Women's Health Matters

Researchers confirm what yogis have known for a while

2007-11-26T09:22:00.000-08:00

When I first started my yoga teacher training, we learned about the use of neti pots. Neti pots are an old ayurvedic tool for cleaning the nose and sinuses. You fill the pot with warm salt water and run the water into one nostril and let it drain out the other. This practice has been used for a long time to clear clogged sinuses due to colds, allergies, and asthma.

Apparently, researchers at the University of Michigan thought the practice had some merit. They tested the use of saline sprays against the use of what they called "saline irrigation." The only difference between saline irrigation and the neti pot is the tool itself. Rather than a neti pot, saline irrigation is done with the use of a bulb syringe.

Specifically, the researchers randomly assigned 127 people with chronic sinus and nasal problems to either the saline spray or the saline irrigation. They found that the people who used the saline irrigation had less nasal discharge (i.e., snot) and reported fewer symptoms of stuffiness and congestion after 8 weeks than those who used only the saline spray. Their recommendation: nasal irrigation is a useful therapy for nasal and sinus symptoms.

So if you suffer from chronic sinus problems, you may want to add sinus irrigation to your regimen. And if you're into pretty things - there are a lot of lovely neti pots to try. It's not a dainty practice, but it sure saves on Kleenex.

Mood Disorders during Pregnancy Linked to Postpartum Depression

2007-11-18T16:07:00.000-08:00

There's a lot of societal pressure to be excited about being pregnant. One popular depiction of this pressure is the Sex and the City episode where Miranda finds out the sex of her baby. She later tells Carrie how she "faked her ultrasound" - meaning she faked a big, happy smile when the sonographer said, "Congratulations!! It's a boy!"

Miranda never gets characterized as having a mood disorder during pregnancy. But for women who do experience depression or anxiety while pregnant, the excitement of pending motherhood can be dulled by the pain of sadness or worry that permeates each day. Unfortunately, a large number of women experience mood disorders during pregnancy. A study published this month in Obstetrics and Gynecology revealed that 54% of pregnant women experienced anxiety and 37.1% experienced depression. Further, women who experienced anxiety or depression during pregnancy were up to four times as likely to experience postpartum depression.

That's no small number - and it suggests that we have a lot of work to do if we want to help women who experience mood disorders during and after pregnancy. The Mom’s Opportunity to Access Help, Education, Research, and Support for Postpartum Depression (MOTHERS) Act is a bill currently pending in Congress that has the potential to increase women's access to screening and help for postpartum depression. This recent research only highlights the importance of this legislation. We need to do more so that moms get the help they need when they need it.

Traveling and Smoking during Pregnancy leads to Obesity

2007-10-29T12:40:00.000-07:00

The next two weeks I'll be busy traveling for different meetings, so my posting will be extra light. However, before I embark on my travels, I want to leave you with this headline from Yahoo! news: Smoking Mothers Lead to Fat Children.

Apparently, Japanese researchers have found that children of women who smoked at any time during pregnancy are three times as likely to be obese. This does not bode well for my state - which has the 5th highest obesity rate in the nation, and where nearly 30% of women smoke during pregnancy. It seems beyond low birth weight and prematurity, later obsesity is yet another reason to quit smoking if you become pregnant. Not to mention, you will reduce your risk for heart disease, cancer, and stroke.

Quitting smoking is difficult, but help is available.

Sex may not work, but sweeping the membranes might

2007-10-23T07:39:00.000-07:00

Last week I wrote about a study that suggested sex doesn't get the contractions rolling. This week, however, a study was published that suggests there is something that might work. It's called sweeping or stripping the membranes. To do the procedure, your doctor or midwife will place 1 or 2 fingers through the opening of your cervix and separate the membranes of the amniotic sac from their attachment to the lower part of your uterus. The goal is to trigger a local release of prostaglandins, or the hormones responsible for softening the cervix and stimulating labor. The procedure can be uncomfortable, and often results in period-like cramping, irregular contractions, and sometimes bleeding. (Sex is looking pretty good right now even if it doesn't work, huh?)

In this research, the investigators reviewed 22 studies of nearly 3,000 women and examined labor outcomes. They found that women who had their membranes swept were more likely to give birth before 41 weeks gestation. Further, they found there were no differences in risks of infection for either mother or baby.

The authors concluded that the decision to sweep the membranes needs to be balanced with the discomfort of the procedure. Interestingly, they also suggest that routinely sweeping the membranes does not seem to produce important clinical benefits - although they aren't the ones who've been pregnant for 10 months. Ultimately, this is an important decision to discuss with your health care provider. Meantime, Barry White anyone?

Talk therapy works for postpartum depression

2007-10-22T07:44:00.000-07:00

A couple of months ago I wrote a piece on light therapy for postpartum depression (PPD). A study released this month shows that talk therapy - with a professional or a mom peer - can help also. This is an important finding, because many women prefer not to take antidepressants when they are breastfeeding.

In this study, the investigators reviewed 10 clinical trials that included nearly 1,000 women. The trials tested psychological and social interventions that included cognitive behavioral therapy (CBT), counseling, and peer support groups facilitated by a health care professional. They found that women who received any of the psychological or social therapies were 30% less likely to have depressive symptoms within one year after giving birth compared to women who received postpartum care as usual. Additionally, peer support groups appeared to be just as effective as formal psychological care, such as CBT, which is great news for moms who can't afford a weekly trip to a therapist.

The study authors additionally noted two key take-home points. First, PPD is treatable, and a wide variety of treatment options is available. Second, social support is critical for moms who are experiencing PPD. Sometimes there is a tendency for new moms to try to pretend all is well, because they're "supposed" to be happy about their new addition. But having support from other women who've experienced PPD can help to normalize the experience and reduce the stigma associated with having a postpartum mood disorder.

So if you or someone you know is experiencing PPD, know there is help. Postpartum Support International is a great resource to find a peer support group in your area. Additionally, Postpartum Progress is a blog written by mom and advocate Katherine Stone, who experienced postpartum obsessive compulsive disorder. She provides a broad array of information on postpartum depression and other mood disorders that readers will find helpful.

