A guide to Cultural Competency for LGBTQ Patients

Cultural competency spans far beyond ideas of just race, ethnicity and cultural practices. One of the areas where additional competency is greatly needed is the field of LGBTQ patient care. Many LGBTQ individuals face unique challenges in the healthcare system including unconscious bias, discrimination, prejudice and altogether rejection. In addition, hetero-normative language and practices can cause patients to feel uncomfortable even before the care process really begins.

In an effort to advise health and social services agencies on best practices, the National LGBT Cancer Network has created a guide for effective competency training.  This can serve as a valuable tool for organizations looking to strengthen their practice and competency with LGBTQ populations. It can also provide useful information for individuals as well. For current and future physicians, being familiar with the practices outlined can help you become a training leader within your work place, and an advocate for better LGBTQ patient care.


Resources:

Best Practices in LGBTQ Cultural Competency Training 

National LGBT Cancer Network Website 

Kaiser Foundation Policy Brief: Health and Access to Care and Coverage for LGBT individuals in the U.S.

Infectious Disease in the News Pt. II: Enterovirus D68

Enteroviruses are single-stranded RNA viruses that commonly cause disease in the warmer months of the year.  Some of the better known enteroviruses include polio, Coxsackie A and B, and echovirus.  They can be found in the respiratory secretions and stool of an infected person.   Most infections with non-polio enteroviruses are asymptomatic or cause a brief febrile illness, but some have been associated with pleurodynia (inflammation  of the lining of the lung), myopericarditis (inflammation of the lining of the heart), acute hemorrhagic conjunctivitis, aseptic (non-bacterial) meningitis, encephalitis, herpangina (painful mouth blisters), and hand-foot-and-mouth disease.

Enterovirus D68 is one of more than 100 non-polio enteroviruses.  First identified in California in 1962, the virus caused sporadic illness similar to the common cold until August 2014 when cases of severe respiratory disease in children were diagnosed in the Midwest.  Since that time, cases have been reported from 43 states, the District of Columbia, and Canada.  Some have required hospitalization and respiratory support.  Children with asthma appear to be at increased risk for more severe respiratory illness.  There have also been reports of associated polio-like paralysis though this is less definitive. No antiviral medications are available to treat enteroviruses, and there are no vaccines to prevent disease (other than polio vaccine).

Like other respiratory viruses, D68 spreads from person to person through coughing, sneezing, or touching a surface previously touched by an infected person.  So, the best way to protect yourself and prevent spread is through good personal hygiene – hand-washing, avoiding touching your eyes, nose and mouth, not sharing cups or eating utensils, disinfecting commonly used surfaces, and covering coughs and sneezes with a tissue.

Resources:

Enterovirius D68 CDC Information page 

What Parents Need to Know (Healthy Children.org) 

Hand Washing: A Powerful Antidote to Illness (Healthy Children.org) 

A Closer look at Gender Pay Inequality

The American Association of University Women (AAUW) recently released their fall 2014 report "The Simple Truth About the Gender Pay Gap" that gives a great overview of pay inequality in America based on gender. The report looks closely at differences by race, specific occupations and within all 50 states. It also addresses common misconceptions about why this gap exists. Most importantly, it addresses how this often overlooked problem effects women and their families and why it is something that needs to be addressed, especially in light of the Paycheck Fairness act being blocked by the senate this past September. For many women equal pay could mean better life for themselves and their families, as higher income is associated with lower stress, greater autonomy and better overall health. Everyone has something to gain if we can get rid of the gender gap.

Resources: 
AAUW Gender Gap Summary Page

The Simple Truth About the Gender Pay Gap - Full Report 

More Protection From Ebola for Hospital Staff

Adding to our post from yesterday,  news has been circulating evaluating how hospitals are handling Ebola  and the risks it can pose to staff. Particularly, nurses have began to speak out ever since the Dallas nurse who was recently diagnosed Ebola (After treating the first patient in the U.S. to develop the disease)  was said to have contracted it through a "breach in protocol". Now, many are speaking out about the protocol in their own hospitals to spread awareness and cause change.  The article Ebola–RNs Call for Highest Standards for Protective Equipment, including Hazmat Suits and Training gives insight into what nurses are reporting across the country. It is hopeful as healthcare providers take a stand, both the hospitals and those in policy will work to make the handling of infectious diseases safer for both patients and the workers providing their care. 

