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CDC Warns Of Fetal Alcohol Exposure, Says Drinking Any Time In Pregnancy Is Risky

(Source: “Vital Signs: Alcohol-Exposed Pregnancies — United States, 2011–2013")

(Source: “Vital Signs: Alcohol-Exposed Pregnancies — United States, 2011–2013″)

If you’re a sexually active woman of childbearing age and not using birth control, public health officials say you should stop drinking alcohol — completely. That includes beer, wine or any other alcoholic beverage you might be considering.

In a report out Tuesday,  the U.S. Centers for Disease Control and Prevention notes that exposure to alcohol, even in the first weeks of pregnancy, puts developing babies at risk for fetal alcohol spectrum disorders, “characterized by lifelong physical, behavioral, and intellectual disabilities.” Because these disorders are completely preventable by abstaining from alcohol, and because officials say there is “no known safe amount of alcohol” that women can drink at any time during pregnancy, their basic message is: “Why take the risk?”

“Women wanting a pregnancy should be advised to stop drinking at the same time contraception is discontinued,” the report concludes. “Health care providers should advise women not to drink at all if they are pregnant or there is any chance they might be pregnant.”

Here’s more from the CDC news release:

An estimated 3.3 million U.S. women between the ages of 15 and 44 years are at risk for exposing their developing baby to alcohol because they are drinking, sexually active, and not using birth control to prevent pregnancy, according to a new CDC Vital Signs report. The report also found that 3 in 4 women who want to get pregnant as soon as possible do not stop drinking alcohol.

Alcohol use during pregnancy, even within the first few weeks and before a woman knows she is pregnant, can cause lasting physical, behavioral, and intellectual disabilities that can last for a child’s lifetime. These disabilities are known as fetal alcohol spectrum disorders (FASDs). There is no known safe amount of alcohol – even beer or wine – that is safe for a woman to drink at any stage of pregnancy.

About half of all pregnancies in the U.S. are unplanned and, even if planned, most women will not know they are pregnant until they are 4-6 weeks into the pregnancy when they still might be drinking.

During a telephone briefing with reporters, Anne Schuchat, the CDC’s deputy director, said:

What we’re recommending is women who are not trying to get pregnant make sure they have a conversation about birth control and how to avoid becoming pregnant. If they are not using contraception and are fertile and are drinking they could be at risk… One in two deliveries in this country occurs to someone who wasn’t actually trying to get pregnant when they got pregnant. So we do think that fertile woman that are not using contraception ought to be aware that they may become pregnant and that drinking during even that first couple of weeks of pregnancy can be risky.

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Why To Exercise Today: Minimizing ‘Menopause Misery’

(pennstatelive/Flickr)

(pennstatelive/Flickr)

A new report suggests a path toward reducing “menopause misery”: Give up your sedentary lifestyle.

A paper — titled “Sedentary lifestyle in middle-aged women is associated with severe menopausal symptoms and obesity,” and published online in the journal Menopause — looks at more than 6,000 women across Latin America ages 40-59. Researchers found that compared to active women, sedentary women (who made up about 63 percent of participants) reported more “severe” menopause symptoms, including hot flashes, joint pain, depressed mood and anxiety and other symptoms like sex problems, vaginal dryness and bladder problems.

Sedentary lifestyle was self-reported (always a possible red flag in a study like this) as less than three 30-minute sessions of physical activity per week; activities included walking, biking, running, jogging, swimming or working out.

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Dr. Donald Thea On What We Know About The Zika Virus

For the first time, a Massachusetts resident has been diagnosed with the Zika virus.

He or she is from Boston and traveled in a country where the virus is being transmitted. The symptoms were mild, the patient did not have to be hospitalized, and is expected to make a full recovery.

Dr. Donald Thea, professor of global health and director of the Center for Global Health & Development at Boston University, joined WBUR’s Morning Edition to discuss the virus and this case in Boston.

Related:

First Case Of Zika Virus In Boston Is Confirmed

BOSTON — A Boston resident has been diagnosed with the mosquito-borne Zika virus, the Boston Public Health Commission confirmed Thursday.

The patient, who contracted the virus while traveling abroad, is expected to make a full recovery, BPHC said in a statement.

“The vast majority of people who contract Zika do not get seriously ill, and recover quickly when they do,” Scott Zoback, spokesman for the BPHC, said in a statement.

The Zika virus, which has been found in Africa, Southeast Asia, South America and the Pacific Islands, is spread to people through the bite of an infected mosquito. The Centers for Disease Control and Prevention is advising pregnant women to avoid traveling to countries where the virus is present because there are concerns it may be linked to severe birth defects.

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Panel Recommends Depression Screening For Women During And After Pregnancy

(Chris Martino/Flickr)

(Chris Martino/Flickr)

On Tuesday the U.S. Preventive Services Task Force released new recommendations on screening for depression in adults, notably calling for depression screening in women both during and after pregnancy.

