McClatchy/Times reports that reform would affect women in three main areas: gender-based pricing, preventive care and financial assistance for lower-income parents. The bills in Congress would make the practice of gender-based pricing illegal; eliminate copayments and deductibles for preventive care, such as mammograms and Pap tests; require reasonable rates for maternity coverage; and provide financial assistance to people who are unable to afford health insurance, according to McClatchy/Times.
According to the National Women's Law Center, women ages 15 to 44 spend 68% more on health care than their male peers. An NWLC survey found that insurers in 47 states and Washington, D.C., that permit gender rating charged 40-year-old women between 4% and 48% more than their male counterparts. A 2009 Commonwealth Fund study found that 45% of women ages 18 to 64 were uninsured or underinsured, compared with 39% of men, based on 2007 data.
Rep. Jan Schakowsky (D-Ill.) said women "are in double jeopardy" because they are "usually charged more" and also "earn less than men." She added that "even if [women] were charged the same premiums, they would pay a bigger percentage of their income" (Lightman, McClatchy/Contra Costa Times, 10/6).
Reprinted with kind permission from nationalpartnership. You can view the entire Daily Women's Health Policy Report, search the archives, or sign up for email delivery here. The Daily Women's Health Policy Report is a free service of the National Partnership for Women & Families, published by The Advisory Board Company.
© 2009 The Advisory Board Company. All rights reserved.
суббота, 29 октября 2011 г.
Health Reform Proposals Include Several Changes To Improve Women's Coverage
Health care reform legislation under consideration in Congress "would dramatically change the rules" on how health insurance covers women, McClatchy/Contra Costa Times reports. In the current insurance market, women typically are charged more for coverage because they tend to use more preventive care. In many states, women can be denied coverage from insurers that consider pregnancy or previous caesarean sections pre-existing conditions.
суббота, 22 октября 2011 г.
Most Arguments Over Sex Education 'Miss The Point,' Time Opinion Piece Says
Congress this spring "will dive once more into the war over sex education" as it debates whether to eliminate $176 million in federal funding for abstinence-only education programs, Amy Sullivan-Anderson writes in a Time opinion piece that will be published in the magazine's March 30 issue. Although advocates "will debate at top volume the merits of abstinence-only efforts vs. more comprehensive education programs that also teach about birth control and sexually transmitted infections, ... [t]hese arguments miss the point," Sullivan-Anderson writes. "We now have a pretty good sense of which sex-education approaches work," she says. A "[s]ubstaintial" body of research, including a 2007 Bush administration report, has shown that comprehensive sex education programs are "most effective at changing teen sexual behaviors," according to Sullivan-Anderson. She notes that comprehensive sex education programs are "largely uncontroversial outside Washington" and that "[v]ast majorities of parents favor" such programs.
What is missing from the sex education debate is "the political will and community investment necessary to educate kids about sexuality and healthy relationships in a truly responsible and honest way," Sullivan-Anderson writes. Students need programs that do not "end after two weeks" and that give them "a safe space to return to for answers and advice," she says. According to Sullivan-Anderson, an "innovative relationship and sex education curriculum" in an Anderson County, S.C., school district is an example of "what can happen when a community decides that it's crazy to spend more time teaching kids about decimals and fractions than about dating and sex." The program, which the school district runs in conjunction with a local teen pregnancy prevention organization, extends through three years of middle school and into high school, in addition to an after-school program for at-risk teens. Sullivan-Anderson writes that there is "growing evidence" that such programs "can be more effective than abstinence-only curriculums at persuading teens to behave more responsibly" and can reduce sexual risk in three areas: delaying the age at which teens first have sex, decreasing the number of sexual partners and increasing condom use among sexually active teens. The "crucial difference" between the newer comprehensive curriculums and their older counterparts is the "new emphasis on behavior," she says, adding that schools and parents are "increasingly putting their support behind the comprehensive approach."
