A Note from the Editor-in-Chief
Lawrence D. Devoe, M.D.
Welcome to the October 2007 Editor-in-Chief’s page. In keeping with our approach to highlighting manuscripts of special interest, I have listed the following articles below:
In This Issue:
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Findings From a 10-Year Follow-up of Bone Mineral Density in Competitive Perimenopausal Runners
J. Fanning, L. Larrick, L. Weinstein, T. J. Horrigan, M. P. Marcotte and R. F. Flora
The increasing lifespan of American women means that three decades of their lives will be spent in menopause. While there is controversy regarding the prevention of postmenopausal medical complications, osteoporosis will become a serious problem for millions of women. Steroidal and nonsteroidal agents for prevention of bone loss have been available for a number of years. However, the effectiveness of pharmacologic regimens is mitigated in the absence of other lifestyle measures such as calcium and vitamin supplementation as well as weight-bearing exercise. How much exercise should be performed, and, as important, can exercise prior to menopause help in forestalling the inevitable loss of bone density? Fanning and colleagues have conducted a small study which has the advantage of long-term follow-up to address these questions. The results of this study supports the “use it or lose it” lifestyle approach touted for menopausal patients. As others have found, age-related bone loss is inevitable. However, entering menopause with better bone mass may give women a temporary buffer against osteopenia and osteoporosis. It remains to be determined whether continued running will lessen the degree of bone loss compared with nonrunning control patients. Although not covered in this study, there may be other health benefits with this activity for improved cardiovascular and metabolic status.
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Patients Presenting with Birth Plans: A Case-Control Study of Delivery Outcomes
S. H. Deering, J. Zaret, K. McGaha and A. J. Satin
The concept of patient-designed plans for the conduct of their labor and delivery reflects the growing impact of consumerism on hospital care. Encouraging patients to determine the parameters of their management is viewed across medical fields as beneficial. Hospitals view this activity as a means of enhancing patient satisfaction. Do birth plans affect the outcome of care? And, if so, what outcomes are altered? Surprisingly, there is a lack of objectively assessed data to answer these basic questions. Deering et al have looked at a small group of patients who appeared to be at low risk for complications and compared them to comparable patients without birth plans. Granted that birth plans differ and patient requests may vary, it does not appear that delivery outcomes differed from those patients without birth plans with the exception of epidural analgesia rates. This is both good and bad news. The good news: contrary to some urban legends, birth plan patients were not more likely to have a cesarean section. The bad news: contrary to patient expectations, episiotomy rates were not lowered. Such studies are essential for both patients and their caregivers in terms of counseling and providing realistic expectations of labor outcomes. Now we need more data on infant outcomes.
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Paraoxonase Levels in Women with Polycystic Ovary Syndrome
I. V. Fenkci, M. Serteser, S. Fenkci and S. Kose
Paraoxonase (PON1) has been identified previously as an enzyme that could detoxify organophosphates, not a particularly useful function in humans. However, in the past decade, there has been increasing interest in this enzyme as risk factor for cardiovascular disease since it has been shown to break down low-density lipoproteins. This comes at a time when much attention has been directed toward women with polycystic ovary syndrome who are at higher risk for metabolic syndrome. Fenkci and co-authors have connected some of the dots in this study. The fact that these patients had evidence of metabolic syndrome (insulin-resistance, dyslipidemia) is not a novel finding. However, the lowered PON1 which they observed when compared with control patients suggests that this might prove to be a useful marker in the future for assessing cardiovascular risk in this select gynecologic population.
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