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Women’s Health

Behavioral Science, Nutrition, Research, Women's Health

Adventurous eaters more likely to be healthy, new study shows

Adventurous eaters more likely to be healthy, new study shows

9044506418_142bb67dcc_zAre you willing to sample chocolate-covered silkworm pupae? What about blood sausage or, for the vegetarians among us, some shoo-fly pie (one of my personal favorites)?

If any or all of those sound tasty, or at least worth trying, then you’re probably a food neophile, aka an adventurous eater. And for you, I’m the bearer of good news: Adventurous eaters have lower body-mass indexes and are generally more conscious about healthy eating than their less adventurous diners, according to a study published recently in Obesity.

Researchers from Cornell University and the University of Vermont recruited about 500 women and had them complete a survey on their eating habits and willingness to try new things and foods. The answers shed insight into the connections between healthy habits and adventurousness:

…Adventurous eaters were less concerned that a food was easy to prepare and about its price, but more interested in cooking as a way to connect with their heritage and more likely to have friends over for dinner. Given that cooking at home is associated with lower BMI and increased consumption of healthy foods, if adventurous eaters are comfortable with foods that were harder to prepare, and often have friends over for dinner, it may be that they prepare their own food more often than non-adventurous eaters. Furthermore, eating with others versus eating alone has been associated with decreased intake in some studies. The lower concern about price of foods exhibited by more adventurous eaters is in line with characteristics of foodies, who are much more concerned with food quality than food price. Because healthy foods are often more expensive than junk foods and require preparation, adventurous eaters may be more likely to procure and prepare these types of foods than non-adventurous eaters.

The authors go on to write that the findings “have exciting practical implications” and suggest “several strategies [that] practitioners could use to help increase adventurousness.” But they acknowledge the research has several limitations, including its lack of men and definition of “adventurousness.”

Previously:  Where is the love? A discussion of nutrition, health and repairing our relationship with food, “They might be healthier, but they’ll still be junk foods”: Expert comments on trans-fat ban and Examining how food texture impacts perceived calorie content
Photo by Smabs Sputzer

Chronic Disease, Neuroscience, Pregnancy, Research, Women's Health

Women with epilepsy face elevated risk of death during pregnancy and childbirth – but why?

Women with epilepsy face elevated risk of death during pregnancy and childbirth - but why?

5987537049_ed5eff3b31_zWomen with epilepsy face a higher risk of death and a host of complications during their pregnancies than other women, according to a new study published today in the Journal of the American Medical Association Neurology.

The researchers found women with epilepsy had a risk of 80 deaths per 100,000 pregnancies, more than 10 times higher than the risk of 6 deaths per 100,000 pregnancies faced by other women.

That’s a big deal, neurologists Jacqueline French, MD, from NYU Langone Medical Center, and Stanford’s Kimford Meador, MD, write in an accompanying editorial.

“The study should sound a major alarm among physicians and researchers,” French and Meador write. But, it fails to answer an integral question, they say: Who exactly is at risk and why did the women die?

Women with epilepsy are more likely to have hypertension, diabetes and a variety of psychiatric conditions. Are those conditions responsible for the differences in death rates, the authors question.

The study also fails to distinguish between women with well-controlled epilepsy and those continuing to suffer seizures. “These are critical questions, and, without the answers, we are left in the unsatisfying position of having to advise all women with epilepsy that they may be at higher risk,” French and Meador write. The study “raises far more questions than it answers. Most women with epilepsy have uncomplicated pregnancies.”

The authors conclude: “Future studies need to confirm and build on the present findings to improve the care of women with epilepsy during pregnancy.”

Previously: Treating intractible epilepsy, Ask Stanford Med: Neurologist taking questions on drug-resistant epilepsy and How epilepsy patients are teaching Stanford scientists more about the brain
Photo by José Manuel Ríos Valiente

NIH, Pregnancy, Research, Technology, Women's Health

Scientists create a placenta-on-a-chip to safely study process and pitfalls of pregnancy

Scientists create a placenta-on-a-chip to safely study process and pitfalls of pregnancy

2798127284_487b56b9cf_zThese days it seems that just about anything can be recreated on a microchip. But still, I did a double-take when I read about the new way that scientists are using technology to study pregnancy: They’ve created a “placenta-on-a-chip.”

A functioning placenta is critical for a healthy pregnancy because it regulates the flow of nutrients, oxygen and waste products between the mother and fetus. It also controls the fetus’ exposure to bacteria, viruses and other harmful substances. Researchers would like to learn more about how the placenta acts as a “crossing guard” and how it can regulate the body’s traffic so well. Yet, studying the placenta is hard to do because it’s highly variable, and tinkering with the placenta is risky for the fetus.

