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Women’s Health

Cardiovascular Medicine, Emergency Medicine, In the News, Research, Women's Health

New test could lead to increase of women diagnosed with heart attack

New test could lead to increase of women diagnosed with heart attack

12192161504_34544b2f38_zSimilar numbers of men and women come to the emergency room complaining of chest pain, and similar numbers of men and women die from heart disease each year (in fact, slightly more than half are women), so why are only half as many women being diagnosed with heart attacks?

A study recently published in the BMJ and funded by the British Heart Foundation suggests that the reason for the difference lies in the diagnostic methods: blood tests. Researchers at the University of Edinburgh found that if blood tests are administered with different criteria for each gender, women’s heart attack diagnoses are much higher. Better tests could limit under-diagnosis and prevent women from dying or suffering from future heart attacks. (And women are more likely than men to die after suffering an attack; twice as likely in the few weeks afterward!)

Blood diagnostic tests measure the presence of troponin, a protein released by the heart during an attack. Previous research showed that men produce up to twice as much troponin as women, so Anoop Shah, MD, and fellow authors hypothesized that if different thresholds of troponin levels were used for men and women, it would correct the disparity.

The researchers administered two tests on patients complaining of chest pain, once using methods that are standard around the world, and then again using a highly sensitive troponin test and gender-specific thresholds. MNT reports:

When using the standard blood test with a single diagnostic threshold, heart attacks were diagnosed in 19% of men and 11% of women. However, while the high-sensitivity blood tests yielded a similar number of diagnoses in men (21%), the number of heart attack diagnoses in women doubled to 22%.

In addition, the researchers observed that participants whose heart attacks were only diagnosed by the high-sensitivity test with gender-specific diagnostic thresholds were also at a higher risk of dying or having another heart attack in the following 12 months.

This research included a little more than 1,000 subjects; the BHF is now funding a clinical trial on more than 26,000 patients to verify the results.

Photo by MattysFlicks

Cancer, Genetics, Stanford News, Videos, Women's Health

Stanford specialists discuss latest advancements in breast cancer screening and treatment

Stanford specialists discuss latest advancements in breast cancer screening and treatment

Invasive breast cancer will affect one in eight women in the United States during their lifetime. Many women, and men, may believe that if they don’t have a family history of breast cancer, then they’re not at risk of developing the disease. However, this is a common myth: About 90 percent of patients diagnosed with the disease have no family history of breast cancer.

But the good news is that breast cancer detected in the early stages can be very effectively treated. Additionally, breast-cancer death rates have been falling over the past 25 years as a result of increased awareness, improvements in treatments and earlier detection.

During a recent Stanford Health Library talk, captured in the above video, breast-cancer specialists discussed the latest advancements in genetic testing, diagnostic imaging, reconstructive surgery and treatments and adjunct therapies to surgery.

Previously: Don’t hide from breast cancer – facing it early is key, Despite genetic advances, detection still key in breast cancer and Ask Stanford Med: Radiologist responds to your questions about breast cancer screening

Global Health, Pediatrics, Public Safety, Research, Stanford News, Women's Health

Working to prevent sexual assaults in Kenya

Working to prevent sexual assaults in Kenya

Kenyan slumsThe little girl bounded up to us, wearing a filthy pink sweater, with a beaming smile on her face, and gave me a huge hug. Surprised at the reception, I hugged her back and swung her gently back and forth. She giggled and ran to hug my colleagues, then, hopping over an open sewer, darted into an alley that lead to her home. We followed as quickly as we could over the slippery mud, down one alleyway than another. Within a few minutes we reached her house, a 5’ by 10’ structure made of mud and wood, without windows, electricity, or locks. The girl, named Lianna*, lives here with her two year-old brother, who calls her “Mama”, as she is his primary caretaker. Their mother is a bartender and likely also a sex worker, and returns home only occasionally. The home is filthy, smells bad, and is without food or water. Yet this beautiful child, brimming with energy and intelligence, is proud to show it to us and to introduce us to her sibling.

Lianna is a resident of Korogocho, one of the poorest informal settlements (known to many as slums) in the Nairobi region of Kenya. Korogocho itself has about 52,000 residents, and it borders on other, larger informal settlements such as Dandora. Poverty and lack of sanitation are the norm in these communities, and crime is extremely high. Girls in these settlements may be especially vulnerable, with 18-25 percent of adolescent girls reporting being sexually assaulted each year, often by friends and relatives.

