An article published Online First in The Lancet Oncology reports that human papillomavirus (HPV) DNA testing prevents more invasive cervical cancer compared to cytology screening alone. It detects persistent high-grade lesions which lead to cervical cancer at an earlier time. Consequently, HPV testing should become the main screening tool for women aged 35 years or older at longer screening intervals, with cytology reserved for triage of women who test positive for HPV.

DNA testing for HPV is widely recognized as superior in detection of precancerous lesions called high-grade cervical intraepithelial neoplasia (CIN2 and CIN3) compared with cytology. However, HPV testing is less exact. It also results in more false-positive tests than conventional Pap smears. However, it is unclear whether shifting to HPV testing from standard cytology in cervical cancer screening programmes increases their effectiveness in preventing invasive cervical cancer. This is particularly true in developed countries where advanced cervical cancers are rare among screened women.

Guglielmo Ronco and colleagues from Italy led The New Technologies for Cervical Cancer (NTCC) screening study. It reviewed the benefits and risks of introducing HPV testing for cervical cancer screening and evaluated the most appropriate age for initiating HPV testing.

Two rounds of screening were done for two separate recruitment phases. Women, aged 25 to 60 years, were randomly assigned to conventional cytology only or to HPV testing plus cytology (first phase) and HPV testing alone (second phase). During both phases all women with an abnormal cytology result were referred to colposcopy. In the HPV group, during phase one all women who were HPV-positive and aged 35 to 60 years were referred to colposcopy, whereas women aged 25 to 34 years were referred to colposcopy only if cytology was also abnormal or if HPV testing was persistently positive. During phase two, women in the HPV group were referred for colonoscopy if the HPV test was positive.

A similar number of invasive cancers were detected in each group according to the findings in the first round of screening. There were nine in the cytology group compared with seven in the HPV group. But in the second round no cancers were detected in the HPV group compared with nine in the cytology group. This suggests that HPV-based screening is more effective than cytology at preventing invasive cervical cancer, probably because of earlier detection and treatment of CIN.

Significantly, for women aged 35 years or older, the combination of HPV testing with cytology did not increase the sensitivity of screening. This indicates that increased detection of CIN3 was primarily due to HPV testing.

On the other hand, among younger women aged 25 to 34 years, HPV testing led to over-diagnosis and treatment of regressive CIN2 lesions which is associated with increased risk of pregnancy-related morbidity.

The authors explain: “Our data support the use of stand-alone HPV testing as the primary screening test. The extremely low detection of CIN3 at round two in the HPV group (2 per 10 000) indicates that HPV-based screening at extended intervals is safe.”

They say in conclusion: “Further follow-up is needed to define how long screening intervals can be safely extended. Research is needed to define the optimum management of HPV-positive women…to minimise the costs related to increased referral to colposcopy and overdiagnosis of regressive lesions.”

In an associated comment, Philip Castle and Hormuzd Katki from the National Cancer Institute in the USA write in conclusion: “HPV testing shows a great deal of promise to revolutionise cervical cancer screening…We advocate that clinical management be based on estimating a woman’s individual risk of cervical precancer, rather than complex algorithms. Data from the current study could be used to develop risk estimates to make the promise of more effective and cost-effective cervical cancer prevention a reality.”

“Efficacy of human papillomavirus testing for the detection of invasive cervical cancers and cervical intraepithelial neoplasia: a randomised controlled trial”

One of the most exciting times for pregnancy is the routine ultrasound that is usually performed around the 18th week of pregnancy when physicians check fetal growth, perhaps check the sex of the baby, and count all the fingers and toes. For a very few women, the scan may detect something a little more serious – a condition called amniotic band syndrome, or ABS.

Amniotic constriction bands are strands of fluid-filled sacs that surround a baby in the womb. They are caused by a tearing of the inner part of the placenta called the amnion, which produces the fiber-like bands that may trap the baby’s extremities such as the arms, legs, fingers or toes. As the baby grows, the bands constrict or tighten, they cause a reduction in blood supply and they may develop abnormally or become amputated. In more serious cases, the band may cause an abnormal gap in the face, called a cleft, or cause a defect in the abdomen or chest wall. The most severe cases occur if the band becomes wrapped around the head or umbilical cord, which can result in fetal death.