Infectious Disease in the News Pt. I: Ebola

Ebola is caused by infection with one of five filovirus strains, a type of single-stranded RNA virus.  It can be transmitted to people from wild animals and further spreads via human-to-human transmission, causing severe, often fatal disease in humans and non-human primates.  Although its natural reservoir is unknown, fruit bats have been implicated. 

Ebola was first discovered in 1976 near the Ebola River in the Democratic Republic of the Congo. Over the years, sporadic outbreaks have occurred in remote African villages.  The current outbreak was first reported in March 2014.  It is the largest in history, involving both rural and urban areas in multiple countries in West Africa, and has been designated the first Ebola epidemic the world has ever known. Human-to-human transmission occurs via direct contact (through broken skin or mucous membranes) with blood, and other bodily fluids (e.g. saliva, stool, semen, breast milk) of infected people.  Contaminated surfaces and materials such as clothing and bedding also serve as sources of infection.     

Previously known as Ebola hemorrhagic fever because of the internal and external bleeding that can occur, the illness has an incubation period between exposure and the onset of clinical illness that ranges from 2-21 days.  Humans are not infectious until they develop symptoms which typically mimic a flu-like illness with the sudden onset of fever, fatigue, muscle pain, headache and sore throat. This is followed by vomiting, diarrhea, rash, impaired kidney and liver function, and in some cases bleeding.  Leukopenia (low white blood cell counts), thrombocytopenia (low platelet counts), and elevated liver enzymes can be seen.   A definitive diagnosis can be made using specialized testing of blood samples (e.g. ELISA, RT-PCR, electron microscopy or cell culture) under maximum biological containment conditions. 

The average case fatality rate is ~50%, though can be as high as 90%.   There are no specific, proven therapies or vaccines for Ebola, though several health workers have been treated with ZMapp, an investigational product comprised of three humanized monoclonal antibodies.  There is also interest in empirically transfusing convalescent whole blood or plasma from patients who have recovered to patients with early Ebola disease.  Supportive care may improve survival, but this unfortunately is lacking in many African countries.  Gowns, gloves, masks and goggles or face shields should be worn by healthcare personnel and family members caring for ill patients, and hand washing should occur often. These have also been in short supply in Africa and strict infection control practices have been lacking. 

Current CDC recommendations for individuals who may have had contact with ill patients include isolation (staying at home and avoiding public contact) and monitoring daily temperatures and symptoms for 21 days to detect any potential illness as quickly as possible.  

Resources: 

CDC Ebola information page

Tis' the (Flu) Season! - Facts about the Flu and Dispelled Myths

Every September when we think about “back to school” season, we should also think about another season just around the corner - flu season.  Many people shrug off getting vaccinated against the flu with a variety of excuses like: “I never get the flu”, “the flu is just like a bad cold” or “I’d rather get the flu than get a flu shot which GIVES me the flu”.  So, let’s dispel some of these misconceptions.

How Dangerous is Influenza?

The flu is not just another cold.  In addition to making you feel absolutely miserable for days with fever, congestion, cough and body aches, it is far more dangerous than the common cold or other circulating upper respiratory infections.  Each year approximately 200,000 people in the U.S. are hospitalized due to influenza, and up to 49,000 die.  Compare that to the annual mortality from breast cancer (~40,000) or AIDS (~19,000) in the United States.  Although morbidity and mortality are generally highest among young children and adults over age 65, last year, 60% of hospitalizations occurred among adults between the ages of 18 and 64 – those who had vaccination rates of only 37%.    

When is Flu Season?

Flu seasons are unpredictable and vary from year to year in terms of timing, severity, and length.  Although influenza activity most commonly peaks in the U.S. between December and February, some years have seen cases begin as early as October and continue as late as May.

How is Flu Spread?