Meditation: It does a mind-body good

2007-10-18T04:28:00.000-07:00

For those of us who meditate, we know it works. It calms the mind, brings clarity and focus, and helps to ease the effects of challenges in our lives. Some folks are skeptical about "all that mind-body" stuff, and they're not going to be swayed by personal opinion. So it's really nice when research backs you up and says, Yep, it's not all in your head. This stuff really works.

Where is this great evidence, you ask? The National Academy of Sciences (which, by the way, is the adviser to the U.S. on science, engineering, and medicine) publishes a weekly rag. In the most recent edition there was a study on meditation. And how it works. And not just for long-time practitioners.

The researchers enrolled 80 Chinese college students into their study. They randomly assigned 40 students to a test group and 40 to a comparison group. They taught the test group a form of meditation known as integrative body-mind training, which incorporates meditation and mindfulness work. The group practiced for 5 days 20 minutes at a time. The comparison group was taught a relaxation technique, which they also practiced for 20 minutes daily over 5 days. Before and after the 5-day training, the students were given a variety of tests to examine their emotional states and concentration abilities.

They found that compared to the relaxation group, the meditation group had less anxiety, fatigue, depression, and anger. They also showed decreases in stress and increases in their immune response. All in 5 days. 100 minutes. With no previous training.

You too can receive the benefits of meditation. There are a host of guided meditation CDs that can get you started (just check out your favorite book store or Amazon). A practice called yoga nidra is one of my favorites. And you don't have to spend a lot of time. Just 20 minutes a day to be on your way to less stress and greater relaxation. Sounds too good to be true, huh? But it isn't.

Barry White, pregnancy, and labor

2007-10-15T05:51:00.001-07:00

It has been standard practice to tell healthy women who want to get labor going to turn up the volume on Barry White and get busy with their partner. However a study published this month suggests that having sex likely won't pump up the contractions.

Researchers recruited 210 women who were going to be inducted for non-emergency reasons. They assigned each women by chance to one of two groups. The first group was told to have sex to encourage labor. The second group was given no advice about sex before their induction.

They found that women who were told to have sex were more likely to do so - 60.2% compared to 39.6% in the group that was given no advice. However, they also found there were no differences between the two groups in rates of spontaneous labor - or labor starting on its own before the scheduled induction. There also were no differences between the groups in how many women had a C-section or in their babies' birth outcomes.

Bottom line: increasing sexual activity doesn't seem to promote labor. So if your libido is low, don't feel like you have to have sex to get the ball rolling. On the other hand, if sex sounds good, have at it. While an orgasm might not promote labor, it might be your last one for a while - so enjoy!

Poor quality relationships may lead to a broken heart

2007-10-11T08:55:00.000-07:00

This summer I wrote about a study that showed women who keep their feelings to themselves during an argument with their partner were more likely to have depression and irritable bowel syndrome, and also more likely to die.

A study published this week in the Archives of Internal Medicine provides further support that having a poor marital relationship contributes to bad health - specifically bad heart health. Researchers in Britain studied over 9,000 men and women. They asked the participants questions about their close relationships (including their marriages), such as how much support they receive and how much stress and worry the relationship causes. After adjusting their calculations for other factors that can affect heart disease, such as age, obesity, high cholesterol, depression, and work stress, they found that people who reported negative close personal relationships were more likely to have heart disease and heart attacks.

Now this is not to say you should run out and divorce your partner if your relationship isn't quite up to snuff. However, it does suggest that relationship maintenance might be in order - especially if you have children or jobs that limit couple time. Schedule a "date night." Make time for sex. Remind yourself why you got together in the first place - and tell each other about those great qualities. Also make time for yourself - even if it's only 10 minutes in a hot bath. If these steps don't lead to improvement, couples therapy is always a great option.

Virtually nursing-in? Try nipple-soothing peppermint

2007-10-10T07:19:00.000-07:00

If you plan to do some extra breastfeeding today as part of the great virtual breast fest, here's a tip from a recent study on preventing and soothing those nipple cracks that might arise.

Researchers studied whether peppermint gel, lanolin gel, or a neutral ointment were better for soothing the nipple pain and cracking that are often associated with first-time breastfeeding. They enrolled 216 women into the study and randomly gave them one of the 3 gels. They did not tell the women which gel they received, but they did tell them to use the gel daily for the first two weeks of breastfeeding. They found the peppermint gel was much more effective than either lanolin or a neutral ointment in reducing the rate of nipple and areola (the area around the nipple) cracks and pain.

Sore nipples are a common reason some women fail to continue breastfeeding in the early days of trying. However, breastfeeding is so beneficial to moms and babies that women's health researchers will take time to figure out how to keep mom comfortable while she and her infant learn to feed.

Now if we could only figure out how to keep the general public feeling comfortable when they see a mom breastfeeding....

Panic attacks possibly linked to heart disease and death

2007-10-09T07:51:00.000-07:00

If you've ever had a panic attack, this headline may not surprise you. Many of the symptoms of panic attacks can mimic a heart attack: racing heart, chest pain, sweating, nausea, dizziness, and shortness of breath. These symptoms usually peak within 10 minutes, and they can be accompanied by fear of leaving home. Approximately 1 in 75 people experience panic disorder, and it is more common in women than men.

Researchers investigated the relationship between panic attacks and heart disease in a study of nearly 3,400 postmenopausal women. They found that women who had experienced a panic attack in the previous 6 months were four times as likely to have heart disease, and three times as likely to have a stroke. These women also were 75% more likely to die from heart attacks and stroke.

If you are in this population of women (i.e., a postmenopausal women who has been diagnosed with panic disorder or who has experienced panic attacks), these findings may seem worrisome. However, it is important to note (as the investigators do) that the number of women who actually had an event (i.e., heart attack, heart-related disease, or stroke) was extremely small - only 81 women, or 2.5% of the those studied. Still, it is something to discuss with your doctor, who may recommend additional tests to evaluate your heart and vascular health.

Meantime, also know there is treatment for panic disorder. Anti-anxiety medications and cognitive behavioral therapy can help to alleviate the symptoms and improve your quality of life.

Pregnancy weight gain - one size doesn't fit all

2007-10-08T08:16:00.000-07:00

Most women know about the traditional weight gain recommendations for pregnancy: 25-35 pounds if you're normal weight (body mass index = 20-25), up to 10 pounds more if you started the pregnancy underweight (BMI <> 25). However, a new study published this week in Obstetrics & Gynecology suggests that these guidelines may be out of date, at least as far as obese women are concerned.

