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Women's Health Office Act Becomes Law
The health reform legislation, the Patient Protection and Affordable Care Act, included a provision for the Women's Health Office Act, a Society for Women's Health Research top priority. “With President Obama's signature on the health insurance reform bill, simply being a woman will no longer be considered a preexisting condition, ending the health insurance industry practice of overcharging and choosing to deny women coverage at times for basic medical needs,” said Rep. Chris Murphy (D-CT). “And we will finally take the necessary steps to protect the volumes of research and information on women's health that we've gathered in recent years so that we can continue to make strides in improving health outcomes for women into the future.”
ORWH 20th Anniversary Is in September: Mark Your Calendars
The Office of Research on Women's Health will celebrate its 20th anniversary September 27, 2010, at the Natcher Conference Center on the National Institutes of Health campus in Bethesda, MD.
FDA Issues Safety Communication About Oral Bisphosphonates and Atypical Femur Fractures
The U.S. Food and Drug Administration issued a Safety Communication about an ongoing safety review of oral bisphosphonate medications and atypical subtrochanteric femur fractures after news reports raised concerns about whether an increased risk for this type of fracture exists in patients with osteoporosis taking one of these medications. The FDA states it has reviewed the existing data and believes the data do not show a clear connection between the drugs and the risk of atypical subtrochanteric femur fractures. The federal agency is working with the American Society of Bone and Mineral Research Subtrochanteric Femoral Fracture Task Force and other outside experts to gather additional information. The FDA asked healthcare professionals to follow drug label recommendations when prescribing the drugs, discuss known benefits and risks with patients, and report any adverse events to the FDA's MedWatch program. The agency urged patients not to stop taking their medication unless instructed by their healthcare providers.
Women's Leading Causes of Death
Heart disease was the leading killer of women in 2006, claiming 25.8% of females of all ages, followed by cancer at 22%, and stroke at 6.7%, according to recently released data from the Centers for Disease Control and Prevention. The percentages were very similar for white and black females, 26% and 25.5%, respectively, for heart disease; 22% and 21.6% for cancer; and 6.7% and 6.8% for stroke. However, for white women, chronic lower respiratory disease was the fourth leading cause of death at 5.8%, whereas diabetes at 5% ranked fourth for black women, with chronic lower respiratory disease ranking seventh at 2.5%. Alzheimer's disease at 4.5% was fifth for white females, but kidney disease at 3.2% was the fifth leading cause of death for black women. Alzheimer's disease ranked ninth in black women at 2.3%. For Hispanic females, heart disease ranked first at 22.8%, cancer second at 21.7%, stroke third at 6.4%, diabetes fourth at 5.4%, and unintentional injuries fifth at 5%. The top rankings differed for American Indian or Alaska natives and Asian or Pacific Islander females, with cancer being the leading cause of death, followed by heart disease. The rankings for American Indian or Alaska native females were cancer at 19.2%, heart disease at 18.8%, unintentional injuries at 8.1%, diabetes at 7%, and stroke at 4.9%. For Asian or Pacific Islander females, the leading causes of death were cancer at 26.9%, heart disease at 23.7%, stroke at 9.8%, and diabetes and unintentional injuries, both at 4%.
Cesarean Delivery Rates Highest Ever
The National Vital Statistics System, a part of the Centers for Disease Control and Prevention, released the latest data regarding trends in cesarean delivery in the United States. The cesarean delivery rate was 32% in 2007, an increase of 53% since 1996 and the highest ever in the country and higher than that found in most other industrialized countries. There were 1.4 million cesarean births in 2007, an increase of 71% from 1996, when there were 797,119 cesarean births. The rate rose for mothers in all age and racial groups and for infants at all gestational ages. Rates for early preterm infants rose 36% and for late preterm and term infants nearly 50%. Women younger than 25 years experienced the greatest increases in cesarean deliveries, 57% from 2000 to 2007. Older women are more likely to have a cesarean delivery, with women aged 40-54 years having one at more than twice the rate of mothers younger than 20, 48% and 23% respectively. Rates increased in all states, but they varied widely, with six states—Colorado, Connecticut, Florida, Nevada, Rhode Island, and Washington—reporting a 70% jump in cesarean deliveries. Cesarean birth rates in 2007 ranged from 25% in Alaska, Idaho, New Mexico, and Utah to more than 35% in Florida, Louisiana, Mississippi, New Jersey, and West Virginia.
Chlamydia Infection Rates Up in 2008
The Chlamydia infection rate continues to climb in the United States, with 583.8 cases per 100,000 women diagnosed with the disease in 2008, up from 539.8 per 100,000 in 2007 and 395.1 per 100,000 in 1999. The District of Columbia had the highest rate in the country, 1,430.8 per 100,000 women in 2008, followed by Mississippi with 1,084 cases per 100,000 women and Alaska with 989.8 per 100,000. The states with the lowest rates were New Hampshire with 232.2 cases per 100,000, West Virginia with 269.2 per 100,000, and Maine with 273.9 per 100,000.
Vaginal Birth After Cesarean Delivery
The Agency for Healthcare Research and Quality released “Vaginal Birth After Cesarean: New Insights,” an evidence report/technology assessment prepared by the Oregon Evidence-based Practice Center at the Oregon Health & Science University in Portland. After reviewing 203 studies of maternal and infant outcomes, it concluded that vaginal birth after cesarean section is “a reasonable and safe choice for the majority of women with prior cesarean.” In addition, the report indicates there is emerging evidence of serious harms associated with multiple cesarean deliveries. Maternal mortality was significantly increased for elective repeat cesarean delivery at 13.4 per 100,000 compared with 3.8 per 100,000 for a trial of labor. Maternal hysterectomy, hemorrhage, and transfusions rates did not differ significantly between the two cohorts. The risk of uterine rupture increased significantly in laboring women, 47 per 1,000 compared with 3 per 1,000 women with an elective cesarean delivery. Six percent of uterine ruptures were associated with perinatal death. Women who had delivered by cesarean section in the past were at a statistically significant risk of placenta previa compared with women with no prior cesarean section. Perinatal mortality was higher in the laboring group, 1.3 per 1,000 compared with 0.5 per 1,000 in the elective cesarean cohort.
