'Tis the season - flu season that is

Monday, October 1st marks the official start of flu season. While anyone can get the flu vaccine if they want to reduce their chances of getting the flu, the Centers for Disease Control recommends some groups of adults get vaccinated every year, because they are at increased risk for severe complications if they do become sick. These groups include:

• Women who will be pregnant during flu season
• People who have weakened immune systems, such as from HIV/AIDS, chemotherapy, organ transplants, or autoimmune disorders (e.g., multiple sclerosis, rheumatoid arthritis)
• People who have chronic health conditions, such as heart problems, lung disease (e.g., asthma, emphysema, bronchitis), diabetes, and kidney disease
• People 50 years and older
• People who work in a health care setting or family members of those in high risk groups

For the folks noted above, you unfortunately have to get vaccinated with an injection (this is the inactive, or "killed," form of the virus). However, if you are a healthy adult under age 50 who is not pregnant, you can avoid the needle. FluMist is a nasal spray vaccine that will spare you the shot.

The best time to get vaccinated starts Monday. October and November are the recommended months to provide the best chances for keeping the bug away. However, you still may receive some benefits if you get vaccinated in December or later. And remember: it takes two weeks for full immunity to develop, so plan ahead. (You never know when there's going to be another vaccine shortage.) Call your health care provider for an appointment or find a flu shot clinic near you today.

PMS: You are what you eat - or something like that

Periods are bad enough without adding premenstrual agonies to the front end. You know what I'm talking about - the bloating, breast tenderness, irritability, fatigue, acne, crying spells, anxiety, and food cravings (chocolate, salt, both - do I hear chocolate covered pretzels anyone?) that occur a week or so before your period arrives.

There has been a lot written in the popular media about easing PMS symptoms through changes in diet, such as consuming less caffeine and sodium and increasing vitamin B intake. But a study published in the Journal of Women's Health actually looked at what proportion of the participants' diets consisted of what kinds of foods (e.g., fats, carbs, fiber) and how these proportions related to their premenstrual symptoms. The study consisted of 3,302 ethnically diverse women who participated in SWAN (Study of Women's Health Across the Nation). They did find some relationships between what women ate and how they felt. But you may be surprised by the results (I sure was).

Fat intake was associated with fewer premenstrual cravings and less bloating (potato chips okay). Caffeine was associated with more anxiety and mood changes (pumpkin spice latte from Starbuck's not okay). Alcohol consumption was associated with less anxiety and mood changes (glass of red wine okay), but more headaches (or maybe not okay). Fiber was associated with more breast pain (bran muffin maybe not okay, I'm still not sure about this one - see below).

Perhaps more important than the dietary findings, they found certain subgroups of women experienced PMS differently. Perimenopausal women reported significantly more premenstrual symptoms than premenopausal women. Additionally, women with depression reported more PMS symptoms, especially anxiety and mood changes. Conversely, 0lder women reported less anxiety, mood changes, and back pain. Finally, overweight and obese women reported more cravings and bloating than normal weight women.

Is there a dietary moral here? The authors of the study say no. With the exception of caffeine, most of the dietary relationships were in the opposite direction - that is, fat and alcohol were actually associated with fewer symptoms, not more. Additionally, I would add there are other benefits of fiber intake that may outweigh the monthly nuisance of breast pain (although I'm not someone who experiences breast pain, so I might be convinced otherwise). They also didn't time their study to measure food intake and then track subsequent symptoms in the same 2-week period. Had they done this, they might have identified some different relationships between food and symptoms. Perhaps the more important part of this study is the identification of subgroups of women who are at higher risk for PMS symptoms, namely perimenopausal women, overweight women, and women with depression. If you are in one of these subgroups and you experience PMS, talk to your health care provider about ways to alleviate your symptoms.

Improve depression with exercise

Exercise produces a lot of benefits. It reduces the risk of stroke and heart disease. It lowers the "bad cholestrol" while increasing the "good cholesterol." It helps to reduce blood pressure and maintain a healthy weight. According to research published online this month in Psychosomatic Medicine, exercise is also an effective treatment for depression.