Investigators analyzed data from more than 120,000 obese women in Missouri to see how the weight they gained during pregnancy affected three outcomes: blood pressure, rate of cesarean sections, and the infant's birth weight. They found that 23% of obese women gained less than 15 pounds, 31% gained the recommended 15-25 pounds, and nearly 50% gained more than 25 pounds. The women who gained less weight during pregnancy had the best outcomes, including less pregnancy-induced high blood pressure and normal weight babies.

The researchers also calculated optimal ranges of weight gain during pregnancy based on pre-pregnancy BMI. Women with BMIs of 30-34.9 had the best outcomes when they gained between 10 and 25 pounds. These same women were more likely to have low birth-weight babies when they lost weight, but they had fewer other complications like high blood pressure and C-section deliveries. Women with a BMI of 35-39.9 did best when they gained less than 9 pounds. For women with a BMI of 40 or higher, losing up to 9 pounds produced the best outcomes.

As you can see, this study's findings contradict the current guidelines, which were established in 1990 when obesity wasn't so common. However the current guidelines may be no more. The Institute of Medicine plans to reevaluate its recommendations for weight gain during pregnancy to reflect more recent evidence about pregnancy and birth outcomes.

What does this mean for you? If you are obese and pregnant, or planning to become pregnant, talk to your doctor or midwife about the best weight gain - or weight loss - strategy. And remember, no matter what weight you are, it's important to eat a nutritious and well-rounded diet while pregnant and postpartum.

'Tis the season - flu season that is

2007-09-28T07:54:00.000-07:00

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

2007-09-27T08:15:00.000-07:00

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

2007-09-25T07:28:00.000-07:00

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

2007-09-25T06:19:00.001-07:00

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

2007-09-24T05:33:00.000-07:00

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

2007-09-21T07:50:00.000-07:00

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

2007-09-20T08:05:00.000-07:00

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...

2007-09-19T08:18:00.000-07:00

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

2007-09-18T07:39:00.000-07:00

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

2007-09-17T07:55:00.000-07:00

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?

2007-09-13T07:07:00.000-07:00

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

2007-09-12T06:42:00.000-07:00

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

2007-09-11T06:21:00.000-07:00

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?

2007-09-10T06:36:00.000-07:00

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

2007-09-07T11:12:00.000-07:00

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

2007-09-05T14:05:00.000-07:00

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?

2007-09-04T17:19:00.000-07:00

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

2007-09-03T18:34:00.000-07:00

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?

Light treatment for postpartum depression

2007-08-29T08:40:00.000-07:00

If one good thing came from Tom Cruise's public insult of Brooke Shields - and the cadre of new mothers who have taken antidepressants for postpartum depression (PPD) - it's that people started paying attention to a disorder that is often hidden because of fear and stigma.

Postpartum depression is characterized by any of the following symptoms over a 2-week period or more within the first year after delivery: restlessness, irritability, sadness, hopelessness, feeling overwhelmed, crying a lot, having little energy or motivation, appetite changes, sleep disturbances, difficulty focusing, remembering or making decisions, feeling worthless or guilty, loss of interest in pleasurable activities, withdrawal from friends and family, headaches, chest paints, heart palpitations, hyperventilation, not having interest in the baby, and thoughts of hurting the baby or oneself. There are a number of contributing causes of PPD. These include rapid changes in hormonal levels (specifically progesterone and estrogen) after delivery, low thyroid levels, exhaustion from delivery, broken sleep patterns, feeling overwhelmed by parenting responsibilities, doubting one's ability to be a "good" mother, stress resulting from changes at work and home, feeling a loss of one's pre-pregnancy identity, having less free time, and having less control over time.

The two most common treatments for PPD are talk therapy and antidepressants. Findings from a study released this month, however, show that light therapy may be a promising new treatment, especially for women who refuse medication because they are breastfeeding or simply do not like the idea of taking medicine. Light therapy involves exposure to specific wavelengths of light, or very bright full-spectrum light, for a prescribed amount of time. It has been used successfully to treat a variety of conditions, including acne, seasonal affective disorder, and non-seasonal depression.

Researchers in Canada studied the effects of light therapy on 15 women who had a diagnosis of PPD but who were not taking antidepressants. The women were assigned to one of two treatment groups: 30 minutes of daily light exposure between 7AM and 9AM using a 10,000-lux bright light or 30 minutes of daily light exposure between 7AM and 9AM using a 600-lux red light. After 6 weeks of light therapy, both groups of women showed significant reductions in their depressive symptoms, with an average of 49% improvement. Additionally two women (one in each group) experienced a complete remission, or absence of PPD symptoms.

While these findings are encouraging, this study followed a small number of patients, and the authors acknowledge that more work needs to be done to determine whether this approach is as useful for PPD as it is for seasonal affective disorder. Additionally, none of the patients were suicidal, so nothing can be said about how light therapy might work for women with more severe symptoms. However, the upside is that more treatment options offer women more control over how their depression is managed, which can improve the ability to cope with the disorder.

If you are interested in learning more about light therapy, the Mayo Clinic has a nice piece with information about the risks and benefits. You also can talk to your doctor or mental health care provider about whether light therapy may be worth a try.

What you think about your depression affects how you cope

2007-08-28T06:30:00.000-07:00

When you are diagnosed with a mental health problem such as depression, one issue you have to face is how to deal with the diagnosis. Research suggests that women generally use what's called "emotion-focused coping," which includes crying, dwelling on the causes and implications of their depression (aka ruminating), and seeking support from others. (Versus men who cope by distracting themselves with hobbies, sports, alcohol, and drugs.)

A study published this month shows that people's emotional reactions to their depression diagnosis affect how they cope. Researchers interviewed 189 patients (133 women) in a primary care clinic who were taking antidepressants. They found women who believed their depression would have a greater negative impact on their lives used more maladaptive coping strategies, such as blaming themselves, ruminating about their illness, and disengaging from others. On the other hand, women who perceived they had some control over their depression and who believed their depression was caused by an identifiable stressor (such as relationship or job difficulties) used more active coping strategies, such as planning, acceptance, problem-solving, reframing the illness positively, and religious/spiritual supports.

