Women and Bleeding Disorders
Posted by on December 24, 2010 - 4:43am

Bleeding disorders refer to conditions that keep your blood from clotting properly after a cut or injury.   Women generally notice a problem because of heavy or abnormal menstrual periods.  Heavy bleeding or menses is one of the most common problems women report to their doctors.   In the U.S., one out of every five women report heavy bleeding.

Signs of a possible bleeding disorder include:

  • menstrual periods that last more than 7 days, gushing of menstrual blood that limit daily activities, passing of clots bigger than a quarter, and the need to change a tampon or pad every hour or more.
  • low blood iron or anemia
  • heavy bleeding after dental or other surgery, or during childbirth
  • frequent nose bleeds (10 minutes or more)
  • bleeding from cuts (longer than 5 minutes)
  • easy bruising (weekly, raised, and larger than an inch).
  • having one or more of the above symptoms plus a family member with a bleeding disorder such as von Willebrand disease or hemophilia.

If you have any of these symptoms, they should be discussed with your doctor.   Bleeding disorders are common in women but many women are too embarrased to talk with their provider about it.   They can be dangerous if not treated.

The U.S. Center for Disease Control (CDC) supports a network of specialized healthcare centers to prevent and reduce complications experience by people with certain blood disorders.  Visit their site for more information.

On a personal note, one of my college professors was the doctor who developed one of the first tests (Quick Bleeding Time) used to help diagnose  bleeding disorders and my first job after college was at a university that was researching blood disorders.    At that time, we had a female teenager whose blood platelets (an irregular, disc-shaped element in the blood that assists with blood clotting; during normal clotting, the platelets clump together to trap fibrin threads that form a clot) were "slippery" and did not form clots when she experienced a cut.      She was one of the very first identified cases of a condition that was given the name von Willebrand disease.    We've come a long way in the last 4 decades in understanding and treating these and other diseases like hemophilia.  In fact, many young people today do not even know what hemophilia is, yet is was a debilitating and deadly condition that played a major role in ending some historical Russian dynasties and often affects certain animals like thoroughbred horses.  To read about its fascinating history click HERE.

Obesity increase Risk of Death
Posted by on December 21, 2010 - 5:11pm

Study Shows Strong Link between Obesity and Mortality

The largest study of its kind has confirmed a strong association between overweight and obesity and an increased risk of death. The study also identified a range of body-mass index (BMI) at which mortality risk is lowest, confirming earlier studies indicating that people who are in the normal weight range have a significantly lower risk of dying from a host of causes compared with those who are overweight. The findings were published December 2 in the New England Journal of Medicine.

Obesity and overweight continue to be major health problems in the United States. Approximately two-thirds of the adult U.S. population are overweight or obese, meaning that they have a BMI of 25 or higher.

Researchers from NCI and other NIH institutes, as well as from other U.S. and foreign health agencies and universities, pooled data on 1.46 million people from 19 long-term prospective cohort studies. The participants in these cohort studies were white and from more industrialized countries, limiting the extent to which the findings can be extrapolated to other populations, the researchers explained. The analysis focused on participants who had never smoked and did not have cardiovascular disease or cancer at study entry, eliminating “potentially strong confounders” of mortality risk that have affected some earlier studies, explained the study’s lead author, Dr. Amy Berrington de Gonzalez of NCI’s Division of Epidemiology and Cancer Genetics.

Overall, the lowest mortality risk was seen for those with a BMI between 20 and 24.9. Above that level, every 5-unit increase in BMI increased the risk of death by 31 percent. The risk of death was substantially elevated in the severely obese, those with a BMI of 40 or higher. Women who fell into this category had a 2.5-fold higher risk of death compared with women in the lowest risk BMI range. The risk relationship was similar for men.

Across the BMI levels that correspond with overweight and obesity, the relationship between BMI and mortality was strongest for participants who were younger than 50 at study entry, Dr. Berrington de Gonzalez added.

