Newsletter - Issue 4, June 2012

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Reducing Teen Pregnancy: Tips for Parents

Dr. Sheila Overton photo

Sheila Overton, M.D., FACOG,
OB/Gyn with Capital Women's Care in Silver Spring, MD

Recent reports show that teen pregnancy and births in the U.S. have reached an all-time low, so it's tempting for parents, healthcare providers, and community leaders to think, "problem solved!" and move on to another issue. But here is the reality: Approximately 750,000 teen pregnancies occur annually in the U.S., and roughly one in three teen girls gets pregnant before age 20.

The term "teen pregnancy" doesn't begin to convey the cascade of public health and social problems that occur when teen girls get pregnant. Teen pregnancy is the leading cause of high school dropout among girls. And, according to The National Campaign to Prevent Teen and Unplanned Pregnancy, about 25% of teen mothers go on welfare within three years of their child's birth, often relegating themselves, and their children, to a life of poverty.

A host of health problems associated with teen pregnancy, including a higher rate of preterm birth and low-birth-weight babies for teen moms, accompanies these social ills.

But there is good news. Parents strongly influence their teens, and play a key role in reducing teen pregnancy by helping their teens make healthy, responsible, and values-based decisions about sex.

The following tips are excerpted from my book, Before It's Too Late: What Parents Need to Know About Teen Pregnancy and STD Prevention. This list gives you some ideas to think about and say to yourself even before you talk to your child. As a prepared parent, you'll be more effective in guiding your teen.

7 Things to Tell Yourself

  1. I don't have to be perfect.
    Parents often tell me that they fear "getting it wrong" if they talk to their kids about sex. Here is what I tell these anxious parents: You don't have to be an expert to communicate effectively. Demonstrate a caring attitude, and you're more than halfway there. If you say something that doesn't sound quite right to you, you can always clarify your comments later.

  2. I have multiple opportunities to get my points across to my teen.
    It's important to avoid trying to say everything you want to get across in one session or "The Talk." Teens - and parents - cringe at the thought of "The Talk". Your goal should be to have many conversations about sexual issues, some planned, but many impromptu. Be alert for teachable moments and use them wisely.

  3. I am approachable.
    Think about the traits that would make it easier for your child to approach you with concerns about sexual health and relationships. In my seminars and talks with teens over more than two decades, teens consistently say that they rate these approachable traits highest: nonjudgmental outlook, good listener, warm and calm demeanor, lighthearted approach, and open-mindedness.

  4. I remember my teen years.
    Even under the most ideal circumstances, talking with your teen about relationships, dating, or sex, can be a little awkward. Accept that your teen might feel uncomfortable, and don't let that stop the conversation. Think back to your teen years and how you would have felt during such conversations.

  5. Shorter can be better.
    Your conversations with your teen don't have to be formal or lengthy to be helpful. For example, making a brief comment about a teen romance scene you both viewed on television can get your point across about what you feel is appropriate behavior for teens in a dating relationship.

  6. Don't assume anything.
    I've heard parents make comments like, "Oh no, my daughter's not having sex - she doesn't even have a boyfriend." What that parent might not realize is that her daughter may have participated in oral sex at a party last weekend. Don't be afraid to ask your child, "Have you felt pressure to have sex or even had sex?"

  7. I communicate love and concern.
    Your teen is very special to you, and you want the very best for him or her. Your teen needs to feel this and to hear this as often as possible. Teens who feel loved by their parent(s) are less likely to engage in risky sexual behavior.

Sheila Overton, M.D., FACOG, is an ob/gyn and author of Before It's Too Late: What Parents Need to Know About Teen Pregnancy and STD Prevention, available at amazon.com through www.droverton.org (free book discussion guide available under "buy the book" tab). Dr. Overton ran a teen pregnancy prevention program in Los Angeles for more than 10 years. She is currently in private practice in Silver Spring, Maryland. Follow her on Twitter @DrOverton.

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June 19 is World Sickle Cell Day

Nita Thompson

Nita Thompson of African American Blood Drive and Bone Marrow Registry for Sickle Cell Disease Awareness volunteered to run the Parent's Guide to Cord Blood exhibit booth at the 2012 Cord Blood Symposium

Sickle Cell Disease (SCD) is a painful, life-threatening illness that affects people of every racial and ethnic background, and is the most frequently occurring genetic disease on Earth. To raise awareness that SCD is global health issue, the United Nations passed a resolution that June 19 is World Sickle Cell Day.

Nita Thompson has dedicated her life to correcting misperceptions and educating the public about SCD. Where normal red blood cells are round, those of SCD patients are deformed with many shaped like a sickle, they are hard and tend to stick together. Clumps of sickle cells can block small blood vessels, causing very painful "crisis" episodes and in severe cases lead to strokes, heart attacks, and death. To combat these symptoms, some SCD patients often need blood transfusions every two, three or four weeks for the rest of their lives!