ARHP Releases Sexual Health Fundamentals Consensus Paper
The Association for Reproductive Health Professionals sponsored a series of consensus meetings of sexuality, clinical science, and behavioral science experts to address a need for improved competency of healthcare providers to address issues related to women's sexual health. They developed evidence-based tools, competencies, and recommendations to help healthcare providers improve care of women with sexual dysfunction. Competencies include an understanding of psychosocial issues and how relationship, fatigue, stress, and other factors influence sexual function; clinical skills to communicate about, diagnose, and manage sexual health issues; and practice-related skills. The association has posted the clinical competencies and fact sheets about female sexual functioning, common myths, and tips for talking with patients about sex and sexuality on its website.
MMWR Reports on Severe 2009 Pandemic Influenza in Pregnant Women
The March 26, 2010, Morbidity and Mortality Weekly Report describes the severity of the 2009 pandemic influenza A (H1N1) infection in pregnant and postpartum women, summarizing 17 cases in which these women required admission to New York City intensive care units. Nine of the patients were admitted to ICUs from April to June, and 8 were admitted from October to December. The average length of stay was 12 days. Patients ranged in age from 20 to 37 years, with a median age of 23 years. Two women died. Twelve of the women did not have any known risk factors for flu complications; 1 had asthma and cardiovascular disease, which was diagnosed postmortem; 1 had sickle cell disease; 1 had asthma; 1 had a seizure disorder; and 1 had diabetes mellitus. All the women were treated with oseltamivir antiviral therapy; however, only 1 woman started the drug within 2 days of onset of symptoms, which is associated with better outcomes. Only 1 of the 17 women had received a 2009 H1N1 vaccination. Eleven of the women were in their third trimester, and 9 of the women delivered during the hospitalization, 4 by emergency cesarean section. There were 8 live births and 1 stillborn. Of the live births, 1 died soon after birth and 6 were admitted to the neonatal ICU. The authors encouraged health departments and healthcare providers to educate the public and postpartum women about flu risks and start empiric antiviral therapy as soon as possible.
Reproductive Health 2010 Conference
The Association of Reproductive Health Professionals, the Planned Parenthood® Federation of America, and the Society of Family Planning will hold their annual conference, Reproductive Health 2010, in Atlanta, September 22-25, 2010.
Gene Variants That Increase Preterm Birth
Researchers at the National Institutes of Health have discovered maternal and fetal DNA variants involved in the regulation of inflammation and of the extracellular matrix, which appear to increase the risk for preterm labor and delivery. Prior research by Roberto Romero, M.D., chief of the perinatology research branch and program head for perinatal research and obstetrics at the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), found that about 1 in 3 preterm infants is born to a mother with a silent infection in the amniotic fluid. The mother and baby fight the infection by using hormones that stimulate the immune system and also play a role in labor. Romero theorized that the mother or the fetus or both signal the onset of labor when the uterine environment becomes unfavorable and threatens survival. The severity of the immune response varies among individuals. The team also found DNA variants in genes involved in the extracelluar matrix associated with preterm labor. The findings may explain why preterm labor occurs in some patients and not others, said Alan E. Guttmacher, M.D., acting director of the NICHD. NIH scientists hope the study will lead to new strategies for identifying patients at risk for preterm birth and ways to reduce its occurrence.
Reasons for Women's Admissions to Hospitals
The Agency for Healthcare Research and Quality reported that women accounted for nearly 60% of the 39.4 million hospital admissions in 2007, with the leading reason being pregnancy and childbirth, responsible for about 5 million of the 23.2 million women's hospital admissions. Cardiovascular disease contributed to 2 million hospital stays for women, followed by pneumonia at 608,000 admissions, osteoarthritis at 498,000 admissions, depression and bipolar disorder at 442,000 admissions, urinary tract infection at 383,000 admissions, septicemia at 354,000 admissions, and skin infections at 282,000 admissions. The data were collected as part of the 2007 Nationwide Inpatient Sample, a part of AHRQ's Healthcare Cost and Utilization Project.
Gynecologic Cancer Foundation Issues Annual State of the State Cancer Report
The Gynecologic Cancer Foundation released its 2009 State of the State of Gynecologic Cancers Report available for download at its website. The report highlights the latest data about each gynecologic cancer's symptoms, risk factors, screening and prevention, incidence, and treatment. The report also includes an update about legislation of interest to the gynecologic cancer community, an article about the importance of patient-physician surviorship teams as survival rates increase for women with gynecologic cancers, and another about fitness.
The ISIS Lifestyle and Fertility Study
The Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) is sponsoring an observational clinical trial to learn if certain lifestyle factors can influence a couple's ability to conceive and have a baby. The ISIS Study will look at the health habits of couples who are planning their first pregnancy and then attempt to measure the effect these habits have on the couple's fertility. The ISIS Study hopes to clarify the link between lifestyle and fertility. Researchers believe that information gained in this project may help future couples in their attempts to conceive. Researchers plan to enroll 1150 couples. Women must be aged 20-34, have regular periods, and use some form of contraceptive. The trial is taking place at Dartmouth Medical School/Boston IVF/Harvard Vanguard Medical Associates in Boston; Dartmouth-Hitchcock Medical Center in Lebanon, NH; and Penn State University in University Park, PA.