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Patient Care, Pediatrics, Pregnancy, Stanford News, Women's Health

A prenatal partnership that benefits patients, medical students

A prenatal partnership that benefits patients, medical students

prenatal partnership

Over on the Lucile Packard Children’s Hospital Stanford blog, writer Julie Greicius highlights an elective program at Stanford’s medical school that fosters personal connections between prenatal patients and Stanford medical students. The course is designed to offer doctors-in-training the opportunity, early on, to be on the other side of patient care. Emily Ballenger, who’s expecting twins later this month, and medical student Sunny Kummar have partnered up through the program, with Sunny offering extra support by attending prenatal appointments, the babies’ birth, and the first few pediatric appointments.

Relationship building is fundamental to patient-centered care, and with this program the doctor-to-be has the opportunity to identify with the patient experience in his or her supportive role. Without the pressures of being in the medical provider role, the student has the opportunity to practice listening, empathy and compassion.

The value of programs such as this is that they shift the paradigm of the traditional-doctor patient relationship. The scale is tipped from being purely clinical to one focused more on listening and learning from each other. The patient, the doctor-in-training, and their future patients all stand to benefit.

Ballenger’s obstetrician is Susan Crowe, MD, who has long supported the program. “I encourage my patients to participate because it’s a win for future care of obstetric and pediatric patients,” she says in the piece. “I really believe that the patient-centered care we strive for can be better achieved if we train our physicians to really learn from and listen to our patients themselves. One of the biggest strengths of the program is that the patient perspective comes first. It sets the groundwork for that way of thinking in terms of training our medical students.”

Medical schools around the country offer similar programs, recognizing that it’s the human connection that initially draws young doctors to medicine, and Stanford has offered this program since at least 1991. The course directors are Yasser El Sayed, MD, obstetrician-in-chief at Stanford Children’s Health, and Janelle Aby, MD, clinical associate professor of pediatrics.

Jen Baxter is a freelance writer and photographer. After spending eight years working for Kaiser Permanente Health plan she took a self-imposed sabbatical to travel around South East Asia and become a blogger. She enjoys writing about nutrition, meditation, and mental health, and finding personal stories that inspire people to take responsibility for their own well-being. Her website and blog can be found at www.jenbaxter.com.

Previously: Countdown to clinics: The 5 best things about jumping into third year
Photo courtesy of Lucile Packard Children’s Hospital

Aging, Genetics, Imaging, Immunology, Mental Health, Neuroscience, Research, Women's Health

Stanford’s brightest lights reveal new insights into early underpinnings of Alzheimer’s

Stanford's brightest lights reveal new insights into early underpinnings of Alzheimer's

manAlzheimer’s disease, whose course ends inexorably in the destruction of memory and reason, is in many respects America’s most debilitating disease.  As I wrote in my article, “Rethinking Alzheimer’s,” just published in our flagship magazine Stanford Medicine:

Barring substantial progress in curing or preventing it, Alzheimer’s will affect 16 million U.S. residents by 2050, according to the Alzheimer’s Association. The group also reports that the disease is now the nation’s most expensive, costing over $200 billion a year. Recent analyses suggest it may be as great a killer as cancer or heart disease.

Alarming as this may be, it isn’t the only news about Alzheimer’s. Some of the news is good.

Serendipity and solid science are prying open the door to a new outlook on what is arguably the primary scourge of old age in the developed world. Researchers have been taking a new tack – actually, more like six or seven new tacks – resulting in surprising discoveries and potentially leading to novel diagnostic and therapeutic approaches.

As my article noted, several Stanford investigators have taken significant steps toward unraveling the tangle of molecular and biochemical threads that underpin Alzheimer’s disease. The challenge: weaving those diverse strands into the coherent fabric we call understanding.

In a sidebar, “Sex and the Single Gene,” I described some new work showing differential effects of a well-known Alzheimer’s-predisposing gene on men versus women – and findings about the possibly divergent impacts of different estrogen-replacement  formulations on the likelihood of contracting dementia.