Other names for the condition include Streeter dysplasia, congenital constriction bands or rings, or amniotic deformity adhesions mutilations (ADAM).

Amniotic banding affects approximately 1 in 1,200 to 1 in 15,000 live births. It is also believed to be the cause of about 178 in 10,000 miscarriages. About 80% of cases involve the hands and fingers and a significant number of clubfoot cases are correlated with ABS.

The timing of the rupture is believed to occur between 28 days after conception to 18 weeks of gestation. Late bands can occur and present at birth, even after a normal ultrasound was performed earlier in the pregnancy. The cause is generally unknown. It most often happens spontaneously, but can also occur if the woman experiences trauma to the lower abdomen.

If diagnosed in utero, rare because the individual strands are small and difficult to see, a higher level 3D ultrasound or MRI may be used for a more detailed and accurate diagnosis. Most often, the baby will be monitored throughout the remainder of the pregnancy, particularly if the bands are not in danger of amputating a limb or causing significant deformity. In these cases, fetal surgery, called amniotic band release surgery, may be considered.

After birth, plastic or reconstructive surgery for the infant will be considered, depending upon the extent of the deformity. Other therapies, such as physical or occupational therapy, would also be considered.

Amniotic band syndrome is considered a chance event and does not appear to be hereditary, except in the case of Ehlers-Danlos syndrome (EDS), a connective tissue disorder. The cause of the amnion tearing is often unknown and there are no preventative measures a mother-to-be can take to prevent its occurrence.

A new study from Zambia suggests that halting breastfeeding early causes more harm than good for children not infected with HIV who are born to HIV-positive mothers. Stopping breastfeeding before 18 months was associated with significant increases in mortality among these children, according to the study’s findings, described in the Feb. 1, 2010 issue of Clinical Infectious Diseases, and available online now.

The researchers’ initial hypothesis, which proved to be incorrect, suggested that by 4 months of age, children would have passed the critical developmental point when breastfeeding is essential to their survival. However, stopping breastfeeding at 4 months, compared to usual breastfeeding as the child reaches 6 months to 24 months or older, did not decrease mortality or play a significant role in protecting the child from HIV transmission.

These findings were consistent with those for mothers not infected with HIV; longer breastfeeding is necessary to protect children against potentially fatal infectious diseases, especially those prevalent in low-resource settings. To prevent postnatal HIV transmission, however, mothers with HIV should be on antiretroviral drugs.

“Our results help support the recent change in the World Health Organization (WHO) guidelines for prevention of mother-to-child HIV transmission,” said study author Louise Kuhn, PhD, of Columbia University in New York City. “The new guidelines encourage postnatal use of antiretrovirals through the duration of breastfeeding to prevent vertical [mother-to-child] transmission.”

Before patting yourself on the back for resisting that cookie or kicking yourself for giving in to temptation, look around. A new University of Georgia study has revealed that self-control – or the lack thereof – is contagious.

In a just-published series of studies involving hundreds of volunteers, researchers have found that watching or even thinking about someone with good self-control makes others more likely exert self-control. The researchers found that the opposite holds, too, so that people with bad self-control influence others negatively. The effect is so powerful, in fact, that seeing the name of someone with good or bad self-control flashing on a screen for just 10 milliseconds changed the behavior of volunteers.

“The take home message of this study is that picking social influences that are positive can improve your self-control,” said lead author Michelle vanDellen, a visiting assistant professor in the UGA department of psychology. “And by exhibiting self-control, you’re helping others around you do the same.”

People tend to mimic the behavior of those around them, and characteristics such as smoking, drug use and obesity tend to spread through social networks. But vanDellen’s study is thought to be the first to show that self-control is contagious across behaviors. That means that thinking about someone who exercises self-control by regularly exercising, for example, can make your more likely to stick with your financial goals, career goals or anything else that takes self-control on your part.

