Posted by on November 6, 2009 - 11:08am

Guest blog by Dr. Jennifer Hirshfeld-Cytron, Reproductive Endocrinology and Infertility Fellow, Department of Obstetrics and Gynecology, Northwestern Memorial Hospital

The Obstetrics and Gynecology Grand Rounds this morning was given by past FIGO (International Federation of Gynecology and Obstetrics) and previous chairman of the department, Dr. John Sciarra.  He provided an incredibly informative and moving description of the global issues affecting women, particularly in the developing world.  He highlighted the issues of maternal mortality, maternal morbidity, STDs, cervical cancer, and education inequality.

For instance, in Afghanistan, 1 in 6 women will DIE from pregnancy related complications compared to 1 in 4100 in the developed world.  Pregnancy related complications include: abortion related deaths, hemorrhage, thrombotic events and eclampsia (see below). 20.5 million unsafe abortions occur each year worldwide and account for 60,-80,000 deaths.

Furthermore, HIV/AIDS accounts for 11% of worldwide deaths with approximately 47 percent of the 34.3 million adults living with HIV/AIDS being women. Cervical cancer, a preventable cancer with appropriate screening, sex education and potentially the vaccine, affects 200,000 women worldwide and is second only to breast cancer in incidence.  Cervical cancer screening in the developed world centers on cytology, which is not available in the developing world. He further highlighted the inequities of women.   Worldwide women work 66% more than men but receive only 15% of the income.  Illiteracy in parts of the developing worth is greater than 65% for women. This just begins to highlight the complicated issue of providing appropriate family planning education to the developing world.

These staggering and incredibly disturbing statistics leave us with only one question; how can we raise the status of women worldwide? Efforts are being done to partner developed with developing world medical schools to increase technical skills for the care of women, such as safe abortions.  A website (www.glowm.com) has been started by Dr. Sciarra and others providing education in the form of book chapters and how-to videos to begin to enhance knowledge to the developing world.  Access is huge problem for women and foundations such as the Bill and Melinda Gates Foundation are working towards these and other efforts.  In short, get involved.

As Mahmoud Fathalla, past president of the International Federation of Gynecology and Obstetrics, said: "Women are not dying because of diseases we cannot treat. They are dying because societies have yet to make the decision that their lives are worth saving."

Posted by on November 4, 2009 - 11:34am

Dr. Sabra L. Klein, an assistant professor of molecular microbiology and immunology at the Johns Hopkins Bloomberg School of Public Health, and Phyllis Greenberger, the president and chief executive of the nonprofit Society for Women’s Health Research, recently wrote an opinion piece for the New York Times called, "Do Women Need Such Big Flu Shots?".

Image: McAlpin, NYdailynews.com

Image: McAlpin, NYdailynews.com

The gist of their argument is actually based on the same idea as many of our recent blog entries: women, on average, have a much stronger immune system than men. The authors cite studies that demonstrate that women produce more antibodies in response to the same vaccine dose than men do. The authors conclude that women could therefore be given a smaller dose of the H1N1 flu vaccine and still get the same protection; the vaccine that is saved by giving women smaller doses would allow more people to get the much in-demand shot.

It's an interesting hypothesis that really highlights the need for more gender-aware research and clinical trials. Sure, women were included in the clinical trials of the vaccine, but were they ever tested with a more tailored dosage? I'd guess not; I'd imagine the tests were more simply on the efficacy of the standard, male-tailored dose in women, not on whether a different dose could work as well. I applaud the article for highlighting these questions that definitely need to be addressed!

Posted by on November 2, 2009 - 10:42am

Diabetes mellitus is an endocrine disease affecting approximately 7% of the US population.  Diabetes is categorized into two classes: Type 1, or insulin dependent diabetes, and Type 2, or adult onset diabetes.

Type 1 Diabetes is a condition in which the pancreas produces little or no insulin, a hormone necessary for the metabolism of glucose.  Type 1 Diabetes is generally diagnosed in childhood or early adolescence and is considered to be primarily genetic in origin.  Symptoms include extreme hunger, fatigue, rapid weight loss and blurry vision.  There is no cure for Diabetes, but successful treatment includes insulin injections, blood sugar monitoring, a healthy diet, and regular exercise.

Type 2 Diabetes accounts for 90-95% of all Diabetes cases in the United States.  In Type 2 Diabetes, the body is either insulin resistant or the pancreas does not produce enough insulin.  This type is often preventable and is strongly linked to obesity.  Symptoms are similar to Type 1 Diabetes but, depending on the severity, treatment may only include blood sugar monitoring, a healthy diet, and regular exercise.  Severe or advanced cases may require medication and/or insulin injections.

