I missed this earlier in the summer, but wanted to let you know about a government report, Older Americans 2010: Key Indicators of Well-Being, which provides information on the health status of Americans aged 65 years and older, including life expectancy, chronic health conditions, symptoms of depression, prescription drug costs, obesity, physical activity, mammograms, and more. Several of the topics are split into male and female data, such as the percentage of women and men who have heart disease, hypertension, and other conditions, so this could be a good quick reference source for understanding some aspects of the health status of women older than 65.

Random Aside: does the generic descriptor “older Americans” bother anyone else? It always makes me ask, “Older than what/who?”

Princeton University is hosting a conference this fall (October 15 & 16), “Open Hearts, Open Minds and Fair Minded Words,” featuring speakers from around the country on the topic of abortion.

The stated goals of the conference are to:

1. Explore new ways to think and speak about abortion.
2. Approach issues related to abortion with open hearts and open minds.
3. Define more precisely areas of disagreement and work together on areas of common ground.
4. Get to know those on multiple sides of the issues more personally.

Speakers will include experts in law, bioethics, medicine, theology, and other topics. The full program is available online, and includes panels on topics including morality, prevention of unintended pregnancy, conscience clauses, Constitutionality, and other issues.

Early discounted registration ends September 8.

The American College of Nurse-Midwives (ACNM) issued a press release [PDF] today responding to the American College of Obstetricians and Gynecologists’ (ACOG) recently revised recommendation on vaginal birth after cesarean. The ACNM calls  for “concerted efforts to expand access to vaginal birth after cesarean (VBAC) in the U.S.” (for background, see our previous post).

The ACNM release is accompanied by a more complete statement [PDF] that reviews the ACOG recommendation and outlines ACNM’s response. It includes a discussion of how the ACOG’s specific recommendation that VBAC be undertaken at “facilities capable of emergency deliveries” may continue to limit women’s ability to choose VBAC.

Last night, talk show host Rachel Maddow discussed tactics used by anti-choice activities to restrict women’s access to abortion. She focused on Virginia Attorney General Ken Cuccinelli II, who has issued an opinion [PDF] indicating that the state may impose additional restrictions on providers of first trimester abortions, including allowing the Board of Health to regulate them as “hospitals.” An article in the Roanoke Times explains:

Cuccinelli’s opinion notes that health centers specializing in reproductive services are characterized as physicians’ offices that are exempt from state hospital licensure requirements. Forcing those facilities to meet hospital standards would bring more demanding requirements for space, equipment and staffing that abortion rights supporters argue would limit access to legal, first-trimester abortions.

Maddow spoke to NARAL Pro-Choice Virginia President Tarina Keene about what this could mean for abortion access in that state. Keene indicated that such regulations could potentially close 17 of the state’s 21 abortion clinics (making our past discussions of the difficulties provider face integrating abortion into their office practices all the more relevant). The organization has issued a statement arguing that:

This move has nothing to do with upholding the law or protecting women’s health, and everything to do with ideology and politics. Attorney General Cuccinelli is trying to accomplish through brute force of executive power what he couldn’t accomplish through the democratic process in his time as a State Senator – restricting women’s access to reproductive healthcare by shutting down abortion providers. These targeted regulations of abortion providers (TRAP) laws have nothing to do with safety and have everything to do with ideology.

Those who support the change will inevitably ask, “Don’t you want women to be as safe as possible when they have abortions?” Of course pro-choice women’s health and reproductive rights advocates want abortion to be safe. But this seemingly innocuous question ignores the fact that those pushing for such changes are working to restrict abortion access, rather than responding to any demonstrated need for improved facilities.

As Keene observes in the interview, “They have hijacked the language, and, unfortunately, what they’ve also done is make people feel like abortion is dangerous and it’s also scary.”

In reality, the data shows that legal abortion in the first trimester is very safe — far safer than continuing a pregnancy.

View the full interview (with transcript) below:

Visit msnbc.com for breaking news, world news, and news about the economy

While it’s not strictly women’s health, I wanted to pass along these resources on keeping up with food recalls (especially in light of the current egg recall estimated to affect around half a million eggs). The resources below can help keep you informed about product safety in this and future recall events.

