Journal of Women s Health &amp Gender-Based Medicine (J Wom Health Gend Base Med)

Publications in this journal

• Article: The association of hormone replacement therapy and coronary calcium as determined by electron beam tomography.

  Enrique F Schisterman, Amy M Gallagher, C Noel Bairey Merz, Brian W Whitcomb, David Faraggi, Kristen B Moysich, Howard Lewin
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  ABSTRACT: Observational studies have shown that hormone replacement therapy (HRT) is associated with lower coronary heart disease (CHD), and animal studies demonstrate potent antiatherosclerotic estrogen effects. Paradoxically, recent clinical trials have not demonstrated a protective effect. This paradox may be explained by a healthy woman effect bias. Women using HRT have improved health outcomes unrelated to underlying atherosclerotic burden. Examination of the association between coronary calcium (CC), a marker of atherosclerotic plaque burden, and the use of HRT in postmenopausal women may help address this paradox. The study population comprised 641 asymptomatic postmenopausal women, 425 (66%) of whom were taking HRT. Data obtained from a self-administered questionnaire and blood samples were analyzed. Electron beam tomography (EBT) for CC was performed on each subject. Analysis of variance (ANOVA) was used to evaluate adjusted means. Independent t tests found that age, low-density lipoproteins (LDL), high-density lipoproteins (HDL), body mass index (BMI), vitamin use, coronary calcium score (CCS), coronary calcified volume (CCV), and the number of coronary calcium lesions (CCL) were significantly different between the HRT group and the non-HRT group. However, after controlling for potential confounders, no significant differences were observed in CCS, CCV, or the number of CCL between the HRT and non-HRT groups. Stratifying by BMI shows that obese/overweight women taking HRT have lower adjusted CCS and fewer CCL than the obese/overweight women not taking HRT. These findings demonstrate no association between HRT use and CCS, CCV, and CCL after adjusting for measurable confounders in postmenopausal women. Our failure to demonstrate an independent association between HRT use and a marker of atherosclerotic plaque burden suggests that a healthy woman effect may explain the beneficial association between HRT use and CHD in observational studies.
  Journal of Women s Health &amp Gender-Based Medicine 10/2002; 11(7):631-8.
• Article: Toward optimal health: the experts discuss polycystic ovary syndrome.

  Andrea Dunaif, Rogerio A Lobo
  Journal of Women s Health &amp Gender-Based Medicine 10/2002; 11(7):579-84.
• Article: Biologic and molecular mechanisms for sex differences in pharmacokinetics, pharmacodynamics, and pharmacogenetics: Part II.

  Marietta Anthony, Mary J Berg
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  ABSTRACT: There are specific pharmacology issues related to women's unique physiology, including the hormonal changes that occur throughout their life span. Studies have shown alterations in drug metabolism in relation to phase of menstrual cycle, during pregnancy, or after menopause. In the brain, hormones can alter the response to drugs through various mechanisms. Estrogen and other compounds can bind to the estrogen receptor and modulate a wide range of activities within the cell. In addition, animal studies have demonstrated sexual dimorphism in the brain in terms of both the type of response to estrogen and the response as related to timing of administration. Many normal physiological changes that occur during pregnancy can affect pharmacokinetics and pharmacodynamics. These changes during pregnancy are dramatic rises in levels of estrogen and progesterone, increases in maternal blood volume, altered protein binding resulting from a drop in albumin levels, and a rise in levels of other plasma proteins. The field of chronobiology offers a way to study these changes in biological functions. Chronopharmacology is the study of how biological rhythms, particularly 24-hour, menstrual cycle, and annual rhythms, impact the pharmacokinetics and pharmacodynamics of drugs as a function of their timing. Chronopharmacokinetics is the study of the absorption, distribution, metabolism, and elimination of medicines according to the time of day, menstrual cycle, or year. In addition to applying chronobiology to the study of drugs used in women, new technologies were addressed from computer modeling, pharmacogenetics (genetics of the response to drugs), and in vivo drug metabolism studies.
  Journal of Women s Health &amp Gender-Based Medicine 10/2002; 11(7):617-29.
• Article: Abnormal cervical screen follow-up among low-income Latinas: Project SAFe.

