Strengthening Research in Academic OB/GYN Departments (1992) / Chapter Skim
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EXECUTIVE SUMMARY
EXECUTIVE SUMMARY
Pages 1-34
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infertility, which affects about 10 percent of bed couples who want an epidemic of sexually fled diseases that include 4 million cases annually of chla~nydial infection and 24 million people in He United States infected with he papillomavin~s, many types of which are associated with comical carcinoma and severe dysplasia. To address the question of whether He field of OBIGYN lacks a sufficiecdy vigorous research capability, He Nanonal Rate of Child Health and Hum 1
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To learn about the concerns of the OB/GYN academic "smrch comm~mity, He committee sent letters to all chairs of Anemic OB/GYN d~arunents ~ He United Sow and Anew; it received replies from 50 individuals, some of whom responded as representatives of le~g OB/GYN prof~onal societies. The commit also commissioned background papers and authorized interviews of a wide may of knowledgeable individuals.
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It is Limp chat only 50 physicians in documents of OB/GYN received NHI research training or career development support between 1980 and 1989 a finding that bow ill for the fire of OB/GYN research manpower. · Initiation of the Reproductive Scientist Development Program is a prong sign.
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It is not knows }low this level of finding compares with ~t of past years. 1h earlier decades, organizations such as Me Josiah Macy, Ir., Rockefeller, Ford, and Mellon foundations played an important role both in s~pordog research Id Gaining and in providing early support for the cheers of many of Yes Cat prominent investigators ~ OB/GYN.
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It is difficult, however, to interleave research training with clinical liaising; as a ret, these physicians are not equipped Ace the methodological tools for research nor Ace the basic science knowledge Act would allow them to undertake investigation in We molecular aspects of biology if that is whale Den ink lie. Acg~g this knowledge revues at least two to Wee years.
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· Debt, when combined with the many other dents to an investigative career, does rent in the loss of talented individuals from the pool of OB/GYN investigators. Although there is little information on the role of debt ill Be Vision to enter a career in investigation, analysis of Be income needed to repay venous levels of debt shows that en~y-level academic salaries let alone Mining and felIawship shpends~o not allow for comfortable repayment of tibe average debt accrued by the time ~ individual enters OBIGYN residency.
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Despite this lack of regimentation, however, there is no evidence that applications from OB/GYN receive unbalanced reviews. Scientific Review Administrators possess Valuable knowledge ~ could enable mves~gators to improve their grant applications.
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· Two c= - problems are Be need for clinical income to s~port salmies and the difficulty of sustaining young investigators umlil they become independent. Most importantly, chairs of OB/GYN deferments play a pivotal role in establishing Be importance of research in a deft, smog external support and providing internal leadership.
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Committee Recommendations The committee concluded ~at, in order to accomplish He proposed agenda of important research it is necessary to strengthen He OB/GYN research ente~pnse. The highest priority should be He building of physician research manpower so that more departments of OB/GYN would be able to successfully compete for research support.
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Actions that would help overcome some of tibe problems OB/GYN research now confronts might include the Nations late of Child Heals and Human Development's chafing its Me to signal to He public and institute staff its commitment to and responsibility for reproductive health. NICE could also recognize the Pounce of programs in reproductive health by establi~g He position of deputy director for reproductive heals or by appoinimg a board+~fied OB/GYN to the position of deputy doctor.
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Program costs willnotbe large and should be home by a consortium of OB/GYN professional associations, the pharmaceutical industry, ~e~c departments of OB/GYN, and He Public Health Service. · Professional grows and other pnvaWsector organi~ons Cat support He Reproductive Scientist Development Program should ensure its stability Hugh a long-tenn commitment of resources.
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conduct important epidemiologica1 and behavioral research ~ is relevant to OB/GYN; and (3) cream interdepartmental research linkages.
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Recommendations for Leadership ltdividuals Woo a strong interest ~ research should be represented in decision-~ing positions in leading OB/GYN professional org~iz~ons. OB/GYN leaders should take the inidative ~ demonstrating to foundation and voluntary health agency As and other representatives, to leaders of professional emaciations, and to relevant foundations of mdus~ial co~pomions, ways in which expanded support of Gaining for OB/GYN investigators would be a worthwhile investment.
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Dig the period of this shady, NIH inertia three activities that will result ~ research agendas that overlap cony areas of He co~ttee's wow: He Pregnancy, Birth, and Infant Research Plan of the National Institute of Child Health and Human Development, a research agenda being developed by He Task Force on Opportunities for Research on Women's Health, and tibe development of a strategic plan that brought together a panel on ~rodllc~ve biology and development and one on i~t heals and mortality. ~ light of these larg~scale efforts, He committee felt Hat it would be duplicative to produce a comprehensive, detailed research agenda.