Coming at it from so many angles, and at such high power, is bound to score a direct hit on this menace eventually. Until then, the word is to stay active, sleep enough and see a lot of your friends.

Previously: The reefer connection: Brain’s “internal marijuana” signaling implicated in very earliest stages of Alzheimer’s pathology, The rechargeable brain: Blood plasma from young mice improves old mice’s memory and learning, Protein known for initiating immune response may set up our brains for neurodegenerative disease, Estradiol – but not Premain – prevents neurodegeneration in woman at heightened dementia risk and Having a copy of ApoE4 gene variant doubles Alzheimer’s risk for women, but not for men
Illustration by Gérard DuBois

Health Disparities, Men's Health, Public Health, Research, Stanford News, Women's Health

Why it’s critical to study the impact of gender differences on diseases and treatments

man_womanWhen it comes to diagnosing disease and choosing a course of treatment, gender is a significant factor. In a Stanford BeWell Q&A, Marcia Stefanick, PhD, a professor of medicine at the Stanford Prevention Research Center and co-director of the Stanford Women & Sex Differences in Medicine Center, discusses why gender medicine research benefits both sexes and why physicians need to do a better job of taking sex difference into consideration when make medical decisions.

Below Stefanick explains why a lack of understanding about the different clinical manifestations of prevalent diseases in women and men can lead to health disparities:

…Because we may have primarily studied a particular disease in only one of the sexes, usually males (and most basic research is done in male rodents), the resulting treatments are most often based on that one sex’s physiology. Such treatments in the other sex might not be appropriate. One example is sleep medication. Ambien is the prescription medicine recently featured on the TV show, 60 Minutes. Reporters found out that women were getting twice the dose they should because they had been given the men’s doses; consequently, the women were falling asleep at the wheel and having accidents. Physicians had not taken into account that women are smaller and their livers’ metabolize drugs differently than do men’s. Some women have responded by reducing their own medication dosages, and yet that practice of self-adjusting is not the safest way to proceed, either.

Previously: A call to advance research on women’s health issues, Exploring sex differences in the brain and Women underrepresented in heart studies
Photo by Mary Anne Enriquez

Parenting, Sleep, Women's Health

What other cultures can teach us about managing postpartum sleep deprivation

What other cultures can teach us about managing postpartum sleep deprivation

New_mom_072114Prior to becoming a mom, I felt fully confident that caring for a newborn would be less demanding than, or at least equal to, the physically grueling trainings from my college soccer days or my sleepless year of graduate school. But I soon learned that both of these experiences paled in comparison to the exhaustion I encountered after the arrival of my 8-pound-plus bundle of joy. So I was interested to read a recent Huffington Post blog entry from the Stanford Center for Sleep Sciences and Medicine examining how mothers in other countries cope with postpartum sleep deprivation.

In the entry, Mara Cvejic, MD, a neurologist at the University of Florida and former sleep medicine fellow at Stanford, notes that although sleep deprivation can profoundly affect cognitive function and mood, the brain of a postpartum mom is actually growing. She writes:

… despite all the formidable evidence of sleep deprivation in the everyday person, the scientific evidence of what happens to the postpartum brain is positively astounding — it thrives. A study published by the National Institutes of Health in 2010 actually shows that a mother’s brain grows from just 2-4 weeks to 3-4 months post delivery without any significant learning activities. The gray matter of the parietal lobe, pre-frontal cortex, hypothalamus, substantia nigra, and amygdala all form new connections and enlarge to a small degree. The imaging study confirms what animal studies have shown in the past — that these brain regions responsible for complex emotional judgment and decision-making actually bulk up with use. Rationale to the study shows that mothers who have positive interactions with their offspring — soothing, nurturing, feeding, and caring for them — are performing a mental exercise of sorts. Their learned coping skills in the face of novel child-rearing actually muscularize their brain.