Healthcare providers especially need to be educated about SCD, says Thompson. When SCD patients in pain crisis go to an emergency room where they are not known by the staff, they may be suspected of drug addiction. One patient was told by medical staff, "You can't have Sickle Cell, you're white". To help spread the word about SCD, Thompson started the group, African American Blood Drive and Bone Marrow Registry 4 Sickle Cell Disease Awareness, or AA4SCDAwareness.

The statistics are that 1 out of 400-500 African American newborns has SCD and 1 out of 1,000-1,400 Hispanic newborns has SCD. Due to high birth rates and under-diagnosis in the community, it is estimated that by 2013, Latinos will exceed African Americans treated in California hospitals for SCD. All US states now screen newborns for SCD. Among adult African Americans, it is known that 1 out of 10-12 is a carrier of the genetic trait for SCD. If both parents are carriers, there is a 1 in 4 chance each offspring will have SCD.

At present, the only cure for SCD is a stem cell transplant to completely replace the patient's immune system. The stem cells may come from either bone marrow or cord blood. However, due to the risks of taking high dose chemotherapy for a transplant, this cure is reserved for the sickest patients, such as children having strokes. Researchers are running clinical trials in an effort to make transplants available to more SCD patients by using Reduced Intensity Chemotherapy (see ClinicalTrials.gov)

The connection between SCD and cord blood is that most African Americans who need stem cell transplants cannot find matching bone marrow donors, and receive transplants of stem cells from cord blood instead. So the efforts to treat SCD patients are intertwined with the need for more cord blood donations from ethnically diverse babies.

AA4SCDAwareness promotes blood and marrow donation drives, spreads awareness at health fairs and school programs, helps patients navigate the health system, advocates for legislation and is the WSCD Coordinator for Activity Suggestions. To learn how you can get involved, contact Nita Thompson at AA4SCDAwareness@aol.com

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Amniotic Fluid Cells for Future Tissue Engineering

Dr. Julie Allickson photo

Julie G. Allickson, PhD, MS, MT (ASCP) is the Director of Translational Research at Wake Forest Institute for Regenerative Medicine.

Amniotic fluid has been used for more than 70 years for prenatal diagnosis (1). It is extracted, by a procedure called "amniocentesis", generally between the 14th and 20th weeks of pregnancy, to assess for genetic birth defects. In addition to the fluid required for testing, the doctor will also withdraw a small amount (a few milliliters) of additional fluid, in case any further testing is required. That extra fluid could be used to isolate fetal stem cells from the baby, as it contains a varied population of cells that originate from the tissues of the baby's skin, respiratory, digestive and urinary tracts.

Stem cells may be one important component of "tissue engineering" to maintain or repair a functional tissue or organ. Tissue engineering has the potential to revolutionize the way we deliver healthcare and may improve the quality of life for millions in the future. One of the most important applications would be to grow life-saving organs in the laboratory to replace living or cadaveric donors used in organ transplantation. There is an extreme shortage of organs available for donation, which does not allow for treatment for a large portion of patients. The need for organs far outpaces the supply.

Stem cells from many different sources are being assessed therapeutically across over 4000 trials listed on ClinicalTrials.gov. Amniotic fluid may provide an important source of immature cells discarded by the developing baby. The primitive nature of the cell may lend itself to a large number of applications due to its plasticity. There is no need to force the cells to become pluripotent, no potential to grow tumors, and no ethical considerations associated with the cell. Furthermore the cells have demonstrated that they are capable of suppressing or altering an immune response (2).

Amniotic fluid cells can differentiate into the three embryonic germ cell layers, and thus harbor the potential to become every cell type in the human body. Here is a list of cell types that scientists have grown from amniotic fluid cells: adipogenic, osteogenic, myogenic, endothelial, neuronal and hepatic lineages (3); epithelial lung (4), cardiomyogenic (5, 6), smooth muscle in a cryo-injured bladder (7), hematopoietic (8), hepatocyte (9) renal (10), and tendon (11), to name a few. A subpopulation of the cells in the amniotic fluid, referred to as c-kit+, can be expanded to more than 250 population doublings while maintaining normal chromosones and long telomeres.

What is even more exciting for the future of tissue engineering, is that some amniotic fluid cells seem to function as specific organ precursor cells (12). For example, one cell line seems to be progenitors of kidney cells. In pre-clinical studies they were able to protect kidneys from tubular necrosis (13).

In the future, amniotic fluid cells may be a useful reservoir of stem cells for in-utero treatment of congenital conditions that carry a heavy burden on the patient and society (12). A case in point would be spina bifida, which is currently under investigation. The amniotic fluid cells surrounding a sick baby can be harvested and grown to treat that baby. This can be done during the course of the pregnancy, and without fear of the cells being rejected since they are native to the patient.

Anthony Atala, M.D., Director of the Wake Forest Institute for Regenerative Medicine, has stated that 99% of the U.S. population could conceivably find genetic matches for tissue regeneration or engineered organs from just 100,000 unique amniotic fluid samples. The amniotic fluid cell source may be revolutionary in the field of healthcare as highly proliferative, immature cells capable of immune modulation.

