GoodSearch - Searching for a Cause

GoodSearch uses the Yahoo! Search Engine, and donates money to an organization selected by the searcher based on the number of searches run. According to the GoodSearch FAQ,

Search engines make most of their money from companies that pay an advertising fee when users click on links during a search. At GoodSearch, we've developed a patent-pending way to track and direct these search-generated proceeds to charities. In other words, a portion of advertiser dollars (and not your own!) earned as a result of your search, are now passed along to the organization you've chosen to support.

You can add GoodSearch to your Explorer or Firefox toolbar.
(Found via LibrarianInBlack)

Local and national organizations relevant to women's health you may contribut to using GoodSearch include:

Boston Women's Health Book Collective, Inc. (the Our Bodies Ourselves people)

Breast Cancer Education Initiative, Inc - Germantown, TN

Human Being Care, HIV Resources, Inc. - Jackson, TN

Memphis Regional Planned Parenthood, Inc. - Memphis, TN

Ovarian Cancer National Alliance

Planned Parenthood of Middle and East Tennessee, Inc. - Nashville, TN

Susan G Komen Breast Cancer Foundation

Tennessee Breast Cancer Coalition Inc. - Nashville, TN

Y-ME National Breast Cancer Organization, Inc.

Please note that I am not necessarily familiar with these organizations and am not endorsing them, but found them as women's health donation options through the GoodSearch list of charities, which really needs a subject browse and location search. At this time, you may only search by organization name.

Technorati Tags: charity; search; women's health
MeSH Tags: Charities; Internet (consumer health); Women's Health (consumer health)

Surgeries to Avoid

Consumer Reports has released an article titled, "12 Surgeries You May Be Better Off Without." The procedures specific to women are hysterectomy, C-section, and episiotomy. The article describes some conditions for which the surgeries are commonly performed, and gives recommendations for when the surgeries should and should not be done.
(Found via Kevin, MD)

Fact sheets on these procedures:
Hysterectomy - National Women's Health Information Center
Episiotomy: A Cut You May Not Need - MayoClinic.com
What You Need to Know About Cesarean Birth - March of Dimes

Technorati Tags: C-section; episiotomy; hysterectomy; surgery
MeSH Tags: Cesarean Section; Episiotomy; Hysterectomy OR Hysterectomy, Vaginal

It's Self-Cleaning, Ladies

Several feminist bloggers have been discussing recent news on douching. The referenced study, published in the Dec 05 issue of Sexually Transmitted Diseases, examined whether intervention could reduce the prevalence of douching among women. Discussion on blogs such as I Blame the Patriarchy, Feministing.com, and Pandagon, centers around the statistic that >25% of U.S. women of childbearing age report douching regularly.

Why is this notable? Because douching is not recommended or considered safe, because:

Douching changes the delicate chemical balance in the vagina (and the vaginal flora), which can make a woman more prone to bacterial infections. It also can spread existing vaginal or cervical infections up into the pelvic organs (uterus, fallopian tubes, and ovaries).

Research shows that women who douche on a routine basis tend to have more problems than women who do not douche or who rarely douche. These problems include vaginal irritation, infections (called bacterial vaginosis or BV), and sexually transmitted diseases (STDs). Women who douche often are also more at risk for getting pelvic inflammatory disease (PID). PID is an infection of a woman's pelvic organs. It is caused by bacteria, which can travel from a woman's vagina and cervix up into her pelvic organs. If left untreated, PID can lead to infertility (not being able to get pregnant) and ectopic pregnancy (pregnancy in the fallopian tube instead of the uterus). Both BV and PID can lead to serious problems during pregnancy, such as infection in the baby, problems with labor, and early delivery.

Douching also does not prevent pregnancy, as some women seem to believe. The bottom line? Your vagina is self-cleaning, and douching may actually cause health problems. Not to mention that you probably don't want to give your money to a company who sells you cleanliness and confidence, only to help you get infections.

Worth noting in the results of the 2002 edition of the National Survey of Family Growth, which measures such things, are the education, sexual, and racial disparities in douching activitity. Those who reported having douched in the past 12 months were more likely to have first had sex prior to age 15, live in the South, be African American, and/or have reached lower educational levels. Those who douched were more likely to report having family planning or medical care in the past 12 months. Given the study that interventions reduce douching, and the fact that these women are getting healthcare, it seems that healthcare providers should make more of a point to ask and educate about this practice. I have never been asked in a GYN visit whether or not I douche. It seems that if providers ask, it opens up a window to educate the patients.

Technorati Tags: douche; hygiene; women's health
MeSH Tags: Irrigation/adverse effects OR Vaginal Douching/adverse effects

Search Request Roundup #2

This is the second installment of Search Request Roundup, in which I look at recent searches that led to my blog and provide some information on the desired topics.

Symptoms of Pregnancy: MayoClinic.com has this nice overview of early symptoms of pregnancy, which include tender, swollen breasts or nipples, fatigue, slight bleeding or cramping, nausea, frequent urination, constipation, dizziness, headaches, and other fun.

Uterine Penile Penetration: FamilyDoctor.org provides information on painful sexual intercourse (dypareunia), and says, "Women report the feeling that "something is being bumped into." The uterus may hurt if there are fibroid growths, the uterus is tilted or if the uterus prolapses (falls) into the vagina. Certain conditions or infections of the ovaries may also cause pain, especially in certain sexual positions. Past surgeries may leave scar tissue that can cause pain. Because the bladder and intestines are close to the vagina, they may also cause pain during sex." I could not find anything suggesting the penis could actually penetrate the uterus.

Women's Medical Check Up: It's hard to tell what this searcher wanted, but here are some charts explaining when certain health screenings should occur (parts 1 & 2), and a guide from Planned Parenthood on how to prepare for and what to expect during a gynecological exam.

Symptoms of Miscarriage: MedlinePlus has a good overview on miscarriage, covering symptoms, causes, signs, tests, and complications. The listed symptoms include low back or abdominal pain, bleeding, and/or tissue/clot-like material expelled from the vagina. The March of Dimes has more detailed information on causes of miscarriage.

