Human teratogens update 2011: Can we ensure safety during pregnancy?

Anniversaries of the identification of three human teratogens (i.e., rubella virus in 1941, thalidomide in 1961, and diethylstilbestrol in 1971) occurred in 2011. These experiences highlight the critical role that scientists with an interest in teratology play in the identification of teratogenic exposures as the basis for developing strategies for prevention of those exposures and the adverse outcomes associated with them. However, an equally important responsibility for teratologists is to evaluate whether medications and vaccines are safe for use during pregnancy so informed decisions about disease treatment and prevention during pregnancy can be made. Several recent studies have examined the safety of medications during pregnancy, including antiviral medications used to treat herpes simplex and zoster, proton pump inhibitors used to treat gastroesophageal reflux, and newer‐generation antiepileptic medications used to treat seizures and other conditions. Despite the large numbers of pregnant women included in these studies and the relatively reassuring results, the question of whether these medications are teratogens remains. In addition, certain vaccines are recommended during pregnancy to prevent infections in mothers and infants, but clinical trials to test these vaccines typically exclude pregnant women; thus, evaluation of their safety depends on observational studies. For pregnant women to receive optimal care, we need to define the data needed to determine whether a medication or vaccine is “safe” for use during pregnancy. In the absence of adequate, well‐controlled data, it will often be necessary to weigh the benefits of medications or vaccines with potential risks to the embryo or fetus. Birth Defects Research (Part A), 2012. © Published 2012 Wiley Periodicals, Inc.     

Women's perspectives on counseling about risks for medication‐induced birth defects

PURPOSE : This qualitative study explored women's experiences with counseling about medication‐induced birth defects, as well as how and when they would like to receive information on medication‐induced birth defects from their health care providers (HCPs). METHODS : We conducted four focus groups with 36 women of reproductive age (18–45 years old) in Pittsburgh, Pennsylvania. Twenty‐one women were using medications to treat a chronic health condition, and two were pregnant. Content analysis was performed by three independent coders using a grounded theory approach. Discrepancies were resolved by consensus. RESULTS : Women reported depending on their HCPs for information about the risks of teratogenic effects of medications on a pregnancy, but felt the information they had been provided was not always comprehensive. Women want HCPs to initiate discussions about potentially teratogenic medications at the time the medications are prescribed, regardless of whether the woman is sexually active or planning a pregnancy. Women want clear information about all potential outcomes for a fetus. Factors women reported as being critical to effective teratogenic risk counseling included privacy, sufficient time to discuss the topic, and a trusting relationship with their HCP. CONCLUSIONS : Women of reproductive age think that providing information about the possible teratogenic effects of medications could be improved by routine discussions of teratogenic risks at the time medications are prescribed. Birth Defects Research (Part A), 2010. © 2009 Wiley‐Liss, Inc.     

Electronic Medical Records and Electronic Health Records: Overview for Nurse Practitioners

Electronic medical records (EMRs) and electronic health records (EHRs) have become essential systems by which nurse practitioners (NPs) communicate vital patient information to other members of the health care team as well as to patients. In this article we examine the important distinctions between EMRs and EHRs; review the genesis of these types of records; summarize applicable provisions of the Health Insurance Portability and Accountability Act from a recent legal case centered around NP utilization of EMRs and EHRs; address open patient access to medical information; and examine threats to security. Suggestions are offered on ways in which NPs can safeguard confidential patient information.     

Self‐medication in insects: current evidence and future perspectives

1. Self‐medication is an ability to consume or otherwise contact biologically active organic compounds specifically for the purpose of helping to clear a (parasitic) infection or reduce its symptoms. Consumption of these compounds may either take place before the infection is contracted (prophylactic consumption) or after the infection is contracted (therapeutic consumption). 2. An important insight is that self‐medication is a form of adaptive plasticity, and as such, consumption of the medicinal substance when uninfected must impose a fitness cost (otherwise the substance would be universally consumed). This distinguishes self‐medication from several closely related phenomena such as microbiome effects or compensatory diet choice. 3. A number of recent studies have convincingly demonstrated self‐medication within several different, distantly‐related, insect taxa. Here I review evidence of self‐medication in the wooly bear caterpillar Grammia incorrupta Edwards, the armyworm Spodoptera Guenée, the fruit fly Drosophila melanogaster Meigen, the monarch butterfly Danaus plexippus Kluk, and the honey bee Apis mellifera Linnaeus. 4. These studies show not only that self‐medication is possible, but that the target of the medication behaviour may in some cases be kin rather than self. They also reveal very few general patterns. I therefore end by discussing future prospects within the field of insect self‐medication.     

An evaluation of self‐reported mobile phone use compared to billing records among a group of engineers and scientists

Most epidemiologic studies of potential health impacts of mobile phones rely on self‐reported information, which can lead to exposure misclassification. We compared self‐reported questionnaire data among 60 participants, and phone billing records over a 3‐year period (2002–2004). Phone usage information was compared by the calculation of the mean and median number of calls and duration of use, as well as correlation coefficients and associated P‐values. Average call duration from self‐reports was slightly lower than billing records (2.1 min vs. 2.8 min, P = 0.01). Participants reported a higher number of average daily calls than billing records (7.9 vs. 4.1, P = 0.002). Correlation coefficients for average minutes per day of mobile phone use and average number of calls per day were relatively high (R = 0.71 and 0.69, respectively, P < 0.001). Information reported at the monthly level tended to be more accurate than estimates of weekly or daily use. Our findings of modest correlations between self‐reported mobile phone usage and billing records and substantial variability in recall are consistent with previous studies. However, the direction of over‐ and under‐reporting was not consistent with previous research. We did not observe increased variability over longer periods of recall or a pattern of lower accuracy among older age groups compared with younger groups. Study limitations included a relatively small sample size, low participation rates, and potential limited generalizability. The variability within studies and non‐uniformity across studies indicates that estimation of the frequency and duration of phone use by questionnaires should be supplemented with subscriber records whenever practical. Bioelectromagnetics 32:37–48, 2011. © 2010 Wiley‐Liss, Inc.     

Prevalence of human T‐lymphotropic virus type 1 carriers among pregnant women in Hokkaido,Japan

As there is a risk of MTCT of HTLV‐1, the HSGP HTLV‐1 MTCT was organized in 2011. To determine how many pregnant women are infected with HTLV‐1 in Hokkaido, which is the northernmost and the second largest island in Japan with a population of 5 467 000 and 39 392 newborns in 2011, the HSGP HTLV‐1 MTCT asked all facilities that may care for pregnant women in Hokkaido in July 2013 to provide information on the number of pregnant women who underwent screening for anti‐HTLV‐1 antibody using particle agglutination or chemiluminescent enzyme immunoassay, and the numbers of those with positive, equivocal, and negative test results in the screening and confirmation tests using western blotting or PCR methods in 2012, respectively. A total of 111 facilities participated in this study and provided information on 33 617 pregnant women who underwent screening in 2012, corresponding to approximately 85% of all pregnant women who gave birth in Hokkaido in 2012. Of 81 candidates for a confirmation test because of positive (n = 77) or equivocal (n = 4) results on screening, 63 (78%) underwent the confirmation test and, finally, 34 (0.1%) and 33 563 (99.8%) women were judged to be HTLV‐1 carriers and non‐carriers, respectively. It was concluded that the prevalence rate of HTLV‐1 carriers was low, one per 1000 pregnant women in Hokkaido. Approximately 40 infants are born yearly to mothers infected with HTLV‐1 in Hokkaido.