VanDellen’s findings, which are published in the early online edition of the journal Personality and Social Psychology Bulletin, are the result of five separate studies conducted over two years with study co-author Rick Hoyle at Duke University.

In the first study, the researchers randomly assigned 36 volunteers to think about a friend with either good or bad self-control. Those that thought about a friend with good self-control persisted longer on a handgrip task commonly used to measure self-control, while the opposite held true for those who were asked to think about a friend with bad self-control.

In the second study, 71 volunteers watched others exert self-control by choosing a carrot from a plate in front of them instead of a cookie from a nearby plate, while others watched people eat the cookies instead of the carrots. The volunteers had no interaction with the tasters other than watching them, yet their performance was altered on a later test of self-control depending on who they were randomly assigned to watch.

In the third study, 42 volunteers were randomly assigned to list friends with both good and bad self-control. As they were completing a computerized test designed to measure self-control, the computer screen would flash the names for 10 milliseconds – too fast to be read but enough to subliminally bring the names to mind. Those who were primed with the name of a friend with good self-control did better, while those primed with friends with bad self-control did worse.

In a fourth study, vanDellen randomly assigned 112 volunteers to write about a friend with good self-control, bad self-control or – for a control group – a friend who is moderately extroverted. On a later test of self-control, those who wrote about friends with good self-control did the best, while those who wrote about friends with bad self-control did the worst. The control group, those who wrote about a moderately extroverted friend, scored between the other two groups.

In the fifth study of 117 volunteers, the researchers found that those who were randomly assigned to write about friends with good self-control were faster than the other groups at identifying words related to self-control, such as achieve, discipline and effort. VanDellen said this finding suggests that self-control is contagious because being exposed to people with either good or bad self-control influences how accessible thoughts about self-control are.

VanDellen said the magnitude of the influence might be significant enough to be the difference between eating an extra cookie at a party or not, or deciding to go to the gym despite a long day at work. The effect isn’t so strong that it absolves people of accountability for their actions, she explained, but it is a nudge toward or away from temptation.

“This isn’t an excuse for blaming other people for our failures,” vanDellen said. “Yes, I’m getting nudged, but it’s not like my friend is taking the cookie and feeding it to me; the decision is ultimately mine.”

High blood pressure may put women at greater risk for dementia later in life by increasing white matter abnormalities in the brain, report researchers from the University of Pittsburgh Graduate School of Public Health in a study published online in the Journal of Clinical Hypertension.

“Hypertension is very common in the U.S. and many other countries, and can lead to serious health problems,” said Lewis Kuller, M.D., Dr.P.H., professor of epidemiology, University of Pittsburgh Graduate School of Public Health. “Proper control of blood pressure, which remains generally poor, may be very important to prevent dementia as women age.”

The study, part of the multisite and long-term Women’s Health Initiative Memory Study (WHIMS), included 1,424 women 65 or older who had their blood pressure assessed annually and underwent magnetic resonance imaging (MRI) of the brain. Researchers assessed white matter lesions, which are associated with increased risks for dementia and stroke. White matter makes up 60 percent of the brain and contains nerve fibers responsible for communication among the brain’s regions.

Women who, at the start of the study, were hypertensive, meaning a blood pressure of 140/90 or higher, had significantly more white matter lesions on their MRI scans eight years later than participants with normal blood pressure. Lesions were more common in the frontal lobe, the brain’s emotional control center and home to personality, than in the occipital, parietal or temporal lobes.

“Women should be encouraged to control high blood pressure when they are young or in middle-age in order to prevent serious problems later on,” said Dr. Kuller. “Prevention and control of elevated blood pressure and subsequent vascular disease in the brain may represent the best current preventive therapy for dementia.”

Regularly practicing yoga exercises may lower a number of compounds in the blood and reduce the level of inflammation that normally rises because of both normal aging and stress, a new study has shown.

The study, done by Ohio State University researchers and just reported in the journal Psychosomatic Medicine, showed that women who routinely practiced yoga had lower amounts of the cytokine interleukin-6 (IL-6) in their blood.

