My Blog Posts

Posted by on October 8, 2018 - 4:15pm

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.

Posted by on September 23, 2018 - 2:36pm

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.

Posted by on January 5, 2015 - 2:27pm
Posted by on November 20, 2014 - 2:51pm

This year, September 16 marked Global Female Condom Day. Compared to other forms of birth control, female condoms are not widely known about, although they have many advantages. The most important aspect about female condoms is that they are the only woman-initiated birth control product that protects women from both pregnancy and STI’s. While male condoms protect against both of these conditions, a woman does not have complete control over their use as she does with a female condom.

Other benefits of female condoms include:

  • They are non-hormonal for women unable to use hormonal birth control
  • They are latex-free for those with latex allergies

  • There are a variety of brands sold over-the-counter

  • Their design allows for pleasure enhancement for men and women during intercourse

Female condoms have the potential to prevent unwanted pregnancy, especially in countries and regions where prescription birth control and other forms of women-initiated birth control, like IUDs, are not readily available. Additionally, they could be instrumental in reducing HIV/AIDS and other STI rates by giving women more control over protection during intercourse.

The first step to achieving more widespread use of the female condom is education and awareness. For more information on the female condom, click here.

Sources:

Widsom, Phylisa. “It’s Global Female Condom Day! 6 Reasons why the Female Condom is Worth Reconsidering (Hint: It’s not that Scary).”  Bustle.com. 16 September 2014. 

National Female Condom Coalition. 

Posted by on August 20, 2014 - 2:19pm

It’s been over a year since the controversial Texas law (House Bill 2) leading to abortion clinic restrictions passed, and the repercussions are starting to be felt throughout the state. The law, which was passed on July 18, 2013, created several new requirements, which abortion clinics need to meet to remain in operation. One requirement, which came into effect November 2013, called for clinic doctors to have admitting privileges at a hospital within a certain radius of the clinic. Since then, not all doctors could comply, and the number of clinics in Texas decreased by half from 41 to 20. The last restriction comes into effect on September 1 and requires that all clinics upgrade their facilities to make them ambulatory surgical centers. This will likely to lead to the closure of several more clinics.

This final requirement calls for clinics that do not currently meet its standards to renovate facilities to have a specific hallway width, establish full male and female locker rooms and include a janitor’s closet, among other things. Proponents of the law claim that these changes protect the health of women undergoing an abortion. However, Heather Busby, executive director of NARAL Pro-Choice Texas, states that abortions are among the safest office-based procedures performed, with a low complication rate of under 0.05%. Therefore, she points out that the requirements are not linked to the safety of the procedure and are unnecessary.

According to Busby, since the number of clinics in Texas has dropped, women are having to wait longer in their pregnancy before they are able to have an abortion, and are having to travel greater distances, or even leave the state. Unfortunately, watchdogs are predicting that when the last requirement comes into effect in September, even more clinics will close, potentially bringing the number down to around 6 or 8 clinics in the state. Busby points out there are already no clinics in East Texas or in the Rio Grande Valley, and the one clinic left in El Paso is at risk of closure. Texas clinics have filed a lawsuit to stop the last requirement from going into effect, but if it fails, women in Texas may find it increasingly difficult to receive safe abortions. Other states across the country are trying to pass similar laws in an effort to restrict women’s access to healthcare.

Feibel, Carrie. “Half of Texas Abortion Clinics Close After Restrictions Enacted.” NPR. 18 July 2014.

Posted by on July 25, 2014 - 3:13pm

On March 25, the Supreme Court heard arguments regarding challenges to the contraception mandate of the Affordable Care Act, with a decision expected to come down in late June. Here’s a rundown of the main aspects of this important case:

What is being challenged?

Under the contraception mandate in the Affordable Care Act, employers are required to provide employees with comprehensive health insurance, including a range of contraceptive methods for women. Organizations exempt from this mandate include small employers that are not required to provide any health insurance to employees, religious organizations and organizations with select insurance plans that were grandfathered in. Religiously-affiliated non-profit organizations may request exemptions as well. The main issue being decided is whether for-profit organizations can choose not to cover contraceptive care in health insurance plans based on religious objections. This comes down to the scope of the Religious Freedom Restoration Act of 1993 (RFRA), which currently does not apply to for-profit corporations.

Who is challenging the law?

The cases were brought by two for-profit corporations, that while not religious or religiously-affiliated, claim to operate based on religious principles. The corporations are Hobby Lobby, a craft store chain based in in Oklahoma City and owned by a Christian family, and Conestoga Wood Specialties, a Pennsylvania-based company that makes wood cabinets and is owned by a Mennonite family.