Researchers tested the effectiveness of 4 types of depression treatments: a led exercise regimen, a home exercise program, an antidepressant known as a selective seritonin reuptake inhibitor (SSRI), and a placebo, or a pill that does not contain any medicine. They sorted 202 adults (153 women) with depression into each of the groups and followed them for 4 months.

They found that 41% of all patients no longer met the criteria for major depressive disorder. When they broke the groups down by treatment group, they saw improvements in all 4 groups. Secifically 45% of the led exercise group, 40% of the home-based exercise program, 47% of the antidepressant group, and 31% of the placebo group saw improvements. Interestingly, the rates of improvement were very similar for those in the led exercise group and those taking antidepressants. Further, although participants in the 3 "active" treatment groups (led exercise, home exercise, and antidepressants) had greater improvements than the placebo group, nearly one-third of those in the placebo group still got better. The investigators noted that improvements in depression may be related to factors other than treatment type, such as attention from mental health care providers and monitoring of symptoms.

Per the investigators, it is important to note that this study does not demonstrate that exercise is better than SSRIs for relieving depression. So if you are taking antidepressants, this is not license to stop your medication without first discussing the pros and cons of such a decision with your doctor. However, the study authors d0 note that exercise can increase positive thoughts, enhance self-concept, and change how the body responds to stress, all of which can lead to fewer depressive symptoms. So if you have depression or are prone to a depressed mood, try some exercise - you might see improvements in your mood, as well as other areas of your life.

In your face(book): Calling all breastfeeding moms

As noted in the description of this site, my purpose is to relay research findings in a way that is more accessible to women who are not researchers themselves. However, occasionally something comes to my attention that is not research per se, but supports what research shows is a positive health behavior.

Today that something is breastfeeding - or more specifically, a breastfeeding event sponsored by the League of Maternal Justice. As I have discussed before, breastfeeding is healthy for babies AND moms for a variety of reasons. These mothers have united to support not only the act of breastfeeding, but the right to breastfeed undisturbed in a public venue, and the right to not be censored on a social media site for showing yourself breastfeeding.

So if you are (or have been) a breastfeeding mother, you can participate in this event on October 10th at 10AM. Check out the website for more details.

Men better than women at assessing heart attack risk

Most people know that your family's medical history is an important part of your own medical history. It helps you to understand what kinds of health problems you may be more likely to acquire, based on your genetic make-up.

A new study, however, suggests that young women with a family history of heart attack are less likely to understand their risk for heart disease and more likely to make poor lifestyle choices that increase their risk. Researchers analyzed data from nearly 2,500 men and women ages 30-50 who participated in the Dallas Heart Study and who had a family history of premature heart attacks. They defined family as a first degree relative (i.e., mother, father) and "premature" as a male family member who had a heart attack before age 50 and a female family member who had a heart attack before age 55.

They found that compared to women with no family history of heart attack, having such a family history was linked to having 2 or more traditional risk factors for heart disease (i.e., high cholesterol, high blood pressure, diabetes, and smoking). The investigators did not find this association for men. They also found that women with a family history of heart attack were more likely to have coronary artery calcification, or buildup in the walls of the arteries in the heart. This build-up matched that for men without a family history of heart attack. Women with a family history of heart attack also were less likely to make healthy lifestyle choices. They smoked more and exercised less than men with the same family risk. Finally, fewer women with a family history of heart attack perceived their risk of heart attack to be as high as men with the same family history.

These findings are not surprising, but they are concerning. Men typically have been the focus of research and education on heart disease. Consequently, women may underestimate their actual risk, despite their family histories. Yet this is a dangerous precedent, as heart disease is the number one cause of death for women just as it is for men.