Sexual Harrassment Laws: The EEOC provides information on federal sexual harrassment laws, which apparently only apply when there are 15 or more employees at a workplace...

What does FAAFP mean?: This "Degree of Fellow" credential is issued by the American Academy of Family Physicians to physicians "who have distinguished themselves among their colleagues, as well as in their communities, by their service to family medicine, by their advancement of health care to the American people, and by their professional development through medical education and research."

Technorati Tags: health screening; miscarriage; physicians; pregnancy; sexual harrassment; sexual health
MeSH Tags: Abortion, Spontaneous; Dyspareunia; Pregnancy; Sexual Harrassment/legislation and jurisprudence

Contribute Your Pregnancy or Childbirth Story to a New Book

The folks from Our Bodies Ourselves are soliciting stories of childbirth and pregnancy for inclusion in a new book. You can fill out a simple web form to share your story for this project, which will "explore the strengths and limitations of our current maternity care system and how women can get the best care possible."

Perhaps some of our locals, such as Bad Bad Ivy, Ms. Booty Homemaker, BusyMom, or Jamie of BlondeMomBlog have something they'd like to contribute. Hmmm?

(Found via BitchPhD)

Technorati Tags: books; childbirth; pregnancy
MeSH Tags: Parturition OR Labor, Obstetric; Pregnancy

More from Yahoo! Answers

I had another look at Yahoo! Answers today, as I am interested in what types of women's health questions are being asked of strangers on the web. Among the notable questions:

I have been bleeding continuously since I gave birth in January. What could be the cause of this?

What does it mean when a woman has a white creamy gel substance in her vagina? - one of the (wrong) answers: It's just white blood coming out. And don't worry it's just normal for a female to experience these.

Can you get pregnant from oral sex? - users correctly answered no, and pointed out the risk of STDs

I recently had a tubal ligation and D & C they had to do laparotomy what is the recovery time? - what the patient could expect should have been explained before the procedures were done

I had my tubes tied in Jan of 1999 and still have problems with pain is this normal so day i cant hardly move?

What are tampons? - I added an answer to this one, linking to a site that explains how they're used and TSS risks

And the most disturbing:
what are the symptoms of lossing my virginity? i was drunk and i dont know what happened, when i asked the guy he told me thathe did it to me but i want to know my self. so is ther any symptoms for that? many thanks

I remain disturbed that these individuals haven't asked their healthcare providers about these issues, particularly in cases of prolonged bleeding or pain. It's not clear whether a lack of information, lack of access to healthcare, embarrassment, or some other factor is responsible. Something strikes me as seriously wrong when a girl wants to know "symptoms" of losing her virginity because she may have been sexually assaulted while drunk. These women clearly have an information need that is not being filled through traditional, expert channels. If I were experiencing long-term pain or bleeding, I would make an appointment or call my provider right away, and I'm interested in why others would not. So, to my readers, are there questions you won't ask your healthcare provider? If so, why? If you're a healthcare provider or librarian, what's your take on this information disconnect? To the health librarians - are you willing to begin answering some of these questions? Do you feel any professional responsibility to stamp out health misinformation and improve the links between individuals and the information they need, outside of your institution? Just curious.

Technorati Tags: health information; librarians; librarianship; Yahoo
MeSH Tags: Health Promotion AND Internet; Internet/utilization

A little catching up

A couple of things of note from the last few weeks:

11/05: The CDC released preliminary data for 2004 on infant and maternal health. Among the findings: 1) the rate of c-section delivery rose 6% to be 29.1% of all births, reaching the highest level ever reported in the US, and a 40+% increase since 1996; 2) no improvements in timely receipt of prenatal care was found; 3) the rate of vaginal birth after cesarean has declined 67% since 1996.

11/29/05: Mother Jones has put together a timeline of activities related to emergency contraception, with links to the text of press releases, statements, news articles, and legislation relevant to the drug and the controversy over over-the-counter access.

12/6/05: The legislature of Virginia has moved to allow certified professional midwives to legally practice in the state.

12/22/05: Feministing.com points out some rather offensive T-shirts with slogans such as "It ain't rape if she ain't awake," "By reading this you consent to oral sex," "Stop rape. Consent," "Slept my way to the top," and "Abuse me." I'm all for free speech, but not so much for making money from having a laugh about sexual abuse.
Technorati Tags: childbirth; emergency contraception; midwifery; sexual abuse; vbac
MeSH Tags: Cesarean Section; Contraception, Postcoital; Midwifery; Sex Offenses; Vaginal Birth After Cesarean

The Information Deficit

Information technology, women's health, and librarianship collided in an interesting way for me this week. Yahoo! launched a new online tool, Yahoo! Answers. This site allows users to ask almost any question, and receive answers online from other Yahoo! users. Unlike Google Answers, researchers aren't vetted in any way, and there is no charge for receiving answer. Unlike asking your local librarian, there is limited opportunity to clarify the question, or correct/weed out misleading or inaccurate information.

For example, I was browsing the Yahoo! Answers questions, and came across this one: When do you start to show during pregnancy?
Three people answered, with responses ranging from "3 months" to "it depends on..." After receiving answers, the user can choose to select the best answer, call for a vote on an answer when there are multiple answers, or extend the deadline on answering the question. In this way, the user may actually think their question is answered appropriately and close the question, even if the provided answer is wrong. Likewise, if another more knowledgable user wants to add clarifying information, this can't be done on a closed question.

The thing that really disturbed me about this question was the follow-up from the author: "Thanks that help me a lot because i really don't know if i'm pregnant but i have the syptoms of pregnancy and i have not started my period in 3.5 months."
Clearly, this user has information needs beyond "when do you start to show?" These might include:

That a pregnancy test can be obtained at a drugstore for $10-$15.