Resources at Northwestern for Diabetes:

The Division of Endocrinology at Northwestern Memorial Hospital provides comprehensive diagnosis and treatment for a variety of endocrine related disorders.  Physicians in the department specialize in endocrine tumors, endocrine disease genetics, gestational diabetes, and offer specialized services in diagnosis and treatment of Type 1 and Type 2 Diabetes.  The department participates in a variety of NIH-sponsored research trials.  Results from NMH’s participation in the National Institute’s of Health 10-year study on prevention of type 2 diabetes can be found at http://www.feinberg.northwestern.edu/news/2009C-October/Diabetes.html.

Click to see physician finder:

http://nmhphysicians.photobooks.com/

Northwestern Physicians/ Researchers specializing in Diabetes treatment:

The Division of Endocrinology, Metabolism, and Molecular Medicine at Northwestern University features a diverse faculty, many of whom are leaders in their field.  The department, headed by Dr. Andrea Dunaif, is committed to clinical and basic science research development and training.  The research interests of the department are diverse and extend to multiple subfields of endocrinology.  Researchers studying diabetes include Dr. Franck Mauvais-Jarvis, who studies the role of estrogen receptors in pancreatic cells, Dr. M. Geoffrey Hayes, PhD, who studies the genetic components of diabetes, and Dr. Boyd E. Metzger, MD, whose research on gestational diabetes has been widely published.

IWHR Highlighted Researcher

Dr. Robert F Kushner, MD, MS is the Clinical Director of the Northwestern Comprehensive Center on Obesity and a Professor of Medicine at the Feinberg School of Medicine.  Dr. Kushner has published various books, book chapters, and articles and serves on the editorial board of various prestigious journals including Obesity, Obesity Management, and the Journal of the American Dietetic Association.  Popular publications include Dr. Kushner’s Personality Type Diet, Treatment of the Obese Patient and Fitness Unleashed: A Dog and Owner’s Guide to Losing Weight and Gaining Health Together.  Although Dr. Kushner’s research interests are in obesity and nutrition, his research and publications have implications for a diabetic population.  Recently he published a study in Obesity examining various lifestyle interventions for prevention of weight gain in type II diabetic patients taking the common diabetes medication pioglitazone (Actos®).  The study showed that the weight gain side effects commonly associated with this medication can be diminished or alleviated by lifestyle interventions such as medical nutrition therapy (MNT).  The greatest success was seen in patients who received intensive follow up MNT, which included lessons in meal planning, food preparation, goal-setting and exercise recommendations.

For information on Dr. Kushner or to purchase his books:

http://www.counselingoverweightadults.com/

Other Useful Links and Resources:

http://www.nlm.nih.gov/medlineplus/diabetes.html
http://www.cdc.gov/diabetes/
http://www.diabetes.org
http://www.dlife.com/

Posted by on October 29, 2009 - 2:35pm
Aryana, Kathryn, Jenaun, Estella and Geeleeyaw at the 2009 Illinois Women’s Health Conference.

Aryana, Kathryn, Jenaun, Estella and Geeleeyaw at the 2009 Illinois Women’s Health Conference.

On Wednesday, October 28, 2009, five high school senior girls, who are participants of the Women’s Health Science Program for High School Girls and Beyond (WHSP), whsp.northwestern.edu, attended the 2009 Illinois Women’s Health Conference, http://www.idph.state.il.us/about/womenshealth/events.htm, in Oak Brook, Illinois.  To be selected, the high school girls had to write essays to explain why they wanted to attend the conference.  All the girls shared very thoughtful and meaningful reasons for wanting to participate in this opportunity.  To highlight a few of the student responses, Jenaun shared that she wanted to attend because she is still undecided on her college major and career choice and thought that participating in the conference would broaden her knowledge of the healthcare career options. Geeleeyaw thought that this would be a good opportunity for her to meet new people and talk to clinicians about her interests in pursuing a career in the healthcare field.   Lastly, Aryana wanted to attend because she is passionate about women’s health and wants to play an active role in supporting and improving the health of women.

The high school girls gained valuable and useful experiences and knowledge at the conference.  Upon arrival the high school girls checked in and received their conference nametag, bag, and materials.  The high school girls attended multiple sessions, including:

  • Cardiovascular Disease in Disparate Populations: The Facts – and What We Should Do
  • Breast Cancer – Reconstruction After the Fact
  • Energy for Life: Strategies for Peak Performance and Whole Body Wellness
  • Nutrition and Women’s Health – Health Foods or Healthy Foods
  • The Practical Clinical Approach to Women’s Sexuality

Students were expected and encouraged to take notes and ask the presenters questions at each of the sessions.

