Kaiser Daily Women's Health Policy Report Highlights Recently Released Studies

The following highlights recently released studies on women's health issues.

Pregnancy & Childbirth

"Fostering International Collaboration in Birth Defects Research and Prevention: A Perspective From the International Clearinghouse for Birth Defects Surveillance and Research," American Journal of Public Health: Lorenzo Botto of CDC's National Center on Birth Defects and Developmental Disabilities and colleagues examined three methods of monitoring birth defects: an example of the "intersection of surveillance and research," an example of the "evolution from surveillance to outcome research," and an example of a public health collaboration in genetics (Botto et al., AJPH, 3/29).


"Work Activity in Pregnancy, Preventive Measures, and the Risk of Delivering a Small-for-Gestational-Age Infant," AJPH: Agathe Croteau of the Universite Laval's CHUL Research Centre and colleagues examined women in Quebec who between January 1997 and March 1999 had single live births to evaluate whether "some occupational conditions," such as an irregular daily schedule, during pregnancy increase the likelihood of delivering an infant with a low birthweight. The study concludes, "Certain occupational conditions experienced by pregnant women can increase their risk of having an [infant with a low birthweight], but preventive measures can reduce the risk" (Croteau et al., AJPH, 3/29).


"Factors Associated With the Rise in Primary Cesarean Births in the United States, 1991-2002," AJPH: Eugene Declercq of Boston University's School of Public Health and colleagues from the National Center for Health Statistics examined factors contributing to changes in rates of caesarean sections in the U.S. between 1991 and 2002. The researchers concluded that changes in c-section rates during the study period were not related to shifts in risk profiles of the pregnant women (Declercq et al., AJPH, 3/29).


"Patient Privacy and Conflicting Legal and Ethical Obligations in El Salvador: Reporting of Unlawful Abortions," AJPH: Heathe Luz McNaughton of the University of North Carolina-Chapel Hill School of Public Health and colleagues examined the possible reasons that lead El Salvadorian OB/GYNs to report women who underwent abortion despite "ethical and human rights standards" that "oblige providers to respect patients' privacy" (Luz McNaughton et al., AJPH, 3/29).


"Paternal Age as a Risk Factor for Low Birthweight," AJPH: Nancy Reichman of Robert Wood Johnson Medical School and Julien Teitler of Columbia University evaluated whether there is a connection between paternal age and low birthweight among urban U.S. residents. Reichman and Teitler -- who controlled for maternal age, demographic factors and gender -- concluded that paternal age is a risk factor that contributes to the low birthweight of an infant (Reichman/Teitler, AJPH, 3/29).


"Associations of Maternal Age- and Parity-Related Factors With Trends in Low-Birthweight Rates: United States, 1980 Through 2000," AJPH: Quanhe Yang of CDC and researchers at the University of California-Los Angeles and Emory University's Rollins School of Public Health examined how shifts in the ages of U.S. pregnant women affect birthweight trends. The authors concluded that "delayed childbearing may play an increasingly important role in low-birthweight trends" in the U.S. (Yang et al., AJPH, 4/6).


"Thrombolytic Therapy of Acute Ischemic Stroke During Pregnancy," Neurology: A. Murugappan of the Stroke and Neurological Critical Care Programs at Wayne State University School of Medicine and colleagues examined eight pregnant women whose brains were deprived of oxygen because of a blood clot or other occlusion and who then were treated with thrombolytic therapy to break up the blockage. The study concludes that, while pregnant women can be treated with thrombolytic therapy, "risks and benefits" to both the pregnant woman and the fetus "must be carefully weighed" (Murugappan et al., Neurology, March 2006).

Public Health
"Improving Birth Control Service Utilization By Offering Services Prerelease vs Postincarceration," AJPH: Jennifer Clarke of Rhode Island Hospital and colleagues examined whether providing contraceptive services within a prison compared with after inmates' release would increase female inmates' use of contraceptives. The study finds that providing contraceptives during women's incarceration is "feasible" and "greatly increases birth control initiation" compared with only providing services after their release (Clarke et al., AJPH, 3/29).


"Reproductive Health Care and Family Planning Needs Among Incarcerated Women," AJPH: Clarke and colleagues examined the "level of risk for sexually transmitted diseases ... and the productive health needs" of 484 female inmates in Rhode Island to evaluate how best to plan for their release. The women had "extremely high risks" for sexually transmitted infections and pregnancy because of inconsistent contraceptive and condom use and more than one sexual partners and had a "high prevalence" of unintended pregnancies and STIs, the study finds. The researchers concluded that female inmates need reproductive health services because the services will "benefit the women, the criminal justice systems and the communities to which the women will return" (Clarke et al., AJPH, 3/29).


"Fertility Regulation and Reproductive Health in the Millennium Development Goals: The Search for a Perfect Indicator?" AJPH: Ruth Dixon-Mueller, an independent consultant, and Adrienne Germain of the International Women's Health Coalition examined the U.N. Millennium Development Goals and found that the MDGs are missing a measurement of a woman's ability to "regulate [her] fertility safely and effectively." The study looks at three possible indicators to measure women's reproductive health: "contraceptive prevalence and total fertility; unmet need for contraception and unplanned births; and unsafe abortion and abortion mortality" and recommends that using only one of these measurements is "insufficient." The researchers concluded that a monitoring system should be incorporated into the MDGs or should exist as a "parallel effort by reporting governments and other agencies" (Dixon-Mueller/Germain, AJPH, 3/29).


"Risk for New Onset of Depression During the Menopausal Transition," Archives of General Psychiatry: Lee Cohen of Massachusetts General Hospital and Harvard Medical School and colleagues examined the relationship between menopause and the emergence of depression in women with no history of mood disorders. The study finds that women with no previous diagnosis of depression who experience the menopausal transition earlier have a higher risk of developing depression (Cohen et al., Archives of General Psychiatry, April 2006).


"Associations of Hormones and Menopausal Status With Depressed Mood in Women With No History of Depression," Archives of General Psychiatry: Ellen Freeman, a research professor at the University of Pennsylvania School of Medicine, and colleagues enrolled 231 women who were about to enter menopause and had no history of depression at time of enrollment and studied the women for eight years (Reuters Health, 4/4). The researchers evaluated the women using the Center for Epidemiological Studies of Depression scale and found that women were more than four times as likely to have a score of 16 or greater during the menopausal transition as compared with when they were premenoupausal. In addition, the study finds that women are two-and-a-half times as likely to be diagnosed with a depressive disorder during the menopausal transition compared with when they are premenoupausal (Freeman et al., Archives of General Psychiatry, April 2006).

Sexually Transmitted Infections

"Valacyclovir Therapy To Reduce Recurrent Genital Herpes in Pregnant Women," American Journal of Obstetrics and Gynecology: William Andrews of the Center for Research in Women's Health at the University of Alabama-Birmingham and colleagues examined the effect of Valtrex -- known generically as valacyclovir -- therapy among 112 pregnant women with genital herpes (Williams et al., American Journal of Obstetrics and Gynecology, March 2006). The researchers recorded no symptoms of herpes infection up to two weeks after delivery among any of the infants of the women treated with Valtrex and concluded that Valtrex therapy was safe for both pregnant women and their infants (Douglas, Reuters Health, 4/5).


"Epidemiology of HPV 16 and Cervical Cancer in Finland and the Potential Impact of Vaccination: Mathematical Modelling Analyses," PLoS Medicine: Ruanne Barnabas of the Cancer Epidemiology Unit at the University of Oxford and colleagues developed a transmission model for the most common strain of human papillomavirus -- HPV 16 -- in Finland to estimate the likelihood of virus transmission. Researchers found that HPV vaccines have the potential to reduce the incidence of cervical cancer caused by specific HPV strains. In addition, high levels of vaccine coverage over several decades, along with long-lasting vaccine protection, would have the greatest effect on the incidence of HPV type-specific cervical cancer, the researchers said (Barnabas et al., PLoS Medicine, May 2006).















"Reprinted with permission from kaisernetwork. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at kaisernetwork/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork, a free service of The Henry J. Kaiser Family Foundation . © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.


View drug information on Valtrex.

Senate Panel Holds Hearing On Rape Kit Backlog

A Senate panel on Tuesday held a hearing on the backlog of untested rape kits nationwide, CBS News reports. Several witnesses at the hearing called on lawmakers to address the situation after a CBS investigation revealed 20,000 rape kits in major cities nationwide have never been tested. The investigation also found that an additional 6,000 kits were waiting months or even years to be tested in crime laboratories.

"We need to be figuring a way to get our local law enforcement up to where they need to be," Sen. Jeff Sessions (R-Ala.) said at the hearing.

Several senators called for the bolstering of a 2005 law (P.L. 108-405) designed to reduce the backlog of untested rape kits. According to Linda Fairstein, who led the Manhattan District Attorney's Sex Crimes Unit, New York's effort to test every kit has resulted in a rape arrest rate of 70%. "We need to find, identify, test and get results on every rape kit that exists in this country," she said. Witness Debbie Smith said, "Each box holds within it vital evidence that is crucial to the safety of women everywhere" (Keteyian, CBS News, 12/15).


Reprinted with kind permission from nationalpartnership. You can view the entire Daily Women's Health Policy Report, search the archives, or sign up for email delivery here. The Daily Women's Health Policy Report is a free service of the National Partnership for Women & Families, published by The Advisory Board Company.


© 2009 The Advisory Board Company. All rights reserved.

Federal Judge Rules In Favor Of Teacher Challenging Ohio Law On Union Membership Due To Abortion-Rights Stance

U.S. District Court Judge Gregory Frost on Thursday ruled an Ohio law that allows only members of religions with "historically held conscientious objections" to union membership to opt out is discriminatory, the Columbus Dispatch reports.