That there are other causes of amenorrhea aside from pregnancy

That if a pregnancy is confirmed, at least two recommended prenatal care visits have already been missed

Information on pregnancy and prenatal care

Where to go in the local community for low and reduced cost care

A good librarian could have delved further into the request with the patron to bridge the gap between the stated need and the real need. Unfortunately, due to the closed answer, other Yahoo! users cannot provide this type of information. The implications of the question are notable - that the asker thinks she might be pregnant, hasn't gotten her period in months, and is looking to find out whether she should be showing yet as confirmation or refutation of a pregnancy. One wonders about the circumstances she is facing, and what led her to ask an anonymous and decidedly non-expert online community for an answer.

I've been troubled by this user's question, and the distance between the answer she got and the answer she needs. I'd also like to use this opportunity to encourage people to use their local librarians. You may think of them as the people who check out the books, but this is like saying a doctor writes prescriptions. While true, there is a vast store of expertise and knowledge in your librarian that can be used to answer your every question. As your doctor is an expert on medicine, and your lawyer is an expert on your legal needs, your librarian is an expert at digging up the information you need, no matter how trivial or profound. Your librarian will never close your question, and will never let an answer go at face value when you give her/him signs that you really need more.

Technorati Tags: health information; librarians; search
MeSH Tags: Internet/utilization; Librarians; Library Services

First post....

Well, I've decided that I'm going to try blogging about myself: as a working mom, as a wife, as a woman, as a friend, and as a daughter. Some days I'm all those things in one, somedays I don't want to be any of them, I just want to be Lisa. But all in all, I love being a mommy to my two wonderful boys, a loving wife to my amazing husband, a friend to many, and a dutiful daughter to the two best parents anybody could have ever asked for. This will be my own personal journey into growth and development and maybe someone can learn something and hopefully I will learn a lot! I'll also be blogging about the boys I'm sure and how they make me feel incompetant sometimes and the best mommy in the world others. Happy Reading!

Nashville Was Talking, Rachel Will Be Talking...

I know, I know, I've been a bad blogger with few updates. The end of this semester has been a killer. Fear not, blog reader - because I'm focusing on medical librarianship, I was able to set it up so my independent study for next semester (starting Jan 4) will be to work on this blog. Regular updates will be required, and I'm looking forward to it. Next weekend, I'll try to catch you up on some stories that have slipped by in the interim.

Here's what I was up to during my 4-day Thanksgiving tenure as the guest-blogger at Nashville Is Talking:

Fun With Light Poles

Middle Ground on Immigration?

First Car Reminscence

When You Just Can't Get Enough Consumerism

Another Lovely Pic From Sugarfused

Freedom of Speech is Killin' the Children!

The NiT Movie Roundup

Metro as Absentee Landlord?

6 Degrees of Sharon Cobb

Some Good News from New Orleans

TN Voting Machines to Get Upgrade

World AIDS Day

Because You Never Know What Girls Might Do With Accurate Information (on the Oak Ridge High School censorship of an article on contraceptives)

Live Tape-Delayed Thanksgiving Blogging

Airline Woes

Electoral Insights

Charlie and the Amoral, Capitalist Factory

Williamson County Wastefulness?

Excellent Use of the Phrase "Crap Shoot"

Striving For Understanding

Response to the "Kid Haters"

A Morbid Commemoration

Is it April 1 Already?

That Doesn't Look Like Fondant

I'm Buying Coffee

What You're All Thankful For

Nashville Isn't Talking

The Holidays are for Sharing

Same Story, Different Day (uh, Century)

BLOG - a Poem (check it out if you want a glimpse of how I wrote circa 1984)

ThanksGIVING

What's on the Menu?

Oh Yeah

I've been guest-blogging over at Nashville is Talking for the holiday weekend, preceded by mid-term projects for the grad program, which is my excuse for my extended lack of posts. Will be back soon!

FDA has Named a New Director for its Office of Women's Health

Kathleen Uhl, M.D., FAAFP, has been appointed as the new director of the FDA's Office of Women's Health. The previous director, Dr. Susan Wood, resigned in August in response to the FDA's handling of the Plan B decision. An interview with Wood appears in the current Nerve magazine.

According to the FDA's press release, Uhl is board certified in Family Medicine, first joined the FDA in 1998, most recently as Supervisory Medical Officer in CDER's Pregnancy and Lactation Labeling Team in the Office of New Drugs, and will take on the role in mid-December.
Technorati Tags: FDA
MeSH Tags: United States Food and Drug Administration

GAO issues report on FDA's Plan B Actions

The Government Accountability Office issued a report today titled, "Decision Process to Deny Initial Application for Over-the-Counter Marketing of the Emergency Contraceptive Drug Plan B Was Unusual." That is the most humorous title I've ever seen on a government report. Aside from that, the report describes the GAO's findings after the Office was asked to examine "1) how the decision was made to not approve the switch of Plan B from prescription to OTC, 2) how the Plan B decision compares to other proposed prescription-to-OTC switches from 1994 through 2004, and 3) whether there are age-related marketing restrictions for prescription Plan B and other prescritpion and OTC contraceptives." Questions about the process were raised because "the not-approvable decision for the Plan B OTC switch application was contrary to the recommendations of FDA's joint and advisory committe and FDA review staff." The GAO reviewed the FDA's actions prior to the 5/6/04 non-approvable letter for the initial application. The full text of the report is available here as a PDF.

I haven't had time to read all 62(!) pages of the report, but here are a few direct excerpts from the "What GAO Found" section:

The Plan B decision was not typical of the other 67 proposed prescription-to-OTC switch decisions made by FDA from 1994 through 2004

The Plan B OTC switch application was the only one during this period that was not approved after the advisory committees recommended approval

The Plan B action letter was the only one signed by someone other than the officials who would normally sign the letter

Further, there are no age-related marketing restrictions for any prescription or OTC contraceptives that FDA has approved, and FDA has not required pediatric studies for them

FDA identified no issues that would require age-related restrictions in the review of the original prescription Plan B new drug application

GAO found that high-level management’s involvement for the Plan B decision was unusual for an OTC switch application and FDA officials gave GAO conflicting accounts about when they believed the decision was made

The Acting Director acknowledged to GAO that considering adolescents’ cognitive development as a rationale for a not-approvable decision was unprecedented for an OTC application, and other FDA officials told GAO that the rationale differed from FDA’s traditional practices.