Although the cancer-specific mortality risk was smaller than the mortality risk associated with cardiovascular disease, the study only assessed overall cancer risk, she said. “Based on previous studies, we know that the relationship between obesity and cancer varies by cancer type,” she continued. So, while obesity is strongly associated with an increased risk of postmenopausal  breast cancer and renal cancer, for example, it is not associated with some other cancers. As a result, when cancer is considered as a single disease, the overall association is weaker, Dr. Berrington de Gonzalez said.

High Power Jobs Can Stress Women's Hearts
Posted by on December 20, 2010 - 2:51pm

Women who report having high job strain have a 40 percent increased risk of cardiovascular disease, including heart attacks and the need for procedures to open blocked arteries, compared to those with low job strain, according to research presented at the American Heart Association's Scientific Sessions 2010.

In addition, job insecurity -- fear of losing one's job -- was associated with risk factors for cardiovascular disease such as high blood pressure, increased cholesterol and excess body weight. However, it's not directly associated with heart attacks, stroke, invasive heart procedures or cardiovascular death, researchers said.    Job strain, a form of psychological stress, is defined as having a demanding job, but little to no decision-making authority or opportunities to use one's creative or individual skills.

"Our study indicates that there are both immediate and long-term clinically documented cardiovascular health effects of job strain in women," said Michelle A. Albert, M.D., M.P.H., the study's senior author and associate physician at Brigham and Women's Hospital, Boston, Mass. "Your job can positively and negatively affect health, making it important to pay attention to the stresses of your job as part of your total health package."

Researchers analyzed job strain in 17,415 healthy women who participated in the landmark Women's Health Study. The women were primarily Caucasian health professionals, average age 57 who provided information about heart disease risk factors, job strain and job insecurity. They were followed for more than 10 years to track the development of cardiovascular disease. Researchers used a standard questionnaire to evaluate job strain and job insecurity with statements such as: "My job requires working very fast." "My job requires working very hard." "I am free from competing demands that others make."

The 40 percent higher risks for women who reported high job strain included heart attacks, ischemic strokes, coronary artery bypass surgery or balloon angioplasty and death. The increased risk of heart attack was about 88 percent, while the risk of bypass surgery or invasive procedure was about 43 percent.

"Women in jobs characterized by high demands and low control, as well as jobs with high demands but a high sense of control are at higher risk for heart disease long term," said Natalie Slopen, Sc.D., lead researcher and a postdoctoral research fellow at Harvard University Center on the Developing Child in Boston.

Previous research on the effects of job strain has focused on men and had a more restricted set of cardiovascular conditions. "From a public health perspective, it's crucial for employers, potential patients, as well as government and hospitals entities to monitor perceived employee job strain and initiate programs to alleviate job strain and perhaps positively impact prevention of heart disease," Albert said.

Source:   American Heart Association (2010, November 15). ScienceDaily.

Hormone Therapy and Dementia
Posted by on December 17, 2010 - 6:04pm

Hormone Therapy Use May Increase Or Decrease Dementia Risk Depending Upon Timing

Compared to women never on hormone therapy, those taking hormone therapy only at midlife had a 26 percent decreased risk of dementia; while women taking HT only in late life had a 48 percent increased risk of dementia, according to Kaiser Permanente researchers.   Women taking HT at both midlife (mean age 48.7 years) and late life had a similar risk of dementia as women not on HT, according to the study which appears in the Annals of Neurology. The study was funded in part by the National Institutes of Health.

Although previous research has shown that initiation of postmenopausal estrogen hormone therapy in late life increases the risk of dementia, animal studies and some observational studies have suggested that midlife use of HT may be beneficial. This is the first observational, long-term study to directly compare the effect of hormone therapy status in both midlife and late life on risk of dementia.