South Carolina's 1988 Comprehensive Sex Education Act requires sex education from elementary school through high school, including a minimum of 12.5 hours of "reproductive health and pregnancy prevention education" during high school. The state law allows each school district "to make its own decisions about what sex education should involve," but "with federal funding limited to abstinence-only programs, local districts have a powerful incentive to restrict their sex education curriculums," Sullivan-Anderson writes. The program in Anderson County's District 3, called Impact, "is sometimes referred to as 'abstinence first' or 'abstinence plus' because it combines factual information about birth control and STIs with a strong message that kids should wait to have sex," according to Sullivan-Anderson. Other school districts in Anderson County are interested in replicating the program in their schools, but the "only thing stopping them is money," she says. Sullivan-Anderson writes that since District 3's program began, teen birth rates in the school district were stable for three years and then dropped the last two years.
However, "even if every community in America woke up tomorrow and decided to put an end to the sex-education wars -- laying aside the chastity belts and condom bananas and embracing comprehensive, abstinence-first education -- it's not clear that much would change," according to Sullivan-Anderson. Despite "all the battles over funding and policies, no one really knows how sex education is taught inside most classrooms," she continues. She writes that "very few" states and local school districts "set standards on how to give students factual information about sex or teach them to develop healthy relationships. Even fewer attempt to evaluate what is covered in the classroom, and 17 states don't even require sex education to be taught in public schools." She notes that the National Center for Health Statistics recently reported that teen birth rates in 2007 increased for the second year, reversing a decline that began in the early 1990s. "Taking sex education seriously isn't easy," Sullivan-Anderson writes, "But we can't afford to keep failing our children."
Sullivan-Anderson also profiles a 16-year-old student participating in the Impact program (Sullivan-Anderson, Time, 3/19).
Reprinted with kind permission from nationalpartnership. You can view the entire Daily Women's Health Policy Report, search the archives, or sign up for email delivery here. The Daily Women's Health Policy Report is a free service of the National Partnership for Women & Families, published by The Advisory Board Company.
© 2009 The Advisory Board Company. All rights reserved.
What is missing from the sex education debate is "the political will and community investment necessary to educate kids about sexuality and healthy relationships in a truly responsible and honest way," Sullivan-Anderson writes. Students need programs that do not "end after two weeks" and that give them "a safe space to return to for answers and advice," she says. According to Sullivan-Anderson, an "innovative relationship and sex education curriculum" in an Anderson County, S.C., school district is an example of "what can happen when a community decides that it's crazy to spend more time teaching kids about decimals and fractions than about dating and sex." The program, which the school district runs in conjunction with a local teen pregnancy prevention organization, extends through three years of middle school and into high school, in addition to an after-school program for at-risk teens. Sullivan-Anderson writes that there is "growing evidence" that such programs "can be more effective than abstinence-only curriculums at persuading teens to behave more responsibly" and can reduce sexual risk in three areas: delaying the age at which teens first have sex, decreasing the number of sexual partners and increasing condom use among sexually active teens. The "crucial difference" between the newer comprehensive curriculums and their older counterparts is the "new emphasis on behavior," she says, adding that schools and parents are "increasingly putting their support behind the comprehensive approach."
South Carolina's 1988 Comprehensive Sex Education Act requires sex education from elementary school through high school, including a minimum of 12.5 hours of "reproductive health and pregnancy prevention education" during high school. The state law allows each school district "to make its own decisions about what sex education should involve," but "with federal funding limited to abstinence-only programs, local districts have a powerful incentive to restrict their sex education curriculums," Sullivan-Anderson writes. The program in Anderson County's District 3, called Impact, "is sometimes referred to as 'abstinence first' or 'abstinence plus' because it combines factual information about birth control and STIs with a strong message that kids should wait to have sex," according to Sullivan-Anderson. Other school districts in Anderson County are interested in replicating the program in their schools, but the "only thing stopping them is money," she says. Sullivan-Anderson writes that since District 3's program began, teen birth rates in the school district were stable for three years and then dropped the last two years.