The recommendations, published in the Journal of the American Medical Association, suggest: “All adults older than 18 years should be routinely screened for depression. This includes pregnant women and new mothers as well as elderly adults.”

Why?

“Depression is among the leading causes of disability in persons 15 years and older,” the task force statement said. “It affects individuals, families, businesses, and society and is common in patients seeking care in the primary care setting. Depression is also common in postpartum and pregnant women and affects not only the woman but her child as well. …The [task force] found convincing evidence that screening improves the accurate identification of adult patients with depression in primary care settings, including pregnant and postpartum women.”

The government-appointed panel found that the harms from such screening are “small to none,” though it did cite potential harm related to drugs frequently prescribed for depression:

The USPSTF found that second-generation antidepressants (mostly selective serotonin reuptake inhibitors [SSRIs]) are associated with some harms, such as an increase in suicidal behaviors in adults aged 18 to 29 years and an increased risk of upper gastrointestinal bleeding in adults older than 70 years, with risk increasing with age; however, the magnitude of these risks is, on average, small. The USPSTF found evidence of potential serious fetal harms from pharmacologic treatment of depression in pregnant women, but the likelihood of these serious harms is low. Therefore, the USPSTF concludes that the overall magnitude of harms is small to moderate.

Nancy Byatt, medical director at the Massachusetts Child Psychiatry Access Project for Moms (MCPAP for Moms) and an assistant professor of psychiatry and obstetrics and gynecology at UMass Medical School, said the new recommendations “are an incredibly important step to have depression care become a routine part of obstetrical care.”

She added: “Depression in pregnancy is twice as common as diabetes in pregnancy and obstetric providers always screen for diabetes and they have a clear treatment plan. The goal [here] is that women are screened for depression [during pregnancy and postpartum] and they are assessed and treated and this becomes a routine part of care just like diabetes.”

Dr. Ruta Nonacs, who’s in the psychiatry department at Massachusetts General Hospital and editor-in-chief at the MGH Center for Women’s Mental Health, sent her thoughts via email:

In that the USPSTF recommendation recognizes pregnant and postpartum women as a group at high risk for depression, this represents a step in the right direction in terms of ensuring that psychiatric illness in this vulnerable population is identified and appropriately treated. However, there remain significant obstacles to overcome. Research and clinical experience indicate that while pregnant and postpartum women with mood and anxiety disorders can be identified through screening, many women identified in this manner do not seek or are not able to find treatment.

While screening is important, we must also make sure we tend to the construction of a system that provides appropriate follow-up and treatment. Because stigma continues to be significant with regard to mental health issues in mothers and mothers-to-be and because there are concerns regarding the use of medication in pregnant and nursing women, we must make sure that after screening, we help women to access appropriate resources and treaters who have expertise in the treatment of women during pregnancy and the postpartum period.

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Analysis: Can Mindful Eating Really Help You Lose Weight Or Stop Binging?

(t-mizo/Flickr)

(t-mizo/Flickr)

Updated 1/23

By Jean Fain
Guest Contributor

Mindfulness is all the rage. But does mindful eating — paying very close attention to your food and to your body’s signs of true hunger and satiety — really help you lose weight or stop binging?

On the one hand, paying closer attention to how you eat and why seems like a no-brainer for improved health. But in fact, mindful eating is steeped in controversy — pitting doctors against nutritionists, parents against children, therapists against clients, even colleagues against one another.

Proponents of mindful eating (also known as intuitive eating) like nutrition researcher Linda Bacon and other advocates of “Health at Every Size” — a self-described political movement promoting healthy habits and self-acceptance, rather than diets — recite a lengthy list of benefits related to mindful eating.

Critics of mindful eating offer a number of negatives: some say such navel-gazing about food makes it unappetizing, while others say mindful eating is superficial and ineffective, even irresponsible when it supplants traditional treatments for life-threatening eating issues.

Still others, like many who posted comments on my recent NPR interview with Jean Kristeller, author of the book, “The Joy of Half a Cookie,” dismiss mindful eating as a joke. One example: “Yes, let’s add more dietary neurosis to the babel of nutritional advice. How about this: eat the whole cookie. Have two, even. Just eat cookies less often, and eat nutritious food as the rule rather than the exception.”

According to Dr. James Greenblatt, an eating disorder expert, chief medical officer of Walden Behavioral Care and the author of “Answers to Binge Eating,” mindful eating is not only pointless in some cases, it’s potentially dangerous.

