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NIH Office of Research on Women's Health Holds Strategic Planning Workshops
The NIH Office of Research on Women's Health will hold the third of four regional scientific workshops and public hearings at the Women and Infants Hospital/Brown University, Providence, RI, September 21–23, 2009. The workshops are designed to promote interactive discussion among leading scientists, healthcare providers, public policy experts, women's health advocates, and the general public. Written and public testimonies are accepted. A fourth regional workshop is planned for October at Northwestern University in Chicago, and a final meeting will be held at the National Institutes of Health in March or April 2010. The office will produce, by September 2010, a document indicating strategic research priorities for women's health research in the coming decade.
NIH Interdisciplinary Women's Health Research Symposium Coming in November
The NIH Office of Research on Women's Health will hold its sixth annual interdisciplinary women's health research symposium on November 17, from 8 a.m. until 4:15 p.m., at the NIH Clinical Center, Lipsett Amphitheater, in Bethesda, MD. Scholars in the Building Interdisciplinary Research Careers in Women's Health (BIRCWH) program will present sessions. In addition, senior investigators in the Specialized Center of Research on Sex and Gender Factors Affecting Women's Health program will present live and poster sessions.
Women Are Underrepresented in High-Impact Published Clinical Cancer Research
Women were underrepresented as participants in recently published, high-impact studies of nonsex-specific cancers, said researchers at the University of Michigan Comprehensive Cancer Center in Ann Arbor, in an article published in the journal Cancer. The investigators reviewed 1534 cancer research articles published in eight journals in 2006, analyzing the percentage of participants compared to the proportion expected according to population-based estimates of sex-specific cancer incidence. Journals included The New England Journal of Medicine, JAMA, The Lancet, the Journal of Clinical Oncology, the Journal of the National Cancer Institute, The Lancet Oncology, Clinical Cancer Research, and Cancer. They found 661 prospective clinical trials with more than 1 million participants. The majority of studies included a lower proportion of women than the proportion of women having that type of cancer in the general population. The mean percentage of women participants was 38.8%. Studies receiving government funding had a higher percentage of female participants, 41.3% vs. 36.9%, compared with nongovernment-supported studies. The National Institutes of Health's Revitalization Act of 1993 says clinical trials should enroll adequate numbers of women to allow for subgroup analysis. “We know there are biological differences between the sexes, as well as social and cultural differences. Studies need to be able to assess whether there are differences in responses to treatment, for example, between women and men,” said Reshma Jagsi, M.D., assistant professor of radiation oncology at the University of Michigan Medical School.
Genetic Links to Age at Menarche and Menopause with Cancer and Heart Disease
Early onset menarche and late natural menopause are associated with breast and endometrial cancers. Early menopause also increases the risk of osteoporosis and cardiovascular disease. Newly discovered gene variants might expand understanding of the biological pathways regulating these traits and help with prevention of the diseases, according to a study by researchers from the Harvard School of Public Health, Brigham and Women's Hospital, the National Cancer Institute, the Broad Institute of Harvard, and MIT. The team analyzed more than 317,000 gene variants from 17,438 women participating in the Nurses' Health Study and the Women's Genome Health Study. They identified 10 genetic variants in two chromosomal regions associated with age at menarche and 13 variants in four chromosomal regions associated with menopause. “Insights into the genetic factors influencing the timing of menarche and natural menopause might shed light on normal reproductive function and the prevention of the diseases associated with these two traits,” said lead author Chunyan He, a doctoral student in the Harvard School of Public Health Department of Epidemiology while conducting the research.
USPSTF Reaffirms Syphilis Screening and Recommends Folic Acid in Pregnancy
After conducting a targeted literature review, the U.S. Preventive Services Task Force (USPSTF) reaffirmed a 2004 recommendation to universally screen pregnant women for syphilis infection because of risks associated with untreated infection and stillbirth, neonatal death, bone deformities, and neurological impairment. The task force also recommended that all women planning or capable of pregnancy take a daily 0.4 mg–0.8 mg folic acid supplement to help prevent neural tube defects in newborns, which result from a malformation of the embryo's central nervous system. Approximately 1 in every 1000 pregnancies is affected by neural tube defects. Women in the United States generally do not consume sufficient amounts of folic acid-fortified foods. Women should start taking the folic acid supplements at least 1 month prior to conception and continue taking them through the first 2 or 3 months of pregnancy. Taking the recommended doses of folic acid has not been found to cause serious harm. The USPSTF's folic acid advice applies to women without a history of pregnancy affected by neural tube defect or women taking certain anticonvulsants. Women in these categories, typically, should take higher doses of folic acid.
