Safety Alert for Vanderbilt-Area Women

Vanderbilt Security has issued alerts for two recent incidents - one rape and one simple assault. On August 26, a student was raped: "A man in a white vehicle asked the student, who was in front of the Kappa Alpha House at 201 24th Avenue South, if she needed a ride. The student got into the car thinking it was a taxi. The student was taken to an off campus location where she was sexually assaulted."
Suspect Description: Male black, in his 30s.
Vehicle description: White 4 door car, possibly a taxi cab"

On August 29, a student was also assaulted by a taxi driver. "The student stated that she was walking on 24th Avenue between Vanderbilt Place and Kensington Place when a taxi cab driver offered her a ride. When the student attempted to get into the back of the vehicle, the driver locked the back doors and told her to get into the front seat... During the trip, the student said the driver touched her neck and arm and made inappropriate comments. After arriving at the off campus destination and leaving the vehicle, the student said the suspect blocked her path with his vehicle multiple times."
Suspect Description: Male, black or person of Indian descent, late 20s or early 30s, 6'0", 180 pounds, slender build, slender face, short black hair ("spikey" in the front), brown eyes, dark complexion, last seen wearing a short sleeve shirt. In addition, the driver spoke with an international accent.
Vehicle Description: White 4 door Sedan. The vehicle had a "Taxi" style light on top, a pay meter in the front of the vehicle, with possible a dark blue interior.

If you have any information on these incidents, you are asked to contact VU POLICE AT 32(2-2745) or call crime stoppers as 74-CRIME (742-7463) if you wish to remain anonymous.

Resources:

MedlinePlus has a good page of resources for information on rape and sexual assault.

"What to do if you're raped" - from FamilyDoctor.org

Searchable directory of emergency contraception providers
Technorati Tags: rape; sexual assault

Director of FDA's Office of Women's Health resigns

Susan Wood (Director of the FDA's Office of Women's Health) resigned on Wednesday in reaction to the agency's delay in making a decision about OTC status for the Plan B emergency contraceptive. According to the NYTimes, Wood stated, "I can no longer serve as staff when scientific and clinical evidence, fully evaluated and recommended for approval by the professional staff here, has been overruled."
Technorati Tags: emergency contraception; FDA

Refusing VBAC for Liability Reasons

Via Kevin, MD, I learned about this story in USAToday titled "Battle lines drawn over C-sections." The piece describes women who were not allowed to attempt vaginal birth after C-section due to the doctor/hospital's concerns about litigation if uterine rupture were to occur. For example, "In Oklahoma, most OB/GYNs won't allow patients to attempt a VBAC because their malpractice insurance no longer will cover claims resulting from such births."

"And some women, such as Barbara Roebuck, never bother going to the hospital. Roebuck, 37, delivered four babies vaginally before requiring a C-section for her fifth, who was breech. Pregnant with her sixth, she says she saw four doctors in a futile search for one who would let her try a VBAC. Every one of them said: 'Hospital policy. You don't have a choice,' Roebuck recalls." According to the story, some women were apparently encouraged to temporarily relocate in order to have the choice of how to give birth.

As the article mentions, the incidence of perinatal death due to uterine rupture during VBAC seems to be very low, about 1.5/10,000. A very detailed evidence report on the topic is available here. It seems that this should be evaluated on a woman-by-woman basis, rather than forcing surgery on women due to potential litigation issues.

Some resources:

Vaginal Birth After C-Section Health Decision Guide - from MayoClinic.com

Vaginal Birth After Cesarean Delivery - from UpToDate Patient Information

Birth Choices After Cesarean Section - from KidsHealth Medical Research News for Parents

Researchers Advise Against Attempting VBACs in Birth Centers - press release from the American College of Obstetrics and Gynecology

Vaginal Birth after Cesarean - from the American Pregnancy Association, outlines risks of repeast Cesarean vs. VBAC.

