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Janvier 2003 (II)


Un nouveau dispositif féminin de stérilisation est approuvé aux États-Unis.

L'administration américaine US Food and Drug Administration (FDA) vient d'approuver Essure, une nouvelle méthode non chirurgicale de stérilisation féminine. Essure est un petit appareil métallique qui est implanté dans les trompes , provoquant une cicatrisation du tissu qui ferme de manière permanente les trompes.

Les petits appareils sont insérées à travers le col, en une demi-heure, sans anesthésie générale et sans hospitalisation par le moyen d'un hystéroscope.

La stérilisation n'est pas immédiate, mais nécessite la croissance du tissu de cicatrisation qui peut prendre jusqu'à trois mois avant que les trompes ne soient bouchées. Les femmes doivent employer une autre méthode de contraception pendant cette période de trois mois ainsi que le rappelle la FDA. Après trois mois les patientes doivent revenir pour s'assurer que les trompes sont complètement bloquées.

Dans l'étude, qui comprend plus de 600 femmes, qui furent suivies pendant un an aucune grossesse ne s'est déclarée chez les personnes où les appareils ont été implantés avec succès. La FDA a indiqué souhaiter que l'on continue les études chez ces femmes pour une période de cinq ans pour écarter toute complication à long terme de cet appareillage.

Essure et la procédure d'implantation coûteront 2500 dollars ce qui est comparable au coût de la ligature traditionnelle. Essure est déjà approuvé au Canada, en Australie, à Singapour et en Europe et sera disponible aux États-Unis en mars 2003.

SOURCE: Kaiser Daily Reproductive Health Report, 5 November 2002


NEW FEMALE STERILIZATION DEVICE APPROVED IN UNITED STATES


The US Food and Drug Administration (FDA) have just approved Essure, a new non-surgical method of female sterilization.

Essure consists of small metal coils that are implanted in the fallopian tubes, prompting scar tissue to grow and permanently "plug" the tube. The coils are inserted through the cervix in a half-hour outpatient procedure called hysteroscopic sterilization that requires no surgical incision or general anaesthesia. Sterilization is not immediate following the procedure, as the scar tissue may need to grow for up to three months before the fallopian tubes are completely blocked.

The FDA has warned that women must use another method of contraception during that three-month period. After three months, patients must return for testing to ensure that the fallopian tubes have been completely blocked.

In studies of more than 600 women who were followed for one year, no pregnancies occurred among women in whom the devices had been implanted successfully. The FDA stated yesterday that it will require the manufacturer to continue studying these women for at least five years to rule out any long-term complications from Essure.

Essure and the procedure required to implant it is expected to cost about US $2,500, which is comparable to the cost of traditional tubal ligation. Essure is already approved for use in Canada, Australia, Singapore and Europe, and will be available in the US from March 2003.

SOURCE: Kaiser Daily Reproductive Health Report, 5 November 2002


L'AUTO - EXAMEN DES SEINS NE REDUIT PAS LA MORTALITE DUE AU CANCER DU SEIN

Doit-on continuer de conseiller aux femmes de s'auto-examiner les seins ?
Cette pratique qui devrait normalement diminuer l'incidence du cancer du sein ne semble pas être efficace.
C'est ce qui ressort d'une publication récente de l'Institut National Américain du Cancer.

En conclusion de cet article du 2 Octobre 2002 il est dit que "dans les pays en développement où les mammographies ne sont pas accessibles il ne semble pas qu'il faille consacrer les ressources limitées à des efforts de prévention préconisant la palpation".

SOURCE: Journal of the National Cancer Institure. 2002;94(19):1420-1421, 1445-1457, 2 October 2002.
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BREAST SELF EXAMINATION DOES NOT REDUCE MORTALITY FROM BREAST CANCER


More intensive teaching of breast self-examination (BSE) increased the rate of benign breast biopsies but did not reduce mortality related to breast cancer, according to a report in the October 2 issue of the Journal of the National Cancer Institute. The investigators believe the time would be better spent teaching women about breast cancer symptoms and performing a more thorough clinical breast examination.

In a controlled trial, 266,064 female factory workers in Shanghai were randomized to either a BSE instruction group or to a control group receiving no information on breast cancer screening. Women in the instruction group were initially taught how to perform BSE, took part in reinforcement sessions one and three years later, received regular reminders to practice BSE monthly, and practiced BSE under medical supervision every six months for five years.

After 10 to 11 years, breast cancer mortality was the same in both groups. During every year of the trial, women taught BSE found more benign breast lesions than did controls, suggesting that healthcare costs related to biopsies could increase without necessarily detecting breast cancer at an earlier stage.