The case involves Carol Katter, a Catholic teacher in the St. Mary's School District in western Ohio who opposes abortion rights. Katter said she refused to pay dues to the National Education Association because she said the union supports abortion rights. Katter sued the State Employment Relations Board after the panel ruled against her claim for a religious exemption, the Dispatch reports.

Frost in his ruling wrote that the law discriminates among religions by recognizing the Mennonite and Seventh-day Adventist objections to joining unions while denying the same right to others. "The statute further differentiates between two employees who have the same religious beliefs, are members of churches with formal doctrines against supporting labor unions, but one of the churches has recently embraced a doctrine, while the other has historically embraced it."

Frost ruled that Katter and others who opt out of unions will have to pay the equivalent of their dues to qualified nonreligious charities and will be entitled to the protections of the union. The NEA and the Ohio Education Association did not return calls for comment (Nash, Columbus Dispatch, 6/26).

"Reprinted with permission from kaisernetwork. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at kaisernetwork/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork, a free service of The Henry J. Kaiser Family Foundation . © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

HIV And The Desire To Become Pregnant

About one in four women who have tested positive for the human immunodeficiency virus (HIV) expect pregnancy and motherhood to be a part of their future, recent research suggests.



A woman's age at the time she learns of her HIV status appears to influence this decision. Women in an Ohio State University study who learned of their HIV infection when they were under age 30 were almost four times more likely to say they wanted to become pregnant than were women who were over 30 when they learned they had HIV.



Researchers say the findings point to a need for clinicians to be aware that women with HIV might be struggling with decisions about motherhood - a relatively new phenomenon accompanying the increase in HIV-positive women of childbearing age and the longer survival rates among patients who receive treatment.



"We shouldn't assume that women aren't going to become pregnant or don't want to become pregnant now that they have HIV. That's an erroneous assumption," said study co-author Julianne Serovich, professor and chair of human development and family science at Ohio State. "Clinicians should be routinely discussing pregnancy with HIV-positive women of childbearing age."



In 2005, 29.5 percent of all new reported HIV infections and 27 percent of new AIDS cases in the United States were among women, according to the Centers for Disease Control and Prevention. Twenty years earlier, only 5 percent of new AIDS cases were reported in women. HIV is the virus that causes AIDS.



The study is published in a recent issue of the journal AIDS and Behavior.



The researchers collected questionnaires about pregnancy decisions from 74 women who were participants in a larger, long-term study led by Serovich that explored women's HIV disclosure decisions and mental health. This particular line of research emerged from interviewers' observations that participants were talking about pregnancy and, in some cases, becoming pregnant. Simultaneously, health care professionals were sharing stories with researchers about the women's success in avoiding transmission of the HIV virus to their babies.



"It became obvious that this is a disease that is manageable for women," said lead study author Shonda Craft, who completed the research while she was a doctoral candidate at Ohio State.



"If a woman is 19 years old and diagnosed with HIV, she can still assume she has her whole life ahead of her. Deciding whether to have a family is part of the development process for young women, including these young women," said Craft, now an assistant professor of family social science at the University of Minnesota. "This study is about living with a chronic disease, and not just the physiological piece of that, but also the psychological and sociological factors, as well."
















Women in the study were asked to quantify how influential several factors were on their decision about whether or not to become pregnant after their HIV diagnosis.



Aside from external influences, age emerged as a major factor in the choice. Nearly 40 percent of women age 30 and younger chose to become pregnant while 11 percent of the women over 30 opted for pregnancy.



The most influential external factors on women's choices against pregnancy, regardless of age, were fear of transmitting HIV to a child or other concerns about preserving their own health. Conversely, a powerful personal desire to have children was associated with a woman's choice to become pregnant.



Within the women's social network, medical personnel had the strongest influence on their decisions about pregnancy - either for or against having a baby.



Though there are no guarantees of safely conceiving and delivering a healthy baby for women with HIV, the medical community has found ways to reduce health risks for both mother and child, said Michael Brady, professor and chair of pediatrics at Ohio State and a co-investigator on the study's funding grant. Women who are HIV-positive should receive antiretroviral medications throughout their pregnancy and during labor, and their newborns should receive antiretroviral medication for the first six weeks of life. Delivery by Caesarean section also can reduce risk of transmission of the virus to the infant, but should be performed if required for the mother's health or if the mother's level of virus in the blood is high. With optimal care, the risk of transmission can be as low as 1 percent, Brady said.



There is also a risk associated with conception of the child, Brady noted. Though transmission of HIV from an infected woman to an uninfected male partner is not universal during unprotected sex, it can happen. Even if both partners are already infected with HIV, an infected male partner might transmit a new strain of HIV to his infected female partner, which can cause problems for the mother and fetus as well.



"We don't understand all of the factors that affect the risk of transmitting HIV with an individual sex act. Taking medications and lowering the viral load reduces but doesn't eliminate the risk. Some people interested in having a child may be willing to accept this risk. But there is a risk," Brady said.



One finding of the study surprised the researchers. Women who had the most negative self-image associated with their HIV status were also the most likely to want to become pregnant.



"We would have predicted that the lower the stigma, the more likely women would choose to become pregnant. We saw the exact opposite - that those with high stigma were making more choices in favor of pregnancy," Serovich said.



For some women who feel highly stigmatized by their disease, the rewards of pregnancy might offer therapeutic benefits, the researchers suggest.



"When you're pregnant, you get lots of attention, people come up to you and touch your belly. You get a shower, people do things for you. There are certainly a lot of very positive repercussions of pregnancy that may help women feel better," Serovich said.



Though much of Serovich's earlier research focused on HIV-positive men, she sees a need for a deeper examination of issues facing women who are infected.



"There hasn't been a lot of work done in this area and as women live longer and stay healthier, we need to know even more," she said. "What is clear is that women can live with this and have many options."







This study was funded by the National Institute of Mental Health.



Additional co-authors were Robin Delaney of human development and family science and Dianne Bautista of statistics, both at Ohio State.



Emily Caldwell


Source: Julianne Serovich


Ohio State University

Immune Cell Function Can Be Suppressed By Leading Pathogen In Newborns

Group B Streptococcus (GBS), a bacterial pathogen that causes sepsis and meningitis in newborn infants, is able to shut down immune cell function in order to promote its own survival, according to researchers at the University of California, San Diego School of Medicine and the Skaggs School of Pharmacy and Pharmaceutical Sciences. Their study, published online July 13 in the Journal of Experimental Medicine, offers insight into GBS infection - information that may lead to new medical therapies for invasive infectious diseases that affect nearly 3,500 newborns in the United States each year.



The UC San Diego researchers describe how GBS fools the immune system into reducing production of antibiotic molecules. "We have discovered that the bacteria have evolved to use a trick we call 'molecular mimicry,'" said Victor Nizet, MD, UC San Diego professor of pediatrics and pharmacy. "Like a wolf in sheep's clothing, GBS can enter our body without activating the immune cells that are normally programmed to kill foreign invaders."



The findings represent a collaborative effort between the laboratories of senior authors Nizet and Ajit Varki, MD, distinguished professor of medicine and cellular and molecular medicine. Varki is also co-director of the UCSD Glycobiology Research and Training Center, where the investigators have been exploring the interaction of bacterial pathogens with the innate immune system. Their most recent focus has been on the special role of Siglecs (short for sialic acid binding Ig-like lectins), members of the immunoglobulin family of antibodies.



Siglecs sense a chemical structure known as sialic acid - a sugar molecule that is abundant on the surface of all human cells - and send signals that control the gene expression and function of immune cells. Many specialized Siglecs receptors send negative signals, recognizing sialic acids as "self." These signals help keep the immune cells turned off under baseline conditions, avoiding unnecessary inflammation in the absence of infection or injury. Earlier this year, in a manuscript published in the journal Blood, the same UC San Diego team demonstrated that GBS decorates its own surface with sialic acid, closely resembling human molecules, and is thus able to bind Siglecs on immune cells, shutting down the cells' normal functions.



In the new study, the researchers discovered that GBS can also bind a human Siglecs receptor through a particular protein expressed on the bacterial surface. This is the first time a protein has been reported to functionally interact with Siglecs, and presents the possibility that additional pathogenic microbes may have evolved similar ways to manipulate the human immune system.



According to the study's lead author, Aaron Carlin, MD, PhD, when GBS proteins bind to Siglecs, it profoundly affects immune-cell function by decreasing its ability to engulf the bacteria, a process known as phagocytosis.
















"The immune cells reduce their production of antibiotic molecules, allowing the GBS bacteria to survive the encounter and proliferate," said Carlin, who recently completed his doctoral studies in UC San Diego's Medical Scientist Training Program.



Knowledge of the mechanisms by which crafty pathogens engage Siglec receptors to fool the immune system may reveal new targets for medical therapy. "Blocking engagement of the Siglec could help boost the immune system and aid in clearing GBS infection in the critically ill newborn," said Nizet. "Alternatively, perhaps the bacterial molecule could be exploited as a novel treatment for human diseases involving abnormal inflammation, for example, rheumatoid arthritis."



Siglecs are among the most rapidly evolving parts of the human genome. This suggests that strong natural selection pressures are present to modify their expression, according to Varki, with pathogenic microbes likely playing a critical role.



"There are important variations in Siglec expression and function between humans and other species, among human populations, and across the age spectrum. Evidence is accumulating that Siglecs may profoundly affect susceptibility or resistance to several important infectious diseases," said Varki.



According to the UC San Diego researchers, the new study likely has broad implications for understanding the propensity of certain bacterial pathogens to produce human disease. It also explains why some individuals or groups may be more predisposed to suffer more severe outcomes than others.



