Young Women with Ovarian Insufficiency at Risk for Depression
Posted by on December 8, 2010 - 7:35am

Young women with the menopause-like condition, primary ovarian insufficiency, are much more likely than other women to experience depression at some point during their lives, according to a study from the National Institutes of Health. The finding suggests that all women diagnosed with the condition should be evaluated for depression.

Depression is a serious medical illness affecting the brain which involves more than feeling blue or sad for a few days. Symptoms include persistent feelings of sadness, difficulty sleeping or over sleeping, energy loss, and feelings of worthlessness.

Primary ovarian insufficiency, or POI, results in a menopause-like condition years before normal menopause begins — sometimes as early as the teens or twenties. Women with POI stop producing normal amounts of reproductive hormones, develop hot flashes, and typically become infertile. The study authors evaluated 174 women with POI and found that 67 percent either were currently clinically depressed or had been depressed at least one time in their lives.

The researchers noted that this proportion was more than twice the rate of depression found by a national survey of women in the general population.

"Because of the strong association with depression, our results indicate all women diagnosed with POI should be thoroughly evaluated for depression," said Lawrence M. Nelson, M.D., co-senior author of the study and head of the Integrative and Reproductive Medicine Group at the NIH’s Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD). "Simply asking patients if they are depressed is not sufficient. Primary care physicians should evaluate their patients with a diagnostic screening test to determine if treatment or referral to a mental health specialist for further evaluation is needed."

The study's first author was Peter J. Schmidt, M.D., of the National Institute of Mental Health (NIMH).   The study appears in The Journal of Clinical Endocrinology and Metabolism.

The study was unable to determine why women with POI are more likely than other women to experience depression. The investigators cited results of a previous study, which had suggested that depression might trigger physical changes that ultimately lead women to develop POI. However, in the current study, more than 73 percent of women with POI first experienced depressive symptoms after developing the irregular menstrual cycles believed to be an indicator of impending POI.

The findings also did not support the hypothesis that most women with POI become depressed after they are told of their diagnosis, when they learn that they will likely be infertile. In the current study, more than 68 percent of patients with POI who had depression had become depressed after the onset of irregular menstrual cycles, but before receiving the diagnosis of POI.

In a previous study, Dr. Schmidt found that women entering natural menopause at an appropriate age are at greater risk of depression late in the menopause transition, when estrogen levels are particularly low.

"Future studies are needed to help determine whether hormonal changes, perhaps combined with a particular genetic makeup, might predispose some women to depression," said Dr. Schmidt.

The authors also noted that studies of women undergoing natural menopause have found that estrogen supplements relieve symptoms of depression in some women. The authors added that it is possible that estrogen supplements might relieve symptoms of depression in women with POI.

NIMH provides information about women and depression in its booklet Women and Depression: Discovering Hope.

Time to Test Your Knowledge about the Flu!
Posted by on December 5, 2010 - 1:48am

We've all heard lots of reports about the flu and flu vaccine but are you game to check your knowledge?   Click HERE to learn what you really know about the flu!

No doubt about it.   The flu season is here---especially in the Northern Hemisphere.   With global travel, all you readers in the warmer climates could easily be at risk as snow birds head to your fair lands.    The general consensus among health professionals and public health agencies is to get a flu shot....every year.  If you have a chronic condition it's even more important.  December 5-11, 2010 is National Influenza Vaccination Week and there will be a lot of agencies offering flu vaccinations in your community. Please take advantage of the opportunity.

If you want to learn more about the risks, symptoms, and treatment of the flu, click HERE for guidelines from the Center for Disease Control (CDC).

Is Thyroid Cancer Incidence Up?
Posted by on December 3, 2010 - 11:05am

The American Cancer Society projects the U.S. incidence of thyroid cancer in 2010 at 44,670 cases (14.4 cases per 100,000 people)  with women having 3 times the rate of men.   The rate of thyroid cancer diagnosis has doubled since 1990, in large part because of improved diagnosis, but also because of unknown factors.

Despite the increase, thyroid cancer death rates have been relatively stable over the years.   The ACS predicts 1,690 deaths in the U.S. in 2010.  It remains a very treatable disease. Many people develop benign lumps, known as nodules, in the neck, but only one in 20, are malignant.   Even when it is an aggressive form of the disease, there is a 97% survival rate after 5 years.

The cause for this increase in new cases has created much debate among the scientific community.  Is the real reason better detection rates or is there truly an increase in cases?

