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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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Gestational diabetes among pregnant service members, active component, U.S. Armed Forces 2012 – 2016

Infographic
1/5/2018
Gestational diabetes is an abnormal increase in blood sugar levels that can adversely affect the health of both a pregnant woman and her baby. During 2012 – 2016, 4,017 (6.3%) of active component female service members who had live births were affected by gestational diabetes. Women aged 25-34 and 35-49 years had consistently higher annual prevalences of gestational diabetes than younger females. The percentage of pregnant service members affected by gestational diabetes was more than twice as high for obese women as for non-obese women (12.4% vs. 5.5%). The percentage of live births affected by gestational diabetes increased with increasing age and was highest among Asians/Pacific Islanders. Access the full report in the November 2017 MSMR (Vol. 24, No. 11). Go to: www.Health.mil/MSMR

This infographic documents the incidence and prevalence of gestational diabetes pregnant service members, active component, U.S. Armed Forces, 2012 – 2016.

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Pregnancies and live births among female service members

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12/21/2017
Women have been able to serve officially in the U.S. military since 1901. Both the number of women serving in the active component and their occupational roles have steadily increased and expanded. Currently, almost one in seven active component service members are female and more than 95% of military occupational specialties are open to women. This infographic summarizes data on the demographic and military characteristics of women including women of childbearing potential (WOCBP) in the active component of the U.S. Armed Forces during 2012 – 2016. Data on pregnancy-related care and birth rates are also presented. FINDINGS •	In 2016, WOCBP comprised the vast majority of active component service women. •	202,849 women served in the active component of the Army, Navy, Air Force, or Marine Corps. 197,947 (97.6%) were WOCBP. Pie chart displays depicting this information. •	In 2016, 13.1% of all WOCBP had at least one pregnancy-related event. Pie chat displays depicting this information. Female stick figures display to show visual of the largest proportions of WOCBP. Breakdown of WOCBP by service: •	Army (32.9%) •	Air Force (30.0%) •	Navy (29.7%) •	Marine Corps (7.5%) Pie chart displays to visually depict breakdown of WOCBP by service. The largest proportions of WOCBP were: •	In a communications / intelligence occupation (32.3%) •	Junior enlisted rank (46.5%) •	Non-Hispanic white (43.4%) •	20 – 24 years old (34.3%) Live births: •	There were 63,879 live births during the surveillance period. •	Overall live birth rate was 64.9 live births per 1,000 person-years (p-yrs). This rate of live births decreased steadily from 69.8 per 1,000 p-yrs in 2012 to 59.7 per 1,000 p-yrs in 2016. Line graph displays this information. Rates of live births were highest among: •	Women who were 30 – 34 years old •	Enlisted or junior officer rank •	Army •	In healthcare / intelligence occupations •	Married Access the full report in the November 2017 MSMR (Vol. 24, No. 11). Go to: www.Health.mil/MSMR

This infographic summarizes data on the demographic and military characteristics of women including women of childbearing potential (WOCBP) in the active component of the U.S. Armed Forces during 2012 – 2016. Data on pregnancy-related care and birth rates are also presented.

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Pregnancies among female service members, Active component, U.S. Armed Forces, 2012 – 2016

Infographic
12/21/2017
With the increasing numbers of service women and the expansion of roles available to women within the military, understanding the epidemiology of pregnancy is important for both the health of U.S. service women and the readiness of the U.S. fighting force, two closely related issues. Between 2012 – 2016, 344,536 unique women of childbearing potential (WOCBP) served at least 1 day in the military, and of those, 132,466 spend at least 1 day as a recruit trainee. Of the 224,718 WOCBP who served at any time in 2016, 13.1% had at least one pregnancy-related event during that year. A “pregnancy-related event,” refers to a health care encounter (visit) for which the record contains a diagnosis code for either pregnancy or a positive pregnancy test. In 2016, the highest prevalence of pregnancy-related events was among service women 30-34 years of age (16.8%) and among senior enlisted women (13.7%). Pie chart displays depicting the information. The annual prevalence of pregnancy-related events decreased slightly, from 14.2% in 2012 to 13.1% in 2016. Line plot graph displays this information. FINDINGS •	Prevalence of pregnancy-related events was approximately evenly distributed among the race/ethnicity categories and military occupation groups. •	A slightly higher percentage of WOCBP in the Army (14.5%) had pregnancy-related events compared to WOCBP in the other services. •	A higher percentage of women who were married (21.4%) had a pregnancy-related event, compared with those in the single (5.7%) or “other” (8.8) categories. •	Only 0.2% of women who served during a recruit training period in any given year had a pregnancy-related event. Access the full report in the November 2017 MSMR (Vol. 24, No. 11). Go to www.Health.mil/MSMR.  Graphic on infographic shows a pregnant service member.