Why do coping strategies matter? The researchers suggest that maladaptive coping may actually worsen depressive symptoms, while active coping may help to lessen them. Further, women in particular may benefit from strategies that increase their active coping skills and improve their sense of control over their disorder.

If you have been diagnosed with depression, it may be helpful to talk to your mental health care provider about how the diagnosis has affected you emotionally. You also may ask your provider to give you more detailed information about your depression, such as: how long you can expect to have symptoms, whether the symptoms will wax and wane or decrease gradually over time, how the symptoms will affect you in the short- and long-term, how the treatment will affect you short-term and over time, and how long your provider expects you will need treatment. The answers to these questions will vary for different people, and also can vary for the same person for different depressive episodes, depending on the severity of the episode. Having open and clear communication with your provider can assist you in developing a sense of control over your depression and help you to manage your illness constructively as you heal.

Cod Liver Oil for Depression

2007-08-27T08:02:00.000-07:00

Omega-3 fatty acids have been shown to protect against disease, including coronary heart disease and cancer. A new study shows that omega-3s also may be useful for depression.

Researchers examined a community-based sample of nearly 22,000 people in Norway. They found that people who took daily cod liver oil, which is rich in omega-3s, were significantly less likely to have high depression symptoms than people who did not consume daily cod liver oil. These calculations were adjusted for other factors associated with depression, including age, smoking habits, alcohol use, exercise habits and use of antidepressants and lithium. Additionally, these researchers found that the longer individuals used cod liver oil, the lower their risk for depressive symptoms.

The dose of cod liver oil that was studied was 0.7 - 1.2 grams of omega-3 fatty acids. Of this, 0.3-0.6 was DHA, which can reduce blood triglycerides, and 0.3-0.6 was EPA., which is thought to lower inflammation. Additionally, the cod liver oil supplements contained vitamins A, D, and E.

Based on this study, cod liver oil or another omega-3 fatty acid supplement might be a useful addition to your diet, especially if you have a family or personal history of depression. In addition to supplements, fish such as wild salmon, herring, mackerel, anchovies, and sardines are great sources of omega-3s. Do be mindful, however, that omega-3 supplementation isn't for everyone. There are some risks, including increased bleeding in patients taking aspirin or coumadin, reduced glycemic control in diabetics, and increased susceptibility to bacterial infection due to a suppressed immune system. Be sure to talk to your doctor to weigh the risks and benefits before you add supplements. Meantime, a little extra fish in the diet never hurt anyone.

Depression screening and a note about next week

2007-08-24T08:54:00.000-07:00

I had a request for "as much information as I could provide" on women and depression. Next week I'll be doing a 5-part series on recent research on depression, including some new findings on treatment.

If you have requests for future topics, please feel free to send them to me at leighann [at] uky [dot] edu. Meantime, here's an online depression screening tool sponsored by the Department of Psychiatry at New York University's School of Medicine. If you have had a history of depression, or think you might be prone to a depressed mood, you may want to periodically check in with yourself using this tool. It may give you an idea of whether you have symptoms that warrant seeking help from a mental health professional.

If you decide to use this tool, please note the disclaimer on its use, taken from the NYU website [ODST=Online Depression Screening Test]:

"ODST is a preliminary screening test for depressive symptoms that does not replace in any way a formal psychiatric evaluation. It is designed to give a preliminary idea about the presence of mild to moderate depressive symptoms that indicate the need for an evaluation by a psychiatrist."

Is work getting you down?

2007-08-23T06:25:00.000-07:00

My colleague and I have done a bit of research on job quality and mental health, so this study caught my attention - especially since it's a study of folks born around the same time I was.

Researchers studied over 800 employed men and women born between 1972 and 1973 in New Zealand. They looked at the stress these folks experienced at work, including psychological job demands (e.g., work load and time pressures), physical job demands (e.g., heavy lifting and work hazards), control over what work gets done and when, and social support from colleagues and supervisors. They also examined their mental health - specifically anxiety and depression.

After adjusting their calculations for income level, a history of a mental health disorder in adolescence, having a generally negative personality, and other job stressors, they found that women who reported having high psychological job demands were 75% more likely to have depression or anxiety than female workers with low psychological job demands. In fact, when they analyzed the data over time, they found that high demand jobs were linked to new cases of depression and anxiety in workers without any history of either disorder prior to entering the labor force.

Most people who work experience job stress at one point or another. However, it's clear from this study that strategies for reducing stress are in order. Yoga, meditation, and breath work are great tools that I use. And anything that gets your heart pumping and gives your head a rest is always good. You also may want to talk to your supervisor about ways to minimize job stress, such as getting more help with job responsibilities or adjusting deadlines if possible. This can help to reduce your risk for depression and anxiety and improve your quality of life and well-being.

Sex after Cancer

2007-08-22T17:11:00.000-07:00

Last week I wrote about a study that showed long-time survivors of vaginal and cervical cancers experienced sexual problems, including lack of desire, painful intercourse, and inability to have an orgasm. I'm thrilled to report there are some folks in the field who care about this issue and want to help.

In a study published this month in the Archives of Sexual Behavior, researchers developed and tested a brief (3 session) intervention to treat female sexual arousal disorder (FSAD) in women with gynecologic cancer. FSAD is characterized by the inability to maintain arousal and vaginal lubrication during sex. The one-hour sessions included educational information, cognitive and behavioral therapy, and mindfulness training in three main areas: (1) sexual arousal, (2) orgasm, sexual desire, and sexual distress, and (3) quality of life, depression, and relationship satisfaction.

The brief intervention indeed helped. The women experienced improved sexual response, including genital arousal (yes, they actually checked this with a probe, some erotica, and a locked door - see the article if you're interested in more details), orgasm, and satisfaction with sex. Additionally, the women had less depression, and greater overall quality of life.

The downside of this study is that it was small - only 22 women participated - so they need to repeat the study with larger and more diverse groups of women to ensure this positive effect was not just the result of giving the program to a group of highly motivated women. Meantime, I'm just happy that someone is taking the time, energy and effort to develop such an intervention. They've been taking care of men's sexual health after cancer for a good decade now - it's about time we catch up.

Marital silence can be deadly

2007-08-21T07:35:00.000-07:00

Every marriage has conflict - that's just part of being married. However a new study shows that over time women who do not speak up during marital conflicts are four times as likely to die than women who express themselves openly during arguments. These same women are also more likely to have depression and irritable bowel syndrome.