Technorati Tags: emergency contraception; FDA; politics; Plan B; women's rights
MeSH Tags: Contraception, Postcoital; Levonorgestrel; Health Policy: Politics; Women's Health

Feminism is Good for Your Health

Remember the old bumper sticker, "If you're not [angry], you're not paying attention?" Looks like it's time for a new one reading, "If you're not angry, you're hurting your health." A small study published in the November issue of the journal Biological Psychiatry compared "Ninety-two healthy adults engaged in stress-challenge tasks, during which cardiovascular responses, hypothalamic-pituitary-adrenocortical (HPA) axis responses (i.e., cortisol), emotional expressions (i.e., facial muscle movements), and subjective emotional experience (self-reported) were assessed." The authors concluded that "Analyses of facial expressions revealed that the more fear individuals displayed in response to the stressors, the higher their cardiovascular and cortisol responses to stress. By contrast, the more anger and disgust (indignation) individuals displayed in response to the same stressors, the lower their cortisol levels and cardiovascular responses." The abstract of the study is available for free here, and a summary provided by womenshealth.gov is available here.

Okay, the title of this post was a bit of a joke, but I got a chuckle out of it. :)
Technorati Tags: heart disease; stress
MeSH Tags: Anger; Fear; Heart Diseases; Stress, Psychological

Ortho Evra Warnings Issued

CNN has a story today, Warning issued about birth control patch. There is concern about increased risk of blood clots in women using the patch compared to those on the pill. The FDA also issued a press release and a set of questions and answers about the patch. According to the FDA materials, "A woman on Ortho Evra may be exposed to approximately 60% more estrogen than if she were taking a typical 35 microgram estrogen birth control pill." The FDA has released a new label for the product, which is available here as a PDF.
Technorati Tags: birth control; contraception
MeSH Tags: norelgestromin

The Last Abortion Clinic

NPT aired the Frontline special, The Last Abortion Clinic, tonight, including interviews with health professionals and activists on both sides of the abortion debate. The program discussed current abortion politics and issues in general, but also provided coverage focused on the only remaining abortion clinic in Mississippi. The website for the program provides general information on the abortion issue in America, a discussion of young womens' attitudes, a map detailing each states' abortion regulations, and the text of extended interviews with those featured in the program. A synopsis of the issues covered in the show is available, and it will be available for viewing online after 5pm on Wednesday.
Technorati Tags: abortion; PBS; reproductive rights
MeSH Tags: Abortion, Induced

Sexual Activity Among Tennessee's Teenage Girls

The Nashville City Paper today published an article entitled, "Teen Sex Activity Rate Jumps." The article actually focuses specificially on teenage girls, as the information comes from preliminary data presented at a recent conference on pregnancy and infant health. Among the findings, comparing girls in grades 9-12 in 2004 compared to 2003 (quoted directly from the article):

"Sex in the last three months rose from 36 percent in 2003 to 41 percent in 2004;

Sex with more than four people rose from 12 percent to 15 percent;

Experienced date violence rose from 9 percent to 11 percent;

Been forced to have sex rose from 13 percent to 15 percent; and

Had sex under the age of 13 rose from 4 percent in 2003 to 13 percent in 2004

Condom use decreased from 48 percent in the last survey to 30 percent in 2004"

Many readers may focus on the opening statement of the article: "Sexual activity among female teenagers grades 9-12 in Tennessee has jumped from 47 percent in 2003 to 55 percent in 2004. About 13 percent of girls under the age of 13 have been sexually active." Josh Tinley astutely points out that the article does not explain how "sexual activity" is defined for the purposes of this study. This document (PDF) from the CDC, the administrator of the Youth Risk Behavior Survey from which the data is gathered, provides the text of the 2005 questions. A reading of the survey reveals that sexual activity is described as "sexual intercourse," although a definition of that term is not provided for the survey participants.

The results are certainly a cause for concern, if only because they seem to indicate that teen girls are having sex more, but using condoms less frequently. I am also troubled by the increase in "date violence" and girls having been forced to have sex. According to the Census Bureau's 2003 American Community Survey, there were 107,755 girls aged 15-17 enrolled in school in 2003. As a proxy for the number of TN girls in grades 9-12 in 2004, it's not perfect, because the age groups don't match up exactly and the population has likely changed. However, if you take 15% of that conservative 2003 figure, that's 16,163 girls who reported having been forced to have sex and 11,853 who reported date violence. In light of these findings, here is a list of sexual assault programs in Tennessee.

The complete national report is expected in spring of 2006; the survey also addresses issues such as weapons, seat belt use, drugs and alcohol, and smoking.

Technorati Tags: abuse; public health; rape; sex; Tennessee
MeSH Tags: Adolescent Behavior; Risk-Taking; Sexual Behavior/statistics and numerical data

Vinnie Helps Chart Your Period

Odd book alert: I stumbled across Vinnie's Giant Roller Coaster Period Chart & Journal Sticker Book today. The book description on Amazon says, "The curse, the crimson tide, Aunt Flo-no matter what you call it, menstruation is often a taboo subject. Then along came Vinnie, who’s made it his mission in life to demystify periods for women (and men!) the world over." If I were still in the dark about menstruation, I'm not sure I'd want a male, unibrowed, mechanic named "Vinnie" explaining it to me. It just seems rather strange, but I feel oddly compelled to get my hands on a copy. You really have to view the cover image to appreciate the true and intriguing weirdness of the illustrations. Check out the customer reviews on Amazon, which are split between thinking the book is cool and useful, and thinking it's weird and creepy. The author, an art school attendee, apparently came up with the idea for his tampon cases and the books after his friends complained that their tampons were getting crushed in their backpacks. To which I say, check out the bevy of menstrual product alternatives, or make better use those little zip front/side pockets, ladies.
Technorati Tags: alternative menstrual products; books; menstruation; tampons
MeSH Tags: Books, Illustrated; Menstrual Cycle

Update on Emergency Contraception Bill in House

The bill number for the proposed legislation to either get the FDA to act on OTC status for Plan B, or, failing that, to go ahead and make it available over the counter, is HR 4229. You can read the official full text of the bill, keep up with Congressional actions on the legislation, and view the list of Representatives co-sponsoring the bill (none from TN), courtesy of the always useful THOMAS site.

