Monday, May 15, 2017

A Day by Women, for Women


Image result for ann reeves jarvisYesterday was Mother’s Day, and while reading through the Sunday Philadelphia Inquirer I discovered something that as a daughter, mother and physician I never knew before:  rather than being a “Hallmark holiday”, Mother’s Day actually has its roots in a social reform and political action movement.  I learned that in 1858 social activist Ann Reeves Jarvis organized “Mother’s Day Work Clubs” in response to high maternal and infant mortality rates in the US.  The coalition raised money to buy medicines and hire mothers’ helpers for those suffering from tuberculosis,  inspect food and milk for contamination, and visit homes to teach mothers how to improve sanitary conditions.  
The Maternalist campaign (as it was subsequently dubbed) grew to over 10 million American women and became a formidable Washington lobby.  The funding secured for state-level programs on maternal and infant hygiene, prenatal health clinics, and visiting nurses for pregnant and new mothers contributed to a 10% decline in the overall infant mortality rate.  
Ann’s daughter Anna subsequently started a campaign to create a day commemorating the efforts and service of mothers like her own.  In 1908, the first official Mother’s Day was celebrated by 15,000 people in Grafton and Philadelphia.  A few years later in 1914, President Woodrow Wilson signed a resolution designating the second Sunday of May as Mother’s Day.  In light of all of the sociopolitical controversy and challenges facing us today, it’s heartening to know that women are ready to protect and defend the work of the Maternalists that started more than a century ago – and not only on Mother’s Day, but every day.   


 

       Judith Wolf, MD                                       Associate Director, WHEP

Friday, May 12, 2017

Is Gluten Allergy Even Real?!

Have you ever seen labels at grocery stores claiming to be gluten free on items ranging from certain crackers to ketchup and wondered what gluten really is-- a made up word from marketing experts to start yet another diet fad or a legitimate condition?

Truth is, gluten is a protein found within wheat, barley, and rye (grains that are surprisingly found a wide variety of foods). Many of us do not have the enzymes to completely break down this protein, which often remains undigested in our gut. For those of us who are gluten tolerant, these peptides or pieces of proteins are eliminated. However, for those who are gluten intolerant, the peptides are dangerous to the body, because they may cross our intestinal barrier and cause the immune system to attack the villi of the intestine that are important for absorbing nutrients. Hence, this autoimmune disease may eventually lead to malabsorption which can be very serious.

The truest label of gluten intolerance is known as celiac disease, which affects 1 in 133 individuals though up to 85% have yet to be diagnosed.  Both genetic (1 in 10 people with affected close relatives are at risk) and environmental circumstances can play a role. The symptoms of celiac disease range from bloating, gas, diarrhea, weight loss, depression, abdominal pain, anemia, and with children, distended abdomen, dental defects, and failure to thrive. Sometimes, this disease may also cause dermatitis herpetiformis (DH) that can cause itchy blisters. The only known treatment is to have a gluten-free diet; taking probiotics is also encouraged. However, not all individuals who believe they are allergic to gluten may have celiac but are in fact allergic to other foods that may be associated with wheat or are victims of a "created disease" without an underlying biological condition. 

The problem today is that there is a significant rise in celiac disease. In the 1950s prevalence of the disease was approximately 0.2%. Today, however, this number has grown to 1% which may not seem large but statistically is 3 million people out of 300 million individuals. According to Dr. Guandalini in an interview with University of Chicago, this rise may be attributed to the extreme cleanliness many children born in the United States are accustomed to. This hygiene hypothesis suggests that babies are not exposed to the same level of antigens and bacteria as in the past. Consequently, our gut immune system  responds in a autoimmune or allergic fashion.
What is your opinion concerning combating this disease in our every day life?

Meghana Pisupati
IMS 2017

Thursday, May 4, 2017

Research Looks Into Where Healthcare Dollars Are Being Spent





Ever wonder what your healthcare dollars go toward?  New data reveal that spending from 1996 to 2013 had gone far beyond individual treatment and helping alleviate co-pays for doctors' visits. The research breaks it down by 155 conditions, 6 types of health care, and 38 age and sex categories. Despite the growth in healthcare spending very little is known about how spending on each condition varies, especially by age. Healthcare spending in the United States is greater than in any other country in the world, so it’s very important to understand why. This study looked at government budgets, insurance claims, facility surveys, household surveys, and official US records from 1996-2013.