Influenza is spread by droplets up to 6 feet away through coughing, sneezing or talking. You can also get the flu by touching a surface or object that has flu virus on it and then touching your mouth or nose.  Most people know they can get the flu from patients and coworkers who are sick, but don’t realize they can spread it to others even if they don’t feel sick.  Most healthy adults can infect others beginning 1 day before symptoms develop and up to 5 to 7 days after becoming sick.  Approximately 20% to 30% of people carrying the influenza virus have no symptoms.

Who Should Get Vaccinated?

CDC recommends a yearly flu vaccine(http://www.cdc.gov/flu/protect/vaccine/index.htm) for everyone 6 months of age and older, preferably by October, since it takes about two weeks after vaccination for an immune response to develop. 

Individuals at particularly high risk for influenza include:

• Children younger than 5 (especially those younger than 2 years of age)

•Adults 65 and older

•Pregnant women

•People with chronic health issues like asthma, diabetes, heart disease, cancer and HIV/AIDS.

Dispelling the Myths

“The flu vaccine can give you the flu”

Injectable flu vaccines contain inactivated, non-infectious virus particles.  Although the nasal spray vaccine does contains live flu virus, it is attenuated (weakened) in such a way to be able to stimulate immunity without causing illness.  People not only mistake the side effects of the vaccine for the flu but also erroneously attribute illness with other unrelated cold viruses to the flu. 

“I can take antibiotics if I get the flu”

Antibiotics only treat bacterial infections – not the influenza virus.  Although there are antiviral medications against the flu, to be effective in reducing the duration and severity of illness, they must be taken within 48 hours of the beginning of symptoms. 

“I don't need to get a flu shot every year”

Influenza viruses are constantly changing (mutating), so each year flu vaccines are updated to protect against the most common circulating viruses.  Although protection from the vaccine decreases over time, protection typically lasts about a year.

“Pregnant women should not get a flu shot”

Pregnant women and their offspring are at very high risk for complications from the flu.  Pregnant women are 7 times more likely to be hospitalized than non-pregnant women and account for 5% of all flu-related deaths.  All pregnant women should to be vaccinated with inactivated flu vaccine.   

“Getting the flu vaccination is all I need to do to protect myself from the flu.”

Besides vaccination, avoid contact with people who have the flu and wash your hands frequently!

Bottom Line

By getting vaccinated and practicing good personal hygiene, you not only help to protect yourself, but your family, friends and patients.

Thoughts on Feminism

Feminism is getting a lot of buzz lately, with many examples of violence and unequal treatment towards women flooding the airways. However, there are mixed ideas about what feminism is, who is a feminist and the ultimate goals surrounding the idea.

The answer is very simple. Feminism is an ideology that focuses on creating equal rights for women and feminine qualities. Traditionally, women have not had equal opportunities to many things (employment, voting, education), which caused feminist movements to develop. There have been significant and positive changes in women's rights, but there still strides to be made. Women are still paid less than men (for the same work) and experience violence on a much higher scale.  Because of factors such as these exist, the focus of feminist ideals is mostly on women. However, men are not excluded. Feminism seeks to defend men who are perceived as feminine from back lash that should not exist in the first place. Feminism tells us that it is okay for a man to express his feelings and he should not be afraid of being "less than a man". Feminism glorifies a man in his role as a father, instead of making him think that is a woman's job. Feminism does not come at the expense of men and NEVER seeks to put a man down simply for his chromosomal make up.

At the same time, feminism does not seek to control women, want them to dominate men, or force them into certain careers. If a woman wants to be a stay at home mother, that is great. Feminism wants to make sure that she has the resources to look after her children and that society does not devalue the hard work that she does.

Some people may have made you think otherwise in the past, but feminism is not a bad word. It is not just about women; it impacts men as well and won't be recognized without the help of men. Thankfully, we are seeing more attention being paid to this issue. From Emma Watson's speech for the He for She Campaign to Joseph Gordon Levitt's Re: Feminism video. However, it would be great to see these messages promoted beyond celebrities and national meetings.

