Private cord blood banking is not cost-effective because it costs an additional $1,374,246 per life-year gained, according to a new analysis by UCSF researchers. The research team also concluded that private cord blood banking is cost-effective only for families with a child with a very high likelihood of needing a stem cell transplant.
The researchers used a technique called decision analysis that tracks hypothetical groups of people and allows comparison of expected costs and health benefits of two alternative strategies (in this case, private cord blood banking versus no cord blood banking). Results of the study appear in the October 2009 issue of the journal Obstetrics & Gynecology.
Cord blood is collected from the umbilical cord shortly after a baby's birth and has the potential to treat a variety of medical conditions ranging from leukemia to metabolic disorders to cerebral palsy. Public cord blood banks store cord blood at no cost and make the blood available to anyone needing treatment, or for research purposes.
Private cord banks charge a fee to store a baby's cord blood for his/her own possible future use or for a family member's possible future use.
"While there are plausible medical advantages of umbilical cord blood stem cells, many of these benefits are primarily theoretical at this point," said Aaron Caughey, MD, PhD, co-author of the paper, a UCSF associate professor of obstetrics, gynecology and reproductive sciences, and director of the UCSF Center for Clinical and Policy Perinatal Research. "Expectant parents need to understand the true likelihood of their family benefitting from private cord blood banking in order to make an informed decision about this expensive process."
Private umbilical cord blood banking companies in the United States market directly to consumers, at times describing cord blood as a "biologic insurance" for their unborn child, the researchers note. However, a survey of private cord blood banks by the American Society for Blood and Marrow Transplantation found that of the approximately 460,000 cord blood units banked, only 99 were confirmed as being shipped for use in treatment.
The decision-analytic model used by the research team included four baseline assumptions: a cost of $3,620, the lowest price quoted from major blood banking company web sites, for umbilical cord blood banking and storage for 20 years; a .04 percent chance of requiring an autologous (self) or stem cell transplant; a .07 percent chance of a sibling requiring an allogenic (from another person) stem cell transplant; and a 50 percent reduction in risk of graft-versus-host disease if a sibling receives a transplant of banked umbilical cord blood cells.
The UCSF team concluded that if the cost of umbilical cord blood banking is less than $262 or the likelihood of a child needing a stem cell transplant is greater than one out of 110, then private umbilical cord blood banking becomes cost-effective.
The American Academy of Pediatrics (AAP) encourages cord blood donation when the cord blood is stored in a bank for public use and discourages storing cord blood as "biological insurance" because there currently are no scientific data to support autologous transplantation. The AAP does encourage private cord blood banking when there is knowledge of a full sibling in the family with a medical condition (malignant or genetic) who potentially could benefit from cord blood transplantation.
"The discrepancy between the benefits of private cord blood banking perceived by families and the lack of benefit seen in this analysis, and in the opinions of professional societies, has important implications for how doctors counsel patients," said Anjali Kaimal, MD, MAS, lead author of the study and a recent graduate of the UCSF Maternal-Fetal Medicine fellowship which is directed by Caughey. Kaimal's work on the study was done while at UCSF; she currently is a physician at Massachusetts General Hospital.
Co-authors of the study are Catherine Smith, MD; Russell K. Laros, Jr, MD; and Yvonne W. Cheng, MD, MPH, all from UCSF.
Caughey's work is supported in part by a grant from the Robert Wood Johnson Foundation Physician Faculty Scholars Program.
Source:
Karin Rush-Monroe
University of California - San Francisco
суббота, 31 декабря 2011 г.
суббота, 24 декабря 2011 г.
HIV Transmission May Be Slowed Following Study Of 'Good Bacteria' In Women
Beneficial bacteria found in healthy women help to reduce the amount of vaginal HIV among HIV-infected women and might make it more difficult for the virus to spread, boosting the possibility that "good bacteria" might someday be tapped in the fight against HIV.
The findings come from physicians and scientists at the University of Washington and the University of Rochester Medical Center, who worked together in an effort to learn more about how HIV survives and spreads from person to person. The study involving 57 women was done in Seattle and Rochester through the Women's HIV Interdisciplinary Network (WHIN), which is based at the University of Washington.
The team studied the vaginal environment, examining the mix of bacteria that reside there and taking into account several other factors. Physicians tracked the level of HIV virus in the vagina as well as infection by common sexually transmitted diseases like trichomoniasis, gonorrhea and chlamydia, and other more common types of vaginal infections.