These findings emerged from a 10-year study that examined heart health and overall death rates for 3,682 men and women. The researchers adjusted their calculations for other risk factors of heart disease and death, including age, blood pressure, body mass index, smoking, diabetes, and cholesterol levels. Interestingly, other aspects of marriage, including self-rated marital happiness, marital satisfaction, and types and numbers of disagreements were not related to heart disease or death in women.

It seems there is a health promotion theme this week: speak up! to your partner, to your doctor. Stating openly and honestly what you're thinking and how you're feeling can improve your health and help you live longer. And if you're not feeling confident about your ability to speak your mind the next time you have a spat with your spouse, here are some tips to start. If these suggestions seem out of reach, a professional counselor also may help. Take the steps necessary to build confidence in your ability to constructively speak your mind - your quality of life and longevity may depend on it.

Eat Better, Breathe Easier

2007-08-20T08:05:00.001-07:00

Most everyone knows that eating a diet high in fruits, vegetables, whole grains, and lean meats reduces the risk of a number of diseases, including cancer and obesity. A study published this month shows that a healthy diet also reduces the risk of chronic obstructive pulmonary disease, or COPD. COPD occurs when the tubes that carry air in and out of the lungs are partially blocked, making it difficult to breathe. This finding is especially significant for women, because the COPD death rate for women nearly tripled between 1980 and 2000.

Smoking and second-hand smoke exposure are the main culprits of COPD, but not all smokers contract COPD. Additionally, this new study shows that even exsmokers had a lower risk of contracting COPD if they primarily consumed healthy foods. Also interesting: lean women (those with a body mass index less than 21) who consumed a higher fat diet with more refined sugars were more likely to contract COPD whether or not they exercised regularly.

Often smoking and poor eating habits go hand-in-hand, so it's clear that women who smoke are at an even greater risk for developing COPD than previously thought. However, these new findings also suggest that even women who used to smoke can help reduce their future risk for COPD by improving their diets. There are a number of resources available to improve eating habits. Here's a sample. Also visit with your doctor, who may be able to tell you about local resources in your community.

As for smoking...let's all breathe easier.

Dr. X, You're Fired! (No, this isn't a post on Donald Trump)

2007-08-19T05:26:00.000-07:00

There was an interesting article on CNN this week about knowing when to find a new doctor. I thought I'd share, as there are some key points to consider when evaluating your relationship with your physician. The experts quoted suggest you should fire your doctor when:

(1) You don't think your doctor is listening to you.
(2) Your doctor becomes annoyed, frustrated, condescending, or expresses dislike when you ask questions.
(3) Your doctor can't explain what's going on with you in a way that you understand.
(4) You feel badly when you leave the doctor's office.
(5) You don't like your doctor, or you think your doctor doesn't like you.

As women we sometimes find it difficult to speak up for ourselves. However, it's very important that we do, especially because some diseases (like heart disease) look symptomatically different for women than men. Doctors don't always listen, either. One of the experts quoted wrote in a recent book about a case he had as a young doctor. A female patient complained about indigestion that he chalked up to complaining and whining. It turned out the woman had a torn aorta and she died.

So be proactive about your health and frank with your doctor about what you're feeling. Your health depends on it. And if your doctor makes you feel badly for expressing concerns or doesn't listen to what you're saying, it's time to move on.

Weight Matters in Pregnancy: Part III

2007-08-17T06:25:00.000-07:00

Last week I wrote two posts about how excess weight during pregnancy may result in poor infant outcomes, including large for gestational age newborns and a variety of birth defects. A study published this week provides further evidence for watching weight before and during pregnancy - only this time the evidence focuses on moms.

After reviewing long-term medical data from over 37,000 women who had live births in Israel, the researchers found that women who were diagnosed with gestational diabetes (diabetes during pregnancy) had increased risk for later cancer of the pancreas. They did not find the same cancer risk for women who had insulin-dependent (type I) diabetes.

What does this have to do with obesity, you ask? One of the primary risk factors for gestational diabetes is a high body mass index (BMI). And research shows that more and more women are being diagnosed with gestational diabetes - which is not surprising given the growing problem of overweight and obesity in the United States. So, I’ve said it before and I’ll say it again: If your BMI is high and you’re thinking about pregnancy, you may want to talk to your doctor about how to lose weight first. It’s a decision that will improve not only your baby’s health, but your own.

Making Babies Part II - Alternative Therapies

2007-08-16T06:36:00.000-07:00

I had a request for information about yoga for infertility, so I did some investigating. When I say investigating, it means I checked PubMed, which is considered "the source" for medical research. Here's what I found.

To date, no published studies have actually documented yoga in relation to fertility outcomes (so here's a novel study idea for the complementary and alternative medicine [CAM] researchers out there). However, a single article on yoga and meditation for infertility published in the journal Fertility and Sterility did suggest that yoga and meditation can help patients to handle the challenges of fertility treatments, including developing patience (which is a requirement when first attempts at assisted pregnancy fail), reducing overall stress, and growing more in touch with their bodies.

Studies have documented, however, the use of acupuncture as an adjunct therapy to infertility treatments, and specifically IVF. A recent review of these studies suggested that acupuncture may indeed be a useful aid in improving the success rate of IVF, as well as improving the quality of life of women who undergo it.

According to another review of the effectiveness of vitamins and herb supplements, too few studies have been conducted on how well they work for infertility. However, the author noted preliminary evidence suggests chasteberry, antioxidants, and Fertility Blend may have some benefit.

One thing that is important, couples who decide to use CAM therapies in conjunction with fertility treatments should inform their doctors, so they can be certain doctor-prescribed therapies are not contraindicated with the naturopathic remedies. Also, while there are no published studies on the subject, if you do want to try yoga for infertility you might find some ideas here.

(Note: As stated in my sidebar, always check with your doctor before starting any physical activity.)

Making Babies - Assisted Reproductive Technology Style

2007-08-14T09:49:00.000-07:00

Anyone who has had fertility issues knows that it is a huge investment emotionally, physically, psychologically, and financially. Of the many things to think about when undergoing fertility treatment, one issues has been how to factor in the relationship between fertility treatments today and possible breast cancer tomorrow. Does the benefit of having a child outweight the risk of possible future disease that may take you from your child at some point?