“Mindful eating clearly has a place in our treatment plans,” Greenblatt explained in a recent email exchange. “But, as a sole intervention for some of our patients, it is like asking opiate abusers to utilize mindful heroin detox. Many eating disorders reflect a severe neurochemical abnormality that needs to be addressed with biological interventions first, before adding other psychotherapeutic strategies and mindfulness.”
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Commentary: When Sexual Violence Survivors Give Birth, Here’s What You Should Know

By Sarah Beaulieu
Guest Contributor

Sarah Beaulieu (Courtesy of the author)

Sarah Beaulieu (Courtesy of the author)

It shouldn’t have been a surprise that childbirth would leave me traumatized.

In retrospect, it seems obvious that when a survivor of sexual violence feels pain in her vagina caused by a strange being inside of her, the experience might trigger memories of an earlier trauma. But what wasn’t so obvious were the many ways that the childbirth and medical professionals didn’t prepare me for these unexpected and painful emotions related to giving birth.

With 20 years of therapy under my belt, I consider myself to be a fairly confident survivor with many tools in my resilience box. None of these tools prepared me for what happened during the birth of my son. After 12 hours of relatively peaceful labor in the hands of midwives, I dozed off, preparing for a long night. I woke up with at least two sets of hands inside of me, alarms ringing and a sense of panic in the room. My son’s heart rate had dropped dangerously low, and I needed an immediate C-section.

This experience — traumatic for even the healthiest woman — wrecked me, surfacing old post-traumatic stress disorder symptoms and pulling me into depression and anxiety. With the help of a hospital social worker, I emerged from my emotional dark place a few months later, and immersed myself in learning more about birthing as a sexual assault survivor. My experience was scary, but it couldn’t be that uncommon, I thought. After all, 1 out of 4 women share a sexual abuse history like mine, and U.S. women gave birth to nearly 4 million babies last year.

My research led me to Penny Simkin and Phyllis Klaus, two legendary birth educators who compiled much of the existing research into a single manual, “When Survivors Give Birth.”

I learned that, in fact, there were approaches to childbirth that were especially helpful to survivors of sexual violence. Not only that, but it was fairly common for pregnancy and birth to re-trigger memories and emotions related to past sexual violence. Yet despite this, the topic of sexual violence wasn’t typically covered by my midwifery practice, recommended childbirth literature or my natural childbirth class.

First and foremost, health care providers can adopt a trauma-informed approach to care for laboring mothers. Knowing that 25 percent of patients in labor and delivery will have a history of sexual violence, there is a benefit for all staff to be educated about sexual violence and its impact on birth. There are medical reasons too: Childhood trauma, including child sexual abuse, is a documented risk factor of postpartum depression and anxiety, which impacts 10 to 15 percent of new mothers — and their babies and families — each year.

Knowledge starts with screening for a history of sexual violence on standard intake forms and first visits. It also means creating a health care environment where survivors feel comfortable disclosing such histories. In my midwife’s office, there were pamphlets for every possible pregnancy complication, from gestational diabetes to heartburn to exercise during pregnancy. So, why not a pamphlet on giving birth as an abuse survivor?

Cat Fribley, an Iowa-based sexual assault advocate and doula whose practice focuses specifically on sexual violence survivors, describes trauma-informed care as “supporting the whole person with collaboration, choice and control, cultural relevance, empowerment and safety — both physical and emotional. This requires making certain adjustments to the way they work with survivors, acknowledging both the challenges that arise from sexual trauma, as well as unique coping skills — such as dissociation — that may help the survivor through the process of childbirth.”

Here’s an example: At one birth Fribley attended, “the birthing mother became visibly upset when new and unknown staff would enter the room while she was laboring. A simple sign on the door asking people to knock and announce themselves before entering helped make the birthing mom feel more in control of her environment — and the exposure of her body.” Continue reading

When It Comes To Happiness, Time Trumps Money, Study Suggests

(Amanda/Flickr)

(Amanda/Flickr)

By Joshua Eibelman
CommonHealth Intern

What do you value more: your money or your time?

A new study by researchers at the University of British Columbia suggests that those who place a greater value on their time, rather than their money, are happier.

Among the study’s 4,600 participants, there was an almost even split between those who prefer money and those who put a higher value on their time.

While the participants’ median age ranged from 20-45, older people tended to value time over money, possibly because over the years, their priorities shifted, and they feel greater satisfaction from quality time with friends and family, researchers found.

The study, published in the journal Social Psychological and Personality Science, looked at what kinds of trade-offs people were willing to make to achieve “happiness.” For instance, participants were asked whether they would prefer a higher paying job farther from home or a lower paying job closer to home.

College students surveyed at the University of British Columbia were asked various questions about what fields of study and jobs they’d choose and how they would prioritize time commitments versus potential salaries.

Participants were told that they’d been admitted to two graduate programs and had to decide between a higher starting salary with more more work hours, or a lower salary with fewer hours, the study said.

