Preventing Obesity in Midlife Women: A Recommendation From the Women's Preventive Services Initiative.

DESCRIPTION: The Women's Preventive Services Initiative (WPSI), a national coalition of women's health professional organizations and patient advocacy representatives, developed a recommendation for counseling midlife women aged 40 to 60 years with normal or overweight body mass index (BMI; 18.5 to 29.9 kg/m2) to maintain weight or limit weight gain to prevent obesity with the long-term goals of optimizing health, function, and well-being. This recommendation is intended to guide clinical practice and coverage of clinical preventive health services for the Health Resources and Services Administration and other stakeholders. Clinicians providing preventive health care to women in primary care settings are the target audience for this recommendation. METHODS: The WPSI developed this recommendation after evaluating results of a systematic review of the effectiveness and harms of interventions to prevent weight gain and obesity in women aged 40 to 60 years without obesity. Seven randomized clinical trials including 51 638 participants and using various counseling and behavioral interventions were included. Trials indicated favorable weight changes with interventions that were statistically significantly different from control groups in 4 of 5 trials of counseling, but not in 2 trials of exercise. Few harms were reported. RECOMMENDATION: The WPSI recommends counseling midlife women aged 40 to 60 years with normal or overweight BMI (18.5 to 29.9 kg/m2) to maintain weight or limit weight gain to prevent obesity. Counseling may include individualized discussion of healthy eating and physical activity.

Physically and sexually violent experiences of reproductive-aged women displaced by Hurricane Katrina.

PURPOSE: Measure the frequency of physical and sexual abuse in a sample of reproductive aged women displaced by Hurricane Katrina, and compare those experiences to the year before Hurricane Katrina. METHODS: Sixty-six English-speaking women aged 18-49 years residing in Louisiana Federal Emergency Management Agency (FEMA) housing were screened for physical and sexual abuse seven to nine months after Hurricane Katrina, using modified 30x7 cluster sampling methodology. FINDINGS: Twenty-three percent (95% confidence interval [CI], 14, 34%) of women reported being hit or verbally threatened since Hurricane Katrina. Abuse had increased for 33% (95% CI, 13, 63%) and decreased for 13% (95% CI, 4, 37%) of women. Twenty percent (95% CI, 6, 51%) of abused women were with a new partner, while 13% (95% CI, 4, 39%) reported new abuse with the same partner. Four women reported sexual abuse since Hurricane Katrina. Compared to before the storm, the frequency of sexual abuse was the same for two women, and one reported new abuse with the same partner. CONCLUSIONS: Physical abuse was not uncommon among displaced women following Hurricane Katrina. Increasing and new abuse were the most commonly reported experiences. Violence against women should not be overlooked as a continued, and perhaps escalating, occurrence requiring attention following displacement after disasters of such magnitude as Hurricane Katrina.

Betamethasone-induced hypokalemic periodic paralysis in pregnancy.

BACKGROUND: Acute hypokalemic periodic paralysis may be induced by betamethasone injections during pregnancy. CASE: A healthy 23-year-old gravid woman at 32 weeks of gestation with preterm premature rupture of membranes received two doses of 12-mg intramuscular betamethasone 24 hours apart to accelerate fetal lung maturation. She developed significant proximal muscle weakness within 16 hours after the initial dose. Her serum potassium was 1.6 mEq/L. Oral and parenteral potassium replacement restored her neuromuscular function over several days. She delivered by repeat cesarean at 34 weeks of gestation without complications for her or the neonate. CONCLUSION: Hypokalemic periodic paralysis, a rare cause of weakness, may be induced by betamethasone injections during pregnancy and is reversible with low-risk interventions.

Pharmacist-administered subcutaneous depot medroxyprogesterone acetate: a pilot randomized controlled trial.

BACKGROUND: The objectives of this study were to assess the feasibility of administering subcutaneous depot medroxyprogesterone acetate (DMPA-SC) in a pharmacy setting and assess patient satisfaction. STUDY DESIGN: Fifty women, at least 18 years of age, presenting to a family planning clinic to initiate, continue or restart any form of DMPA were randomized to receive two subsequent injections at a nearby pharmacy by trained pharmacists or at the clinic. Women completed two follow-up surveys to rate their satisfaction with DMPA-SC and their clinic/pharmacy experiences. RESULTS: The relative risk of returning and receiving a second DMPA-SC injection of women randomized to the pharmacy compared with those randomized to the clinic was 0.73 (95% CI 0.42-1.27). The relative risk of returning and receiving a third DMPA-SC injection was 0.75 (95% CI 0.39-1.46). Most women found the pharmacy setting convenient (70%), private (100%), the providers respectful (100%) and were satisfied with DMPA-SC and the pharmacy as a clinical site (> or = 89%). No significant difference in patient satisfaction with location, convenience, privacy, and respect from providers was found between study groups (p>.05), nor were there significant differences in attitudes or satisfaction among women between their two follow-up injections. CONCLUSION: Administration of DMPA-SC by pharmacists in a pharmacy setting is feasible. Continuation rates and patient satisfaction with DMPA-SC and the pharmacy setting were comparable to those who received DMPA-SC in a family planning clinic.

Women's knowledge and sources of information on the risks and benefits of oral contraception.

OBJECTIVE: To assess the knowledge of the risks and benefits of oral contraceptives (OCs) in a heterogeneous group of women and to identify their sources of information. METHODS: A self-administered questionnaire assessing demographics, contraception history, knowledge of risks and benefits of OCs, and information sources was given to literate English- and Spanish-speaking women waiting for appointments at 4 clinics serving distinct populations in Portland, Oregon. RESULTS: Approximately half of the 211 women studied were of the opinion that OCs decreased the risk of acne, dysmenorrhea, and menorrhagia and increased the risk of weight gain, headaches, and thrombosis. Less than 15% knew of the decreased risk of anemia, endometrial cancer, colon cancer and pelvic inflammatory disease, but 28% understood the decreased risk of ovarian cancer. Seven percent to 36% of women used their own experiences in assessing the effect of OCs on a variety of general and reproductive factors. Women relied primarily on printed information for knowledge of OCs' effects on cardiovascular health and cancer. CONCLUSION: Women in this heterogeneous population of women were unaware of several benefits of OCs. Women relied heavily on their own experiences in assessing the risks and benefits of OCs. Women cited printed information more frequently than medical personnel as major sources of information on cardiovascular and oncological risks and benefits of OCs. The Internet, however, played a minimal, if any role in educating women about OCs.