California Leading the Way in Preventing Maternal Deaths

In the last two decades, the US has seen a rise in the number of women dying from childbirth, an opposing trend from the majority of other countries in the developed and developing world who have seen their numbers decline.

While the US has not released an official rate since 2007, a recent study reports that the number of maternal deaths, defined as occurring during pregnancy or within 42 days of birth, has increased from 19 per 100,000 live births in 2000 to 24 per 100,000 in 2014, an increase of over 25%. Furthermore, the CDC estimates that a majority of these deaths are preventable.

As a response to this trend, concerned medical professionals in California formed the California Maternal Quality Care Collaborative (CMQCC) in hopes of preventing maternal deaths. The CMQCC first gathered data to determine the most common causes of maternal death, which informed the development of training programs and guidelines attempting to address those causes.

One of the leading causes of maternal death found in the CMQCC's research was hemorrhage, which led them to develop a program to help doctors decrease the number of medically unnecessary C-sections they perform. C-sections can sometimes lead to hemorrhage, especially in mothers who have undergone the procedure before. Aspects of this program include step-by-step guidelines on how to prepare for and directly treat hemorrhage as well as how to effectively measure blood-loss.

CMQCC programs, like the one addressing hemorrhage, have been implemented across the state, garnering impressive results. As a result of these efforts, the maternal death rate in California was cut in half between 2006 and 2013, falling to 7.3 deaths per 100,000 live births, a third of the nation-wide rate reported the next year. These results are even evident in underserved areas of the state that see the women most vulnerable to maternal death.

To read more about the maternal death rate in California and the US, explore the references below:

About the author: 
Madison Lyleroehr earned her M.A. degree in Social Sciences from the University of Chicago, where she focused on Sociology and qualitative research methods. She is currently a Research Study Coordinator in the Feinberg School of Medicine's department of Medical Social Sciences where she oversees studies focused primarily on patient-reported outcomes. Her passion for women's health has driven her various volunteer and advocacy efforts, addressing issues in reproductive health, sexual health and education, and sexual violence prevention.

Women Are Taking Strides Towards Healthy Living

A recent study published by the Centers for Disease Control found that women are more likely to use walking as a form of leisure, exercise, or transportation, compared to men [1]. The study analyzed survey data from 75,000 individuals across the United States between the years 2005 and 2015. They found that while the number of both male and female walkers significantly increased between 2005 and 2015, women were outpacing men by several percentage points.

Walking is an excellent way to stay in shape, as it is one of the safest, convenient, and affordable forms of physical activity. The study authors suggest that walking should be encouraged, especially amongst women, since only 47% of women in the U.S. meet the recommended guidelines for physical activity [2].

With the surge of new health technologies such as wearable fitness trackers or mobile phones with built-in health apps, it is incredibly easy to track physical activity. Some reports suggest that aiming for 10,000 steps a day is ideal, although that may change based on your age and health status [3-4]. So, get walking! 

For more tips on how to incorporate walking into your daily routine, visit the following resources:

References:
1. Ussery et al., MMWR. 2017; 66(25);657–662.
2. Center for Disease Control 
3. Tudor-Locke & Bassett. Sports Med. 2004;34(1):1-8.
4. Schneider et al., Am J Health Promot. 2006;21(2):85-9.

Mind the Gender Gap in Academic Medicine

Women account for almost half of all medical school graduates in the United States, yet they lag behind men in the higher ranks of academic medicine and in leadership roles, according to the Association of American Medical Colleges. This disparity increases even more so for women of color who represent 11% of full-time faculty and 3% of department chairs [1].

Stanford University recently published an article in their Spring issue of Stanford Medicine entitled, "Pursuing Parity," which highlights the barriers female faculty members have faced throughout their careers such as gender bias in recruitment and promotion practices and managing the stresses of work-life balance [2]. The article on female faculty was just one part in a larger series focused on the issue of sex, gender, and medicine.

Meanwhile, Northwestern University faculty have also been vocal in bringing attention to gender disparities in academic medicine. Last year, NU faculty members Drs. Angira Patel and Sarah Bauer penned an article which encourages female physicians to stand by their career and family choices and advocates for an open dialogue about the inequities that exist for women in medicine [3]. Both articles stress the importance of policies which support transparency, limit unconscious or implicit bias, and foster an inclusive culture and climate.

For further reading you may be interested in the following:

  • Quota of Four – A historical perspective surrounding the first female graduates of Northwestern's medical school, penned by NU alum and science writer, Megan Thielking. 
  • Letter to a Young Female Physician – An perspective piece in the New England Journal of Medicine, written by Dr. Suzanne Koven, an assistant professor of medicine at Harvard Medical School. 