Over the last 30 years, ultrasound and fine needles biopsies have helped diagnose cases that would never have been found before.  A study published in the Journal of the American Medical Association in 2006 reported that 140 % increase in thyroid cancer from 1973-2002 was a result of increased diagnostic capacity.  Many of these were extremely small, papillary thyroid cancer tumors (most common and treatable type) that would have never caused  problems in the majority of cases.

This "over-diagnosis" raises another debatable question, are we doing unnecessary surgeries on cancers that are unlikely to create harm?  Further confusing the issue is the fact that about 10-30% of fine needle biopsies come back with an inconclusive diagnosis for malignancy, yet, all or part of the thyroid is removed. Once the final pathology is done on the removed tissue, only 15-20% turn out to be malignant.

This is definitely a complicated issue and a new molecular test is undergoing clinical trials at nearly 50 sites that researchers hope will sort benign from malignant nodules in the indeterminate fine needle  biopsy samples. If this new test helps produce a more certain diagnosis, patients who come back negative could avoid surgery but continue to be monitored through clinical exams and occasional ultrasounds.

To read more about thyroid cancer, click HERE.

Younger Women at Risk for Pelvic Inflammatory Disease
Posted by on December 2, 2010 - 10:11am

Pelvic inflammatory disease (PID) refers to infection of the uterus (womb), fallopian tubes and other reproductive organs that causes symptoms such as lower abdominal pain.   It is a serious complication of some sexually transmitted diseases, especially chlamydia and gonorrhea.   PID can damage the fallopian tubes and tissues in and near the uterus and ovaries and can lead to serious consequences including infertility, ectopic pregnancy (a pregnancy in the fallopian tube or elsewhere outside the womb), abscess formation and chronic pelvic pain.

More than 750,000 women in the US experience an episode of acute PID every year.

PID occurs when bacteria move upward from a women's vagina or cervix into her reproductive organs.   A prior episode of an PID increases the risk of another episode because the reproductive organs may be damaged during the initial bout of infection.

Sexually active women in their childbearing years are most at risk, and those under age 25 are more likely to develop PID than those older than 25.   This partly because the cervix of teenage girls and young women is not fully matured, increasing their susceptibility to the STDs that are linked to PID.   The more sex partners a women has, the greater her risk of developing PID.   Also, a woman whose partner has more than one sex partner is at greater risk of developing PID, because of the potential for more exposure to infectious agents.   Women who douche may have a higher risk of developing PID.   Research has shown that douching changes the vaginal flora in harmful ways, and can force bacteria into the upper reproductive organs.

Women who have an intrauterine device (IUD) inserted may have a slightly increased risk of PID near the time of insertion compared with women using other contraceptives or no contraceptive at all.  However, this risk is greatly reduced if a women is tested and, if necessary, treated for STDs before an IUD is inserted.

Signs and symptoms of PID include:

  • lower abdominal pain
  • fever
  • unusual vaginal discharge that may have a foul odor
  • painful intercourse
  • painful urination
  • irregular menstrual bleeding
  • pain in the right upper abdomen.

If the PID is caused by a chlamydial infection, a woman may only have mild symptoms or even no symptoms.   This often leads to an undiagnosed case of PID which can become a serious problem.

To read more about the causes,  diagnosis, treatment and complications of PID, click HERE.

Source:   Centers for Disease Control and Prevention

Women and HIV/AIDS
Posted by on November 30, 2010 - 11:04am

December 1 is World AIDS Day and the Institute for Woman's Health Research in Chicago is focusing this blog on HIV/AIDS in Women.  There is also a link to a comprehensive update at the end of this page.

Both women and men need similar types of HIV care, but there are some important differences:

  • Women often have gynecological conditions as a result of HIV infection. These can include persistent and difficult-to-treat vaginal yeast infections, pelvic inflammatory disease, cervical dysplasia (abnormal cell changes in the cervix), and an increased likelihood of developing cervical cancer.
  • Women may have concerns about pregnancy and childbirth—whether for a current pregnancy or for the future. It is best to talk with your provider about these concerns.
  • Women who are diagnosed with HIV should have a Pap smear and a pelvic exam ASAP. They should have a follow-up Pap smear 6 months later.
  • Women are less likely to develop Kaposi’s Sarcoma, a type of cancer that is a common opportunistic infection and an AIDS-defining condition.
  • Women are often diagnosed later in the stages of HIV infection, so they can be more susceptible to opportunistic infections.
  • Women often must be stronger advocates for themselves and their treatment when engaged in HIV care. Many times women face multiple barriers to care.

Frequently Asked Questions
If I am diagnosed with HIV, can I still get pregnant?
Yes. Being diagnosed with HIV shouldn’t prevent you from getting pregnant. You can take medications that will help to prevent your baby from getting HIV from you. For more information, see Having Children.