However, "even if every community in America woke up tomorrow and decided to put an end to the sex-education wars -- laying aside the chastity belts and condom bananas and embracing comprehensive, abstinence-first education -- it's not clear that much would change," according to Sullivan-Anderson. Despite "all the battles over funding and policies, no one really knows how sex education is taught inside most classrooms," she continues. She writes that "very few" states and local school districts "set standards on how to give students factual information about sex or teach them to develop healthy relationships. Even fewer attempt to evaluate what is covered in the classroom, and 17 states don't even require sex education to be taught in public schools." She notes that the National Center for Health Statistics recently reported that teen birth rates in 2007 increased for the second year, reversing a decline that began in the early 1990s. "Taking sex education seriously isn't easy," Sullivan-Anderson writes, "But we can't afford to keep failing our children."
Sullivan-Anderson also profiles a 16-year-old student participating in the Impact program (Sullivan-Anderson, Time, 3/19).
Reprinted with kind permission from nationalpartnership. You can view the entire Daily Women's Health Policy Report, search the archives, or sign up for email delivery here. The Daily Women's Health Policy Report is a free service of the National Partnership for Women & Families, published by The Advisory Board Company.
© 2009 The Advisory Board Company. All rights reserved.
суббота, 15 октября 2011 г.
Women Who Suffer Migraine With Aura Have Better Outcomes After Stroke
Women with a history of migraine headache with aura (transient neurological symptoms, mostly visual impairments) are at increased risk of stroke. However, according to new research reported in Circulation: Journal of the American Heart Association stroke events in women with migraine with aura are more likely to have mild or no disability compared to those without migraine.
In a new analysis of the Women's Health Study involving 27,852 women over 13.5 years, researchers found those who have migraine with aura and who experience an ischemic stroke were twice as likely to have no significant disability from stroke.
"The message from this study should be reassuring for migraineurs," said Tobias Kurth, M.D., Sc.D., the study's principal author and associate epidemiologist at Brigham and Women's Hospital in Boston, Mass.
"It is important for women who have migraine with aura to know that their risk of stroke is considerably low and there is high likelihood of a migraine-associated stroke being mild."
The reason for these results is unclear. But Kurth, who is also director of research at INSERM in Paris, France, speculated that mechanisms, perhaps involving smaller vessels - not the traditional mechanisms for stroke, lead to a smaller size stroke.
Compared to those without migraine history, women with migraine and aura were more likely to have a good to excellent functional outcome - defined as having no symptoms and no significant disability, researchers said.
Women participating in the study were divided into four groups: 22,723 who reported no migraine history; 5,129 who reported a migraine history; 3,612 who had active migraine; and of those who reported active migraine, 1,435 reported active migraine with aura.
Researchers evaluated functional ability after stroke at hospital discharge using the modified Rankin Scale, a seven-point scale that measures degree of impairment.
At the onset of the study, women completed a questionnaire about their headaches that allowed classification into the groups of migraine with and without aura, history of migraine or no history of migraine. Each following year, the women reported new medical conditions, including transient ischemic attack (TIA) or stroke, which were confirmed after medical record review.
During 13.5 years of follow-up, 398 TIAs and 345 ischemic strokes occurred.
Women in the study were primarily Caucasian, average age 55, healthy and working in the healthcare field.
There is currently little reason to believe that the association differs for women with other characteristics or men, Kurth said.
The first author is Pamela M. Rist, M.Sc., a doctoral student at the Harvard School of Public Health and research fellow at Brigham and Women's Hospital. Other co-authors are: Julie E. Buring, Sc.D.; Carlos S. Kase, M.D.; Markus Schurks, M.D., M.Sc. Author disclosures are on the manuscript.
The Women's Health Study is supported by grants from the National Heart, Lung, and Blood Institute and the National Cancer Institute. Grants from the Donald W. Reynolds, Leducq and Doris Duke Charitable foundations funded part of the study.
