Fertility preservation in patients undergoing gonadotoxic therapy or gonadectomy

The Practice Committee of the American Society for Reproductive Medicine Opinion, 2018

“Patients preparing to undergo gonadotoxic medical therapy or radiation therapy or gonadectomy should be provided with prompt counseling regarding available options for fertility preservation. Fertility preservation can best be provided by comprehensive programs designed and equipped to confront the unique challenges facing these patients.

Over 100,000 individuals less than 45 years of age are diagnosed with cancer annually in the United States. Over the past 4 decades, advancements in cancer therapies, particularly chemotherapeutics, have led to dramatic improvements in survival. Given the reproductive risks of cancer therapies and improved long-term survival, there has been growing interest in expanding the reproductive options for cancer patients. Indeed, both cancer survivors and the medical community have acknowledged the importance of patient counseling” …

continue reading on the American Society for Reproductive Medicine practice guidelines.

On a ce devoir de faire sans pesticides, dit Paul François

“ça sera bon pour nos fermes, pour le consommateur, et pour l’environnement ” ~Paul François~

Fabrice Nicolino est allé à la rencontre de Paul François sur son exploitation agricole céréalière en Charente. Gravement intoxiqué à la suite d’un accident, il est passé du conventionnel au bio.

Air pollution may increase dementia risk by 40 percent, London study finds

Are noise and air pollution related to the incidence of dementia ?
A cohort study in London, England, 2018

Air pollution may increase the chance of developing dementia, a study has suggested, in fresh evidence that the health of people of all ages is at risk from breathing dirty air, TheGuardian reports.

Abstract

Objective
To investigate whether the incidence of dementia is related to residential levels of air and noise pollution in London.

bmDesign
Retrospective cohort study using primary care data.

Setting
75 Greater London practices.

Participants
130 978 adults aged 50–79 years registered with their general practices on 1 January 2005, with no recorded history of dementia or care home residence.

Primary and secondary outcome measures
A first recorded diagnosis of dementia and, where specified, subgroups of Alzheimer’s disease and vascular dementia during 2005–2013. The average annual concentrations during 2004 of nitrogen dioxide (NO2), particulate matter with a median aerodynamic diameter ≤2.5 µm (PM2.5) and ozone (O3) were estimated at 20×20 m resolution from dispersion models. Traffic intensity, distance from major road and night-time noise levels (Lnight) were estimated at the postcode level. All exposure measures were linked anonymously to clinical data via residential postcode. HRs from Cox models were adjusted for age, sex, ethnicity, smoking and body mass index, with further adjustments explored for area deprivation and comorbidity.

Results
2181 subjects (1.7%) received an incident diagnosis of dementia (39% mentioning Alzheimer’s disease, 29% vascular dementia). There was a positive exposure response relationship between dementia and all measures of air pollution except O3, which was not readily explained by further adjustment. Adults living in areas with the highest fifth of NO2 concentration (>41.5 µg/m3) versus the lowest fifth (<31.9 µg/m3) were at a higher risk of dementia (HR=1.40, 95% CI 1.12 to 1.74). Increases in dementia risk were also observed with PM2.5, PM2.5 specifically from primary traffic sources only and Lnight, but only NO2 and PM2.5 remained statistically significant in multipollutant models. Associations were more consistent for Alzheimer’s disease than vascular dementia.

Conclusions
We have found evidence of a positive association between residential levels of air pollution across London and being diagnosed with dementia, which is unexplained by known confounding factors.

Long-Term Dangers of Birth Control Pills

Dr. Elizabeth Plourde, Clinical Laboratory Scientist, Author, talks, 2011

Dr. Elizabeth Plourde talks about the dangers of using birth control pills for many years and why they are dangerous.

  • Video published on 26 Sep 2011 by iHealthTube.com.

L’interdiction des pesticides: c’est ici et maintenant, dit Marie-Lys Bibeyran

“Nous voulons que nos enfants puissent vivre et survivre” ~Marie-Lys Bibeyran~

Ouvrière viticole en Gironde, Marie-Lys Bibeyran raconte son combat pour faire reconnaitre les maladies des ouvriers liés aux produits chimiques.