Those who are willing to make trade-offs in favor of time, the study found, tend to be happier. Interestingly, researchers report, “These findings could not be explained by materialism, material striving, current feelings of time or material affluence, or demographic characteristics such as income or marital status.”

Happiness was measured though a number of self-reporting tools and questions about the number of positive emotions people feel in a day, said lead researcher Ashley Whillans, a doctoral student in social psychology at the University of British Columbia.

Whillans likened preferences for either time or money as “personality characteristics.” Continue reading

Bad Odors And Brain Fog: 5 Things Nobody Tells You About Quitting Cigarettes

On a break from his midday hosting duties, WBUR's Jack Lepiarz lights up outside the station. (Robin Lubbock/WBUR)

On a break from his hosting duties, WBUR’s Jack Lepiarz lights up outside the station. (Robin Lubbock/WBUR)

WBUR’s Jack Lepiarz is no wimp. He not only braves live air multiple times a day as the station’s midday anchor, he also performs around the country as a circus whip-master, and even recently attempted to break the Guinness world record for whip strokes per minute.

But Jack has yet to defeat the most insidious physical and psychological challenge many of us ever face: his smoking habit.

He has plenty of company: Almost 1 in 5 Americans smoke, the CDC says. He writes here about some of the unexpected obstacles involved, in hopes of helping other would-be quitters and their supporters. And he’ll document his fight periodically this year. Please stay tuned. — Carey

I’m about to try again. This weekend will mark my fourth attempt to quit smoking over the last 10 weeks or so. At age 27, I’ve been smoking for a little more than seven years, with multiple attempts to quit every year since three months after I started. When they tell you that nicotine is as addictive as heroin, they’re not kidding.

I’m at the point where I’ve started and stopped so many times that I know what I’m getting into, but every time, I seem to notice a new symptom or side effect of nicotine withdrawal. Almost always, I’m surprised. We hear about cigarette cravings, irritability and other symptoms of withdrawal — but the process of quitting also carries with it some other, lesser known symptoms.

1. The Mental Fog

By far my least favorite side effect, and one that I find the hardest to explain. You know that feeling you have right after you wake up? Half present, half in another world? This is your brain — not on drugs. I’ve described it as similar to going a day without coffee — except worse. (Believe me, I’ve tried.) Or being in a state of constantly having just had two beers. You can’t focus, you can’t sit still, you can’t formulate any thoughts that last in your brain for more than 30 seconds.

Except for how much you want a cigarette.

2. The Smell

This is one that sneaks up on you. Most people know that smoking dulls your sense of taste and smell, but it’s such a gradual process when you start smoking that you don’t notice it. For me, it rarely takes more than 36 hours to get those senses back strongly — and never in a good way.

The first time I really noticed it was last winter, when after a day of not smoking I drank a soda and nearly spat it out. I never knew it was that sweet.

The smell aspect hit me when I tried to quit on a hot, humid day in July. Long story short, we all need to wear more deodorant. Also brush our teeth more. Also, cities just smell awful in general. Also, yes, I recognize the irony of a smoker complaining about bad smells. You notice just how bad cigarettes smell, too.

3. The Constant Hunger Continue reading

Don’t Miss: Surprise, Your Patient Satisfaction Survey Was Not Anonymous

A patient undergoing chemotherapy treatment at Duke Cancer Center in Durham, N.C. (Gerry Broome/ AP)

A patient undergoing chemotherapy treatment at Duke Cancer Center in Durham, N.C. (Gerry Broome/ AP)

Imagine that you submitted what you thought was an anonymous bit of needed input at work, only to hear from the very colleague you critiqued that it was useful feedback.

Now imagine that all this takes place when you’re at your most vulnerable, sick and reeling and in need of extensive help — and at a hospital, where privacy is supposed to be paramount.

That’s the cautionary tale of this beautifully written new Cognoscenti post: “Harming Patient Satisfaction In The Process Of Measuring It.” It begins badly:

The first time the social worker asked if she could check in with me was this past summer during chemo. We chatted some, and after a while she got up to leave. Then she parted the privacy curtain, stepped out, poked her head back in and said, “Oh, I forgot to ask. What are you most afraid of?”

Patients are often criticized for what are called “door handle comments” — those comments brought up as the health care provider is walking out of the room and already has one hand on the door. They are often doozies — a patient who has had a very straight-forward appointment might state that they have been having chest pain. Or a myriad of other disclosures that, had they been revealed earlier on, would have directed the appointment very differently.

Health care professionals do it, too.

Then it gets even worse: Author Marjorie S. Rosenthal of the Yale School of Medicine describes filling out a patient satisfaction survey, and then hearing about it from the social worker herself.

The social worker comes over, pulls the curtain and sits down. We talk about my children, work and me. And then she tells me that she appreciates the constructive criticism I gave her in my patient satisfaction survey.

What?! She knows what I wrote and she is acknowledging that to me? Continue reading