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Yaz (An Oral Contraceptive Pill) And Blood Clots: What The “Higher Risk” Means

Two studies published in this weeks’ British Medical Journal, one from the US and the other from the UK, report that users of drosperinone containing oral contraceptives (Yaz, Yasmin and their generics) have increased relative risks for non-fatal blood clots compared with users of pills containing levonorgestrel.

While neither study is perfect, and indeed have some very major limitations, they add to a growing body of evidence that pills containing drosperinone may impart higher risks for blood clots than older pills. Yaz is not alone in this regard – other studies have suggested that pills containing the newer progestins gestodene and desogestrel also impart slightly high clot risks than the so-called first and second generation pills containing the older progestins norethindrone and levonorgestrel.

I won’t go into the studies’ limitations here, but will say that trying to get our hands around comparative data on clot risks between various pills is an extraordinarily difficult process given that the diagnosis of blood clots is not always straightforward (or correct), pill choices are not randomized and fraught with prescribing bias, and confounding risk factors for clotting are numerous and difficult to control for. I wish folks would stop trying to answer these questions on the quick and cheap using claims and pharmacy databases without requiring chart review and strict diagnostic criteria. But that’s the way these studies are being done, and that’s the data I am being forced to contend with in my practice, so let’s talk about it. Read more »

*This blog post was originally published at The Blog That Ate Manhattan*

Beer Bellies Anyone? Waist Measurement Can Determine Risk For Heart Disease

Beer-mug-with-tape-measure

Extra fat that accumulates around the abdomen goes by many names: beer belly, spare tire, love handles, apple shape, middle-age spread, and the more technical “abdominal obesity.” No matter what the name, it is the shape of risk.

Abdominal obesity increases the risk of heart attack, stroke, diabetes, erectile dysfunction, and other woes. The danger zone is a waist size above 40 inches for men and 35 inches for women.

As I describe in the April 2011 issue of the Harvard Men’s Health Watch, beer is not specifically responsible for a beer belly. What, then, is to blame? Calories. Take in more calories with food and drink than you burn up with exercise, and you’ll store the excess energy in fat cells.

Many studies indicate that people who store their extra fat around the midsection (apple shape) are at greater risk for heart and other problems than people who carry it around their thighs (pear shape). An analysis of 58 earlier studies covering over 220,000 men and women suggests that excess fat is harmful no matter where it ends up. This work was published in The Lancet. Read more »

*This blog post was originally published at Harvard Health Blog*

Domestic Violence Has Become One Of The Top Public Health Issues Facing US Women

Domestic violence knows no boundaries: cultural, socio-economic, religious, level of education, gender or age. It can occur in any relationship and to anyone, but especially to women. In fact, roughly 25 percent of women will become a victim at one time or another during her lifetime.

Abuse is defined as any act used to gain power and control over another person, which can take on many forms. It can include physical, sexual, emotional, economic, coercion, threats, isolation and/or intimidation.

Domestic violence is abuse that occurs within interpersonal relationships and has become one of the top public health issues facing women in the United States. It is a leading cause of injury to women between the ages of 14 and 44 in this country.

There are risk factors that may increase the likelihood that a person becomes a victim to domestic violence. These can include: history of violence or abuse in a past relationship, physical or mental disability, unemployment, poor living situation, substance abuse, unplanned pregnancy, recently separated or divorced, social isolation and witnessed abuse as a child. Read more »

*This blog post was originally published at Society for Women's Health Research (SWHR)*

British Women Would Trade Longer Life For Thinner Bodies

College-aged women in the UK say they would trade longevity for an ideal body weight.

320 women studying at 20 British universities (ages 18-65; average, 24.49) completed a survey in March.

The research, conducted for new eating disorder charity The Succeed Foundation, in partnership with the University of the West of England (UWE), found that nearly 30% of women would trade at least one year of their life to achieve their ideal body weight and shape:
–16% would trade 1 year of their life
–10% would trade 2-5 years
–2% would trade 6-10 years
–1% would trade 21 years or more Read more »

*This blog post was originally published at ACP Internist*

How Much Vitamin D Do You Need?

Hand-and-sun

How much vitamin D is enough, and what’s the best way to get your daily dose of the so-called sunshine vitamin? It depends who you ask.

I just attended the latest Forum at the Harvard School of Public Health. The title, “Boosting Vitamin D: Not Enough or Too Much?” was a tip-off that we weren’t going to get a simple take-home message. (Watch a video of the event beginning Wednesday, March 30.)

Some background: Vitamin D isn’t really a vitamin. It’s a hormone. The body makes it when sunlight strikes the skin. This converts a cousin of cholesterol into a substance that ultimately becomes vitamin D. It is best known for helping the digestive system absorb calcium and phosphorus, so it is important for bone health. New research suggests—emphasis on suggests—that vitamin D may also be involved with regulating blood pressure, fighting cancer, and improving the immune system. Read more »

*This blog post was originally published at Harvard Health Blog*

Latest Interviews

IDEA Labs: Medical Students Take The Lead In Healthcare Innovation

It’s no secret that doctors are disappointed with the way that the U.S. healthcare system is evolving. Most feel helpless about improving their work conditions or solving technical problems in patient care. Fortunately one young medical student was undeterred by the mountain of disappointment carried by his senior clinician mentors…

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How To Be A Successful Patient: Young Doctors Offer Some Advice

I am proud to be a part of the American Resident Project an initiative that promotes the writing of medical students residents and new physicians as they explore ideas for transforming American health care delivery. I recently had the opportunity to interview three of the writing fellows about how to…

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Latest Book Reviews

Book Review: Is Empathy Learned By Faking It Till It’s Real?

I m often asked to do book reviews on my blog and I rarely agree to them. This is because it takes me a long time to read a book and then if I don t enjoy it I figure the author would rather me remain silent than publish my…

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The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

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Eat To Save Your Life: Another Half-True Diet Book

I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…

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