Physicians also monitored the levels of beneficial bacteria known as Lactobacillus in the vagina, as well as hydrogen peroxide, which is produced by the bacteria and hinders the virus. They also measured the level of HIV in the women's blood and the rate of progression of the disease overall.
The team found that women with hydrogen-peroxide-producing Lactobacillus in the vagina had lower levels of HIV virus in genital secretions - what physicians call the genital viral load. Physicians know that the lower the level of HIV in the sexual tract, the less likely that the virus will be spread from person to person through sexual contact.
Scientists have previously recognized from laboratory studies that Lactobacillus might give women some natural protection against HIV. The bacteria, commonly found in most women, bind to the virus and secrete hydrogen peroxide. The bacteria are a close cousin of the Lactobacillus bacteria found in the small intestine, a type of "good" bacteria widely found in yogurt.
While previous work in the laboratory has indicated that Lactobacillus might help prevent HIV infection in women, the current study actually links, in women, decreased levels of the virus in the vagina with the presence of Lactobacillus that produce hydrogen peroxide there.
The team also found that the amount of the virus in the vagina varied in step with the presence of Lactobacillus: Women who did not have the bacteria at first but who had acquired it by a subsequent visit had their vaginal HIV levels drop, while vaginal HIV levels increased in women in whom the good bacteria had disappeared between visits.
The research was presented this week at the Conference on Retroviruses and Opportunistic Infections in Boston by Jane Hitti, M.D., associate professor in the Department of Obstetrics & Gynecology at the University of Washington School of Medicine. Hitti has been working closely with Robert Coombs, M.D., Ph.D., the principal investigator for the WHIN study and professor of Laboratory Medicine and of Medicine at the University of Washington. Amneris Luque, M.D., associate professor of Medicine and medical director of the AIDS Center at Strong Memorial Hospital, and Susan Cohn, M.D., associate professor of Medicine at the University of Rochester School of Medicine and Dentistry, also took part in the study.
"These findings underscore the importance of maintaining a healthy, Lactobacillus-dominant vaginal flora for HIV-positive women," said Hitti. "I hope that we can explore Lactobacillus replacement in the future for women who do not have this bacteria, as a strategy to decrease the amount of HIV in the vagina."
"The research opens up some doors," said Luque. "Sexual activity is the most common mode of transmission of HIV. Perhaps we can make it less likely to spread by somehow taking advantage of good bacteria as a natural way to stop HIV and prevent transmission. These findings are striking, though preliminary, and should be looked at further."
Luque and Cohn both care for patients at Strong's AIDS clinic, which provides ongoing care for approximately 900 patients with HIV. The center is part of a broader AIDS treatment and research effort at the University of Rochester Medical Center. The University is the only institution in the nation to be part, since inception, of two major national AIDS research efforts - the search for a vaccine, and the testing of new treatments. More than 3,000 Rochester-area residents have taken part in treatment and vaccine studies at the University's HIV/AIDS Clinical Trials Unit, funded by the National Institute of Allergy and Infectious Diseases.
Cohn stresses the importance of HIV-positive women participating in clinical research. "These women made a large contribution to knowledge about HIV and reproductive health by participating in this study. Advances in the care of HIV-positive women really depend on the dedication of study subjects."
Source: Tom Rickey
University of Rochester Medical Center
The findings come from physicians and scientists at the University of Washington and the University of Rochester Medical Center, who worked together in an effort to learn more about how HIV survives and spreads from person to person. The study involving 57 women was done in Seattle and Rochester through the Women's HIV Interdisciplinary Network (WHIN), which is based at the University of Washington.
The team studied the vaginal environment, examining the mix of bacteria that reside there and taking into account several other factors. Physicians tracked the level of HIV virus in the vagina as well as infection by common sexually transmitted diseases like trichomoniasis, gonorrhea and chlamydia, and other more common types of vaginal infections.
Physicians also monitored the levels of beneficial bacteria known as Lactobacillus in the vagina, as well as hydrogen peroxide, which is produced by the bacteria and hinders the virus. They also measured the level of HIV in the women's blood and the rate of progression of the disease overall.
