Minn. Medical School Switches To Mannequins To Teach Pelvic Exams

Starting this semester, second-year students at the University of Minnesota Medical School will practice pelvic exams on mannequins instead of human patients, the AP/Minneapolis Star Tribune reports. According to school officials, one reason for the switch is to reduce costs. The school has been spending more than $150,000 annually to recruit and train practice patients for the students to examine in class (AP/Minneapolis Star Tribune, 2/18).

Under the new curriculum, students will work with plastic models and observe as a faculty member conducts a pelvic exam on a patient. Previously, students had one opportunity to practice on a patient during their second year, with the next opportunity coming six months to one year later, during their third-year obstetrics and gynecology clerkship, USA Today reports. Sharon Allen -- a professor of family medicine and community health and course director of the class called, "Physician and Patient" -- said, "They were doing [the pelvic exam] once, as more of a comfort and exposure type of experience, but not really learning the skill until their clerkship." The Patient and Physician class is students' introduction to interviewing and examining patients. Allen added, "We looked at the cost-benefit ratio and didn't think it was worth it" to have real patients.

Linda Perkowski, associate dean for curriculum and evaluation, said the decision was not solely financial, adding, "Money is important but we would never decide something just based on money" (Epstein, USA Today, 2/19). Jan van Dis, an assistant professor, said school officials are aware of students' concerns that the change might affect the quality of their education, adding that the decision could be reversed if the new curriculum is not effective (AP/Minneapolis Star Tribune, 2/18).


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.


© 2010 The Advisory Board Company. All rights reserved.

Time To Move Beyond 'Language Of Blame' In Discussing HIV/AIDS, New York Times Column Argues

On the subject of HIV/AIDS, "the fact is that for most new infections, the language of culpability and blame simply no longer applies," infectious disease expert Abigail Zuger writes in a New York Times opinion piece. Although "[y]ou don't hear much about AIDS in America anymore," the disease "endures right here in the U.S.A.: our outpatient clinics are bursting at the seams, and new cases show up daily," Zuger states.

"A million domestic stories are languishing untold, but they are not the operatic tragedies we have grown used to," Zuger continues. Rather, "these are nuanced and complicated fables, with morals that extend beyond the disease itself," she writes.

As an example, Zuger cites a Florida case in which Olympic athlete Darren Chiacchia "was charged a few months ago with what is a first-degree felony in Florida: repeatedly exposing a sexual partner to HIV." Many states have similar laws that were enacted "back in the hysterical old days of AIDS, a period lasting roughly from 1981, when the first reports of the syndrome were published, to 1996, when combination drug 'cocktails' proved remarkably effective against HIV," Zuger writes. Today in the U.S., for a person with HIV "to die of AIDS in the future would probably require a substantial amount of bad judgment or back luck: the medications, if properly prescribed and properly taken, appear almost infallible," according to Zuger.

Despite the scientific advances, Zuger acknowledges that HIV "still sows terror, uncertainly, shame and endless complications." However, "at the same time, we believe deeply in prevention," she says. Zuger asks, "And so whose fault is a new HIV infection, really? Is it mine, for giving it to you, or is it yours, for being stupid and cavalier enough to get it?"

Zuger continues that an article published last month in the New England Journal of Medicine demonstrates that new HIV infections are "increasingly concentrated in specific pockets" of the U.S., "among the poorest of the poor, the disenfranchised and socially marginalized, where substandard education means no escape." The prevalence of HIV is "so high" in these places "that simply living brings risk of infection," according to Zuger. "In other words, if you are a woman in some ZIP codes, falling in love and getting married, with no sexual partner but your husband, puts you at risk for HIV," Zuger states, concluding, "We see these women in our clinics, more and more of them, but you won't find them in court. Whom would they sue?" (Zuger, New York Times, 4/20).


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.


© 2010 The Advisory Board Company. All rights reserved.

