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Experts tout importance of preconception health care

BY Michael Johnsen

WASHINGTON In collaboration with the Centers for Disease Control and Prevention, experts representing a variety of professional organizations, including the Association of Women’s Health, Obstetric and Neonatal Nurses; the American College of Nurse-Midwives; the American Academy of Family Physicians; and the American College of Obstetricians and Gynecologists, summarized the evidence supporting preconception health care in a special supplement to the American Journal of Obstetrics and Gynecology, AWHONN (Association of Women’s Health, etc.) announced last week.

The journal supplement reports on 15 areas, such as infectious disease, immunization, nutrition, environmental exposures and psychosocial stress, in which preconception care can be improved.

The supplement concludes that there is strong evidence to support more screening, health promotion and primary care interventions for women, such as smoking cessation and the intake of folic acid, calcium and other vitamins. “Unfortunately, the current status of preconception care in the United States is far from ideal,” AWHONN stated. “Only one in six obstetrician/gynecologists or family physicians provide preconception care to the majority of the women for whom they provide prenatal or maternity care.”

The CDC defines preconception care as interventions that identify and decrease medical, behavioral and social risks to the health of a woman before conception. For example, women who take medications that may cause birth defects can be counseled to switch to safer medications prior to conception.

“It is critical that every child has a healthy start. Therefore we need fundamental changes in how we provide care to reproductive-aged women,” stated Barbara Moran, president of AWHONN. “Nurses are typically the first and most consistent point of contact in the health care setting,” she said. “They spend more time with patients—up to 4 times on average—than any other health care provider. Nurses are well situated to provide health promotion, risk assessment and counseling within the primary care setting.”

The supplement continues the work of the CDC Expert Panel on the Content of Prenatal Care.

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Study finds smoking may increase risk of atrial fibrillation

BY Michael Johnsen

DURHAM, N.C. Cigarette smoking may contribute to the risk of atrial fibrillation a study published this month in the American Heart Journal found.

Atrial fibrillation is a disorder found in about 2.2 million Americans, according to the American Heart Association. During atrial fibrillation, the heart’s two small upper chambers (the atria) quiver instead of beating effectively. Blood isn’t pumped completely out of them, so it may pool and clot. If a piece of a blood clot in the atria leaves the heart and becomes lodged in an artery in the brain, a stroke results. About 15% of strokes occur in people with atrial fibrillation.

The likelihood of developing atrial fibrillation increases with age. Three to 5 percent of people over 65 have atrial fibrillation.The association between cigarette smoking and the risk of atrial fibrillation was examined in 5,668 subjects without atrial fibrillation at baseline as part of the Rotterdam Study, a population-based cohort study among subjects over the age of 55. Researchers found that both current smokers and former smokers had increased risks of atrial fibrillation as compared to people who never smoked. No differences were found between men and women.

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Study: Treadmill use may help suppress appetites

BY Michael Johnsen

BETHESDA, Md. A vigorous 60-minute workout on a treadmill is more likely to help people lose weight by suppressing appetite than 90 minutes pumping iron, the American Physiological Study announced earlier this month, citing results from a recent study published in the American Journal of Physiology-Regulatory, Integrative and Comparative Physiology.

This line of research may eventually lead to more effective ways to use exercise to help control weight, stated senior author David Stensel of Loughborough University in the United Kingdom.

There are several hormones that help regulate appetite, but the researchers looked at two of the major ones, ghrelin and peptide YY.

Ghrelin is the only hormone known to stimulate appetite. Peptide YY suppresses appetite.

Researchers found that the treadmill session caused ghrelin levels to drop and peptide YY levels to increase, indicating the hormones were suppressing appetite. However, a weight-lifting session produced a mixed result. Ghrelin levels dropped, indicating appetite suppression, but peptide YY levels did not change significantly.

“The finding that hunger is suppressed during and immediately after vigorous treadmill running is consistent with previous studies indicating that strenuous aerobic exercise transiently suppresses appetite,” Stensel said. “The findings suggest a similar, although slightly attenuated response, for weight lifting exercise.”

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