Approximately 20 to 25 percent of women of childbearing age are asymptomatic carriers of GBS on their vaginal mucosal surface. Newborns can become infected with GBS that invade through the placenta to initiate infection in the womb, or during delivery by exposure to contaminated vaginal fluids. Screening of pregnant women for GBS and antibiotic prophylaxis during labor is used to reduce the risk of newborn transmission, yet it estimated that approximately 3,500 newborns still develop invasive GBS infections annually in the United States. In addition to neonatal disease, GBS is increasingly associated with serious infections in adult populations such as pregnant women, diabetics, and the elderly.



This study was financed by grants from the National Institutes of Health. Co-authors contributing to the study were Yung-Chi Chang, PhD and Charles King, PhD, of the UCSD Department of Pediatrics; Nancy Hurtado-Ziola, PhD of the UCSD Department of Cellular and Molecular Medicine, and Thomas Areschoug, PhD, and Gunnar Lindahl, PhD, of Lund University in Sweden.



Source:
Debra Kain


University of California - San Diego

More Support For GP Obstetricians In Rural Areas, Australia

The Australian Government will further improve incentives for GPs providing obstetric services in rural and remote areas.


At present, GPs in some larger rural communities who deliver 20 or more babies per year, or GPs in smaller communities who meet the obstetric requirements of their community, are eligible for an annual bonus procedural payment under the Government's Practice Incentive Program.


The bonus was significantly increased earlier this year. It is comprised of an incentive payment of up to $17,000 per year, with an additional loading depending on rurality. In total these doctors can receive up to $25,500 per annum.


The Government has decided to again improve eligibility by including another category of those GPs who are fully participating in the obstetric roster of the local community. This means that those GPs who may not meet the requirement of delivering 20 babies per year, but are fully involved in the local obstetric roster, may be eligible for a payment.


This change will help maintain access to obstetric services for rural and regional women.


Details about the qualification criteria and payment level will be finalised in consultation with the profession. Information will be provided to rural and remote GPs in the near future.


www.health.au

Persistent Genital Arousal In Women, Doctors Uncover New Syndrome

Doctors have identified a new sexual condition affecting women. Tentatively labelled Persistent Sexual Arousal Syndrome, its primary symptom is relatively constant, unrelieved feelings of genital arousal in the absence of genuine sexual interest or desire.


Writing in the International Journal of STD & AIDS [published by the Royal Society of Medicine], David Goldmeier and Sandra Leiblum said PSAS in women had been unrecognised until now.


"Persistent sexual arousal syndrome occurs when a woman becomes involuntarily aroused for extended periods of time in the absence of sexual desire," said Dr Goldmeier.


"This genital arousal is highly distressing as it is unprovoked and unrelieved by orgasm," he said.


The study said it was unclear what the causes of PSAS were although a link to antidepressants has not been ruled out. Clinical observations of the condition have found evidence of engorgement and oedema of the labia, vulva and clitoris.


"Due to the reluctance of women to come forward we are unsure how common the problem is," said Dr Goldmeier.



"Many women feel embarrassed to talk about the symptoms and those that have come forward have reported a high degree of distress and even sometimes, suicidal thoughts," he said.


A recent internet survey by Dr Leiblum suggests women with PSAS come from a range of backgrounds and age groups.


"Much remains to be elucidated in regard to PSAS including its prevalence, aetiology and management," they write.


"It deserves continued research not only since it is such a distressing and perplexing condition, but also because understanding its aetiology and treatment may lead to greater understanding of other aspects of female sexual response."


Although there is no specific therapy to treat PSAS, Dr Goldmeier has been working with affected women in the UK.


"It is critical that we raise awareness of persistent sexual arousal syndrome amongst clinicians and the general population," said Dr Goldmeier.


"Women should not feel marginalised by this condition and I urge them to seek assistance," he said.


Persistent genital arousal in women - a new syndrome entity [PDF 45k]


'Persistent genital arousal in women - a new syndrome entity' by D Goldmeier and S Leiblum is published in the April issue (Vol. 17) of the International Journal of STD and AIDS.


IJSA is published monthly by the Royal Society of Medicine. Its Editor is Professor Wallace Dinsmore.


ROYAL SOCIETY OF MEDICINE

New Findings May Change The Way Heart Disease Is Detected And Treated In Women, From The 'Harvard Women's Health Watch'

Results of a landmark study
suggest that many women with heart disease don't get a proper diagnosis
because they have a form of the disease that doesn't show up on the usual
diagnostic tests. The new research shows that heart disease is not one but
several disorders and may shed light on why heart disease often behaves
differently in men and women, according to the February 2007 issue of
"Harvard Women's Health Watch."


In the Women's Ischemia Syndrome Evaluation (WISE) study, women with
chronic chest pain underwent standard diagnostic procedures, including
stress tests and coronary angiograms. Earlier studies had found that among
people who show signs of trouble on stress tests, women are far more likely
than men to appear free of blockages on follow-up angiograms. This was also
true in the WISE study. But newer tests, including ultrasound of the blood
vessels, revealed heart problems the angiograms didn't pick up. Many of
these women had a condition called vascular dysfunction, in which the blood
vessels supplying the heart don't expand properly to accommodate increased
blood flow. Vascular dysfunction may affect not only the large coronary
arteries, but also the smaller vessels that serve the heart -- a problem
dubbed microvessel disease.



The WISE results may help explain why women with heart disease are
often underdiagnosed and undertreated. In men, the main problem may be a
blockage in a large coronary artery, which shows up on an angiogram, while
women are more likely to have microvessel disease that can't be seen. With
this in mind, the WISE investigators are working to develop a new system
for screening women for heart disease.



Harvard Health Publications

health.harvard.edu/women

For African-American Women On Hemodialysis, Social Support, Psychological Factors Contribute To Fatigue

African Americans account for approximately 32% of patients diagnosed with ESRD, more than any other racial group in America. While fatigue is a common side effect for ESRD patients, studies have not explored factors contributing to fatigue, especially among African American women with ESRD. In the November-December 2007 issue of Nephrology Nursing Journal, Amy G. Williams, MSN, RN, and co-authors explored physiologic (anemia, uremic malnutrition), psychological (mood disorders) and situational factors (social support) contributing to fatigue in this group in hopes of developing life-improving interventions.



The authors found a correlation between social support and uremic malnutrition; this lack of support can lead to noncompliance in dietary requirements, which in turn leads to fatigue. In addition, Williams and co-authors found correlations between anxiety, depression and fatigue.



The authors recommend further research examining the effect of social support and psychological factors on fatigue. For nephrology nurses, understanding the causes of fatigue in African American Women on hemodialysis will help focus assessments and individualized care plans for this patient population.


Fatigue in African American Women on Hemodialysis
Amy G. Williams, MSN, RN; Patricia B. Crane, PhD, RN, FAHA; Daria Kring, MSN, RN, BC
Nephrology Nursing Journal; November-December 2007
annanurse/journal



Nephrology Nursing Journal is a refereed clinical and scientific resource that provides current information on a wide variety of subjects to facilitate the practice of professional nephrology nursing. Its purpose is to disseminate information on the latest advances in research, practice, and education to nephrology nurses to positively influence the quality of care they provide. For more information, visit annanurse/journal.

Fatty Fish Consumption Associated With Lower Risk Of Kidney Cancer In Women

Preliminary research suggests that higher consumption of fatty fish in women is linked with a lower risk of renal cell carcinoma, a common form of kidney cancer, according to a study in the September 20 issue of JAMA.


Renal cell carcinoma (RCC) involving the renal parenchyma (the functional tissue of the kidney) accounts for more than 80 percent of all kidney cancers. Renal cell carcinoma incidence rates in the United States had been increasing in 1970-1990s, especially among black women and men; more recent data suggest a leveling off in this trend for most racial groups. The evidence that fish consumption, especially fatty fish, may be associated with lower risk of several cancers has not been consistent, according to background information in the article.


Previous studies have analyzed total fish consumption and have not taken into account that there are large differences between fatty fish and lean fish in the content of omega-3 fatty acids and vitamin D. Marine omega-3 polyunsaturated fatty acids, eicosapentaenoic acid and docosahexaneoic acid, which are present in significant amounts in fatty cold-water fish (up to 20-30 times higher content than in lean fish), have been reported to slow the development of cancer. Fatty fish has 3 to 5 times higher content of vitamin D than lean fish, and lower serum vitamin D levels have been associated with development and progression of RCC.


Alicja Wolk, D.M.Sc., of the Karolinska Institutet, Stockholm, Sweden and colleagues investigated the association between fatty fish and lean fish consumption and the risk for development of RCC in a population with a relatively high consumption of fatty fish. The participants, from the Swedish Mammography Cohort, included 61,433 women age 40 to 76 years without previous diagnosis of cancer at baseline (March 1987 to December 1990). Participants filled in a food frequency questionnaire at baseline and in September 1997. The researchers considered fatty fish to include salmon, herring, sardines, and mackerel; lean fish included cod, tuna, and sweet water fish; and other seafood included shrimp, lobster, and crayfish.


During an average of 15.3 years of follow-up between 1987 and 2004, 150 RCC cases were diagnosed. After adjustment for potential confounders, an inverse association of fatty fish consumption with the risk of RCC was found, while no association was found with the consumption of lean fish or other seafood.


"In this large population-based cohort with data on long-term diet, we found that women who consumed one or more servings of fatty fish per week had a statistically significant 44 percent decreased risk of RCC compared with women who did not consume any fish. Women who reported consistent long-term consumption of fatty fish at baseline and 10 years later had a statistically significant 74 percent lower risk," the authors write.