Feminism needs to be an everyday word and practice. Gender equality is an essential step in improving the lives of all people. Remember, just because you do not personally feel that you face inequities does not mean that millions of people do not experiences them everyday.

Mentioned Links: 
He for She Campaign Website:  He For She.org 

Preventative Health Lecture Follow-up: Talking with Patients and Vaccinations

After Dr. Nunez’s informative and entertaining lecture on Women’s Health and Prevention Issues this afternoon, a few additional thoughts came to mind.  As she pointed out, sometimes there’s a little bit of a disconnect (or at least order of priorities) between what the patient is seeking help for and what the physician considers most urgent.  In the case presented, the patient was concerned about joint pain (osteoarthritis), but the physician would also be concerned about cardiovascular risk (hypertension, obesity, hyperlipidemia in a post-menopausal woman).  One way of trying to tie the two together to unite common goals might be to explain to the patient that weight loss (which would benefit her lipids and blood pressure control) would also likely ease the stress on her joints (knees) and decrease some of the pain she is experiencing.

On a different note, physicians often forget about vaccinations as an effective preventive care measure.  This patient should have been receiving annual flu vaccinations (as we all should) and should also be asked about the last time she received a tetanus vaccine.  If she is due for a tetanus shot (which many adults neglect/forget since it is received ~ every 10 years), she should receive Tdap.  This tetanus toxoid combined with pertussis vaccine is now recommended for all adults who have not already received it and is especially important for those who may have small children (e.g. grandchildren) in their household, since pertussis is most serious, even potentially fatal, in infants.  When she turns 60, she will be eligible for the shingles vaccine (ZOSTAVAX) and at age 65 for two pneumococcal vaccines (PREVNAR 13 and PNEUMOVAX 23, which are recommended to be given sequentially).  If she were part of a high risk group such as individuals with diabetes, heart disease, chronic liver or lung disease, pneumococcal vaccination would be administered at a younger age.  Guidelines are currently in flux with the availability of two vaccines now for adults, so stay tuned for the CDC to issue new guidelines soon!

Resources:

http://www.cdc.gov/vaccines/schedules/hcp/adult.html

Risk Factors For Heart Disease: Worse for Women & African Americans

A recent study reported in Health Day.com demonstrates the disparity felt by women and African Americans when it comes to risk factors for heart disease. In particular, diabetes and high blood pressure were found to be major contributors to this sex and race gap by increasing the chance for heart disease to develop significantly in these groups when compared to men in general.

When looking at combined risk from 5 factors (High cholesterol, smoking, high blood pressure, obesity and diabetes) blacks had an increased risk of 67% to develop heart disease as compared to 48% in whites. Women had a combined risk of 58% compared to 48% in men. These risks ultimately make these groups more likely to experience poor health outcomes, or even die from complications of heart disease and stroke.

 But why is this happening? From a clinical perspective, the article suggested that " this difference in risk could be due to the fact that heart disease has typically been considered a disease of white men, and doctors have not tackled contributing factors as much when they crop up in women and blacks." If this is the case, this image of the "typical" heart disease patient can be putting lives at risk. It is later suggested that doctors take risk factors more seriously in these populations since their chance for later development is higher.

Patients can also have an important role in bridging this gap. It is important to know your family history, be aware of the things you are at high risk for and  try your best to manage any risk factors you do have. If you don't feel like your doctor is taking your risk factors seriously, seek a second opinion. Remember, your family history does not have to be your biography. Ask your doctor what you can do to reduce your risk factors for heart disease. In some cases, small life changes can make a big difference.

Resources:

Original Article: Women, African Americans Hit Harder by Heart Disease Risk Factors, Heath Day.com

Article Referenced: Philly.com 

Article: How to Prevent and Control Coronary Heart Disease Risk Factors , NIH

Video: Heart Healthy Tips, 5 Superfoods 

Possible Health Benefits of Lower Bedroom Temperatures

You may want to think twice before turning down your air conditioner! An interesting study was released recently investigating the possible health benefits of sleeping in cooler temperatures at night. It is something we usually do not think about, but some are starting to think it can really make a difference. Specifically, researchers set out to see if it had an effect on stores of brown (good) fat which has the potential to improve metabolism.  Sponsored by the American Diabetes Association, researchers took 5 healthy young men and had them sleep in a controlled environment. During the course of the experiment, they had them all sleep in different room temperatures. It was found that when the temperature was cooler, significantly higher amounts of brown fat were found. This implies that there is possibility of metabolic benefit to sleeping in colder temperatures.

