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Women's Health Month: Take ownership of health, wellness issues

Navy Cmdr. Francesca Cimino, M.D. (standing) confers with a colleague in the Family Medicine department at Uniformed Services University of the Health Sciences in Bethesda, Maryland. (Courtesy photo) Navy Cmdr. Francesca Cimino, M.D. (standing) confers with a colleague in the Family Medicine department at Uniformed Services University of the Health Sciences in Bethesda, Maryland. (Courtesy photo)

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EDITOR’S NOTE: October is Women’s Health Month, an opportunity to increase awareness about health issues important to women throughout their lifetime such as heart disease, breast and ovarian cancers, stroke, diabetes and chronic lower respiratory diseases, among other illnesses. This month, Health.mil will focus on the importance of recognizing the health and medical needs of women who are part of the DoD community, addressing preventable health concerns and encouraging early detection and treatment of disease among women and girls in the DoD community. 

This month’s first article, by Cmdr. Francesca Ciminio, M.D., a family physician and Assistant Professor at Uniformed Services University of the Health Sciences, Bethesda, Md., emphasizes small things that you can do to maintain health and fitness to live a healthy life.


October marks Women's Health Month, an opportunity for the Military Health System to increase awareness among female beneficiaries about important health and wellness issues that span a lifetime.

As an experienced family physician, I know, in the MHS, we have a receptive audience. Women are significantly more likely than men to make and keep appointments with their health care providers, according to the Centers for Disease Control and Prevention’s National Health Interview Survey.

Many of these appointments are for routine screenings: mammograms to check for breast cancer, Pap tests to detect cervical cancer. These are important, of course. Thanks to improvements in detection and treatment, more and more breast cancer patients are becoming breast cancer survivors. And U.S. cervical cancer survival rates are among the highest in the world.

But women's health encompasses more than these preventive cancer screenings. Did you know the No. 1 killer of women is heart disease? The American Heart Association's Life's Simple 7 identifies seven risk factors that women as well as men can improve though lifestyle changes to achieve ideal cardiovascular health.

Managing blood pressure, controlling cholesterol, reducing blood sugar – all of these actions matter. And they're as vital to long-term health and longevity as cancer screenings. Now that I've gotten older, I'm particularly cognizant that as we age, heart disease becomes more of an issue. Damage accumulates over time.

Excess weight also has been linked to heart disease. I know some women find tackling this issue particularly daunting. CDC statistics show that more women than men are obese, and that women are more likely to become obese as we age. (About 36.5 percent of women ages 20-39, and 44.7 percent of women ages 40-59, are obese. These figures compare to 34.8 percent of men ages 20-39, and 40.8 percent of men ages 40-59.)

A small weight loss may not necessarily get you to a healthy body mass index, but it can play a role in overall longevity. Losing even 5 pounds can be exponentially beneficial in terms of how it can improve blood sugar and cholesterol levels and lower risk of heart disease.

One tip is to cut added sugar from your diet. The Food and Drug Administration has updated its guidelines to suggest no more than 10 percent of daily calories come from added sugars. The FDA also updated the nutrition labeling on food packages to help us keep track of this amount in packaged products.

It's amazing how quickly added sugar accumulates. It shows up in the sneakiest places, including ketchup, salad dressing, canned soups, even your favorite "nutrition" bar. Be a smart shopper and read the label -- especially because there are, literally, dozens of different names for sugar on nutrition labels.

Many women are aware of the AHA's recommendation for 150 minutes weekly of aerobic activity. I'd like to encourage you to think about making physical activity an everyday part of life, and not something to accomplish only during dedicated workouts. If your schedule precludes you from spending 30 minutes on an elliptical machine or stationary bike on any given day, all is not lost. Make a daily habit of climbing the stairs instead of riding the elevator, and parking your car further from your destination so you can get a few more steps in.

All movement matters. According to a Harvard study, simply being more mindful of how movement adds up to exercise helped hotel maids lose weight and improve their blood pressure.

Finally, I'd like to encourage you to be your own best advocate when it comes to health and wellness. For example, urinary incontinence comes up frequently when I ask my patients about it, but patients have sometimes been reluctant to be the first to broach the topic. Incontinence may be normal for women who've experienced childbirth, but that doesn't mean you have to resign yourself to it. It's treatable. So are problems associated with sex and comfort, interest, pain, and pleasure.