A multidisciplinary team at Stanford has been working in these communities on a sexual assault prevention project with two Kenyan non-governmental organizations (NGOs), Ujamaa and No Means No Worldwide (NMNW), for about two years. This past July, my colleague Mike Baiocchi, PhD, and I traveled to Kenya to meet the local NGO staff, become familiar with the communities they work in, and advance their research capacity.

Ujamaa, led by Jake Sinclair, MD, a pediatrician from John Muir Hospital, has been working in these and other settlements, including Kibera, Mathare, Huruma, Kariobangi, for more than 14 years, and has partnered with NMNW for several years. NMNW, led by Lee Paiva Sinclair, developed a curriculum to reduce sexual assault by teaching empowerment and self-defense, and works with Ujamaa to implement this curriculum in the slums. The Stanford team became involved in order to research the effectiveness of this intervention.

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Cancer, Clinical Trials, Events, Stanford News, Women's Health

Country music stars thank Under One Umbrella for supporting Stanford Women’s Cancer Center

Country music stars thank Under One Umbrella for supporting Stanford Women's Cancer Center

7856258414_163d347129_zCombatting cancer isn’t cheap. It takes an innovative team with access to top equipment and support. A team that can provide compassionate care while developing new therapies and scouring through detailed data to uncover unknown aspects of the disease.

At the Stanford’s Women’s Cancer Center, that’s where the Under One Umbrella movement comes in. Now in its sixth year, this group has raised more than $23 million for projects benefitting women with cancer. That money pays for leading doctors and researchers, drug and clinical trials, improved facilities, new treatments, tools and more.

“Your generosity is palpable,” Mark Pegram, MD, director of the Stanford Breast Cancer Oncology Program, told the several hundred donors who gathered at Sharon Heights Golf & Country Club in Palo Alto for the group’s annual luncheon earlier this week. Researchers are making molecular “portraits” of breast cancer to determine which patients would benefit from chemotherapy, he said. They’re testing a treatment that “packs all the punch of chemo, but with no chemo side effects.”

Due to a gift from Sonoma County winery Chateau St. Jean, all of the proceeds from the luncheon were used to support the programs, according to Lisa Schatz, former chair of the steering committee.

During the event, organizers screened a video tribute to Gwen Yearwood, a former patient of the Stanford Women’s Cancer Center, featuring her daughters — singer Trisha Yearwood and Beth Bernard. Then, out came Yearwood and her husband, Garth Brooks to serenade the attendees. “Our family is so grateful,” Yearwood said. “We’re an example of the many families who have benefited from (Stanford) care.”

In appreciation of their service, each donor left the luncheon with a pink umbrella, which came in handy as the Bay Area received much-needed rain in the following days.

Additional information about the group is available on its Facebook page.

Previously: Stanford Women’s Cancer Center: Peace of mind and advanced care under one umbrella, At Stanford event, cancer advocate Susan Love talks about  “a future with no breast cancer” and Don’t hide from breast cancer — facing it early is key 
Photo by 55Laney69

Parenting, Pediatrics, Pregnancy, Technology, Women's Health

Stanford alumni aim to redesign the breast pump

Stanford alumni aim to redesign the breast pump

2014-11-21 15.02.36

Three Stanford graduates have an idea that could dramatically impact the daily life of active breastfeeding women: They plan to design and build a breast pump that is discreet, intuitive, and supportive of mothers. This may sound obvious, but nothing like it currently exists. In August of this year, Cara Delzer, MBA; Gabrielle Guthrie, MFA; and Santhi Analytis, PhD, founded Moxxly, “a consumer products company designing for women.” They’re in the final stretch of their 16-week incubation with Highway 1, which helps hardware startups move from a concept to a prototype ready for production.

“We’ve talked to women, hundreds of women, who have told us things like ‘pumping makes me feel like a cow,'” shares Delzer, Moxxly’s CEO, who I interviewed in late November. So she and her colleagues are aiming to re-imagine the pumping experience.

