multidisciplinary approach is recommended and clinicians should have access to vulval pain clinics and a psychologist, therapist or psychosexual medical specialist, in order to provide good quality care.
Dr Catherine Coulson, from the Department of Reproductive Medicine at St Michael's Hospital in Bristol, who co-authored the paper said " Desire disorders become more common as women get older and are affected to an extent by hormones. Loss of desire may be experienced at the menopause regardless of age and is often reported after a surgically induced menopause.
"Similarly, a loss of desire may be a result of a previous experience of pain, guilt, shame, embarrassment or awkwardness. As a result, the woman may have learned to keep a tight rein on her emotions generally to avoid conflict or to suppress her anger.
"Some sexual problems need more time and expertise than is available in a general gynaecology clinic. However listening to the patient in an active way, understanding the exact nature of the problem and its impact on the woman and her relationship, if she has one, can in itself be therapeutic."
Professor Neil McClure, TOG editor-in-chief said, "There is much cross-over in the study of women's sexual dysfunction between medicine and psychology. As clinicians, we need to understand the complex layers of physical, psychological and social reasons why women sometimes have these difficulties if we are to provide women with the care they need.
"What is important is that gynaecologists have the appropriate training and skills to manage women presenting with psychosexual problems and that they are always vigilant in their identification."
The Obstetrician & Gynaecologist ( TOG ) is published quarterly and is the Royal College of Obstetricans and Gynaecologists' (RCOG) medical journal for continuing professional development. TOG is an editorially independent, peer reviewed journal aimed at providing health professions with updated information about scientific, medical and clinical developments in the specialty of obstetrics and gynaecology.
Reference
Coulson C, Crowley T. Current thoughts on psychosexual disorders in women. The Obstetrician & Gynaecologist 2007: 9 :217-222.
rcog
Sexual dysfunction has been reported in 43% of women and most of these difficulties focus around areas such as desire, arousal, orgasm and sexual pain. A review carried out by the American Psychiatric Association in 1999 expanded these fields to include physical and psychological causes. The existence of non-coital pain disorder was also noted.
It is now widely accepted that responsive desire, triggered by mental and physical arousal, occurs in the majority of women, rather than spontaneous desire, which is less common. These problems are a result of a combination of biological, interpersonal, environmental and psychological factors that impact on a woman's reaction to sex.
The authors recognise that gynaecological conditions and procedures can be distressing for some women. Although overall sexual wellbeing improves after some forms of gynaecological treatment such as a hysterectomy, some women miss the sensations felt before surgery. Negative obstetric experiences such as birth trauma are also known to affect women's sexual response to stimuli. Other forms of treatment, whether drug-based or in the form of radiotherapy, have also been known to affect women's desire.
The common sexual disorders are:
- Sexual desire disorder - usually a result of personal experiences and cultural programming. Depression can have an effect and hormonal treatment is usually used.
- Sexual arousal disorder - a combination of physical and psychological factors. Pre-existing conditions such as diabetes or previous injuries may have an impact. Pharmacological treatment is used alongside physical treatment such as the use of lubricants.
- Orgasmic disorder - more common among younger women. Cognitive behavioural therapy, sexual education and Kegel exercises often used as treatment.
- Sexual pain disorder - (Dyspareunia) a physical condition that occurs when pain is experienced during penetration, usually a result of muscle tension in the vulva or pelvis. It is sometimes associated with dermatological conditions such as psoriasis and sometimes misdiagnosed as recurrent thrush. Vaginismus is also a physical condition but often a result of phobias caused typically by childhood sexual trauma or a background of severely oppressive religious orthodoxy. A combination of counselling and physical treatment such as the use of vaginal trainers has been known to help patients.
The authors recommend that doctors should be sympathetic to the sensitive nature of these sexual problems. They must have detailed notes of the woman's medical, pain, psychological and sexual history and need to have an understanding of the psychosexual function and the ability to communicate about these matters in a non-judgemental, non-intrusive manner.
Clinicians should also have some understanding of non-verbal communications in order to identify when women are feeling tense and anxious, and if they are displaying behaviours (such as complaining about pelvic pain, distress about having periods or disassociation during the time of genital examination) that reveal an underlying problem. A multidisciplinary approach is recommended and clinicians should have access to vulval pain clinics and a psychologist, therapist or psychosexual medical specialist, in order to provide good quality care.