Why is the law being challenged?

The corporations challenging the contraception mandate believe that certain forms of birth control drugs and devices, including the morning after pill and IUDs, are equivalent to abortion because they may prevent embryos from implanting in the uterus. As such, they believe that covering the cost of these forms of contraception makes the them complicit with abortion. The corporations do not oppose all forms of birth control, including condoms, diaphragms, sponges, certain drugs and sterilization.

How is the administration defending the law?

Donald B. Verrilli, Jr., the current solicitor general who is representing the U.S. administration, has stated that the law offering comprehensive contraceptive care to women promotes public health and ensures equal access to healthcare for women. He also emphasized that it should be doctors, not employers, who should decide the best form of contraception for women. Additionally, a brief from the Guttmacher Institute points out that many women cannot afford highly effective forms of birth control, and so upholding the law will reduce unplanned pregnancy and abortions.

What are the potential outcomes and implications of the decision?

There are many ways the decision could go, each with varying repercussions. If the Supreme Court decides the RFRA does not cover for-profit organizations, it will end those organizations’ ability to challenge the contraception mandate based on religious beliefs. The Supreme Court could decide the RFRA does apply to for-profit organizations, but still rule on the side of the administration. This would be a less decisive win for the administration that would likely lead to more challenges. If the Supreme Court rules in favor of Hobby Lobby and Conestoga Wood Specialties, it will impact women’s access to affordable birth control, while opening the door to other religious objections raised by employers, such as hiring gay and lesbian individuals, or offering benefits to same sex spouses.

For more information, see the sources below:

Liptak, Adam. "Supreme Court Hears Cases on Contraception Rule."  The New York Times. 25 March 2014.
Totenberg, Nina. "Supreme Court Justices Divide by Gender in Hobby Lobby Contraception Case." NPR. 25 March 2014.

Fuller, Jaime.  "Here's What You Need to Know About the Hobby Lobby Case." The Washington Post. 24 March 2014.
"Health Care Law's 'Contraception Mandate' Reaches the Supreme Court."  Pew Research: Religion and Public Life Forum. 20 March 2014.

Posted by on March 26, 2014 - 8:47am

In early February, the American Heart Association published new guidelines aimed at preventing stroke in women. Due to several factors, women are more prone to stroke and generally have more difficulty recovering from stroke than men. A stroke occurs when a blood clot forms in a vessel leading to the brain, cutting off its oxygen supply. Women suffer strokes more often than men because they tend to live longer than men, undergo reproductive hormonal changes through contraceptives and hormone replacement therapies, and face an increased risk of stroke during pregnancy.

Due to these risk factors, the American Heart Association outlines the following guidelines:

  • Women with a history of high blood pressure before pregnancy may be able to take low-dose aspirin after the first trimester of pregnancy. Similarly, pregnant women with moderately high blood pressure may be able to be treated with medication.
  • A history of preeclampsia, or high blood pressure during pregnancy, should be considered a risk factor for stroke, along with cholesterol, obesity and smoking.
  • Women should be tested for high blood pressure prior to starting hormonal birth control, and although data is conflicting, hormone replacement therapy during menopause may increase the risk of stroke, so should not be used for stroke prevention.
  • As migraines with aura (sensory warning signs, such as tingling sensations or flashing lights) have been linked to stroke, women who experience migraines with aura should quit smoking.
  • Women over 75 should be tested for atrial fibrillation, another risk factor of stroke.

It is vital that stroke awareness and prevention begins at an early age and that blood pressure is monitored and treated appropriately throughout a woman's life. It is also important to note that these are only guidelines and that cases will vary by individual, so it is important to discuss issues or concerns related to stroke with your doctor.

Source: Walton, Alice G. "A Woman's Guide to Stroke Prevention." Forbes. 7 February 2014.

Posted by on February 13, 2014 - 3:59pm

A recent report in Fertility & Sterility has indicated that among women between the ages of 18 and 40, there is a significant amount of misconception regarding fertility and becoming pregnant. Dr. Illuzzi, an OB/GYN at Yale University School of Medicine, led a study in which 1,000 women of various ages and backgrounds completed a survey about their knowledge of reproductive health. The results showed a lack of knowledge across the board, with higher educated women knowing only slightly more than less educated women.

Over one-third of the women surveyed believed that specific positions during intercourse, such as elevating the pelvis, increase the odds of conception, although there is no scientific evidence to back this up. Additionally, only 10 percent of women know when the best time of the month to conceive is. The majority of women thought that sex must take place after ovulation to become pregnant, while in reality, pregnancy is most optimal when intercourse occurs 1 to 2 days prior to ovulation.