The Women's Health Research Institute promotes the inclusion and advancement of women in science and medicine. The Institute has established several programs to promote the next generation of women in the basic and health sciences and to address the "leaky pipeline" in academia. More information on these programs can be found below:

References:
1. Association of American Medical Colleges, Analysis In Brief. 2016; 16(4).
2. Zonana, K. Pursuing Parity, Stanford Medicine. 2017; 34(2). 26-31, 44-45.
3. Patel and Bauer. Pulled by different forces, women in medicine need to stand by their career and family choices, Stat News. 2016.

Global Obesity Rates Higher in Women

Over the last several decades, there has been a dramatic increase in the number of overweight and obese individuals both in the United States and abroad. The obesity epidemic has affected all segments of the population, adults and children alike, causing major public health concern. A new study published in the New England Journal of Medicine, examined the prevalence of obesity in 176 countries and found that obesity rates were higher among adult women across the globe, regardless of educational or socioeconomic status [1]. This indicates that women are disproportionally affected in the obesity epidemic on a global scale and could suggest that women are more likely to suffer poor-health outcomes compared to men.

The authors estimate that in 2015 alone, 4 million people across the globe died from obesity-related causes such as cardiovascular disease, stroke, and diabetes. Interestingly, they did not report a sex difference in death or disability rates from obesity-related causes. Even-so, their results indicate a need for better education, programing, and research related to the prevention of obesity, with an emphasis on the influence of sex and gender.

To read more from the WHRI on the topic of obesity: 

 

Reference:
1. GBD 2015 Obesity Collaborators et al. N Engl J Med. 2017; 377(1):13-27.

Generating STEAM for Reproductive Science

On Saturday, June 24th the Women’s Health Research Institute hosted its annual Women’s’ Health Science Program (WHSP) for Chicago Public High School students. This year’s theme, “Reproductive Science Saturday,” introduced students to the fields of reproductive science and medicine through interactive lectures and hands-on laboratory experiences led by Northwestern University students, faculty, and staff.

Previous WHSP programs have emphasized the interconnectedness between the STEM disciplines – science, technology, engineering, mathematics, and medicine. New in 2017, the WHSP program added an art component to its traditional STEM focus. “Over the last several years there has been a strong movement to incorporate the arts into STEM education, also known as STEAM. We know that STEM and the arts are often influenced by one another, but that connection runs deeper as the arts can be used as a tool to teach or communicate science,” says Dr. Nicole Woitowich, the WHRI Director of Science Outreach and Education.

WHSP students participated in a STEAM project created by Master’s of Science in Reproductive Science and Medicine student, Megan Runge. Students learned about the hormonal and cellular changes that take place throughout the menstrual cycle and were asked to depict them using canvas, glue, paper, and gemstones. Students created colorful flowers which also serve as a “menstrual cycle clock,” that allows them to keep track of their cycle and reminds them of the physiological changes that take place within the ovary.

“This type of activity engages students in the reproductive sciences, in a way that isn’t traditionally utilized,” Woitowich states. Thrilled with the success of the project, she hopes that the arts continue to remain a part of the WHSP program, “As with any STEM field, we rely on our creativity to generate ideas or solve problems, so it’s important to foster those skills together and early-on.”

For more details on how to create your own menstrual cycle clock or how to incorporate this activity into a classroom, please contact the WHRI at womenshealthresearch@northwestern.edu.

Women Face Poorer Outcomes After Burn Injury

Accidental burns are one of the most common household injuries, often arising from exposure to hot surfaces or liquids. Yet, burns can also be caused by exposure to certain chemicals, electricity, sunlight, or fire. While the majority of accidental burns are minor, and can be treated at home – some burns require immediate medical treatment.

Types of Burns
Burns vary in severity depending on how many layers of skin are damaged. For example: 

  • First degree burns affect only the top layer of skin, known as the epidermis.
  • Second degree burns extend partially into the dermis.
  • Third degree burns damage the entire dermal layer.
  • Fourth degree burns extend beyond the skin into the fat, muscle, and bone.

In addition, the amount of skin, or total surface area, damaged by a burn can also impact its severity.