Technorati Tags: C-section; childbirth; VBAC

Commenting Open on FDA Plan B Decision

I should point out that, regarding making emergency contraception available OTC, the issue they are currently accepting public comment on is "Circumstances Under Which an Active Ingredient May Be Simultaneously Marketed in Both a Prescription Drug Product and an Over-The-Counter Drug Product." You may submit comments on that issue here. I reasonably sure that this particular issue is not one that folks on either side of the debate actually care about; the docket includes the questions of whether age-restricted OTC status could be enforced, and whether the OTC and prescription drug could be marketed in the same packaging. However, I would encourage you to complete a response addressing these concerns if the end result of making EC more accessible to women is one that you care about.
Technorati Tags: emergency contraception; FDA; Reproductive Rights

FDA Delays Emergency Contraception Decision

FDA Commissioner Lester Crawford released a statement today indicating that the agency would delay a decision on Barr Laboratories' application to make Plan B emergency contraceptive availalble over the counter to women 16 years of age or older. The rationale for the decision is that "What we are saying today is that the Agency is unable at this time to reach a decision on the approvability of the application because of these unresolved regulatory and policy issues that relate to the application we were asked to evaluate," the regulatory issues being whether a drug can have both prescription and over the counter status at the same time, whether the two could be "marketed in a single package," and how the limitation would be enforced.

I'm not sure why these are such big issues - we enforce age limits on other products through carding, and the same-package-for-different-status problem seems somewhat trivial. As for being both OTC and prescription, the release doesn't really explain the rationale for that being a problem, except that "If it needed a prescription for one group of people, then it needed a prescription for all people. That was FDA’s practice for a very long time." Barr submitted the new application to exclude younger women because their initial application was rejected due to the FDA's concern over a lack of safety data for the drug in younger women. Barr released their own response to the latest decision here. CNN also covers the story with varying reactions.

The FDA states that there will be at least a 60-day delay in order to receive public comments: "We are beginning a process that will address the regulatory questions today, but we believe we can only decide these issues in an open, public process. Through this process, all interested parties can weigh in on the questions of whether a drug may be both prescription and over the counter based on uses by different subpopulations and whether the prescription and over the counter versions of the drug may be marketed in a single package." Information on submitting comments is available as a PDF at http://www.fda.gov/bbs/topics/news/2005/cd0584.pdf FDA does have an online commenting feature, but todays docket isn't loaded yet. I'll update this post with the link when commenting is available on this issue.
Technorati Tags: emergency contraception; FDA

Happy Birthday, Right to Vote!

Today marks the 85th anniversary of the day Secretary of State Bainbridge Colby certified the ratification of the 19th Amendment to the Constitution, thereby giving women the right to vote. Information and document images here and here. Although not strictly a women's health issue, voting is ever-important as women's health issues continue to be politicized. To celebrate the day, I share with you this story:

One of my clearest, fondest memories of my Korean Grandmother is being allowed to go in a voting booth with her when I was barely tall enough to see over the ballot options and buttons. It was a pleasant day outside, voting took place in a public school on a hill, and I remember excitedly stepping into the booth with her and having the curtain pulled around us. Grandma then cast her vote, and off we went, but it didn't seem at all anti-climatic. It was exciting, and also something that had to be done. There were many other times during my childhood when I was loaded up in the car, because "we have to take Grandma to vote." When she was born in 1926, women had only had the right to vote for 6 years. I was stunned to realize that one of my great-grandmothers had turned 19 before women were allowed to vote. We see the old photos and think the suffrage movement was something "a really long time ago," but I think most of us forget that we may have known women in our lives who were not always legally entitled to vote.

I don't doubt that those early trips to the voting booth contributed to my lingering interest in all things political, and the fact that I have never missed an opportunity to vote in a presidential election (something unusual for my age bracket). I don't remember who she voted for that day, but the message certainly stayed with me.

I encourage you all to become more informed about politics, particularly issues that affect your body and health, and get out there and vote. It wasn't so long ago that the women in our families didn't have that choice.

Technorati Tags: voting; women's rights

Timken High School Ruminations

The Canton Repository carried an opinion piece on Sunday providing the revelation that 65 (13.3%) of Timken High School's (Canton,OH) 490 female students are pregnant. The piece provided some additional statistics: "According to the Canton Health Department, through July, 104 of 586 babies born to Canton residents in Aultman Hospital and Mercy Medical Center — the county’s largest hospitals — had mothers between 11 and 19. That’s nearly 18 percent, or three times the total number of babies born at the same hospitals to teen parents living elsewhere in Stark County and beyond." Local folks took up discussion here. The piece contained the line, "Suspects range from movies, TV and video games to lazy parents and lax discipline." The blogosphere elsewhere and talk radio had a good chuckle about how it was really sex that was getting these girls pregnant, and isn't it funny that their school mascot is the Trojans? Har, har, move along now...