"Our results support the hypothesis that frequent consumption of fatty fish may lower the risk of RCC possibly due to increased intake of fish oil rich in eicosapentaenoic acid and docosahexaneoic acid as well as vitamin D," they write. "Our results, however, require confirmation because this is the first epidemiological study addressing this issue."


Editor's Note: This study was supported by grants from the Swedish Cancer Foundation, the Swedish Research Council/Longitudinal Studies, and V?stmanland County Research Fund Against Cancer. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.


American Medical Association (AMA)


515 N. State St

Chicago, IL 60610

United States

ama-assn

Trust For America's Health Releases Report On Connection Between Women's Health And Stalled Infant Mortality Rates

Trust for America's Health (TFAH) released a report, Healthy Women, Healthy Babies, in conjunction with the release of the Annie E. Casey Foundation's KIDS COUNT DATABOOK 2008. The report explains why after 40 years of progress, infant mortality rates in the U.S. have stalled since 2000. TFAH finds that the deteriorating health of American women, due in part to wide-spread chronic disease epidemics like obesity and diabetes, is taking a toll on American infants, resulting in stagnated improvement when it comes to infant health. TFAH's report offers recommendations for Congress and the American health system to aggressively improve the health of new-born infants.


"In the wake of all the great medical breakthroughs over the last 40 years, one would assume that infant mortality rates would plummet. Instead, medical progress has been cancelled out in the delivery room by the deteriorating health of childbearing-aged women and their lack of health care access; and infant mortality rates have stalled as a result," said Jeff Levi, Executive Director of Trust for America's Health. "American women, children and families simply deserve better."


Levi added, "We know now that an infant's chances of sickness, disability and survival often hinge on the health of the mother, before she even becomes pregnant. Therefore, the way to reduce risks to new born babies is to invest in a woman's health throughout her childbearing years. If we concentrate our efforts most on those hit hardest by the biggest health problems - low-income and minority women - we will once again see healthier babies and dropping infant mortality rates."


"Two of the most disturbing trends in our 2008 KIDS COUNT Data Book that we are releasing today are the increase in the rate of low-birthweight babies and the lack of progress in infant mortality," said Laura Beavers, coordinator of the national KIDS COUNT project at the Annie E. Casey Foundation. "The Trust for America's Heath's report, Healthy Women, Healthy Babies provides us with the information we need to turn this around and to begin to once again see steady progress on both of these critical indicators."


Healthy Women, Healthy Babies reports that approximately 30 percent of women who give birth have some form of pregnancy complication, which cost the U.S. at least $26.2 billion in 2005. Prematurity and low birth weights are often associated with health issues in the mother, such as diabetes, high blood pressure, or obesity. Many experts now believe that because the early weeks after conception are critical to a baby's development, traditional prenatal care, which usually begins in the first three months of a pregnancy, comes too late to prevent many serious maternal and child health problems. The way to ensure infant mortality rates resume their fall is to assure that all women are insured and have access to primary care. If we improve the health of all women aged 15-44 and execute earlier interventions for those with chronic health conditions and risks, we will also see better birth outcomes.















KEY RECOMMENDATIONS OF Healthy Women, Healthy Babies, which were drawn from interviews and comments from 10 leading experts in maternal and child health, include:



-- Fully Implement and Enhance Medicaid Policies.

- Assuring better health coverage for poor women through state expansion of Medicaid coverage. States should have the authority to cover women without a federal waiver and allow Medicaid benefits to follow women after the birth for 24 months. Both changes would significantly reduce infant mortality.


-- Expand Other Programs that Provide Primary Care and Other Services to Women of Childbearing Age.


- Federal programs like the Healthy Start Infant Mortality Reduction Program, Community Health Centers, Title X Family Planning and Title V Maternal and Child Health Block Grant need better funding to reach all those at risk.


-- Make Research on Preconception Health and Health Care a Priority.


- Research needs to be jump-started through increased funding at organizations like the Centers for Disease Control's National Center on Birth Defects and Developmental Disabilities, the National Center for Chronic Disease Prevention and Health Promotion, and the Eunice Kennedy Shriver National Institute of Child Health and Human Development.


Healthy Women, Healthy Babies was supported by a grant from the Annie E. Casey Foundation.



Trust for America's Health is a non-profit, non-partisan organization dedicated to saving lives by protecting the health of every community and working to make disease prevention a national priority. healthyamericans.


The Annie E. Casey Foundation is a private charitable organization, whose primary mission is to foster public policies, human-resource reforms, and community supports that more effectively meet the needs of today's vulnerable children and families. For more information, visit aecf.

America's Health

Decrease In Breast Cancer Rates Began Before HRT Was Linked To Higher Breast Cancer Rates, Report Says

A decline in breast cancer incidence began in 1998, before hormone replacement therapy use was linked to breast cancer, according to an American Cancer Society report published in the May 3 edition of Breast Cancer Research, the Wall Street Journal reports. According to the Journal, the recent decline in breast cancer incidence often is attributed to a drop in HRT use after the release of a 2002 Women's Health Initiative study (Parker-Pope, Wall Street Journal, 5/3).

Peter Ravdin, a research professor in the Department of Biostatistics at M.D. Anderson Cancer Center, and colleagues in December 2006 at the 29th Annual San Antonio Breast Cancer Symposium presented data showing that breast cancer incidence among U.S. women dropped by 7% from 2002 to 2003. Ravdin and colleagues in a study published last month in the New England Journal of Medicine found that the decline in breast cancer incidence observed from 2002 to 2003 continued in 2004 (Kaiser Daily Women's Health Policy Report, 4/20). For the ACS report, Ahmedin Jemal, an epidemiologist at ACS, and colleagues examined the pattern of breast cancer rates since 1975. The researchers found a 10.6% overall decline in breast cancer rates between 1999 and 2003, according to the study. In addition, the study found a 5% decrease in breast cancer rates in the years leading up to the WHI 2002 study. According to Jemal, the decrease in incidence was seen across several age groups and was greatest for small tumors and early-stage cancers that often are detected through mammography.

Reasons for Decline
The ACS report found that some of the decline in breast cancer incidence likely is the result of decreased HRT use after the release of the WHI study and another factor in the decline might be that fewer women are being screened for breast cancer (Wall Street Journal, 5/3). Ravdin and colleagues also found that the decrease in breast cancer rates is most likely associated with a drop in both HRT use and mammography rates. HRT use decreased by about 30% in 2002 after the WHI study found that breast cancer risk increased for women who used the treatment for an extended period of time (Kaiser Daily Women's Health Policy Report, 12/18/06). According to the Journal, the ACS report's findings suggest that thousands of early stage cancers could be undetected but might show up later at a more advanced stage.

Reaction
Ravdin said whether a decrease in HRT use will have a "long-term effect" on decreasing breast cancer incidence or "whether eventually there will be an increase in incidence again, we don't know that." Marisa Weiss, a Philadelphia-based oncologist and founder of the Web site breastcancer, said that women saw their doctors less after HRT use declined and began receiving mammograms less regularly. "There are few reasons to see your doctor because he's no longer prescribing HRT, and the absolutely required mammogram doctors must have prior to prescribing HRT drops out." Len Lichtenfeld, ACS deputy chief medical officer, said the new repot is important because many women have been confused about breast cancer, HRT use and screening. He said the "message a woman is hearing is, 'I don't have to worry about breast cancer any more because I'm not taking hormones,'" adding that he is concerned that women will stop seeking mammograms (Wall Street Journal, 5/3).


The ACS report is available online.

"Reprinted with permission from kaisernetwork. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at kaisernetwork/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork, a free service of The Henry J. Kaiser Family Foundation . © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

Kaiser Daily Women's Health Policy Report Highlights Recently Released Journal Articles

The following highlights recently released journal articles on women's health issues.

Pregnancy & Childbirth
"Cigarette Smoking Affects Uterine Receptiveness," Human Reproduction: Sergio Soares of IVI-Lisboa and colleagues compared in vitro fertilization outcomes of 44 women who smoked more than 10 cigarettes per day with 785 nonsmokers and women who smoked fewer than 10 cigarettes per day. About 34.1% of women who smoked more than 10 cigarettes daily became pregnant through IVF, compared with 52.2% of women who smoked less than 10 cigarettes per day. The study found that 60% of the heavy smokers had multiple births, compared with 31% of the nonheavy smokers. Soares said that more studies are needed to determine if tobacco affects the uterus differently in some women (Reaney, Reuters, 11/8).

Public Health
"Ovarian Cancer in Younger vs Older Women: A Population-Based Analysis," British Journal of Cancer: John Chan of the Stanford University's Division of Gynecologic Oncology and colleagues examined the medical records of 28,165 U.S. women who were diagnosed with ovarian cancer between 1988 and 2001, including 400 under age 30, 11,601 women ages 30 to 60 and 16,164 women older than age 60. The study found that 65.3% of the women under age 30 had stage I-II ovarian cancer, compared with 40.2% of women ages 30 to 60 and 22.5% of women older than age 60. The five-year survival rate for the women under age 30 was 78.8%, compared with 58.8% for the ages 30 to 60 group and 35.2% for the over age 60 groups (Chan et al., British Journal of Cancer, November 2006). Researchers called for further research to be conducted into the biological and molecular differences that could account for the disparities in survival rates among the age groups, Reuters reports (Reuters, 11/7).