Source:
Karen Astle
American Heart Association
In a new analysis of the Women's Health Study involving 27,852 women over 13.5 years, researchers found those who have migraine with aura and who experience an ischemic stroke were twice as likely to have no significant disability from stroke.
"The message from this study should be reassuring for migraineurs," said Tobias Kurth, M.D., Sc.D., the study's principal author and associate epidemiologist at Brigham and Women's Hospital in Boston, Mass.
"It is important for women who have migraine with aura to know that their risk of stroke is considerably low and there is high likelihood of a migraine-associated stroke being mild."
The reason for these results is unclear. But Kurth, who is also director of research at INSERM in Paris, France, speculated that mechanisms, perhaps involving smaller vessels - not the traditional mechanisms for stroke, lead to a smaller size stroke.
Compared to those without migraine history, women with migraine and aura were more likely to have a good to excellent functional outcome - defined as having no symptoms and no significant disability, researchers said.
Women participating in the study were divided into four groups: 22,723 who reported no migraine history; 5,129 who reported a migraine history; 3,612 who had active migraine; and of those who reported active migraine, 1,435 reported active migraine with aura.
Researchers evaluated functional ability after stroke at hospital discharge using the modified Rankin Scale, a seven-point scale that measures degree of impairment.
At the onset of the study, women completed a questionnaire about their headaches that allowed classification into the groups of migraine with and without aura, history of migraine or no history of migraine. Each following year, the women reported new medical conditions, including transient ischemic attack (TIA) or stroke, which were confirmed after medical record review.
During 13.5 years of follow-up, 398 TIAs and 345 ischemic strokes occurred.
Women in the study were primarily Caucasian, average age 55, healthy and working in the healthcare field.
There is currently little reason to believe that the association differs for women with other characteristics or men, Kurth said.
The first author is Pamela M. Rist, M.Sc., a doctoral student at the Harvard School of Public Health and research fellow at Brigham and Women's Hospital. Other co-authors are: Julie E. Buring, Sc.D.; Carlos S. Kase, M.D.; Markus Schurks, M.D., M.Sc. Author disclosures are on the manuscript.
The Women's Health Study is supported by grants from the National Heart, Lung, and Blood Institute and the National Cancer Institute. Grants from the Donald W. Reynolds, Leducq and Doris Duke Charitable foundations funded part of the study.
Source:
Karen Astle
American Heart Association
суббота, 8 октября 2011 г.
Non-Parental Care Of Infants Tied To Unfavorable Feeding Practices
With more new mothers in the workplace than ever before, there has been a corresponding increase in the number of child-care facilities in the United States.
At the same time, data from a variety of sources point to a growing prevalence of overweight infants and toddlers.
Is there a connection?
According to a new study co- University of Illinois community health professor Juhee Kim and Karen Peterson, a professor of nutrition and society at Harvard University's School of Public Health, child-care factors and feeding practices may indeed play a role.
"Our study is the first to report, to our knowledge ... the potential importance of infant child care on infant nutrition and growth," the researchers said in an article published in the July issue of the Archives of Pediatrics & Adolescent Medicine, a publication affiliated with the Journal of the American Medical Association. "The results of this study indicate that structural characteristics of child care, such as age at initiation, type and intensity, were all related to infant feeding practices and weight gain among a representative sample of U.S. infants."
Specifically, Kim and Peterson found that 9-month-old infants who routinely receive non-parental care - provided by relatives, licensed day-care centers or more informal child-care providers - may experience higher rates of unfavorable feeding practices. The babies also weigh more than those whose primary caregivers are their parents.
The researchers' findings could have significant public-health ramifications, as weight gain in infancy can ultimately be a predictor of obesity later in life.
Obesity, in turn, is linked to a number of chronic illnesses, such as diabetes and hypertension, as well as adulthood morbidity and mortality.