The women also showed smaller increases in IL-6 after stressful experiences than did women who were the same age and weight but who were not yoga practitioners.

IL-6 is an important part of the body’s inflammatory response and has been implicated in heart disease, stroke, type-2 diabetes, arthritis and a host of other age-related debilitating diseases. Reducing inflammation may provide substantial short- and long-term health benefits, the researchers suggest.

“In addition to having lower levels of inflammation before they were stressed, we also saw lower inflammatory responses to stress among the expert yoga practitioners in the study,” explained Janice Kiecolt-Glaser, professor of psychiatry and psychology and lead author of the study.

“Hopefully, this means that people can eventually learn to respond less strongly to stressors in their everyday lives by using yoga and other stress-reducing modalities.”

For the study, the researchers assembled a group of 50 women, age 41 on average. They were divided into two groups – “novices,” who had either taken yoga classes or who practiced at home with yoga videos for no more than 6 to 12 sessions, and “experts,” who had practiced yoga one of two times weekly for at least two years and at least twice weekly for the last year.

Each of the women was asked to attend three sessions in the university’s Clinical Research Center at two-week intervals. Each session began with participants filling out questionnaires and completing several psychological tests to gauge mood and anxiety levels.

Each woman also was fitted with a catheter in one arm through which blood samples could be taken several times during the research tasks for later evaluation.

Participants then performed several tasks during each visit designed to increase their stress levels including immersing their foot into extremely cold water for a minute, after which they were asked to solve a series of successively more difficult mathematics problems without paper or pencil.

Following these “stressors,” participants would either participate in a yoga session, walk on treadmill set at a slow pace (.5 miles per hour) designed to mirror the metabolic demands of the yoga session or watch neutral, rather boring videos. The treadmill and video tasks were designed as contrast conditions to the yoga session.

Once the blood samples were analyzed after the study, researchers saw that the women labeled as “novices” had levels of the pro-inflammatory cytokine IL-6 that were 41 percent higher than those in the study’s “experts.”

“In essence, the experts walked into the study with lower levels of inflammation than the novices, and the experts were also better able to limit their stress responses than were the novices,” Kiecolt-Glaser explained.

The researchers did not find the differences they had expected between the novices and experts in their physiological responses to the yoga session.

Co-author Lisa Christian, an assistant professor of psychology, psychiatry and obstetrics and gynecology, suggested one possible reason:

“The yoga poses we used were chosen from those thought to be restorative or relaxing. We had to limit the movements to those novices could perform as well as experts.

“Part of the problem with sorting out exactly what makes yoga effective in reducing stress is that if you try to break it down into its components, like the movements or the breathing, it’s hard to say what particular thing is causing the effect,” said Christian, herself a yoga instructor. “That research simply hasn’t been done yet.”

Ron Glaser, a co-author and a professor of molecular virology, immunology and medical genetics, said that the study has some fairly clear implications for health.

“We know that inflammation plays a major role in many diseases. Yoga appears to be a simple and enjoyable way to add an intervention that might reduce risks for developing heart disease, diabetes and other age-related diseases” he said.

“This is an easy thing people can do to help reduce their risks of illness.”

Bill Malarkey, an professor of internal medicine and co-author on the study, pointed to the inflexibility that routinely comes with aging.

“Muscles shorten and tighten over time, mainly because of inactivity,” he said. “The stretching and exercise that comes with yoga actually increases a person’s flexibility and that, in turn, allows relaxation which can lower stress.”

Malarkey sees the people’s adoption of yoga or other regular exercise as one of the key solutions to our current health care crisis. “People need to be educated about this. They need to be taking responsibility for their health and how they live. Doing yoga and similar activities can make a difference.”

As a clinician, he says, “Much of my time is being spent simply trying to get people to slow down.”

New research shows that premature babies who listened to the music of Wolfgang Amadeus Mozart get stronger faster, compared to those who do not. Scientists of Tel Aviv University compared infants born prematurely, finding that those who listened to Mozart gained weight faster and became stronger compared to babies who did not listen to music.