"Oral Contraceptive Use as a Risk Factor for Premenopausal Breast Cancer: A Meta-Analysis," Mayo Clinic Proceedings: Chris Kahlenborn of Altoona Hospital and colleagues analyzed data from 34 studies about breast cancer and oral contraceptive use published after 1980 to determine the risk associated with premenopausal breast cancer and oral contraceptive use, Reuters Health reports. Study participants were all ages 50 or younger or premenopausal. The study found that women who used oral contraceptives were 1.19 times more likely to develop breast cancer than women who did not use oral contraceptives. For women who had given birth, oral contraceptive use was associated with a 1.29 times greater likelihood of developing breast cancer, and the risk for women who had never given birth was 1.24 times greater than for women not using oral contraceptives, the study found. The risk of developing breast cancer was 1.15 times greater for women who used oral contraceptives prior to their first full-term pregnancy and 1.52 times greater if oral contraceptives were used four years prior to their first full-term pregnancy. In a related Mayo Clinic Proceedings editorial, James Cerhan of the Mayo Clinic College of Medicine writes that the "absolute risk" of developing premenopausal breast cancer after oral contraceptive use "is very small," adding that benefits of oral contraceptive use also should be considered when analyzing the risks (Reuters Health, 11/7).
















"Reprinted with permission from kaisernetwork. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at kaisernetwork/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork, a free service of The Henry J. Kaiser Family Foundation . © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

What Are The Signs And Symptoms Of Breast Lumps?

The signs and symptoms of breast lumps vary, and depend mainly on what is causing them (it). A symptom is sensed by the patient, while a sign is detected by others, including the doctor or nurse. An example of a symptom might be pain, while dilated pupils could be a sign.


Fibroadenosis (fibrocystic breast disease) - also known as benign breast disease, fibrocystic breast changes, and mammary dysplasia. Benign (non-cancerous) changes occur in breast tissue, resulting in:

Breast discomfort and general tenderness
Irregular lumps, cysts or swellings
Itching
Sensitive nipples


What Are Breast Lumps?


What Are The Signs And Symptoms Of Breast Lumps


What Are The Causes Of Breast Lumps?


How Is A Breast Lump Diagnosed?


What Are The Treatment Options For A Breast Lump?

Symptoms may alter during the menstrual cycle - tending to become more pronounced just before or during menses (menstrual bleeding). After the menopause women do not generally have symptoms any more.


Women may have very different symptoms, and the same woman may experience varying symptoms on different occasions. For some patients fibroadenosis is a slight nuisance, while for others it is extremely painful. Doctors say fibroadenosis is the female body's normal reaction to changes in hormone levels.


Fibroadenoma - these are small, solid, rubbery, benign (non-cancerous) lumps, consisting of fibrous and glandular tissue. They sometimes develop outside the milk duct. Doctors often recommend a tissue sample (biopsy) to rule out cancer because they appear as a lump. Signs and symptoms include:

A well-rounded, smooth, solid lump
May get larger during pregnancy
Occur in women of childbearing years
They are painless
They may disappear on their own, but can often persist and slowly grow
When touched they move easily
They have a rubber-like texture

Breast cyst - a cyst is a closed sac-like structure - an abnormal pocket of fluid, like a blister - that contains either liquid, gaseous, or semi-solid substances. A cyst is located within a tissue, and can occur anywhere in the body and can vary in size - some are so small they can only be viewed through a microscope, while others may become so big that they displace normal organs.















A breast cyst is a fluid-filled sac within the breast; there may be many or just one. They are typically:

Round
With distinct edges
With a soft grape like or water-filled balloon texture
The cyst may feel firm
More common in woman in their 30s and 40s.
They normally go away after the menopause, unless the woman is taking HRT (hormone replacement therapy)
They may be tiny or several centimeters in diameter
Pain is unusual, unless the cyst is a large one and grows during the menstrual cycle

Experts believe breast cysts develop when milk ducts become blocked.


Unless the cyst is large and causing discomfort, in which case it may be drained, it does not normally require treatment.


Breast cancer - during the early stages breast cancer does not have any palpable symptoms (symptoms the patient can notice). However, as the tumor grows, the way the breast looks and feels can change. The following changes may occur:

A thickening in the breast, or near it (in the underarm area)
A lump in the breast or near it (in the underarm area)
The lump feels firm, usually has an irregular shape, and seems anchored (stuck) to either deep tissue within the breast or the skin of the breast or nearby area.
The size and/or shape of the breast may change
There may be puckering or dimpling in the skin of the affected breast
The nipple of the affected breast may turn inward
There may be a discharge from the nipple; the discharge may be bloody
The skin on the breast and/or nipple may be scaly, red or swollen


What Are Breast Lumps?
What Are The Signs And Symptoms Of Breast Lumps
What Are The Causes Of Breast Lumps?
How Is A Breast Lump Diagnosed?
What Are The Treatment Options For A Breast Lump?

Hereditary Breast Cancer - A High Cost To Patient And Healthcare Provider Alike

Some women who carry the BRCA gene mutation, which predisposes to breast cancer, may choose to have a prophylactic mastectomy rather than undertake lifetime surveillance, a Dutch scientist will tell the 6th European Breast Cancer Conference (EBCC-6) today (Wednesday 16 April). The mastectomy option appears to give an excellent result in avoiding breast cancer, with a remaining risk of less than 1%, Dr. Reinie Kaas, from the Surgical Department of the Netherlands Cancer Institute, Amsterdam, The Netherlands, will say.



Dr. Kaas set out to study the effects of prophylactic mastectomy in 250 patients who were BRCA carriers. "It was thought that after such a mastectomy the risk of being diagnosed with breast cancer was about 5%," she says "and therefore there was debate about whether continued surveillance was necessary or not. We decided to try to answer this question in order that women at high risk should be able to make an informed choice."



Women with mutations in the BRCA1 or BRCA2 genes have an estimated lifetime risk of developing breast cancer of about 85%. Currently strategies to deal with this risk are surveillance with monthly breast self-examination, bi-annual clinical breast examination by a physician and annual mammography plus breast MRI, or prophylactic mastectomy, where the entire breast is removed. About half of the carriers choose the latter strategy. The surveillance strategy does not prevent breast cancer, and especially in BRCA1 carriers, who mostly have fast growing tumours, 25-30% of carriers are diagnosed when the tumour is already more than 2cm in diameter.



Dr. Kaas and her team found that only one out of the 250 carriers studied was diagnosed with a breast cancer, and this was likely to be because the axillary tail (a small part of the breast that extends towards the armpit) had not been completely removed. "Our epidemiologists are investigating how many breast cancers are avoided up to the age of 80 in these women," she says. "But on current evidence we can safely state that continued follow-up, which can be costly as well as stressful for the patient, is not warranted in patients who have had a prophylactic mastectomy. Surveillance in those BRCA carriers who do not opt for mastectomy has to start at an early age, and the frequent visits to the doctor and the many examinations which need to be undertaken regularly can be a source of great stress for many women.



"However, the decision to remove healthy breasts is solely the decision of the woman, and healthcare services should not press women to make this choice simply to reduce costs."



In another presentation to the conference tomorrow (Wednesday) Dr. Yvonne Kamm, a medical oncologist from the Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands, will say that the costs of screening for BRCA carriers are very high, and even more so because the MRI that is used can have a high false positive rate, leading to further investigations.
















"The MRI is expensive in itself, but useful because it can detect very small tumours which might not be picked up otherwise. But it also detects many other abnormalities that are not cancer, and this implies not just extra cost but also considerably anxiety for the women concerned," she says.



Between September 1999 and 2005, Dr. Kamm and her team screened 196 women at risk of hereditary breast cancer. When an abnormality was found, the women underwent further investigations. The women were screened for a median period of 2 years; this included 1149 breast examinations, 494 mammograms, and 436 MRI scans. Abnormalities led to further investigations; 32 breast examinations, 17 mammograms, 64 MRI scans, 114 ultrasound examinations, and 48 biopsies.



The cost of the first screening programme was ?‚¬254 per woman year, and the extra costs of further investigations ?‚¬61 per woman year. During the 6 year period 13 cancers were found.



"The total costs to find one breast cancer were high - ?‚¬13168," says Dr. Kamm. We know that such intensive screening works, and that it can find breast cancer at an early stage. Therefore, we have made the choice to screen intensively women at very high risk from breast cancer."




Catalogue nos: 109, Wednesday 14.30 hrs CEST (Hall 15.2)

18, Wednesday Poster Session (Hall 11)



European Breast Cancer Conference

Lost That Lovin' Feeling? Don't Blame The Pill

When your sex drive is sputtering, you may want to take a closer look at several factors in your life.


In fact, it's natural for people to ask: Is the loss of sexual desire due directly to taking the birth control pill? The answer to this question which has been asked for more than 40 years, since the oral contraceptive was introduced may now be less murky, according to researchers at the Ohio State University Medical Center.


Dr. Jonathan Schaffir, an obstetrician and gynecologist with the medical center, reviewed more than 25 years' worth of studies, examining the relationship between oral contraceptives and libido, and concluded that the pill has little, if any, effect on a woman's sex drive. His study was published in a recent issue of the Journal of Sex & Marital Therapy.


The issue has roots in the early forms of the pill, developed in the 1960s, which often contained high levels of estrogens and progestins many times as much as 80 to 150 micrograms in single doses. The makeup of birth control pills caused many women to become bloated, feel breast tenderness or experience nausea.


"These side effects could easily have caused women to feel extremely uncomfortable, translating into decreased libido," noted Schaffir. "Also much less was known about the human sexual response at that time, which could have led to information based on opinion and not on fact."


Schaffir made a critical assessment of the published information, to see if there is a way to predict whether certain types of hormonal contraception or certain segments of the population are more prone to changes in libido.


Schaffir noted that some women, indeed, experience a change in libido while taking oral contraceptives, but he could find no predictable patterns for this in the literature.