A new study may help couples answer this question. Danish researchers reviewed records of over 54,000 women who received fertility treatments to investigate the suspected link between fertility drugs and breast cancer. They found there was no overall increase in breast cancer risk after using the most common of fertility drugs, including gonadotrophins (e.g., Factrel, Lutrepulse, Relisorm), clomiphene citrate (clomid), human chorionic gonadotropin (e.g., Novarel, Ovidrel, Pregnyl, Profasi), or gonadotropin-releasing hormone (e.g., Lupron, Synarel). There also was no relationship with how many cycles the woman received fertility treatments.

The study did show, however, that women who used progesterone were three times as likely to develop later breast cancer risk. There also was a slightly elevated breast cancer risk for women who had never had children and used gonadotropins.

If you are considering or undergoing fertility treatments and you are using some of the more common drugs, hopefully this study will give you some peace of mind. However, if you're being prescribed progesterone or gonadotropins, this study suggests that a frank discussion with your doctor about the risks and benefits is in order. Your future health may depend on it.

What's sex got to do with it?

2007-08-13T05:20:00.000-07:00

Apparently a lot, according to a new study published in Gynecologic Oncology this month. In the first (!!) study of its kind, researchers examined the sexual health and functioning of long-time survivors of vaginal and cervical cancers. Compared to similar women without cancer, the cancer survivors were more likely to experience a variety of sexual problems, including lack of desire, painful intercourse, inability to have an orgasm, vaginal dryness, and anxiety about their sexual performance. Further, despite the fact that most of these women had their sexual organs removed or destroyed during their cancer treatments, only one-third of doctors actually talked to these women about their sexual health.

The lack of talking isn't for lack of wanting to talk either - at least not on the patients' part. Most of the cancer survivors surveyed believe sex is an important part of life and they want their doctors to discuss their sexual health. So why aren't they?

It's no secret that we Americans have a lot of hang-ups when it comes to sex. Just take a look at your neighborhood abstinence-only (sex) education program ("zippers closed, buttons buttoned") to see that. But we're talking about consenting adult women (average age = 49 years), nearly three-fourths of whom were married and several more who were in long-term partnerships. In my view, doctors need to step it up and take responsibility for initiating conversations about sexual health with female patients. Further, these conversations need to occur not only with cancer survivors, but with all women across the lifespan, and especially as women age and hormonal shifts affect sexual health and functioning.

While I would like to think my call to arms will inspire physicians to talk to their patients about sex and sexual functioning, it's clear from this study that women unfortunately can't depend on their doctors to initiate such conversations. Rather, women need to be proactive partners in their health care, and sometimes this means bringing up difficult conversations. ("Well, Dr. X, I'm not having orgasms when I make love to my husband.") Women deserve to enjoy sex in the same way as men - and the way that little blue pill flies off the shelves, my guess is men are enjoying it fully, doctor-approved.

Moms Get "A" for Minding Children's Health

2007-08-10T13:11:00.000-07:00

Single moms often receive a lot of flack for, well, being single moms, whereas single dads are patted on the back for "stepping up" to their parenting responsibilities. A study published online this week should give single moms a boost, however. Apparently, when it comes to their children's health, single moms are way ahead of single dads in terms of health behaviors.

Researchers examined data from over 62,000 children (0-17 years) in the United States. They found that only 1/2 of children in single-father families saw a doctor for a check-up. Conversely, more than 2/3 of children in single-mother households received a "well-child" check-up. Further, children in single-mother families had a lower risk of drug use, had fewer problems in school, and exhibited fewer risky behaviors compared to children in single-father families - all this despite the fact that single moms are more likely to be poor, which is a risk factor for both limited health care access and a variety of health problems.

Why are moms better than dads at getting their kids in for a check-up? The authors of the study suggest that single moms may have a better grasp of the public programs available to them. The authors also suggest that dads may be bigger risk-takers, whereas moms don't want to take a chance with their children's health. Clearly, this is an area for more research. Meantime, single moms everywhere should be applauded for taking care of their children's health.

Weight Matters in Pregnancy: Part II

2007-08-09T08:42:00.000-07:00

If my previous post on weight matters in pregnancy didn't convince you that starting your pregnancy obese can be bad for your baby, findings from a study published this week just might.

Researchers reviewed the birth outcomes of more than 4,000 women in eight states over a five-year period. They found that mothers who were obese (defined as a body mass index of 30 or greater) prior to pregnancy were significantly more likely to have infants with birth defects, including spina bifida, heart deformities, malformed rectums, hypospadias (abnormal opening of the urethra in males), short or missing limbs, hernias in the diaphragm, and abdominal wall defects. These researchers made sure that this was an obesity issue by not including infants whose birth defects had a known or suspected genetic cause and adjusting their calculations for women who took folic acid, which has been shown to reduce some birth defects.

I may sound like a broken record here, but the evidence continues to mount regarding the need to address overweight and obesity, especially among women of childbearing age. Additionally, given that: (1) Kentucky's rate of neural tube defects (such as spina bifida) is 1.5 times the national average; (2) birth defects are the leading cause of infant mortality in Kentucky; and (3) we already know that we're the fifth heaviest state in the nation, we've got some work to do if we want to meet our goals for improved birth outcomes in the Commonwealth.

FREE Antibiotics (yes, your contacts are working)

2007-08-08T08:42:00.000-07:00

Although this blog is primarily dedicated to relaying research findings, every now and then a story will capture my interest that I have to share.

This week, Publix (a major supermarket in the South and one I used to frequent when I lived in Athens, GA) announced that they will be offering a FREE prescription drug program at all of its 684 pharmacies for the 7 following antibiotics: Amoxicillin, Cephalexin, Sulfamethoxazole / Trimethoprim (SMZ-TMP), Ciprofloxacin (excluding ciprofloxacin XR),
Penicillin VK, Ampicillin, and Erythromycin (excluding Ery-Tab).

Anyone (that's right, anyone - no income or insurance requirements to be met) who has a prescription can receive up to 14 day's worth of the above antibiotics, which will be filled free of charge. Furthermore, Publix is not limiting the number of prescriptions customers may fill. So if you get a sinus infection every month for the rest of the year and need antibiotics each month, you can get your medicine for free each time. (Of course, if that's the case, I might recommend a new doctor.)