If you are among the women with a family history of heart disease, know the risk factors, including which ones you can control. Then make those healthy lifestyle choices - stop smoking, eat less fat, move your body, and limit stress. This is not just a men's disease, and you can be affected.

Even OBs don't always know when they're in labor

My colleague, Dr. Wendy Hansen, is featured on Parents.com this week. She is an OB/GYN and division chief for maternal-fetal medicine at the University of Kentucky. She discusses how when she was pregnant, she wasn't sure whether she was going into labor - despite having delivered over 600 women before she herself gave birth to her first set of twins (she has two sets who are 15 months apart - whew!).

This should make you feel pretty good about calling your doctor or midwife at 2AM when you think you might be having contractions, but you're not sure, and your husband says wait until the morning, but your back is hurting, and it could be back labor, and you are 35+ weeks, and there's definitely something going on in there, but it could just be gas pains....have you called yet?

If this sounds all too familiar, listen to Dr. Hansen and make the call. As she notes in the article, if you were a 50 year old man with chest pains, you'd want to get checked out just in case, right? What you're feeling may be nothing, but it may be labor. Wouldn't you rather know?

Prescriptions don't always come with pregnancy warnings

Physicians prescribe medications for women of childbearing age all the time. However, new research shows women who could become pregnant often aren't receiving counseling regarding the risk of birth defects for some classes of medications.

If you're not up to speed on how medications are classified with respect to pregnancy outcomes, here's a quick primer. The Food and Drug Administration (FDA) classifies drugs based on how teratogenic they are - or what is their capacity to cause abnormal development in an embryo or fetus. The FDA uses 5 categories to denote levels of safety.

Class A drugs show no evidence of causing birth defects in studies of pregnant women. Class B drugs show no risk for birth defects in the second or third trimester. In the first trimester there either is no research on these drugs, or human studies did not demonstrate adverse effects, while animal studies did. Class C drugs are those that either have caused birth defects in animal studies and there are no studies of women, or no studies (either animal or human) exist at all, so risks are unknown. Class D drugs have been shown to cause birth defects, but the benefits of use outweigh the known risks, as in the case of life-threatening illness or serious disease. Finally, Class X drugs have been shown to cause birth defects, and they are not recommended during pregnancy.

In a study published this week in the Annals of Internal Medicine, investigators reviewed the health records of nearly 500,000 women ages 15-44 in northern California, including detailed information about medications prescribed, prescriptions filled, and contraceptive use and counseling. They found that 1 in 6 women was prescribed a Class D or X drug, and internal medicine and family practice docs prescribed the largest share of these drugs. They also found nearly one-half of women who were prescribed a Class D or Class X medication did not receive any contraceptive counseling, even though these drugs are known to cause birth defects. Finally, fewer than one-half of women who filled a prescription for a Class D or Class X drug also filled a prescription for contraception or had previously been sterilized.

Why does this matter? Unplanned pregnancies are not rare - in fact research shows that 50% of American women ages 15-44 will have at least one unplanned pregnancy in her lifetime. As a woman of childbearing age, this may be one of those instances where you have to be proactive in your healthcare. If you're sexually active - or have even the remote possibility to be - and your doctor prescribes a new medication, you may want to ask about the risks during pregnancy, just in case. Better to have one awkward moment in the doctor's office than 40 weeks of wondering if your newborn is going to be healthy.

Facebook breastfeeding debate driving you to drink? Not so fast...

If you've been keeping up with the discussions about Facebook letting pro-anorexia members freely mingle (despite research that says "pro-ana" websites are bad for women) while they ban breastfeeding moms for posting pictures of their children eating (despite research that shows breastfeeding is good for women AND their children), you'll know it's enough to drive anyone to drink.

Not so fast. While research does suggest women may receive some benefits from alcohol consumption, new research published yesterday in the online version of the International Journal of Cancer shows caution is in order.