Longitudinal Validation of the Premenstrual Symptoms Impact Survey (PMSIS)
QualityMetric, Inc., of Rhode Island reported at the American College of Obstetricians and Gynecologists' annual clinical meeting that the validation studies of the Premenstrual Symptoms Impact Survey showed that the six-question survey, to identify women with premenstrual syndrome or premenstrual dysphoric disorder, demonstrated internal consistency, test-retest reliability, and validity across two time points. More than 1800 women, aged 18–45 and with at least one premenstrual symptom, participated in the study, completing the online questionnaires at two time points 4 weeks apart. Premenstrual disorders can interfere with interpersonal relationships, social activities, work productivity, and health-related quality of life. PMSIS was developed to measure the effect of symptoms on the woman's health-related quality of life. The team concluded that PMSIS is a reliable and valid tool for evaluating health-related quality of life in women with premenstrual disorders and that the survey can be used as a self-evaluation tool and as a vehicle to initiate a conversation between women with premenstrual disorders and their clinicians so they can obtain treatment to control the symptoms. The survey also can be used to monitor changes in health-related quality of life in women with the disorder.
Women's Health Highlights: Recent Findings
The Agency for Healthcare Research and Quality recently published a summary of AHRQ-supported women's health research findings from January 2005 through December 2008. Topics include cardiovascular disease, cancer screening and treatment, reproductive health, chronic illness, violence, costs and access to care, quality and safety, medications, and data sources for gender research. The report highlights disparities in women's care for heart disease, including preventive interventions, such as cholesterol control, low-dose aspirin therapy, and treatment for heart attack and congestive heart failure. In regard to cancer screening and treatment, AHRQ-supported studies found several factors affect the accuracy of mammogram interpretation, that lesions overlooked on mammography represent missed opportunities for early diagnosis, and that requiring women to pay for a portion of the mammogram fee decreases the rate of screening. Researchers also determined that more attention should be paid to breast cancer survivors' quality of life, that race and age affect the degree of pain in women with breast cancer, and that death and complications following breast cancer surgery are rare. Breast and gynecological cancers account for one fourth of all women's cancer hospitalizations. In the cost and access section, researchers report that women spend an estimated $108 billion a year on healthcare, more than 40% for female-specific conditions.
Journal of Women's Health Entire Legacy Content Available Online
The entire legacy content of Journal of Women's Health, beginning with the very first issue, is now available online at www.liebertonline.com/jwh. The legacy content consists of 17 volumes, 144 issues, over 2,200 articles, and over 25,000 pages; 100% of the legacy content is fully searchable, and citations are reference linked through CrossRef.
Menopause Transition May Cause Trouble Learning
Women in perimenopause reported a decline in cognitive performance, specifically being unable to learn as well as during premenopause, according to a study reported in the journal Neurology. Researchers led by Gail A. Greendale, M.D., at the David Geffen School of Medicine at the University of California, Los Angeles, analyzed cognitive processing speed, verbal memory, and working memory in 2362 participants, aged 42–52, from the Study of Women's Health Across the Nation. The researchers tested the women throughout the four stages of menopause transition. Premenopausal, early perimenopausal, and postmenopausal women scored higher on repeated processing speed testing, but late perimenopausal women did not improve over time. Verbal memory scores increased during premenopause and postmenopause but not during early or late perimenopause. Women rebounded to premenopausal levels during postmenopause, which the researchers say could indicate that cognitive changes are time limited. Hormone therapy started before the last menstrual period helped verbal memory and processing speed, but hormones begun after the final menstrual period had a detrimental effect. “These perimenopausal test results concur with prior self-reported memory difficulties—60% of women state that they have memory problems during the menopause transition,” said Dr. Greendale. “The good news is that the effect of perimenopause on learning seems to be temporary.”