  Kathleen Ell, Betsy Vourlekis, Laila Muderspach, Jan Nissly, Deborah Padgett, Diana Pineda, Olga Sarabia, Pey-Jiuan Lee
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  ABSTRACT: Cervical cancer incidence and mortality rates are dramatically higher among low-income women than in the general population, in part due to poor adherence to recommended diagnostic follow-up after an index Pap test. This report describes a pilot study of the Screening Adherence Follow-Up Program (SAFe), an individualized, structured case management program designed to assess for and intervene in response to a variety of potential personal and systems barriers to follow-up adherence. Interventions included health education, counseling, and systems navigation. A clinical decision-making algorithm was used to determine service intensity and level of intervention. Services were provided to 196 low-income women, predominantly Latinas, who had either a low-grade or high-grade squamous intraepithelial lesion (LGSIL or HGSIL) abnormal Pap result. Adherence rates to at least one follow-up appointment after enrollment and baseline intervention were 83% following LGSIL and 93% for HGSIL. Over 1 year post-enrollment, 41% of women with LGSIL were fully adherent, with 42% partially adherent; 61% of women with HGSIL were fully adherent, with 32% partially adherent. In a comparison group of 369 nonenrollees (women who refused participation or could not be located for consent), adherence rates were 58% for LGSIL and 67% for HGSIL. A survey among a random sample of women served indicated that 93% were "mostly" or "very" satisfied, overall, with SAFe services. The intervention team--a peer counselor and a master's degreed social worker--addressed multiple psychosocial and systems navigation problems to reduce potential barriers to adherence, including knowledge, attitudinal, psychosocial, psychological distress, systems communication, and resource access problems. SAFe appears highly acceptable to women and may significantly enhance medical care management following an abnormal cervical screen for a carefully targeted group of women at risk for suboptimal follow-up adherence.
  Journal of Women s Health &amp Gender-Based Medicine 10/2002; 11(7):639-51.
• Article: Ovarian autoimmune disease and ovarian autoantibodies.

  Judith Luborsky
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  ABSTRACT: Detection of specific autoantibodies remains the most practical clinical and research marker of autoimmune disease. The lack of consensus on ovary specific antibodies as a marker for ovarian autoimmunity has clinical and research consequences. The objective of this review is to summarize the evidence for ovarian autoimmunity and the detection of ovary specific autoantibodies in humans. Evidence favors the presence of an autoimmune disease of the ovary. Ovarian autoantibodies are associated primarily with premature ovarian failure (POF) and unexplained infertility. Variations in detection of ovarian autoantibodies are likely to be due to study design elements such as antibody test format, antigen preparation, and criteria for study and comparison groups. In addition, multiple targets appear to be involved in ovarian autoimmunity including ovarian cellular elements and oocyte related antigens. Many studies only assess one target antigen, leaving individuals with ovarian autoimmunity unidentified. The next most significant advance in characterizing ovarian autoimmunity will be definitive identification of the specific antigens and development of standardized tests based on use of specific antigens.
  Journal of Women s Health &amp Gender-Based Medicine 10/2002; 11(7):585-99.
• Article: Biologic and molecular mechanisms for sex differences in pharmacokinetics, pharmacodynamics, and pharmacogenetics: Part I.

