Mediterranean Diet May Reduce Risk of Stroke More Among Women Than Men

WHR Blog -

The Mediterranean Diet is known to have many health benefits, but a recent study published in the journal Stroke examined the impact that the diet has specifically on the risk of stroke, and whether the diet impacts the risk of stroke in men and women differently. The Mediterranean Diet emphasizes eating fish, fruits, vegetables, and nuts, and using olive oil as the main source of fat. It also includes moderate alcohol consumption, but only small quantities of meat and dairy. [1]

The study was conducted in the United Kingdom, among a population-based group of 23,232 individuals aged 40 to 77, of whom 54.5% were women. The individuals in the study were followed for 17 years, with stroke incidence calculated and stratified by sex and risk of cardiovascular disease. To determine adherence to the Mediterranean diet, participants completed a 7-day diet diary. [1]

The findings indicate that overall, the risk of stroke among all the study participants decreased significantly with greater adherence to the Mediterranean diet. Interestingly, when stratified by sex, the risk of stroke among women was reduced even more, and although there was a decrease of risk of stroke among the male population, it was not significant. [1] The overall risk of stroke incidence decreased 17% among both men and women, decreased 22% among just women, and decreased only 6% among men. [2] Researchers are unsure what causes the difference in risk reduction among men and women on the Mediterranean diet, and suggest further studies to understand more clearly associations between diet and risk of stroke.

References

[1] Paterson, K.E., Myint, P.K., Jennings, A., Bain, L.K.M, Lentjes, M.A.H., Khaw, K.T., & Welch, A.A. Mediterranean Diet Reduces Risk of Incident Stroke in a Population With Varying Cardiovascular Disease Risk Profiles. Stroke. 2018 Oct; 49(10): 2415–2420.

[2] Reinberg, S. Mediterranean Diet May Cut Stroke Risk for Women, But Not Men. U.S. News & World Report. 20 Sept. 2018. 

WHRI Welcomes Interns and Contributors for 2018-2019

WHR Blog -

The Women’s Health Research Institute at Northwestern University is committed to the promotion, advancement, and retention of women in science and medicine. To this end, we have a variety of programs that support women who are interested in or currently pursuing careers in these fields.

We are thrilled to introduce our team of interns and contributors for the 2018-2019 academic year. Please join us welcoming, Mary Cormier, Janki Patel, and Sarah Henning:

Mary Cormier is a junior at Northwestern University studying Neuroscience and Anthropology. Mary is interested in studying the social determinants of health and disease. She is passionate about health equity, and is involved a student organization which provides supplementary, peer-modeled health curriculum to high school partners throughout Chicago. She will be working with Dr. Niki Woitowich to develop strategies to provide access to clinical research opportunities to under-resourced communities via the Illinois Women’s Health Registry.

Janki Patel is a Master's student in the Health Communications program at Northwestern University. She has plans to begin medical school next year at Midwestern University, ultimately aspiring to focus on women's health. She is interested in community education, specifically related to women's health and the of social determinants of health on individuals and communities. She will be working with Institute leadership to create effective, and educational communication strategies related to women’s health research. 

Sarah Henning, MPH, returns as a contributing author for the WHRI blog. Sarah first began writing for the Institute blog as an undergraduate student at Northwestern University and then took a hiatus while she pursued a degree in Master of Public Health at the University of Illinois at Chicago. Sarah is passionate about promoting women’s health, particularly, reproductive and mental health, and raising awareness about health disparities. In her spare time, she volunteers at a number of organizations which focus on these issues.