For women with access to mammographic screening, the authors recommend that BSE not substitute for regular screening by mammography. However, they recommend additional studies to determine whether highly motivated women could be taught to detect cancers developing between regular screenings, and whether diligent BSE enhances the benefit of mammographic screening.

"In developing countries, where mammographic screening is not available, it would not seem to be a good use of the limited funds available for preventive services to promote practice of BSE," said the researchers.

SOURCE: Journal of the National Cancer Institure. 2002;94(19):1420-1421, 1445-1457, 2 October 2002.

ESPACER LES NAISSANCES DE TROIS A CINQ ANNEES EST PLUS SAIN POUR LES MERES ET LES BEBES

L'évidence a régulièrement montré qu'attendre deux années entre les naissances donne une meilleure chance de survie aux nourrissons et aux enfants de moins de cinq ans. Maintenant, de nouvelles études montrent qu'attendre plus longtemps - trois à cinq années - entre les naissances est même meilleur. Les mères ainsi que les enfants bénéficient de plus longs intervalles entre les naissances, selon la dernière publication de Population Reports. Les enfants naissant 3 à 5 années après l'enfant précédent ont près de 2 1/2 fois plus de chances de survivre à l'âge de cinq ans que les enfants nés moins de 2 ans après l'enfant précédent, selon le rapport, Birth Spacing: Three to Five Saves Lives ( "Trois à Cinq sauve des vies" ).

Les nouveaux résultats viennent du programme de Demographic and Health Surveys (DHS) , qui a analysé plus de 430.000 grossesses dans 18 pays."Dans chaque pays des milliers d'enfants en plus pourraient survivre chaque année si toutes les femmes espaçaient leurs naissances au moins de 3 années," selon les estimations de DHS citées dans le rapport.

Au Nigéria, par exemple, si tous les couples espaçaient les naissances de 3 à 5 années, les décès d'enfants de moins de cinq ans pourraient tomber de 23%. De manière identique au Pakistan, les décès d'enfants de moins de cinq ans pourraient chuter de 46% si toutes les femmes espaçaient leurs naissances de 3 à 5 années, selon le rapport Hopkins.

Malencontreusement, dans beaucoup de pays, l'espacement des naissances au-delà de trois années est loin d'être la pratique actuelle et par suite beaucoup de vies sont encore perdues. Les raisons pour lesquelles les intervalles plus courts sont plus risqués sont peu comprises, mais les chercheurs soupçonnent que les mères qui ont des naissances fréquentes n'ont pas le temps de restaurer leurs propres réserves alimentaires ou l'allaitement au sein. Aussi, les enfants d'âge proches sont en concurence pour la nourriture et autres ressources.

Mondialement beaucoup de femmes ont des intervalles de naissance plus courts que 3 ans. Dans 55 des pays étudiés, 26% des mères donnent naissance moins de deux années après une naissance précédente. Près de 31% des couples attendent 2 et 3 années pour avoir un autre enfant. Dans beaucoup de pays en voie de développement les femmes préféreraient attendre plus longtemps entre les naissances qu'elles le font réellement. En 1998 au Kenya, par exemple, les intervalles médians furent de 35 mois comparés avec les intervalles préférés de 49 mois. Si les femmes au Kenya pouvaient réaliser l'intervalle de 49 mois, 17% supplémentaires d'enfants de moins de cinq ans survivraient .Le rapport appelle à aider les femmes à réaliser leurs intervalles préférés de naissance par la continuité de soins, une pleine gamme de choix de méthodes contraceptives , et une source stable d'approvisionnement.

SOURCE: Johns Hopkins Population Information Programme, 14 October
LINKS: Birth Spacing: Three to Five Saves Lives Birth Spacing: Three to Five Saves Lives



SPACING BIRTHS THREE TO FIVE YEARS APART IS HEALTHIER FOR MOTHERS AND BABIES


Evidence has consistently shown that waiting two years between births gives infants and children below five a better chance of survival. Now, new studies find that waiting even longer -three to five years - between births is even better. Mothers as well as children benefit from longer birth intervals, according to the latest issue of Population Reports.

Children born 3 to 5 years after the previous child are about 2.5 times more likely to survive to age five than children born less than 2 years after the previous child, according to the report, Birth Spacing: Three to Five Saves Lives. The new findings come from the Demographic and Health Surveys (DHS) programme, which analyzed outcomes of more than 430,000 pregnancies in 18 countries."In every country thousands more children could survive each year if all women spaced their births at least 3 years apart," according to DHS estimates cited in the report. In Nigeria, for example, if all couples space births between 3 to 5 years, deaths of children under the age of five could fall by 23%. Similarly in Pakistan, death of under-five children in Pakistan could fall by as much as 46%, if all women spaced their births 3 to 5 years apart, according to the Hopkins report.