She goes on to outline how new moms from Bulgaria to Sweden, and everywhere in between, turn to “hammocks, spa treatments, hired help, warm foods, arctic cradles, and cardboard” to cope with a lack of sleep. Personally, I’m in favor of Americans adopting this Malaysian tradition:

Food and warmth are also a focus of the Malaysian confinement of pantang. Steeped in the belief that the women’s life force is her fertile womb, she undergoes a 44-day period of internment to focus on relaxation, hot stone massage, lulur (full body exfoliation), herbal baths, and hot compresses. Typically a bidan, what can only be described as a live-in midwife and nanny combined, is hired to attend on the new mother. This is sometimes a family member, such as her mother or mother-in-law.

Previously: The high price of interrupted sleep on your health, What are the consequences of sleep deprivation? and Study: Parents may not be as sleep-deprived as they think
Photo by sean dreilinger

Parenting, Pregnancy, Technology, Women's Health

First-time moms often seek information online prior to first prenatal visit

First-time moms often seek information online prior to first prenatal visit

pregnant_laptopWhen I was eight weeks pregnant with my first child, I walked into my obstetrician’s office for my initial prenatal visit. I vividly remember being exhausted and sucking on watermelon lollipops for the entire two-hour appointment in an effort to relieve my morning sickness. While in the office, a nurse handed me a thick folder stuffed with various pamphlets and fact sheets on everything from nutrition to genetic testing – but much of the information reviewed wasn’t new to me. I’d already logged plenty of hours online reading about such topics.

So I was interested to read today about findings of a Penn State study showing that many other first-time moms also turn to “Dr. Google,” as well as social media, to find answers during the early weeks of their pregnancy. Women also continued turning to the Internet for information after their doctor visit and found traditional literature lacking. From a release on the study, which appears in the Journal of Medical Internet Research:

Following the women’s first visit to the obstetrician, many of them still turned to the internet—using both search engines and social media—to find answers to their questions, because they felt the literature the doctor’s office gave them was insufficient.

Many of the participants found the pamphlets and flyers that their doctors gave them, as well as the once-popular book What to Expect When You’re Expecting, outdated and preferred receiving information in different formats.

They would rather watch videos and use social media and pregnancy-tracking apps and websites.

“This research is important because we don’t have a very good handle on what tools pregnant women are using and how they engage with technology,” says [Jennifer Kraschnewski, MD]. “We have found that there is a real disconnect between what we’re providing in the office and what the patient wants.”

Noting the prevalence of misinformation online, Kraschnewski added, “We need to find sound resources on the Internet or develop our own sources” [to refer patients to].

Previously: Text message reminders shown effective in boosting flu shot rates among pregnant women and Examining the effectiveness of text4baby service
Photo by Adam Selwood

Pain, Pregnancy, Stanford News, Women's Health

Study shows women prefer less-intense pain at the cost of a prolonged labor

Study shows women prefer less-intense pain at the cost of a prolonged labor

child_birthAs a friend’s due date approached, she confided in me that the thought of going into labor was terrifying. It was her first pregnancy and we debated at length the pros and cons of having an epidural for pain management. Her main concern, like others, was that the common method of pain relief could prolong labor. Recent findings have shown that an epidural can lengthen the second-stage of labor for more than two hours.

In the end, she decided her birth plan needed to be flexible and include the option of an epidural, regardless of how it may impact the length of her labor. New research shows many would agree. Brendan Carvalho, MBBCh, chief of obstetric anesthesia at Stanford and lead author of the study, told Reuters that “Interestingly, intensity is the driver” behind women’s labor preferences.

More from the article:

For the study, Carvalho and his colleagues gave a seven-item questionnaire to expectant mothers who had arrived at the hospital to have labor induced but were not yet having painful contractions. The women took the survey a second time within 24 hours of giving birth.

The questionnaire pitted hypothetical pain level, on a scale of zero to 10, against hours of labor.

A sample question asked, “Would you rather have pain intensity at two out of 10 for nine hours or six out of 10 for three hours?”