First, some good resources for keeping up with product recalls in general:

• From the FDA: Recalls, Market Withdrawals, & Safety Alerts (you can sign up for email alerts)
• Recalls.gov: news about and links to recalls of food, medicines, cosmetics, and other consumer products (you can also sign up for alerts from various government agencies through this site)
• USDA: news on food-related recalls from the USDA’s Food Safety & Inspection Service
• FoodSafety.gov – food safety information and recall news
• Consumer Product Safety Commission – recall and product safety news (non-food items, like child, household, and recreational products)

If you have access to a mobile device, there are also apps for tracking recalls, such as these from the U.S. government.

Now, some egg recall-specific resources:

• URGENT Nationwide Egg Recall; Eggs in Their Shells May Put Consumers at Risk for Salmonella – main alert page from the FDA
• Also from the FDA: Salmonella Enteritidis Outbreak in Shell Eggs
• How can I tell if my eggs have been recalled? – a guide to finding the relevant carton codes, from the FDA, with a list of recalled brands and relevant dates
• Tips to Reduce Your Risk of Salmonella from Eggs – egg safety information from the CDC
• FoodSafety.gov: Eggs & Egg Products – basic overview and links to additional recall and egg safety information

The summer 2010 Guttmacher Policy Review includes a piece, Off Base: The U.S. Military’s Ban on Privately Funded Abortions, which describes current military policy on abortion, including the existing ban on public funding and debate about lifting the ban on privately funded abortions in military medical facilities.

For context, the piece explains:

Earlier this year, the Senate Armed Services Committee moved toward restoring abortion rights to some 200,000 active duty women in the U.S. military, by voting to reverse current policy prohibiting the performance of abortions in military facilities, even in cases when U.S. servicewomen pay out-of-pocket for the procedure.The amendment to change the policy was sponsored by Sen. Roland Burris (D-IL) and is now attached to the pending Department of Defense (DOD) authorization bill.

The ban on privately funded abortions was apparently put in place in 1988, lifted by former President Clinton in 1993, and reinstated by Congress in 1995. According to the author, the ban particularly affects servicewomen stationed overseas, where legal abortion may not be available in the country’s own facilities. The author makes an argument that the policy against privately funded abortion in Department of Defense facilities not only strips women of their right to an abortion and endangers their health and safety, but that the policy may have negative effects on the military through the loss of women who would otherwise choose abortion.

As the review’s author states for a related press release:

This debate is not about the morality or legality of abortion, but whether women who enlist in the military, and especially those who are living overseas, should be discriminated against as a result…It’s time that we stop treating women in uniform as second-class citizens by denying them timely access to a legal, Constitutionally protected health care service their civilian counterparts can freely obtain.

Readers may also be interested in another piece from the same policy review, The Potential of Health Care Reform to Improve Pregnancy-Related Services and Outcomes.

Earlier this summer, we wrote about the President’s Cancer Panel report on environmental causes of cancer. Relatedly, the National Institutes of Health announced this week the formation of a committee to focus in part on environmental factors related specifically to breast cancer.

The committee will “develop and coordinate a strategic federal research agenda on environmental and genetic factors related to breast cancer.” It will apparently review current federal breast cancer research activities and make recommendations for improving these programs.

The committee is composed of representatives from the EPA, CDC, National Cancer Institute, the National Institute of Environmental Health Sciences, and other federal agencies, along with several physicians and scientists, and representatives from the advocacy groups Zero Breast Cancer, Breast Cancer Options, Academy for Cancer Wellness, Huntington Breast Cancer Action Coalition, National Breast Cancer Coalition, and the Breast Cancer Fund.

For more information, the National Institute of Environmental Health Sciences provides some (rather technical) resources on breast cancer and the environment, and has produced a report (most recently in 2008) on the State of the Evidence: The Connection Between Breast Cancer and the Environment [PDF]. The National Cancer Institute provides an online “understanding cancer” series which includes a set of slides and information on cancer and the environment.

In June, we wrote about the FDA’s Advisory Committee for Reproductive Health Drugs recommendation to approve ulipristal acetate (brand name “ella”) for emergency contraception. On Friday, the FDA did approve the drug, as a prescription-only emergency contraceptive to be taken up to 120 hours (5 days) after contraceptive failure/unprotected sex. Existing “Plan B”-type emergency contraception is currently approved for use up to 72 hours.

Despite the five-day use window for this drug (and the three-day window for others), some media outlets persist in calling it a “morning-after” pill. Ahem.

At the time of our June post, a transcript of the Advisory Committee meeting – which includes the text of presentations and detailed discussion of the drug – was not yet available. That transcript is now online [PDF], including comments from representatives of Planned Parenthood and the National Women’s Health Network.