  Marietta Anthony, Mary J Berg
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  ABSTRACT: There are pharmacological differences between women and men that have important clinical consequences. For several drugs, there is a higher incidence in women of drug-induced QT prolongation and a potentially fatal arrhythmia, torsades de pointes. This may be a reflection of the longer baseline QT interval in women. A difference in cardiovascular disease between women and men is that women have a higher mortality rate after myocardial infarction (MI). Women also have a higher rate of hemorrhagic stroke after receiving thrombolytic therapy for an MI. Differences in effectiveness of analgesics have been demonstrated, with kappa opioids providing pain relief for women but not men. Drugs may have different pharmacokinetics in women and men because of differences in phase I and phase II enzymes that metabolize drugs. Conflicting results about biological sex differences have been reported for the major drug metabolizing enzyme, cytochrome P450 3A4 (3A4) and may be related to a role for P-glycoprotein, a cell membrane transporter, reported as two times higher in male livers than those of females. It has been reported that boys need a higher dose of 6-mercaptopurine, which is metabolized by thiopurine methyltransferase (TPMT). TPMT is reported to be 14% higher in male human liver biopsies than those from females. Verapamil, a drug for angina and hypertension, has different clearance and side effects in men and women. Ethnic/racial variations have also been demonstrated with the drug metabolizing enzymes, CYP2C9, 2C19, and 2D6.
  Journal of Women s Health &amp Gender-Based Medicine 10/2002; 11(7):601-15.
• Article: Gender bias in physicians' management of neck pain: a study of the answers in a Swedish national examination.

  Katarina Hamberg, Gunilla Risberg, Eva E Johansson, Göran Westman
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  ABSTRACT: Research has raised concerns about gender bias in medicine; that is, are women and men being treated differently because of gender stereotyped attitudes among physicians? We investigated gender differences in the diagnosis and management of neck pain as proposed in a written test. The design eliminated differences related to communication and patient behavior. In a national examination for Swedish interns, using modified essay questions, the examinees were allocated to suggest management of neck pain in either a male or a female bus driver with a tense family situation. The case description was identical with the exception of patient gender. The open answers were coded for analysis. Two hundred thirty-nine interns (41% women) participated. Chi-square-tests were used to measure differences in proportions, and t test was used to evaluate differences in means. In certain areas, significant gender differences were detected. Proposals of nonspecific somatic diagnoses, psychosocial questions, drug prescriptions, and the expressed need of diagnostic support from a physiotherapist and an orthopedist were more common with females. Laboratory tests were requested more often in males. Both male and female physicians contributed to the gender differences. When assessing the impact of the patient-doctor relationship for health outcome, male physicians underlined the importance of patient compliance foremost in female patients, and female physicians did the opposite. The results suggest that physicians' gendered expectations are involved in creating gender differences in medicine. The inclusion of gender theory and discussions about gender attitudes into medical school curricula is recommended to bring about awareness of the problem.
  Journal of Women s Health &amp Gender-Based Medicine 10/2002; 11(7):653-66.
• Article: Maintaining fairness: who gets funded at NIH, and is the process fair?

  Florence P Haseltine
  Journal of Women s Health &amp Gender-Based Medicine 10/2002; 11(7):569-70.
• Article: Entertainment outreach for women's health at CDC.

  Kathryn E Wilson, Vicki H Beck
  Journal of Women s Health &amp Gender-Based Medicine 10/2002; 11(7):575-8.
• Article: The personal costs and convenience of screening mammography.

  Lisa Gale Suter, Connie Y Nakano, Joann G Elmore
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  ABSTRACT: Few studies have examined the impact of women's personal costs on obtaining a screening mammogram in the United States. All women obtaining screening mammograms at nine Connecticut mammography facilities during a 2-week study period were asked to complete a questionnaire. Facilities included urban and rural fixed sites and mobile sites. The survey included questions about insurance coverage, mammogram payment, and personal costs in terms of transportation, family care, parking, and lost work time from the women's perspective. The response rate was 62% (731 of 1189). Thirty-two percent of respondents incurred some type of personal cost, including lost work time, family care, and parking. Women incurring personal costs were more likely than those without personal costs to attend an urban facility (46% vs. 23%, p < 0.01) and be under the age of 50 (40% vs. 26%, p < 0.01). Overall, 61% of women listed convenience and 17% listed cost as a reason for choosing a mammography facility; 23% reported that cost might prevent them from obtaining a future mammogram. One third of women obtaining mammograms may be incurring personal costs. These personal costs should be considered in future cost-effectiveness analyses.
  Journal of Women s Health &amp Gender-Based Medicine 09/2002; 11(7):667-72.
• Article: Body image and African American females' sexual health.