The team found that women with hydrogen-peroxide-producing Lactobacillus in the vagina had lower levels of HIV virus in genital secretions - what physicians call the genital viral load. Physicians know that the lower the level of HIV in the sexual tract, the less likely that the virus will be spread from person to person through sexual contact.
Scientists have previously recognized from laboratory studies that Lactobacillus might give women some natural protection against HIV. The bacteria, commonly found in most women, bind to the virus and secrete hydrogen peroxide. The bacteria are a close cousin of the Lactobacillus bacteria found in the small intestine, a type of "good" bacteria widely found in yogurt.
While previous work in the laboratory has indicated that Lactobacillus might help prevent HIV infection in women, the current study actually links, in women, decreased levels of the virus in the vagina with the presence of Lactobacillus that produce hydrogen peroxide there.
The team also found that the amount of the virus in the vagina varied in step with the presence of Lactobacillus: Women who did not have the bacteria at first but who had acquired it by a subsequent visit had their vaginal HIV levels drop, while vaginal HIV levels increased in women in whom the good bacteria had disappeared between visits.
The research was presented this week at the Conference on Retroviruses and Opportunistic Infections in Boston by Jane Hitti, M.D., associate professor in the Department of Obstetrics & Gynecology at the University of Washington School of Medicine. Hitti has been working closely with Robert Coombs, M.D., Ph.D., the principal investigator for the WHIN study and professor of Laboratory Medicine and of Medicine at the University of Washington. Amneris Luque, M.D., associate professor of Medicine and medical director of the AIDS Center at Strong Memorial Hospital, and Susan Cohn, M.D., associate professor of Medicine at the University of Rochester School of Medicine and Dentistry, also took part in the study.
"These findings underscore the importance of maintaining a healthy, Lactobacillus-dominant vaginal flora for HIV-positive women," said Hitti. "I hope that we can explore Lactobacillus replacement in the future for women who do not have this bacteria, as a strategy to decrease the amount of HIV in the vagina."
"The research opens up some doors," said Luque. "Sexual activity is the most common mode of transmission of HIV. Perhaps we can make it less likely to spread by somehow taking advantage of good bacteria as a natural way to stop HIV and prevent transmission. These findings are striking, though preliminary, and should be looked at further."
Luque and Cohn both care for patients at Strong's AIDS clinic, which provides ongoing care for approximately 900 patients with HIV. The center is part of a broader AIDS treatment and research effort at the University of Rochester Medical Center. The University is the only institution in the nation to be part, since inception, of two major national AIDS research efforts - the search for a vaccine, and the testing of new treatments. More than 3,000 Rochester-area residents have taken part in treatment and vaccine studies at the University's HIV/AIDS Clinical Trials Unit, funded by the National Institute of Allergy and Infectious Diseases.
Cohn stresses the importance of HIV-positive women participating in clinical research. "These women made a large contribution to knowledge about HIV and reproductive health by participating in this study. Advances in the care of HIV-positive women really depend on the dedication of study subjects."
Source: Tom Rickey
University of Rochester Medical Center
суббота, 17 декабря 2011 г.
63% Of Women Report Sexual Problems With Orgasm Proving Biggest Issue In Teens And 20s
Almost two-thirds of females attending a general urology practice reported that they suffered from sexual dysfunction, according to a paper in the August issue of BJUI.
Dysfunction rose with age in all categories except orgasm, with more than half of women aged from 18 to 30 reporting orgasm problems, significantly higher than women aged 31 to 54.
Researchers asked 587 women aged from 18 to 95, who attended a urology clinic in New Jersey, about six key areas of female sexual dysfunction (FSD): lack of desire, arousal issues, lack of lubrication, problems achieving orgasm, lack of satisfaction and pain during intercourse.
"We found that 63% of the women suffered from FSD and that there were significant links between FSD and age, menopausal status and use of selective antidepressants" says co-author Dr Debra Fromer, head of the Center for Bladder, Prostate and Pelvic Floor Health at Hackensack University Medical Center, New Jersey.
Twelve per cent of the women who took part in the study were aged 18-30, 27% were 31-45, 25% were 46-54, 24% were 55-70 and 12% were 70 plus.
They attended a typical American metropolitan urology practice caring for conditions such as urinary incontinence, urinary tract infections, pelvic floor problems and kidney stones.