At the end of the day, the girls completed the conference evaluation form and submitted it to the conference staff.  They all expressed that they greatly appreciated this opportunity because, as the only high school students in attendance, they were able to get firsthand experience interacting with real healthcare professionals.  With the two educators who coordinated the opportunity, Megan Faurot, Director of Education Programs at the Institute for Women’s Health Research, and Kathleen Grimes, Science Department Coordinator at Young Women’s Leadership Charter School, the girls discussed what colleges they were applying to and how they plan on pursuing their career goals.   Kathryn wants to pursue a career in animal science and Estella is planning on combining her love of cooking and science to become a dietitian or nutritionist.   WHSP will continue to support and encourage all of these girls as they make the transition from high school to college and beyond to become the next generation of women leaders in science and medicine.

Posted by on October 29, 2009 - 9:36am
Image: bodyandmore.auburnpub.com

Image: bodyandmore.auburnpub.com

Medscape Today recently wrote an article detailing the physician's dilemma regarding delivering test results, and how this may differ based whether the results are normal or identify a potentially dangerous problem. Much of the discussion uses PAP smear results as way to discuss the issue: it something women are supposed to do fairly regularly, and the results can be life-changing. In the article, doctors discuss whether a phone call is the best way to deliver results. If so, who should do the calling: the doctor or a nurse? The general conclusion seemed to be that a form letter or nurse's call is sufficient for normal test results, but that the doctor should do the notification for abnormal results. Interestly, the mode of doctor notification was disagreed upon: some doctors made phone-calls, others required appointments. I found some of the quotes on the topic annoying:

""Patients with multiple questions are offered an appointment," says an internist. "I am not going to provide unreimbursed care that includes lengthy phone calls." An ob/gyn agrees. "If I am going to spend more than 2 minutes talking to a patient, the reality of reimbursement is that it must be a billable visit. The patient needs to come in.""

I will say that other doctors disagreed and found this practice as gouging as I did. Either way, it's obvious that the issue is still up for debate. What do you all think? How would you prefer to receive test results? What do you think are your particular healthcare provider's motivations for delivering news as he or she does?

Posted by on October 23, 2009 - 2:22pm

Did you know that males require estrogen for many key biological processes, including spermatogenesis? Actually, many of the actions thought to be caused by testosterone in males is actually caused by estrogen signaling instead. These are some of the cool facts about estrogen signaling that were covered in the most recent Institute for Women's Health Research hosted talk by Dr. Jeffrey Weiss, entitled, "The complexities of estrogen signaling."

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Photo: Huge Galdones

Estrogen itself can target the brain, heart, bone, breast, and the gonads in both men and women. It is lipophillic, which means it is soluble in fats rather than water. This is how estrogen can so easily pass through the fatty membranes surrounding or cells. Estrogen acts through the estrogen receptor (ER). The estrogen receptor is a protein that consists of three regions: it has a part (or domain) for binding to DNA, a domain for binding to other proteins, and a domain for binding to estrogen.

When estrogen binds to the ER, it can then work in several different ways. First, in classical signaling, the ER moves from the cell membrane to the nucleus, and binds directly to the DNA in order to cause the expression or repression of certain proteins. Second, in non-classical tethered signaling, the ER moves to the nucleus, but it binds to other proteins bound to DNA, rather than directly binding to the DNA. Lastly, in non-classical membrane signaling, the ER does not move to the nucleus, but rather binds to other proteins at the cell membrane.

It was thought that most of the actions of estrogen in the body comes from classical signaling, but recent data suggests that non-classical signaling is actually responsible for many of these effects. In fact, there are many outcomes of completely inactivating the ER in animals that are then restored by allowing only non-classical ER signaling to occur. These include the presence of large blood-filled cysts in the ovary, an underdeveloped uterus, the creation of sperm in the male, and fluid reabsorption in the testes.

This is obviously a huge field of research, but Dr. Weiss did a great job of laying the foundation for a basic understanding of the work being done. For further information, I highly recommend you check out the basic research papers that he referenced most heavily in his talk:

Posted by on October 21, 2009 - 10:00am
Image: Indigo Instruments

Image: Indigo Instruments

In a recent post called, "Autoimmunity and Gender", we mentioned that one reason women are more prone to autoimmune disorders, or those conditions where the body's immune system attacks its own cells, is because of chromosomal influence, but we didn't elaborate. If you're guessing that it has something to do with the sex chromosomes, the X and Y, you are totally correct...but it may not be for the reason you think. It is not merely the presence of the two X chromosomes in genetic females that leads to autoimmune disorders, but the way the body handles them.