Ah, but then there was time for the story to sink in, and your friendly women's health blogger still has some questions:

1) Who released this story, and why? This is not a tinfoil hat question, I'm just genuinely curious why a school district (if they released the info) would put out this kind of story while not providing any information on how a future three-pronged program "addressing pregnancy, prevention and parenting" will work. If I were in charge of the school, I'd have a fully researched and planned program, and then put out the story as, "Pregnancy rates have been unusually high, and we are hoping to improve the futures of our female students by doing X, Y, and Z, which have shown to make dramatic improvements in A and B."

2) Is this an unusual percentage for the school, or are pregnancy rates typically this high? A little trend data would provide some context. According to Stark County health department data for 2003-04, the rate of births to teen mothers of Canton in 2001 was 42.7 per 1,000, while the county rate was 20.3. The rate of births to teen mothers with no 1st trimester prenatal care was 304.5 for Canton, and the infant and neonatal death rates are also higher than for the county.

3) Is there anything that would provide some clues as to why Canton girls are getting pregnant at a much higher rate than those in the rest of the county? Are there socioeconomic factors that play into the equation? What kind of sex ed is provided at Timken, and how is the rest of the county doing it differently?

4) Is there any data on the rate of sexually transmitted infections in young girls in Canton? I can only assume that if they're not using protection to prevent pregnancy, they're not using it to prevent STDs, either.

5) Do these girls have access to health care coverage or reduced cost services that will ensure healthy pregnancies and births?

6) Are there any existing support services to help these girls stay in school? My own high school provided a daycare service, through which girls interested in becoming childcare workers could get hands on training, and teenage mothers could have the resources to continue on and earn their diplomas.

7) Can we count out the media influence factor, given the seemingly extreme localization of the higher pregnancy rate at Timken, assuming that girls at other schools had the same opportunities to be exposed to the same media?

As this story sunk in, I thought of course about the implications for these girls' education and poverty status. The thing that really struck me, however, was the lack of real information on what the school was doing/teaching, how that differs from other areas of the county with lower pregnancy rates, whether this is normal for the school, etc. It seemed that this story went for the sensational rather than providing the full story, which I'm sure most of you aren't surprised by. It seems that we could try a little harder when reporting this type of news though, and accompany it with less media-blaming and har har-ing about how sex causes pregnancy. I'm fairly sure these girls knew that, so what is going wrong at Timken, and now what?
Technorati Tags: public health; teen pregnancy

Countdown to FDA Decision on EC

I was reminded via email today that a decision is expected on 9/1 regarding whether emergency contraception drug Plan B will be made available over the counter. I couldn't find the issue in the list of FDA-related items open to public comment, or other pre-decision press on the FDA website. If you feel compelled to send a comment, the FDA's contact information is available here. I'll have information on the decision as soon as it is released.
Technorati Tags: emergency contraception

Sometimes you just have to laugh

The New York Times published a piece titled "A Perilous Journey from Delivery Room to Bedroom," in which an MD describes the men he treats who confess having trouble being attracted to their wives after witnessing them in the act of childbirth. The article suggests that some of these men are suffering from post-traumatic stress disorder, and delivers such gems as "They seem to have trouble seeing them as sexual beings after seeing them make babies" and "Women may want to consider the risks as they invite their partners to watch them bring new life into the world. For some of the passion that binds them together may leave their lives at the very same time." Lovely.

