Clinical Capsules
The State of Cervical Cancer
Most U.S. states are falling behind when it comes to cervical cancer screening rates, coverage of routine screening tests in public insurance programs, and legislation on cervical cancer, according to a new report from Women In Government. In the best-performing states, at least 80% of women in the appropriate age range have been screened in the last 3 years, and Medicaid programs cover both Pap testing and HPV tests in routine screening of women aged 30 and older.
But while 46 states and the District of Columbia cover HPV testing through Medicaid when medically necessary, many physicians are not routinely offering it, said J. Thomas Cox, M.D., director of the Women's Clinic at the University of California, Santa Barbara. “Therefore, it is imperative to inform doctors and women about HPV, and to ensure access to HPV testing and to the vaccine for HPV when it becomes available,” he said in a statement. A copy of the report is available online at
Nerve Block for Breast Ca Surgery
Paravertebral block for the surgical treatment of breast cancer offers significant quality of life advantages over general anesthesia, according to a prospective randomized trial, Christina Weltz, M.D., said at a breast cancer symposium sponsored by the Cancer Therapy and Research Center.
In a study of 41 patients undergoing breast-conserving therapy who were randomized to receive either paravertebral block or general anesthesia, Dr. Weltz of Mount Sinai Medical Center, New York, reported that the patients in the paravertebral group spent less time in the recovery room, used fewer pain and antiemetic medications, and returned to work more quickly than those in the general anesthesia group.
Focus on Folic Acid
Women of childbearing age with a family history that puts their potential children at high risk for neural tube defects should supplement their diets with 4 mg of folic acid each day, according to the U.S. surgeon general. But the increased folic acid should be taken through folic acid supplements, not by increasing the number of multivitamins, the surgeon general said, because of the risk of vitamin A poisoning.
The surgeon general made these recommendations while announcing his agenda for 2005. Women of childbearing age without family history of neural tube defects should supplement their diets with 400 mcg of folic acid each day, according to Surgeon General Richard H. Carmona.
Postpartum OCD
The addition of quetiapine to antidepressant therapy may benefit treatment-resistant obsessive-compulsive disorder in women diagnosed with major depression postpartum onset and OCD, said Shaila Misri, M.D., and Lisa Milis, both of St. Paul's Hospital and British Columbia Women's Hospital, Vancouver.
In a 12-week trial of 14 patients with a mean age of 33 years, nine patients presented with new-onset OCD; three of them had a history of OCD onset at the birth of their first child and experienced continued symptoms after the postpartum period. Five patients experienced worsening of existing OCD symptoms during the postpartum period (J. Clin. Psychopharmacol. 2004;24:624-7).
Eleven (79%) of the patients fully responded to dual therapy, with mean response time at 5.9 weeks and mean dose at response time at 112.5 mg/day, the researchers said. Two patients showed no change in their OCD symptoms, and one showed partial (33%) improvement. Full response was defined as a greater than 50% reduction in the Yale-Brown Obsessive Compulsive Scale.
Gender Differences in Panic Disorder
Gender differences exist in panic disorder patients with or without agoraphobia in the areas of anxiety symptoms and the personality characteristics of extraversion, with fewer differences seen in other areas, according to Meredith Foot and Dianna Koszycki, Ph.D., both of the University of Ottawa.
They looked at 101 outpatients, including 56 women and 23 men who had panic disorder with agoraphobia and 13 women and 9 men who had panic disorder alone. Significant gender differences were not found for patients who completed the 16-item, self-reported Anxiety Sensitivity Index. However, men scored significantly higher on the AS-Social Concerns subscale, and women tended to score higher than men on the AS-Physical Concerns subscale (Depress. Anxiety 2004;20:123-30).
“Women in the current study tended to have greater concerns about the physical consequences of anxiety than men, whereas men were significantly more concerned about the social consequences of anxiety,” Ms. Foot and Dr. Koszycki said.
—From staff reports
