A New Contraceptive and HarvestPlus

The U.S. Food and Drug Administration has approved a new contraceptive for women developed by the Population Council.  Annovera; (segesterone acetate and ethinyl estradiol vaginal system) is a combined hormonal contraceptive for women of reproductive age and is the first vaginal ring contraceptive that can be used for an entire year. It is a reusable donut-shaped (ring), non-biodegradable, flexible vaginal system that is placed in the vagina for three weeks followed by one week out of the vagina, at which time women may experience a period (a withdrawal bleed). This schedule is repeated every four weeks for one year (thirteen 28-day menstrual cycles).  It is not felt during sex.  It does not prevent sexually transmitted diseases.  

Annovera is washed and stored in a compact case for the seven days not in use. It does not require refrigeration prior to dispensing and can withstand storage temperatures up to 30°C (86°F).  This new contraceptive is considered suitable for women who do not always remember to take the pill regularly, or who used the previously available contraceptive ring that had to be replaced every month. Women in developing countries may find this method convenient, as they are often unable to find other contraceptives on a regular basis.  The Population Council plans to make it available in Latin America, Asia and Africa as well as in the US.   It will be released in 2019.

The efficacy and safety of Annovera were studied in three, open label clinical trials with healthy women ranging from 18 to 40 years of age. Based on the results, about two to four women out of 100 women may get pregnant during the first year they use Annovera.

All hormonal contraception carries serious risks. Annovera carries a boxed warning relating to cigarette smoking and serious cardiovascular events. Women over 35 who smoke should not use Annovera. Cigarette smoking increases the risk of serious cardiovascular events from combination hormonal contraceptive use.

HarvestPlus is an international organization that uses ‘biofortification’ to make plants more nutritious. Its work is in Asia, Africa and Latin America. It uses conventional plant breeding rather than genetic modification, and focuses on three crucial micronutrients that are most limited in the diets of the poor—vitamin A, zinc, and iron, breeding these into key staple crops. Harvest Plus screens thousands of different types of crop seeds stored in seed banks that have naturally higher amounts of iron, zinc, and vitamin A. They use these more nutritious seeds to breed new crop varieties with higher micronutrient content that are also high yielding and have other traits farmers want. Together with farmers, they test these new varieties in the target region. The national government then officially releases the best-performing varieties of micronutrient-rich crops for farming communities to grow, eat, and sell in local markets.

Iron deficiency during childhood and adolescence impairs mental development and learning capacity. In adults, it reduces the ability to do physical labor. Severe anemia increases the risk of women dying in childbirth. Five hundred million women aged 15 to 49, at the peak of their productive years, are anemic due to iron deficiency. This condition reduces their productivity, decreases their economic potential, and affects their reproductive health outcomes.

Zinc is involved in more body functions than any other mineral. Its role includes acting as a necessary component of more than 200 enzyme systems, normal growth and development, the maintenance of body tissues, sexual function, vision, and the immune system. Zinc is essential for survival, and zinc deficiency has serious consequences for health, particularly during childhood when zinc requirements are increased. In addition, zinc deficiency also causes stunting. Randomized controlled trials showed that zinc supplementation can reduce the severity of morbidity from a number of common childhood infections, including diarrhea, pneumonia, and possibly malaria, by one-third. 

Vitamin A is essential for good vision and cell differentiation. Deficiency results in growth retardation, damage to mucous membrane tracts, reproductive disorders, eye damage—and ultimately blindness. Children with vitamin A deficiency are often deficient in multiple micronutrients and are likely to be anemic, have impaired growth, and be at increased risk of severe morbidity from common childhood infections such as diarrheal diseases and measles. Pregnant women with vitamin A deficiency may be at increased risk of mortality.

Today, biofortified crops, including vitamin A orange sweet potato, iron beans, iron pearl millet, vitamin A yellow cassava, vitamin A orange maize, zinc rice, and zinc wheat, have been grown in more than 40 counties in Asia, Africa and Latin America. Crop improvement continues to develop varieties with higher levels of vitamins and minerals that are adapted to a wide range of agro-ecological conditions, and ensuring that the best germplasm for climate-adaptive and consumer-preferred traits continues to be used in breeding biofortified crops.

