Ellen W Seely

Harvard Medical School, Boston, Massachusetts, United States

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Publications (131)889.87 Total impact

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    ABSTRACT: To assess health care providers' knowledge regarding pregnancy outcome as a risk factor for cardiovascular disease and evaluate the variables associated with their responses to questions about routine surveillance for cardiovascular disease. A voluntary, anonymous survey of internal medicine and obstetric and gynecologic health care providers at an academic institution. Responses to a case-based and direct inquiry questionnaire were evaluated. The overall response rate was 65% (173/265). When assessing cardiovascular risk, gynecologists compared with internists significantly more often requested a pregnancy history (44/49 [90%] compared with 56/75 [75%], P=.039) and more often attached importance to a history of preeclampsia (35/48 [73%] compared with 41/75 [55%], P=.028). When a history of preeclampsia was obtained, internists more often obtained a fasting glucose test (25/52 [48%] compared with 9/43 [20.9%], P=.009). A minority of health care providers recognized the importance of fetal growth restriction. Both health care provider groups demonstrated similar knowledge of general cardiovascular risk factors, screening tools, and interventions. Higher general cardiovascular knowledge was significantly associated with identification of pregnancy complications as cardiovascular risk factors (P=.001). When assessing cardiovascular risk, internists were less likely than gynecologists to include a pregnancy history. However, once identified as at risk for cardiovascular disease, gynecologists were less likely than internists to obtain appropriate testing. Education concerning the link between certain pregnancy complications and future cardiovascular disease is needed. Areas of opportunity for education in both medical specialties are identified.
    Obstetrics and Gynecology 05/2015; 125(6):1. DOI:10.1097/AOG.0000000000000856 · 4.37 Impact Factor
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    ABSTRACT: Chronic kidney disease affects approximately one in ten North Americans and is associated with a high risk of cardiovascular disease. Chronic kidney disease in women is characterized by an abnormal sex hormone profile and low estradiol levels. Since low estradiol levels are associated with an increased cardiovascular risk in healthy women, our objective is to determine the effect of hormone therapy on all-cause mortality, cardiovascular mortality, and cardiovascular morbidity in women with chronic kidney disease. Studies examining hormone therapy for adult women with chronic kidney disease will be included. The primary outcome is all-cause or cardiovascular mortality and morbidity. We will search electronic bibliographic databases (MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials (CENTRAL)) along with relevant conference proceedings, table of contents of journals, and review articles. Two investigators will independently screen identified abstracts and select observational cohort studies, case-control studies, and randomized controlled trials examining hormone therapy in women with chronic kidney disease. These investigators will also independently abstract data from relevant full-text journal articles and assess risk of bias. Where possible, these data will be summarized using pooled or combined estimates for the risk ratio or hazard ratio of all-cause mortality, cardiovascular mortality, and cardiovascular morbidity in women with chronic kidney disease with and without hormone therapy. A random effects model will be used, and meta-regression and subgroup analyses will be used to explore potential source of heterogeneity. Given the high burden of cardiovascular disease in women with chronic kidney disease, this study will help guide clinical practice by summarizing current evidence on the use of hormone therapy for prevention of all-cause mortality, cardiovascular mortality, and cardiovascular morbidity in this population. The final protocol was registered with PROSPERO ( CRD42014014566) .
    04/2015; 4(1):44. DOI:10.1186/s13643-015-0020-8
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    ABSTRACT: To examine the teratogenic potential of statins. Cohort study. United States. A cohort of 886 996 completed pregnancies linked to liveborn infants of women enrolled in Medicaid from 2000 to 2007. We examined the risk of major congenital malformations and organ specific malformations in offspring associated with maternal use of a statin in the first trimester. Propensity score based methods were used to control for potential confounders, including maternal demographic characteristics, obstetric and medical conditions, and use of other drugs. 1152 (0.13%) women used a statin during the first trimester. In unadjusted analyses, the prevalence of malformations in the offspring of these women was 6.34% compared with 3.55% in those of women who did not use a statin in the first trimester (relative risk 1.79, 95% confidence interval 1.43 to 2.23). Controlling for confounders, particularly pre-existing diabetes, accounted for this increase in risk (1.07, 0.85 to 1.37). There were also no statistically significant increases in any of the organ specific malformations assessed after accounting for confounders. Results were similar across a range of sensitivity analyses. Our analysis did not find a significant teratogenic effect from maternal use of statins in the first trimester. However, these findings need to be replicated in other large studies, and the long term effects of in utero exposure to statins needs to be assessed, before use of statins in pregnancy can be considered safe. © Bateman et al 2015.