According to this study, the three most expensive conditions in 2013 were:
1)   Diabetes - $101 billion
2)   Ischemic heart disease - $88 billion
3)   Low back & neck pain - $88 billion
Another finding from this study showed that 38% of personal health spending in 2013 was for people over age 65.  Treatment of two conditions, hypertension and hyperlipidemia, were among the top 20 incurring spending. These results are not surprising, but it’s good to have factual evidence for it.

What makes this study different from its predecessors is that it “contains information and methodological improvements that were lacking in existing studies.” This will help “researchers and policy makers to focus more precisely on which conditions had increased spending, as well as on the ages and types of care where growth in health care spending is most accurate.” Hopefully this information will help to control US healthcare spending and at the very least provide a framework for future investigations into health care spending. Thoughts?



 Rachel Miller 
DUCOM 2017

Thursday, April 20, 2017

Pregnancy and Pertussis Prevention




Pregnancy is often considered one of the most beautiful yet complicated experiences in a woman's life. Woman are justifiably concerned about ensuring that they give their children the best start in life that they possibly can. Because of this love for their unborn child, women often modify their diets, stop drinking coffee and alcohol, and take the necessary vitamins and vaccines.  One of these important vaccines, Tdap (tetanus, diphtheria, acellular pertussis), can protect infants for the first 2 months from pertussis, better known as whooping cough. Infants younger than 2 months of age are not eligible to receive the vaccine, but their mothers are. When pregnant women are vaccinated, they develop protective antibodies that cross the placenta into the infant's bloodstream.  The ideal time for pregnant women to receive this vaccine is between 27 and 36 weeks of gestation.  And any adult planning to be in close contact with the newborn should also be vaccinated.
Currently, there are an estimated 16 million cases of whooping cough around the world and 195,000 deaths annually. This staggering number represents individuals of varying ages.  For most adolescents and adults, pertussis presents most often as a lingering, troublesome cough.  However, for infants under a year of age, pertussis can be particularly severe and potentially fatal. This is because the coughing spasms associated with pertussis may interfere with the ability of infants to breathe.                                   
As seen in a study conducted by Kaiser Permanente*, vaccination during pregnancy resulted in up to 91.4% protective efficacy during the first 2 months of the child's life - a very vulnerable period.  The CDC's vaccine schedule for children recommends a series of shots between 2 months-6 years with a closely related vaccine known as DTaP . This vaccine has shown 85% protection after the second shot at 4 months.

So remember ladies, stay healthy, fit, and get your vaccines!


* Baxter R, Bartlett J, Fireman B, et al.  Effectiveness of vaccination during pregnancy to prevent infant pertussis. [published online April 3, 2017]. Pediatrics. doi: 10.1542/peds.2016-4091





Wednesday, March 29, 2017

Pushing Away the Pelvic Exam

Going to the gynecologist can sometimes be a scary thing, especially when many women don't know what to expect. However, the major reason is because of the infamous pelvic exam that many of us dread. Pelvic exams are a way for physicians to look for illness in organs of the body such as the vulva, uterus, cervix, etc. This exam has traditionally been conducted annually (though this may be changing), when a woman is pregnant, or if she has an infection. Generally, this test should not be conducted during one's menstrual period, or post douche, use of birth control cream, or sex. Further, this examination can often be uncomfortable because of its invasive nature and use of hands. Often times, cultural or social barriers may be the root cause of a patient's hesitation to get this examination.

Pelvic exams can detect diseases ranging from ovarian cancer to STIs like bacterial vaginosis, genital herpes, trichomoniasis.  In fact, the United States has been shown to conduct twice as many cystectomies and hysterectomies compared to European countries because of findings on bimanual examinations.

However, often times, these exams may reveal benign conditions that can cause anxiety due to the need for further testing. Moreover, these tests are not the most effective screening tool to detect cancer, and additional measures are needed.

Therefore, considering these pros and cons, patients should have a say in and understand why their pelvic exam is being conducted.  Their awareness and understanding about its utility will help make them more comfortable with the exam. To ensure this sense of partnership between patients and physicians, medical evidence and personal support must be given to women to assure them that they are empowered in their decision making.