In their study, Kim and Peterson analyzed baseline data from a nationally representative sample of 8,150 9-month-old infants to determine whether infant-feeding practices and non-parental care might be a factor in the rise in weight of the infants. They used data collected for children enrolled in the Early Childhood Longitudinal Study, Birth Cohort, conducted by the U.S. Department of Education's National Center for Education Statistics.
Kim and Peterson found that 55.3 percent of the infants had received regular, non-parental child care, with half of those infants receiving full-time child care. Among babies in child care, 40 percent began receiving such care at age 3 months; 39 percent, between 3 and 5.9 months, and 21 percent at 6 months or older.
"Weight gain and the prevalence of overweight were lowest among infants who received care by parents," the researchers noted in the published article.
The researchers also examined data regarding breastfeeding initation for babies receiving parental and non-parental care, along with the stage at which solid foods were introduced to the infants. Only starting solid foods before 4 months of age was associated with increased overweight among infants.
"Infants who initiated child care before 3 months of age had lower rates of ever having been breastfed and higher rates of early introduction of solid foods," they wrote. "Infants in parental care were more likely to have breastfeeding initiated and solid foods introduced after 4 months of age compared with those in child-care settings."
Further, infants in part-time child care gained more weight -175 grams - by 9 months of age, compared with those receiving only parental care. Those being cared for by relatives also showed a weight gain - 162 grams.
"A strength of our findings," the researchers noted, "is that the observed effects of child-care factors remained significant after controlling for maternal pre-pregnancy BMI (body mass index) and a child's birth weight."
"Although both factors are known to be strong predictors of childhood overweight status, in our study, only birth weight was a significant factor in weight gain."
Kim said there are a couple of important take-home messages from their research results for parents and child-care providers.
"Parents may want to have enough communication with child-care providers about when, what and how to feed their babies during their stay in day care, which is important to avoid potential risk of overfeeding or underfeeding at home," she said.
"Child-care professionals can encourage parents' active involvement in the decision process of what, when and how to feed infants. Child-care providers also need to participate in nutrition-education/training programs to understand the importance of starting solid foods, transition from breast milk or formula to foods, and how to implement recommended practices to ensure a healthy eating environment."
Kim hopes to be able investigate relationships among child care, feeding practices and weight gain in children in other parts of the world.
"It would be interesting to conduct a cross-cultural study," she said. "Considering eating is a socio-economical and cultural event, the impact of child care on infant feeding practices - food consumption - might be different among different countries."
The current research was supported in part by the Berkowitz Fellowship of the department of nutrition, Harvard School of Public Health; an Early Childhood Longitudinal Study, Birth Cohort training grant from the National Center for Education Statistics; and training grants on statistical analysis for education policy from the American Educational Research Association.
Source: Melissa Mitchell
University of Illinois at Urbana-Champaign
At the same time, data from a variety of sources point to a growing prevalence of overweight infants and toddlers.
Is there a connection?
According to a new study co- University of Illinois community health professor Juhee Kim and Karen Peterson, a professor of nutrition and society at Harvard University's School of Public Health, child-care factors and feeding practices may indeed play a role.
"Our study is the first to report, to our knowledge ... the potential importance of infant child care on infant nutrition and growth," the researchers said in an article published in the July issue of the Archives of Pediatrics & Adolescent Medicine, a publication affiliated with the Journal of the American Medical Association. "The results of this study indicate that structural characteristics of child care, such as age at initiation, type and intensity, were all related to infant feeding practices and weight gain among a representative sample of U.S. infants."
Specifically, Kim and Peterson found that 9-month-old infants who routinely receive non-parental care - provided by relatives, licensed day-care centers or more informal child-care providers - may experience higher rates of unfavorable feeding practices. The babies also weigh more than those whose primary caregivers are their parents.
The researchers' findings could have significant public-health ramifications, as weight gain in infancy can ultimately be a predictor of obesity later in life.