    BMJ (online) 03/2015; 350(mar17 10):h1035. DOI:10.1136/bmj.h1035 · 16.38 Impact Factor
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    ABSTRACT: To determine the most accurate questions for providers to ask patients when taking a history of pregnancy complications, as recommended by the 2011 American Heart Association's (AHA) Guidelines for the Prevention of Cardiovascular Disease in Women. A pregnancy recall questionnaire was administered to 971 patients who agreed to be contacted for future research after participating in a prospective, longitudinal cohort of 1608 pregnant women, initiating care between 2006 and 2009. The survey included several questions for each pregnancy complication, informed by a literature review and pilot study. Medical records from the study pregnancy were used as the gold standard. Prevalence, sensitivity (sens), specificity (spec), positive predictive value (PPV), negative predictive value (NPV) and/or Spearman's correlation coefficients were calculated for each question. 54% (526) of individuals re-contacted responded. Responders were more likely to be older, white, educated, nulliparous, and deliver low birthweight infants at the time of the index pregnancy than non-responders. Mean length of recall was 4.35 years (SD 0.46) postpartum. The individual, binary questions, "Did you have gestational diabetes during the study pregnancy?" and "During the study pregnancy, did you have preeclampsia?" most accurately discriminated GDM (sens 92%, spec 98 %) and preeclampsia (sens 82%, spec 96%). The continuous questions, "What was the birthweight of the baby?" and "How many weeks pregnant were you when you delivered?" out-performed categorical questions for both birthweight (r=0.95) and gestation length (r=0.85). This validated questionnaire demonstrates that the majority of women can accurately recall their pregnancy history, on average, more than 4 years post-partum. Further validation of this pregnancy recall instrument in other patient populations may be helpful for clinical application of the 2011 AHA recommendations in order to identify women at high risk of developing cardiovascular disease. E.B. Carter: None. J.J. Stuart: None. L.V. Farland: None. J. Rich-Edwards: None. C. Zera: None. T.F. McElrath: None. E.W. Seely: None. Copyright © 2014.
    01/2015; 5(1):63. DOI:10.1016/j.preghy.2014.10.124
  • Ellen W Seely, Kathy E Kram, S Jean Emans
    Translational Research 12/2014; 165(4). DOI:10.1016/j.trsl.2014.12.002 · 4.04 Impact Factor
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    ABSTRACT: Chronic hypertension is a common medical condition in pregnancy. The purpose of the study is to examine the association between maternal chronic hypertension and the risk of congenital malformations in the offspring.
    American Journal of Obstetrics and Gynecology 09/2014; 212(3). DOI:10.1016/j.ajog.2014.09.031 · 3.97 Impact Factor
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    ABSTRACT: OBJECTIVE: To test the feasibility and effectiveness of a Web-based lifestyle intervention based on the Diabetes Prevention Program modified for women with recent gestational diabetes mellitus to reduce postpartum weight retention. METHODS: We randomly allocated 75 women with recent gestational diabetes mellitus to either a Web-based lifestyle program (Balance after Baby) delivered over the first postpartum year or to a control group. Primary outcomes were change in body weight at 12 months from 1) first postpartum measured weight; and 2) self-reported prepregnancy weight. RESULTS: There were no significant differences in baseline characteristics between groups including age, body mass index, race, and income status. Women assigned to the Balance after Baby program (n=36, three lost to follow-up) lost a mean of 2.8 kg (95% confidence interval -4.8 to -0.7) from 6 weeks to 12 months postpartum, whereas the control group (n=39, one lost to follow-up) gained a mean of 0.5 kg (-1.4 to +2.4) (P=.022). Women in the intervention were closer to prepregnancy weight at 12 months postpartum (mean change 20.7 kg; -3.5 to +2.2) compared with women in the control arm (+4.0 kg; +1.3 to +6.8) (P=.035). CONCLUSION: A Web-based lifestyle modification program for women with recent gestational diabetes mellitus decreased postpartum weight retention.