Unfortunately, in many countries, spacing births beyond three years is far from the current practice and as a result many lives are still being lost. The reasons why short intervals are riskier are little understood, but researchers suspect that mothers who give births frequently may not have time to restore their own nutritional reserves or breast milk. Also, children close in age are more likely to compete for food and other resources.

Worldwide many women have birth intervals shorter than 3 years. In 55 countries studied, some 26% of mothers give birth less than two years after a previous birth. About 31% of couples wait between 2 and 3 years to have another child. In many developing countries women would prefer to wait longer between births than they actually do.

A 1998 survey in Kenya, for example, found that median intervals were 35 months compared with preferred intervals of 49. If Kenyan women could achieve the 49 month interval, an additional 17% of children under five would survive.The report calls on reproductive health programmes to help women achieve their preferred birth intervals by providing continuity of care, a full range of contraceptive methods to choose from, and a steady source of supply.



SOURCE: Johns Hopkins Population Information Programme, 14 October
LINKS: Birth Spacing: Three to Five Saves Lives Birth Spacing: Three to Five Saves Lives


LE NONOXYNOL-9 CONTENU DANS LES PRESERVATIFS PEUT AUGMENTER LE RISQUE D'HIV

Le spermicide nonoxynol-9 n'est pas efficace comme moyen de protection contre l'infection HIV et peut réellement augmenter les risques de contracter le virus du sida , selon une étude publiée dans le "Lancet" du 28 Sept. 2002
Une étude randomisée, sur 765 ouvrières a été conduite dans quatre sites : au Bénin, en Cote d'Ivoire, en Afrique du Sud et en Thaïlande; les unes recevant les préservatifs avec nonoxynol-9 et les autres des préservatifs avec un gel "placebo" .
Les femmes ont pris note de leurs relations sexuelles entre les visites, fournissant des détails sur la nature, la fréquence et l'emploi du contraceptif.

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NONOXYNOL-9 MAY INCREASE RISK OF HIV



The spermicide nonoxynol-9 is not effective as a means of protection against HIV infection and may actually increase a woman's odds of contracting the virus, according to a study published in the Sept. 28 issue of the Lancet.

A randomized, placebo-controlled, triple-blinded phase II/III trial of 765 female sex workers at four sites in Benin, Cote d'Ivoire, South Africa and Thailand were assigned to one of two groups -- those receiving nonoxynol-9 and those receiving a placebo gel.The women were provided with either the nonoxynol-9 gel and condoms or a placebo gel and condoms and were also asked to record their sex acts between visits, providing details about the nature and frequency of the acts and their contraceptive use.

Among the 376 women using nonoxynol-9, there were 59 HIV seroconversions during the follow-up period, compared to 45 seroconversions among the 389 women using the placebo gel. The HIV incidence per 100 woman years was 14.7 for the women using nonoxynol-9 and 10.3 for the placebo group. Women who reported using nonoxynol-9 more than the mean of 3.5 applications per working day were almost twice as likely to acquire HIV compared to women who were in the placebo group. HIV risk did not vary between women who used nonoxynol-9 less frequently and those in the placebo group.

The authors of the report commented that "nonoxynol-9 no longer has a part to play in HIV prevention," concluding, "Although efforts to promote condoms should be increased, research on additional HIV prevention methods, such as other female-controlled methods, microbicides and vaccines, should be reinforced".

In related news, a "broad-based" coalition of more than 85 scientists and health groups, calling itself the "Call to Discontinue N-9 for Rectal Use," yesterday called on condom and lubricant manufacturers to voluntarily cease using nonoxynol-9 in their products, the San Jose Mercury News reports.

Lori Heise, director of the Global Campaign for Microbicides, which is leading the campaign, said that nonoxynol-9 is still safe if the primary intent for use is as a contraceptive during vaginal sex and not as a preventive measure for STDs.

Some condom and lubricant manufacturers have already removed the substance from their products. However, the three largest manufacturers -- Ansell, maker of Lifestyles condoms; Church & Dwight, maker of Trojan condoms; and SSL International, maker of Durex condoms -- have "resisted, arguing that nonoxynol-9 lubrication on condoms provides women with back-up protection against pregnancy" in the event of condom failure, the coalition states. If manufacturers do not comply with the coalition's request, the group will ask stores to voluntarily remove products containing nonoxynol-9 from their shelves. The coalition -- which has support from amfAR, Planned Parenthood, the Gay & Lesbian Medical Association, the National Women's Health Network and the Association of Reproductive Health Professionals -- is also asking for "accelerated" microbicide research.

SOURCE: Kaiser Daily HIV/AIDS Report; Global Campaign for Microbicides release, 27 September 2002





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