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.

Low-Cost Program Encourages Latina Moms To Seek Postpartum Care

Latinas participating in an educational intervention program were two-and-a-half times more likely to seek postpartum care than were those who did not have access to a similar program, a new study finds.


Although 80 percent of women with private insurance receive related health care after having a baby, only 59 percent of women with Medicaid insurance do, according to the Health Employer Data and Information Set (HEDIS). Women of low income, particularly Latinas and other minorities, have greater health risks due to below-average rates of postpartum follow-up visits, the authors write.


"Having patients come back for postpartum checkups is very important," said lead study author Flavio Marsiglia, Ph.D., the director of the Southwest Interdisciplinary Research Center (SIRC) at the School of Social Work at Arizona State University. "It is during this time that some health and mental problems, such as depression, may be recognized."


The study relied on the Familias Sanas, or Healthy Families, program and examined postpartum visit rates and other wellbeing measures. It appears in the August issue of the Journal of Health Care for the Poor and Underserved.


During a first prenatal visit, researchers invited women to participate in the randomized controlled study if they were less than 34 weeks pregnant, at least 18 years old and identified their ethnicity as Latina or Hispanic. The women each met between five and 20 times with a bicultural and bilingual prenatal partner a student in the social work program.


Among other things, the prenatal partner conducted a baseline assessment, provided education, assisted with communication and helped arrange regular prenatal and postpartum visits.


The study included 440 women seen at the Women's Care Clinic at Maricopa Medical Center in Phoenix. Of these, 221 women participated in the intervention and 219 were in the control group. Eighty-four percent of participants were first-generation immigrants and 73 percent had an annual income of less than $20,000. Most women were of Mexican heritage and in their late 20s. Eighty percent had a previous pregnancy.


"Educating patients and encouraging them to come back during visits near the termination of OB care are ways to increase the number of women who continue using health care between pregnancies," Marsiglia said. The time between pregnancies, called the interconception period, can be a time to address folic acid consumption before conception, family planning and pregnancy risks such as hypertension and diabetes.


"The program is very similar to the Comprehensive Perinatal Services Program in California that encourages educating patients throughout the antepartum period," said Peyman Banooni, M.D., an OB/GYN specialist who serves the Hispanic population in two downtown Los Angeles clinics. "Cultural sensitivity, resolving language barriers, educating patients about the system and longer health insurance coverage after delivery will definitely improve access to care and health outcomes."


However, he said "the assumption that by patients coming to postpartum visit, it will lead to better health outcomes for the patients" needs to be proven in further studies." He also said that the findings can only be applied to similar populations and not necessarily all Latino populations.


"Medical personnel are asked to do more and more and often they cannot humanly respond to all of those demands," Marsiglia said. "Cost-effective interventions like Familias Sanas can be relatively easy to implement and can significantly improve providers' and patients' outcomes."


Marsiglia FF, Bermudez-Parsai M, Coonrod D. Familias Sanas: an intervention designed to increase rates of postpartum visits among Latinas. J Health Care Poor Underserved 21(3), 2010.


Source: Health Behavior News Service

Women Need To Be Aware Of Changes, IU Simon Cancer Center Breast Expert Says

Every day, women face a barrage of headlines about breast cancer. What should they do with all of that information?


George Sledge, M.D., an internationally recognized breast cancer expert, pointed out that, despite all of the near-constant news and information about breast cancer, it is not the disease that impacts most women.


"It's important to know that, while breast cancer is a common cancer, it is not the most common cause of death in American women. Heart disease is far more common. Women need not be paralyzed by the prospect of breast cancer."


Overall, the American Cancer Society says a woman has about a one in eight chance of developing breast cancer during her lifetime. There will be 182,460 new cases of breast cancer in the United States in 2008.


Dr. Sledge, Ballve-Lantero Professor at the Indiana University School of Medicine and an oncologist and researcher at the Indiana University Melvin and Bren Simon Cancer Center, said women need to be knowledgeable - not overwhelmed - about steps they should take regarding their breasts.


For starters, women should undergo regular screening mammography, beginning at age 40.


"Fortunately, a great majority of women today are diagnosed with what we consider early-stage disease," Sledge said. "That's been a trend in recent years because of screening mammography."


Other than mammography, women need to pay attention to their bodies. "Women need to be aware of change in their breasts," Sledge added. "If they notice a lump, mass, or a new area of tenderness that they haven't noticed before, they should get that checked out promptly."


A woman should know about her family history. A woman is at greater risk of developing breast cancer if she has one of the following:


-- A personal history of breast, ovarian, or colon cancer


-- A close relative who was diagnosed with breast cancer before menopause or in both breasts


-- Never had children or who had her first child after age 30


Once detected, breast cancer is usually treated by both local therapy and systemic therapy.


In local therapy, the goal is to eliminate the cancer in the breast and the related lymph nodes and minimize the risk of recurrence. Treatment options include surgery - breast preservation, lumpectomy (removes only the breast lump and surrounding tissue), or mastectomy (removal of all breast tissue) - and radiation therapy.


Systemic therapy involves eliminating tumor cells that might have escaped into the circulation and minimizing the risk of developing distant sites of tumor growth. Treatment options include chemotherapy, hormonal therapy, and newer and an ever-expanding class of agents known as biological therapy.


"We live in an era where we have far more to offer women with breast cancer than ever before," Sledge said. "We live in an era where our ability to screen for breast cancer has gotten better than ever before. We live in an era where there's the prospect for new diagnostic and therapeutic technology for breast cancer."