    Obstetrics and Gynecology 09/2014; 124(3):563-570. DOI:10.1097/AOG.0000000000000420 · 4.37 Impact Factor
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    ABSTRACT: Objective As obesity is a risk factor for placental dysfunction, we hypothesized that maternal body mass index (BMI) would be associated with alterations in serum angiogenic markers. Study Design We included 2399 singleton pregnancies with and without placental dysfunction in a prospective longitudinal cohort study of angiogenic markers. We modeled the relationship between categorical and continuous BMI, sFlt-1 and PlGF over gestation, stratified by pregnancy outcome. Results In women with normal pregnancies, higher BMI was associated with lower sFlt-1 values across gestation (p<0.0001), lower PlGF in the second and third trimester (p<0.0001), and rate of change in PlGF (p<0.0001). Similar relationships were seen between maternal BMI, sFlt-1 (p<0.0001) and PlGF (p=0.0005) in women with clinically evident placental dysfunction. Conclusions: sFlt-1 value is inversely associated with maternal BMI. The pattern of change in PlGF is also dependent on maternal BMI, indicating that obese women may have abnormalities in angiogenesis near term.
    American journal of obstetrics and gynecology 09/2014; 211(3). DOI:10.1016/j.ajog.2014.03.020 · 3.97 Impact Factor
  • Ellen W Seely, Jeffrey Ecker
    Circulation 03/2014; 129(11):1254-61. DOI:10.1161/CIRCULATIONAHA.113.003904 · 14.95 Impact Factor
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    ABSTRACT: A history of preeclampsia is a risk factor for the future development of hypertension and cardiovascular disease (CVD). The objective of this study was to assess, in women with prior preeclampsia, the level of knowledge regarding the link between preeclampsia and CVD, motivators for and barriers to lifestyle change and interest in a lifestyle modification program to decrease CVD risk following a pregnancy complicated by preeclampsia. Twenty women with a history of preeclampsia participated in 5 phone-based focus groups. Focus groups were recorded, transcribed, and analyzed. Qualitative content analysis was used to identify common themes across focus groups. Consensus was reached on a representative set of themes describing the data. Women with prior preeclampsia were in general unaware of the link between preeclampsia and future CVD but eager to learn about this link and motivated to achieve a healthy lifestyle. Major perceived barriers to lifestyle change were lack of time, cost of healthy foods and family responsibilities. Perceived facilitators included knowledge of the link between preeclampsia and CVD, a desire to stay healthy, and creating a healthy home for their children. Women with prior preeclampsia were interested in the idea of a web-based program focused on lifestyle strategies to decrease CVD risk in women. Women with prior preeclampsia were eager to learn about the link between preeclampsia and CVD and to take steps to reduce CVD risk. A web-based program to help women with prior preeclampsia adopt a healthy lifestyle may be an appropriate strategy for this population.
    BMC Pregnancy and Childbirth 12/2013; 13(1):240. DOI:10.1186/1471-2393-13-240 · 2.15 Impact Factor
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    ABSTRACT: Age, sex, hypertension and dietary sodium are proposed to affect plasma and urinary catecholamines. Yet no prior study has examined the simultaneous effects of these factors within the same study population. So results may have been confounded by factors not determined. We investigate, for the first time, the impact of simultaneously determined predictors of plasma and urinary catecholamines and the relationship of catecholamines with the diagnosis of hypertension. Hypertensive and normotensive subjects (n=308) were studied off antihypertensives in liberal and low sodium balance. 24 h urinary catecholamines (norepinephrine and epinephrine) were measured. Plasma catecholamines were measured supine after overnight fast. Repeated measures multivariate linear regression models examined the effect of sex, race, age, body mass index (BMI), dietary salt (liberal salt vs low salt), hypertension status and mean arterial pressure (MAP) on plasma and urinary catecholamines. Logistic regression determined the relationship of catecholamines with diagnosis of hypertension. Dietary sodium restriction and increasing age predicted increased plasma and urinary norepinephrine, with sodium restriction having the greatest effect. Female sex predicted lower urinary and plasma epinephrine. Neither plasma nor urinary catecholamines predicted the diagnosis of hypertension. In summary, specific demographic factors variably impact catecholamines and should be considered when assessing catecholamines in research and clinical settings.Journal of Human Hypertension advance online publication, 14 November 2013; doi:10.1038/jhh.2013.112.