To overcome these challenges, an interdisciplinary team led by a University of Pennsylvania researcher created a two-chambered microchip that mimics the structure and function of the human placenta. The study was published online in the Journal of Maternal-Fetal and Neonatal Medicine and is reported on in this National Institutes of Health press release:

The device consists of a semi-permeable membrane between two tiny chambers, one filled with maternal cells derived from a delivered placenta and the other filled with fetal cells derived from an umbilical cord.

After designing the structure of the model, the researchers tested its function by evaluating the transfer of glucose (a substance made by the body when converting carbohydrates to energy) from the maternal compartment to the fetal compartment. The successful transfer of glucose in the device mirrored what occurs in the body.

As Roberto Romero, MD, chief of the perinatology research branch at the NIH’s National Institute of Child Health and Human Development, explains in the press release, this new technology could help researchers explore how the placenta works, and what happens when it fails, in ways that couldn’t be safely done before. This, the researchers say, could lead to more successful pregnancies.

Previously: NIH puts focus on the placenta, the “fascinating” and “least understood” organPlacenta: the video game, The placenta sacrifices itself to keep baby healthy in case of starvation, research showsThe placenta sacrifices itself to keep baby healthy in case of starvation, research shows and Program focuses on the treatment of placental disorders
Photo by Jack Fussell

Global Health, Nutrition, Pediatrics, Stanford News, Technology, Women's Health

Stanford initiative aims to simultaneously improve education and maternal-child health in South Africa

Stanford initiative aims to simultaneously improve education and maternal-child health in South Africa

Nomfusi_counselingWhat if we could “leapfrog” over the education and technology gap in low-resource countries, while at the same time improving maternal and early childhood health in those areas? That is precisely the promise of a new Stanford-sponsored initiative spearheaded by Maya Adam, MD, a lecturer in the human biology program here.

I recently had the chance to speak on the phone with Adam and hear more about this project, which consists of designing picture-based educational videos that are loaded on tablets and distributed among community-health workers. At present, the video on child nutrition is being used as a pilot in South Africa through the organization Philani, where twelve “mentor mothers” have been using the tablets since March. As you’ll read below, there is immense potential for the project to scale up in the near future.

What have the results of this initiative been so far?

The feedback that we’ve gotten was that a lot of the mothers being counseled said, “You know, you’ve been using phrases like ‘balanced diet’ for many years, and I didn’t quite know what that meant until I saw the plate with the green vegetables and the little bit of protein and the little bit of grains.” Certain phrases became clearer when they were drawn in pictures. Also, we found a lot of the children wanted to come watch because it was a screen-based activity.

The workers themselves found it useful to convince their patients, for example, of the importance of prenatal care, because when the patients heard it both from the video and from them, it was almost as if the video was validating their messaging. So they’re very eager to have the project continue. They have a whole list of other videos they want us to make, from breastfeeding to HIV/AIDS prevention… It’s really been a powerful way both to teach and give these highly intelligent women access to technology that could enhance their education and help them overcome the barriers in their lives.

How easy would it be to use these videos in different regions of the world? 

slider-9_compressedWe have videos translated into English, Xhosa, and now Spanish, because they’ll be used next in Guatemala… We can use English in the U.S. in under-resourced locations. These are all very universal messages, and that’s why it’s so exciting: For a relatively small amount of effort, we can make videos that can be both translated into many other languages, and subtly altered visually so they resemble women and children in each different part of the world. For example, while we were creating the video, we put the braids that African women traditionally wear in their hair on a different layer of the Photoshop, so that layer can be removed and the resulting woman will have straight dark hair that would be more appropriate for use, say, in Guatemala.

We thought a lot about how to represent food. A real plate of food from South Africa would be culturally inappropriate in Guatemala, but by using cartoon images of fruits and vegetables, it becomes much more universal… We tried to show a variety of different fruits and vegetables without specifically showing that “this is a guava,” because a guava might not grow in other parts of the world.

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Mental Health, Neuroscience, Research, Women's Health

When dementia hits home: The global impact of dementia on women

When dementia hits home: The global impact of dementia on women

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A report released last week by Alzheimer’s Disease International calls attention to the disproportionate effects of dementia on women worldwide.

As noted in the report, women are more at risk for dementia than men for two primary reasons: age and genetics. Women’s longer lifespans leave them more vulnerable to the age-related condition. In addition, there are biological factors that make women more likely to suffer from dementia.