Key findings of the survey included:
-- The most sexually active age groups were 31-45 year-olds (87%), 18-30 year-olds (85%) and 46-54 year-olds (74%). It then fell sharply in 55-70 year-olds (45%) and in women who were over 70 (15%).
-- The top overall problem was lack of desire (47%), followed by orgasm problems (45%), arousal issues (40%), lack of satisfaction (39%), lack of lubrication (37%) and pain (36%).
-- Five of the six categories increased as the women got older: desire from 36 to 96%, arousal from 27 to 54%, lubrication from 26 to 45%, satisfaction from 28 to 88% and pain from 10 to 56%.
-- The only category that bucked the trend was orgasm, with problems higher in the 18-30 age group (54%) than in the 31-45 (43%) and 46-54 (48%) age groups. It then rose to 66% at 55-70 and 87% when women were over 70.
The top three problems by age group were:
-- 18-30: orgasm (54%), desire (36%) and satisfaction (28%)
-- 31-45: desire (48%), orgasm (43%) and satisfaction (40%)
-- 46-54: desire (65%), satisfaction (53%) and orgasm (48%)
-- 55-70: desire (77%), orgasm (66%), satisfaction (65%)
-- Over 70: desire (96%), satisfaction (88%) and orgasm (87%).
"FSD can have a major effect on women's quality of life" says Dr Fromer. "Self-esteem, sense of wholeness and relationships can be seriously and adversely affected, exacting a heavy emotional toll.
"Researchers have found significant associations between major categories of sexual dysfunction, reduced physical and emotional satisfaction and general well-being.
"That is why it is so important to ensure that problems are identified and tackled wherever possible. For example a number of hormone and other drug treatments have been shown to benefit women with FSD."
Known risk factors for FSD include age, a history of sexual abuse or sexually transmitted infections, depression, lower socioeconomic status, lifestyle, overall physical health and sexual experience.
"Interestingly, our study found very similar levels of dysfunction to an age-matched Turkish study" adds Dr Fromer. "This suggests a biological cause for FSD rather than societal or cultural factors, although they make some contribution to certain psychological aspects of the disorder."
Source: Wiley - Blackwell
Dysfunction rose with age in all categories except orgasm, with more than half of women aged from 18 to 30 reporting orgasm problems, significantly higher than women aged 31 to 54.
Researchers asked 587 women aged from 18 to 95, who attended a urology clinic in New Jersey, about six key areas of female sexual dysfunction (FSD): lack of desire, arousal issues, lack of lubrication, problems achieving orgasm, lack of satisfaction and pain during intercourse.
"We found that 63% of the women suffered from FSD and that there were significant links between FSD and age, menopausal status and use of selective antidepressants" says co-author Dr Debra Fromer, head of the Center for Bladder, Prostate and Pelvic Floor Health at Hackensack University Medical Center, New Jersey.
Twelve per cent of the women who took part in the study were aged 18-30, 27% were 31-45, 25% were 46-54, 24% were 55-70 and 12% were 70 plus.
They attended a typical American metropolitan urology practice caring for conditions such as urinary incontinence, urinary tract infections, pelvic floor problems and kidney stones.
Key findings of the survey included:
-- The most sexually active age groups were 31-45 year-olds (87%), 18-30 year-olds (85%) and 46-54 year-olds (74%). It then fell sharply in 55-70 year-olds (45%) and in women who were over 70 (15%).
-- The top overall problem was lack of desire (47%), followed by orgasm problems (45%), arousal issues (40%), lack of satisfaction (39%), lack of lubrication (37%) and pain (36%).
-- Five of the six categories increased as the women got older: desire from 36 to 96%, arousal from 27 to 54%, lubrication from 26 to 45%, satisfaction from 28 to 88% and pain from 10 to 56%.
-- The only category that bucked the trend was orgasm, with problems higher in the 18-30 age group (54%) than in the 31-45 (43%) and 46-54 (48%) age groups. It then rose to 66% at 55-70 and 87% when women were over 70.
The top three problems by age group were:
-- 18-30: orgasm (54%), desire (36%) and satisfaction (28%)
-- 31-45: desire (48%), orgasm (43%) and satisfaction (40%)
-- 46-54: desire (65%), satisfaction (53%) and orgasm (48%)
-- 55-70: desire (77%), orgasm (66%), satisfaction (65%)
-- Over 70: desire (96%), satisfaction (88%) and orgasm (87%).
