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

Sunday, February 26, 2017

Calling for a Transformation in Trans-Health

The right to health means that every individual has the right to the highest attainable standard of physical and mental health, according to the National Economic and Social Rights Initiative. This means that this accessibility should be provided to individuals despite gender, race, sex, or economic standings. 

However, this standard for health seems to falter even in this progressive day and age when it comes to individuals who have courageously chosen to confront their gender dysphoria and opt toward a more fulfilling life. Studies estimate that there are approximately 1.4 million adults who identify as transgender today in the United States, yet healthcare accessibility remains sparse. This is because of common misconceptions concerning trans-healthcare requirements, and the lack of insurance coverage on behalf of a wide number of providers. Moreover, it is estimated that only approximately 7% of medical schools incorporate LGBTQ related curriculum during their preclinical years, which explains the lack of specialists and refusal of care on the basis of expertise. 
Therefore, in order to enable transgender individuals to have the same access to care as cis individuals, there must be better health care insurance, specialized for the needs of transgender individuals and an incorporation of transgender healthcare practices into medical school curricula. The raising of awareness concerning transgender healthcare needs and medication will prove immensely beneficial to truly enable heath care access for all, without stigma, prejudice, or ignorance. What other ways can we help to improve access for everyone? Comment below!       

Meghana Pisupati
Drexel IMS 2017

Monday, February 20, 2017

Reinstated Mexico City Policy: What does it mean?

Two days after the Women’s March, Trump signed an executive order that reinstated a policy that bans federal funds going to international groups that provide or discuss abortion as an option for family planning.  (Of note, federal funds have never been used to directly provide abortions in other countries.)  This restriction of funds is devastating to groups like Marie Stropes International and Planned Parenthood International who provide women in developing counties access to family planning services, such as contraception. 

This policy has gained and loss support over the past two decades.  President Ronald Reagan first instituted the ban in 1984 at the United Nations conference in Mexico City (hence the name). Clinton than rescinded the ban during his presidency.  President George W Bush reinstated the ban and President Obama overturned it once again.  Interestingly, a study done at Stanford University in 2011 showed during the Bush administration that contraceptive use in Africa was reduced and abortion rates were increased, underscoring the importance of family planning services. 

But what does this policy really mean for the women living in these developing countries? Marie Strope International estimates that with this policy there will be 6.5 million unintentional pregnancies, 2.2 million abortions and 21, 700 women dying in pregnancy or childbirth.  After the executive order was signed, Cecile Richards, the president of Planned Parenthood tweeted  The world’s most vulnerable women will suffer as a direct result of this policy, which undermines years of effort to improve women’s health.”

So although Trump thinks that he is re-introducing a policy that is “pro-life”, this policy increases rates of abortion and directly causes women’s deaths. 

Thank You.

To all the women of the Women’s March, thank you. 

Thank you for representing unity.  This march brought together all genders, races and religions.  It highlighted that although different, many people stand for equality and are willing to fight for it.  Almost half a million in DC alone came together for women. 

Thank you for representing strength. Young women and girls around the world saw people come together for them - showing them they have value and are important. 

Thank you for representing justice.  As many signs read: “Women’s Rights are Human Rights”.  Reminding the country that it is worth fighting for reproductive rights, equal pay and education of women around the world. 

And thank you to the men that marched.  Your support was seen and spoke volumes.  Your presence showed the respect you hold for the women in your life.

Nora Sherry 
DUCOM 2017

Wednesday, February 8, 2017

Legends of Today and Pioneers of our Past

February is Black History Month
This year, we welcome BHM during a time of adversity, divisiveness and for most of us confusion, driven by our political shift in power and differences of societal views.  Nonetheless, we cannot ignore the long line of historical events that continue to shape us all today, the resilience and determination of our ancestors and the affluence and richness of our culture. Not only who we are, where we came from.  In the midst of our fears, hopelessness and slight trepidation of where we are headed as a Country and as a UNITED front, let’s take a moment to reflect on the great pioneers of our time and the past.
For most millennials, the great African American stars of today would be a Beyoncé, known for her massively successful career and for being the winner of 20 Grammy Awards, to say the least. Serena Williams, often called the greatest tennis player of all time, who held the title of No. 1 for 300 weeks, and currently holds the title for most Open-era, 7 Wimbledon, to name a few. Or Ta-Nehsi Coates, recognized today as the highest profile African American Writer and Journalist, winner of the 2015 National Book Award Nonfiction.  And our esteemed former and first A.A POTUS, Mr. Barak Obama; Coretta Scott King, Mohamed Ali, MLK Jr, Malcolm X, Rep. John Lewis, and boy does the list go on…
Have you asked yourself about the legends that existed before your time and who they were? Let’s start with Dorothy Dandridge, 1st A.A woman to be nominated for an Academy Award during a time of great segregation, the 1950’s.  Jessie Owens, a four-time Olympic gold medalist at the 1936 Berlin Olympics, during a time when Hitler was hailed for his egregious and heinous crimes and swastika symbols were freely displayed on Olympic stage. Today, the Jesse Owens Award is regarded as the USA Track and Field’s highest honor. Novelist, essayist and playwright, James Baldwin, a Harlem native who remains the best of his time, capturing with truth and unique articulation the social injustice and inequality that remains tangible today, more than a decade preceding the Civil Rights movement, publishing “Go Tell it on the Mountain” in 1953.  The history of our African American pioneers are abundant; encompassing great intellects of the 18th century, such as Booker T. Washington, founder of Tuskegee Institute and Dr. W.E.B. Dubois, American educator and the 1st A.A to earn a PhD from Harvard in 1909.  Adventurist, such as Bessie Coleman, the 1st A.A woman to earn an international pilot license in 1921, recognized for her daring stunts in air shows performed around the world, while refusing to be slowed down by racism. And Civil Rights Activists who refused to accept the cruel act of inhumanity, slavery and injustice: Dred Scott (1795-1858), Nat Turner (1800-1831), Harriet Tubman (1822-1913), and Fredrick Douglass (1818-1995).
We must always keep in mind: We cannot fully understand who we are, and in its entirety where we are going, unless we understand where we have come from.
Mrs. Lidyvez Sawyer, MPH
Drexel University College of Medicine
Office of Diversity, Equity & inclusion