Women are also more likely to be the caregivers to those with the disease. Women care not only for family members — they’re often also employed in low-paid caregiving professions. This is particularly true in lower income countries, where as many as 62 percent of people with dementia live, according to the report.

The burden of dementia strains family structures and community dynamics in these disadvantaged nations. In the report, Faraneh Farin, who is involved with the Iran Alzheimer Association, describes the situation in countries like Iran:

Nowadays, more women are working to support their families but should they need to care for a family member, then it is expected that they quit their jobs resulting in their marginalization. It seems that either way, whether a woman has dementia or she cares for a loved one, she is trapped in the cycle which has been constructed by the society. Dementia is an issue that engages a woman’s entire life.

The global costs of dementia amount to more than $600 billion, yet many sufferers, caregivers and programs lack adequate funds. The report calls for additional resources for female dementia victims and caregivers, and it highlights the need for additional research on dementia’s effects, especially in countries with lower incomes. These countries also need to develop national strategies that consider the needs of women, the report states.

Alzheimer’s Disease International aims to elevate the awareness of dementia’s impact on women globally and to spur national efforts to improve care. As Executive Director Mark Wortmann wrote in the Foreward: “I hope the report will find its way onto the desks of policy makers to help improve the quality of life for women living with dementia, as well as the millions of women all around the world who provide care and support for them.”

Alex Giacomini is an English literature major at UC Berkeley and a writing and social media intern in the medical school’s Office of Communication and Public Affairs.  

Previously: Study suggests yoga may help caregivers of dementia patients manage stressStanford neuroscientist discusses the coming dementia epidemic, and Science Friday explores women’s heightened risk for Alzheimer’s
Photo by Valerie Everett

Cancer, Medical Education, Stanford News, Surgery, Videos, Women's Health

Why become a doctor? A personal story from a Stanford oncologist

Why become a doctor? A personal story from a Stanford oncologist

Why become a doctor? It certainly isn’t easy, and it requires years of study and a sizable financial investment. If you ask physicians how, and why, they selected their careers, you’ll get a variety of stories that offer insight into the many benefits of pursuing medicine.

Pelin Cinar, MD, a GI oncologist here, tells her own story in this recent Stanford Health Care video.

As a child, Cinar was impressed with the respect her uncle, a gynecologist, received from family members. Then, in high school, her mother was diagnosed with cancer. Meanwhile, she began pursuing the courses that matched her interest in science. Her mother recovered but then relapsed when Cinar was in college and taking pre-med requirements.

During her medical education at the University of California-Irvine, Cinar discovered that all of her favorite rotations and subjects were based on oncology. “It took off from there,” she says in the video.

Previously: Students draw inspiration from Jimmy Kimmel Live! to up the cool factor of research, Stanford’s senior associate dean of medical education talks admissions, career paths and Thoughts on the arts and humanities in shaping a medical career

Health Disparities, Health Policy, In the News, Medicine and Society, Women's Health

Report: Health-care industry needs to focus on women

Report: Health-care industry needs to focus on women

16755600997_ca15a76fcf_zThe health-care industry needs to pay much more attention to women. That’s the argument laid out in a recent piece on MedCity News, which shared findings of a survey (.pdf) from the Center for Talent Innovation. That report shows that women make the majority of health-care decisions but are inadequately equipped to do so, and it calls on health-care companies, which are increasingly oriented towards consumers, to bridge that gap.

According to the survey, which included more than 9,200 respondents from the U.S., U.K., Germany, Japan, and Brazil, 94 percent of women make decisions for themselves and 59 percent make decisions for others; when working moms are considered separately, 94 percent make decisions for others. And yet, 58 percent of these decision makers lack confidence in their decision making.

The report says this is due to “three profound famines”: lack of time, lack of knowledge, and lack of trust. Seventy-seven percent of women don’t know what they need to do to stay healthy; 62 percent lack the time. Only 38 percent of working mothers passed a “health literacy quiz,” and the report showed that women are unlikely to trust online information (31 percent), their insurance companies (22 percent), or pharmaceutical companies (17 percent).

The report suggests that health-care companies need to understand women in the context of their family and career responsibilities, which is quite different from standard male-based “life stage analysis.” Moreover, they need to understand that women think about health more broadly than freedom from illness and health risks. Fully 79 percent said that health means “having spiritual and emotional wellbeing,” while 77 percent called it “being physically fit and well rested.”