Dr Catherine Coulson, from the Department of Reproductive Medicine at St Michael's Hospital in Bristol, who co-authored the paper said " Desire disorders become more common as women get older and are affected to an extent by hormones. Loss of desire may be experienced at the menopause regardless of age and is often reported after a surgically induced menopause.
"Similarly, a loss of desire may be a result of a previous experience of pain, guilt, shame, embarrassment or awkwardness. As a result, the woman may have learned to keep a tight rein on her emotions generally to avoid conflict or to suppress her anger.
"Some sexual problems need more time and expertise than is available in a general gynaecology clinic. However listening to the patient in an active way, understanding the exact nature of the problem and its impact on the woman and her relationship, if she has one, can in itself be therapeutic."
Professor Neil McClure, TOG editor-in-chief said, "There is much cross-over in the study of women's sexual dysfunction between medicine and psychology. As clinicians, we need to understand the complex layers of physical, psychological and social reasons why women sometimes have these difficulties if we are to provide women with the care they need.
"What is important is that gynaecologists have the appropriate training and skills to manage women presenting with psychosexual problems and that they are always vigilant in their identification."
The Obstetrician & Gynaecologist ( TOG ) is published quarterly and is the Royal College of Obstetricans and Gynaecologists' (RCOG) medical journal for continuing professional development. TOG is an editorially independent, peer reviewed journal aimed at providing health professions with updated information about scientific, medical and clinical developments in the specialty of obstetrics and gynaecology.
Reference
Coulson C, Crowley T. Current thoughts on psychosexual disorders in women. The Obstetrician & Gynaecologist 2007: 9 :217-222.
rcog
суббота, 16 июля 2011 г.
Accounting For Temporal Changes In Health Practices When Calibrating Models
The introduction and subsequent widespread use of the Papanicolaou (Pap) test has considerably reduced rates of cervical cancer in the last 50 years. The study entitled, "Calibrating Longitudinal Models to Cross-Sectional Data: The Effect of Temporal Changes in Health Practices," published in Value in Health, and performed by Douglas Taylor and colleagues, found that a considerable bias was introduced in the results of a cervical disease model when historical changes in cervical screening practices were not considered in the calibration process.
According to study author Dr. Milton Weinstein, "This study demonstrates that it is important for calibrated health care models to take into account temporal changes in clinical practices in order to more accurately reflect the effects of new interventions."
Source:
ISPOR
According to study author Dr. Milton Weinstein, "This study demonstrates that it is important for calibrated health care models to take into account temporal changes in clinical practices in order to more accurately reflect the effects of new interventions."
Source:
ISPOR
суббота, 9 июля 2011 г.
Time To Transplant Bridged For More Women Using Smaller Heart Pump
A small, implantable device that helps the heart pump blood works equally well for men and women but may benefit twice as many women awaiting transplants, researchers reported at the American Heart Association's Scientific Sessions 2007.
"The fact that we have a technology where the outcomes in women are equal to men is important," said Roberta C. Bogaev, M.D., lead author of the study and medical director of heart failure and cardiac transplantation at the Texas Heart Institute in Houston. "Historically, because of their size, such devices have been unavailable to women of small stature. Now that we have a pump about the size of a D battery, it will allow us to expand mechanical circulatory support options to more women."
The device, called The HeartMate II, is an implantable left ventricular assist device (LVAD) that supports the heart for patients with severe congestive heart failure and minimal medical options. It's powered by a battery-run unit worn outside the body.
The U. S. Food and Drug Administration is reviewing the manufacturer's request to approve use of the experimental pump in heart failure patients.
The phase II study participants received the LVAD as a "bridge" to keep them alive until a donor heart became available.
The trial involved 231 patients with advanced heart failure, 52 (23 percent) of them women, who were treated at 40 heart transplant centers in the United States.
"This is the first trial to include this many women," said Bogaev, who is also assistant professor of medicine at Baylor College of Medicine in Houston. "Most ventricular assist device trials before HeartMate II enrolled less than 10 percent women."
Women in the study were 20 to 69 years old (average age 56). The men were 17 to 68 (average age 54). The cause of heart failure was more likely to be coronary artery disease in men (43 percent) than in women (31 percent). The women tended to have suffered a weakened heart because of pregnancy, cancer chemotherapy, a viral infection, or unknown cause of heart failure.