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· Continued investigation of Be molecular biology of mom chromogen processes. Continued investigation of the biochemical composition of cortical granules and the significance of cortical granule dibiscmce Nor to sperm-egg fission, as well as their general role in Be fe~imion process.
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Continued investigation of the molecular biology of sperm capacitation Continued investigation of the molecular biology of He Twosome reaction with an emphasis on understanding the si=ficmce of the hydrolytic enzymes and their role In the general process of fer~i~ion. · Definidon of the molecular events of the first cleavage, focusing on He involvement of cycling.
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Investigation of the influences of maternal disease states and en~r~ronmental insults on maturationa1 events. · Refinement of techniques for fetal surveillance and He development of better indices for normal and abnormal fimction.
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ExEcTnnz SHERRY Preterm Labor Preterm, Premature Rupture of the Fetal Membranes 19 · Research must be directed to understanding Me regulation of synthesis and degradation of the extracellular matrix of the fetal membranes and contiguous decode pari~lis. It is suspected, but not established, that infechon by way of the action of bacterial toxins (lipopolysa~haride, or UPS)
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Develop conbac~ves Tut protect women against breast and Cal Increase user satisfaction by offering contrac~ptors a wider army of · Provide conbacephon for some ~mdersewed groups Naming men, lactating mothers, teenagers, "d premenopa'~C~1 women. · Develop con~acep~ves that protect women against sexually transmitted diseases (STDs)
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· Conduct long~rm studies on NORPLANT to damming the health bmefits end nsksoflong~ m,low~ose,progestin~nlycontra~pnon compared with combined oral contraceptives. · Develop biodegradable implant that can be removed at any tone and that do not have a long Pod of drug tail - if.
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. · Test candidate compounds for evidence of andie~ty effects and effectiveness against selected STDs in vitro.
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· Establish immunogenicity of He LEI and PSH receptor peptide segments by Mining the inte~achon of antibodies developed against specific receptor pervade segments with the recombinant extracellular dot of the respective receptor, and with isolated ovarian and testicular membranes containing the LH and PSH receptors, re~ec~vely. · {mm~m17n, male and female rats with venous combinations of WRH-andgen and Pacific LH/FSH receptor peptide segments, and damming their effects on sex steroid production, gonadotropin secretion, s~lmatogenesis, ovulation, and fertility.
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· Determine the ~dwv of effectiveness during the postcoital period when He combined drugs could be most effectively administered. Select He most promising combination of drugs for small-scale clinical trials, and perform He appropriate toxicology.
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. Normal implantation in the endometriam is modulated by a number of growth factors, and research into the role of growth factors in tubal fimction may provide important answers on die etiology and genesis of tubal ectopic pregnancies.
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· The mechanisms of action of a vanity of modulators of GnRH pulse generator activity must be elucia~t-.
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The mech~imnc Hat cause the inhibition of the GnRH pulse generator shortly after bird and its reawak~ing at the time of puberty red a complete mystery. The initiation of puberty continues to be a cenbal, unsolved problem in human biology.
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Uterine Neopl~cmc · Can hansv~ginal ultrasonography become a cost-effective tool for early utenne cancer damson, similar to the project deathbed in the discussion on ovarian cancer? · Specialized treatment Dials are needed to determine optimal methods for combing chemotherapy and radiation Dewy, as well as chemotherapy and hormone manipulation, to enhance Spouses In survival.
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Consequen~dy, doled mapping and analysis of the epitomes of He proteins associated with STD organisms in eliciting immune response are necessary. The mucosal immune system of the hum female genital tract and its role in the prevention of infection andlor susceptibility to infection should be studied more intensely.
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· Evaluate the safety and efficacy of experiments an~v~1 drugs against HEV and treatment of opportunistic infections ~ both pregnant and nonpregnant women.
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Natural history shoddies of HPV infection and the influence of the June system are critically important in attempts to prevent the development of cervical cancer. · Encourage therapeutic studies of STDs Mat Pacifically address efficacy and safer as well as compliance and cost.
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· Conduct epidem~ological and basic studies to better define the risk factors and biological mechanic ~t influence progression of REV infection to anog~tal neoplasia. Urgently needed are ~V natal history studies ton ex~e He roles of viral type and Mime stall · Exa~ne~ the mucosal immune system of the hum female genital tract, its re~ion~p to other mucous immune systems, and its role in the prevention of STDs and HIV infection.
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Give special attention to adolescent psychosocial needs m~ emphasis on suicide prevention and support strategies. Characterize the Role of Spas in Adverse P~nangy Outcomes · Study factors such as the infecting pathogen, the stage of gestation dig which infection occurs, chronicity of infection, and behavioral pat$ems such as drug abuse.
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