When looking for a consistent biological effect of hormonal contraception on sexual desire, androgens would probably be the factor most suspected to play a role, said Schaffir. "It was shown that the birth control pill decreased the concentration of free androgens, including testosterone, but that doesn't necessarily translate to a loss of libido. Chemical changes occurred, but they did not apparently impact sexual behavior for the vast majority of women," he said.


Similarly, the effect of progestin on women's sexual desire was not dramatic. "A small minority of all the users of progestin were actually bothered by a low libido," said Schaffir.


Based on his review of studies dating from 1975 to 2004, Schaffir found that only a small minority of oral contraceptive users experienced a negative effect on sexuality. Furthermore, he found no reliable predictor of a negative effect in those who experienced such side effects.


"Studies showed that it was a problem for a small number of women using birth control pills to experience decreased libido, but it didn't happen predictably in any specific sub-population, or with any particular type of hormonal contraception," said Schaffir. "In fact, changes in sexual desire could as likely represent a combination of biological, psychological and social phenomena as any hormonal effect.















"The available literature illustrated that decreased libido is an idiosyncratic, unpredictable reaction in a small minority of women," stated Schaffir.


Schaffir reassured patients and clinicians that women should continue to use oral contraceptives without fear of an adverse effect on libido. "Don't let such fear factor into your decision of whether to take hormonal birth control pills," said Schaffir.


If you are experiencing a diminishing sex drive, you may want to ask yourself:


Have you recently started taking a medication?


There are some medications that are known to interfere with libido, and antidepressants are probably the most notorious group, said Schaffir. You may want to consult your physician, because stopping or changing the medication could be effective, he said. Schaffir and other researchers at Ohio State are part of ongoing FDA phase II and phase III trials, involving hormonal and non-hormonal medications that some day may directly improve sexual drive, noted Schaffir. But currently there is no one pill that you can take for a lack of libido.


Have you recently had increased tensions or stresses in your sexual relationship?


The only thing that to this point has been consistently effective in treating low libido is sex therapy, or couples therapy, in which you talk with a counselor about a relationship or discuss sexual goals, noted Schaffir. This emphasizes the fact that such a difficulty is probably many times psychological, and not just biological, he said.


Ohio State University Medical Center

450 W. 10th Ave.

Columbus, OH 43210

United States

osumedcenter.edu

Maternal Health Must Become A Priority In Developing Countries

"Mothers are the backbones of communities. When they die, children become orphaned, families are fragmented," said Jean Chamberlain Froese, MD, during the President's Program at The American College of Obstetricians and Gynecologists (ACOG) 57th Annual Clinical Meeting. Although making pregnancy and childbirth safer in countries where maternal mortality is extraordinarily high can seem like a daunting task, employing practical solutions is possible to improve maternal health and pregnancy outcomes, according to Dr. Froese.


In her presentation, "Where Have All the Mothers Gone?," Dr. Chamberlain Froese spoke about her personal experience working in Uganda to make childbirth safer there. The logical first step in improving a community's overall health care is to improve maternal health, she said, because the equipment and systems necessary for a strong maternal health program also benefit the overall community. "The needs in developing countries are so immense and seem overwhelming, but once you've got the basics for a good maternal health program, you've got a good structure that will help the general population as well," Dr. Chamberlain Froese said.


Communities need to be educated about pregnancy risks and common pregnancy complications so that pregnant women become a priority, according to Dr. Chamberlain Froese. Two key components in reaching this goal include grassroots public education and agenda setting.


Governments need to allocate money toward improving the infrastructure, such as roads, because muddy and pothole-laden roads can make an emergency trip slow and dangerous. In some instances, pregnant women may stand on the side of the road, hemorrhaging while trying to flag down a car or public bus, but no one stops.


Agenda setting among political leaders is key to improving maternal health. Four members of the Ugandan Parliament have participated in a master's of public health (MPH) leadership program overseen by Dr. Chamberlain Froese. This program trains Ugandan professionals from many disciplines to make motherhood safer for African women. One member of the Ugandan Parliament has introduced new legislation to improve safe motherhood.


Awareness is increasing little by little. A Uganda journalist from the national daily newspaper has completed the MPH program and has helped bring attention to the issue. "There was nothing on safe motherhood for three months in the national newspapers. And now there are regular features every one to two weeks that cover issues concerning safe motherhood and reproductive health," Dr. Chamberlain Froese said.


Dr. Chamberlain Froese is the executive director of the nonprofit organization Save the Mothers and assistant professor of ob-gyn at McMaster University in Hamilton, Ontario. For the last four years, she has spent eight months of the year in Uganda overseeing the MPH leadership program. Before that, she spent five years in Yemen improving conditions for pregnant women.


The American College of Obstetricians and Gynecologists (ACOG) is the nation's leading group of physicians providing health care for women. As a private, voluntary, nonprofit membership organization, ACOG: strongly advocates for quality health care for women; maintains the highest standards of clinical practice and continuing education of its members; promotes patient education; and increases awareness among its members and the public of the changing issues facing women's health care.

Source
American College of Obstetricians and Gynecologists

Children Of Women Who Smoked During Pregnancy At Increased Risk Of Becoming Smokers

New research has revealed that prenatal exposure to nicotine increases the vulnerability to nicotine self-administration in adolescent mice. The results support the hypothesis that adolescents with prenatal nicotine exposure are more likely to start smoking earlier than their peers and that they are also more susceptible to the addictive effects of nicotine, especially as a result of stress and peer pressure. The study performed with mice is part of a project researching the behavioural and molecular mechanisms of nicotine addiction. The research project was carried out under the Academy of Finland's Research Programme on Substance Abuse and Addictions.


The key observation made by the Finnish and Russian researchers in the project was that adding nicotine to the drinking water of pregnant mice led to differences between the control and nicotine-exposed offspring in terms of nicotine self-administration. Treating the dams with nicotine during the prenatal period increased the frequency of self-administration in the offspring compared to the control group, even at lower doses.


The study also examined the receptor-level combined effects of opioids (morphine and morphine-related compounds) and nicotine. A receptor is a human protein to which endogenous and exogenous compounds bind. Once the receptors are activated, they trigger a number of intracellular signals. The compounds that bind to a receptor may also alter or turn off the receptor signalling. The present study was conducted using cell lines that express different subtypes of nicotinic receptors. Nicotine attaches to these receptors and activates them.


The results of the research project show that morphine and its related compounds, which normally attach to their own receptors, also bind to nicotinic receptors, causing altered nicotine responses. This provides a possible explanation for the common concurrent use of nicotine and other substances. The results may also pave the way for the development of new medication used to treat both smoking and drug addiction.


The study was conducted as a joint Finnish-Russian project between the Division of Pharmacology and Toxicology at the University of Helsinki, the Saint Petersburg Pavlov Medical University and Shemyakin-Ovchinnikov Institute of Bioorganic Chemistry in Moscow. The project was a concrete example of how people, research and knowledge can transcend national and cultural boundaries. The Finnish part of the project received funding from the Academy of Finland.


Sources: Suomen Akatemia, AlphaGalileo Foundation.

Leading Breast Cancer Researcher And Study Co-Author Rowan T. Chlebowski Explains Seemingly Contradictory Findings On Estrogen And Breast Cancer

Rowan T. Chlebowski, M.D., Ph.D., a principal investigator at the Los Angeles Biomedical Research Institute (LA BioMed), provided his assessment of the seeming contradictions between a previous Women's Health Initiative (WHI) study and a new abstract to be presented June 4 at the 2011 American Society of Clinical Oncology.



The abstract reports on the National Cancer Institute of Canada MAP.3 trial, the first study to evaluate an aromatase inhibitor for primary breast cancer prevention. Aromatase inhibitors lower the amount of estrogen in the body and are used for advanced and adjuvant breast cancer management in postmenopausal women. In the MAP.3 trial, the aromatase inhibitor exemestane reduced breast cancer incidence by a statistically significant 65% (P=0.002).



Dr Chlebowski, a co-author of the MAP.3 study, also was a co-author of a WHI report in JAMA this year on April 6th which provided updated follow-up of the WHI trial evaluating estrogen alone in post-menopausal women with prior hysterectomy. There, estrogen addition, as conjugated equine estrogens, surprisingly resulted in a statistically significant 23% reduction in breast cancer incidence (P=0.02).



Dr. Chlebowski noted "it seems paradoxical that both estrogen reduction with exemestane and estrogen addition result in lower breast cancer incidence but there is supportive underlying biology. Apparently, breast cancers which are driven by estrogen can only tolerate estrogen levels in a fairly narrow range. Thus, substantial change in the estrogen environment in either direction can influence breast cancer growth."



Dr. Chlebowski is a medical oncologist who has led several prior reports focusing on hormone effects on malignancies, including breast, lung and colorectal cancer.


Source
LA BioMed

Intensity-Modulated Radiation Therapy Reduces Side Effects For Cervical Cancer

Preliminary results from a University of Pittsburgh study evaluating extended-field intensity-modulated radiation therapy (IMRT) for cervical cancer found that it resulted in significantly reduced side effects and outcomes comparable to standard radiotherapy. The findings were presented 7-Nov-2006 at the 48th Annual Meeting of the American Society for Therapeutic Radiology and Oncology (ASTRO) in Philadelphia.



"We have been limited in our ability to treat women with cervical cancer with optimal doses of radiotherapy because of debilitating side effects that greatly impact their quality of life," said Dwight E. Heron, M.D., study co-author and associate professor of radiation oncology, University of Pittsburgh School of Medicine. "Our study demonstrates that with IMRT, we can target high-energy beams directly to the tumor site and the areas of concern where the cancer cells may travel, resulting in less side effects and enabling us to give a full therapeutic dose."



