more_vertWe have greatly admired your leadership as Secretary-General of the UN. Over your 10 years heading the world’s most important international organisation, you have played an exemplary part in strengthening the global health agenda—championing awareness of women’s and children’s health, global warming, and humanitarianism. But there is one issue that concerns us deeply.
Preference: Women's Health
Quality of life increasing focus after breast cancer surgery
With the 5-year survival rate of breast cancer now at 90%, quality of life outcomes have never been more important.
According to a clinical focus in the Medical Journal of Australia, cancer specialists have changed their approach when determining the best outcomes for their patients.
“As survival has improved, the focus of surgical management has rightly undergone a major evolution to recognise the importance of aesthetic and other quality-of-life outcomes, including less extensive axillary surgery and sentinel node biopsy for most patients,” Professor Andrew Spillane from the University of Sydney and President of Breast Surgeons of Australia and New Zealand explained.
Treatment for breast cancer is now thought of as a package of care which allows for flexibility in treatment options and a range of benefits for the patient.
Related: Missing link in breast cancer gene mutations
Cancer Australia recommends all breast cancer patients are managed by a multidisciplinary team comprising of relevant surgeons, nursing, medical and supportive care specialists who meet at diagnosis and any major treatment hurdle.
“The multidisciplinary input into individual cases helps to alleviate the biases that individual specialists may have,” Professor Spillane explains.
Neoadjuvant chemotherapy (chemotherapy before surgery) is increasingly recommended due to its increase in aesthetic and quality-of life outcomes for the patients. Although it has no proven survival advantage, it does help the surgeon as tumours that respond well to neoadjuvant chemotherapy tend to receive the best prognosis.
Related: Breast cancer more deadly for the young
Other surgeries such as oncoplastic breast surgery and immediate breast reconstruction both improve the quality of life and reduce the trauma of the surgery by improving the aesthetic appearance of the breast.
There is also increased information available to patients and their doctors about breast cancer risks from lifestyle choices, family history and previous hormonal exposures which gives women an opportunity to reduce risk factors.
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[Obituary] Willard Cates, Jr
Public health advocate and pioneering epidemiologist in HIV/AIDS and women’s reproductive health. Born on Nov 16, 1942, in Cleveland, OH, USA, he died from leiomyosarcoma on March 17, 2016, in Chapel Hill, NC, USA, aged 73 years.
[Editorial] Domestic violence in China
A survey from the All-China Women’s Federation in 2013 reported that a quarter of Chinese women are victims of domestic abuse at some point in their lives, and the real number is likely to be much higher. Although anyone can be a victim of domestic abuse, women experience the overwhelming majority of attacks, and almost 90% of reported cases in China involve women experiencing abuse from their husbands. Until now, Chinese law has included no specific protection against violence in the home. Domestic violence was only accepted as grounds for divorce in 2001, and was deemed a private matter, with no legal definition and poor police protection.
[Series] Stillbirths: ending preventable deaths by 2030
Efforts to achieve the new worldwide goals for maternal and child survival will also prevent stillbirth and improve health and developmental outcomes. However, the number of annual stillbirths remains unchanged since 2011 and is unacceptably high: an estimated 2·6 million in 2015. Failure to consistently include global targets or indicators for stillbirth in post-2015 initiatives shows that stillbirths are hidden in the worldwide agenda. This Series paper summarises findings from previous papers in this Series, presents new analyses, and proposes specific criteria for successful integration of stillbirths into post-2015 initiatives for women’s and children’s health.
[Series] Stillbirths: progress and unfinished business
This first paper of the Lancet Series on ending preventable stillbirths reviews progress in essential areas, identified in the 2011 call to action for stillbirth prevention, to inform the integrated post-2015 agenda for maternal and newborn health. Worldwide attention to babies who die in stillbirth is rapidly increasing, from integration within the new Global Strategy for Women’s, Children’s and Adolescents’ Health, to country policies inspired by the Every Newborn Action Plan. Supportive new guidance and metrics including stillbirth as a core health indicator and measure of quality of care are emerging.
[Series] Why invest, and what it will take to improve breastfeeding practices?
Despite its established benefits, breastfeeding is no longer a norm in many communities. Multifactorial determinants of breastfeeding need supportive measures at many levels, from legal and policy directives to social attitudes and values, women’s work and employment conditions, and health-care services to enable women to breastfeed. When relevant interventions are delivered adequately, breastfeeding practices are responsive and can improve rapidly. The best outcomes are achieved when interventions are implemented concurrently through several channels.
[Comment] Stillbirths: ending an epidemic of grief
Not all global health issues are truly global, but the neglected epidemic of stillbirths is one such urgent concern. The Lancet’s first Series on stillbirths was published in 2011.1 Thanks to tenacious efforts by the authors of that Series, led by Joy Lawn, together with the impetus of a wider maternal and child health community, stillbirths have been recognised as an essential part of the post-2015 sustainable development agenda, expressed through a new Global Strategy for Women’s, Children’s and Adolescents’ Health which was launched at the UN General Assembly in 2015.
[Correspondence] Global Financing Facility: where will the funds come from?
The recent World Report by Ann Danaiya Usher (Nov 7, p 1809),1 shows some misunderstanding about the fundamental aspects of the Global Financing Facility (GFF) for every woman and every child. This facility was established to support financing for the UN Secretary-General’s renewed Global Strategy for Women’s, Children’s and Adolescents’ Health.2 As GFF partners, we would like to clarify how the GFF is acting to help low-income and middle-income countries to achieve sustainable financing for reproductive, maternal, newborn, child, and adolescent health.
Potato consumption linked to gestational diabetes
A study published in the BMJ has found a link between a woman’s pre-pregnancy consumption of potatoes and her chances of suffering gestational diabetes.
The researchers from the Eunice Kennedy Shriver National Institute of Child Health and Human Development and Harvard University tracked 15,632 women over a 10-year period, which resulted in 21,693 singleton pregnancies.
Of these pregnancies, 854 were affected by gestational diabetes.
After taking into account risk factors such as age, family history of diabetes, diet quality, physical activity and BMI, researchers found that higher total potato consumption was significantly associated with a risk of gestational diabetes.
The researchers found that if women substituted two servings of potatoes a week with other vegetables, wholegrains or legumes, there is a 9-12% lower risk of contracting gestational diabetes.
They say one explanation of the findings is that potatoes have a high glycaemic index which can trigger a rise in blood sugar levels thanks to the high starch content.
Related: Odds, risks and appropriate diagnosis of gestational diabetes: comment
The most recent Australian dietary guidelines released in 2015 say Australians need to eat less starchy vegetables.
The authors of the study admit that the observational nature of their study means no definite conclusions can be drawn about cause and effect.
However, they conclude: “Higher levels of potato consumption before pregnancy are associated with greater risk of GDM, and substitution of potatoes with other vegetables, legumes, or whole grain foods might lower the risk.”
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