Soccer Heading May Impact Women More than Men

WHR Blog -

A recent study in the journal Radiology reports that heading a soccer ball, which is a common action for both male and female athletes in the sport of soccer, may pose more of a health risk for women than for men. The study took place between 2013 and 2016, and was a subset of a larger study of both male and female amateur soccer players. The study included 94 athletes - 49 men and 49 women - matched for age and history of heading a soccer ball. Among the females in the study, there was a median of 469 soccer ball headings a year, compared to 487 among the male study participants. The investigators used diffusion-tensor imaging, which is a type of MRI-technology, to examine differences in the structure of white matter in the brain of the participants. [1] In an interview about the study, the lead author, Michael Lipton, describes white matter as a connector of neurons within the brain, and that alterations or abnormalities in white matter may be associated with decreased cognitive function, such as issues with memory. [2]

The results of the study indicate that the female participants who were exposed to the same amount of soccer ball heading as male participants experienced more alteration to the microstructure of their brain’s white matter than the males. This suggests that women may respond differently, or have greater sensitivity, to low-level, repetitive, trauma to the brain than men. [1]

This study highlights the importance of sex-inclusive research, and examining sex differences in a variety of disciplines. While Lipton makes it clear that this doesn’t mean women or men should stop playing soccer, it points to a need for additional research, which may help improve athlete health and the safety of sports.

References

[1] Rubin T.G., Catenaccio E., Fleysher R., Hunter L.E., Lubin N., Stewart W.F., Kim M., Lipton R.B., & Lipton M.L. MRI-defined White Matter Microstructural Alteration Associated with Soccer Heading Is More Extensive in Women than Men. Radiology. 2018 Jul 31:180217.

[2] Kiley Watson, S. Heading May Be Riskier For Female Soccer Players Than Males. NPR. 31 July, 2018.

The Importance of Gender-Responsive Trauma-Informed Care

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Trauma is a complex concept, but has been succinctly defined by the Substance Abuse and Mental Health Services Administration (SAMHSA) as resulting “from an event, series of events, or set of circumstances that is experienced by an individual as physically or emotionally harmful or life threatening” [1]. Trauma is pervasive, and while many individuals recover without negative effects, for some, even if experienced for just a short time, trauma can have long-lasting effects on mental, physical, and emotional health. For this reason, it is important to address trauma and provide support for individuals who have experienced traumatic events. Health practitioners, or any professional that works in a service sector, will encounter individuals that have experienced trauma - not just those that work in the behavioral health field [1]. This is why it is critical to understand what trauma-informed care is, and how to use it in practice.

According to SAMHSA, a trauma-informed approach to care involves:

  • Realizing that trauma has a widespread impact on individuals and that there are different possible paths to recovery

  • Recognizing symptoms of trauma in all individuals within a system

  • Incorporating what is known about trauma into policies and practices

  • Avoiding re-traumatization [1]

SAMHSA has also indicated that there are six key principles vital to using a trauma-informed approach in practice: safety; trustworthiness and transparency; peer support; collaboration and mutuality; empowerment, voice and choice; and cultural, historical, and gender issues. This last principle includes the provision of gender-responsive care, or interacting with individuals with the consideration of specific needs based on gender [1].

Ensuring that trauma-informed care is gender-responsive is important, because women and men typically experience different types of trauma, and react to trauma in different ways. For example, women are more likely to experience trauma at the hands of an intimate partner, while the risk of trauma for men is more often from a stranger. Naturally, the effects of these types of trauma often differ, as do the processes to recover from them [2].

A gender-responsive, trauma-informed approach to care should be used in all environments, but it is particularly important to use this approach when treating women in certain settings, such as mental health care and substance use treatment. This is because mental health issues and substance use disorders are often co-occurring among women. Additionally, while both men and women experience these issues, for women, there is a strong link between these disorders and trauma. Research suggests that between 55% to 99% of women that have co-occurring mental health and substance use issues experienced trauma in the form of abuse within their lives [3]. For these reasons, it is important that both mental health care and treatment for substance use be both trauma-informed and gender-responsive.

To learn more about trauma-informed care or access resources for implementing a trauma-informed approach, visit https://www.samhsa.gov/nctic/trauma-interventions.

 

References:

[1] Substance Abuse and Mental Health Services Administration. SAMHSA’s Concept of Trauma and Guidance for a Trauma-Informed Approach. HHS Publication No. (SMA) 14-4884. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2014.