Delzer experienced the current, poorly-imagined pumps firsthand after the recent birth of her child: “I just remember watching my husband take piece after piece out of the pump box for the first time thinking, how in the world am I going to put this together? All those pieces, and clean them? I was already overwhelmed as a new mom, but completely overwhelmed by the pump.” Once she went back to work, she found that she was spending 25 percent of her day dealing with the logistics of pumping – mentally integrating it into her schedule, worrying about having all the parts. The experience is similar for many of today’s busy, mobile moms.

Meanwhile, Guthrie was at Stanford developing her passion for designing for women, Delzer recounts. “A lot of things that have been designed for women and girls in the past have followed this ‘shrink it and pink it’ trope where you literally make it smaller and bright pink and think, ‘Oh, now the girls will buy it.’ Well, Gabrielle doesn’t buy it.” For her masters’ thesis, Guthrie interviewed working moms, and the breast pump kept coming up as something that needed to be redesigned. She spent much of her last year at Stanford working on just that. At a hackathon, she and Analytis worked together to put the new designs into practice, and Analytis, whose PhD is in mechanical engineering, was hooked on solving this problem as well.

The three women “got together, looked one another in the eyes and said, ‘Do we believe this is a problem? Do we believe we can solve it? Do we believe the time is now?’ And it was yes, yes, yes,” said Delzer. They took on the challenge despite the fact that the breast pump is an FDA-regulated medical device and they will face a lengthy review process. They invented the name “Moxxly” with the intent of conveying spunkiness and strength, and incorporated XX to signify women.

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Cancer, Mental Health, Research, Women's Health

Women with mental illness less likely to be screened for breast cancer

Women with mental illness less likely to be screened for breast cancer

Previous research has shown that women are up to 40 percent more likely to experience a mental-health condition than men. Now findings published in the British Journal of Psychiatry caution that women with depression, anxiety or other mood disorders are likely missing out on important breast-cancer screenings.

In the study, British researchers conducted a systematic review and meta-analysis and comparing rates of mammography screening between women with mental illness and those without. PsychCentral reports:

Researchers found that there were significantly reduced rates of mammography screening in women with mental illness, depression, and severe mental illness such as schizophrenia.

The effect was not present in women with distress alone, suggesting distress was not the explanation.

“In this study, we found that mental ill health was linked with 45,000 missed screens which potentially could account for 90 avoidable deaths per annum in the UK alone. Clearly patients with mental illness should receive care that is at least comparable with care given to the general population. Every effort should be made to educate and support women with mental illness called for screening,” [said Alex Mitchell, MD, who led the study.]

Previously: A new way of reaching women who need mammograms, Despite genetic advances, detection still key in breast cancer, Medicine X explores the relationship between mental and physical health: “I don’t usually talk about this”Examining link between bipolar disorder, early death and Examining the connection between mental and physical health

Big data, Cancer, Health Disparities, Imaging, Public Health, Women's Health

A new way of reaching women who need mammograms

A new way of reaching women who need mammograms

black Woman_receives_mammogramI’ve taken cancer screenings for granted since I’m one of those fortunate enough to have health insurance, and it didn’t occur to me that many uninsured women were going without regular mammograms to screen for breast cancer. A story today on Kaiser Health News mentions this fact and highlights a partnership that Chicago public-health officials have forged with a company named Civis. The private company includes staffers that helped with the Obama campaign’s get-out-the-vote efforts, and then moved on to help find people eligible to enroll for health insurance through the Affordable Health Care Act. The company used its expertise to identify women who were in the right age group (over 40) and were uninsured in Chicago’s South Side area; those women then were then sent fliers about free screenings available to them.

The article describes some other cities using similar “big data” efforts for public-health purposes:

This project represents a distinctive step in public health outreach, said Jonathan Weiner, professor and director of the Johns Hopkins Center for Population Health IT in Baltimore. But Chicago is not the only city investigating how population data can be used in health programs, he added, citing New York City, Baltimore and San Diego as other examples.

“It’s a growing trend that some of the techniques first developed for commercial applications are now spinning off for health applications,” he said. So far, he said, “these techniques have not been as widely applied for social good and public health,” but that appears to be changing.