An excellent place to start change is the management structure of health-care companies, the report suggests. Despite being the “CMOs” (Chief Medical Officers) for their families, women are underrepresented in other “C-level” roles in these companies:

We find that, while the health-care industry employs a large number of female professionals, their ideas, insights, and capabilities haven’t been fully supported, endorsed, and promoted. Without women in power, women’s ideas don’t get the audience they deserve, because… leaders only see value in ideas they personally relate to or see a need for.

MedCity news writer Nina Ruhe sums up another area for improvement. “Doctors, insurance companies and pharmaceutical companies can start instilling trust in women again by letting them know exactly what they should know in regards to their personal health and the health of their families,” she writes.

Events, Mental Health, Sexual Health, Stanford News, Women's Health

Women’s health experts tackle mood disorders and sexual assault

Women's health experts tackle mood disorders and sexual assault

3131235412_fa7f528735_zEarlier this week I reported from the Women’s Health Forum, held on Monday for the sixth year running. The hardest part about attending the event was deciding which among all the interesting talks to attend.

Among the many sessions, the two that most piqued my interest focused on women’s mental health. Katherine (Ellie) Williams, MD, spoke about mood disorders related to the menstrual cycle, and Laraine Zappert, PhD, discussed the psychological impact of sexual assault. Both are from the school’s Department of Psychiatry and Behavioral Sciences.

Williams’ talk began with a cartoon of a dishwasher bursting with dishes, clothes, a phone, a vacuum – above a caption quip about PMS. The out-of-control energy of the sketch conveys the affective thundercloud often associated with women and their “hormones.” Williams identified three periods when this thundercloud may be an actual mood disorder, as opposed to “normal” fluctuations: pre-menstrual, perinatal, and perimenopausal.

Technically speaking, “PMS” is about physical symptoms and is fairly common, whereas pre-menstrual dysphoric disorders (PMDDs) is all about mood and affects less than 5 percent of women. The disruption happens in the luteal phase of a woman’s cycle, usually the two weeks after ovulation – this is a big chunk of time we’re talking about, nearly 50 percent! Treatments for disorders in all periods include exercise, acupuncture, and diet supplements, and pharmaceuticals like certain birth control pills and antidepressants (which interestingly work differently for women with PMDD than for people in general – when taken only during that luteal phase, they have fast onset time and cause no withdrawal symptoms).

Researchers are learning more about how to predict and prevent cycle-related mood disorders, and increasingly it is clear that life context plays a major role. Stressful life events, interpersonal conflicts, marital tension, and previous mental-health instabilities (from being a perfectionist to having suffered childhood abuse or major depressive breakdowns) are the primary risk factors. This knowledge means clinical practitioners have to think much more broadly about how to help women, particularly in terms of prevention, Williams said.

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Global Health, LGBT, Public Health, Public Safety, Women's Health

Advocating for the rights of women and LGBT individuals in the developing world

Advocating for the rights of women and LGBT individuals in the developing world

Randy Barry - smallLast spring, I traveled to Washington, D.C. for my first experience as a citizen-activist, lobbying in Congress for the rights and well-being of women and LGBT individuals in the developing world. I recently returned there to see some of the impact of that work – crucial new appointees, new legislators in support of key issues and new words of encouragement from both sides of the political aisle.

I visited Washington as part of a 170-person delegation from the American Jewish World Service (AJWS), an international organization that promotes human rights and seeks to end poverty in developing countries. Our goal was to advance several initiatives, including passage of the International Violence Against Women Act, and changes to ensure that U.S. foreign contracts and foreign aid programs do not discriminate against LGBT individuals.

I was thrilled to hear a talk by Randy Berry, the State Department’s first-ever Special Envoy for the Human Rights of LGBT Persons, who assumed the new post in February. Just a year ago, AJWS had made the appointment of a special envoy one of its priority issues, and many of us, myself included, had met with our Congressional representatives to push for the position. I had been motivated by my experiences as an AJWS Global Justice Fellow in Uganda in 2014, when we met with LGBT activists who were living in a climate of terror because of the country’s impending anti-gay law. We heard stories of people who had been raped, beaten, harassed, evicted from homes and jobs and subjected to summary arrest.

I realized it was important to make LGBT rights a priority issue for U.S. foreign policy. Berry, the new U.S. envoy, said AJWS had been a “prime mover” in the creation of his new office – gratifying news indeed. He said he views LGBT rights as a “core human rights issue.”

“We are talking about equality, and it should go hand-in-hand with what we are doing in gender equality and in the disabled community,” he told us. “One of the most disturbing elements of discrimination is that it’s the first step to denying one’s humanity.”