However, is the same true for women? We do not know. Since the study only included 5 men, it is impossible to know if the same results would have been found in a group of 5 women. With the possible metabolic benefits this study eludes to, it is hopeful that it will be repeated not only with women, but with a larger and more diverse group.

Resources:
Article abstract and link in PubMed

Article: Let's Cool it in the Bedroom  New York Times

Video Presentations from the Academy of Women's Health

The Academy of Women's Health is currently offering complimentary videos on their women's health website. Two talks are availible on two very interesting and important topics: fibroids and STD's. Click here to access the webpage including a short description of each talk, and a link to access them. Direct links to the YouTube videos of these talks have been posted below. Enjoy! 

Resources:

Video: Fibroids: New Options in Medical & Surgical Management

Video: Sexual Health: Do Ask, Do Tell

Academy of Women's Health Website

How Racial Stereotypes can Isolate Women Experiencing Infertility

The article Infertility, Endured Through a Prism of Race  from the New York times brings to light an issue that has gotten less attention than needed. This examined how racial stereotypes about conception can isolate minority women (specially African Americans) who are dealing with infertility. Stereotypes as well as cultural expectations, depict black women as very fertile and able to have children whenever they are ready. It is also not an issue that is talked about as much in the black community, and women of color are under-represented in the population of women seeking help to conceive.

This is the case even when black women on average, are twice as likely to experience problems with fertility as white women. However, those most often seeking help with issues of fertility are white women of higher income and education. It is explained that these women often have the best healthcare coverage and resources to work with, but this is not exclusively why they are the highest population utilizing these services. Even when all services were covered by insurance, black women were less likely to seek out fertility treatments. The article attributes this to a lack of resource information, cultural beliefs and bias from medical professionals. Many times black women are not given the same medical advising with doctors focusing more on STD's then issue of fertility.

For all women, it is important to make sure that fertility is not an issue you are experimenting alone. Speak to people you trust and your doctor about any problem you may be having. Seek out resources and talk to others who have gone through the same things. By being open and honest about your situation, you will not only help yourself but you may also help someone close to you who is dealing with the same thing.


Resources:
Article: Infertility Endured Through A Prism of Race - NY Times

Fertility for Colored Girls - Organization dedicated for fertility empowerment in African American women

Congratulations to DUCOM class of 2014!

Today, after four years of hard work (and many more preceding) Drexel University College of Medicine's class of 2014 got their degrees! WHEP congratulates you and we are happy to call you all doctors! Good luck on the journey ahead and never forget the valuable things you learned as a student at DUCOM!

A Special shout out goes to our pathway students! the students in the class of 2014 are truly special and all have great things in store for them. We are glad to have provided support for the last leg of your race. Go show the world what you are made of!

This week is National Women's Health Week!

Women's Health Week is May 11th-17th. It is a time to reflect on the advances that have been made in women's health, while focusing on the many areas that still need attention. It can also serve as a reminder for all women to check your health. Are you up to date on all of your primary care visits? Is there a concern that you've been meaning to get checked out? Is there a bad habit that you would like to quit? Don't wait! Now is the time to take charge of your health! If you are worried about the cost of a doctors visit, the ACA has made yearly check up's for women more affordable and on many health plans, completely free.

This week serves as a great reminder to stay healthy, but don't forget, it is important for women and the people around them to be concerned for their health everyday! 

Resources: 

Women's Health.gov - Women's week infographic

My Family Health Portrait - Keep track of your family history and 

share at your yearly doctors visits.

Celebrating Nurse and Teachers!