Mental health is another topic to bring up with your health care provider. Research has shown that hormonal changes at three stages of a woman's life—puberty, post-pregnancy, and during perimenopause—may trigger clinical depression. You don't need to suffer in silence.

The MHS provides a variety of programs, resources, and tools to maintain and improve the health of our female warfighters and beneficiaries. During Women's Health Month and indeed, any other time, let us know how we can help you.

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2018 #ColdReadiness Twitter chat recap: Preventing cold weather injuries for service members and their families

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1/18/2018
During the 5-year surveillance period, 105 cold weather injuries were diagnosed and treated in service members deployed outside the U.S. of these, 39 (37%) were immersion injuries; 33 (31%) were frostbite; 16 (15%) were hypothermia; and 17 (16%) were “unspecified” cold weather injuries. Pie chart for cold weather injuries during deployments displays depicting the information above. Number of cold weather injuries bar chart: Of all 105 cold weather injuries during the surveillance period, 68% occurred during the first two cold seasons. Bar chart shows the number of cold weather injuries by year: •	2012-2013 cold season had 35 cold weather injuries •	2013-2014 cold season had 100 cold weather injuries •	2014 -2015 cold season had 13 cold weather injuries •	2015-2016 cold season had 11 cold weather injuries •	2016 – 2017 had 10 cold weather injuries Access the full report in the October 2017 MSMR (Vol. 24, No. 10). Go to: www.Health.mil/MSMR  #ColdReadiness

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Did you know…?  •	From 2012 – 2016, there were 63,879 live births to women of childbearing potential in the active component. The overall live birth rate was 64.9 live births per 1,000 person-years (p-yrs). The live birth rate decreased steadily from 69.8 per 1,000 p-yrs in 2012 to 59.7 per 1,000 p-yrs in 2016. The decrease was primarily driven by declining rates among women in their 20s. Overall, live birth rates were highest among women who were: •	30-34 years old •	Army members •	In healthcare occupations •	Married Of the total 63,879 live birth deliveries: •	24.7% were cesarean •	75.3% were vaginal Pie chart depicting this information displays. United States map displays showing the highest numbers of deliveries during the surveillance period reported by military hospitals at: •	Naval Medical Center Portsmouth, VA (7.4%) •	Naval Medical Center San Diego, CA (6.1%) •	The Carl R. Darnall Army Medical Center, TX (4.1%) •	Womack Army Medical Center, NC (3.8%) •	Tripler Army Medical Center, HI (3.7%) Live birth rates were broadly similar among the race/ethnicity groups, although the overall rate was slightly higher among American Indians/ Alaska Natives. Access the full report in the November 2017 MSMR (Vol. 24, No.11). Go to: www.Health.mil/MSMR

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Pertussis, commonly known as “whooping cough,” is a vaccine-preventable illness more common and more severe in children than in adults. Infections during the first few months of life can be particularly severe, with almost all deaths from pertussis occurring in infants less than 6 months of age. A vaccinated mother’s antibodies against pertussis protect the baby during pregnancy until it can receive the vaccine at two months of age. Approximately 400 probable and 50 confirmed cases occur annually among service members and other adult beneficiaries of the Military Health System. In 2012, the Advisory Committee on Immunization Practices recommended Tdap for every pregnancy to reduce the burden of pertussis in infants. This surveillance study assessed Tdap vaccination coverage among pregnant service women during 2006 through 2014. FINDINGS: •	There were records of a total of 137,133 live birth deliveries to service women •	Only 1%  – 3% of service women received a Tdap vaccine during pregnancy from 2006  – 2011 •	Tdap vaccination coverage increased substantially  – 8% in 2012 to 54% in 2014 •	Navy women had the highest  annual proportion of vaccine coverage at 65% in 2014 •	First deliveries had the highest vaccination coverage at 57% in 2014 •	Fourth or subsequent deliveries had the lowest coverage at 41% in 2014 More education and attention by military physicians and pregnant service women about the benefits of Tdap vaccination are needed to bring coverage closer to 100%. Learn more in MSMR Vol. 22 No. 5 May 2015 at Health.mil/MSMR  Images on graphic: •	Baby icon to depict live birth deliveries •	Pie charts showing the findings in visual form •	Line graph showing the percent vaccinated among Navy, Marine Corps, Army, Air Force and Coast Guard The line graph shows the annual percentages of active component service women with a live birth delivery who received a Tdap vaccine during pregnancy, by year of delivery and service, 2011– 2014.

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