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The Science of Sex and Gender in Human Health
The Office of Research on Women's Health, Office of the Director, National Institutes of Health, and the Office of Women's Health, Food and Drug Administration, have developed an online educational website called The Science of Sex and Gender in Human Health. Designed for researchers, clinicians, and members of academia, the program aims to increase scientific understanding of the physiological differences between the sexes, how these differences influence illness and health, and the implications for health policy. Currently, a six-lesson course, The Basic Science and the Biological Basis for Sex- and Gender-Related Differences, is available for continuing education credit.
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
Global Study of Women's Health
The Eunice Kennedy Shriver National Institute of Child Health and Human Development is conducting a large-scale, international study to gather prospective epidemiological data on the impact of and risk factors for endometriosis across countries worldwide. Researchers anticipate the study will provide novel insights into the effects of the condition and associated symptoms on women's lives across different countries, as well as explore differences in the effects of various potential risk factors. The research will take place at more than 20 international sites and at the National Institutes of Health Clinical Center in Bethesda, MD. At NIH, 250 premenopausal women between 18 and 45 years of age who are having their first diagnostic laparoscopy or laparoscopy for tubal sterilization and with no prior history of surgically confirmed endometriosis will participate. Researchers will ask about quality of life, medical and family history, use of healthcare services, and risk factors for endometriosis. The primary purpose of this survey is to collect systematic, comprehensive epidemiological information on the impact of endometriosis among women worldwide in terms of prevalence, diagnostic delay, quality of life, economic effect indicators, healthcare utilization, and risk factors.
Osteoporosis-Linked Fractures Rise Dramatically
The Agency for Healthcare Research and Quality reports the rate of patients admitted to the hospital for treatment of osteoporosis-associated hip, pelvic, and other fractures increased by 55% from 1995 to 2006, when there were 254,000 hospitalizations, costing $2.4 billion. Women were six times more likely than men to be hospitalized for an osteoporosis-related fracture, accounting for 89% of injurious osteoporosis stays. Ninety percent of the hospitalizations were for patients aged 65 or older, and 37% of them involved patients aged 85 and older. Hospitalization rates were highest in the Midwest, at 107 stays per 100,000 population, and lowest in the Western region of the United States, at 68 stays per 100,000 population. The researchers used data from hospitals that comprise 90% of all discharges in the United States, for patients with all types of insurance and the uninsured. Injuries were found in 25% of all hospitalizations with an osteoporosis diagnosis. The most frequently occurring injuries were pathological fractures, hip fractures, and fractures of the vertebrae, ribs, and pelvis. In more than 16% of the cases, treatments for hip and leg fractures were rendered, with 8.1% of the stays requiring a hip replacement.
OHSU Fellowships: Women's Health Fellowship
Oregon Health & Science University's Division of General Internal Medicine, offers a 2-year fellowship in a collaborative effort with the Portland Veterans Affairs Medical Center. The flexible program focuses on clinical, research, and educational training to prepare fellows for careers in women's health. Fellows devote 25% of their time to developing the clinical skills needed to care for women. They take part in weekly continuity clinics and can select from many different electives. Half to 70% of the fellows' time is dedicated to training in research methodology and a research project, and 10%–25% of the time is spent developing teaching skills. Fellowship applicants should have completed a residency in internal medicine, family medicine, obstetrics and gynecology, psychiatry, or surgery and be board eligible or board certified in their specialty at the time they start the fellowship.
19th Annual Renfrew Center Foundation Conference for Professionals
The Renfrew Center Foundation will hold its 19th annual professional conference, Feminist Perspectives and Beyond: The Art and Science of Eating Disorders Treatment, November 12–15, 2009, at the Philadelphia Airport Marriott hotel. The Renfrew Center Foundation works to better understand the causes of eating disorders to develop improved treatment methods. The Renfrew Center, in Philadelphia, has treated more than 50,000 women and adolescent girls with destructive eating and purging behaviors since its founding in 1985. The 2009 conference will explore best practices in integrating what clinicians know about the successful treatment of eating disorders. Keynote speakers will talk about the psychology, biology, and spirituality of the feminine life cycle; mindsight, self-regulation, and attachment to promote health; and perspectives on what makes a difference in eating disorders treatment. Workshops will include tips for helping patients move beyond their comfort zones and overcoming shame. Others will offer participants suggestions for integrating evidence-based interventions into practice, combining different treatment models to enhance outcomes, incorporating shared eating experiences into the treatment plan, effectively dealing with exercise issues, and caring for themselves.