The most recent action on the bill was a referral to the House Committee on Energy and Commerce. Tennessee's Bart Gordon and Marsha Blackburn serve on this committee. To contact the Committee, fill out this form. To write to your Representative, select your state and enter your zip code on this House webpage; it will figure out who your Rep is and allow you to complete an online form with your feedback.

Thanks to Chris, who gets to be honorary librarian-for-the-day for digging up the bill number.
Technorati Tags: emergency contraception; FDA; politics; Plan B; women's rights
MeSH Tags: Contraception, Postcoital; Levonorgestrel; Health Policy: Politics; Women's Health

Former President Clinton Establishes Breast Cancer Fund

In collaboration with the National Breast Cancer Coalition, former President Clinton has helped establish the Virginia Clinton Kelley Fund. Clinton's mother died from breast cancer in 1994. According to the NBCC's website, the fund will "support NBCCF programs, which educate and train breast cancer survivors to influence research and public policy, foster innovation in research and health care, and expand access to quality care. This fund will also support collaborations among women with breast cancer, researchers and health care stakeholders." The Kaiser Network reports that the fund will also support "high-risk" research.

Breast cancer resources:

Breast Cancer Home Page - National Cancer Institute

What You Need to Know About Breast Cancer - National Cancer Institute

Breast Cancer - MedlinePlus Medical Encyclopedia

MedlinePlus Breast Cancer

Detailed Guide: Breast Cancer - American Cancer Society

Breast Cancer Glossary - Cleveland Clinic Foundation

Y-ME National Breast Cancer Organization

Breast Cancer (neoplasms) Clinical Trials - ClinicalTrials.gov
Technorati Tags: Bill Clinton; breast cancer; cancer
MeSH Tags: Breast Neoplasms; Organizations, Nonprofit

House Bill to Make Emergency Contraception Available OTC

Thursday, 4 members of Congress introduced legislation regarding making Plan B emergency contraception available over-the-counter. A summary with links to press coverage/releases is available from Kaiser's Daily Women's Health Policy. The legislation requires the FDA to make a decision on allowing OTC status within 30 days of enactment of the bill; if the FDA fails to do so, the drug would automatically obtain OTC status. The bill was introduced by Representatives Carolyn Maloney (D-NY), Christopher Shays (R-CT), Jay Inslee (D-WA) and Joe Crowley (D-NY), members of the Congressional Pro-Choice Caucus. Maloney's press release is available here, and the text of the proposed legislation is available here (PDF).

Note: I haven't found this yet in the THOMAS legislative information website. When it's up, I'll post a link so you can follow the bill status.
See update post for the bill's site (including actions and status) and info on finding and contacting your Representative.
Technorati Tags: emergency contraception; FDA; politics; Plan B; women's rights
MeSH Tags: Contraception, Postcoital; Levonorgestrel; Health Policy: Politics; Women's Health

Daily Women's Health Policy Report

I just discovered this gem from the Kaiser Family Foundation, the Daily Women's Health Policy Report. It provides updates on government activities and legislation that affect women's health. Look for a couple of policy-related posts shortly.
Technorati Tags: policy; women's; politics
MeSH Tags: Health Policy: Politics; Women's Health

Fun with Infectious Diseases

Your women's health blogger is home with a case of strep throat, and just awoke from a several-hour nap. Apparently only about 5-10% of sore throats are caused by bacteria (rather than viruses); this blogger suffered from enough of these infections as a child to recognize the red throat stripes and miraculously get a clinic appointment this morning. Seriously, I'd rather get 5 shots than a throat culture. Here's some information on the culprit, while the fever has subsided. Ugh.

MedlinePlus Medical Encyclopedia article - covers symptoms, treatment, complications (including scarlet and rheumatic fever, and kidney inflammation)

Overview from FamilyDoctor.org

Lengthier overview from MayoClinic.com

In other infectious news, the CDC has posted the weekly flu map. Check it out periodically and watch how influenza spreads across the nation.
Technorati Tags: flu; influenza; strep
MeSH tags: Influenza; Pharyngitis; Streptococcal Infections

Oh My Nashville: EC and Rape

An interesting discussion has been going on at Nashville is Talking regarding emergency contraception, particularly a case in Tucson in which a woman was refused EC at a pharmacy after being raped. This was one of the most remarked upon stories on NiT for a couple of days, starting here, followed by a compelling and colorful response (as usual) from Aunt B., and continuing here. I've stayed out of the fray for a few days, wanting to collect my thoughts. I try to stick to information provision, but politics seem to frequently intrude into the world of women's health, and there is no doubt that prescription refusals have an impact on women's access to healthcare. I was surprised by some of the comments from other area bloggers/blog commenters. Let's take them point by point, and try to provide some info in each area:
(Warning: this is a long post, but it's a topic that merits attention and informed discussion)

First, the basics of the story that sparked so much discussion. Regarding the sexual assault victim - "While calling dozens of Tucson pharmacies trying to fill a prescription for emergency contraception, she found that most did not stock the drug. When she finally did find a pharmacy with it, she said she was told the pharmacist on duty would not dispense it because of religious and moral objections." You can read the full story here.

Some of the arguments:

Point: If you wouldn't be worried about an obstetrician refusing to provide abortions, you shouldn't be worried about this.