"This study is unique because we had a group of women who were on HT in midlife only and could look at their dementia risk over time, and we found a modest, protective association. We also found that if you start HT late in life, you have a 50 percent increased risk of dementia, which is consistent with other studies," said study lead author Rachel Whitmer, PhD, a research scientist with the Kaiser Permanente Division of Research in Oakland, Calif. "Women should speak with their doctor about what's best for their individual situation, however it appears from this study that women who are on short-term HT in midlife may benefit from a modest protective association, while initiation in late-life can cause harm."

Adjustment for high cholesterol, hypertension and stroke did not reduce the magnitude of the effect of late life HT on increased risk of dementia, according to the researchers. It's also possible that in the group of women who used HT both in midlife and late life; the potential modest benefit of midlife use was counteracted by a negative effect of late life use, they explained.

This study is part of an ongoing body of research at Kaiser Permanente to better understand the modifiable risk factors for dementia.

Limitations of this most recent study include the fact that HT information in midlife was self-reported and therefore researchers do not know the dose or type of HT involved. Also, because the pharmacy database was initiated in 1994, researchers do not have information on the duration of midlife HT.

Source: Kaiser Permanente

Highly Active Women Gain Less Weight than Men
Posted by on December 16, 2010 - 3:03pm

People will gain significantly less weight by middle age – especially women – if they engage in moderate to vigorous activity nearly every day of the week starting as young adults, according to new Northwestern Medicine research.

Women particularly benefitted from high activity over 20 years, gaining an average of 13 pounds less than those with low activity; while men with high activity gained about 6 pounds less than their low-activity peers. High activity included recreational exercise such as basketball, running, brisk walking or an exercise class or daily activities such as housework or construction work.

“Everyone benefits from high activity, but I was surprised by the gender differences,” said lead author Arlene Hankinson, M.D., an instructor in preventive medicine at Northwestern University Feinberg School of Medicine. “It wasn’t that activity didn’t have an effect in men, but the effect was greater in women. Now women should be especially motivated.”

The study will be published Dec. 14 in the Journal of the American Medical Association.

There could be several reasons for the gender difference, Hankinson said. Women are less likely than men to overestimate their activity, according to previous studies. “Men may not be getting as much activity as they report,” Hankinson explained.  In addition, men in the high-activity group compensated by eating more than their low-activity counterparts, which could have led to more weight gain. The highly active women didn’t eat more than low-activity women in the study.

There were many ways to achieve the study’s definition of high-activity levels, Hankinson noted. One way was 150 minutes of moderate to vigorous activity a week.

The study participants -- 1,800 women and nearly 1,700 men — are part of the Coronary Artery Risk Development in Young Adults (CARDIA) Study, a multi-center, longitudinal and population-based observational study designed to describe the development of risk factors for coronary heart disease in young black and white adults.

Coauthor Stephen Sidney, M.D., associate director for clinical research at the Kaiser Permanente Division of Research. “Common medical problems such as heart disease, diabetes and obesity have their origins in childhood and can generally be prevented by maintaining a normal weight, not smoking, exercising regularly and eating a healthy diet throughout life.”

Hankinson’s research is the first to measure the impact of high activity over 20 years between young adulthood and middle age and to frequently examine participants (seven times) over that period. Study participants are more likely to remember and accurately report their behavior with regular exams, she said.   Previous studies, Hankinson said, looked at a single exercise intervention’s effect on weight for a short period of time or examined participants in longer studies at only two points in time -– the beginning and the end.

“We wanted to see if people’s activity levels during their youth were enough to help them keep weight off in middle age, or if they needed to up the ante,” Hankinson said. “It’s difficult to avoid gaining weight as you age. Our metabolic rate goes down. We develop conditions or have lifestyles that make it harder to maintain a high level of activity.”

“The study reinforces that everyone needs to make regular activity part of their lifestyles throughout their lives,” she said. “Not many people actually do that.” The active group in the study comprised only 12 percent of the participants.  Lower levels of activity had a negligible effect on weight gain in the study. “High activity was the only kind that made a significant difference,” Hankinson noted.