The early signs say that the new effort in Chicago, which started earlier this year, is working. One hospital saw a big jump in the number of free mammograms, from 10 a month to 31, though the full impact may not be understood for a few months. It’s not “a silver bullet” as one expert cited in the story notes, but it’s a much more precise tool than most public-health outreach programs have had access to until now.

Previously: Screening could slash number of breast cancer casesDespite genetic advances, detection still key in breast cancerStudy questions effects of breast cancer screenings on survival rates and New mammogram guidelines echo ones developed by physicians group
Photo by National Cancer Institute

Medical Education, SMS Unplugged, Women's Health

Learning the pelvic exam with Project Prepare

Learning the pelvic exam with Project Prepare

SMS (“Stanford Medical School”) Unplugged was recently launched as a forum for students to chronicle their experiences in medical school. The student-penned entries appear on Scope once a week; the entire blog series can be found in the SMS Unplugged category.

This past Friday, half my class crowded into a small room in the basement of the Li Ka Shing Center. When we walked in, we saw our names written on the board, under one of the following headings: “Male Pelvic Exam,” “Female Pelvic Exam,” and “Female Breast Exam.”

It felt like a safe space to make mistakes, ask questions, and fumble a little bit – without feeling like I was in over my head

For many of us, this was our first session of Project Prepare – a 3-session, 8-hour course designed to teach medical students how to provide supportive care for patients in the area of sexual health. (The history of the program is included in this article.) The teachers in Project Prepare take the dual role of patient and educator, using their own bodies to help students learn how to perform pelvic and breast exams.

This was my first day of the course, and I was scheduled to do the female pelvic exam session with a patient-educator whom I’ll call Stacie. I had heard from other classmates who had already done this session that it was “intense” and that it took some time to emotionally recover afterwards. I’d heard from others that it was “incredible;” one classmate even said it made her to want to be a Project Prepare patient-educator herself. The many mixed messages rolled together in my mind and distilled into a single overwhelming sense of anxiety.

But Stacie made everything so easy. She didn’t beat around the bush about how awkward or uncomfortable the experience could be. The first thing she asked us was, “What have you heard about Project Prepare?” and when I said I’d heard it was “intense,” she responded, “Why do you think that is?” In doing so, she set the tone for the rest of the afternoon: gentle, filled with open-ended questions and non-judgmental responses.

Over the next three hours, Stacie guided a fellow classmate and me through the exam techniques and word choice that accompany the 5-part female pelvic exam. She pointed out nuances that would never have otherwise crossed my mind, like how saying “that’s perfect” and “great” are fine in other parts of a medical interview or exam but painfully awkward and even inappropriate in the context of a pelvic exam.

After the session, I looked up Project Prepare, curious as to how many medical schools invite the team to their campuses. I was surprised to see that only Stanford, Touro University College of Osteopathic Medicine (both in CA and NV), Kaiser, and UCSF are on Project Prepare’s list of clientele. Though I still have two sessions left, it is so clear to me that Project Prepare is a unique, effective way of teaching students the pelvic and breast exams. As a medical student, the idea of doing these delicate exams for the first time on a real patient (one who is not simultaneously a trained educator) is terrifying. I had this experience last year, at Stanford’s Arbor Free Clinic, where I performed my first pap smear, with the guidance of an attending physician. I recall how scared I felt that I might hurt my patient and somehow “mess up.” In contrast, my experience with Project Prepare felt like a safe space to make mistakes, ask questions, and fumble a little bit – without feeling like I was in over my head.

This week, I have two more sessions with the Project Prepare teaching team, and this time, my feelings leading up to the sessions are colored with excitement rather than anxiety. To the Project Prepare patient-educators: Thank you so much for sharing your time, your knowledge, and most of all, your bodies, with us, as we take this journey from classroom to clinic. Our medical school experience feels more complete because of you.

Hamsika Chandrasekar is a second-year student at Stanford’s medical school. She has an interest in medical education and pediatrics.

Previously: Reality Check: When it stopped feeling like just another day in medical school

Global Health, Pregnancy, Stanford News, Women's Health

Stanford undergrad uncovers importance of traditional midwives in India

Stanford undergrad uncovers importance of traditional midwives in India

IMG_0348Lara Mitra grew up taking regular vacations with her family in her ancestral home, the state of Gujarat in India, but those short trips barely prepared her for her first long-term stay. She says the 10 weeks she spent studying maternal delivery practices were eye opening in many ways. The work she did while there made a big enough impact that it landed her on a list of 15 impressive Stanford students featured in Business Insider last month.