Other notable findings in the study include women’s thoughts on what can decrease fertility and prevent conception. Around 25% of surveyed women were unaware that factors such as obesity, smoking, and a history of sexually transmitted disease can cause infertility. In fact, the number one factor women cited as causing infertility was stress. Stress can have many negative side-effects, but according to Dr. Illuzzi, research does not currently support that it leads to infertility. While most of the women surveyed were aware that conception becomes more difficult with age, many did not know that later pregnancies are also more likely to result in miscarriage and chromosomal defects.

If you are concerned about fertility, or have questions about becoming pregnant, it is best to talk to your doctor, but you can get more information on websites such as the American College of Obstetricians and Gynecologists.

Source: Doucleff, Michaeleen. “You’d Think We’d Have Baby-Making All Figured Out, But No.” NPR. 27 January 2014.

Posted by on January 16, 2014 - 12:56pm

Every year there are roughly 137 million births globally. Of these, about 10% may result in serious complications. Tragically, approximately 5.6 million babies are stillborn or pass away soon after, and around 260,000 women pass away every year in childbirth. These situations often occur in underdeveloped countries or rural areas where women do not have access to hospitals or procedures such as a cesarean section when undergoing an obstructed or prolonged labor. Currently, when situations like this arise, options to extract the baby include using forceps or a vacuum extractor, which can twist the baby’s spine, crush its head, or cause hemorrhaging. Despite these statistics and outdated technologies, there has been little to no technological advancement in this area for years.

However, Jorge Odón, a car mechanic from Argentina, recently came up with an idea for a new type of low cost device to help extract a baby from the birth canal. It consists of a plastic bag inside of a plastic sleeve. The bag is placed gently around the baby’s head and then inflated to grip it. When the sleeve is pulled, the baby emerges with it. This device is likely safer than using forceps or a vacuum extractor to assist in a difficult labor, and as there is less contact between the baby’s head and the birth canal, the risk of passing an infection such as HIV from mother to child may be diminished.

This birthing assistance device, known as the Odón Device, has been endorsed by the World Health Organization, which plans to increase testing from 30 Argentine women to 100 more women in China, India and South Africa to further determine its effectiveness and safety. The device has also received grants from donors, and has been licensed for production by an American company. If additional tests verify the claims that some doctors are making - that the device is safe to be used by midwives with minimal training - then the device may see clinical use in two to three years.

For more information on the Odón device, visit the WHO website here.

Sources:

Posted by on November 14, 2013 - 10:26am

According to the American College of Obstetricians and Gynecologists, around 85% of women who menstruate experience one or more premenstrual syndrome (PMS) symptoms such as irritability, depression, bloating, or muscle pain. A similar, but more severe condition is known as premenstrual dysphoric disorder, or PMDD, which is rare (affecting only about 1% of menstruating women), but can cause disabling emotional and physical symptoms in women during the weeks leading up to their periods.

There are three criteria that need to be met to diagnosis PMDD, as opposed to PMS or other conditions. To receive a PMDD diagnosis, a woman’s symptoms must correspond to her menstrual cycle for at least two successive months, and if symptoms include depression, this depression must only be present in the days prior to menstruation. Symptoms must also be disruptive to the point that a woman has difficulty completing her normal activities.

Until recently, psychiatrists did not technically consider PMDD to be a disorder, but the new Diagnostic and Statistical Manual (DSM-5) officially recognizes PMDD as a mental disorder. This decision has been praised by many, while met with reservations from others.

With PMDD now classified as a mental disorder, some believe that this will help women receive treatment for a condition that may have previously been overlooked. Some women diagnosed with PMDD feel positively about the classification, stating that the recognition helps them feel they are not alone. However, others are concerned that because PMDD only affects women, it may contribute to stereotypes or affect perceptions about women’s capabilities. For example, Dr. Sarah Gehlert of Washington University in St. Louis points out that if a woman is involved in a child custody case and is diagnosed with PMDD, the fact that she has a mental disorder may impact the outcome of the case. Gehlert is also concerned that due to potential financial opportunities, PMDD may be overdiagnosed in otherwise healthy women with normal hormone changes. While understanding more about the biology behind PMDD may help clarify its classification as a mental disorder, for now, women will have to live with the positive and negative outcomes of this new designation.

Source: Standen, Amy. “Should Severe Premenstrual Symptoms be a Mental Disorder?” NPR. 21 Oct. 2013.

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