"FSD can have a major effect on women's quality of life" says Dr Fromer. "Self-esteem, sense of wholeness and relationships can be seriously and adversely affected, exacting a heavy emotional toll.
"Researchers have found significant associations between major categories of sexual dysfunction, reduced physical and emotional satisfaction and general well-being.
"That is why it is so important to ensure that problems are identified and tackled wherever possible. For example a number of hormone and other drug treatments have been shown to benefit women with FSD."
Known risk factors for FSD include age, a history of sexual abuse or sexually transmitted infections, depression, lower socioeconomic status, lifestyle, overall physical health and sexual experience.
"Interestingly, our study found very similar levels of dysfunction to an age-matched Turkish study" adds Dr Fromer. "This suggests a biological cause for FSD rather than societal or cultural factors, although they make some contribution to certain psychological aspects of the disorder."
Source: Wiley - Blackwell
суббота, 10 декабря 2011 г.
New York Health Commission Recommends Closure Of Hospital That Specializes In Childbirth
The New York state Commission on Health Care Facilities in the 21st Century last week released a report that recommended the closure of Victory Memorial Hospital and Skilled Nursing Center in New York City -- which specializes in childbirth and serves many Chinese and Russian immigrants, the New York Times reports (Mindlin, New York Times, 12/3). New York Gov. George Pataki (R) and the state Legislature formed the commission last year to recommend changes to the state's health care system, which is the most expensive in the country. The commission's report recommends nine hospital closures and the reconfiguration of 48 additional hospitals in the state. Pataki and Gov.-elect Eliot Spitzer (D) on Wednesday endorsed the report (Kaiser Daily Health Policy Report, 11/30). Victory Memorial has a program for pregnant Muslim women to receive care by only female physicians and nurses. In addition, the hospital contains phones with two handsets so physicians and patients can speak with outside interpreters. "The ethnic minorities we serve don't have automobiles," Donald Zarou, chief of obstetrics and Victory Memorial, said, adding, "What are they going to do, wait for a bus while they have three-minute contractions?" According to the Times, the hospital might close next year unless it is spared by the bankruptcy protection it filed last month (Mindlin, New York Times, 12/3).
"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.
"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, 3 декабря 2011 г.
Vaginal Ring Could Protect Against HIV, Researcher Says
A researcher with Weill Cornell Medical College has developed a vaginal ring that releases microbicides and could prevent HIV and unplanned pregnancies, ANI/Times of India reports. Brij Saxena -- a professor of reproductive biology and endocrinology and lead author of a recent study on the ring in the journal AIDS -- said that laboratory testing showed the device would be effective at preventing HIV infection and pregnancy by releasing several types of nonhormonal agents and microbicides. He added that if proven successful in clinical trials, the device would allow women to effectively protect themselves from HIV and avoid pregnancy.
According to Saxena, the ring releases antiretroviral drugs over a period of 28 days. He noted that the device potentially could serve as an alternative method to prevent other sexually transmitted infections. Jeffrey Laurence, co-author of the study and a physician at New York Presbyterian Hospital-Weill Cornell Medical Center, said, "No one has ever conquered a viral epidemic with treatment, so prevention is the most effective option." He added, "Ideally, an HIV vaccine is the most desirable method, but that is not foreseeable in the near future. The next best thing would be something that would prevent infection and put the power in the susceptible female partner's control. That's the potential a device such as this can offer" (ANI/Times of India, 5/20).
Reprinted with kind 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.
© 2009 Advisory Board Company and Kaiser Family Foundation. All rights reserved.
According to Saxena, the ring releases antiretroviral drugs over a period of 28 days. He noted that the device potentially could serve as an alternative method to prevent other sexually transmitted infections. Jeffrey Laurence, co-author of the study and a physician at New York Presbyterian Hospital-Weill Cornell Medical Center, said, "No one has ever conquered a viral epidemic with treatment, so prevention is the most effective option." He added, "Ideally, an HIV vaccine is the most desirable method, but that is not foreseeable in the near future. The next best thing would be something that would prevent infection and put the power in the susceptible female partner's control. That's the potential a device such as this can offer" (ANI/Times of India, 5/20).
Reprinted with kind 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.
© 2009 Advisory Board Company and Kaiser Family Foundation. All rights reserved.
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