Researchers followed over 41,000 postmenopausal women of diverse ethnic backgrounds, including African-American, Japanese-American, Latina, Native-Hawaiian and White women. They tracked the women for an average of 8 years and recorded their dietary intake (including alcohol consumption), lifestyle decisions, genetic risk factors, and health outcomes. The investigators found women who drank 2 or more alcoholic beverages of any kind (wine, liquor, or beer) daily had twice the risk of contracting endometrial cancer (cancer of the lining of the uterus) as women who did not drink. They did not find an increased risk for endometrial cancer among women who consumed less than 2 alcoholic drinks daily.

When they separated women according to their preferred/most often consumed beverage, there were differences in rates of endometrial cancer. Women who drank 2 or more servings of wine daily were 3 times as likely to develop endometrial cancer as non-drinkers. Women who drank just 1 or more servings of hard liquor were on average twice as likely to develop endometrial cancer as those who abstained. The investigators did not find any differences among women who preferred beer, mostly because few women identified beer as their primary drink of choice.

The investigators also studied alcohol consumption in relation to other risk factors for endometrial cancer, such as body mass index, history of pregnancy, use of hormone replacement therapy, and smoking. They found lean women (women with a BMI less than 25) who consumed at least two drinks daily had greater risk for endometrial cancer than overweight and obese women. Women who never gave birth also were at greater risk for endometrial cancer if they consumed 2 or more drinks daily. Smokers and women who used hormone replacement therapy did not show increased risk for endometrial cancer based on their alcohol consumption.

So while you may derive some health benefits from enjoying your favorite libation, there also are some risks if you get too carried away too often. In addition to "how many" drinks you have, be mindful of how much you pour into a glass. (Do you ever notice a bottle of wine lasts longer in a restaurant - when someone else is pouring - than it does at home?). Here's a guide to standard serving sizes (yes, that reads 5 ounces for a glass of wine). Bottom line: moderation is key.

Pro-Anorexia Websites Bad on All Counts

As lactivists continue to fight for the rights of breastfeeding moms everywhere, my husband over at It's Not a Lecture pointed out that while Facebook is banning photos of breastfeeding moms - and banning the moms themselves in some cases - they continue to let pro-anorexia members mingle and meet using their network. I don't want to get in the middle of a communications debate on this blog - I'll leave that to the PR experts (is that an oxymoron?). However, I do think the timing of this study in the International Journal of Eating Disorders is very interesting.

Researchers investigated the mental and emotional effects of three types of websites on 235 college women: a pro-anorexia website, a women's fashion website, and a home decor website. They found that compared to women who viewed the fashion and home decor sites, women who viewed the pro-anorexia site were more likely to feel negative emotions, to have poor social self-esteem, and to not feel confident about their appearance after 25 minutes of navigating the site. They also were more likely to feel heavy, to want to exercise more, to think about their weight, and to compare themselves to images of thin women on the site. Essentially, women who viewed the pro-anaorexia site felt worse about themselves, worse about their bodies, and worse about their appearance.

I don't know if the folks at Facebook care about the research. I do know the unfortunate reality is that young women looking for "pro-ana" friends don't need Facebook to find each other. There are plenty of pro-ana websites with chat room capabilities on the web - and you can access many of them without even registering. Ultimately, I think it's up to parents to protect their daughters: monitor what they access on the internet and on social media sites, and perhaps more importantly, love them and instill in them a sense of worth and self-confidence. Also know if, despite your best efforts, they develop the disease, there is help.

Pump it up: Strength training key for premenopausal women

Few women need to be convinced that exercise is good for them. Yet many women find it very difficult to make exercise part of their lives. The reasons for not exercising abound. I'm too tired. I don't have time. It's too cold/hot/rainy outside. A gym membership is too expensive. I've tried exercise before, but I didn't lose weight. I can't get motivated. You get the picture.

New research, however, suggests that just two weekly, one-hour dates with weights can have important positive health benefits for overweight and obese premenopausal women.

