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Contents
8(3): Pp. 242 - 247
Melissa K. Frey, Mollie A. Biewald, Michael J. Worley, Jolyn S. Taylor, Stephanie N. Lin and Kevin Holcomb
[Open Access Plus] |
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Introduction: Lynch syndrome was first described in the 1950s however until recently it was rarely included in medical school curricula. As a result, many practicing physicians have limited exposure, potentially contributing to significant under diagnosis. As identification of Lynch syndrome prior to malignancy allows for intensified screening, prophylactic surgery and improved patient outcomes, all physicians should be aware of the characteristics of affected families. We aim to determine the overall level of awareness of Lynch syndrome among medical students at an American medical school. Methods: A voluntary and anonymous questionnaire was delivered to students at an American medical school. The survey instrument assessed the respondent's perceived knowledge regarding the genetics and recommended screening for carriers of Lynch syndrome mutations. Results: The questionnaire was distributed to the entire student body (405 students) with a response rate of 50%. Fiftynine percent of students reported that they had learned about Lynch syndrome; 27% of first year students, 44% of second year students; 90% of third year students and 100% of fourth year students. Of the students familiar with Lynch syndrome, the reported knowledge of the underlying genetics was 46%, available genetic screening, 18%, criteria used to screen for the syndrome, 24%, recommendations for colon screening, 31% and recommendations for endometrial cancer screening, 17%. Conclusion: The majority of medical students surveyed had been exposed to Lynch syndrome and awareness increased over each year of education. Significantly more students were aware of recommendations for colon cancer screening than endometrial cancer screening (32% versus 17%, p = 0.01). Studies of the natural history of Lynch syndrome indicate that affected women are more likely to present with endometrial cancer than colon cancer and while there are no prospective data proving the efficacy of endometrial cancer screening in this high-risk population, the endometrium is easily accessible and can be sampled using simple office techniques. In addition, prophylactic hysterectomy and bilateral salpingo-oophorectomy are reasonable risk reducing interventions for the prevention of both uterine and ovarian cancer. Our findings suggest that increased emphasis must be placed on teaching the gynecologic manifestations of Lynch Syndrome in order to avoid the misconception that it is simply a colon cancer syndrome.
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5(4): Pp. 230 - 238
Pascale Barate and Marleen Temmerman
[Open Access Plus] |
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More than two decades after the launch of the Safe Motherhood Initiative, maternal health in many developing countries has shown little or no improvement. Year after year, more than half a million mothers continue to die in silence. The specificities of the complex cross-cutting issue only partly explain why tireless efforts have led to insufficient progress so far. While some success stories prove that results can be obtained quickly, the dissensions and deficiencies the Initiative has encountered have strongly weakened its impact. However, recent developments over the past 3 years allow us to foresee the silence will soon be broken. While advocacy begins to subsequently raise awareness, more financial means are mobilized. As a consensus on the priority interventions has finally been reached (Women Deliver conference, London, October 2007), more coordinated actions and initiatives are being developed. The strive for the achievement of the Millennium Development Goals helps to create the political momentum the cause strongly needs to generate new leadership, develop and implement the adequate strategies. Sensible focus on resources and structure as well as innovative management will be crucial in that process.
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3(3): Pp. 145 - 160
Kjell Haram, Einar Svendsen and Ole Myking
[Open Access Plus] |
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Intrauterine growth restriction (IUGR) is an important clinical problem associated with increased perinatal mortality and morbidity. The most preferred small for gestational age (SGA) definition is birth weight below the 10th percentile, adjusted for gestational age. The incidence of IUGR is about 4 to 7 %. A variety of hormones are involved. IUGR may be due to chromosomal defects, smoking, early-onset preeclampsia ( < 34 weeks), connective tissue and inflammatory rheumatic diseases, maternal infections, several drugs, twin-to twin transfusion, anorexia nervosa, low maternal pre-pregnancy or small weight gain during pregnancy. High hemoglobin (Hb) levels during the first 10-20 weeks of pregnancy may also cause IUGR. Complications due to IUGR include fetal or neonatal death, dysmaturity, and physical as well as temporary or permanent mental defects. Low birth weight children may have behavioral problems, psychiatric disorders and lower intelligence test scores later in life. There is a relationship between IUGR, timing and progression of puberty, and polycystic ovary syndrome. Fetal changes of lipid metabolism and homeostasis in IUGR may place the grown adult at risk for hypertension, diabetes mellitus and coronary artery disease. Mothers of low weight offspring have an increased risk for cardiovascular and kidney disease later in life.
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