As a researcher who studies low-income families, I am thrilled that Publix has taken this step. There are so many documented cases of families choosing among rent, food, and medicine. In fact, next week a student and I will be presenting on unmet health care needs at a conference on rural women's health sponsored by the Office of Women's Health. One of our findings in this low-income group was that the women with acute needs (i.e., unexpected illness or injury) did not fill their prescriptions. There will be more to come on our research next week. For now, I'm excited about this trend of companies stepping up to help families meet their economic and health care challenges. And, if you live in Alabama, Florida, Georgia, South Carolina, or Tennessee, find the Publix nearest you and take advantage of this great opportunity.

Om Sweet Om

2007-08-07T05:20:00.000-07:00

As a long-time yoga practitioner and instructor, I am always interested in new research on the benefits of yoga practice. Two recent studies suggest that yoga can both boost your mood and improve your migraines.

In one recent study, researchers compared the effects of one hour of reading to one hour of practicing yoga on brain functioning. They found the yoga practitioners had a 27% increase in GABA levels, while the readers experienced no change. GABA is the primary inhibitory neurotransmitter in the central nervous system, and low levels of GABA are associated with mood disorders, including depression, anxiety, and manic-depression (bipolar).

In a randomized controlled trial of yoga versus self-care for migraine sufferers, the patients who were randomly assigned to yoga showed significant improvements over those assigned to self-care in headache intensity, frequency, and pain levels. The yoga practitioners also had significant reductions in symptoms of anxiety and depression and use of migraine medications compared to those in the self-care group.

Other research suggests that yoga can improve quality of life in breast cancer patients, decrease seizure activity in individuals with drug-resistant epilepsy, improve gastrointestinal symptoms in adolescents with irritable bowel syndrome, and improve chronic lower back pain. Sound too good to be true? Learn more and judge for yourself. Meanwhile I'll keep doing my sun salutations. Namaste.

Weight Matters in Pregnancy

2007-08-06T06:08:00.000-07:00

Ask the average woman how much weight she should gain during pregnancy, and she'll probably respond 25-35 pounds. This Institute of Medicine guideline has been the practice for nearly 20 years. However, this recommendation is for normal weight women (i.e., body mass index [BMI] 18.5-24.9). The IOM also recommends that overweight and obese women limit their gestational weight gain according to their prepregnancy BMI.

A recent study, however, shows that many overweight and obese women are not limiting their weight gain during pregnancy, and this can have serious consequences for both the mother and newborn. In their study of over 7,500 women, researchers found that 64.3% of overweight and 52.9% of obese women gained more weight during pregnancy than recommended by the IOM for their BMI. Further, overweight and obese women were more likely to deliver by C-section and give birth to infants who were large for gestational age, with associated complications including the infant’s anterior shoulder becoming stuck above the pubic bones during delivery, birth canal lacerations, and fetal hypoglycemia (low blood sugar). Overweight/obese women also were less likely to initiate or continue breastfeeding beyond 10 weeks.

So if you are planning to become pregnant in the next year, take a look at your BMI. If you're above 25, talk to your doctor about steps to lose weight. Further, once you become pregnant, keep an eye on your diet and the scale. Pregnant women need only an additional 300 calories per day. By watching your weight before and during pregnancy, you'll not only improve your own health, but you'll also improve the health of your baby.

Stop Smoking, Start Gaining?

2007-08-03T08:53:00.000-07:00

Many women who smoke say they are afraid to stop smoking for fear of gaining weight. However, new research suggests that reductions in smoking rates had less than a 1% effect on increased rates of obesity nationwide. Further, a forthcoming study shows that among weight-concerned smokers trying to quit, nicotine has only a small and temporary effect on weight maintenance.

What does contribute to weight gain? A social network analysis of over 12,000 people between 1971 and 2003 showed that friends and family are key. Individuals were 57% more likely to become obese if a friend became obese, 40% more likely if a sibling became obese, and 37% more likely if a spouse became obese. Further, same sex friends and family members had more influence on weight gain than opposite sex friends and family members.

So if you're worried about how quitting smoking might affect your waistline, fret no more. And whether you smoke or not, do take a look around your inner circle. If you see women friends and family members packing on the pounds, you may want to suggest a walk as opposed to a meal when spending time together.

ATTENTION MOMS: GOT STRESS?

2007-08-02T10:39:00.000-07:00

Well, duh, you say. Just the fact that you are a mom means you have stress. It's also not news to you that more stress means worse mental health. However, researchers have found that the source of your stress matters. Using nationally representative data, these researchers identified three key predictors of poor mental health:

(1) lack of support, including nobody to provide you emotional help with parenting or give you a break when you need it;

(2) spending too much time with your child. That's right too much time - moms who think they don't spend enough time with their kids don't experience the same negative mental health effects; and

(3) difficulty paying for child care. Other financial difficulties, such as trouble paying for medical care or supplies for the child, lack of health insurance for the child, and missed or delayed health care for the child did not produce the same negative mental effects.

Further, these authors found that having more than one stressor exponentially increased the likelihood that moms experience poor mental health. Moms with two or more stressors were nearly 12 times as likely to have poor mental health compared to moms with no stressors (apparently these women exist, but I have yet to meet them).

So what does this all mean for moms out there? It means get help when you need it - ask your partner, your family, your friends. It means there really is too much time with your child and not enough time for yourself, so don't feel guilty about taking me-time when you need it. (Recall the last flight you took....first put the oxygen mask on yourself, then help children and disabled passengers.) It means as a society we need to do a much better job of helping working moms with childcare strategies they feel good about. Co-op (pdf) anyone?

Mandate HPV Vaccine for Boys?

2007-08-01T07:20:00.000-07:00

A new research finding on HPV is certain to add to the controversy about whether young women should be mandated to receive the HPV vaccine. Wait - did I say young women? It seems this new finding implicates young men. Dr. Laura Koutsky, a researcher at the University of Washington who led some of the original research and clinical trials that resulted in Gardasil, Merck's HPV vaccine, has discovered the presence of HPV under the fingernails of young men.