  Gina M Wingood, Ralph J DiClemente, Kathy Harrington, Susan L Davies
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  ABSTRACT: This study examines the association between African American adolescent females' body image and their sexual health. African American adolescent females (n = 522) completed a survey that assessed body image using a 7-item scale (alpha = 0.71) and a face-to-face interview that assessed sexual behaviors. In logistic regression analyses, controlling for depression, self-esteem and body mass index (BMI), adolescents who were more dissatisfied with their body image were more likely to fear abandonment as a result of negotiating condom use (adjusted odds ratio [AOR] = 3.3, p = 0.02), more likely to perceive that they had fewer options for sexual partners (AOR = 2.4, p = 0.001), more likely to perceive themselves as having limited control in their sexual relationships (AOR = 2.0, p = 0.002), and more likely to worry about acquiring HIV(AOR = 1.5, p = 0.04). There was an association between having a greater dissatisfaction with one's body image and never using condoms during sexual intercourse in the past 30 days (AOR = 1.6, p = 0.04) and more likely to engage in unprotected vaginal sex in the prior 6 months (AOR = 1.6, p = 0.04). Prior research has demonstrated an association between African American women's body image and greater obesity risk, lower self-esteem, and greater depression. The present study has shown an association between body image dissatisfaction and a range of sexual attitudes, beliefs, and behaviors. Women who are more dissatisfied with their body image may be at greater risk for unintended pregnancy, sexually transmitted infections (STIs), and HIV infection.
  Journal of Women s Health &amp Gender-Based Medicine 07/2002; 11(5):433-9.
• Article: Toward optimal health: the experts discuss attention deficit disorder.

  Jodi Godfrey Meisler
  Journal of Women s Health &amp Gender-Based Medicine 07/2002; 11(5):417-21.
• Article: Contemporary management of hyperlipidemia in women.

  Lori J Mosca
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  ABSTRACT: The objective of this paper is to review prospective, large-scale studies of lipid-lowering therapy and hormone replacement therapy, and to provide clinical recommendations for the management of hyperlipidemia in women within the context of the revised National Cholesterol Education Program (NCEP) guidelines. Recent English language literature derived from a MEDLINE search (January 1990-July 2001) and bibliographies of relevant papers were reviewed, and data were abstracted from identified papers. Hyperlipidemia is largely undertreated in women. Previously, hormone replacement therapy (HRT) was considered first-line treatment for the management of hypercholesterolemia to prevent coronary artery disease (CAD) in women. Recent studies, however, show no benefit of HRT for secondary prevention of coronary events, despite its beneficial effects on lipids. Large-scale, controlled clinical trials indicate that women, even those with only moderately elevated cholesterol, benefit from the lipid-lowering effects of statins for both high-risk primary and secondary prevention of CAD. Based on this evidence, the recently revised NCEP guidelines recommend statins as first-line therapy for women with hyperlipidemia, an approach that is supported by the American Heart Association and the American College of Cardiology. With its emphasis on aggressive intervention for persons with multiple risk factors, the new guidelines substantially increase the number of women eligible for pharmacological therapy. All women with hyperlipidemia should receive counseling regarding lifestyle approaches for lowering cholesterol. The decision to use HRT should be made in the context of other conditions hormones may affect. Alternative hormonal regimens for lipid management may include selective estrogen receptor modulators and phytoestrogens, but results of randomized clinical trials are necessary before firm recommendations can be made regarding their clinical value in preventing CAD.
  Journal of Women s Health &amp Gender-Based Medicine 07/2002; 11(5):423-32.
• Article: Women and arthritis: burden, impact and prevention programs.