Meghana Pisupati

IMS 2017

Thursday, March 23, 2017

Not So Stoked about these Stroke Treatment Disparities

One second has the potential to change a life. Never has this been truer than for patients who suffer from a stroke, an unpredictable condition which may occur at any time or place. Strokes are the fifth major leading cause of death within the United States, and the increase in survival rate post incidence can be attributed to the immense medical advances.

There are two types of strokes, an ischemic stroke and hemorrhagic one. Hemorrhagic strokes are caused by a blood vessel that has broken open, creating a rupture, and is treated by stopping the bleeding. In contrast, majority of the strokes are ischemic or when there is a blood clot in a vessel that goes to the brain. These are treated by removing the clot with medication such as tissue plasminogen activator (tPA was approved by the FDA in 1996).


tPA, or Alteplase is administered via IV through the arm and works to dissolve a clot and improve blood flow after a CT or MRI. This form of treatment must be given within 3-4.5 hours in eligible patients, and often times, has full recovery in many patients. Often times, the administration of tPA may prevent 1 out of 6 patients from death or long term disabilities and other brain injuries.

So what's the problem with this drug you ask? Recent studies conducted by Dr. Archit Bhatt and colleagues at the Providence Brain and Spine Institute identified three factors that affected disparities amongst patients who were able to receive ultrafast door-to-needle times. Of the three are arrival time, day, and surprisingly, sex. Men were 2.2 times more likely to receive this treatment compared to women. These staggering results prompt me to ask why these disparities exist.

Similar results were observed by Dr. Tracy Madsen at Brown's Warren Alpert Medical School, where of 563,087 stroke patients from 2005-2011, only 3.8% had received tPA. What appears to be even more appalling was the fact that there were racial as well as gender biases in concerns to the receiving of tPA. Moreover, the type of insurance seemed to play a role in treatment, since 29% private insurance holders were more likely to receive this drug compared to those on Medicare, even though treating stroke patients with tPA may save payers $25,000 per patient in a lifetime.  Certainly, more research needs to be conducted on the reasoning, both economical and social, behind why more people who need this form of treatment and are within the 3 hour time slot are not in fact receiving.

Comment below to let us know how to achieve this!

Meghana Pisupati
IMS 2017

Thursday, March 9, 2017

A Day Without a Woman and Why It Matters



Image result for A day without a WomanYesterday we celebrated ourselves, women and all gender oppressed people of all backgrounds, race, nationality, immigration status, age or disability, religion, sexual identity, gender expression, and economic status.  

On January 21st over 5 Million US demonstrators joined the Women’s March worldwide and over 1 Million in DC to make our voices heard. But it’s not over. We stood united yesterday in solidarity making March 8th A Day Without a Women to speak against for inequity, injustice and for the human rights of women.
The first International Women’s Day took place in 1911 in Denmark, Switzerland, Germany and Austria (According to the International Women’s Day website).  On March 8th we reflect on the courageous acts of ordinary women, who have and continue to play an extraordinary role to eradicate the inequities that continue to plague women today: receiving lower wages, discrimination, sexual harassment and job insecurity (to name a few).
Why does it matter? According to the Economist Gender Equality Scale: Glass Ceiling Index, a metric that demonstrates where women have the best chance of equal treatment at work, categorized the US below average in significant areas, when compared to 28 other Countries. The Organization for Economic Co-operation and Development OECD performs an international biannual analysis of the economic trend to promote policies that will improve the economic and social well-being of people. The US, when compared to other Countries, was below the OECD average on wage gap equity, child care cost, paid maternity leave and women employed in parliament and government; and barely above average on gender equality for higher education.  Although the OECD has showed improvements on the gender equity on an international scale, Finland scoring the highest among 28 Countries, the wage gap continues to widened, furthering the notion that there is much work to be done.  This is among other women rights issues that have stemmed from the current administration, further jeopardizing our reproductive rights: the defunding of Planned Parenthood and overturning Roe vs. Wade. 
Yesterday, united in love and in the spirit of liberation, women:
  1. took the day off from (UN) paid labor
  2. avoided shopping for one day (unless from women or minority owned businesses)
  3. wore RED in solidarity with A Day Without a Women
We won’t stop until we close the doors to discrimination, gender injustice and all acts of oppression. Women’s rights are human rights.

For more information:

Lidyvez Sawyer, MPH, Director
Office of Diversity, Equity & Inclusion
Drexel University College of Medicine