Exposing the premature babies to one thirty minute session of Mozart decreased the need for calories. The preterm babies expended less energy after hearing the music.

“It’s not exactly clear how the music is affecting them, but it makes them calmer and less likely to be agitated,” says Dr. Mendel, a lecturer at Tel Aviv University. After listening to Mozart the researchers measured how much energy the premature infants expended at rest finding that the infants were more restful, expending fewer calories.

Dr. Mandel says it is possible that “The repetitive melodies in Mozart’s music may be affecting the organizational centers of the brain’s cortex. Unlike Beethoven, Bach or Bartok, Mozart’s music is composed with a melody that is highly repetitive. This might be the musical explanation. For the scientific one, more investigation is needed.

It is important for babies born prematurely to gain weight before leaving the hospital. The researchers hope to learn more about how exposing premature infants to music can facilitate treatment. “The point of our research is to quantify these effects so that standards and care-guides can be developed. We still don’t know the long-term effects of the music, or if other kinds of music will work just as well.”

Other suggestions to help premature infants gain weight, develop and go home include listening to ethnic music, rap music, pop music, and, and other classical music like Bach, Beethoven and Mozart, says Dr. Mandel. Exposing premature infants to music may lead to an entirely new approach for treating babies born too early.

The volcanic eruptions thought responsible for Earth’s largest mass extinction – which killed more than 70 percent of plants and animals 250 million years ago – is still taking lives today. That’s the conclusion of a new study showing, for the first time, that the high silica content of coal in one region of China may be interacting with volatile substances in the coal to cause unusually high rates of lung cancer. The study, which helps solve this cancer mystery, appears in ACS’ Environmental Science & Technology, a semi-monthly publication.

David Large and colleagues note that parts of China’s Xuan Wei County in Yunnan Province have the world’s highest incidence of lung cancer in nonsmoking women – 20 times higher than the rest of China. Women in the region heat their homes and cook on open coal-burning stoves that are not vented to the outside. Scientists believe that indoor emissions from burning coal cause cancer, but are unclear why the lung cancer rates in this region are so much higher than other areas. Earlier studies show a strong link between certain volatile substances, called PAHs, in coal smoke and lung cancer in the region.

The scientists found that coal used in parts of Xuan Wei County had about 10 times more silica, a suspected carcinogen, than U.S. coal. Silica may work in conjunction with PAHs to make the coal more carcinogenic, they indicate. The scientists also found that this high-silica coal was formed 250 million years ago, at a time when massive volcanic eruptions worked to deposit silica in the peat that formed Xuan Wei’s coal.

If you are pregnant or plan to get pregnant, is it safe to take medications, or will they harm you and/or your baby? That’s a question that haunts many pregnant women and medical professionals alike, and it is one that a new research program plans to investigate.

The program is called the Medication Exposure in Pregnancy Risk Evaluation Program (MEPREP), and it is a collaborative effort of the US Food and Drug Administration (FDA) and researchers at the HMO Research Network Center for Education and Research in Therapeutics (CERT), Kaiser Permanente’s multiple research centers, and Vanderbilt University. MEPREP will fund research to study the effects of prescription medications used by women during pregnancy.

Medication and Pregnancy
Everything a woman consumes during pregnancy passes through the placenta to the unborn child, so it is important to avoid medications if possible, especially during the first eight to ten weeks when the baby’s heart, lung, and brain systems are being formed. Some medications are considered safe to take during pregnancy, even though no medication is safe for 100 percent of the people. The effects of many other prescription and over-the-counter drugs on the unborn child are not known. Women who are taking prescription medications and who plan to become pregnant should talk to their doctor before they get pregnant to determine if and how safe it will be for them to continue their medication.