Investigators randomly placed 164 women into one of two groups: (1) a treatment group, where women were taught a stretching and weight-lifting routine that included both machines and free weights; and (2) a non-treatment group, where women were mailed an informational brochure from the American Heart Association on the recommended 30-minutes daily of moderate exercise. Both groups were told not to change their eating habits, and they were followed for two years.

Although the women in the treatment group did not lose weight, they did experience changes in their body composition. The women had less total body fat, a lower overall percentage of body fat, and less abdominal/mid-section fat. Further, the women who did not lift weights actually showed increases in total body fat, in the ratio of body fat to lean body mass, and in abdominal fat. The increase in belly fat is particularly concerning, because it is associated with higher risk for cardiovascular disease and metabolic disorders, including the metabolic syndrome.

The investigators suggested that strength training can help to slow weight gain and the development of obesity in women, which is on the rise. If you currently exercise but do not strength train, you might think about adding weights to your weekly routine - especially if you are overweight. Here are some weight training tips from the Mayo Clinic, as well as a slide show of strengthening exercises for major muscle groups. And for those of you who do not exercise at all, check with your doctor. Once you get the okay, there are a number of reliable resources to get you moving. And as for those excuses...

Avandia - the next Vioxx?

In two studies published in JAMA today, it appears that a popular class of drug for diabetes, known as thiazolidinedione (popular brand names = Avandia [rosiglitazone] and Actos [pioglitazone]) is causing some heart problems. Avandia was found to increase risk for heart attack by 42% and double the risk of heart failure. Actos also was found to increase the risk of heart failure, although it reduced risk of heart attack, stroke and death.

Actos and Avandia are used most often in the treatment of type 2 diabetes. The drugs act on similar mechanisms to lower glucose (blood sugar) levels in the body. They can be prescribed alone, or in conjunction with other therapies, such as insulin.

This is not the first time research has suggested these drugs may cause serious cardiac events. This past May, the New England Journal of Medicine published two studies that also revealed Avandia caused some heart problems. In response, a federal advisory panel met to discuss the drug and voted to keep it on the market. The FDA also placed stricter warnings on both Avandia and Actos in June.

Does this sound familiar? Drs. Solomon and Winkelmayer seem to think so. They wrote a great piece on common threads between the Vioxx case and the current findings on Avandia. It seems the jury is still out, because at present GlaxoSmithKline is keeping Avandia on the market. However, if this does become another Vioxx, let's hope GSK doesn't wait too long to do the right thing.

Meantime, if you're taking Avandia or Actos, you may want to discuss this new research with your health care provider. You also want to remember that good nutrition, exercise, and maintaining a healthy weight are also important for managing your type 2 diabetes.

Metabolic Syndrome: you can decrease your risk

Most people have heard about common diseases like high blood pressure, diabetes, and arthritis. However, few people know about the metabolic syndrome, which is a disorder that affects an estimated 25% of Americans (and growing), and is associated with serious disease.

The metabolic syndrome is a group of conditions related to your metabolism that occur at the same time. These conditions include: (a) obesity, especially around your belly/mid-section; (b) high blood pressure; (c) abnormal cholesterol levels, including low levels of the "good cholesterol" (HDL) and high levels of triglycerides, or fat in your blood; and (d) insulin resistance, where the normal process your body uses to get sugar (glucose) into your cells does not work, resulting in increased levels of both insulin and glucose in your blood. Having any one of these conditions increases your likelihood of heart disease, heart attack, type 2 diabetes, and stroke. However, having them in combination can double and even triple your risk.

The good news is that lifestyle changes are key to preventing and treating the metabolic syndrome. In a study published in this month's International Journal of Obesity, researchers followed 224 people (80% of whom were women) for one year after assigning them to one of four groups: (1) use of an appetite suppressant alone, (2) a lifestyle modification program to lose weight, (3) the appetite suppressant plus the group lifestyle modification, and (4) the appetite suppressant plus brief meetings with their primary care physicians on weight loss, food diaries, healthy food choices, etc.