Obesity, in turn, is linked to a number of chronic illnesses, such as diabetes and hypertension, as well as adulthood morbidity and mortality.
In their study, Kim and Peterson analyzed baseline data from a nationally representative sample of 8,150 9-month-old infants to determine whether infant-feeding practices and non-parental care might be a factor in the rise in weight of the infants. They used data collected for children enrolled in the Early Childhood Longitudinal Study, Birth Cohort, conducted by the U.S. Department of Education's National Center for Education Statistics.
Kim and Peterson found that 55.3 percent of the infants had received regular, non-parental child care, with half of those infants receiving full-time child care. Among babies in child care, 40 percent began receiving such care at age 3 months; 39 percent, between 3 and 5.9 months, and 21 percent at 6 months or older.
"Weight gain and the prevalence of overweight were lowest among infants who received care by parents," the researchers noted in the published article.
The researchers also examined data regarding breastfeeding initation for babies receiving parental and non-parental care, along with the stage at which solid foods were introduced to the infants. Only starting solid foods before 4 months of age was associated with increased overweight among infants.
"Infants who initiated child care before 3 months of age had lower rates of ever having been breastfed and higher rates of early introduction of solid foods," they wrote. "Infants in parental care were more likely to have breastfeeding initiated and solid foods introduced after 4 months of age compared with those in child-care settings."
Further, infants in part-time child care gained more weight -175 grams - by 9 months of age, compared with those receiving only parental care. Those being cared for by relatives also showed a weight gain - 162 grams.
"A strength of our findings," the researchers noted, "is that the observed effects of child-care factors remained significant after controlling for maternal pre-pregnancy BMI (body mass index) and a child's birth weight."
"Although both factors are known to be strong predictors of childhood overweight status, in our study, only birth weight was a significant factor in weight gain."
Kim said there are a couple of important take-home messages from their research results for parents and child-care providers.
"Parents may want to have enough communication with child-care providers about when, what and how to feed their babies during their stay in day care, which is important to avoid potential risk of overfeeding or underfeeding at home," she said.
"Child-care professionals can encourage parents' active involvement in the decision process of what, when and how to feed infants. Child-care providers also need to participate in nutrition-education/training programs to understand the importance of starting solid foods, transition from breast milk or formula to foods, and how to implement recommended practices to ensure a healthy eating environment."
Kim hopes to be able investigate relationships among child care, feeding practices and weight gain in children in other parts of the world.
"It would be interesting to conduct a cross-cultural study," she said. "Considering eating is a socio-economical and cultural event, the impact of child care on infant feeding practices - food consumption - might be different among different countries."
The current research was supported in part by the Berkowitz Fellowship of the department of nutrition, Harvard School of Public Health; an Early Childhood Longitudinal Study, Birth Cohort training grant from the National Center for Education Statistics; and training grants on statistical analysis for education policy from the American Educational Research Association.
Source: Melissa Mitchell
University of Illinois at Urbana-Champaign
суббота, 1 октября 2011 г.
Joint Surgery Predicted By Number Of Children And Use Of HRT
According to a study published in the Annals of the
Rheumatic Diseases, women who have many
children, used hormone replacement therapy, and had early puberty are
more likely to have surgery performed on their joints - especially on
their knees.
Researchers from the United Kingdom studied 1.3 million middle-aged UK
women who took part in the Million Women Study. The health of the
participants was tracked beginning around age 50, and they were
monitored for about six years. Baseline information provided data on
the age of the participants when they had their first and last
menstrual events, how many children to whom they had given birth, and
their use of oral contraceptives and hormone replacement therapy (HRT).
The researchers used the follow-up data to see if the women were
admitted to hospital for a knee or hip replacement for the inflammatory
joint disease, osteoarthritis.
Dr Bette Liu (Cancer Epidemiology Unit, University of Oxford, Oxford,
UK) and colleagues report that over 12,000 of the women needed a hip
replacement and a little less than 10,000 required a knee replacement
during the follow-up time period.
