Preventing Obesity in Midlife Women: A Recommendation From the Women's Preventive Services Initiative.

DESCRIPTION: The Women's Preventive Services Initiative (WPSI), a national coalition of women's health professional organizations and patient advocacy representatives, developed a recommendation for counseling midlife women aged 40 to 60 years with normal or overweight body mass index (BMI; 18.5 to 29.9 kg/m2) to maintain weight or limit weight gain to prevent obesity with the long-term goals of optimizing health, function, and well-being. This recommendation is intended to guide clinical practice and coverage of clinical preventive health services for the Health Resources and Services Administration and other stakeholders. Clinicians providing preventive health care to women in primary care settings are the target audience for this recommendation. METHODS: The WPSI developed this recommendation after evaluating results of a systematic review of the effectiveness and harms of interventions to prevent weight gain and obesity in women aged 40 to 60 years without obesity. Seven randomized clinical trials including 51 638 participants and using various counseling and behavioral interventions were included. Trials indicated favorable weight changes with interventions that were statistically significantly different from control groups in 4 of 5 trials of counseling, but not in 2 trials of exercise. Few harms were reported. RECOMMENDATION: The WPSI recommends counseling midlife women aged 40 to 60 years with normal or overweight BMI (18.5 to 29.9 kg/m2) to maintain weight or limit weight gain to prevent obesity. Counseling may include individualized discussion of healthy eating and physical activity.

Screening for Anxiety in Adolescent and Adult Women: A Recommendation From the Women's Preventive Services Initiative.

DESCRIPTION: The Women's Preventive Services Initiative (WPSI), a national coalition of women's health professional organizations and patient representatives, developed a recommendation on screening for anxiety in adolescent and adult women to improve detection; achieve earlier diagnosis and treatment; and improve health, function, and well-being. The WPSI's recommendations are intended to guide clinical practice and coverage of services for the Health Resources and Services Administration and other stakeholders. The target audience for this recommendation includes all clinicians providing preventive health care to women, particularly in primary care settings. This recommendation applies to women and adolescent girls aged 13 years or older who are not currently diagnosed with anxiety disorders, including pregnant and postpartum women. METHODS: The WPSI developed this recommendation after evaluating results of a systematic review of the effectiveness of screening, accuracy of screening instruments, and benefits and harms of treatments in adolescent girls and adult women. No studies directly evaluated the overall effectiveness or harms of screening for anxiety. Twenty-seven screening instruments and their variations were moderately to highly accurate in identifying anxiety (33 individual studies and 2 systematic reviews; 171 studies total). Symptoms improved and relapse rates decreased with psychological therapies (246 randomized controlled trials [RCTs] in 5 systematic reviews) and with selective serotonin reuptake inhibitors or selective serotonin and norepinephrine reuptake inhibitors (126 RCTs in 3 systematic reviews). The WPSI also considered the effect of screening on symptom progression and identification of associated and underlying conditions, as well as implementation factors. RECOMMENDATION: The WPSI recommends screening for anxiety in women and adolescent girls aged 13 years or older who are not currently diagnosed with anxiety disorders, including pregnant and postpartum women. Optimal screening intervals are unknown, and clinical judgment should be used to determine frequency. When screening suggests the presence of anxiety, further evaluation is necessary to establish the diagnosis and determine appropriate treatment and follow-up.

Women's Preventive Services Initiative's Well-Woman Chart: A Summary of Preventive Health Recommendations for Women.

The Well-Woman Chart summarizes current recommendations for preventive health services for women from adolescence and continuing across the lifespan. It was developed by the Women's Preventive Services Initiative, a national collaborative of women's health professional organizations and patient representatives. The Well-Woman Chart includes current clinical guidelines from the U.S. Preventive Services Task Force, Bright Futures from the American Academy of Pediatrics, and the Women's Preventive Services Initiative that are covered with no cost-sharing for public and most private insurance plans under the prevention service mandate of the Affordable Care Act. The structure of the Well-Woman Chart is based on age intervals and pregnancy status categories that align with existing recommendations. The target audience for the Well-Woman Chart is all clinicians providing preventive health care for women, particularly in primary care settings, and patients affected by the recommendations. The preventive services recommendations apply to females 13 years of age and older and pregnant females of any age. The Well-Woman Chart provides clinical guidance for screening, counseling, and other recommended preventive services for women during health care visits based on age, pregnancy status, and risk factors.

The fetal and neonatal brain protein neuronatin protects PC12 cells against certain types of toxic insult.

The protein neuronatin is expressed in the nervous system of the fetus and neonate at a much higher level than in the adult. Its function is unknown. As a result of variable splicing, neuronatin mRNA exists in two forms, alpha and beta. Wild type PC12 cells express neuronatin-alpha. We have isolated a PC12 variant, called 1.9, that retains many of the neuron-like properties of wild type PC12 cells, but it does not express neuronatin and it exhibits markedly increased sensitivity to the toxic effects of nigericin, rotenone and valinomycin. Pretreatment of the 1.9 cells with alpha-methyltyrosine, which inhibits dopamine synthesis, had little effect on the cells' sensitivity to nigericin, rotenone or valinomycin indicating that dopamine-induced oxidative stress was not involved in the toxicity of these compounds. However, flattened cell subvariants of the 1.9 cells, which do not have any neuron-specific characteristics, did not exhibit increased sensitivity to nigericin indicating that some neuronal characteristic of the 1.9 cells contributed to the toxicity of nigericin. After the neuronatin-beta gene was transfected into and expressed in the 1.9 cells, they regained wild type PC12 levels of resistance to nigericin, rotenone and valinomycin. These studies suggest that the function of neuronatin during development could be to protect developing cells from toxic insult occurring during that period.

Increasing timely and available prenatal studies by electronic health records.

BACKGROUND: The government is encouraging the adoption of electronic medical records (EMRs). There is little information about using EMRs in the obstetric literature and none about using them in family medicine residencies. Our purpose was to assess if using an EMR was associated with improvement in the ordering and availability of prenatal tests. METHODS: A retrospective chart review comparing the rate at which prenatal laboratory values were present on the chart, ordered on time, and recorded on a prenatal flow sheet. RESULTS: Comparison of charts before and after implementation of an EMR showed statistically significant improvement in the percent of patients with all first trimester (87.5% vs 96.0%; P=.0025), quadruple screening tests (91.1% vs 98.1%; P=.012), and second trimester screening results (93.5% vs 100%; P=.044) in their charts; first trimester laboratory tests (91.6% vs 99.5%; P=.001) and second trimester ultrasounds (90.9% vs 97.3%; P=.027) being ordered on time; and first trimester results (88.2% vs 95.5%; P=.009), quad screen results (93.1% vs 98.0%; P=.0495), and second trimester ultrasounds (93.5% vs 100%; P=.003) being recorded on the American Congress of Obstetricians and Gynecologists flow sheet. CONCLUSION: Adopting an EMR was associated with an improved rate at which prenatal tests were ordered on time, present on the chart, and recorded on a prenatal flow sheet.