See our previous post for further discussion of the new emergency contraceptive.

As we know, the majority of U.S. counties lack an abortion provider, and ensuring that proper training in the procedure is available to future healthcare providers is one key aspect of making and keeping abortion available. As the new school year approaches and new medical and nursing students are arriving at campuses all over the country, we thought we’d list resources for students interested in organizing to promote and protect abortion training in their programs. Two organizations working hard to provide information and resources on abortion training and availability are Medical Students for Choice and Nursing Students for Choice.

Medical Students for Choice provides student organizing resources including tips on curriculum reform and tools for student leaders, a list of U.S. and Canadian ob/gyn and family practice residency programs that offer abortion training, recommended reading, and other tools and support. The organization is also on Facebook and Twitter.

Nursing Students for Choice is a relatively new organization that focuses on reproductive health training for nursing students. Their website provides resources for getting involved and for starting campus chapters. The organization also has a new blog as well as Facebook presence.

Via @NLIRH, we learned that the National Latina Institute for Reproductive Health, California Latinas for Reproductive Justice and the Colorado Organization for Latina Opportunity and Reproductive Rights have teamed up for the first annual Latina Week of Action for Reproductive Justice, starting today and running until August 15th.

As part of the week, the groups are asking supporters to contact their Congressional representatives “to ask the Department of Health and Human Services (HHS) to support comprehensive family planning services that include contraception as a key women’s health service under the Women’s Health Amendment.” As with many online action campaigns, you can put in your zip code to identify your Representative and Senators and send them a letter explaining that “Latinas, immigrants, and women of color will be disproportionately affected if contraception is not made affordable and accessible.”

There is also an online conversation about Latinas and contraception happening all week, with an inaugural blog post, My-So-Called-Sex-Education, up at Nuestra Vida, Nuestra Voz (NLIRH’s blog) on the need for information about and access to contraception. Further discussion will happen on Facebook, via Twitter (#latinaRJwk), and on partnering blogs such as VivirLatino. There are in-person events taking place in a few cities; check out this page for details.

The Health on the Net foundation is conducting a survey of how people (both health professionals and patients) use the Internet for finding and accessing health information. They estimate that the survey will take 10-15 minutes, and it is available in both English and French.

You may have seen HON code certification on some health-related websites; the certification denotes that the site has met certain criteria for credibility and transparency, and has applied for certification and been approved. HON provides a list of some of the principles used in evaluating health websites.

Other guides for evaluating the quality and reliability of health information websites are provided by the National Library of Medicine (my current favorite, available in English and Spanish), the National Cancer Institute, and the Medical Library Association. NLM also provides an online tutorial with more visual examples (although I can’t seem to find captions or a transcript for the audio track).

If you’re interested in reading more about how people are using the internet for health information, the Pew Internet & American life Project provides commentary, presentations and reports on topics such as chronic disease, social media, e-patients, and the use of the web for health information in general. Additionally, e-patients.net is a great place for kind of geeky discussions by patients on how to become more informed about their health (largely via the internet) and more engaged in their own care.

I served as an official blogger again this year for the Medical Library Association annual conference, held in Washington, DC. In addition to blogging, I got to do two presentations myself!

Here’s a round-up of the posts I wrote, which generally include some good online resources related to the topics at hand. Various posts may be of interest to other med librarians, individuals with NIH-funded or other federally funded research grants, anatomy instructors, those interested in HIV/AIDS or vaccines or community outreach on health, PubMed searchers, and others:

• Section Program: Vaccine Information – speakers from the CDC, a university, and a public health librarian on vaccine safety and information on communication, myths and misperceptions, outreach efforts related to the HPV vaccine, and other topics
• NLM Theater: MyBibliography for Managing NIH Public Access Compliance – easy visual cues to NIH public access compliance with new features for ease of use
• Vendor Profile: Quertle – a PubMed search alternative that includes relationship searching for focusing results
• Vendor Profile: anatomyEXPERT – a brand new anatomy learning tool with great visuals
• AIDS 2010: Evolution of Information – HIV/AIDS info from clinical, librarian, and USAID/global outreach perspectives
• Notes from the Government Relations Committee – on NIH/NLM funding, and FRPAA (the federal research public access act) – I’m brand new to this committee this year
• Online Content: Videos Now Available from Plenary Sessions I & II [these are available to conference attendees and folks who register/pay for the online content]
• Quick Links: More on That Redesigned Pill Bottle – an example of using good design to improve health, a topic from Daniel Pink’s plenary session
• E-Science: Exploring the Librarian’s Role – librarians on data curation and sharing and helping researchers manage and organize their data and connect it to others

I also have a post at my place on my conversation with an ACOG rep about how they disappear old guidelines when new ones become available.