    Journal of human hypertension 11/2013; DOI:10.1038/jhh.2013.112 · 2.69 Impact Factor
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    ABSTRACT: South Asians have increased visceral adiposity, insulin resistance and greater prevalence of type 2 diabetes and cardiovascular disease when compared to Caucasians of European origin. Surrogate markers of insulin resistance such as the composite insulin sensitivity (Matsuda) index correlate with glucose clamps in other populations, but ethnicity can affect these indices. We compared the Matsuda index, homeostasis model assessment (HOMA-IR), quantitative insulin sensitivity check index (QUICKI), and triglyceride/HDL ratio to insulin sensitivity derived from euglycemic clamps in healthy South Asians and Caucasians. Twenty-three healthy South Asians and 18 Caucasians matched for age (mean±SE=33.6±2.1 vs. 36.0±3.0years) and BMI (25.2±1.1 vs. 24.6±0.9kg/m(2)) underwent 75g oral glucose tolerance test (OGTT), 2-h euglycemic hyperinsulinemic clamp (240 pmol·m(-2)·min(-1)), fasting lipid profile, and anthropometric measures. South Asians had higher fasting insulin (41±5 vs. 21±2 pmol/l; p=0.002) and lower HDL-C (1.25±0.06 vs. 1.56±0.10mmol/l; p=0.010), but similar fasting glucose (5.0±0.1 vs. 4.9±0.1mmol/l) levels vs. Caucasians. South Asians had significantly decreased measures of insulin sensitivity derived from both the euglycemic clamp (24.9±1.3 vs. 41.4±1.9μmol·kg(-1)·min(-1); p<0.0001) and OGTT (Matsuda Index 7.60±0.99 vs. 13.60±1.79; p=0.004). The Matsuda index correlated highly with clamp insulin sensitivity in South Asians (r=0.50; p=0.014) and Caucasians (r=0.47; p=0.046). HOMA-IR, QUICKI, and triglyceride/HDL ratio correlated with clamp values in South Asians, but not in Caucasians. In South Asians, Matsuda index, HOMA-IR, QUICKI, and triglyceride/HDL ratio offer simple and valid surrogate measures of insulin sensitivity that can be employed in larger clinical or epidemiological studies in this ethnic group.
    Metabolism: clinical and experimental 07/2013; DOI:10.1016/j.metabol.2013.05.016 · 3.61 Impact Factor
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    ABSTRACT: Background First trimester Pregnancy Associated Plasma Protein A (PAPP-A) levels, routinely measured for aneuploidy screening, may predict development of preeclampsia. This study tests the hypothesis that first trimester PAPP-A levels correlate with soluble fms-like tyrosine kinase-1 (sFlt-1) levels, an angiogenic marker associated with preeclampsia, throughout pregnancy. Methods sFlt-1 levels were measured longitudinally in 427 women with singleton pregnancies in all three trimesters. First trimester PAPP-A and PAPP-A Multiples of Median (MOM) were measured. Student’s T and Wilcoxon tests compared preeclamptic and normal pregnancies. A linear mixed model assessed the relationship between log PAPP-A and serial log sFlt-1 levels. Results PAPP-A and PAPP-A MOM levels were significantly lower in preeclamptic (n = 19), versus normal pregnancies (p = 0.02). Although mean third trimester sFlt-1 levels were significantly higher in preeclampsia (p = 0.002), first trimester sFlt-1 levels were lower in women who developed preeclampsia, compared with normal pregnancies (p = 0.03). PAPP-A levels correlated significantly with serial sFlt-1 levels. Importantly, low first trimester PAPP-A MOM predicted decreased odds of normal pregnancy (OR 0.2, p = 0.002). Conclusions Low first trimester PAPP-A levels suggests increased future risk of preeclampsia and correlate with serial sFlt-1 levels throughout pregnancy. Furthermore, low first trimester PAPP-A status significantly predicted decreased odds of normal pregnancy.