Safe Medications During Pregnancy
Prenatal vitamins are safe to take during pregnancy. Some other medications have not been found to be harmful during pregnancy if they are taken according to package directions. According to WebMD, some of these medications include but are not limited to Actifed, Benadryl, Fiberall/Fibercon, Gaviscon, hydrocortisone cream, Maalox, Metamucil, milk of magnesia, Monistat, Mylanta, Neosporin, Preparation H, Sudafed, Tums, and Tylenol. However, to be safe, women should talk to their doctor about any medications—over-the-counter and prescription—as well as herbal remedies that they are taking before they get pregnant or as soon as they learn they are pregnant.

How many women take medication during pregnancy? In a West Virginia University study, investigators interviewed 578 pregnant women and found that 95.8 percent took prescription medications, 92.6 percent self-medicated with over-the-counter medications, and 45.2 percent used herbal medications. Fifteen percent used ibuprofen. Medications that are contraindicated in pregnancy (e.g., ibuprofen) were used by the women at high rates.

The lack of clinical trials on the safety of medications during pregnancy is due to concerns about the health of the mother and child. Therefore, in order to arrive at some decisions about the safety of these medications during pregnancy, the MEPREP will evaluate information for mothers and their infants from 11 participating research sites that include health care information for about 1 million births that occurred from 2001 to 2007. Many of these women likely took medication during their pregnancies.

According to Gerald Dal Pan, MD, director of the Office of Surveillance and Epidemiology at the FDA’s Center for Drug Evaluation and Research, “This collaborative effort creates a unique resource to study the effects of medication in pregnant women and their children,” an effort that does not place women or their children in jeopardy. The researchers hope that their results “will provide information for patients and physicians when making decisions about medication during pregnancy.”

Hormonal contraceptives are effective in treating menstruation- related disorders such as dysmenorrhea and heavy menstrual bleeding, as well as preventing unplanned pregnancies, according to a new Practice Bulletin issued today by The American College of Obstetricians and Gynecologists (ACOG) and published in the January 2010 issue of Obstetrics & Gynecology. In addition, combined contraceptives containing both estrogen and progesterone offer disease prevention by reducing the risk of developing endometrial, ovarian cancer, and colorectal cancer.

More than 80% of women in the US will use some form of hormonal contraception during their reproductive years. There are several different forms of hormonal contraception including pills, patches, implants, injections, vaginal rings, and the intrauterine device (IUD). Pregnancy prevention is the primary reason that most women use hormonal contraception. However, these contraceptives are also frequently prescribed specifically for non-contraceptive reasons, which is considered off-label use.

“We’ve known for many years that hormonal contraceptives have health advantages beyond preventing pregnancy,” says Robert L. Reid, MD, of Kingston, Ontario, who led development of the document. “These recommendations examine the scientific data supporting the non-contraceptive uses of hormonal contraceptives to treat specific conditions.”

For instance, both oral contraceptives and the single-rod progestin implant help relieve or reduce the symptoms of dysmenorrhea (severe menstrual pain), the most commonly reported menstrual disorder. Dysmenorrhea affects up to 90% of young women and is a leading cause of women missing school and work. A variety of hormonal contraceptives are also useful in treating menorrhagia (excessive menstrual bleeding), which, if left untreated, can lead to anemia. All forms of birth control that contain both estrogen and progesterone have the potential to improve hirsutism (excess hair growth) and acne because they suppress production of the male hormone, androgen. Other potential benefits of hormonal contraceptives include prevention of menstrual migraines, treatment of pelvic pain due to endometriosis, and treatment of bleeding due to uterine fibroids.

“Combined oral contraceptives are effective in normalizing irregular periods, reducing symptoms of premenstrual dysphoric disorder, improving acne, and allowing women to avoid having their period at inconvenient times, such as during a business trip, vacation, or honeymoon ,” says Dr. Reid. “Although there is little data on the newer forms of hormonal contraception in terms of their off-label benefits, experts suggest that they may be as effective as the more studied ones in treating the same conditions.”

The scientific evidence shows that the longer a woman uses the birth control pill, the lower her risk for developing endometrial and ovarian cancer later, up to 20 years after discontinuing use. The pill also seems to offer some short-term protection against colorectal cancer among current or recent users.