Women Often Opt to Surgically Remove Their Breasts, Ovaries to Reduce Cancer Risk
Women at increased risk of breast and ovarian cancer are often choosing surgery as a precautionary measure to decrease their cancer risk, according to a British study. The researchers investigated the options chosen by 211 women with known unaffected BRCA1 or BRCA2 mutations and 3515 women at greater than 25% lifetime risk of breast cancer but no known mutations. Among the mutation carriers, 40% chose to have a bilateral, risk-reducing mastectomy, and 45% chose a bilateral risk-reducing salpingo-oophorectomy. In women without the mutation, 6.4% of participants at 40%–45% lifetime risk, 2.5% at 33%–39% lifetime risk, and 1.8% at 25%–32% lifetime risk underwent a bilateral, risk-reduction mastectomy. More women with BRCA1 (52%) than BRCA2 (28%) mutations opted for a bilateral risk-reducing salpingo-oophorectomy. The ovarian surgeries tended to take place within 2 years of gene testing and among women aged 35–45. Women who had a breast biopsy were more likely than other women to opt for risk-reduction surgery. The authors concluded that careful risk counseling does appear to influence women's decisions for surgery, although the effect is not immediate, and that additional research is need to evaluate communication methods between clinicians and women at risk for breast cancer.
Young, Early-Stage Ovarian Cancer Patients Can Preserve Fertility
Premenopausal women with stage IA and IC epithelial ovarian cancer can safely receive fertility-conserving surgery, according to a recent U.S. study led by Jason D. Wright, M.D., at Columbia University College of Physicians and Surgeons and the Herbert Irving Comprehensive Cancer Center, New York-Presbyterian Hospital/Columbia University Medical Center, both in New York. Wright et al. compared outcomes of 754 women aged 50 or younger who underwent a bilateral oophorectomy to treat ovarian cancer and 432 women who received ovarian preservation. Younger women and those with a later year of diagnosis and a residence in the eastern or western United States were more likely to opt for ovarian conservation, whereas women with endometroid and clear cell histologies and those with stage IC disease were less likely to choose conservation. A second analysis involving 2911 women compared outcomes between women receiving uterine conservation and women receiving hysterectomy. They found uterine preservation had no effect on survival. Younger age, later year of diagnosis, residence in eastern or western United States, a single marital state, mucinous tumors, and patients with stage IA disease were more likely to prefer uterine preservation. Investigators found that ovarian preservation had no effect on survival. The authors concluded that ovarian and uterine-conserving surgery were safe in young women who had stage IA or IC epithelial ovarian cancer.
Multisystem Abnormalities Associated with Older Women's Frailty
Frailty in older women increases nonlinearly in relationship to the number of abnormal physiological systems, according to a recent study published in The Journals of Gerontology Series A: Biological Sciences and Medical Sciences. Using data from the Women's Health and Aging Studies I and II, researchers led by Linda P. Fried at the Mailman School of Public Health, Columbia University, New York, conducted multiple analytical studies to assess the cross-sectional association of frailty in women aged 70–79 years with eight physiological measures: anemia, inflammation, insulin-like growth factor-1, dehydroepiandrosterone sulfate, hemoglobin A1c, micronutrients, adiposity, and fine motor speed. Abnormalities in each system were associated with frailty, but the more systems that were impaired, the more likely the women were to be frail. The researchers concluded that a number of abnormal systems were more predictive of frailty than an individual abnormal system. They wrote, “These findings support theories that aggregate loss of complexity, with aging, in physiological systems is an important cause of frailty. Implications are that a threshold loss of complexity, as indicated by number of systems abnormal, may undermine homeostatic adaptive capacity, leading to the development of frailty and its associated risk for subsequent adverse outcomes. It further suggests that replacement of any one deficient system may not be sufficient to prevent or ameliorate frailty.”
Home Births Can Be as Safe as Hospital Deliveries for Low-Risk Women
Provided a pregnant woman at low risk for complications receives care from well-trained midwives and has access to good transportation and a referral system, planning a home birth poses no increased risk of perinatal mortality and severe perinatal morbidity, according to a study by Dutch researchers. During a 7-year period, the team followed 529,688 low-risk women receiving care led by a midwife at the onset of labor. Slightly more than 60% planned a home birth and 30.8% a hospital delivery. Researchers did not know the intended place of birth for 8.5% of the women. Investigators found no significant differences between planned home and hospital births in relation to intrapartum death, intrapartum death and neonatal death during the first 24 hours, intrapartum and neonatal death up to 7 days, or admission to the neonatal intensive care unit.