This week we celebrate two very important career fields; nursing and teaching . Nurses week is May 6th-12th this year while teachers appreciation week is May 5th- 9th. Take the time to thank and appreciate the nurses and teachers and all they do for us! And if you are a nurse or a teacher, we thank you!

Whats up WHEP: Transdisciplinary Research Projects

Congratulations to the Transdisciplinary Education within Women's Health elective students, class of 2014 for completing their research projects! We were very impressed by the quality of projects and the depth of discussion. You should all be proud of the work you did. We even had a student bring in some flowers to have Spring inside with us as we learned about important issues in women's health!


Current fourth year students... consider joining this great elective!

FDA Safety Warning for Laparoscopic Uterine Morcellation

Just last week, the FDA issued a communication about the possible dangers of Laparoscopic Uterine Power Morcellation for hysterectomy and myomectomy. This process is typically used to perform minimally invasive hysterectomys and to remove uterine fibroids (myomectomy). Morcellation divides the tissue that is being removed into smaller pieces so that they can be easily extracted though a small incision. However, it is estimated that about 1 in 350 women will have an undetected cancerous sarcoma when receiving this treatment, which may cause the cancer to spread to other parts of the lower body. The FDA therefore discourages the use of this treatment for women with fibroids. 

Physicians are advised not to use this type of treatment, especially for women with known or suspected uterine cancer. It is important to discuss in detail, all treatment options with patients who have uterine fibroids. Patients are encouraged to ask questions about the risk and benefits associated with all treatment options. If this is a procedure you have already had done and your removed cells tested negative for cancer, it is recommenced that you have a routine follow-up with your healthcare provider. 

Resources:

Laparoscopic Uterine Power Morcellation in Hysterectomy and Myomectomy: FDA Safety Communication

Information on Uterine Sarcoma

Uterine Fibroids Factsheet

¿Que es la depresión?

La vida tiene muchos altas y bajas pero cuando las bajas siguen mas de un par de semanas o meses y  le detiene de hacer su vida cotidiana, puede ser que este sufriendo de depresión. Esta condición es una enfermedad que puede afectar todos aspectos de su vida como su salud física, su humor y pensamientos. Es importante que sepa que esta condición es seria y no se trata de solo sentir triste por unas horas. Usted no tiene control sobre estos síntomas.

¿Cuales son los síntomas de depresión?

-          sentir ansiedad, tristeza

-          sentimientos de desesperanza

-          falta de interés en actividades que le gustaba antes

-          falta de energía

-          dificultad para mantener la concentración, memoria, y hacer decisiones

-          cambios en su sueno como dificultades en dormir, o durmiendo mas horas

-          comer muy poco o en mucho cantidad

-          pensamientos de suicidio

-          síntomas físicas que no se recuperan con medicamentos, como por ejemplo dolor de cabeza, dolor de panza, o dolor general

¿Como puede conseguir ayuda?

Si siente algunas de estas síntomas, avise a su medico, psicólogo,  o asistente social.  Pensamientos de suicidio puede lastimar a usted o a los que la aman. Si necesita hablar con alguien llame a 1-800-8255. En algunos momentos, puede ser que sienta que estas emociones son permanente pero estos van a pasar. Escribiendo sus pensamientos también puede ayudar. Es muy importante ver un medico para ver si necesita medicamentos.

¿Como puede ayudar a si mismo?

-          haga ejercicio o alguna actividad física

-          haga actividades que disfrutaba antes de tener estas síntomas, como ir al cine o a ala iglesia

-          establezca metas realísticas para si mismo

-          pase tiempo con la gente que la aman y con los que puede hablar con ellos

-          tenga paciencia con el progreso de su humor, puede ser que esto tome tiempo

-          posponga la decisiones importantes en su vida para después de sentirse mejor

-          tenga confidencia en su mejoramiento y transforme sus pensamientos negativos a unos positivos.