All weight loss treatments were successful in helping participants lose weight. Further, they found that weight loss decreased risk for metabolic syndrome: for every 2.2 pounds lost, there was an 8% reduction in the risk for the disorder. Additionally, participants who lost at least 5% of their starting body weight were 59.2% less likely to have the metabolic syndrome, and those who lost at least 10% of their starting body weight were 83.2% less likely to have the metabolic syndrome. Essentially, lose weight - even just a couple of pounds - and you can reduce your risk for the metabolic syndrome and related diseases.

Other ways to prevent and treat the metabolic syndrome? Stop smoking, exercise most days, and eat fiber-rich foods. Sounds like just healthy living to me. Couldn't we all use a little more of that?

It's okay to feel blue

September 11th is a day that was forever changed in 2001. Despite six years having passed and despite your emotional and physical proximity to the events of that day, it is not unusual to feel unsettled on this anniversary.

There has been a fair amount of research on the psychological aftermath of 9/11. One of the most common mental health disorders associated with the terrorist attacks is post-traumatic stress disorder (PTSD). PTSD is an anxiety disorder that develops in response to trauma. Symptoms, which must be present for at least one month, include: being easily startled, losing interest in things you used to enjoy, irritability, aggression and/or violence, difficulty feeling affectionate, feeling emotionally numb with loved ones, flashbacks (reliving the trauma through thoughts and nightmares), and avoiding situations that remind you of the original incident. Symptoms generally develop within three months of the incident, but can emerge years later. The course of PTSD varies with individuals: some will recover within three to six months, while others will develop a chronic condition that lasts several years. Other mental health problems often accompany PTSD, including depression and substance abuse.

A recent review of the research on PTSD after 9/11 identified several groups at higher risk for PTSD. Most obviously, individuals who were directly exposed to the attacks are at high risk for developing PTSD with chronic symptoms. However a number of other groups also are vulnerable to PTSD. These include: people who were geographically close to the attacks, low-income individuals, people with low education, women, Latinos living in New York, and those with poor social supports. Additionally, the researchers noted that repeated exposure to graphic media portrayals of the attacks contribute to PTSD, especially among vulnerable groups.

So if you find yourself feeling low, irritable, or just not yourself today, give yourself a break. Take five minutes several times throughout the day to sit quietly, breathe, mediate, pray - whatever cultivates peace and calmness. The Department of Veterans Affairs also has some good information on self care. In addition, you might want to limit your television viewing and other media coverage this week, so you do not continue to expose yourself to the images of that day - especially if you are among one of the groups identified as more vulnerable to PTSD. Finally, if you think you have undiagnosed PTSD, see your health care provider who can provide the necessary referrals for treatment.

Red, red wine - go to my heart?

I was reading the newest issue of Food & Wine magazine this weekend when I came across an article touting all the health benefits of wine (yeah! for my love of red wine). I was pleased to see they were citing premier medical journals as the sources of their information. However, as I read the fine print, I was dismayed they were making broad claims about wine promoting longevity and reducing heart attack risk "for all" based on studies conducted on men.

So, I did what any good researcher of women's health would do - I went to Pubmed and searched both for the articles they cited and to see whether there were similar findings about women available. I found a couple of things.

The blanket statement that drinking wine "promotes longevity" may be misleading. While the authors of the study cited in F&W indeed found that men who preferred to drink wine had a 34% reduction in mortality because fewer died cardiovascular-related deaths, it is important to note some key limitations of this research, acknowledged by the investigators themselves. For one, this study is of a fairly homogeneous sample of older men. Second, the wine drinkers were healthier to start, including fewer smokers, lower triglycerides, and lower BMIs (all of which are associated with cardiovascular disease). Thirdly, the authors explicitly state that caution must be used when trying to extend these findings to the general population and especially to women. Finally, the authors note the relationship between wine and lower mortality rate may reflect other research that has shown wine drinkers tend to make healthier food choices than drinkers of other alcoholic beverages, rather than reflect the benefits of wine itself. Future research is most definitely needed before making claims about longevity.