Genetic females have two X chromosomes while genetic males have one X and one Y, so females have twice as many X genes as males, right? Wrong! The X chromosome is incredibly rich in genes that are then made into proteins, while the Y has significantly fewer important genes. Fortunately, the body recognizes this potentially harmful difference in gene number and corrects the problem by a process called X-chromosome inactivation. In this process, every cell in the body chooses one X chromosome, either the one inherited from the mother or the one from the father, to make inactive. That DNA in that chosen chromosome is then wound up very very tightly to form what is called a barr body. Because it is wound up so very tightly (a formation called heterochromatin), the genes from the barr body can not be made into proteins, so it is considered inactive.

If genetic females have one active X chromosome, and so do males, how does this influence the risk of autoimmune disorders? Well, remember that every cell chooses which X chromosome to inactivate and that they do this independently of each other. One heart cell may inactive the X chromosome from the mother, while another right beside it inactivates the X chromosome inherited from the father. This makes all genetic females a type of genetic mosaic: our cells can express two different sets of chromosomes depending on which X chromosome is inactivated.

Image: Haane-Mugaas.com

Image: Haane-Mugaas.com

Getting to the point, think about immune cells: they're these destroyer cells whose sole mission is to hunt down and kill any cells that don't match their DNA code. Usually, this is a good way to target the bacteria and viruses that don't belong, but the immune cells can also get a little too good at their job. If an immune cell that has inactivated the maternal X chromosome meets a nerve cell that has inactivated the paternal X chromosome, that immune cell could be triggerred to destroy the "invader." That, in the end, is how having two X chromosomes can lead to increased risk of autoimmune disorders in genetic females.

PS- Why the picture of the calico cat? Besides the fact that cats rule, fur color is also X linked and depends on X chromosome inactivation. One fur cell decides to inactivate the maternal X carrying orange color, so that cell (and all the cells that come from it) are black or white. Nearby, the opposite happens and you get a patch of orange fur from Mom's X chromosome staying active. It's science in action!

For more information:

Posted by on October 19, 2009 - 9:18am
Image: WOLDCnews.com

Image: WOLDCnews.com

CNN Health has just published a nice article outlining many conditions that can be overlooked in women, including polycystic ovary syndrome (PCOS), fibromyalgia, chronic fatigue syndrome, irritable bowel syndrome (IBS), and several autoimmune disorders such as lupus, rheumatoid arthritis, and multiple sclerosis. Included in the article is a quote from Virginia Ladd, founder and executive director of the American Autoimmune Related Diseases Association:

"More than 40 percent of women eventually diagnosed with a serious autoimmune disease have basically been told by a doctor that they're just too concerned with their health or they're a hypochondriac."

The resounding message of the article is to trust your (possibly irritable) gut; if you feel off somehow, keep pursuing the topic with your doctor or get a second opinion.

PS- Look for our blog entry on Wednesday about autoimmune disorders and X chromosome inactivation. It will be a more in-depth entry about the genetic reasons women are more at risk for these conditions.

Posted by on October 15, 2009 - 12:23pm

On October 14-16, 2009 the Office of Research on Women's Health (ORWH), NIH, DHHS along with Northwestern University, Feinberg School of Medicine and Northwestern Memorial Hospital is co-hosting the fourth in a series of regional scientific workshops to explore new dimensions for the NIH women's health research agenda in the next decade.

With continuing rapid advances in science and wider global understanding of women's health and sex/gender contributions to well-being and disease, the purpose of the regional meetings is to ensure that NIH continues to support cutting edge women's health research that is based upon the most advanced techniques and methodologies.

The ideas and recommendations emerging from this conference, which includes public hearings and scientific workshops, and other regional conferences will help inform future women’s health research priorities at the NIH.

Focus areas for discussion at this workshop:

  • Under-Studied and Under-Represented Populations
  • Clinical and Translational Research
  • New Technologies — Bioengineering — Imaging
  • Genetics — Epigenetics
  • Sex Hormones and Disease
  • Neuroscience
  • Women in Science Careers
Posted by on October 14, 2009 - 9:52am
Image: NIH

Image: NIH

As those interested in the field of women's health, we owe a huge debt of gratitude to the people who have come before us and championed the cause. One of the giants in this regard is Dr. Ruth Kirschstein, who passed away last week at the age of 82. Her scientific work helped to further the safety and efficacy of certain vaccines, including those for measles, rubella, and polio, but some of her greatest accomplishments took place outside the lab. Dr. Kirschstein became the first woman to ever head a National Institute of Health when she took over the National Institute of General Medical Sciences in 1974; she also served as acting director of the NIH on several occasions. Those who knew her, knew that her success only made her more passionate about helping other women and minorities go further in the sciencies. One of her many legacies is the Ruth L. Kirschstein National Research Service Award (NRSA) that provides funding opportunities for women and minorities in the sciences. The Scientist has published a more complete story about all of Dr. Kirschstein's awards and accomplishments here, I recommend it as a way to learn about one of our greatest contemporary women scientists.

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