I'm going to be completely transparent here and say that when I first heard about states (including my own) wanting to mandate the HPV vaccine for school-age girls, I was none too pleased. Don't get me wrong, I'm not against vaccines in general. I have no problem vaccinating against chicken pox, tetanus, diphtheria, pertussis, flu, etc. for a couple of reasons. One - in most cases we're talking about airborne diseases, and two - we're not focusing on one sex or the other - both male and female children and adolescents receive them equally.

I DO have a problem mandating a new vaccine for girls only for a disease that until now was assumed to be contracted solely through sexual contact. Why? For a number of reasons. First, and perhaps most importantly, I believe this is a collaborative decision (read choice) for the parents, the physician, and the patient to make that should involve a very important discussion. By mandating this vaccine, we're removing a potential opportunity for parents to have the "sex talk" with their pre-teens. As dreaded as this talk may be to some parents, allowing families to make the decision about the HPV vaccine opens up an important opportunity to discuss: (1) how HPV gets transmitted (SEX); (2) how you can protect yourself (CONDOMS, ABSTINENCE, TALKING WITH YOUR PARTNER ABOUT PREVIOUS PARTNERS); and (3) the fact that this is just one STD of many (HIV, HERPES, GONORRHEA, CHLAMYDIA, to name a few) that the vaccine doesn't protect you from. My fear is that mandating this vaccine may facilitate parents avoiding "the talk" by giving them a false sense of security about their child's health.

Second, I feel uncomfortable mandating a vaccine that is so new to the market. Despite the best attempts at ensuring the safety of a product, there are enough cases of other products deemed to be safe in clinical trials that ultimately were found to cause severe adverse reactions, including death in some cases. Think Vioxx (another Merck product, by the way), Fen-Phen, and Rezulin among others. I'm uncomfortable with taking the decision-making out of parents' hands when we have no long-term data on the vaccine's safety. I think we need to trust parents and physicians to evaluate the data on their own terms and decide independently whether this is the route they want to choose for their daughters and patients. Not to mention, if there were significant adverse events associated with the vaccine over the long-term, is the government agency that mandated the vaccine going to take responsibility for any adverse outcomes? Somehow I doubt it.

Third (and this is the feminist in me talking) I just don't believe that we'd be mandating a vaccine for young men only. This is why Dr. Koutsky's finding is so important. One of the clear principles of epidemiology is to identify the source of an infection and at-risk populations in order to implement control and prevention strategies. With this principle in mind, scientific evidence that reveals the presence of HPV under the fingernails of young men suggests we need to be targeting young men in our control and prevention strategies - not just rushing to vaccinate all young girls and holding young boys unaccountable for their role in HPV transmission. While the HPV vaccine has some very positive potential, for now I'd like parents to retain the choice about whether to vaccinate until we see more long-term safety data on the vaccine and more research on prevention strategies for young men, including a vaccine for pre-teen boys. If and when such a vaccine hits the market, I'll be interested in seeing how many folks want to mandate it for boys.

STIGMA: Keeping Mental Health Problems on the QT

2007-07-31T06:30:00.001-07:00

When I used to practice therapy in an outpatient psychiatric unit of an inner city hospital I co-managed patients with a psychiatrist who would further evaluate and medicate clients as needed. Most of my clients were very distressed when the physician side of the team recommended an antidepressant, anti-anxiolytic, or other medication in conjunction with talk therapy. I would have the same conversation with different patients every time:

ME: If you had diabetes would you feel embarrassed about taking insulin?
CLIENT: No.
ME: Well think of (fill in disorder here) as if it were diabetes. Both conditions have biologic origins that can be helped by medication.

Despite my best attempts, this conversation made very few patients feel better about their diagnosis or its treatment.

It's been over 10 years since I first entered the mental health field, and I'm amazed that little has changed when it comes to the stigma associated with mental health problems, despite the educational campaigns of the federal government and NAMI. This is especially true in rural areas and smaller communities where mental health professionals are scarce and residents so tight knit that folks are afraid if someone sees their car parked in front of the mental health clinic, everyone will know they have a mental health problem before day's end. Unfortunately, this means that rather than seek proper treatment for mental health problems, people self-medicate through the use of alcohol and drugs.

My colleague and I recently published a paper in the Journal of Affective Disorders looking at the percentage of folks who have both a mental (e.g., depression, anxiety, bipolar) and substance use (drug and alcohol abuse and dependence) disorder. While we found no differences between rural and urban folks in terms of the prevalence rates of these disorders, we did find that rural residents were less likely to seek treatment for their disorders than urban folks. We wondered: Is anonymity the key to seeking mental health treatment?

This may be why there is a burgeoning of online communities for folks with mental health problems. This is great in the sense that folks can readily access information and "talk" to people with similar disorders. However, I wonder how stigma is perpetuated by communities who don't share experiences face-to-face. Are we encouraging people with mental health problems to seek support behind a screen name?

Overweight = Undereducated

2007-07-30T12:29:00.000-07:00

A researcher at the University of Texas has discovered that obese girls in America are half as likely to attend college as non-obese girls. This finding is particularly disturbing when you live and work in a state with the fifth highest adult obesity rate in the nation (25.6%) and the third highest rate of overweight high school students (14.6%) that ranks 45th in the percent of adults over age 25 with a bachelor's degree or higher (21.3% compared to 27.2% nationwide). As a health researcher, a citizen of the Commonwealth, and a woman, I worry and wonder - what are we going to do to promote the health and well-being of Kentucky's young women?

Obviously, there isn't a simple solution to the problems of obesity or low educational attainment. However, it is becoming increasingly obvious that schools are one venue for addressing these two critical issues facing the Commonwealth - perhaps even in an integrated fashion. If you saw the movie Akeelah and the Bee, you'll recall her jump rope spelling practice. Innovation such as integrated curriculum is key when working to tackle important issues.

Some of Kentucky's state senators and representatives agree. In the most recent general session, these lawmakers proposed legislation that would bring back physical education into the school day for grades pre-K through 8, including making physical activity a component of the three R's, a la' Akeelah. That sounds a lot better to me than how I received my physical education - running through the hills behind my elementary school with my 40-something fifth grade teacher cattle-prodding me (and the two other students bringing up the rear) to hurry along. Although this bill never made it to the Governor's desk in 2007, the good news is that Kentucky's legislature meets annually. So I'm holding out hope for 2008, especially in light of this recent research. Kentucky's girls deserve better, and I'm confident we can provide it for them.