He acknowledged that he has a daunting job ahead; while the U.S. is making swift progress on gay rights, these rights are just as swiftly being eroded in other parts of the world. Nearly 80 countries now criminalize same-sex behavior, with penalties that include death or life in prison. Yet the fact that the U.S. has made so much progress in recent decades suggests it’s possible to change the climate elsewhere as well, he said.

“Who would have dreamed 20 years ago that we would be where we are today in the United States,” he said. “I am sitting here today with the support of the State Department, the president and members on both sides of the aisle.”

We also saw progress on the International Violence Against Women Act, which would make ending violence against women worldwide a top U.S. diplomatic and development priority. Violence against women and girls is alarmingly pervasive, with as many as one in three being beaten, coerced into sex or subjected to other abuse in her lifetime.

The legislation was reintroduced in the House of Representatives in March with a record 18 co-sponsors, including many more Republicans than in the past. On the morning of our lobbying visits, we heard from seven Members of Congress, including Chris Gibson (R-NY), Richard Hanna (R-NY) and Lee Zeldin (R-NY), all of whom expressed strong support for the bill. David Cicilline (D-RI) described a trip to Liberia in which he met a group of young girls who had been subjected to “hideous, indescribable sexual violence.”

“It made me realize we need to do everything we can to change the lives of these young girls,” he told us.

I couldn’t agree more.

Previously: Stanford study shows many LGBT med students stay in the closetChanging the prevailing attitude about AIDS, gender and reproductive health in southern AfricaLobbying Congress on bill to stop violence against womenPreventing domestic violence and HIV in Uganda and Sex work in Uganda: Risky business
Photo of Randy Berry by Ruthann Richter

Events, Health and Fitness, Nutrition, Obesity, Stanford News, Women's Health

Women’s health expert: When it comes to prevention, diet and exercise are key

Women's health expert: When it comes to prevention, diet and exercise are key

16262076932_96f8309b43_zThis Monday was the sixth annual Stanford Women’s Health Forum, hosted by Stanford’s Women and Sex Differences in Medicine center (WSDM), and I was happy to have been present for the lively talks. The forum focused on prevention, and the keynote, delivered by Marcia Stefanick, PhD, professor of obstetrics and gynecology and WSDM director, highlighted physical activity and weight management as the key preventative actions for women to take.

High blood pressure remains the number one preventable cause of death in women, with physical inactivity and high BMI, both of which contribute to high blood pressure, in third and fourth place. (For the curious readers, smoking comes in second.) Because prevention requires changes in behavior, behavior was what Stefanick focused on. Rather than reinforcing many women’s feelings of embarrassment about their weight, she said, providers should help women feel that they can do something about it.

Healthier behaviors must include diet and exercise. Both fatness and low fitness cause higher mortality; realistic expectations about how to change both should factor into care. Stefanick emphasized that weight loss should be slow: 10 percent of one’s body weight baseline over six months, or one pound per week for moderately overweight people, and no more than two pounds per week. And we need to stop being so sedentary, Stefanick exclaimed. The classic principles of exercise apply – gradually increase the frequency, intensity, and/or duration of exertion. Adults should be getting at least two and a half hours of moderate-intensity aerobic physical activity per week, in addition to doing muscle-strengthening activities at least twice a week, the conference flyer read.

However, citing the problems of eating disorders and older women losing weight without trying, Stefanick stressed that “weight management is a spectrum; there are extremes at both ends.” In describing variations on mesomorphic, endomorphic, and ectomorphic body types, she stated that “we don’t know what the optimal body type is.” It probably varies for each person.

Something I found particularly interesting was Stefanick’s description of gynoid vs android fat distribution patterns (which I learned as “pear” and “apple” body shapes, respectively). Gynoid distribution around the hips, thighs, and butt is more common in women, and includes more subcutaneous fat, while in android distribution, which is more common in men, fat collects around the belly and chest and is actually dispersed among the organs. Such intra-abdominal fat is more damaging to health, as it affects the liver and lipid profile and can cause heart disease, but it’s also much easier to get rid of through exercise (which is one reason men overall have less trouble losing weight than women).

In the spirit of more personalized care, Stefanick also discussed how recommended weight changes during pregnancy should vary according to the person’s prenatal BMI. Someone underweight could gain up to 40 pounds and be healthy, she pointed out, while obese people might actually lose weight during pregnancy for optimal mother-baby health.

Previously: Why it’s critical to study the impact of gender differences on diseases and treatmentsWhen it comes to weight loss, maintaining a diet is more important than diet typeApple- or pear-shaped: Which is better for cancer prevention?A call to advance research on women’s health issues and To meet weight loss goals, start exercise and healthy eating programs at the same time
Photo by Mikaku

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