With the increasing numbers of service women and the expansion of roles available to women within the military, understanding the epidemiology of pregnancy is important for both the health of U.S. service women and the readiness of the U.S. fighting force, two closely related issues. This infographic documents pregnancies among female service members, active component, U.S. Armed Forces from 2012 – 2016.

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Live births among female service members, active component, U.S. Armed Forces, 2012 – 2016

Infographic
12/21/2017
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

This infographic documents live births among female service members, active component, U.S. Armed Forces from 2012 – 2016.

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Tdap vaccination coverage during pregnancy, active component service women, 2006 – 2014

Infographic
8/14/2017
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.

This infographic documents findings from a surveillance study that assessed Tdap vaccination coverage among pregnant service women during 2006 through 2014.

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Absolute and Relative Morbidity Burdens Attributable to Various Illnesses and Injuries, Active Component, U.S. Armed Forces, 2016

Infographic
6/19/2017
Did you know  … ? In 2016, essential hypertension accounted for 52,586 encounters for health care among 29,612 active component service members in the U.S. Armed Forces. Of all cardiovascular diseases, essential hypertension is by far the most common specific condition diagnosed among active duty service members. Untreated hypertension increases the risks of subsequent ischemic heart disease (heart attack), cerebrovascular disease (stroke), and kidney failure. CHART: Healthcare burdens attributable to cardiovascular diseases, active component, U.S. Armed Forces, 2016 Major condition: •	For all other cardiovascular the number of medical encounters was 70,781, Rank 29, number of individuals affected was 35,794 with a rank of 30. The number of bed days was 4,285 with a rank of 21. •	For essential hypertension the number of medical encounters was 52,586, rank 35, number of individuals affected was 29,612 with a rank of 35. The number of bed days was 151 with a rank of 86. •	For cerebrovascular disease the number of medical encounters was 7,772, rank 79, number of individuals affected was 1,708, with a rank of 96. The number of bed days was 2,107 with a rank of 32. •	For ischemic heart disease the number of medical encounters was 6,629, rank 83, number of individuals affected 2,399 with a rank of 87. The number of bed days was 1,140 with a rank of 42. •	For inflammatory the number of medical encounters was 2,221, rank 106, number of individuals affected 1,302 with a rank of 97. The number of bed days was 297 with a rank of 72. •	For rheumatic heart disease the number of medical encounters was 319, rank 125, number of individuals affected 261, with a rank of 121. The number of bed days was 2 with a rank of 133. Learn more about healthcare burdens attributable to various diseases and injuries by visiting Health.mil/MSMRArchives. #LoveYourHeart Infogaphic graphic features transparent graphic of a man’s heart illuminated within his chest.

This infographic documents healthcare burdens attributable to cardiovascular diseases among active component, U.S. Armed Forces in 2016.