A lengthy discussion of this article has already gone on over at BitchPhD. My contribution? An open letter to the Extraordinary Husband, in anticipation of the day he might feel all traumatized and weird over a thing he will have known was coming for a whole 3/4 of a year:

Dear EH,
Here's the deal. One day, you and I might want to get together and make some babies. On the day the delivery occurs, you are going to be there in the room with me, and I'm not having any of this hiding behind my shoulders garbage. In fact, the chances of my giving birth in the standard flat-on-my-back position are pretty slim. There may be squatting, standing, walking, jumping, or assorted special implements involved, so your shot at staying in one place and avoiding the view is likewise pretty slim. My mom will be there, and everybody else we know has an open invitation as well. You and my mom have both seen all the parts I have to offer, so you'll be fine, and you should count your blessings if I don't have somebody there live-blogging it all. If I'm going to do this thing, and probably sans pain-relieving drugs, you can bet your behind that I'm going to have an audience, and I expect a hearty slap on the back and the exclamation, "You really rocked that pushing, honey!" Suck it up, kiddo, it's going to be messy in there.
Love,
The Cheeky Gyno-Blogger

Okay, so this is not the best representative post for a professional medical librarian-in-training. Seriously, though, women's health issues are so often fraught with the perils of confusing information, missing data, and/or political agendas, sometimes you just have to laugh.
Technorati Tags: childbirth

Male Contraception - is there a market for it?

Morning Edition had a piece today on forms of contraception for men that are currently in development, involving the man receiving testosterone shots. Here's another story on the topic, and a non-hormonal option for men.

My question is this: is there even a market for this? Women - would you give up your own methods of birth control and let the man be responsible? Men - are you even interested in being responsible for contraception? In some ways, this seems like a boon to single folks, if both partners are on contraceptives and can therefore further reduce the risk of pregnancy. However, I'm wondering if most women would insist on their own methods no matter what the men told them about their latest injection. I'm certain that I would. What do you think?
Technorati Tags: birth control; contraception

How is your hospital performing?

The New York Tiimes has an article today titled, "Hospitals are Uneven on Basics," which reviews how Connecticut hospitals are performing on basic care measures, such as providing appropriate treatment to heart attack patients. This information comes from a Department of Health and Human Services resource called Hospital Compare, which can be used to see how frequently hospitals across the nation (including TN) provide what is considered the standard of care.

To use the site, you will select your location, then be taken through a few screens to select the hospitals you want to compare and the areas of care (heart attack, heart failure, and/or pneumonia) and treatments you want to look at. The results will also tell you why each measure/treatment is considered important. A couple of notes: a lot of data is missing for some of the Nashville hospitals (they're either not reporting data, or the sample is too small to draw conclusions), and the site doesn't work perfectly in browsers for Mac. Additionally, I haven't spent enough time with the detailed data to understand how reporting methods may affect the results, so use at your own risk. I would encourage you to look at all the measures, as I have omitted those for pneumonia. I selected Nashville, all listed hospitals, and all areas of care and treatments to obtain the following results, focusing on heart-related statistics because heart diseases are the leading cause of death in the US.

% of heart attack patients given aspirin at arrival: Baptist 98%; Skyline 98%; Centennial 97%; Southern Hills 97%; St Thomas 97%; Vanderbilt 93%; National Average 91%; TN Avg 87%.

% of heart attack patients given aspirin at discharge: Vanderbilt 98%; Baptist 96%; St Thomas 96%; Skyline 89%; Centennial 86%; Southern Hills 70%; National Avg 86%; TN Avg 77%.

% of heart attack patients given beta blocker at arrival: Skyline 100%; Baptist 96%; Vanderbilt 92%; St Thomas 86%; Centennial 84%; Southern Hills 80%; Nat'l Avg 83%; TN Avg 76%.

% of heart attack patients given beta blocker at discharge: Skyline 100%; Baptist 97%; Vanderbilt 94%; Centennial 88%; St Thomas 86%; Southern Hills 84%; Nat'l Avg 84%; TN Avg 74%.

% of heart failure patients given smoking cessation advice/counseling: Centennial 94%; St Thomas 81%; Vanderbilt 79%; Baptist 60%; Nat'l Avg 65%; TN Avg 70%.

% of heart failure patients given discharge instructions: Skyline 88%; Centennial 73%; Vanderbilt 70%; St Thomas 59%; Baptist 46%; Southern Hills 44%; Nat'l Avg 45%; TN Avg 49%.

Links:
MedlinePlus resources on heart attack
MedlinePlus resources on heart failure
Technorati Tags: health care; hospitals; quality of care