Clinical Briefs

Am Fam Physician. 2001 May 1;63(9):1862-1863.

Cardiovascular Benefits of Soy Protein

The Nutrition Committee of the American Heart Association (AHA) has issued a science advisory on soy protein and cardiovascular disease. According to the AHA committee, there is increasing evidence that consumption of soy protein in place of animal protein can lower blood cholesterol levels and may provide other cardiovascular benefits. Previous AHA dietary guidelines stated that while there was evidence of reduced cholesterol levels with the use of soy protein, the findings were inconclusive. This AHA advisory, which appears in the November 14, 2000 issue of Circulation, provides an update on recent research.

The AHA committee reports that isoflavones seem to be the component of soy protein with the most effect on cholesterol levels. Isoflavones have been studied extensively for their possible hypocholesterolemic effects, antioxidant effects and estrogen-like effects on blood vessels. The beneficial effects of estrogen include lower low-density lipoprotein (LDL) cholesterol levels and higher high-density lipoprotein (HDL) cholesterol levels. Researchers found that soy protein containing isoflavones lowered cholesterol levels significantly more than soy protein without isoflavones. However, other studies have concluded that soy protein and isoflavones may be needed for the maximal cholesterol level lowering effect.

A number of clinical trials have demonstrated that consuming 25 to 50 g per day of soy protein is a safe and effective method of lowering LDL cholesterol levels by approximately 4 to 8 percent, and these effects are proportionally greater in persons with hypercholesterolemia. Therefore, the AHA recommends consumption of 25 g or more of soy protein per day with its associated phytochemicals intact to improve lipid profiles in persons with hypercholesterolemia. Soy protein without the isoflavones seems to be less effective. Consuming isoflavones without soy protein does not lower cholesterol levels but may provide other cardiovascular benefits.

AAP Statement on Sexuality, Contraception and the Media

According to the Committee on Public Education of the American Academy of Pediatrics (AAP), early sexual intercourse among American adolescents has become a major public health problem. While early sexual activity may be caused by a variety of factors, the media are thought to play a significant role. In response, the AAP committee has issued a position statement on sexuality, contraception and the media, which appears in the January 2001 issue of Pediatrics.

The AAP committee reports that the United States has one of the highest teenage pregnancy rates in the world. Of all age groups, adolescents have the highest rate of sexually transmitted diseases. According to recent studies, American children spend more than 38 hours per week using media such as television, music, computers and video games. By the time of high school graduation, adolescents will have spent 15,000 hours watching television.

The AAP committee believes that the media are partly to blame for early sexual activity among young persons. While very few studies have examined a possible relationship between sexual content in the media and adolescent behavior, numerous studies have shown the strong influence of television on sexual attitudes, values and beliefs. In all types of media, sexual messages are becoming more explicit in dialogue, lyrics and behavior. These messages often contain unrealistic, inaccurate and misleading information that young persons accept as fact. Adolescents say the media is second only to school sex education programs as a leading source of information about sex.

Fortunately, the media also represents the most easily remediable influence on adolescents. The AAP committee recommends that physicians encourage discussions between patients and their families on the effect the media has on sexual attitudes, beliefs and behaviors. Physicians also should help parents and adolescents identify inappropriate use of sexual images in the media, including portrayals of unsafe sex.

Surgical Alternatives to Hysterectomy

The Health Technology and Advisory Committee (HTAC) has published a physician report on several surgical alternatives to hysterectomy for women experiencing menorrhagia and dysfunctional uterine bleeding. The HTAC was established in 1992 by the Minnesota state legislature. It is an independent, nonpartisan advisory body that evaluates new and emerging health care technologies based on existing scientific research and technology assessments.

According to the HTAC report, these alternative surgical techniques are called endometrial ablation. This procedure involves the removal or destruction of the uterine lining by electrosurgery or the application of heat from laser energy or thermal fluids. The techniques described in the report include transcervical resection of the endometrium, endometrial laser ablation and thermal balloon ablation of the endometrium.

To be eligible for endometrial ablation, patients must meet the following selection criteria: blood loss of more than 80 mL per cycle; bleeding for longer than eight days; blood loss sufficient to cause anemia, or blood loss or symptoms that interfere with normal activities; drug treatment failed, was contraindicated or was refused; uterine size smaller than 12 weeks of gestation, or a uterine cavity less than 12 cm in length; all other causes of excessive menstrual bleeding have been excluded including cancer, precancer and uterine lesions; and childbearing is complete.

The HTAC reports that endometrial ablation is associated with a low rate of complications and few major complications. Physicians should discuss risks and benefits of all options, including endometrial ablation and hysterectomy, with each patient. Following endometrial ablation, diagnosis of endometrial cancer can be difficult and the effects of estrogen replacement therapy in postmenopausal women are unknown. The total and direct costs of endometrial ablation are significantly lower than those for hysterectomy. However, if future retreatment or additional procedures are needed, the cost difference may diminish.

The report (document 000601) and others published by the HTAC maybe obtained by calling 651-282-6374 or by e-mail (htac@health.state.mn.us/). There is no charge for the reports. All reports are also available on the HTAC Web site at http://www.health.state.mn.us/htac/index.htm.

ISMP Self-Assessment Tool for Prevention of Pharmacy Medication Errors

The Institute for Safe Medication Practices (ISMP) received an initial seed grant of $35,000 from the American Pharmaceutical Association Foundation Quality Center to develop the first Medication Safety Self-Assessment Guide for Community Pharmacy. The ISMP is a nonprofit organization that provides timely and accurate medication safety information and encourages safe use of medications.

The ISMP pharmacy guide is intended to serve as a critical goal setting and safe practice resource for chain and retail pharmacies nationwide. Widespread distribution of the assessment tool is planned and results will be analyzed through a voluntary confidential database of self-assessment findings reported to ISMP.

The tool focuses on important aspects of community pharmacy practice, including communication of drug orders and drug information; drug labeling, packaging and naming; drug storage and distribution; and patient monitoring. The results from the self assessment will allow management and pharmacists in chain and retail pharmacies to evaluate their own safe medication practices, identify opportunities for improvement and compare experiences with the aggregate experiences of demographically similar pharmacies.

The design of the guide is similar to the ISMP Medication Safety Self-Assessment tool for hospitals, which was developed last year in cooperation with the American Hospital Association.


Copyright © 2001 by the American Academy of Family Physicians.
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