Extended-field radiotherapy (EFRT) is the method of radiotherapy used with advanced cervical cancer in which the pelvis and abdominal region are irradiated to destroy cancer cells that travel up to the abdominal lymph nodes that drain from the tumor. According to Dr. Heron, standard EFRT causes serious side effects in as many as 40 percent of patients. These side effects can include frequent urination and pain, diarrhea and bowel obstruction and tend to worsen when chemotherapy is given at the same time as radiotherapy.



In the current study, 36 patients with cervical cancer were treated with extended-field IMRT and the chemotherapy agent cisplatin to determine the efficacy of treatment and treatment-related side effects. Of these patients, 34 had a complete response to treatment. Only two patients developed higher-grade gastrointestinal and urinary side effects and 10 developed myelotoxicity, a slowdown of blood cell production that is common with chemotherapy. The overall survival rate at two-year follow-up was 54 percent.



"We found that by using extended-field IMRT and chemotherapy, we were able to effectively reduce the toxic effects of treatment," said Sushil Beriwal, M.D., principal investigator and assistant professor at the University of Pittsburgh School of Medicine and medical director of radiation oncology at Magee-Womens Hospital of UPMC. "This is important because it means there are less treatment interruptions and more patients are able to complete the treatment within the prescribed time period. This, in turn, increases the efficacy of treatment, giving us encouraging evidence that these cervical cancer patients can benefit from IMRT."



Unlike standard radiation therapy, IMRT administers a radiation field that consists of several hundred small beams of varying intensities that pass through normal tissue without doing significant damage but converge to give a precise dose of radiation at the tumor site. IMRT can potentially limit the adverse side effects from radiation while increasing the intensity of doses that can be given to effectively destroy cancer cells.






CONTACT:


Michele Baum



Co-authors of the study include Greg Gan, Joseph L. Kelley, M.D., and Robert P. Edwards, M.D., all with the University of Pittsburgh School of Medicine.



Contact: Clare Collins


University of Pittsburgh Medical Center

Eastern Philosophy Promises Hope For Western Women With Eating Disorders

A psychological technique based on Buddhist philosophy and practice may provide a solution for women who struggle with binge eating and bulimia.



The technique known as 'mindfulness' is being taught to Queensland women to help them understand and deal with the emotions that trigger their binges.



Unlike many therapies for eating disorders, there is less focus on food and controlling eating and more on providing freedom from negative thoughts and emotions.



Griffith University psychologists Michelle Hanisch and Angela Morgan said women who binged were often high-achievers and perfectionists.



When such women perceived they didn't measure up to self-imposed standards or were not in control of situations, they indulged in secretive eating binges. A typical late-night binge could involve four litres of icecream and a couple of packets of chocolate biscuits, Ms Hanisch said.



"Many women develop elaborate methods of hiding the evidence of their binges and some feel so guilty afterwards they also induce vomiting, overuse laxatives or exercise excessively to counteract the effects of the binge," she said.



"Binge eating is largely a distraction - a temporary escape from events and emotions that nevertheless can cause long-term physical problems including electrolyte imbalances. Instead, women need to learn how to react in a different way."



Mindfulness involves exercises similar to meditation that could help people live more in the moment, develop a healthy acceptance of self and become aware of potentially destructive habitual responses.



"Women who have been through the program report less dissatisfaction with their bodies, increased self-esteem and improved personal relationships," Ms Morgan said.



"They learn that thoughts and emotions don't have any power over us as they are just passing phenomena and aren't permanent."



Mindfulness has already been shown to be effective as a treatment for anxiety and depression, substance abuse, and the stress associated with physical conditions such as trauma, chronic pain or cancer.







The eight-week program is being offered at no charge at Griffith University campuses on the Gold Coast and in Brisbane.



Contact: Mardi Chapman


Research Australia

Attendees At Conference Say Contraception Promotes Promiscuity, Harms Relationships, Devalues Children

About 250 people last weekend attended a two-day conference titled "Contraception Is Not The Answer" in Rosemont, Ill., hosted by the Pro-Life Action League, the Chicago Tribune reports. According to the Guttmacher Institute, 98% of 15- to 44-year-old girls and women who have had sex said they have used at least one method of contraception, and more than 40 million women in the U.S. in the age group currently use a form of birth control. In addition, about 91% of likely U.S. voters say couples should "have access to birth control options," according to a July Harris Interactive poll of 1,001 likely voters. Some attendees at the conference planned to say that contraception promotes "sexual promiscuity," leads to a decrease in birth rates, damages relationships between men and women and "devalues children," according to the Tribune. Some experts say that opponents of contraception likely will attempt to restrict access to its use by calling for cuts to federal family planning programs and allowing pharmacists to refuse to fill prescriptions to which they have a "conscience" objection, the Tribune reports. Thomas Euteneuer, president of Human Life International, at the conference called for funding to be "tak[en] away" from Planned Parenthood Federation of America for contraception and sex education services, adding that he believes contraception "doesn't prevent abortions, it causes abortion." Steve Trombley, president of Planned Parenthood Chicago Area, said he does not think contraception opponents' argument that women and men should have sex "only within marriage and only for the purpose of procreation" is "sellable in any corner of America." Some antiabortion advocates disagree with "making contraception an ideological or political target," according to the Tribune. "I'm here to stop abortions, ... and we're coming close to winning on this issue," John Willke, head of the International Right to Life Federation, said, adding, "If we take up an anti-contraception agenda, we won't win the abortion fight in the foreseeable future." However, Libby Gray Macke -- director of Project Reality, an Illinois-based abstinence program -- said advocacy against contraception use is "not just a side issue from pro-life, it's the core issue" (Graham, Chicago Tribune, 9/24).

"Reprinted with permission from kaisernetwork. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at kaisernetwork/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork, a free service of The Henry J. Kaiser Family Foundation . © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

Gout Risk Factors For Women: Obesity, Hypertension, Alcohol And Diuretic Use

Researchers from Boston University School of Medicine found that women with serum uric acid levels over 5 mg/dl had a significantly lower risk of developing gout than men. This study, the first to examine the relationship between uric acid levels and gout risk in women, also evaluated purported risk factors for gout and found that increasing age, obesity, hypertension, alcohol use, and diuretic use to be among leading contributors for women. Results of this 52-year follow-up study are published in the April issue of Arthritis & Rheumatism, a journal of the American College of Rheumatology.



Gout is a common and excruciatingly painful inflammatory arthritis caused by elevated uric acid levels in the blood. When too much uric acid builds up in joint fluid, uric acid crystals form and cause joint swelling and inflammation. Historically, gout was seen as a male disease, however growing evidence suggests the disease is also a concern for older women. According to the Third National Health and Nutrition Examination Survey (NHANES-III) the prevalence of gout in women was 3.5% for ages 60-69 years, 4.6% in the 70-79 age group, and 5.6% in those 80 or older. Furthermore, the Rochester Epidemiology project study found the incidence of gout has doubled among women over the past 20 years.



The research team led by Hyon Choi, M.D., D.Ph., analyzed data from the Framingham Heart Study for 2,476 women and 1,951 men who had a complete follow-up history and who were free of gout at baseline. The mean age at baseline was 47 years for women and 46 years for men. Researchers evaluated serum uric acid levels and risk factors for gout that included: age, body mass index (BMI), alcohol consumption, hypertension, medication use (diuretics, hormone replacement therapy), blood glucose and cholesterol levels, and menopause status. At baseline the mean serum uric acid level was 4.0 mg/dl for women and 5.1 mg/dl for men.



"We identified 104 gout cases in women and 200 in men over the 28-year median follow-up period," said Dr. Choi. "The gout incidence per 1,000 person-years was 1.4 in women and 4.0 in men." Specifically, results showed that the incidence rates of gout for women per 1,000 person-years according to serum uric acid levels of

WHO Reviews Antiretroviral Recommendations For Pregnant, Breastfeeding Women With HIV

The World Health Organization is reviewing its 2006 guidelines on the use of antiretroviral drugs by HIV-positive pregnant and breastfeeding women because of new evidence that prolonged use can cut the risk of mother-to-child transmission, Reuters reports. Current guidelines recommend that these women receive a short-course antiretroviral regimen. However, a new study released at an international AIDS conference on Wednesday shows that a stronger regimen over a prolonged period significantly lowers the risk of mother-to-child transmission.

The study examined 824 pregnant women in Burkina Faso, Kenya and South Africa who received either the standard antiretroviral regimen or a combination of three antiretrovirals. The combination regimen was administered during the last trimester and for a maximum of six months during breastfeeding, according to study leader Tim Farley of WHO's Department of Reproductive Health. Farley said women who received the combination regimen during pregnancy, delivery and breastfeeding had a 42% lower risk of transmitting HIV to their infants than women given the standard course.

Farley added, "The results of this study show an almost twofold reduction in the risk of HIV transmission during the breastfeeding period and also [show] there is no short-term toxicity" to the women or their infants. He said that participants will be monitored for any long-term health effects. WHO is expected to release the updated recommendations by the end of the year (Roelf, Reuters, 7/21).


Reprinted with kind permission from nationalpartnership. You can view the entire Daily Women's Health Policy Report, search the archives, or sign up for email delivery here. The Daily Women's Health Policy Report is a free service of the National Partnership for Women & Families, published by The Advisory Board Company.


© 2009 The Advisory Board Company. All rights reserved.