Marie-Lys Bibeyran anime un comité de bagarre contre les pesticides, le collectif Info Médoc Pesticides, depuis le drame qui a touché son frère.

Sweetening the pill : Could some birth-control drugs kill you?

Could some pharmaceutical birth-control methods be having side-effects that are much more dangerous than women realise ?

Featuring interviews with parents and friends of those who’ve died after complications related to some birth control hormones, Abby Epstein and Holly Grigg-Spall question how much the public really know about their medical effects.

  • Find out more about the Sweetening the Pill documentary on Kickstarter.
  • Video published on 22 Jun 2015 by The Guardian.

The Pill : Association of Hormonal Contraception With Depression

Are some side effects of birth control pills being kept secret ?

November 2016, JAMA Psychiatry published a Danish study that found a correlation between the use of hormonal birth control and being diagnosed with clinical depression. The study tracked hormonal birth control use and prescription of antidepressants over six years for over a million women. They found that women who were on hormonal birth control—be it the pill or a hormonal IUD or vaginal ring—were significantly more likely to be prescribed antidepressants.

These findings are only the latest in a long line of battles between women and their doctors over accurate information, broadly.vice reports in The Racist and Sexist History of Keeping Birth Control Side Effects Secret.

In 2018, the popularity of apps like Natural Cycles highlights the serious issues with contraceptives, the conversation reports.

Illustration by Eleanor Doughty, feature image credit broadly-images.vice.

Key Points

  • Question
    Is use of hormonal contraception associated with treatment of depression?
  • Findings
    In a nationwide prospective cohort study of more than 1 million women living in Denmark, an increased risk for first use of an antidepressant and first diagnosis of depression was found among users of different types of hormonal contraception, with the highest rates among adolescents.
  • Meaning
    Health care professionals should be aware of this relatively hitherto unnoticed adverse effect of hormonal contraception.

Abstract

Importance
Millions of women worldwide use hormonal contraception. Despite the clinical evidence of an influence of hormonal contraception on some women’s mood, associations between the use of hormonal contraception and mood disturbances remain inadequately addressed.

Objective
To investigate whether the use of hormonal contraception is positively associated with subsequent use of antidepressants and a diagnosis of depression at a psychiatric hospital.

Design, Setting, and Participants
This nationwide prospective cohort study combined data from the National Prescription Register and the Psychiatric Central Research Register in Denmark. All women and adolescents aged 15 to 34 years who were living in Denmark were followed up from January 1, 2000, to December 2013, if they had no prior depression diagnosis, redeemed prescription for antidepressants, other major psychiatric diagnosis, cancer, venous thrombosis, or infertility treatment. Data were collected from January 1, 1995, to December 31, 2013, and analyzed from January 1, 2015, through April 1, 2016.

Exposures
Use of different types of hormonal contraception.

Main Outcomes and Measures
With time-varying covariates, adjusted incidence rate ratios (RRs) were calculated for first use of an antidepressant and first diagnosis of depression at a psychiatric hospital.

Results
A total of 1 061 997 women (mean [SD] age, 24.4 [0.001] years; mean [SD] follow-up, 6.4 [0.004] years) were included in the analysis. Compared with nonusers, users of combined oral contraceptives had an RR of first use of an antidepressant of 1.23 (95% CI, 1.22-1.25). Users of progestogen-only pills had an RR for first use of an antidepressant of 1.34 (95% CI, 1.27-1.40); users of a patch (norgestrolmin), 2.0 (95% CI, 1.76-2.18); users of a vaginal ring (etonogestrel), 1.6 (95% CI, 1.55-1.69); and users of a levonorgestrel intrauterine system, 1.4 (95% CI, 1.31-1.42). For depression diagnoses, similar or slightly lower estimates were found. The relative risks generally decreased with increasing age. Adolescents (age range, 15-19 years) using combined oral contraceptives had an RR of a first use of an antidepressant of 1.8 (95% CI, 1.75-1.84) and those using progestin-only pills, 2.2 (95% CI, 1.99-2.52). Six months after starting use of hormonal contraceptives, the RR of antidepressant use peaked at 1.4 (95% CI, 1.34-1.46). When the reference group was changed to those who never used hormonal contraception, the RR estimates for users of combined oral contraceptives increased to 1.7 (95% CI, 1.66-1.71).