What factors most predicted these surgeries? Serial motherhood - or
having additional children - increased the probability of a hip
replacement by 2% and of a knee replacement by 8%. Women who began
menstruation before the age of 11 increased their likelihoods of both
types of surgery by 9 to 15%. The researchers found that previous use
of oral contraceptives did not seem to have a significant effect on the
risk of joint surgery. However, use of HRT raised the probability of a
hip replacement by 38% and of a knee replacement by 58%.
The researchers point out that women on HRT are probably making better
use of health services, which may partly explain their highly
likelihood of joint surgery. They also suggest that female sex
hormones, such as estrogen, may help explain the difference in
osteoarthritis, a condition that is more common among women than men.
"Given the large burden of osteoarthritis and the associated burden of
joint replacement surgery in women worldwide, it is important to
understand the role of potentially modifiable factors for these
conditions. We found that parity, age at menarche and HRT use are all
associated with the risk of hip and knee replacement and that the knee
joint is affected more by these factors than the hip joint. However the
underlying reasons for these findings remain unclear," conclude the
authors.
Reproductive history, hormonal factors and the incidence of
hip and knee replacement for osteoarthritis in middle-aged women
B Liu, A Balkwill, C Cooper, A Roddam, A Brown, V Beral, on behalf of
the Million Women Study Collaborators
Annals of the Rheumatic Diseases (2008).
doi:10.1136/ard.2008.095653
Click
Here to View Journal Website
: Peter M Crosta
Rheumatic Diseases, women who have many
children, used hormone replacement therapy, and had early puberty are
more likely to have surgery performed on their joints - especially on
their knees.
Researchers from the United Kingdom studied 1.3 million middle-aged UK
women who took part in the Million Women Study. The health of the
participants was tracked beginning around age 50, and they were
monitored for about six years. Baseline information provided data on
the age of the participants when they had their first and last
menstrual events, how many children to whom they had given birth, and
their use of oral contraceptives and hormone replacement therapy (HRT).
The researchers used the follow-up data to see if the women were
admitted to hospital for a knee or hip replacement for the inflammatory
joint disease, osteoarthritis.
Dr Bette Liu (Cancer Epidemiology Unit, University of Oxford, Oxford,
UK) and colleagues report that over 12,000 of the women needed a hip
replacement and a little less than 10,000 required a knee replacement
during the follow-up time period.
What factors most predicted these surgeries? Serial motherhood - or
having additional children - increased the probability of a hip
replacement by 2% and of a knee replacement by 8%. Women who began
menstruation before the age of 11 increased their likelihoods of both
types of surgery by 9 to 15%. The researchers found that previous use
of oral contraceptives did not seem to have a significant effect on the
risk of joint surgery. However, use of HRT raised the probability of a
hip replacement by 38% and of a knee replacement by 58%.
The researchers point out that women on HRT are probably making better
use of health services, which may partly explain their highly
likelihood of joint surgery. They also suggest that female sex
hormones, such as estrogen, may help explain the difference in
osteoarthritis, a condition that is more common among women than men.
"Given the large burden of osteoarthritis and the associated burden of
joint replacement surgery in women worldwide, it is important to
understand the role of potentially modifiable factors for these
conditions. We found that parity, age at menarche and HRT use are all
associated with the risk of hip and knee replacement and that the knee
joint is affected more by these factors than the hip joint. However the
underlying reasons for these findings remain unclear," conclude the
authors.
Reproductive history, hormonal factors and the incidence of
hip and knee replacement for osteoarthritis in middle-aged women
B Liu, A Balkwill, C Cooper, A Roddam, A Brown, V Beral, on behalf of
the Million Women Study Collaborators
Annals of the Rheumatic Diseases (2008).
doi:10.1136/ard.2008.095653
Click
Here to View Journal Website
: Peter M Crosta
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