I thought HIV was something that only affected gay men. I’m a straight woman. Am I at risk for HIV?
If you are sexually active or inject drugs (or have sex with someone who does), you are at risk for HIV. Many women are unaware of their partner’s current or past sexual or drug-taking behaviors. It is possible for a man to become infected with HIV by injecting drugs or by having sex with an HIV-positive woman and then transmitting the virus to a different female partner. In addition, many men who have sex with men (MSM) don’t consider themselves “gay” or bisexual, and they may also have sexual relationships with women. It’s important to ask your partner if he has had sexual contact with other men or ever used injection drugs—and for BOTH of you to be tested for HIV before you have sex without a condom. If you have any doubts about your partner’s HIV status, or his sexual or drug-taking behaviors, insist on consistent condom use every time you have sex.

For more information on women and HIV/AIDS from the US Dept. of Health and Human Services, Office On Women's Health, click HERE.

The Chemistry and Mystery of Red Wine
Posted by on November 29, 2010 - 1:01pm

Two scientific articles in the July 2010 issue of American Journal of Clinical Nutrition shed more insight on the chemistry of red wine that may explain why more doctors are suggesting that a little red wine may be heart-healthy.  Both articles focus on resveratrol, a chemical compound found in certain plants. It is called a phytoalexin because plants naturally produce it as an antibiotic substance to fight both bacteria and fungi. Plants containing resveratrol include the grapes and skins of grapes that produce wine, raspberries, mulberries, blueberries and cranberries.  There is growing evidence that resveratrol plays a role in plaque development, fatty tissue growth, and other biological mechanisms that impact the cardiovascular system.

In the first article by Fischer-Posovszky et al reported that resveratrol influences adipose (fatty) tissue mass.   Laboratory tests on human cells in vitro showed that resveratrol  blocked immature fat cells from developing and differentiating affecting the fat cells' ability to function.  These findings indicate that resveratrol might interfere with obesity and other metabolic effects that  could increase the risk of cardiovascular disease.

In the second article, Hamed et al studied the effect of moderate red wine consumption on vascular endothelial function. Endothelial progenitor cells (EPC) are bone marrow-derived cells that are mobilized by the peripheral circulation when vascular repair is needed (e.g., peripheral arterial disease).  In this study, 14 volunteers consumed 250 mL (little more than 8 ounces) of red wine daily for 21 consecutive days.   The researchers reported an improvement on vascular endothelial function.

According to an editorial in the same journal, these findings may suggest that moderate wine consumption provides cardiovascular protection.  However, these findings also raise further questions about whether red wine (resveratrol) can reverse or attenuate established heart disease.    Human clinical trials are needed to substantiate these findings.

While we recognize the concerns about alcohol addiction, a surprising number of reports have come out in favor of moderate red wine drinking.  In fact, a recent report suggested that a periodic glass of wine during a normal pregnancy may be helpful to the mother.   It's hard for a layperson to determine what is hype and what is true.  I recently came upon a website run by the Institute on Lifestyles and Health at Boston University that critiques many of the studies that discuss the benefits and risks of alcohol.   It's web site can be found HERE.

Does Estrogen Make You Smarter?
Posted by on November 26, 2010 - 10:17am

Scientists discover how estrogen works and flip its switch to reap benefits without risks

CHICAGO --- Estrogen is an elixir for the brain, sharpening mental performance in humans and animals and showing promise as a treatment for disorders of the brain such as Alzheimer’s disease and schizophrenia. But long-term estrogen therapy, once prescribed routinely for menopausal women, now is quite controversial because of research showing it increases the risk of cancer, heart disease and stroke.Northwestern Medicine researchers have discovered how to reap the benefits of estrogen without the risk. Using a special compound, they flipped a switch that mimics the effect of estrogen on cortical brain cells. The scientists also found how estrogen physically works in brain cells to boost mental performance, which had not been known.

When scientists flipped the switch, technically known as activating an estrogen receptor, they witnessed a dramatic increase in the number of connections between brains cells, or neurons. Those connections, called dendritic spines, are tiny bridges that enable the brain cells to talk to each other.

“We created more sites that could allow for more communication between the cells,” said lead investigator Deepak Srivastava, research assistant professor in neuroscience at Northwestern University Feinberg School of Medicine. “We are building more bridges so more information can go from one cell to another.”

Previous research has shown an increase in dendritic spines improves mental performance in animals. In humans, people who have Alzheimer’s disease or schizophrenia often have a decrease in these spines.