Information: Obstetrics is a specialized field, and abortion provision is even more specialized. A 2003 survey of US OB/GYN department chairs (78 of 126 responding) found that only 45% offered clinical experience in abortion during the 3rd year OB/GYN clerkship. In the 3rd year, 23% provided no formal education on abortion, and many covered abortion only via lecture. The topic is not covered at all in 17% of US medical schools. Essentially, abortion education is not only not required for obstetricians, it is not necessarily even available. As a result, expecting any and all obstetricians to provide abortion services (regardless of any moral stance) is not only misguided, it would be dangerous, negating the analogy. Pharmacists, on the other hand, are expected (with the exception of conscience clauses) to be able to dispense any medication in stock in a knowledgeable way, and are trained to do so. An MD is not an obstetrician is not an abortion provider, but a pharmacist is a pharmacist.

Point: A woman could just go to another pharmacist.

Information:
1) Not every place has a pharmacy on every corner. Let's assume it's reasonably easy for a woman to obtain EC if there is a provider in her county, as a proxy for being within a reasonable distance. The 2002 Economic Census reports that there were 40,530 pharmacies and drug stores in the US. 39,282 of these offered prescription drugs. As of 7/7/2001, there were 3,141 counties in the US. That works out to an average of 12.5 pharmacies providing prescription drugs per county. Of course, some have many more. A quick search of yellowpages.com for Nashville returns 152 results for pharmacies and drug stores. For the average to work out, for every city like Nashville, teaming with pharmacies, there must be ~12 counties with 0-1 pharmacies.

2) Many pharmacies don't stock the drug. A study based on site vists conducted in Albuquerque, NM found that of 89 pharmacies, only 19 (11%) had emergency contraception in stock. Another report,based on a survey of pharmacists in Pennsylvania found that only 35% would be able to fill the prescription that day. Of those who couldn't fill the prescriptions, 79% reported that it was because the drug was not in stock; others reported that it was against store policy (6%), it conflicted with personal beliefs (7%), or they gave no reason (8%). Several of the pharmacists in the same study provided incorrect information about EC drugs, such as stating that they are not available in the US. Limited access is not only an issue in rural or small metro areas: a 2004 report to the New York City Council found that in NYC, 25% of pharmacies still do not stock EC.

Point: If she had gone to a hospital, she could have obtained the drug.
Information: A 2002 study published in a recent issue of Annals of Emergency Medicine reports on a survey of a sample of emergency rooms nationwide found that 42.2% of non-Catholic and 54.9% of Catholic hospitals reported that EC was unavailable under any circumstances. 37.3% of non-Catholic and 28.8% of Catholic hospitals only provided EC under restricted circumstances, such as sexual assault. Of those who did not provide EC, 47.7% (Non-Catholic) and 53% (Catholic) either refused to provide a referral or provided an invalid referral. Another 2003 study of Oregon emergency departments published in the American Journal of Public Health found that only 61.1% routinely offered EC to rape victims. As a result, it seems that EC provision is not part of routine care of sexual assault patients in all hospitals.

Point: The victim had an obligation to visit the hospital and report the incident to the police.
Information: It's a valid concern that women who don't report rapes leave the rapists free to commit future assaults. However, this particular victim is certainly not alone in not reporting the crime. According to this CDC fact sheet, only 39% of rapes and sexual assaults were reported to police in 2002. It also lists psychological consequences of rape, which include denial, withdrawal, guilt, and distrust of others, which may affect reporting. Regardless of the police reporting, it should not affect her access to legal medical care. The DSM-IV futher lists acute stress disorder as occurring immediately after 14-33% of all traumas, lists hopelessness as a symptom, and states, "Individuals with this disorder often perceive themselves to have greater responsibility for the consequences of the trauma than is warranted. Problems may result from the individual's neglect of basic health and safety needs associated with the aftermath of the trauma." Also among the diagnostic criteria are "Marked avoidance of stimuli that arouse recollections of the trauma" and "impairment in social, occupational, or other important areas of functioning or impairs the individual's ability to pursue some necessary task, such as obtaining necessary assistance or mobilizing personal resources by telling family members about the traumatic experience." According to these definitions, psychological response may be a major factor in underreporting of sexual assault.

Point: The victim's actions (drinking, going home with a stranger) were the cause of the assault.
Information: The responsibility for rape rests with the victimizer. This page of myths and facts from the Office of Violence Against Women directly addresses these issues. A 1995 study found that individuals were more likely to put the blame for rape partly on the victim when she had been consuming alcohol. One wonders if society's attitudes such as this contribute to rape underreporting by making the victim feel responsible for the perpetrator's actions. One of alcohol's biological effect is to impair judgment. I doubt that many people one look their daughter or wife in the eyes and say, "Well, you sort of asked for it." This type of accusation against strangers is hypocritical and does nothing to increase reporting, but may confirm the victim's fears. Additionally, other types of preventive care are available to individuals whose actions could be thought to lead to the incident, such as antiretrovirals for needle sticks, trauma care for drunk drivers who get into car wrecks, and oncology care for long-time smokers.

Point: Pharmacists shouldn't be forced to dispense something they're morally opposed to.
Solutions? Let's ignore for a moment EC's mechanism of action. What are the solutions that allow women to receive treatment, and pharmacists to adhere to their personal beliefs? Some ideas:
1) Require physicians to know which pharmacies stock and dispense the drug. In any other physician referral, it is certain that the place they send you will provide the care they advise. If you need an X-ray, they send you somewhere that does X-rays. If you need surgery, they send you to a surgeon that performs that procedure.
2) Require pharmacies that stock the drug to have at least one staff member who will dispense it on duty at all times.
3) Construct a nationwide database of pharmacies willing to fill the prescriptions, with an indication of the limitations.
4) Make EC available over the counter.

Which of these solutions are morally acceptable, financially agreeable, and serve women's needs in the most efficient way? Again, sorry this was so long - it's a complex topic. That's all for now!