Conclusions and Relevance
Use of hormonal contraception, especially among adolescents, was associated with subsequent use of antidepressants and a first diagnosis of depression, suggesting depression as a potential adverse effect of hormonal contraceptive use.

Is cancer fundraising fuelling quackery ?

Are crowdfunding sites promoting quack treatments for cancer ?

Figures published by The BMJ show how crowdfunding for alternative therapies for patients with terminal cancer has soared in recent years. But there are fears that huge sums are being raised for treatments that are not backed by evidence and which, in some cases, may even do then harm, MedicalXpress reports.

JustGiving’s own figures show more than 2300 UK cancer related appeals were set up on its site in 2016, a sevenfold rise on the number for 2015.

The phenomenon has allowed less well-off patients to access expensive, experimental treatments that are not funded by the NHS but have some evidence of benefit. But many fear it has also opened up a new and lucrative revenue stream for cranks, charlatans, and conmen who prey on the vulnerable.

“We are concerned that so many UK patients are raising huge sums for treatments which are not evidence based and which in some cases may even do them harm.”

The society’s project director, Michael Marshall, said.

Melanie Newman, freelance journalist, London, UK, examines calls to help ensure patients and their donors are not being exploited.

Featured image credit @bmj_company.

The power of the placebo effect

The amazing power of the mind over the body

The placebo effect is an unexplained phenomenon wherein drugs, treatments, and therapies that aren’t supposed to have an effect — and are often fake — miraculously make people feel better. What’s going on?

  • Emma Bryce dives into the mystery of placebos’ bizarre benefits.
  • Video published on 4 April 2016 by TED-Ed.

BPA link to precursor of type 2 diabetes

Experimental BPA Exposure and Glucose-Stimulated Insulin Response in Adult Men and Women

A first-of-its-kind study of a small group of people exposed to a very small amount of bisphenol-A (BPA) is raising questions about the federal government’s stance that low doses of the common chemical are safe — as well as the ethics of conducting such an experiment on humans. The controversial study suggests that BPA exposure deemed safe by the feds could alter the amount of insulin released and elevate people’s type 2 diabetes risk, Environmental Health News reports.
Featured image credit Simon Zhu.

2018 Study Abstract

Aims
Human cross-sectional and animal studies have shown an association of the chemical bisphenol A (BPA) with insulin resistance, type 2 diabetes and other metabolic diseases, but no human experimental study has investigated whether BPA alters insulin/C-peptide secretion.

Methods
Men and post-menopausal women (non-diabetic) were orally administered either the vehicle or a BPA dose of 50-µg/kg body weight, which has been predicted by U.S. regulators (FDA, EPA) to be the maximum safe daily oral BPA dose over the lifetime. Insulin response was assessed in two cross-over experiments using an oral glucose tolerance test (OGTT; experiment 1) and a hyperglycemic clamp (HG clamp; experiment 2). Main outcomes were the percent change of BPA session measures relative to those of the control session.

Results
Serum bioactive BPA after experimental exposure was at levels detected in human biomonitoring studies. In the OGTT, a strong positive correlation was found between HbA1c and the percent change in the insulinogenic index (Spearman=0.92), an indicator of early phase insulin response, and the equivalent C-peptide index (Pearson = 0.97). In the HG clamp study, focusing on the later phase insulin response to a stable level of glucose, several measures of insulin and C-peptide appeared suppressed during the BPA session relative to the control session; the change in insulin Cmax (maximum concentration) was negatively correlated with HbA1c and the Cmax of bioactive serum BPA.

Conclusions
This exploratory study suggests that BPA exposure to a dose considered safe by U.S. regulators may alter glucose-stimulated insulin response in humans.