“We think there is a strong link between the number of dendritic spines and your mental performance,” Srivastava said. “A major theory is if you increase the number of spines, it could be a way to treat these significant mental illnesses. “

Northwestern scientists also found strong clues that estrogen can be produced in cortical brain cells. They identified aromatase, a critical protein needed to produce estrogen, to be in precisely the right spot in the brain cell to make more dendritic spines.

“We’ve found that the machinery needed to make estrogen in these brain cells is near the dendritic spines,” Srivastava said. “It’s exactly where it’s needed. There’s a lot of it in the right place at the right time. “

Next, Srivastava said, he wants to further identify the key molecules involved in the dendritic spine production and target them in the same way as the estrogen receptor in order to ultimately be able to treat schizophrenia and other mental disorders.

Nick Brandon, head of psychiatry at Pfizer Inc., whose group collaborated with the Penzes lab for this work, added, “We are very excited by the emerging data in this area. There is a great deal of literature and precedent for a role of estrogen and estrogen signaling in major mental illnesses. This adds to our understanding of the specific neuronal functions. As we understand the effects of these specific estrogen receptor beta compounds in preclinical models, we are discovering effects on specific neuronal functions, which could be relevant for the treatment of cognitive disorders, depression and schizophrenia. “

Marla Paul is the health sciences editor. Contact her at marla-paul@northwestern.edu

Sugary Drinks Linked to Diabetes and Metabolic Syndrome
Posted by on November 24, 2010 - 12:45pm

In a new meta-analysis published in the November 2010 issue of Diabetes Care, researchers from the Harvard School of Public Health report that consumption of just one or two sugar-sweetened beverages per day is associated with a 26% greater risk of developing type 2 diabetes and a 20% increased risk of developing metabolic syndrome.   Senior author Dr. Frank Hu put this into perspective,  "So for those who drink two to three sodas per day, their risk of developing type 2 diabetes would be increased by 30-40% which is not very different from the increased risk associated with cigarette smoking."

It is not clear from the study if the main reason for the increased risk is due to the increase in calories or due to the combination of  excess calories and some unique metabolic effects of fructose and other components of soft drinks.

The authors note that the jury is still out on the long-term effects of artificial sweeteners in soft drinks, so they caution against substituting diet sodas or drinks for sugar sweetened ones.    Water, nonsweetened tea or coffee may be better choices.

Safety Tips for a Healthy Turkey Dinner on Thanksgiving
Posted by on November 23, 2010 - 2:09pm

November is the busiest month of the year for the US Department of Agriculture Meat & Poultry Hotline. During the week of Thanksgiving(November 25), they get lots of questions about how to safely cook a turkey. Here are answers to some of the more common questions.

How can I tell when the turkey is done?

Whether you roast, brine, deep fry or smoke your turkey, always use a food thermometer to check the temperature of the meat. You won’t overcook your turkey, and you can ensure it has been cooked to a safe minimum internal temperature of 165 °F to destroy bacteria and prevent foodborne illness. Check the temperature in the innermost part of the thigh and wing and the thickest part of the breast. If the turkey is stuffed, the stuffing must also reach 165 °F.

How long does it take to cook a turkey?

Use the Turkey Roasting Chart to determine how long to cook your turkey. These times are approximate and based on fresh or thawed birds at a refrigerator temperature of 40 °F or below.

Is it safe to cook a turkey from the frozen state?

Yes, the cooking time will take at least 50 percent longer than recommended for a fully thawed turkey. Remember to remove the giblet package before cooking your turkey (there are a lot of funny stories about first time turkey cookers who forget to do this!). Remove the giblets carefully with tongs or a fork and use the giblets for the gravy or dressing per your favorite recipe.

Can I cook two turkeys at the same time?

Cooking two turkeys of about the same weight does not double the roasting time. Cooking time is determined by the weight of one bird. Just make sure there is sufficient oven space for proper heat circulation.

What about storing leftovers?

Bacteria spread fastest at temperatures between 40 °F and 140 °F, so chilling food safely reduces the risk of foodborne illness. Discard any turkey, stuffing, and gravy left out at room temperature longer than 2 hours. Divide leftovers into smaller portions. Refrigerate or freeze in covered shallow containers for quicker cooling.
Use refrigerated turkey, stuffing, and gravy within 3 to 4 days or freeze it. Use frozen turkey and stuffing leftovers within 2 to 6 months for best quality. Reheat to 165 °F or until hot and steaming. Gravy should come to a rolling boil.

Can I call the Meat & Poultry Hotline on Thanksgiving Day?