    BMC Pregnancy and Childbirth 04/2013; 13(1):85. DOI:10.1186/1471-2393-13-85 · 2.15 Impact Factor
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    ABSTRACT: Abstract Objective: Low perceived risk for type 2 diabetes (T2DM) may be a barrier to lifestyle change in women with recent gestational diabetes (GDM). We assessed perceived risk for T2DM at delivery and postpartum. Methods: We used a validated diabetes risk perception instrument to survey women with GDM at delivery and postpartum. We compared women with low perceived risk for T2DM at delivery to those with high perceived risk. Results: The majority (N=43 of 70, 61%) perceived high risk at delivery. Women who perceived low risk were younger (30.7 + 6.3 versus 35.0 + 4.5 years, p=0.003) than women who perceived high risk. Although knowledge of risk factors for T2DM was poor (mean 6.0 + 1.9, of 11 points), 95% correctly identified GDM as a risk factor. Perceived risk was maintained in most (N=51 of 58, 88%) who returned for their postpartum visit. Low perceived risk was not associated with loss to follow up, however correct identification of GDM as a risk factor was protective (OR 0.05, 95% CI 0.005, 0.56). Conclusions: Risk perception is accurate in most women with GDM at delivery and postpartum. Further study is needed to translate perceived risk into preventive behaviors in women with recent GDM.
    The journal of maternal-fetal & neonatal medicine: the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians 11/2012; DOI:10.3109/14767058.2012.746302 · 1.21 Impact Factor
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    ABSTRACT: Women with gestational diabetes mellitus (GDM) have a substantial risk of subsequently developing type 2 diabetes. This risk may be mitigated by engaging in healthy eating, physical activity, and weight loss when indicated. Since postpartum depressive symptoms may impair a woman's ability to engage in lifestyle changes, we sought to identify factors associated with depressive symptoms in the early postpartum period among women with recent GDM. The participants are part of the baseline cohort of the TEAM GDM (Taking Early Action for Mothers with Gestational Diabetes Mellitus) study, a one-year randomized trial of a lifestyle intervention program for women with a recent history of GDM, conducted in Boston, Massachusetts between June 2010 and September 2012. We administered the Edinburgh Postnatal Depression Scale (EPDS) at 4-15 weeks postpartum to women whose most recent pregnancy was complicated by GDM (confirmed by laboratory data or medical record review). An EPDS score ≥9 indicated depressive symptoms. We measured height and thyroid stimulating hormone, and administered a questionnaire to collect demographic data and information about breastfeeding and sleep. We calculated body mass index (BMI) using self-reported pre-pregnancy weight and measured height. We reviewed medical records to obtain data about medical history, including history of depression, mode of delivery, and insulin use during pregnancy. We conducted bivariable analyses to identify correlates of postpartum depressive symptoms, and then modeled the odds of postpartum depressive symptoms using multivariable logistic regression. Our study included 71 women (mean age 33 years ± 5; 59 % White, 28 % African-American, 13 % Asian, with 21 % identifying as Hispanic; mean pre-pregnancy BMI 30 kg/m(2) ± 6). Thirty-four percent of the women scored ≥9 on the EPDS at the postpartum visit. In the best fit model, factors associated with depressive symptoms at 6 weeks postpartum included cesarean delivery (aOR 4.32, 95 % CI 1.46, 13.99) and gestational weight gain (aOR 1.21 [1.02, 1.46], for each additional 5 lbs gained). Use of insulin during pregnancy, breastfeeding, personal history of depression, and lack of a partner were not retained in the model. Identifying factors associated with postpartum depression in women with GDM is important since depression may interfere with lifestyle change efforts in the postpartum period. In this study, cesarean delivery and greater gestational weight gain were correlated with postpartum depressive symptoms among women with recent GDM (Clinicaltrials.gov NCT01158131).