Technorati Tags: emergency contraception; pharmacists; rape; sexual assault; women's rights.
MeSH Tags: Contraception, Postcoital; Pharmacists/ethics; Rape/psychology

Homespun Breast Solutions

Beryl Tsang has a simple, DIY solution for women who have undergone mastectomy and want to even things out with a breast prosthesis - knit your own. This breast cancer survivor found the entrepreneurial spirit and founded Tit Bits after being unsatisfied with expensive commercial prostheses, and began knitting her own devices, which are cheaper and can be worn inside a regular bra. Beryl's story, along with directions for making your own, can be found here, or you can purchase one from the Tit Bits website. Your options include "everday" (flesh colors), "fancy" (patterned), or "floosie" (hot pink!); there are also choices for size, nipple, piercing, weighting, and yarn type. It sounds a little crazy, but after looking at the product online, I don't see why this couldn't work. And you'd never be without a hacky sack. :)
Thanks to Boing Boing for the heads up
Technorati Tags: breast cancer; mastectomy

Search Request Roundup #1

On occassion, I'll post resources as a result of searches that led to my site when I haven't already listed much on the topic. It's difficult to tell what the individual intended, so I'll provide some general information.

Ovary Removal

What is Ovarian Cancer? - American Cancer Society

Ovarian Cancer Home Page - National Cancer Institute

Ovarian Cyst - American Academy of Family Physicians

Hysterectomy - Benefits and Alternatives - MayoClinic.com

Methods of Mammography

Screening Mammograms: Questions and Answers - National Cancer Institute

Mammography - Radiological Society of North America

Mammograms and Other Breast Imaging Procedures - American Cancer Society

Breast Cancer Screening - National Cancer Institute
Technorati Tags: breast cancer; cancer screening; hysterectomy; mammograms; ovarian cancer; ovaries

October is National [blank] Month

October is Domestic Violence Awareness Month and National Breast Cancer Awareness Month.

Domestic Violence Resources:

Domestic Violence Toward Women: Recognize the Patterns and Seek Help - MayoClinic.com

Checklist for Leaving an Abuser - what to take with you, from the National Women's Health Information Center

Violence Against Women - NWHIC

Important Phone Numbers

YWCA of Nashville info and local resources

Breast Cancer Resources:

All About Breast Cancer - American Cancer Society

What You Need to Know About Breast Cancer - National Cancer Institute

Breast Cancer Treatment - National Cancer Institute

Breast Cancer Glossary - Cleveland Clinic

Y-ME National Breast Cancer Organization

While I'm at it, it's also National Medical Librarians Month. (list of Nashville medical libraries)
Technorati Tags: abuse; breast cancer; domestic violence; librarians; libraries

Vaccine for Cervical Cancer?

Merck presented the results of a clinical trial indicating that the GARDASIL vaccine "completely prevented early-stage cervical cancer and precancerous cervical lesions caused by the two most common forms of a virus linked to such cancers." The study was conducted on more than 12,000 women aged 16-26 from various countries. The study results were announced at a conference; as such, a full publication that can be evaluated for study design and methods is not yet available. The vaccine would work by preventing HPV infection, the main risk factor for the cancer.

Merck Cervical Cancer Vaccine Prevents Lesions
Experimental Cancer Vaccine Shows Promise
Merck's press release
What you need to know about cancer of the cervix - from the National Cancer Institute

That said, there are groups and individuals who oppose such a vaccine. HPV is a sexually transmitted infection, and vaccination is needed before sexual activity begins. Bridget Maher of the Family Research Council was quoted as saying, "Giving the HPV vaccine to young women could be potentially harmful, because they may see it as a licence to engage in premarital sex." Kristin Hayes of the Abstinence Clearinghouse likewise said "We're against vaccinating children [for HPV]. We don't know what this will do to children psychologically," for a 2005 piece in the journal Cancer Spectrum. Meanwhile, the Amercian Cancer Society estimates that in 2005, 10,370 cases of cervical cancer would be diagnosed in the US, and 3,710 women would die from the disease.
Technorati Tags: cancer; cervical cancer; hpv; stds; vaccines

Who Needs Rights?

An article in today's New York Times addresses the drug, misoprotol, covered in yesterday's post on miscarriage treatment. The piece is entitled, "Abortion Might Outgrow its Need for Roe v Wade," but the content of the article suggests otherwise. The article explains that in Brazil, where abortion is largely illegal, women began using misoprostol to end pregnancies (and suggesting it to other women) because miscarriage is listed as a side effect. If the drug fails, a surgical abortion may still be needed and/or birth defects can result, so the government restricted access to the ulcer drug. As a result, a black market developed. The article does mention the side effects of the drug, but the poor choice of title suggests that if Roe were overturned, women could move on just popping a pill, easy as pie. In reality, the piece suggests that in the absence of legal abortion, women still terminate pregnancies, but do so by resorting to dangerous self-medication practices without proper medical supervision, guessing at dosages and trying drugs that may be entirely inappropriate. The article also says that when the drug fails, Brazilian women turn up at hospitals for miscarriage treatment, potentially resulting in suspicions about whether they intentionally caused it. I imagine that if this became a trend in the US, women would experiment with any number of drugs that have miscarriage as a side effect, and those who prescribe them would come under the same scrutiny as those prescribing pain killers. Ultimately, we may add to the costs of healthcare, add to the size of the drug war (and the black market for drugs) by including women and physicians whose choices have been taken away, and create a new criminal class where all women who miscarry are under a cloud of suspicion. None of this will do anything to correct the situations that cause women to choose to terminate pregnancies, and the NYTimes article does women a disservice by suggesting the overturning abortion legislation would have limited consequences.
Technorati Tags: abortion; New York Times; reproductive rights

Drug Alternative to Surgery for Early Miscarriage

A study in the August 25 New England Journal of Medicine examined the use of the drug Misoprostol (normally used for stomach conditions) compared to vacuum aspiration for early miscarriage. 652 women with 1st trimester miscarriage were assigned to either the drug (491 women) or the surgical procedure (161 women), and followed for whether expulsion was complete at a certain number of days after treatment. 84% of women were sucessfully treated with the drug, and 97% were successfully treated with aspiration. Women receiving the drug were more likely to experience reduced hemoglobin, nausea, vomiting, and diarrhea. However, 83% of women receiving Misoprostol would recommend the drug (compared to 83% for aspiration) and 78% would use the treatment again (compared to 75% for aspiration).