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Flag Football Game

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9/28/2016
Youth participate in a flag football game on Marine Corps Air Station in Yuma, Arizona. (U.S. Marine Corps photo by Sgt. Travis Gershaneck)

Youth participate in a flag football game on Marine Corps Air Station in Yuma, Arizona. (U.S. Marine Corps photo by Sgt. Travis Gershaneck)

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Healthy aging starts sooner than you think

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9/23/2016
Air Force Staff Sgt. Nick Crouse, a medical technician with the 193rd Special Operations Wing's Medical Group out of Middletown, Pennsylvania, takes the blood pressure of a patient. Heart disease, diabetes, and chronic obstructive pulmonary disease are three ailments that take a huge toll on the body as it ages. (U.S. Air Force photo)

Air Force Staff Sgt. Nick Crouse, a medical technician with the 193rd Special Operations Wing's Medical Group out of Middletown, Pennsylvania, takes the blood pressure of a patient. Heart disease, diabetes, and chronic obstructive pulmonary disease are three ailments that take a huge toll on the body as it ages. (U.S. Air Force photo)

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Back to School Health and Safety Checklist

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8/4/2016
Health and Safety Checklist for Back to School

This infographic provides a going back to school health and safety checklist.

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Interim Guidance for Prevention of Sexual Transmission of Zika Virus

Policy

With this update, CDC is expanding its existing recommendations to cover all pregnant couples, which includes pregnant women with female sex partners. This guidance also describes what other couples (those who are not pregnant or planning to become pregnant) can do to reduce the risk for Zika virus transmission. CDC’s recommendations for couples planning to become pregnant have been published separately (9).

Zika Virus and Pregnancy

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6/21/2016
infographic about Zika virus and pregnancy

Zika can cause certain birth defects. This infographic offers information to pregnant women about how to protect themselves from the Zika virus.

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The HPV Vaccine Saves Lives

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5/16/2016
The Defense Department recommends male and female military service members, ages 17-26 years, receive an HPV vaccine series to generate a robust immune response to the quadrivalent human papillomavirus vaccine (HPV4). This graphic highlights information the benefits of the HPV vaccine. The vaccine is most effective among fully vaccinated individuals.   Cancer Prevention Facts •	HPV is the most common sexually  transmitted infection (STI) •	There are more than 40 HPV types that can infect the genital areas •	Some HPV types give warts •	Some HPV types develop cancer  Effective Against STI Transmission •	The HPV vaccine is a safe and effective way to protect yourself from the virus •	The HPV vaccine provides nearly 100% protection from HPV types 6,11,16 and 18 •	HPV vaccine shows early signs of success in reducing HPV infections and related illnesses •	Protection is expected to be long-lasting  Safety Tips •	Getting your HPV vaccine and practicing safe sex such as wearing a condom may lower the risk of HPV •	Limiting the number of lifetime sex partners can also lower the risk of HPV •	When given the HPV vaccine, the body makes antibodies in response to the protection to clear it from the body  Get the Facts •	2,091 female service members aged 17-26 years received 1-3 HPV4 doses during 2006-2012, stratified by number of doses (1, 2, or 3).  Get the HPV Vaccine •	Only 22.5% of eligible service members initiated the series •	Of those, only 39.1% completed the full three-dose series as of June 2011.  Even though the 3 dose regiment provides nearly complete protection against HPV16 and HPV18, in the U.S., only 12% and 19% of female adolescents among commercial and Medicaid plans respectively complete the series.  Read HPV Facts from the CDC: https://www.ok.gov/health2/documents/IMM_Teens_HPV_Facts.pdf  Read the STI issue of the Medical Surveillance Monthly Report at Health.Mil/MSMR   Get the conversation started. Ask your healthcare provider about the HPV vaccine today. Follow us on Twitter @AFHSBPAGE and use hashtag #VaccinesWork.

The Defense Department recommends male and female military service members, ages 17-26 years, receive an HPV vaccine series to generate a robust immune response to the quadrivalent human papillomavirus vaccine (HPV4).

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Study Finds Strong Immune Response to HPV Vaccine Among Female Service Members

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5/11/2016

A new study of female service members that examined their immune response to a vaccine to combat the sexually transmitted virus that causes cervical cancer showed development of antibodies in 80 to 99 percent of recipients against each of the four strains of the disease.

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Breast Cancer

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5/9/2016
infographic about the breast cancer and how to protect against it.

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Smallpox Vaccine in Pregnancy

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2/26/2016

The National Smallpox Vaccine in Pregnancy Registry was created to follow the pregnancy outcomes of women who were exposed to the smallpox vaccine during pregnancy.

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