Some study participants -- six at the Texas Heart Institute alone -- recovered sufficient pumping power to have the device removed and did not require a transplant operation. This can happen when heart failure patients are treated with a ventricular assist device and have a potentially reversible cause of the heart failure.
"They are not sitting in a recliner at home," Bogaev said. "These patients have been able to leave the hospital and return to their normal active life due to the support this device offers."
Among the study's findings:
* For the 194 patients with six-month follow-up data, survival was almost the same for both genders -- 79.5 percent for women and 80.6 percent for men -- among those who had undergone a heart transplant, had their LVAD removed after regaining ventricular function, or remained on the device.
* The average time patients remained on the pump was 175 days for women (range -- 8 to 667 days) and 130 days for men (range -- 0 to 693 days).
* A weakening of contraction in the heart's right ventricle, which required temporarily implanting a right ventricular device, occurred in 10 patients, 9 percent of the women and 4 percent of the men. "What that suggests to me is that the women enrolled in this trial may have presented with more advanced heart failure," Bogaev said. "Now that we have the option of a smaller device, physicians should not delay in referring women for ventricular assist devices."
* Six patients, 3.3 percent women and 2.2 percent men, experienced strokes within two days after their surgery. Twelve patients (13.6 percent women and 5 percent men) suffered strokes more than two days after surgery. "Since this is a small number of patients, we will need to continue to follow patients with this device to determine if this is a significant finding between men and women," Bogaev said.
* After three months of LVAD support, 76 percent of women and 57 percent of men had increased the distance they could walk in six minutes by more than 200 meters (about 656 feet).
* At three months, 84 percent of women and men had New York Heart Association Class I and Class II heart failure symptoms (no or slight limitations on physical activity). When they entered the trial, all patients had Class IV symptoms (unable to carry out any physical activity without discomfort).
* The 11 smallest patients receiving the LVAD were females and all of them remained alive at the six-month follow-up.
"This smaller device is well suited for women and small men, who previously have not had the option of mechanical circulatory support," Bogaev said. "At the Texas Heart Institute, we've been able to increase the percentage of women who benefit from LVADs from 7 percent to 37 percent."
Co-authors are Leway Chen, M.D.; Stuart D. Russell, M.D.; Joseph G. Rogers, M.D.; David J. Farrar, Ph.D.; and Stephanie A. Moore, M.D.
Thoratec Corp., the device manufacturer, funded the study. Dr. Farrar is the company's vice president for research and scientific affairs. The other co-authors are consultants and serve on an advisory board to Thoratec. Statements and conclusions of study authors that are presented at American Heart Association scientific meetings are solely those of the study authors and do not necessarily reflect association policy or position. The American Heart Association makes no representation or warranty as to their accuracy or reliability.
Source: Karen Astle
American Heart Association
"The fact that we have a technology where the outcomes in women are equal to men is important," said Roberta C. Bogaev, M.D., lead author of the study and medical director of heart failure and cardiac transplantation at the Texas Heart Institute in Houston. "Historically, because of their size, such devices have been unavailable to women of small stature. Now that we have a pump about the size of a D battery, it will allow us to expand mechanical circulatory support options to more women."
The device, called The HeartMate II, is an implantable left ventricular assist device (LVAD) that supports the heart for patients with severe congestive heart failure and minimal medical options. It's powered by a battery-run unit worn outside the body.
The U. S. Food and Drug Administration is reviewing the manufacturer's request to approve use of the experimental pump in heart failure patients.
The phase II study participants received the LVAD as a "bridge" to keep them alive until a donor heart became available.
The trial involved 231 patients with advanced heart failure, 52 (23 percent) of them women, who were treated at 40 heart transplant centers in the United States.
"This is the first trial to include this many women," said Bogaev, who is also assistant professor of medicine at Baylor College of Medicine in Houston. "Most ventricular assist device trials before HeartMate II enrolled less than 10 percent women."
Women in the study were 20 to 69 years old (average age 56). The men were 17 to 68 (average age 54). The cause of heart failure was more likely to be coronary artery disease in men (43 percent) than in women (31 percent). The women tended to have suffered a weakened heart because of pregnancy, cancer chemotherapy, a viral infection, or unknown cause of heart failure.