A summary is available from NIH News, and the abstract is available from NEJM.
Technorati Tags: miscarriage; New England Journal of Medicine; research

Share Your Stories

Nashville blogger Sharon Cobb shared her story today of her diagnosis of ovarian cancer. I wish Sharon the best, and congratulate her on taking control of her health (she insisted on a test for early diagnosis that found the cancer). I am interested in others' stories of medical near-misses or having to stand up for your own health, and ask that you post them as comments. In my own case, I broke a chunk off the back of my patella (kneecap) and hobbled around on crutches for 6 weeks before surgery b/c the ER docs didn't catch the break. I also struggled for months to get a serious thyroid condition diagnosed, meanwhile being told that I needed to "reduce stress," and "You're tired? Ask all my nurses - they're tired too." Don't get me wrong - I now have several wonderful healthcare providers who I trust and respect, and have had nothing but good experiences with. I'm just wondering - have you ever had to be an advocate for your own healthcare? Have you ever been misdiagnosed or not diagnosed because a physician didn't take you seriously? How common are these experiences? If you don't mind, please post your stories here. Feel free to post anonymously. Examples like Sharon's, and your own, are important reminders to pay attention, be informed, and ask questions when it comes to your health.
Technorati Tags: health

Playing Catch Up

Posts have been in short supply lately, because I've started the 5th of 6 semesters for my Master's in Library and Information Science, which I'm working on part-time while also working at medical library full-time. You're thinking, "You need a Master's to check out books?!?" Um, no. Those people who check out and stamp your books are probably not "real" librarians, but are likely library assistants, volunteers, or student workers. "Real" librarians have to be managers, budget experts, purchasers, license negotiators, equipment evaluators, teachers, faculty members, copyright law advisors, and masters of all things information-related. And they are all of those things while providing you with expert help on whether there is research on how to prevent non-traumatic blood loss in ICU's or where to find that blue book by that guy that has something to do with brain tumors, how many miles of shoreline Lake Michigan has, or how many people in Georgia had bachelor's degrees in 1990. For more along these lines, check out this post entitled, "Why you should fall to your knees and worship a librarian." Ahem.

That said, I've been a very busy woman. Here are some links to recent women's health items that have caught my eye, but I haven't had time to dig into thoroughly.

Contraception for women over age 40 - National Guideline Clearinghouse

Contraceptive choices for breastfeeding women - National Guideline Clearinghouse

Digital mammography trial results announced - National Institutes of Health

Drug offers alternative to surgical treatment after miscarriage - National Institutes of Health

Mothering the Mother During Childbirth and After - NYTimes story on doulas assisting low-income teenagers

On Moral Grounds, Some Judges are Opting Out of Abortion Cases - NYTimes

More first-time moms opting for c-sections - National Women's Health Information Center
Technorati Tags: women's health

All About Women event - Sept 30 & Oct 1

This year's All About Women event (Nashville, TN) will take place on 9/30 & 10/1 at Gaylord Opryland Resort & Convention Center. This year, the free, two-day event is themed "Live Well," and will feature representatives from numerous health and wellness service providers. Health screenings for anxiety, blood pressure, dental health, blood sugar, body fat, cholesterol and other issues will be provided. There will also be massage services, and information on food and nutrition, finances, domestic violence, substance abuse, and other topics. Bra fittings, door prizes, and free onsite childcare - what more could you ask for? More details at http://www.allaboutwomentn.org/.
Technorati Tags: events; health; health screening; nashville; women's health

Book Review: Baby Catcher

Vincent, Peggy. Baby Catcher: Chronicles of a Modern Midwife. New York: Scribner, 2002.

“You have to lie down! What if the baby falls out?”
“What if the baby falls out? What if…it…falls…out, is that what you said? Well, darlin’ that’s the whole point, ain’t it?”

Beginning with the dramatic story of “Zelda,” Peggy Vincent chronicles her 30+ years of “catching babies” through descriptive accounts of births she attended in hospitals, birth centers, and homes. Vincent details her journey from nursing student to Lamaze instructor to midwife and mentor, inspired by physicians who viewed normal childbirth as a “retrospective diagnosis” and women who were not allowed to control their own birth experiences. The author lovingly tells of the women and births she encountered, including both happy and unfortunate outcomes. Vincent’s work also depicts the struggles midwives face in fulfilling women’s desires for how, where and when childbirth will occur, from reluctant emergency responders to indignant obstetricians and malpractice insurance struggles. This book will be of interest not only to expectant mothers, but also to midwives and others concerned about how the medical establishment treats the process of birth.

Note: The companion website for Baby Catcher is located at http://www.babycatcher.net/index.html, and includes an excerpt, the author's bio, answers to FAQs on home birth and midwifery, links to the author's other essays, and a list of recommended reading.
Technorati Tags: birth; books; book reviews; childbirth; midwifery

Preparing for Future Disasters

It's a good idea to have a disaster kit prepared and stashed away in a closet somewhere, especially if you live in an area prone to natural disasters. Ready.gov, a website of the Department of Homeland Security, provides simple instructions for preparing a kit of emergencies supplies, including a checklist. The site also provides advice on creating a family communication plan, and descriptions of what to expect in natural and other disasters.
Technorati Tags: disaster preparedness; emergencies; natural disasters

Don't Forget Women in Katrina Donations

Many agencies, such as Second Harvest, are collecting food and personal hygiene items for Katrina victims in shelters. The hygiene items listed are usually those such as deodorant and baby-oriented products such as diapers and wipes. Along with canned foods, I'm planning to donate tampons and pads for women to use. Why? If people can't get diapers or deodorant, where are they going to get menstrual products? This need is never specifically mentioned by the donation sites, but I can't think it doesn't exist. I hope through this type of donation, I can help relieve at least one worry of the women displaced by the hurricane. Normally I'm not a supporter of disposable menstrual products, but most women use this type of product, and I hope this will help relieve some of the indiginity of the situation.
Technorati Tags: Hurricane Katrina; menstruation; women's health