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Backgrounder for CDC Recommendations Regarding Selected Conditions Affecting Women’s Health

(MMWR Vol. 49/No. RR-2 March 31, 2000)

This publication focuses on four issues affecting women’s health: falls and resulting hip fractures, exercise-related injuries, breast and cervical cancer screening, and congenital toxoplasmosis; and how prevention can reduce unnecessary illness disability and death. For each report, prevention recommendations are provided, and the need for additional research and intervention development is recognized. Much still needs to be done.

Reducing Falls and Resulting Hip Fractures Among Older Women

Fall-related injuries are the leading cause of injury deaths and disabilities among people aged >65. The most serious injury is hip fracture; half of all older adults hospitalized for hip fracture never regain their former level of function. Hip fracture hospitalization rates for women age >65 increased 23% from 1988 to 1996. Because 95% of hip fractures result from falls, minimizing fall risk is a practical approach to reducing these injuries. Research demonstrates that effective fall prevention strategies require a multifaceted approach that includes behavioral environmental components.

Strategies to prevent falls include:

  • education and skill building to reduce fall risk
  • exercise to improve strength and balance
  • Environmental modification to reduce fall hazards
  • medication assessment to minimize side effects

Exercise-Related Injuries

A review of key civilian and military research on exercise-related injuries identifies a number of risk factors, as well as some strategies for preventing these injuries in women. The same elements of exercise that improve physical fitness (i.e., intensity, duration, frequency of exercise), also influence the risk of injury. The more one exercises, the greater the risk of injury. Higher levels of physical fitness protect the participant against injury, while a history of previous injury predisposes to future injury. The most important risk factors for injuries include low aerobic fitness and the level of training undertaken.

Strategies to reduce the risk of exercise-related injuries to women include:

  • starting slowly (commensurate with their current physical fitness level), and increase the frequency, duration and intensity of training gradually
  • maintaining a high level of aerobic fitness
  • heeding the early signs of injury
  • taking precautions, if one has sustained an injury, to prevent re-injury (e.g., ensuring appropriate recovery and rehabilitation)
  • not smoking tobacco.

Early Detection of Breast and Cervical Cancer Among Low-Income Women

Mammography remains the most effective method of detecting breast cancer in its earliest and most treatable stage. Annual breast cancer screening for women aged 50 and older is widely recommended. In addition, screening is recommended for women aged 40-49 every 1-2 years. Annual Pap tests are recommended until three consecutive Pap tests are interpreted as being normal or benign. Following this, Pap tests can be performed less frequently.

CDC's National Breast and Cervical Cancer Early Detection Program is marking its 10th year of delivering breast and cervical cancer screening among low-income women who are uninsured. Approximately 2.2 million screenings have been provided through agreements with qualifying health agencies, including state and territorial health departments, and American Indian/Alaska Native tribes and tribal organizations.

The potential to reduce death rates from breast cancer for all women is contingent on:

  • increasing initial and repeat breast cancer screening rates
  • detecting the disease at an early stage, -- when a greater number of treatment options are available, improving survival rates.

For cervical cancer increased effort is needed to target groups with higher proportions of unscreened or rarely screened women, including women residing in rural areas; minorities; and recent immigrants who have different attitudes, knowledge, and behaviors regarding disease prevention and health promotion.

Preventing Congenital Toxoplasmosis

Toxoplasmosis is caused by infection with the protozoan parasite Toxoplasma gondii. Acute infections in pregnant women can be transmitted to the fetus and cause severe illness (e.g., mental retardation, blindness, and epilepsy). An estimated 400-4000 cases of congenital toxoplasmosis occur each year in the United States. In September 1998, CDC convened a national workshop to discuss research priorities for preventing congenital toxoplasmosis.

Recommendations for preventing Toxoplasma infection include:

  • cooking meat to a safe temperature (i.e., one sufficient to kill Toxoplasma )
  • cleaning cooking surfaces and utensils after they have contacted raw or undercooked meat or soil (e.g., from fruits and vegetables)
  • pregnant women avoiding changing cat litter or, if no one else is available to change the cat litter, changing litter daily using gloves, then washing hands thoroughly
  • not feeding raw or undercooked meat to cats and keeping cats inside to prevent acquisition of Toxoplasma by eating infected prey

Many cases of congenital toxoplasmosis can be prevented.

This full report will be available on-line after 4p.m. EST, March 31, 2000 at http://www2.cdc.gov/mmwr/mmwr_rr.html

Note to correspondents: Calls specific to the articles on hip fracture and injury prevention can be received directly at (770) 488-4298. Calls specific to the articles on breast and cervical cancer as well as congenital toxoplasmosis can be received directly at (770)488-5131.


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