Marla Paul is the health sciences editor. Contact her at marla-paul@northwestern.edu

Study Shows Gender Difference in Sleep Interruptions
Posted by on December 14, 2010 - 2:16pm
Working mothers are two-and-a-half times as likely as working fathers to interrupt their sleep to take care of others.

That is the finding of a University of Michigan study providing the first known nationally representative data documenting substantial gender differences in getting up at night, mainly with babies and small children. And women are not only more likely to get up at night to care for others, their sleep interruptions last longer—an average of 44 minutes for women, compared to about 30 minutes for men.

"Interrupted sleep is a burden borne disproportionately by women," said sociologist Sarah Burgard, a researcher at the U-M Institute for Social Research (ISR). "And this burden may not only affect the health and well-being of women, but also contribute to continuing gender inequality in earnings and career advancement."

For the study, Burgard analyzed time-diary data from approximately 20,000 working parents from 2003 to 2007, drawn from the U.S. Census Bureau's American Time Use Survey.  The gender gap in sleep interruptions was greatest during the prime childbearing and child-rearing years of the twenties and thirties, she found.

Among dual-career couples with a child under the age of one, 32 percent of women reported sleep interruptions to take care of the baby, compared with just 11 percent of men. The proportion reporting interrupted sleep declined with the age of the child, with 10 percent of working mothers and 2 percent of working fathers with children ages 1 to 2 reporting sleep interruptions, and just 3 percent of working mothers and 1 percent of working fathers with children ages 3 to 5.

"What is really surprising," Burgard said, "is that gender differences in night-time caregiving remain even after adjusting for the employment status, income and education levels of each parent. Among parents of infants who are the sole breadwinner in a couple, for example, 28 percent of women who are the sole breadwinner report getting up at night to take care of their children, compared to just 4 percent of men who are the only earner in the couple."

In related research, Burgard and colleagues found that women get slightly more sleep compared to men. But getting about 15 minutes more total sleep a day may or may not compensate for the greater sleep interruptions women face.

"Women face greater fragmentation and lower quality of sleep at a crucial stage in their careers," Burgard said. "The prime childbearing years are also the time when earnings trajectories are being established, and career advancement opportunities could well be foregone if women reduce their paid work time or see their workplace performance affected because of exhaustion. As a result, sleep interruption may represent an under-recognized 'motherhood penalty' that influences life chances and well-being."

The findings also have implications for public health interventions to improve sleep. "Generally, these interventions target individual behaviors, such as the use of alcohol, caffeine or tobacco," said Burgard. "Or they focus on nightly routines that help people to relax and fall asleep or stay asleep more successfully.

"But for parents of young children, the best approach might be discussions and negotiations about whose turn it is to get up with the baby tonight."The study, forthcoming in the peer-reviewed journal Social Forces, was funded by the National Institute of Child Health and Human Development, the National Institute on Aging, and the Sloan Foundation.

Source:  University of Michigan News Service

One in 4 Overweight Women View Themselves as Normal Weight
Posted by on December 13, 2010 - 8:44am

A new study found that nearly 1 in 4 overweight American women believes her body weight as normal, while conversely, around 1 in 6 normal weight women regards herself as overweight.

The study was done by researchers at the University of Texas Medical Branch (UTMB) and is published in the December 2010 issue of Obstetrics and Gynecology. Over 2200 women ages between 18 and 25 complete questionnaires that asked about health behaviors including how they perceived their body weight.  Then actual measurements were taken using the current standard definition of body mass index  (Normal 18.5-24.9; overweight 25-29.9; and obese >30).

Among the 1162 women that were actually overweight, 23% of them (misperceivers) believed they were of normal weight. Of the 1062 women who had normal weight based on their BMI, 16% considered themselves to be overweight.

The researchers concluded that weight misperception was especially common among reproductive age women and that this should be taken into account while counseling patients about weight management.

To reach the entire article found in Medical News Today click HERE.