Yes! The Hotline will be staffed from 8 a.m. to 2 p.m. Eastern Time on Thanksgiving Day. Call toll-free at 1-888-674-6854. (Our usual hours are Monday through Friday, from 10 a.m. to 4 p.m., Eastern Time.) You can also ask a question in English or Spanish at AskKaren.gov, available 24 hours a day

Is Heart Disease Genetic Destiny or Lifestyle?
Posted by on November 22, 2010 - 11:13am
CHICAGO --- Is cardiovascular health in middle age and beyond a gift from your genes or is it earned by a healthy lifestyle and within your control?Two large studies from Northwestern Medicine confirm a healthy lifestyle has the biggest impact on cardiovascular health. One study shows the majority of people who adopted healthy lifestyle behaviors in young adulthood maintained a low cardiovascular risk profile in middle age. The five most important healthy behaviors are not smoking, low or no alcohol intake, weight control, physical activity and a healthy diet. The other study shows cardiovascular health is due primarily to lifestyle factors and healthy behavior, not heredity.

“Health behaviors can trump a lot of your genetics,” said Donald Lloyd-Jones, M.D., chair and professor of preventive medicine at Northwestern University Feinberg School of Medicine and a staff cardiologist at Northwestern Memorial Hospital. “This research shows people have control over their heart health. The earlier they start making healthy choices, the more likely they are to maintain a low-risk profile for heart disease.”

Why Many Healthy Young Adults Become High Risk

The first Northwestern Medicine study investigated why most young adults, who have a low-risk profile for heart disease, often tip into the high-risk category by middle age with high blood pressure, high cholesterol and excess weight.  The unhealthy shift is the result of lifestyle, the study found. More than half of the young adults who followed the five healthy lifestyle factors for 20 years were able to maintain their low-risk profile for heart disease though middle age. (The five healthy lifestyle factors are not smoking, low or no alcohol intake, weight control, physical activity and a healthy diet.)

“This means it is very important to adopt a healthy lifestyle at a younger age, because it will impact you later on,” said Kiang Liu, lead author of the study and a professor of preventive medicine at the Feinberg School.

There are big benefits to reaching middle age with a low-risk profile for heart disease. These individuals will live much longer, have a better quality of life and generate lower Medicare bills. A low-risk profile means low cholesterol, low blood pressure, no smoking, no diabetes, regular physical activity, a healthy diet and not overweight.

The study followed 2,336 black and white participants, ages 18 to 30 at baseline, for 20 years. Researchers tracked participants’ diet, physical activity, alcohol consumption, smoking, weight, blood pressure and glucose levels at the baseline year, year seven and year 20. The participants are part of the CARDIA (Coronary Artery Risk Development in Young Adults) multi-center longitudinal study sponsored by the National Heart, Lung and Blood Institute.

After 20 years, the prevalence of a low-risk profile was 60 percent for participants who followed all five healthy lifestyle factors, 37 percent for four factors, 30 percent for three factors, 17 percent for two and 6 percent for one or zero. The results were similar for men only, women only, black only and white only.

“From a public health point of view, this shows we should put more emphasis on promoting a healthy lifestyle in young adulthood,” Liu said. “We need to educate and encourage younger people to do this now, so they’ll benefit when they get older.”

Tracking Three Generations of Families for Cardiovascular Health

The second Northwestern Medicine study examined three generations of families from the Framingham Heart Study to determine the heritability of cardiovascular health. Heritability includes a combination of genetic factors and the effects of a shared environment such as the types of foods that are served in a family.  Only a small percentage of the United States population – 8 percent -- has ideal levels of all the risk factors for cardiovascular health at middle age.

The study found that only a small proportion of cardiovascular health is passed from parent to child; instead, it appears that the majority of cardiovascular health is due to lifestyle and healthy behaviors.

“What you do and how you live is going to have a larger impact on whether you are in ideal cardiovascular health than your genes or how you were raised,“ said Norrina Allen, the lead study author and a postdoctoral fellow in preventive medicine at the Feinberg School.

The Northwestern Medicine study looked at three generations of families including 7,535 people at age 40 and a separate group of 8,920 people at age 50. The goal was to see who was in ideal cardiovascular health at these two critical periods in middle age.

“We really need to encourage individuals to improve their behavior and lifestyle and create a public health environment so people can make healthy choices,” Lloyd-Jones said. “We need to make it possible for people to walk more and safely in their neighborhoods and buy fresh affordable fruit and vegetables in the local grocery store. We need physical activity back in schools, widely applied indoor smoking bans and reduced sodium content in the processed foods we eat. We also need to educate people to reduce their calorie intake. It’s a partnership between individuals making behavior changes but also public health changes that will improve the environment and allow people to make those healthy choices.”

Marla Paul is the health sciences editor. Contact her at marla-paul@northwestern.edu

Pages