  Jennifer M Hootman, Joseph E Sniezek, Charles G Helmick
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  ABSTRACT: To characterize the public health burden and impact of arthritis among women, document the growing interest in addressing arthritis as a public health problem, and review new national (Centers for Disease Control and Prevention [CDC]) and state arthritis programs. Arthritis and other rheumatic diseases are a major public health problem, affecting nearly 27 million women in 1997 and accounting for 23.9 million ambulatory medical care visits and 451,000 hospitalizations among women in that year. Arthritis is also the leading cause of disability and is associated with considerable functional limitations. The 1999 National Arthritis Action Plan: A Public Health Strategy prompted first-time congressional funding to the CDC to monitor the burden of arthritis and to establish state arthritis prevention programs through cooperative agreements. The CDC's Arthritis Program also used this funding to build the public health science base, develop national health communications campaigns, foster partnerships, and initiate health systems change. Arthritis in general and selected types, such as rheumatoid arthritis, systemic lupus erythmatosus (SLE), and fibromyalgia, disproportionately affect women. The CDC, state health departments, and their partners are working toward improving the quality of life for women affected by arthritis. Effective, evidence-based interventions, such as self-management education and physical activity programs, are currently available and can reduce pain, improve function, and delay disability, but they remain underused. Future research should focus on improving earlier diagnosis and increasing access to effective interventions.
  Journal of Women s Health &amp Gender-Based Medicine 07/2002; 11(5):407-16.
• Article: Gender differences in pelvic motions and center of mass displacement during walking: stereotypes quantified.

  Lynnelle K Smith, Jennifer L Lelas, D Casey Kerrigan
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  ABSTRACT: A general perception that women and men walk differently has yet to be supported by quantitative walking (gait) studies, which have found more similarities than differences. Never previously examined, however, are pelvic and center of mass (COM) motions. We hypothesize the presence of gender differences in both pelvic obliquity (motion of the pelvis in the coronal plane) and vertical COM displacement. Quantifiable differences may have clinical as well as biomechanical importance. We tested 120 subjects separated into four groups by age and gender. Pelvic motions and COM displacements were recorded using a 3-D motion analysis system and averaged over three walking trials at comfortable walking speed. Data were plotted, and temporal values, pelvic angle ranges, and COM displacements normalized for leg length were quantitatively compared among groups. Comparing all women to all men, women exhibited significantly more pelvic obliquity range (mean ISD): 9.4 +/- 3.5 degrees for women and 7.4 +/- 3.4 degrees for men (p = 0.0024), and less vertical COM displacement: 3.7 +/- 0.8% of leg length for women and 3.3 +/- 0.9% for men (p = 0.0056). Stereotypically based gender differences were documented with greater pelvic obliquity and less vertical COM displacement in women compared with men. It is unclear if these differences are the intrinsic result of gender vs. social or cultural effects. It is possible that women use greater pelvic motion in the coronal plane to reduce their vertical COM displacement and, thus, conserve energy during walking. An increase in pelvic obliquity motion may be advantageous from an energy standpoint, but it is also associated with increased lumbosacral motion, which may be maladaptive with respect to the etiology and progression of low back pain.
  Journal of Women s Health &amp Gender-Based Medicine 07/2002; 11(5):453-8.
• Article: Women's health research: women's health funding for 2003.

  Phyllis Greenberger
  Journal of Women s Health &amp Gender-Based Medicine 07/2002; 11(5):477-8.
• Article: Race, socioeconomic status, and perceived discrimination among healthy women.

  Jennifer M Watson, Isabel C Scarinci, Robert C Klesges, Deborah Slawson, Bettina M Beech
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  ABSTRACT: Perceived discrimination and socioeconomic status (SES) have been found to be related to health problems. However, little is known about how SES and ethnicity relate to perception and responses to discrimination. This study examined the relationship between race and a set of SES indicators, perceived discrimination (race and gender), and responses to perceived discrimination among healthy women. The sample consisted of 460 women between the ages of 18 and 39 (194 black and 266 white). The independent variables included income, education, occupation, and race. The dependent variables included perceived discrimination (race/color and gender) and responses to unfair treatment. Income and education were both directly related to perceived racial discrimination. However, the relationship between education and perceived discrimination was modified by race. For white women, only higher education was related to less perceived discrimination, and there was no significant difference across education levels for black women. Education was the only variable significantly associated with perceived gender discrimination (more highly educated women reported more discrimination). Occupation and race were both related to responses to perceived discrimination. Black women were significantly less likely to talk to someone when treated unfairly than white women (OR = 0.37, 95% confidence interval [CI] = 0.191, 0.716), and women in managerial/professional positions were significantly more likely to do something about being treated unfairly than women in service occupations (OR = 4.76, CI = 2.14, 10.61). Our results suggest that both SES and race play important roles in women's perceptions of and responses to perceived discrimination.
  Journal of Women s Health &amp Gender-Based Medicine 07/2002; 11(5):441-51.
• Article: Efficacy and safety of sildenafil citrate in women with sexual dysfunction associated with female sexual arousal disorder.