My fellow medical librarians posted on various other topics throughout the event at http://npc.mlanet.org/mla10/.

My own presentations were an invited panel on informal publication methods, where I spoke about applying some benefits of informal methods such as blogs to our formal journals, and a paper presentation about approaches my library has taken over the past year to improve management of metadata for our electronic resources, including accountability features and distributing the workload beyond our tech services folks. A’Llyn has a post on the open forum on publication methods.

[cross-posted/adapted from Women's Health News]

Earlier this week, the so-called “Pro-Life Freedom Ride” (alluding to the civil rights freedom rides) arrived at the King Center in Atlanta to demonstrate in opposition to abortion rights. The “freedom ride” campaign is being organized by Priests for Life to “build…on a method that the Civil Rights Movement used effectively forty years ago,” and consists of anti-abortion activists taking a bus to cities “with strategic significance for the movement” (such as Atlanta and Birmingham) to demonstrate against abortion.

The “ride” to Atlanta follows up on previous efforts in the state targeting women of color with the goal of restricting abortion. Atlanta was the target earlier this year of an anti-abortion billboard campaign targeting Black women by referring to Black children as an “endangered species.” Also this year, race-focused anti-abortion legislation was defeated in the state; it was opposed by groups of women of color including SisterSong, SPARK, and SisterLove, who were also active in organizing protests of the “pro-life freedom rides.”

Loretta Ross of SisterSong filed this report {PDF] from their protests of the “Ride” at this week’s events, writing that:

…it was surreal seeing all these white folks carrying signs that said “Abortion is the #1 Killer of Black America.” Can you imagine the optics of the scene? Here’s a group of white folks claiming to save Black babies being protested by mostly African American women and men who are shouting “Trust Black Women!”? Once we saw their signs, Paris instantly created a new chant: “Racism is the #1 Killer of Black America, not Black Women!”

In a statement [PDF] prior to the event, the organizations wrote that the “rides” were “no more than a ploy to turn back the clock on Black women’s right to reproductive freedom,” and Ross got to the heart of the offense of the event, including the appropriation of an important civil rights legacy in the service of restricting the rights of women of color:

We are offended by their cynicism, opportunism, and outright distortions of historical facts. Both Dr. Martin Luther King, Jr. and Coretta Scott King firmly supported reproductive justice for women. Lies by anti-abortionists, no matter how often repeated, cannot change those historical facts.

As Dazon Dixon Diallo of SisterLove stated:

The actions planned by Priests for Life [the group organizing the rides] are insulting, disrespectful, and completely antithetical to the struggle for women’s human rights. They should be ashamed of themselves, and it is our job as Black women and people of color to shame them!

We would expand that to it being the job of *all* people who are pro-choice advocates for human rights and reproductive justice to resist these campaigns.

For more, see:

• SPARK Reaffirms the Agency and Power of Black Women and our Civil Rights Legacy
• SisterSong has photos from the event on their Facebook profile
• Anti-choice “Freedom Rides” Distort the History and Message of Civil Rights Movement – from the National Latina Institute for Reproductive Health

Following up on last week’s ACOG release of an updated VBAC practice bulletin – this one with an increased emphasis on maternal autonomy – we thought we’d take a look around the web for what others are saying about the new statement.

From organizations:
Lamaze International calls the new guideline “a step in the right direction, clearly stating that women with one previous cesarean should be offered VBAC,” but wonders if there is too much of the “immediately available” language still in the current version.

Choices in Childbirth applauds the new version for “encourag[ing] autonomy for women in their maternity care decisions.”

The International Cesarean Awareness Network expresses that ACOG is going to need to take “an active role in educating both women and practitioners about healthy childbirth practices; practices that not only encourage VBAC but discourage the overuse of primary cesareans” in order to “reverse the over a decade long trend of increasing cesarean rates and decreasing VBAC rates.”

From the blogs:
Birthing Beautiful Ideas expresses that the importance of the new guideline is “not because it will effect any immediate policy changes but because it gives women a tool to help them facilitate discussions with their care providers and/or their local hospitals so that they can advocate for their birthing options.”