Sex Differences in Burn Prevalence and Treatment Outcomes
According to the American Burn Association, burn injuries are more common in men than women (68% vs. 32%, respectively). However, a recent study published in the journal Burns & Trauma, found that women are less likely to survive from a serve burn injury compared to men [1]. The authors examined the medical records of over 300 patients admitted to a hospital burn unit with similar burn severity and total amount of skin affected. They found that women were two times more likely to die from a burn injury, compared to men of the same age. Systemic infections, such as sepsis, are a leading cause of death following a severe burn injury. The authors suggest that sex differences in immune response following a severe burn could differ between men and women, but caution that additional research is needed to support their clinical observations.  

For more information on burn injuries consider visiting the following resources:
National Library of Medicine
American Burn Association
Centers for Disease Control – Burn Prevention

Reference:
Karimi et al., Burns Trauma. 2017;5:18. doi: 10.1186/s41038-017-0083-y. eCollection 2017.

Women More Likely to Face Readmission after Heart Attack

Over 2.7 million women in the United States have suffered from a heart attack [1]. Yet, compared to men, heart attacks remain underdiagnosed, understudied, and undertreated in women [2]. A recent study published in the International Journal of Cardiology examined the medical records of 667 patients who were diagnosed with a heart attack [3]. The authors found that women were 1.5 times more likely to be readmitted to the hospital within the first 30 days of a heart attack. Interestingly, women were also more likely to be readmitted for a secondary heart attack or subsequent heart failure compared to men. These findings are consistent with larger population studies [4,5] and in younger patient groups [6].

The authors suggest that several factors may influence the higher rate of readmission.  First, women in this study were older and more likely to have co-morbidities such as chronic kidney disease or diabetes, which may inherently increase the risk of future heart failure. In addition, sociological factors such as quality of life might contribute to readmission. Women are more likely to suffer from depression following a heart attack and, in turn, depression has been linked to an increased risk of cardiovascular disease. However, the authors note that compared to other reports which suggest women may not receive timely or guideline-specific treatment for heart attacks [2,7], their study did not identify any differences in medical treatment between men and women. Together, this may indicate that women may need additional health management and monitoring to prevent readmission following a heart attack. 

For more information on women and heart disease, consider the following resources:
Northwestern Medicine Program for Women’s Cardiovascular Health
American Heart Association: Go Red for Women

References: 
1. Mozaffarian et al., Circulation. 2015; 131(4):e29-e322.   
2. Mehta et al., Circulation. 2016;133:916-947.
3. Lundbäck et al., Int J Cardiol. 2017; E-pub ahead of print.
4. Chaudhry et al., J Am Heart Assoc. 2014; 3(5): e001197.
5. Dreyer et al., Circulation. 2017 Feb 7;135(6):521-531.
6. Dreyer et al., Circulation. 2015 Jul 21;132(3):158-66.
7. Choi et al., Am J Emerg Med. 2016;34(10):1939-1943.

The WHRI Celebrates National Women’s Health Week

The Women’s Health Research Institute joins the U.S. Department of Health and Human Services in celebrating National Women’s Health Week from May 14th through May 20th! The WHRI encourages you to make your health and well-being a top priority. This week we will feature additional information and resources on our blog and social media related to this year’s theme: Your Health at Every Age. Stay connected with us by following us on Twitter (@WomensHealthNU) or on Facebook.

Additional National Women’s Health Week resources can be found through the:
U.S. Department of Health and Human Services, Office of Women’s Health
Illinois Department of Public Health

Sex Not Reported in Most Genetic Studies

One might wonder how biological sex may be over looked in human genetic studies, given that the genome itself contains a glaring sex-difference: the presence or absence of the Y chromosome. However, a recent commentary published in the journal, Biology of Sex Differences, highlights the fact that human genetic studies often overlook or under-report sex differences [1]. Similar to trends in other fields, the authors found that only 1% of studies which look for genetic links to diseases and disorders, otherwise known as genome-wide association studies, report results based on sex. They posit that while investigators are more than likely considering sex-differences, the complex datasets generated by genome-wide studies are typically analyzed by simple statistical methods in order to identify the most significant results. Thus, the data may not be analyzed directly by sex to increase statistical power. Alternatively, data sets which are analyzed by sex, but do not identify any apparent sex-differences, may never be reported. The authors provide the following recommendations for incorporating sex into genetic study design:

  • Perform separate analyses on male and female data 
  • Utilize publically-available data sets to increase sample size
  • Encourage journals to require the reporting of sex statistics.

To read the full article, “From sexless to sexy: Why it is time for human genetics to consider and report analyses of sex,” click here.  

References:

1. Powers et al., Biology of Sex Differences. 2017; 8:15