  Rosemary Basson, Rosemary McInnes, Mike D Smith, Gemma Hodgson, Nandan Koppiker
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  ABSTRACT: Sildenafil citrate (Viagra Pfizer, New York, NY) is indicated for the treatment of erectile dysfunction in men. The nitric oxide-cyclic guanosine monophosphate pathway (NO-cGMP) involved in penile erection and enhanced by sildenafil may also play a role in some components of the female sexual arousal response. The efficacy and safety of sildenafil were evaluated in estrogenized and estrogen-deficient women with sexual dysfunction that included female sexual arousal disorder (FSAD). Patients were randomized to receive 10-100 mg sildenafil or matching placebo. To assess efficacy, patients completed two global efficacy questions (GEQ), the Life Satisfaction Checklist (LSC), an event log of sexual activity, and a 31-item sexual function questionnaire (SFQ). To assess safety, adverse event (AE) data were recorded. A total of 577 estrogenized and 204 estrogen-deficient women were randomized to treatment. All were diagnosed with FSAD, but it was the primary presenting symptom in only 46% and 50% of women, respectively. Differences in efficacy between sildenafil and placebo were not significant for any patient or partner end points (e.g., the two GEQ, the sexual event logs, the LSC, and the SFQ). The main AE were headache, flushing, rhinitis, nausea, visual disturbances, and dyspepsia, which were generally mild to moderate in nature. Any genital physiological effect of sildenafil was not perceived as improving the sexual response in estrogenized or estrogen-deficient women with a broad spectrum of sexual dysfunction that included FSAD. Whether more specific subgroups of women with FSAD could potentially benefit from treatment with sildenafil is an area for future research.
  Journal of Women s Health &amp Gender-Based Medicine 06/2002; 11(4):367-77.
• Article: Quantitative impact of including consumers in the scientific review of breast cancer research proposals.

  Yvonne Andejeski, Isabelle T Bisceglio, Kay Dickersin, Jean E Johnson, Sabina I Robinson, Helene S Smith, Frances M Visco, Irene M Rich
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  ABSTRACT: To evaluate the impact of having breast cancer survivors with advocacy experience (consumers) participate as voting members of scientific review panels for proposals on breast cancer research. As major stakeholders, patients and other consumer advocates sought inclusion in all decision-making processes affecting funding of disease-targeted research. Cross-sectional analysis of assigned proposal scores ranging from 5.0 (acceptable) to 1.0 (outstanding); before (prepanel) and after (postpanel) opinion questionnaires. Forty-six panels reviewed 2206 proposals for the Fiscal Year 1995 Department of Defense (DOD) Breast Cancer Research Program. Analyses were limited to the 42 panels scheduled to meet on site and the 2190 proposals scored by both participant groups. There were 85 consumers and 638 scientists. The main outcome measures were proposal merit scores (raw, overall, and participant-specific means) and opinions concerning perceived benefits and drawbacks of consumer involvement. In general, the voting patterns of consumers were similar to those of scientists. Final proposal scores were the same as those that would have been obtained without consumer voting for 76.2% of the proposals, more favorable for 15.2% of the proposals, and less favorable for 8.6% of the proposals. For all but 13 proposals, the difference was +/-0.1. Prepanel opinions regarding consumer involvement were generally positive. Prepanel and postpanel comparisons almost always showed that significantly greater proportions of participants had positive postpanel opinions than had negative postpanel opinions. Having consumers on review panels was reported to be beneficial (83.9% and 98.2% for scientists and consumers, respectively) and to not have drawbacks (74.7% and 87.3%, respectively). Our results support continued participation of consumers in our peer review process. The DOD program can serve as a model for other research programs considering consumer involvement.
  Journal of Women s Health &amp Gender-Based Medicine 06/2002; 11(4):379-88.