Some study participants -- six at the Texas Heart Institute alone -- recovered sufficient pumping power to have the device removed and did not require a transplant operation. This can happen when heart failure patients are treated with a ventricular assist device and have a potentially reversible cause of the heart failure.
"They are not sitting in a recliner at home," Bogaev said. "These patients have been able to leave the hospital and return to their normal active life due to the support this device offers."
Among the study's findings:
* For the 194 patients with six-month follow-up data, survival was almost the same for both genders -- 79.5 percent for women and 80.6 percent for men -- among those who had undergone a heart transplant, had their LVAD removed after regaining ventricular function, or remained on the device.
* The average time patients remained on the pump was 175 days for women (range -- 8 to 667 days) and 130 days for men (range -- 0 to 693 days).
* A weakening of contraction in the heart's right ventricle, which required temporarily implanting a right ventricular device, occurred in 10 patients, 9 percent of the women and 4 percent of the men. "What that suggests to me is that the women enrolled in this trial may have presented with more advanced heart failure," Bogaev said. "Now that we have the option of a smaller device, physicians should not delay in referring women for ventricular assist devices."
* Six patients, 3.3 percent women and 2.2 percent men, experienced strokes within two days after their surgery. Twelve patients (13.6 percent women and 5 percent men) suffered strokes more than two days after surgery. "Since this is a small number of patients, we will need to continue to follow patients with this device to determine if this is a significant finding between men and women," Bogaev said.
* After three months of LVAD support, 76 percent of women and 57 percent of men had increased the distance they could walk in six minutes by more than 200 meters (about 656 feet).
* At three months, 84 percent of women and men had New York Heart Association Class I and Class II heart failure symptoms (no or slight limitations on physical activity). When they entered the trial, all patients had Class IV symptoms (unable to carry out any physical activity without discomfort).
* The 11 smallest patients receiving the LVAD were females and all of them remained alive at the six-month follow-up.
"This smaller device is well suited for women and small men, who previously have not had the option of mechanical circulatory support," Bogaev said. "At the Texas Heart Institute, we've been able to increase the percentage of women who benefit from LVADs from 7 percent to 37 percent."
Co-authors are Leway Chen, M.D.; Stuart D. Russell, M.D.; Joseph G. Rogers, M.D.; David J. Farrar, Ph.D.; and Stephanie A. Moore, M.D.
Thoratec Corp., the device manufacturer, funded the study. Dr. Farrar is the company's vice president for research and scientific affairs. The other co-authors are consultants and serve on an advisory board to Thoratec. Statements and conclusions of study authors that are presented at American Heart Association scientific meetings are solely those of the study authors and do not necessarily reflect association policy or position. The American Heart Association makes no representation or warranty as to their accuracy or reliability.
Source: Karen Astle
American Heart Association
суббота, 2 июля 2011 г.
NPR Examines Controversial Okla. Abortion Law Facing Court Challenges
NPR's "All Things Considered" on Thursday examined the debate over an Oklahoma law that requires a woman seeking an abortion to answer dozens of questions on topics relating to her job, education, relationship with her partner and why she is opting for an abortion. The law calls for the survey answers to be posted on a state Web site without the women's names.
Opponents of the law, which is being challenged in court by the Center for Reproductive Rights, call it an invasion of privacy that is intimidating to women and unrelated to improving public health. They also fear that posting the answers online will allow people to identify specific women based on the information provided on the surveys, especially in small, rural communities. Linda Meek, executive administrator of Reproductive Services in Tulsa, Okla., said, "If they want to reduce the number of abortions, then they need to concentrate on educating women about preventing unwanted pregnancies, educating them about emergency contraception, birth control -- and making birth control more accessible."
The law's supporters say that the information will help generate greater understanding of why women choose abortion. State Sen. Todd Lamb (R), the principal author of the law and a candidate for lieutenant governor, said, "How can we counsel, how can we treat, how can we offer counseling to mothers to be that are choosing abortion, if we don't have hard-core facts?" (Lohr, "All Things Considered," NPR, 12/17).
Reprinted with kind permission from nationalpartnership. You can view the entire Daily Women's Health Policy Report, search the archives, or sign up for email delivery here. The Daily Women's Health Policy Report is a free service of the National Partnership for Women & Families, published by The Advisory Board Company.
© 2009 The Advisory Board Company. All rights reserved.
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