Julie Allickson has 22 years of experience in Cellular Therapy, Cellular Processing and Regenerative Medicine. She has a Doctorate in Health Sciences along with a Master's Degree in Medical Laboratory Sciences. She is currently an inspector for both NetCord FACT and for AABB, the vice-chair of the AABB Standards Committee for Cell Therapy Product Services, technical advisor for Tissue Engineered Products under ICCBBA, and a founding member of the International Society of Cellular Therapy. Up until recently, Dr. Allickson was Vice President of Laboratory Operations and R & D at Cryo-Cell International, Inc. Since May 2012, Dr. Allickson is the Director of Translational Research at Wake Forest Institute for Regenerative Medicine, Wake Forest University School of Medicine, where she is focused on translation of adult and fetal stem cells.

References

  1. Baranov V.S., Kuznetsova T.V.. Cytogenetics of Human Embryonic Development. St. Petersburg. N-L. 2007:639-639.
  2. Moorefield EC, McKee EE, Solchaga L, Orlando G, Yoo JJ, Walker S, Furth ME, Bishop CE. Cloned, CD117 selected human amniotic fluid stem cells are capable of modulating the immune response. PLoS One. 2011;6(10):e26535. Epub 2011 Oct 26.
  3. De Coppi P, Bartsch G Jr, Siddiqui MM, Xu T, Santos CC, Perin L, Mostoslavsky G, Serre AC, Snyder EY, Yoo JJ, Furth ME, Soker S, Atala A. Isolation of amniotic stem cell lines with potential for therapy. Nat Biotechnol. 2007 Jan;25(1):100-6. Epub 2007 Jan 7.
  4. Carraro G, Perin L, Sedrakyan S, Giuliani S, Tiozzo C, Lee J, Turcatel G, De Langhe SP, Driscoll B, Bellusci S, Minoo P, Atala A, De Filippo RE, Warburton D. Human amniotic fluid stem cells can integrate and differentiate into epithelial lung lineages. Stem Cells. 2008 Nov;26(11):2902-11. Epub 2008 Aug 21.
  5. Bollini S, Pozzobon M, Nobles M, Riegler J, Dong X, Piccoli M, Chiavegato A, Price AN, Ghionzoli M, Cheung KK, Cabrelle A, O'Mahoney PR, Cozzi E, Sartore S, Tinker A, Lythgoe MF, De Coppi P. In vitro and in vivo cardiomyogenic differentiation of amniotic fluid stem cells. Stem Cell Rev. 2011 Jun;7(2):364-80.
  6. Bai J, Wang Y, Liu L, Chen J, Wang Y. Biocharacteristics of c-kit+ human amniotic fluid-derived mesenchymal stem cells and their differentiation into cardiomyocytes in vitro]. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2012 Feb;26(2):152-7.
  7. De Coppi P, Callegari A, Chiavegato A, Gasparotto L, Piccoli M, Taiani J, Pozzobon M, Boldrin L, Okabe M, Cozzi E, Atala A, Gamba P, Sartore S. Amniotic fluid and bone marrow derived mesenchymal stem cells can be converted to smooth muscle cells in the cryo-injured rat bladder and prevent compensatory hypertrophy of surviving smooth muscle cells. J Urol. 2007 Jan;177(1):369-76.
  8. Ditadi A, de Coppi P, Picone O, Gautreau L, Smati R, Six E, Bonhomme D, Ezine S, Frydman R, Cavazzana-Calvo M, Andre-Schmutz I. Human and murine amniotic fluid c-Kit+Lin- cells display hematopoietic activity. Blood. 2009 Apr 23;113(17):3953-60. Epub 2009 Feb 12.
  9. Liu H, Liu DQ, Li BW, Guan LD, Yan ZF, Li YL, Pei XT, Yue W, Wang M, Lu YP, Peng HM, Lv Y. Human amniotic fluid-derived stem cells can differentiate into hepatocyte-like cells in vitro and in vivo. In Vitro Cell Dev Biol Anim. 2011 Oct;47(9):601-8. Epub 2011 Sep 22.
  10. Renal differentiation of amniotic fluid stem cells. Perin L, Giuliani S, Jin D, Sedrakyan S, Carraro G, Habibian R, Warburton D, Atala A, De Filippo RE. Cell Prolif. 2007 Dec;40(6):936-48.
  11. Fuchs JR, Kaviani A, Oh JT, LaVan D, Udagawa T, Jennings RW, Wilson JM, Fauza DO. Diaphragmatic reconstruction with autologous tendon engineered from mesenchymal amniocytes. J Pediatr Surg. 2004 Jun;39(6):834-8; discussion 834-8.
  12. Shaw SW, David AL, De Coppi P. Clinical applications of prenatal and postnatal therapy using stem cells retrieved from amniotic fluid. Curr Opin Obstet Gynecol. 2011 Apr;23(2):109-16.
  13. Perin L, Sedrakyan S, Giuliani S, Da Sacco S, Carraro G, Shiri L, Lemley KV, Rosol M, Wu S, Atala A, Warburton D, De Filippo RE.Protective effect of human amniotic fluid stem cells in an immunodeficient mouse model of acute tubular necrosis. PLoS One. 2010 Feb 24;5(2):e9357.