    Maternal and Child Health Journal 11/2012; DOI:10.1007/s10995-012-1180-y · 2.24 Impact Factor
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    ABSTRACT: Background:Identifying reproductive risk factors in women offers a life course approach to obesity and cardiovascular disease prevention. The association of female reproductive factors with measures of regional body fat distribution has not been comprehensively studied.Methods:We examined the association of female reproductive factors (age at menarche, parity, age at natural menopause, menopausal status) in association with body composition data from women who participated in the Offspring and the Third Generation Framingham Heart Study cohorts. Visceral adipose tissue (VAT) and sc adipose tissue (SAT) were measured volumetrically by multidetector computerized tomography. We modeled the relationship between each fat depot and female reproductive factors after adjusting for various factors such as age, smoking status, alcohol intake, physical activity index, hormone replacement therapy, and menopausal status.Results:Earlier age at menarche was associated with increased body mass index (BMI), waist circumference (WC), VAT, and SAT (P < 0.0001). This association of earlier menarche with adiposity measures was attenuated after adjusting for BMI (all P > 0.70). We observed no association between parity and all parameters of adiposity measurements (all P > 0.24). Similarly, age at natural menopause was not associated with measures of body composition. Despite higher mean BMI among the post- (BMI 27.3 kg/m(2)) compared with the premenopausal women (BMI 25.9 kg/m(2)) in an age-matched analysis, mean VAT was not different between the two groups (P = 0.30).Conclusions:Earlier menarche is associated with overall obesity but not with VAT or SAT after accounting for measures of generalized adiposity. Parity and menopausal age were not associated with adiposity measures. Although postmenopausal women had increased BMI, VAT, and SAT, the association was predominantly due to age.
    The Journal of Clinical Endocrinology and Metabolism 10/2012; 98(1). DOI:10.1210/jc.2012-1785 · 6.31 Impact Factor
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    ABSTRACT: Effective mentoring is an important component of academic success. Few programs exist to both improve the effectiveness of established mentors and cultivate a multispecialty mentoring community. In 2008, in response to a faculty survey on mentoring, leaders at Brigham and Women's Hospital developed the Faculty Mentoring Leadership Program as a peer learning experience for midcareer and senior faculty physician and scientist mentors to enhance their skills and leadership in mentoring and create a supportive community of mentors. A planning group representing key administrative, educational, clinical, and research mentorship constituencies designed the nine-month course.Participants met monthly for an hour and a half during lunchtime. Two cofacilitators engaged the diverse group of 16 participants in interactive discussions about cases based on the participants' experiences. While the cofacilitators discussed with the participants the dyadic mentor-mentee relationship, they specifically emphasized the value of engaging multiple mentors and establishing mentoring networks. In response to postsession and postcourse (both immediately and after six months) self-assessments, participants reported substantive gains in their mentoring confidence and effectiveness, experienced a renewed sense of enthusiasm for mentoring, and took initial steps to build a diverse network of mentoring relationships.In this article, the authors describe the rationale, design, implementation, assessment, and ongoing impact of this innovative faculty mentoring leadership program. They also share lessons learned for other institutions that are contemplating developing a similar faculty mentoring program.
    Academic medicine: journal of the Association of American Medical Colleges 10/2012; 87(12). DOI:10.1097/ACM.0b013e3182712cff · 3.47 Impact Factor
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    ABSTRACT: Abstract Background: Although women comprise an increasing proportion of US medical school faculty, they are underrepresented at higher ranks. Lack of effective mentoring may contribute to this disparity. We examined the role of academic rank, research focus, parenting, and part-time work on mentoring importance, needs, and gaps. Methods: In 2009, women faculty members of Harvard Medical School and Harvard School of Dental Medicine were invited by e-mail to participate in a 28-item structured questionnaire. Descriptive statistics and adjusted logistic regressions were used to identify relevant themes. Results: Of the 1179 women faculty who responded, 54% had a mentor, and 72% without a mentor desired mentoring. The most important mentor characteristic identified was availability. Respondents endorsed most mentoring areas as important (range 51%-99%); 52% of respondents identified mentoring gaps (area important and unmet) in developing and achieving career goals and negotiation skills. Interest in mentorship for skills needed for advancement (research and lecturing skills and getting national recognition) was significantly associated with lower rank. Assistant professors were most likely to identify mentoring related to writing and publishing articles, whereas associate professors identified program development/strategic planning as important. Faculty who are parents identified gaps in finding collaborators and balancing work and family life. Conclusions: This survey identified a desire for both comprehensive and targeted mentoring to address gaps that varied by faculty rank, research focus, parenting, and work time status. Strategies to enhance mentoring should address career stages and include a structured framework for assessing mentoring gaps.