[2] Covington, S. (2012). Curricula to support trauma-informed practice with women. In N. Poole, & L. Greaves (Eds). Moving the Addiction and Mental Health System Towards Being More Trauma-Informed. Toronto, Ontario, Canada: Centre for Addiction and Mental Health (CAMH).

[3] Covington S.S., Burke C., Keaton S., & Norcott C. Evaluation of a trauma-informed and gender-responsive intervention for women in drug treatment. J Psychoactive Drugs. 2008 Nov; Suppl 5:387-98.

Request for Proposals: 2019 Shaw Family Pioneer Awards

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The Women's Health Research Institute is now accepting applications for the 2019 Shaw Family Pioneer Awards. The Shaw Family Pioneer awards provide $12,000 in direct support for sex-inclusive research which focuses on the sex-based determinants of health and disease. To learn more about the Shaw Family Pioneer Awards, please click here

Previous awardess include Jelena Radulovic, MD, PhD from the Department of Psychiatry and Behavioral Sciences and Aline Martin, PhD from the Department of Medicine (Nephrology and Hypertension). 

Surgical Journals to Require Sex-Based Analyses and Reporting

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The Surgery Journals Editors Group announced that they will require sex-based analyses and reporting for all human, animal, tissue, and cell-based research published in their journals. Similar to the NIH sex-inclusion policy, the journals will also require justification for the use of a single sex. This requirement is a likely follow-up to research which identified a significant sex-bias in surgical research (See: Mansukhani et al., 2016 and Xiao et al., 2018 for further reading). 

The joint statement was published within multiple journals this summer, and was most recently featured in JAMA Surgery in August. The WHRI applauds the 74 journal consortium for their efforts to advance sex-inclusive research and encourages other publishers to follow suit. 

 

 

 

 

Female Physicians Provide Better Outcomes in Cardiac Care

WHR Blog -

Cardiovascular disease is the leading cause of death for both men and women in the United States. Yet, we know there are sex- and gender-specific influences that effect cardiovascular health outcomes. For example, women experiencing a heart attack are likely to present with varying symptoms and receive a delay in treatment compared to men, reducing their chances of survival.

A recent study published in the Proceedings of the National Academies of Science found that the treating physician's gender also effects patient survival [1]. The authors examined over 500,000 emergency room medical records between 1991 and 2010 and explored how patient and physician gender relate to health outcomes, such as mortality rates. They found that female patients treated by male physicians were less likely to survive, whereas patients of either gender had similar survival rates if the treating physician was female.

"Over 15 years ago, two studies published in the New England Journal of Medicine identified that women with chest pain were not getting the same treatment as men," says Dr. Marla Mendelson, Associate Professor of Medicine (Cardiology) and Medical Director for the Program for Women's Cardiovascular Health at Northwestern University.

"Here we are with a current study of ER physicians demonstrating a disparity in outcomes: There was higher mortality among female patients treated by male physicians, but similar outcomes for men and women when the physician is female. Despite public awareness and education of physicians, there seems to be an inherent bias in the perception of clinical disease in women," she says.

Mendelson suggests that continuing education for physicians is crucial, "[It] can be addressed beginning at the medical school level, during residency training, and throughout the continuing education of practicing physicians, of all disciplines, involved in the care of women.

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The Women's Health Research Institute promotes awareness of sex- and gender-related health issues and provides education for researchers, physicians, and community members. To learn more about sex and gender disparities in cardiovascular disease, consider reviewing the following resources:

For Physicians:

For Researchers:

For Community Members:

References: 
1. Greenwood et al., Proc Natl Acad Sci U S A. 2018 Aug 6. pii: 201800097. doi: 10.1073/pnas.1800097115. [Epub ahead of print]

NU to Launch AAUW Chapter

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Northwestern University is establishing a chapter of the American Association for University Women (AAUW) this fall. The AAUW empowers women through research, campus initiatives, STEM education, public policy, case support, educational funding, global connections, leadership development, and salary negotiation.