New York State To Cover Nonprescription Plan B Under Medicaid

New York state on Feb. 1 will begin covering Barr Laboratories' emergency contraceptive Plan B purchased without a prescription up to six times per year by women ages 18 and older who are Medicaid beneficiaries, the Albany Times Union reports (Benjamin, Albany Times Union, 1/25). FDA in August 2006 approved the Barr's application to allow nonprescription sales of Plan B to women ages 18 and older. The company in December 2006 announced that Plan B, which can prevent pregnancy if taken within 72 hours of sexual intercourse, is available for nonprescription sales at pharmacies across the country (Kaiser Daily Women's Health Policy Report, 12/8/06). Women under age 18 need a prescription to purchase Plan B, which costs between $25 and $95 and is unaffordable for many Medicaid beneficiaries in New York, according to the Times Union. Former Gov. George Pataki (R) in December 2006 changed state's Medicaid rules to allow Plan B coverage for Medicaid beneficiaries. Gov. Eliot Spitzer (D) is carrying out the new rule. A Spitzer aide said that the cost of providing Plan B initially will be picked up by the state but added that New York plans to make arrangements with the federal government for reimbursement. Christina Tenuta, director of EC programs for NARAL Pro-Choice New York, said the new rule would prevent unintended pregnancies, adding, "It's unfair and not good health policy to block [Plan B] access for low-income women." Dennis Poust, a spokesperson for the New York State Catholic Conference, said the new rule would make it "too easy to abuse" the drug. New York is the third state, after Washington and Illinois, to provide EC coverage to Medicaid beneficiaries, according to Tenuta (Albany Times Union, 1/25).

"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.

BJOG Release: Study Finds Higher Incidence Of Gynaecological Cancers In Urban Areas

New research to be published in BJOG: An International Journal of Obstetrics and Gynaecology has found a higher incidence of gynaecological cancers (uterine, ovarian and cervical cancer) in urban areas of Egypt, as compared to rural areas. The incidence of uterine cancer among urban women was six times higher than that of rural women. The study suggests that women in urban areas may have a higher exposure to environmental xenoestrogens (industrially made compounds that have an oestrogenic activity), which may increase the risk of developing hormone-related cancers.


Cancers specific to female organs such as the breasts and uterus, are associated with higher long term exposure to estrogen. Numerous studies around the world have shown that environmental xenoestrogen presence and exposure is higher in urban areas.


Previous research has shown a three to four times higher urban incidence of breast cancer and estrogen receptor positive breast cancer. In this study, the researchers investigated the urban-rural incidences of gynaecological cancers (uterine, ovarian and cervical cancer) to see if they demonstrate the same trend.


The researchers analysed data from the Gharbiah Cancer Registry for the 4-year period of 1999-2002. The study population consisted of all women diagnosed with uterine, ovarian and cervical cancer in the Gharbiah Province of Egypt during this time.


The key findings indicate that the incidence of all three cancers (uterine, ovarian and cervical cancer) was higher in urban areas. The most striking finding was the almost six times higher incidence of uterine cancer among urban women. The researchers found a gradient of increasing urban-rural differences for all female cancers. Cancers such as leukaemia (which are mainly genetically determined) had the lowest urban-rural difference, followed by that seen for all non-hormonally related cancers. The inclusion of cancers that are largely hormonally dependent increased the urban-rural difference by almost 70% (the urban-rural difference increased by 146% when only hormonal cancers were considered).


Lead author, Dr. Amr Soliman, Associate Professor of Epidemiology at the University of Michigan School of Public Health, said "In this population, there is no significant urban-rural difference among women with respect to other risk factors for uterine and breast cancer, healthcare access, and behaviour. There is also very low use of hormonal pills or therapy among Egyptian women. The higher exposure of urban women to man-made chemicals in the environment that act as hormones is the probable risk factor."


Prof. Philip Steer, BJOG editor-in-chief, said "This study adds to a growing body of literature demonstrating the impact of environmental chemicals on human health. The findings suggest that urban women have a much higher exposure to hormonal agents that increase the risk of them developing hormone-dependent cancers. Further research is warranted to confirm and investigate in more detail the association between xenoestrogens and hormone-related cancers.


Notes


BJOG: An International Journal of Obstetrics and Gynaecology is owned by the Royal College of Obstetricians and Gynaecologists (RCOG) but is editorially independent and published monthly by Wiley-Blackwell. The journal features original, peer-reviewed, high-quality medical research in all areas of obstetrics and gynaecology worldwide. Please quote 'BJOG' or 'BJOG: An International Journal of Obstetrics and Gynaecology' when referring to the journal and include the website: bjog as a hidden link online.


Reference


Dey S, Hablas A, Seifeldin I, Ismail K, Ramadan M, El-Hamzawy H, Wilson M, Banerjee M, B|offetta P, Hartford J, Merajver S, Soliman A. Urban-rural differences of gynaecological malignancies in Egypt (1999-2002). BJOG 2009; DOI: 10.1111/j.1471-0528.2009.02447.x.

Source
Royal College of Obstetricians and Gynaecologists