U.S. Not Meeting Key Women's Health Goals
Posted by on December 10, 2010 - 4:41pm

10-Year State-by-State Report Card in Women’s Health

  • Good: Less Cigarette Smoking, More Colorectal Cancer Screening

  • Bad: Fewer Pap Tests, More Chlamydia, More Binge Drinking

The United States has failed to meet most goals for women’s health — largely federal objectives drawn from the U.S. Department of Health and Human Services’ Healthy People 2010 agenda — according to a report released today on the status of women’s health by the National Women’s Law Center (NWLC) and Oregon Health & Science University (OHSU).

Overall, the nation is so far from meeting the Healthy People and related goals that it receives a general grade of “Unsatisfactory.” Of the 26 health indicators that were graded, the country received a “Satisfactory” grade in only three and received a failing grade in half.

Released today, the 2010 edition of Making the Grade on Women’s Health: A National and State-by-State Report Card, is the fifth in a series of reports since 2000. It grades and ranks each state based on 26 health status benchmarks and also identifies whether states have met 68 health policy goals. NWLC and OHSU developed the report as a resource for advocates, policymakers, and health experts to assess women’s health at the federal and state levels. The Report Card provides comprehensive data for researchers to analyze changes in women’s health and well-being. This edition of the Report Card includes an analysis of the current status of women’s health, a 10-year look back at progress and setbacks, and a comparison to women’s health status in 2007, when the Report Card was last published.

To view the report state by state, click HERE.

The National Women's Law Center is a nonprofit organization that has been working since 1972 to expand opportunities and eliminate barriers for women and their families, with a major emphasis on women’s health, education and employment opportunities, and family economic security.

The Oregon Health & Science University Center for Women’s Health aims to advance and integrate all aspects and modes of health care for women in every stage of life and across the full spectrum of circumstances within the context of research, education, clinical models, health care policy, community action and key partnerships.

Source:   Oregon Health & Science University News Center  12/09/2010

A Campaign to Encourage our Kids to Read!
Posted by on December 9, 2010 - 1:44pm

              Amy Dickinson

This week, I had the opportunity to attend the Illinois Women's Health Conference sponsored by the Illinois Dept. of Public Health in Springfield, Illinois.    The closing speaker was Amy Dickinson, a nationally renowned syndicated advice columnist from the Chicago Tribune.    She talked about how important it is for women to take care of themselves and find something in their lives that they enjoy doing---and making time to do it.   She regaled us with stories about the many women in her family who have supported each other through divorces, foreclosures, single parenthood, caregiving and other challenges.  She complimented the audience, many of them public health nurses, on the important work they do and how important it is that they keep doing it---while finding some time for themselves.  She was truly engaging with her easy going, and real,  storytelling.

She ended her remarks by announcing a campaign to encourage children to read.    Her campaign is called "A Book on Every Bed" and here is how it works:  pick out a children's book, wrap it, place it on a child's bed so it's the first thing they see when they wake up Christmas (or any holiday your family celebrates) morning--before all the chaos of more traditional gift exchanges.  Amy told us she was inspired by Pulitizer Prize winner David McCullough who told her about waking up as a child on Christmas morning with a wrapped book on his bed.

Many people believe that kids who are exposed to books early in life have a head start on learning.   They are also more likely to love reading.   In this high tech world of texting and short cuts to writing, far too many children may grow up without the pleasure of getting to know Tom Sawyer, Yertle the Turtle, Babar the Elephant, Anne of Green Gables or Black Beauty.  So I encourage everyone to join Amy in the "A Book on Every Bed" campaign and let us know how your experience went!

Free Information on Anxiety Disorders
Posted by on December 9, 2010 - 11:57am

The holiday season is a wonderful time to spend with family and friends but it can be stressful, especially if you have an anxiety disorder.   The latest e-newsletter from the Institute for Women's Health Research focuses on the most common anxiety disorders, especially in women.  Click HERE to view our December e-newsletter.

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