Launching an NU chapter within the AAUW will allow all students, faculty, and staff to share membership benefits including:

· Free AAUW membership for all undergraduates and degree-seeking graduates at Northwestern
· Priority for educational project grants and leadership development opportunities for students
· Advocacy for federal public policy that supports education
· Access to AAUW internships in Washington, D.C. for students
· Opportunities for faculty to participate in national selection panels for prestigious awards
· Access for staff and faculty to use AAUW programs to supplement teaching and programming 

The chapter is currently recruiting Northwestern students, staff, and faculty to join its leadership board which will assist in the continued launch, development, and implementation of chapter initiatives. If you would like to serve on the leadership board, you will be asked to complete and submit a brief proposal of interest outlining your goals, ideas, and availability to commit to chapter initiatives.

Please email megan.lenneman@northwestern.edu to learn more about current board positions available. All Northwestern students, staff, and faculty are welcome to apply.

Summer Reading: Reviews of Sex-Based Science and Medicine

WHR Blog -

Are you looking for summer reading suggestions? We’ve compiled a list of some of the most recent reviews related to sex- and gender-inclusive research and organized them by topic. Check out the list below! 

Audiology
Sex bias in basic and preclinical age-related hearing loss research.
Villavisanis et al., Biol Sex Differ. 2018 Jun 13;9(1):23. doi: 10.1186/s13293-018-0185-7.

Cardiology
Female sex as a biological variable: A review on younger patients with acute coronary syndrome.
Bugiardini et al., Trends Cardiovasc Med. 2018 Jun 12. pii: S1050-1738(18)30091-4. doi: 10.1016/j.tcm.2018.06.002. [Epub ahead of print]

Sex differences in cardiac electrophysiology
Ravens, U. Can J Physiol Pharmacol. 2018 Jul 12. doi: 10.1139/cjpp-2018-0179. [Epub ahead of print]

Sex Differences in Cardiovascular Pathophysiology: Why Women Are Overrepresented in Heart Failure With Preserved Ejection Fraction.
Beale et al., Circulation. 2018 Jul 10;138(2):198-205. doi: 10.1161/CIRCULATIONAHA.118.034271.

Endocrinology & Metabolism
Identifying the Critical Gaps in Research on Sex Differences in Metabolism Across the Life Span.
Reusch et al., Endocrinology. 2018 Jan 1;159(1):9-19. doi: 10.1210/en.2017-03019. Review.

Sex differences underlying pancreatic islet biology and its dysfunction.
Gannon et al., Mol Metab. 2018 Sep;15:82-91. doi: 10.1016/j.molmet.2018.05.017. Epub 2018 May 30.

Neurology & Neuroscience
Understanding the impact of sex and gender in Alzheimer's disease: A call to action
Nebel et al., Alzheimers Dement. 2018 Jun 12. pii: S1552-5260(18)30130-4. doi: 10.1016/j.jalz.2018.04.008. [Epub ahead of print]

Sex differences in Alzheimer disease - the gateway to precision medicine.
Girourard et al., Nat Rev Neurol. 2018 Jul 9. doi: 10.1038/s41582-018-0032-9. [Epub ahead of print] Review.

Sex differences in the evaluation and treatment of acute ischaemic stroke.
Bushnell, et al., Lancet Neurol. 2018 Jul;17(7):641-650. doi: 10.1016/S1474-4422(18)30201-1. Review.

Sex Differences in the Neuroimmune System.
Osborne et al., Curr Opin Behav Sci. 2018 Oct;23:118-123. doi: 10.1016/j.cobeha.2018.05.007

Psychiatry
The impact of sex as a biological variable in the search for novel antidepressants.
Williams & Trainor. Front Neuroendocrinol. 2018 May 31. pii: S0091-3022(18)30044-X. doi: 10.1016/j.yfrne.2018.05.003. [Epub ahead of print]

Sex Differences in Psychiatric Disease: A Focus on the Glutamate System.
Wickens et al, Front Mol Neurosci. 2018 Jun 5;11:197. doi: 10.3389/fnmol.2018.00197. eCollection 2018. Review.