GOP Sens. Say Sotomayor Filibuster Possible But Unlikely, Obama Defends Judge's Past Comments

Several Republican senators in appearances on various talk shows on Sunday said that they do not expect the GOP to attempt a filibuster to block the Supreme Court nomination of Judge Sonia Sotomayor, although none ruled the idea out, the Washington Post reports. Sen. Kay Bailey Hutchison (R-Texas) said that she does not think the "need for filibuster will be there unless we have not had a chance to look at the record fully," adding that the Senate "need[s] to look at the record fully" and in an "expeditious way." Sen. Jeff Sessions (R-Ala.), the ranking member on the Senate Judiciary Committee, on NBC's "Meet the Press" said that Sotomayor's 17-year career as a federal judge is "very strong in her favor" and "the kind of background you would look for" in a Supreme Court justice. However, Sessions added that he and other Republican senators are concerned over a remark Sotomayor made in 2001 at a conference on Hispanics in the judiciary. According to the Post, Sotomayor was discussing how her Puerto Rican heritage has influenced her role as a judge when she said, "I would hope that a wise Latina woman with the richness of her experience would, more often than not, reach a better conclusion than a white male who hasn't lived that life." Sessions said the remark "goes against the heart of the great American heritage of an independent judge" (Barnes, Washington Post, 6/1). Judiciary Committee member John Cornyn (R-Texas), appearing on ABC's "This Week," said that senators "need to know ... whether she's going to be a justice for all of us or just a justice for a few of us" (Wallsten, Los Angeles Times, 6/1).

Sen. Charles Schumer (D-N.Y.) -- Sotomayor's sponsor through the confirmation process -- said on "This Week" that she is "virtually filibuster-proof when people learn her record and her story." He added that Sotomayor is "legally excellent" and "not a far-left-wing judge" (Barnes, Washington Post, 6/1).

White House Defends Sotomayor's Comments

White House Press Secretary Robert Gibbs said that he thinks Sotomayor would "say that her word choice in 2001 was poor, that she was simply making the point that personal experiences are relevant to the process of judging." In an interview with NBC News that will air this week, President Obama also defended Sotomayor, saying that "if you look in the entire sweep of the essay that she wrote, what's clear is that she was simply saying her life experiences will give her information about the struggles and hardships that people are going through" (Eggen/Kane, Washington Post, 5/30).














Obama also stood by his decision to nominate Sotomayor in his weekly radio and Internet address on Saturday. Obama said that he is "certain that she is the right choice" and that her record as a federal judge "makes clear that she is fair, unbiased and dedicated to the rule of law." While he said he expects "rigorous evaluation" of Sotomayor, Obama said his "hope is that we can avoid the political posturing and ideological brinkmanship that has bogged down this process, and Congress, in the past" (AP/USA Today, 6/1).

First Meetings With Senators Expected This Week

According to the AP/Chicago Tribune, Sotomayor is scheduled to hold her first meetings with senators this week, beginning on Tuesday with Sessions and Democratic Sens. Harry Reid (Nev.) and Judiciary Committee Chair Patrick Leahy (Vt.). Gibbs said a meeting with Senate Minority Leader Mitch McConnnell (R-Ky.) also is possible, adding that he is hopeful there will be other meetings scheduled throughout the week (AP/Chicago Tribune, 5/31).

The Wall Street Journal reports that the formal Senate confirmation hearings are not expected to begin for several weeks. The White House would like the Senate to confirm Sotomayor before the August recess so she will be on the bench for the court's next term, which begins in October. Although some GOP senators say this might not be enough time to fully examine her record, Sotomayor is expected to be confirmed, the Journal reports (Bendavid, Wall Street Journal, 6/1).


New York Times Editorial Urges Critics To 'Elevate the Discussion' on Sotomayor

A New York Times editorial says a majority of the issues conservatives are raising against Sotomayor are "not among" those on which she needs to be vetted. Sotomayor is "being called racist" and "attacked as not smart enough, as too abrasive," the editorial states, adding, "It is time to elevate the discussion to where it belongs: the Constitution and the role of the judiciary." The editorial continues, "Despite her long service as a federal judge, [Sotomayor's] record on many important issues is sparse," including her views on the right to privacy, "a critical doctrine that provides the basis for abortion rights." Nominees to the Supreme Court "should not go into specifics about cases they might judge," but the Senate in recent years "has allowed them to be far too opaque about their broader views on the Constitution and judging," the editorial says. Republican elected officials and conservative groups "see this nomination as a way to score points off wedge issues that excite their base," the editorial states, concluding, "It diminishes everyone when a nomination process deteriorates into character assassination and ethnic intolerance" (New York Times, 5/31).


Reprinted with kind permission from nationalpartnership. You can view the entire Daily Women's Health Policy Report, search the archives, or sign up for email delivery here. The Daily Women's Health Policy Report is a free service of the National Partnership for Women & Families, published by The Advisory Board Company.


© 2009 The Advisory Board Company. All rights reserved.

California Bill Seeks To Restrict Payments To Egg Donors, Counter Exploitation Of Poor, Minority Women

A California bill seeks to extend to privately funded laboratories a provision under Proposition 71 that says scientists receiving state embryonic stem cell research funds can reimburse egg donors only for their expenses and cannot pay egg donors, the Los Angeles Times reports (Romney, Los Angeles Times, 9/13). State voters in November 2004 approved Proposition 71 to provide $295 million annually for 10 years for human embryonic stem cell research (Kaiser Daily Women's Health Policy Report, 7/21). The bill -- sponsored by state Sens. Deborah Ortiz (D) and George Runner (R) -- also would broaden informed consent requirements for those who donate their eggs for embryonic stem cell research and will pertain only to research laboratories and not to fertility clinics, the Times reports. Emily Galpren, director of health and human rights for the Oakland, Calif-based Center for Genetics and Society, said that without the restrictions, poor and minority women could be exploited for viable eggs (Romney, Los Angeles Times, 9/13). According to Laurie Zoloth of Northwestern University's Feinberg School of Medicine, payments to egg donors would take advantage of women whose economic situations could affect their judgment about the risks associated with the harvesting procedure. Some stem cell researchers say that paying donors is fair because of the discomfort, time and health risks associated with the procedure (Kaplan, Los Angeles Times, 9/13). In addition, opponents of the measure argue that it is "paternalistic" to believe that women cannot make informed decisions on their own, the Times reports. Ann Kiessling, director of the Bedford Stem Cell Research Foundation in Massachusetts, said the payment restrictions would not guarantee that women are not exploited. She added that women are "only going to be protected by good medical care and fully informed consent. How well they're cared for is independent of whether they're going to be compensated." The measure was approved by the state Legislature and has been sent to Gov. Arnold Schwarzenegger (R) for consideration (Romney, Los Angeles Times, 9/13).


"Reprinted with permission from kaisernetwork. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at kaisernetwork/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork, a free service of The Henry J. Kaiser Family Foundation . © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

Washington Business Journal Examines Implementation Of Protections For Breastfeeding Women In Health Reform Law

A provision in the federal health reform law (PL 111-148) requiring employers to provide breastfeeding women with break times and a private place to express milk or breastfeed their infants is a "huge victory" for breastfeeding advocates who have been fighting for a national measure since at least 1992 , the Washington Business Journal reports. As recently as last summer, the Ohio Supreme Court ruled that it was legal for an employer to fire a woman who took breaks to express milk. The law also could provide significant cost savings for employers, "with more breast-fed children leading to fewer sick days and fewer diseases," the Journal reports.

According to the Journal, federal health experts recommend women feed their infants only breastmilk for at least the first six months, which can boost the infant's immunity and decrease the woman's risk of breast cancer later in life. The American Academy of Pediatrics in April released a study showing that 911 infants' lives and $13 billion in health care costs could be saved each year if 90% of breastfeeding women adhered to those recommendations. The Centers for Disease Control and Prevention reports that while nearly 80% of U.S. women breastfeed initially after birth, only 44% breastfeed for six months, largely due to workplace barriers.

The Journal reports that some groups -- including breastfeeding advocates -- are concerned that the language in the law is too vague and could lead to implementation issues. Gina Ciagne, director of breastfeeding and consumer relations for breastfeeding products manufacturer Lansinoh Laboratories, said, "It's amazing and great that they have this language in the bill, but it still leaves so much ambiguity for moms and employers." She added, "If an employer doesn't understand why and how a mother needs to pump milk, maybe a five-minute break seems 'reasonable.'"

Ciagne said that it is an "unfair burden to put on a working mother," adding, "You've got all these agencies and organizations telling moms, 'Oh you really have to do this for the sake of your child, but we’re not going to help you figure out how to do it.'" She added, "There needs to be an overarching voice for pumping, working moms."

In March, almost 100 public health organizations -- including AAP -- petitioned Congress to allocate $15 million to fund a centralized body to provide employers and employees guidance on workplace lactation. Ciagne said that employers should not wait for government guidance to figure out how to support breastfeeding women. Ciagne said, "Some people in this country can't even get permission to go to the bathroom -- and in these economic times, a mom doesn't want to rock the boat."

Lisa Horn, a government relations specialist for the Society for Human Resource Management, said, "It's not one of those provisions that's gotten homed in on yet, because there are so many other provisions to worry about." She added, "But a lot of this is going to have to get fleshed out for employers to know what a reasonable break time is and when that provision will be effective."

In 2008, HHS found that employers who accommodate breastfeeding women see higher rates of employee retention and lower health care costs. Women who are breastfeeding also miss work less often, as mothers of formula-fed infants take off work twice as often to care for sick children. A two-year study of 343 employees of health insurer Cigna who participated in their lactation support program found that about $600,000 was saved by reducing absenteeism rates. Moreover, the company's program resulted in annual savings of $240,000 in health care expenses and 62% fewer prescriptions (Castro, Washington Business Journal, 4/30).


Reprinted with kind permission from nationalpartnership. You can view the entire Daily Women's Health Policy Report, search the archives, or sign up for email delivery here. The Daily Women's Health Policy Report is a free service of the National Partnership for Women & Families, published by The Advisory Board Company.


© 2010 The Advisory Board Company. All rights reserved.