During the summer between her sophomore and junior years, in 2012, Mitra secured a human rights summer fellowship through the Stanford McCoy Family Center for Ethics in Society. She worked with the Self-Employed Womens Association (SEWA), a large non-profit organization in India that helps women become economically self-sufficient, but also gathers other information about the well-being of women in the country. Mitra worked with SEWA officials to design a study looking at how often women in Gujarati villages used hospitals to deliver their newborns instead of delivering at home. Most home deliveries are carried out with the help of a dai, a village local who acts as a midwife but usually doesn’t have formal training.

Maternal mortality rates in India are still alarmingly high, so government agencies have started incentive programs such as offering free ambulance service to and from hospitals for laboring mothers and paying mothers to deliver in a hospital instead of at home, and pays dais to bring laboring mothers to hospitals. In light of all these incentives, it was unclear how often women were still delivering at home. And if they weren’t, Mitra says the question was “Are these dais, these midwife figures still useful? Is there still a job for them?” Mitra was excited to be doing the critical research and says, “It was the first time I wasn’t working in someone else’s lab and designed my own study.”

She found that women were in fact taking advantage of the government programs and delivering more often in hospitals, but the dais still played a critical role. In some situations, such as emergency deliveries, dias stepped in and delivered the children before mother and child were taken to the hospital for examination. Also, unlike in Western countries, husbands don’t play as intimate a role in the delivery, so the dai served as “birth coach” at the hospital, too. Dais also helped with prenatal and post-delivery care. Out of 70 women Mitra interviewed in 15 villages surrounding the Gujarati city of Ahmedabad, 69 said dais still served a useful role.

“More significantly, the trust women had in the dai couldn’t be replicated in doctors,” says Mitra. “Dais were part of a support system for women. The dai would do informal check-ups, and could tell if a C-section would be necessary.”

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Pregnancy, Research, Stanford News, Women's Health

Stanford/VA study finds link between PTSD and premature birth

Stanford/VA study finds link between PTSD and premature birth

pregnant-silhouetteScientists have long suspected that post-traumatic stress disorder raises a pregnant woman’s risk of giving birth prematurely. Now, new research from Stanford and the U.S. Department of Veterans’ Affairs confirms these suspicions.

Women with “active” PTSD, diagnosed in the year before they gave birth, were 35 percent more likely than those without PTSD to spontaneously go into labor early and deliver a premature baby, the study found. Women whose PTSD had been diagnosed further in the past were not at increased risk, however.

The findings, published today in Obstetrics & Gynecology, are based on data from 16,344 births to female veterans. All of the women had been screened for PTSD. The researchers found that 3,049 babies were born to women diagnosed with the disorder at some point prior to delivery, and of these, 1,921 births were to women who had active PTSD.

“This study gives us a convincing epidemiological basis to say that, yes, PTSD is a risk factor for preterm delivery,” the study’s senior author, Ciaran Phibbs, PhD, associate professor of pediatrics and an investigator at the March of Dimes Prematurity Research Center at Stanford University, said in a press release. “Mothers with PTSD should be treated as having high-risk pregnancies.”

The VA has already adopted Phibbs’ recommendation for their patients and is now including a recent PTSD diagnosis among the factors that flag a woman’s pregnancy as high-risk. But the findings aren’t just for veterans, Phibbs told me. “The prevalence of PTSD is higher among veterans, but it’s still reasonably common in the general population,” he said. Nor was the PTSD-prematurity link limited to women with combat experience, he said. Half of the women in the study who had PTSD diagnoses had never been deployed.

Spontaneous premature labor, the focus of this study, accounts for about half of premature births. Phibbs’ team is now investigating the other half of preterm births: They are examining whether PTSD also influences a mother’s risk of developing medical conditions that could cause her physician to recommend an early delivery for the sake of the mother’s or baby’s health.

Previously: Maternal obesity linked to earliest premature births, says Stanford studyThe year in the life of a preemie – and his parents and How Stanford researchers are working to understand the complexities of preterm birth
Photo by Stefan Pasch

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