The take home message from this column is: despite the suffering in our world due to climate change and political chaos, efforts to improve situations of poverty are underway. As far as iron, zinc and Vitamin A are concerned – do not start to take these micronutrients as supplements, get them from your healthy diet and possibly a multi vitamin/mineral pill – not more! Talk to your health-care provider.

HarvestPlus is supported by several sources: the UK Government, the Bill & Melinda Gates Foundation, the US government’s Feed the Future Initiative, the European Commission and donors to the CGIAR Research Program on Agriculture for Nutrition and Health. HarvestPlus is also supported by the John D. and Catherine T. MacArthur Foundation.

Sadja Greenwood MD, MPH   Sub

Legumes Lower Blood Sugar, Diet to Reduce Breast Cancer Risk, Work Related Email after Hours

Legumes Reduce Blood Sugar Levels: Researchers at the University of Guelph (Ontario, Canada) have found that adding legumes to your diet can significantly reduce blood sugar levels.  They experimented with swapping out half a portion of white rice or white potatoes with green or red lentils.  Replacing the half portion of rice with lentils reduced blood glucose levels by 20%. Replacing a half portion of potatoes with lentils reduced blood glucose levels by 35%, compared to the levels found when lentils were not used.  Details of the study were recently published in the Journal of Nutrition.  Lentils can slow digestion and slow the release of glucose into the bloodstream from the starch of white rice or potatoes.  Other legumes with similar properties include beans of all kinds, garbanzo beans, soy beans and peas.  These legumes are nitrogen-fixing, thereby improving soil fertility.  

A Diet to Ward off Breast Cancer:  Results from the Nurses Health Study have indicated that women who had five and a half servings of fruits and vegetables daily, compared to those who had less than two and a half servings, had an 11 percent lower breast cancer risk.  A serving is about one cup.  The effect was especially significant with the most aggressive types of breast cancer. Cruciferous vegetables (broccoli, cauliflower, Brussels sprouts, kale, and cabbage) were especially strongly associated with reduced risk, as were yellow and orange vegetables such as carrots, winter squash, yams and sweet potatoes.  This study has recently been published in the International Journal of Cancer.

A study entitled :Killing me Softly…electronic communications monitoring and employee and spouse well-beinghas shown that when employers expect workers to monitor their work related emails during non-work hours, the result is a problem for the employees and their families.  William Becker, a Virginia Tech associate professor of management in the Pamplin College of Business, wrote that "The competing demands of work and nonwork lives present a dilemma for employees, which triggers feelings of anxiety and endangers work and personal lives."  Their study shows that employees do not need to spend actual time on work in their off-hours to experience the harmful effects. The mere expectations of availability increase strain for employees and their significant others -- even when employees do not engage in actual work during nonwork time. "The insidious impact of 'always on' organizational culture is often unaccounted for or disguised as a benefit -- increased convenience, for example, or higher autonomy and control over work-life boundaries," Becker said. "Our research exposes the reality: 'flexible work boundaries' often turn into 'work without boundaries,' compromising an employee's and their family's health and well-being."   Prospective employees should be told clearly whether or not email availability in off-hours is expected, so they can decide on the suitability of the job.  Employers should establish boundaries on when they expect off-hour work to be done, and how it will be compensated.  

There are several take-home messages from this paper that apply to all of us.  The digital world of screens and phones has taken over most of our lives, even when work demands are not the issue. It is wonderful and amazing to have the knowledge of the world, past and present, in your pocket.   However, making time for talking face to face, reading or writing a book, doing art and playing music are still important ways of being human.  Gardening, walking, hiking and running outdoors, playing sports and watching the sky – name your favorite and leave your screen behind for a while.  But – you might want to turn it on to listen to – Killing me Softly with his Song – its haunting.  

Sadja Greenwood MD, MPH  

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