    Journal of Women's Health 08/2012; DOI:10.1089/jwh.2012.3529 · 1.90 Impact Factor
  • Aditi R Saxena, Ellen W Seely
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    ABSTRACT: Evaluation of: Kwasniewska M, Pikala M, Kaczmarczyk-Chalas K et al. Smoking status, the menopausal transition, and metabolic syndrome in women. Menopause 19, 194-201 (2012). This study was a cross-sectional analysis of 7462 randomly selected Polish women, aged 20-74 years, who had completed the WOBASZ, a Polish National Multicenter Health Survey. Components of metabolic syndrome, including waist circumference, fasting plasma glucose, triglycerides, blood pressure and high-density lipoprotein cholesterol were measured in addition to BMI. The authors assessed the prevalence of metabolic syndrome in pre- and postmenopausal women with respect to smoking status (current smoking, past smoking or never smoked). They determined that the prevalence of metabolic syndrome was 3.3-fold higher in postmenopausal women compared with premenopausal women and that past smoking was associated with higher odds of metabolic syndrome, regardless of menopausal status. Previous studies that have examined the risk of developing metabolic syndrome after smoking cessation did not assess menopausal status in women, and also used reported rather than measured anthropomorphic data. This study provides an additional perspective on the metabolic changes that may occur in women after smoking cessation.
    Women s Health 07/2012; 8(4):367-9. DOI:10.2217/whe.12.31
  • Aditi R Saxena, Ellen W Seely
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    ABSTRACT: OBJECTIVE: In postmenopausal women, a relationship between luteinizing hormone (LH) and cortisol levels has been suggested. Furthermore, LH receptors in the adrenal gland have been shown to mediate adrenocorticotropic hormone-independent Cushing syndrome. In contrast, follicle-stimulating hormone (FSH) receptors have not been found in the adrenal gland. Our objective was to explore the relationship of LH with adrenal function in postmenopausal women, as assessed by 24-hour urinary free cortisol (UFC) and aldosterone excretion rate (AER). METHODS: Participants were studied at a single time point in the fasting state in the Clinical Research Center of Brigham and Women's Hospital. We studied 36 postmenopausal women in sodium balance to control for variation in endogenous levels of plasma renin activity and angiotensin II. Serum cortisol, aldosterone, LH, and FSH levels were measured, as were 24-hour UFC and AER. Correlations were performed by calculation of Pearson's correlation coefficient. RESULTS: Serum LH correlated significantly with log-transformed UFC (r = 0.43, P = 0.01) and inversely with log AER (r = -0.50, P = 0.002). We found no correlation of serum LH with serum cortisol or aldosterone, nor did we find correlation of FSH with these parameters. CONCLUSIONS: In postmenopausal women, serum LH levels correlate significantly with UFC (positively) and AER (negatively). LH stimulation may induce subtle shifts in adrenal function toward cortisol secretion.
    Menopause (New York, N.Y.) 06/2012; DOI:10.1097/gme.0b013e31825540c4 · 2.81 Impact Factor

Publication Stats

4k Citations
889.87 Total Impact Points


  • 1992–2015
    • Harvard Medical School
      • Department of Medicine
      Boston, Massachusetts, United States
    • Tufts University
      Бостон, Georgia, United States
    • Boston University
      Boston, Massachusetts, United States
  • 1989–2015
    • Brigham and Women's Hospital
      • • Department of Medicine
      • • Division of Endocrinology, Diabetes and Hypertension
      • • Department of Obstetrics and Gynecology
      Boston, Massachusetts, United States
  • 1999–2014
    • Harvard University
      Cambridge, Massachusetts, United States
  • 2012
    • Partners HealthCare
      Boston, Massachusetts, United States
  • 2011
    • Yale University
      New Haven, Connecticut, United States
  • 2009
    • Northwestern University
      • Division of Endocrinology, Metabolism and Molecular Medicine
      Evanston, IL, United States
  • 2007
    • Joslin Diabetes Center
      Boston, Massachusetts, United States
  • 2006
    • Massachusetts Institute of Technology
      Cambridge, Massachusetts, United States
  • 2005
    • University of Pittsburgh
      • Department of Obstetrics, Gynecology and Reproductive Sciences
      Pittsburgh, Pennsylvania, United States
  • 2003
    • Beverly Hospital, Boston MA
      BVY, Massachusetts, United States
  • 2000
    • University of Utah
      Salt Lake City, Utah, United States
  • 1998
    • University of Massachusetts Boston
      Boston, Massachusetts, United States
  • 1994
    • Royal North Shore Hospital
      Sydney, New South Wales, Australia