Although F&W's claim that wine reduces heart attack risk referred to (yet another) study of men, there is research out there on women, heart attacks, and alcohol. Investigators studied 1,885 women's drinking patterns and history of non-fatal heart attacks. They found that women who drank alcohol were consistently less likely to have had a heart attack than women who abstained, and this trend was related to how much women drank. Women who drank less than 1 drink per day cut their risk by 4%, whereas women who drank 3 drinks per day cut their risk nearly in half. This is not a license to down a bottle of wine a day, however. The researchers also found that women who drank enough to become drunk at least once a month were three times as likely to have a heart attack as those who did not drink and six times as likely to have a heart attack as those who did drink without becoming intoxicated. Finally, they found that women who drank wine were less likely to have a heart attack than women who drank liquor.

Now I won't argue with F&W about their finding that red wine has tannins, and tannins do protect against heart disease. I also won't argue too much with them about evidence that suggests wine MAY protect against type 2 diabetes, stroke, cataracts, colon cancer, and brain decline, except to say that many of these benefits probably reflect healthier lifestyles rather than properties of wine. What I will say is that you should consume your research as you would a fine wine - pay attention to its complexity and character, gauge its potential, be clear about its possible faults, and know know how to compare it to recognized standards.

Depression more damaging to daily health than other common conditions

After today's headline about the increase in suicide rates among teen girls, new research on the effects of depression on daily health status should come as no surprise.

In a study published in this week's Lancet, researchers examined the effects of depression on everyday health status for 245,404 people living in 60 countries in all regions of the world who participated in the World Health Organization's World Health Survey. They defined everyday health as encompassing several domains, including general health, vision, mobility, self care, pain/discomfort, sleep/energy, emotional processes, and thinking processes. In addition to studying the effect of depression on health status, the researchers also studied and compared the effects of four chronic health conditions on health status: angina, arthritis, asthma, and diabetes.

Several significant findings emerged from this research. First, people who had depression AND one of the four chronic health conditions had significantly worse daily health than people who had depression alone or one of the four conditions alone. Second, people who had angina, arthritis, asthma, or diabetes were significantly more likely to be depressed than people who did not have one of these conditions. Third, women had worse daily health than men. Finally, depression contributed to poor daily health more so than any of the other chronic health conditions. These findings were consistent even across different countries with different demographic characteristics.

This study demonstrates that depression continues to be a public health problem that needs greater attention not only in the United States, but around the world. Unfortunately, much of our lack of attention to this important health issue reflects the stigma associated with mental health problems in our society. If there is an upside to this research, it is that women with chronic health conditions should be aware they are at greater risk for developing depression. If you think you may have symptoms of depression, talk to your health care provider when you see her for your chronic health condition. She should be able to diagnose and treat your depression if necessary, or refer you to someone who can.

Maybe breastfeeding isn't better

After all my ranting about breastfeeding yesterday, I see an article in Pediatrics today that caused me pause. Apparently, women who smoke and breastfeed are lacing their milk with nicotine, and it's having a negative effect.

Researchers in Pennsylvania studied 15 mother-infant pairs to better understand how nicotine affects infants in the short-term. Moms were asked to breastfeed their babies on two separate occasions. On one occasion, the moms dressed in disposable lab coats and gloves and entered a 700 square foot stainless steel chamber to smoke without their babies present. Then they removed their protective garb, washed their hands, provided a sample of breast milk, and breastfed their babies upon demand. The babies were then placed in a crib or on a carpeted floor to sleep. On the second occasion, the moms did not smoke before breastfeeding their babies and putting them down for a nap. On both occasions, researchers monitored the babies' sleep patterns and movement.

The first relevant finding in this study was that both nicotine and cotinine (a metabolite of nicotine) were present in the mothers' breast milk. The researchers estimated the infants received 4.3 times the amount of nicotine when moms smoked before breastfeeding, compared to when they did not.