Women with Chest Pain Less Likely than Men to Get Proper Treatment from Paramedics
Although evidence indicates that people who may be suffering from a heart attack should receive aspirin and nitroglycerin, women are not given the drugs by paramedics as often as men with the same symptoms, according to a University of Pennsylvania study presented at the Society for Academic Emergency Medicine's annual conference. Researchers examined 683 cases from 2006 and 2007 in which patients were brought to one of three hospitals in the University of Pennsylvania Health System by emergency medical personnel after the patient complained about chest pain. They assessed compliance with four prehospital protocols: administration of aspirin and nitroglycerin, starting an IV line, and monitoring of the patient's heart rhythm. Twenty-four percent of women were given aspirin compared with 32% of men. None of the women who were ultimately diagnosed with a myocardial infarction after evaluation at the hospital were given aspirin prior to arrival. Twenty-six percent of women received nitroglycerin compared with 33% of men, and 61% of women had an IV line placed compared with 70% of men. “Women with heart attacks have higher death rates than men, so these findings are very concerning, and it's important for us to try to figure out why this is happening,” says lead author Zachary Meisel, M.D., M.P.H, an emergency physician and Robert Wood Johnson Foundation Clinical Scholar and Senior Fellow at the Leonard Davis Institute of Health Economics at Penn.
Pregnant Women with Novel Influenza A (H1N1) Should Receive Antivirals
The Centers for Disease Control and Prevention recommends that pregnant women with confirmed, probable, or suspected novel influenza A (H1N1) receive antiviral therapy with oseltamivir or zanamivir. The recommendation includes women with HIV infections. Those women should receive oseltamivir, according to AIDSinfo, a Service of the U.S. Department of Health and Human Services. Pregnant women in close contact with people who have confirmed, suspected, or probable cases of H1N1 should receive chemoprophylaxis. The antiviral treatment should start as soon as possible after symptoms commence, with greatest benefit expected if the drugs are begun within 48 hours of symptom onset. Patients should receive the drugs for 5 days when ordered as treatment and 10 days for chemoprophylaxis. The CDC reports that during the first trimester, maternal hyperthermia, a well-studied adverse effect of influenza, doubles the risk of neural tube defects and may be associated with other birth defects and adverse outcomes. Maternal fever during labor is a risk factor for adverse neonatal and developmental outcomes, including neonatal seizures, encephalopathy, cerebral palsy, and neonatal death. Public health officials say the benefits of treatment or chemoprophylaxis outweigh the theoretical risks of antiviral use.
Von Willebrand Disease and Other Bleeding Disorders in Women
Congenital bleeding disorders are underdiagnosed in women with menorrhagia and possibly in cases of other abnormal bleeding, leading to suboptimal treatment. An international consensus panel of experts aims to increase obstetricians' and gynecologists' awareness of von Willebrand disease and other conditions, so that they can offer women effective disease-specific therapies. Approximately 1% of the population has a bleeding disorder. Among women with menorrhagia, 5%–24% have von Willebrand disease, which is caused by a deficiency in or dysfunction of von Willebrand factor. The consensus panel urges physicians to consider a bleeding disorder if the patient has experienced menorrhagia since menarche; if there is a family history of a bleeding disorder; or if the patient has experienced epistaxis, notable bruising without injury, bleeding from trivial cuts, the oral cavity, or gastrointestinal tract, prolonged bleeding after dental extraction, unexpected postsurgical bleeding, hemorrhage from ovarian cysts or corpus luteum, hemorrhage that required blood transfusion, or postpartum hemorrhage. During a workup, patients should receive a complete blood cell count and determination of activated partial thromboplastin time, prothrombin time, von Willebrand factor, coagulation factor VIII, and fibrinogen. Tranexamic acid may be given to women before the hematological evaluation. Treatments depend on the woman's desire for future fertility and time until a desired pregnancy. Women often require a combination of therapies. The panel urges consultation with a hematologist.
Cervical Cancer Vaccine Not Just for Teens
The quadrivalent human papillomavirus L1 virus-like particle vaccine was found to be efficacious in women aged 24–45 years in a study by an international team of researchers. The team enrolled more than 3800 women, aged 24–45, at community and academic health centers and at private providers' offices. The women had no history of cervical disease or cancer or genital warts caused by HPV types 6, 11, 16, and 18. They were randomly selected to receive either the HPV vaccine or a placebo at day 1 and months 2 and 6. All the women received at least one dose. Coprimary efficacy end points were 6 months or more duration of infection and cervical and external genital disease due to HPV 6, 11, 16, 18. The team also looked at HPV due to types 16 and 18 alone. There were 4 cases of infection in the vaccine group and 41 in the placebo cohort. Looking just at HPV 16 and 18, there were 4 cases in the vaccine group and 23 cases in the control cohort. There were no vaccine-related, serious adverse events.