Both pre- and post-labor, women on average preferred less intense pain over a longer duration, according to results published in the British Journal of Anaesthesia.

Previously: From womb to world: Stanford Medicine Magazine explores new work on having a baby
Photo by Mamma Loves

Global Health, Health Disparities, Pregnancy, Research, Women's Health

In poorest countries, increase in midwives could save lives of mothers and their babies

In poorest countries, increase in midwives could save lives of mothers and their babies

midwifeThe World Health Organization reports that most maternal deaths are preventable; yet, preterm birth complications rank among the top 10 causes of death in low- and lower-middle-income countries. Two recent studies from the Johns Hopkins Bloomberg School of Public Health have explored the role skilled midwives may play in saving the lives of women and their babies in poor counties.

In one study, published in The Lancet, researchers found that deploying a small number of midwives – 10 percent more every five years through 2025 – in the world’s 26 poorest countries could stave off a quarter of the maternal, fetal and infant deaths there.

From a release:

The estimates were done using the Lives Saved Tool (LiST), a computer-based tool developed by Johns Hopkins Bloomberg School of Public Health researchers that allows users to set up and run multiple scenarios to look at the estimated impact of different maternal, child and neonatal interventions for countries, states or districts. For this analysis, the tool compared the effectiveness of several different alternatives including increasing the number of midwives by varying degrees, increasing the number of obstetricians, and a combination of the two.

In the other study, published in PLOS One, researchers used the LiST tool in the world’s 58 poorest countries, where they found that 7 million maternal, fetal and newborn deaths will occur between 2012 and 2015. The release continues:

If a country’s midwife access were to increase to cover 60 percent of the population by 2015, 34 percent of deaths could be prevented, saving the lives of nearly 2.3 million mothers and babies.

The researchers say boosting coverage of midwives who provide family planning as well as pregnancy care to 60 percent of women would cost roughly $2,200 per death averted as compared to $4,400 for a similar increase in obstetricians. Midwives are cheaper to train and can handle interventions needed during uncomplicated deliveries, while obstetricians are needed when surgical interventions such as cesarean sections are necessary, [lead author Linda Bartlett, MD] says. Midwives can administer antibiotics for infections and medications to stimulate or strengthen labor, remove the placenta from a patient having a hemorrhage as well as handle many other complications that may occur in the mother or her baby.

Previously: Indonesia’s cash transfer programs are valuable, Stanford health fellow findsStudy cautions babies born at home may be at increased risk for health problemsSimple program shown to reduce infant mortality in African country and Should midwives take on risky deliveries?
Photo by Vinoth Chandar

Global Health, In the News, Pediatrics, Public Safety, Sexual Health, Women's Health

Stanford research shows rape prevention program helps Kenyan girls “find the power to say no”

Stanford research shows rape prevention program helps Kenyan girls "find the power to say no"

The San Francisco Chronicle has a great story today about a collaborative project that is reducing rape and sexual assault of impoverished girls in Kenya.

The story highlights the combined efforts of activists Jake Sinclair, MD, and his wife, Lee Paiva Sinclair, who founded nonprofit No Means No Worldwide to provide empowerment training to Kenayn girls, and the Stanford team that has been analyzing the results of their efforts. As we’ve described before, this work is a great example of the academic chops of Stanford experts’ being combined with on-the-ground activism to make a difference for an urgent real-world problem.

As the article explains:

The girls and hundreds of others like them have participated in a rape-prevention workshop created by Jake Sinclair and Lee Paiva, a San Francisco doctor and his artist wife who have been working in Kenya for 14 years.

Their program is working, and that’s not just according to the dozen or so testimonials online, the couple said. Two studies out of Stanford – one published in April this year, one the year before – have found that girls who have gone through the couples’ classes experience fewer sexual assaults after the workshops.

More telling, perhaps: More than half of the girls report using some tool they learned from the classes to protect themselves, from kicking a man in the groin to yelling at someone to stop.

“It’s great to see the girls just find their voice, to find the power to say ‘no,’ ” Sinclair said. “It’s so enlightening. You can see it in their eyes, that something’s changed.”

