Recent Online First articles (including the Million Women Study critique)

There has been a flurry of articles published at Online First this month:

1) Syncope and profound bradycardia associated with intrauterine contraceptive procedures by Aisling Baird, Jane Dickson, Mary Jensen and Martin Talbot (Case Report)

David Horwell (Advisory Editor) writes:

Avoiding a shocking experience

‘Cervical shock’ – severe bradycardia and loss of consciousness due to vagal stimulation – is a rare but potentially serious complication of procedures involving cervical manipulation such as IUD/IUS insertion or removal. The Journal has recently featured lively correspondence regarding the most appropriate means of preventing or managing this condition. In their case report, Aisling Baird and her co-authors make a compelling case for adherence to the current FSRH and UK Resuscitation Council guidelines, and in particular for the availability of atropine for intravenous use and the training of medical and nursing personnel for its prompt administration.

2 ) Does hormone replacement therapy cause breast cancer? An application of causal principles to three studies. Part 4. The Million Women Study by Samuel Shapiro, Richard D T Farmer, John C Stevenson, Henry G Burger and Alfred O Mueck (Article)

JFPRHC Editor-in-Chief, Anne Szarewski, comments:

Does HRT cause breast cancer? Part 4. The Million Women Study

Shapiro et al. continue their review of breast cancer and HRT papers, this time focusing on the Million Women Study. They conclude that despite its massive size, this study did not satisfy causal criteria.

The paper by Shapiro et al. has received an enormous amount of publicity in the last few days. Links to a number of articles are given below:

3) Using a simulated patient to assess referral for abortion services in the USA by Laura E Dodge, Sadia Haider and Michele R Hacker (Article)

Henrietta Hughes (Associate Editor) says:

Accessing referral for abortion in the USA

All women seeking abortion services need to access services in a timely fashion, which depends on quick and appropriate referrals to abortion providers. In the USA, reproductive health facilities that do not provide abortion may refer women to abortion services. Dodge et al. have investigated the readiness of services to offer this referral. Simulated patients called gynaecological services in the most and least restrictive US states for abortion. The simulated patient received a direct referral for abortion services less than half the time, even after prompting a staff member to provide one. The least restrictive states were most likely to offer a direct referral and the least likely to offer no referral.

4) Ethnic differences in disease presentation of uterine cancer in New Zealand women by Ridvan Tupai Firestone, Lis Ellison-Loschmann, Andrew N Shelling, Alec Ekeroma, Bettina A Ikenasio-Thorpe, Neil Pearce and Mona Jeffreys (Article)

Andrew Horne (Associate Editor) writes:

Maori and Pacific women more likely to present with advanced uterine carcinoma

There is little known about the contributions of ethnicity to the presentation of uterine carcinoma. The authors of this article have retrospectively analysed uterine carcinoma cases presenting in New Zealand over a 10-year period. They show that Maori and Pacific women, specifically those from lower socioeconomic areas, are more likely to present with advanced disease. They propose that these women, similar to African-American women, may be presenting with a more aggressive histological subtype and that this warrants further investigation.

5) Not such a different world: providing contraception services in Lesotho by Nic Robertson (Margaret Jackson Prize Essay 2011)

Walli Bounds (Associate Editor) comments:

Contraception challenges in Lesotho – not so different from the UK

In his 2011 Margaret Jackson Prize Essay, Nic Robertson gives readers a fascinating insight into the challenges facing contraception services, and problems encountered with use of current contraceptive methods, in Lesotho. Based on personal observations during his elective there, he describes with clarity and compassion the difficulties women face in trying to avoid unwanted pregnancy and sexually transmitted infections. Only limited service provision, inadequate staff training, difficulty in accessing clinics, and inadequate clinic facilities, with no running water, electricity or privacy, are some of the obstacles discussed. In conclusion, the author recommends specific areas for future developments, which could help not only women in Lesotho but also those in the UK.

6) Cervical screening among migrant women: a qualitative study of Polish, Slovak and Romanian women in London, UK by Marta Jackowska, Christian von Wagner, Jane Wardle, Dorota Juszczyk, Aleksandra Luszczynska and Jo Waller (Article)

Imogen Stephens (Associate Editor) reflects:

Cervical screening among migrant women in London

Over half a million people from Central and Eastern Europe live in the UK: half of these are women and most of them are young working adults, with few health care needs. They are not familiar with UK health services, and sometimes struggle with language barriers and long working hours. Jackowska and colleagues, through a series of focus groups, have looked at some of the reasons why young women from some of these countries don’t take up cervical screening (“they just don’t trust the British healthcare”). Many of them prefer to travel back to their home countries once a year to visit the doctor in a more familiar setting. The NHSCP is well-organised, free and can be conveniently accessed in a wide range of settings, including community sexual health services. But this study identifies that we are not necessarily very good at getting this message across to migrant groups: and that our services need to be sensitive to language barriers in particular (“some doctors are mean towards someone who is shy or can’t speak English well”).

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