The second relevant finding is that infants who fed after their mothers' smoked slept 36.7% less than when their mothers did not smoke beforehand. Further, there was a direct and negative relationship between nicotine exposure and sleep: the more nicotine the infants were exposed to, the less they slept. This is not wholly surprising - after all, nicotine is a stimulant.

The researchers suggest that although nicotine has been removed from the list of drugs contraindicated during lactation, nursing mothers who smoke still should consider the negative effects of nicotine on their infants. Since nicotine is not stored in breast milk, they suggest these mothers time their breastfeeding and avoid nursing 30 to 60 minutes after smoking, when nicotine levels peak. They also caution there may be other chemicals transferred in breast milk that we don't know about, and these unknown compounds may have negative health consequences.

What's the moral of this story? Quit if you smoke - it's better for you and your baby. If you don't quit, at least avoid nursing when nicotine levels are highest. You'll transfer less nicotine to your baby, and you both may get more sleep. And that's something everyone in the household can benefit from.

Breastfeeding is better for babies AND moms - so why is it discouraged?

As if it weren't enough that Applebee's in Lexington pushed a mom out of their restaurant for breastfeeding her baby in a back corner booth. (So much for that Kentucky law that states breastfeeding in public is legal. Of course, why we need laws for this I'm unclear, but that's for another post).

Now the federal government has toned down its ads to promote breastfeeding. You read correctly, toned down its ads, even though media relations experts advised them against softening the ads, because they wouldn't increase breastfeeding. I mean, why would the federal government want to increase breastfeeding rates? Who cares about the study published this year by the Agency for Healthcare Research and Quality (yes, an agency of the federal government) that showed breastfeeding contributes to good infant AND maternal health? According to this AHRQ study, children who are breastfed get fewer ear and respiratory infections, GI illnesses, and skin rashes. They're also less likely to have asthma, obesity, type 1 and 2 diabetes, and childhood leukemia, and less likely to die from sudden infant death syndrome (SIDS).

As for moms - women who breastfed were less likely to have type 2 diabetes, breast cancer, and ovarian cancer. Conversely, women who stopped breastfeeding early (before 6 months) or never breastfed at all were more likely to have postpartum depression.

So why are we spending money on an ad campaign for breastfeeding that will essentially have no effect on a mother's decision to breastfeed? Talk to your neighborhood pharmaceutical company - apparently it was the infant formula/pharmaceutical lobby that got the Department of Health and Human Services to tone down its ads, because they need to keep those revenues up. And not just in infancy mind you. They want to make sure kids keep needing their prescriptions well into childhood to take care of the asthma, ear infections, and diabetes they develop.

Are we really making health policy based on an industry that does better when people are unhealthy? I say nurse-in at Applebee's today - big PHRMA tomorrow.

Household mold may cause depression

For those of us who are neat freaks, this headline may come in handy the next time you have to nag your partner/roommate/child to clean up. It seems researchers have identified a link between damp, moldy homes and depression in adults.

Most people know that mold can cause some physical health problems, including nasal congestion, coughing, headache, and allergic reactions. A study released last week suggests that mold and dampness also may affect mental health. Researchers from Brown University interviewed nearly 6,000 people in six European cities. For each person, they measured dampness and mold characteristics of the home, as well as depressive symptoms.

They found that people who lived in homes that had any dampness or mold - from minimal to extreme - were more likely to have depressive symptoms than people who lived in homes without any mold or dampness problems. Further, women were one and a half times more likely than men to report depression. The researchers suggest that exposure to the toxins released by household mold may affect the brain's ability to regulate emotions.

If you live in a humid climate, have an older home, or have ever had water damage in your home, you are more likely to have problems with household dampness and mold - and perhaps depression. The EPA provides some great resources on cleaning up mold and preventing mold from invading your home in the first place. You also can monitor your mental health online.

And to all the neat-freaks like me out there --- dehumidifier anyone?