Jill at The Unnecesarean asks How will ACOG handle the PR challenge of promoting VBAC as a safe option? and wonders how the organization and individual physicians will approach the shift in attitudes toward VBAC that the new bulletin represents. She also has links to coverage at several other blogs.

The Well-Rounded Mama is lighting virtual fireworks over the bulletin’s Good News for Vaginal Birth After Multiple Cesarean! (The new guideline says that women with two previous low transverse incisions can be considered candidates for a trial of labor)

Amie Newman at RHRC, Babble, and Broadsheet also discuss the new guideline.

Seen other online commentaries or responses worth a look? Please share them in the comments!

The American College of Obstetricians and Gynecologists (ACOG) has released a new set of guidelines for providers on vaginal birth after cesarean (VBAC). The guidelines should be of interest to anyone who is interested in having a VBAC or who has been concerned about VBAC access and high repeat cesarean rates.

ACOG’s press release on the guidelines is available online; the full recommendation, which appears in the journal Obstetrics & Gynecology (August 2010 issue), is available here as a PDF.

The guidelines, noting the decreasing VBAC rate, increasing cesarean rate, and lack of access to a trial of labor at some hospitals, takes an approach that clearly emphasizes individualized decision-making (rather than blanket policies) and women’s autonomy.

First, the document recognizes that desire for VBAC is not simply a lifestyle choice or preference, but one with implications for women’s health and outcomes:

In addition to providing an option for those who want the experience of a vaginal birth, VBAC has several potential health advantages for women. Women who achieve VBAC avoid major abdominal surgery, resulting in lower rates of hemorrhage, infection, and a shorter recovery period compared with elective repeat cesarean delivery. Additionally, for those considering larger families, VBAC may avoid potential future maternal consequences of multiple cesarean deliveries such as hysterectomy, bowel or bladder injury, transfusion, infection, and abnormal placentation such as placenta previa and placenta accreta.

The authors explain further that, “VBAC is associated with fewer complications, and a failed TOLAC [trial of labor after cesarean] is associated with more complications, than elective repeat cesarean delivery. Consequently, risk for maternal morbidity is integrally related to a woman’s probability of achieving VBAC.”

It goes on to review a number of factors that may be associated with a woman’s likelihood of successfully having a VBAC after a trial of labor, emphasizing the need to examine the clinical picture for an individual woman with regards to the potential benefits and harms of elective repeat cesarean, VBAC, and failed trial of labor. Again, there is explicit consideration for individual autonomy, with the statement that “The balance of risks and benefits appropriate for one patient may seem unacceptable for another.”

With regards to who may be a good VBAC candidate, the document states that “The preponderance of evidence suggests that most women with one previous cesarean delivery with a low transverse incision are candidates for and should be counseled about VBAC and offered TOLAC,” and reiterates that “Individual circumstances must be considered in all cases.”

This recommendation was actually present in the previous (2004) recommendation, but was offset by the so-called “immediately available” standard which led many facilities to decide that offering VBACs was not an option.

The current document states that “Restricting access was not the intention of the College’s past recommendation.” It clarifies that while facilities offering trials of labor should have “staff immediately available to provide emergency care,” when organizing transfers to better equipped facilities is not realistic, “Respect for patient autonomy supports the concept that patients should be allowed to accept increased levels of risk.” Patient counseling and early conversations between the woman and her provider are urged, with the ultimate decision to be “made by the patient in consultation with her health care provider.”

Patient education and access to trial of labor is emphasized throughout, and I think this is the key portion for those concerned about autonomy and forced or court-ordered cesarean:

…none of the principles, options, or processes outlined here should be used by centers, health care providers, or insurers to avoid appropriate efforts to provide the recommended resources to make TOLAC as safe as possible for those who choose this option….Respect for patient autonomy also argues that even if a center does not offer TOLAC, such a policy cannot be used to force women to have cesarean delivery or to deny care to women in labor who decline to have a repeat cesarean delivery.

Also of interest may be the conclusions that women with two previous low transverse incisions, carrying twins, or with single previous cesarean with an unknown type of incision may be candidates for a trial of labor.

Overall, I think the new practice bulletin is going to be much more agreeable to advocates and useful as a tool in encouraging hospitals and providers to reconsider their VBAC practices. We look forward to hearing your take in the comments!