Stanford research scholar Clea Sarnquist, DrPH, who has played an important role in the project, adds:

“A lot of these girls are using voice and verbal skills first,” Sarnquist said. “That’s one of the key things, is teaching the girls that they have the right to protect themselves – that they have domain over their own bodies, and they have the right to speak up for their own self interest.”

The whole story is definitely worth a read.

Previously: Empowerment training prevents rape of Kenyan girls and Self-defense training reduces rapes in Kenya

Fertility, Research, Women's Health

PCOS linked with higher risk of type 2 diabetes even in young women who are not overweight, study finds

PCOS linked with higher risk of type 2 diabetes even in young women who are not overweight, study finds

Women with polycystic ovarian syndrome, which is present in 5 to 10 percent of women of childbearing age and is associated with reproductive and metabolic dysfunction, may be at higher risk for type 2 diabetes. Previous research has shown this correlation in women who are also overweight; now, an Australian study has shown that even young women with PCOS who are not overweight may be at a significantly higher risk for developing diabetes.

From a release:

Over 6000 women aged between 25-28 years were monitored for nine years, including 500 with diagnosed PCOS. The incidence and prevalence of type 2 diabetes was three to five times higher in women with PCOS. Crucially, obesity, a key trigger for type 2 diabetes, was not an important trigger in women with PCOS.

The women studied were aged 25-28 in 2003 and were followed over 9 years until age 34 to 37 years in 2012.

Findings from the large-scale epidemiological study were presented at the recent joint meeting of the International Society of Endocrinology and the Endocrine Society in Chicago.

“Our research found that there is a clear link between PCOS and diabetes,” study author Helena Teede, PhD, said in the release. “However, PCOS is not a well-recognised diabetes risk factor and many young women with the condition don’t get regular diabetes screening even pre pregnancy, despite recommendations from the Australian PCOS evidence based guidelines.”

Previously: Study shows bigger breakfast may help women with PCOS manage symptoms and NIH study suggests progestin in infertility treatment for women with PCOS may be counterproductive

Big data, Obesity, Pregnancy, Public Health, Women's Health

Maternal obesity linked to earliest premature births, says Stanford study

Maternal obesity linked to earliest premature births, says Stanford study

preemiefeetExpectant mothers who are obese before they become pregnant are at increased risk of delivering a very premature baby, according to a new study of nearly 1,000,000 California births.

The study, which appears in the July issue of Paediatric and Perinatal Epidemiology, is part of a major research effort by the March of Dimes Prematurity Research Center at Stanford University School of Medicine to understand why 450,000 U.S. babies are being born too early each year. Figuring out what causes preterm birth is the first step in understanding how to prevent it, but in many cases, physicians have no idea why a pregnant woman went into labor early.

The new study focused on preterm deliveries of unknown cause, starting from a database of nearly every California birth between January 2007 and December 2009 to examine singleton pregnancies where the mother did not have any illnesses known to be associated with prematurity.

The researchers found a link between mom’s obesity and the earliest premature births, those that happen before 28 weeks, or about six months, of pregnancy. The obesity-prematurity connection was  stronger for first-time moms than for women having their second or later child. Maternal obesity was not linked with preterm deliveries that happen between 28 and 37 weeks of the 40-week gestation period.

From our press release about the research:

“Until now, people have been thinking about preterm birth as one condition, simply by defining it as any birth that happens at least three weeks early,” said Gary Shaw, DrPH, professor of pediatrics and the lead author of the new research. “But it’s not as simple as that. Preterm birth is not one construct; gestational age matters.”

The researchers plan to investigate which aspects of obesity might trigger very early labor. For example, Shaw said, the inflammatory state seen in the body in obesity might be a factor, though more work is needed to confirm this.

Previously: How Stanford researchers are working to understand the complexities of preterm birth, A look at the world’s smallest preterm babies and New research center aims to understand premature birth
Photo by Evelyn

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