Impact of Obesity on Oral Contraceptive Pharmacokinetics
Obese women exhibit differences in oral contraceptive pharmacokinetics associated with greater hypothalamic-pituitary-ovarian axis activity, according to a study led by Alison B. Edelman, M.D., M.P.H., assistant professor at the Oregon Health & Science University. Edelman et al. evaluated whether body mass index affected oral contraceptive pharmacokinetics. Reproductive-age women of normal weight and those with obesity were admitted for two 48-hour inpatient stays at the beginning and end of a hormone-free interval. The researchers measured ethinyl estradiol and levonorgestrel during both stays and gonadotropin pulsatility during the second admission. They measured estradiol and progesterone daily during the inpatient stays and twice per week during the second cycle. They found that ethinyl estradiol and levonorgestrel half-life was significantly longer in the obese group than in the normal weight cohort, with a lower maximum ethinyl estradiol and levonorgestrel concentration on cycle 2. More obese women than their normal weight counterparts exhibited estradiol consistent with dominant follicle development and progesterone levels consistent with ovulation during the second cycle.
Adolescent Women Are Less Consistent Than Adults in Using Contraceptives
An international study of women's contraceptive use found sexually active teens, aged 15–19 years, are more likely to inconsistently use contraceptives than women 20–49 years old; consequently, they experience a 25% higher contraception failure rate. The authors, from EngenderHealth of New York, the Bill and Melinda Gates Institute for Population and Reproductive Health, the Johns Hopkins Bloomberg School of Public Health, and Blancroft Research International, surmised that teens face more obstacles than adult women to contraceptive use, such as fear, embarrassment about purchasing the items, cost, and a lack of understanding about correct technique. In addition, if they experience side effects, teens may be more likely to discontinue a birth control method and try another. Adolescents also tend to use contraceptive methods with higher failure rates and are more fertile than older women, which contribute to an increased risk of an unintended pregnancy. Approximately 25% of the women studied who were sexually active had used a birth control method by age 19. The fact that women stay in school longer and delay childbearing has caused a greater demand for contraceptive services and a need for more investment in quality healthcare and programs aimed at increasing knowledge about contraceptives and access to those services. The authors conclude that there is a need for additional research to study the changing dynamics of contraceptive use, especially in relation to reproductive events.
Ovary Removal May Increase Lung Cancer Risk
A Canadian study suggests hormonal factors associated with premature menopause or ovary removal may increase the risk of lung cancer. Investigators from the Université de Montréal, the Research Centre of the Centre Hospitalier de l'Université de Montréal, and the INRS—Institut Armand-Frappier studied 422 women with lung cancer and 577 women without cancer, assessing sociodemographic characteristics, residential history, occupational exposures, medical and smoking histories, and menstruation and pregnancy histories. The team found no association between most characteristics of menstruation and pregnancy and lung cancer risk. However, women who had undergone a bilateral oophorectomy had nearly twice the risk of developing lung cancer compared with women experiencing a natural menopause, and there was an inverse association with age at menopause. Smoking did not affect the results. “Non-natural menopause, particularly surgical menopause, may represent an increased risk with younger age at menopause given that surgery is usually done before natural menopause occurs,” said co-author Jack Siemiatycki, a professor at the Université de Montréal's Department of Social and Preventive Medicine and a scientist at the Research Centre of the Centre Hospitalier de l'Université de Montréal. “It's possible that vulnerability to lung cancer is caused by early and sudden decrease in estrogen levels or potentially long-term use of hormone replacement therapy, and further research is needed to explore these hypotheses.”
Women's Health Research Registry
Cedars-Sinai Medical Center in Los Angeles is enrolling healthy women willing to participate in a clinical trial into a registry aimed at discovering and understanding gender differences and, ultimately, to improve future generations of women's well-being through research. Women have been disproportionately underrepresented in clinical research. Few of the many drugs approved by the U.S. Food and Drug Administration have been adequately tested in women. Physicians manage most common health conditions with treatments developed and tested mainly in men. The registry will allow investigators to readily identify potential study participants. The women will provide general health information via a questionnaire. Registry staff will contact the women to determine their interest in participating in specific research protocols. Cedars-Sinai will allow other approved sites to use the registry, with some provisions.