References:

http://toplarevista.files.wordpress.com/2013/12/quc3a9-es-la-depresic3b3n.jpg

http://www.womenshealth.gov/publications/our-publications/fact-sheet/depression.html#a

Alzheimers Aware: Essential For All Women

These days, Alzheimer's disease is familiar to most, but is often not on the radar for health conditions that older adults are concerned with. In reality, it is the 6th leading cause of death in the U.S., taking more lives then the more commonly monitored breast and prostate cancers combined.  It is also one of the most costly diseases, costing the US close to 215 billion dollars in healthcare costs.

Data from the 2014 Alzheimer's report shows that in several ways, women are at the center of the disease. In fact women make up almost two thirds of those diagnosed with Alzheimer's. Women are also the primary caregivers of this disease, with more than 60% being women. All of these caregivers contribute to billions of dollars of unpaid work hours due to care. This also takes away from time, advancement and benefits at the current job of many caregivers. The report goes on tho show that in general, Alzheimer's overall puts a greater strain the female population than males. Over the age of 60, women are twice as likely as men to develop the disease. So while Alzheimer's should be a concern to everyone,  elderly women and their family and friends should especially  know the signs, so Alzheimer's can be detected early if it does develop.

There is still  a lot left to left to learn about this disease, with much research to be done. Find out ways that you can help to get involved by clicking here and join the movement to eliminate Alzheimer's disease.

Video From the the Alzhimer's association 

Resources:

Alzheimer's Association Official Website

2014 Alzheimer's Report

How To Get Involved 

Wine, Women & Shoes..Sip, Savor and Shop March 2014!

Looking for an absolutely fabulous event that also supports a great cause? Those in the Tri-State area cannot miss the Wine, Women and Shoes event sponsored by the Alzheimer's Association of Delaware Valley! It is an afternoon of shopping and world class wine... who could ask for more? Click Here for more information, tickets or to view a video of last years event. We hope to see you there!

 Resource:
Wine, Women and Shoes Philadelphia

Happy International Women's Day!!

Today is international women's day, a day to honor the unity that exists with women who are the faces of inequality around the world and celebrate achievements and the people who made them possible! Remember to perpetuate the spread of sex and gender equality everyday. To find out more that you can do for International Women's Day, find events or read up on current events visit the International Women's Day Website ! Have a great day!




Resources:
International Women's Day Website

Student Spotlight : Natalie Beaty at the Philadelphia Sexual Assault Response Center

By Natalie Beaty

The Philadelphia Sexual Assault Response Center is a crisis center for people who have been sexually assaulted. I worked there several days during my Women’s Health Ambulatory Medicine clerkship. While there, I worked with Ralph Riviello, M.D. and Mike Boyle, a retired SVU lieutenant, as well as several Sexual Assault Nurse Examiners (SANE), who oriented me to the center. They also trained me on the process of reporting a sexual assault crime, performing a forensic exam, and legal aspects of sexual assault cases.

The first thing that struck me is the set-up of the PSARC facility – it is directly attached to the Special Victims Unit of the Philadelphia Police Department, so it is easy for victims to arrive to the station by 911, give a statement, and then be evaluated by a SANE. This model of sexual assault center location aims to minimize wait times and maximize privacy and comfort for victims. It also eliminates the need for victims without medical injuries that need immediate attention to go to an Emergency Room with long waits to be evaluated. It was implemented through the work of Dr. Riviello and many others, and it is clear to me that the new center provides a calm, clean, safe place for victims to be examined and get information. This is a model which is in place in some cities nationwide, and which hopefully provides a good national model for sexual assault forensic analysis.

The volume of the center was a strong reminder for me about how prevent sexual violence is in our society, and of how important it is for young doctors to be aware of how to help these patients. Since opening in May 2011, the PSARC has handled over 1,000 cases. The center recently moved to 300 E. Hunting Park in August, 2013, and have handled over 40 cases just since that time. One excellent resource I learned more about is Women Organized Against Rape (WOAR). When a victim comes in PSARC, WOAR will be contacted and will come in to speak with the victim after the forensic exam. They provide immediate counseling as well as accompaniment of victims to court, an invaluable service which helps victims navigate the court process. We, as medical trainees, can screen patients for violence, and if they are positive, we should be prepared to refer them to WOAR as a resource.

Working in the PSARC is a unique experience because it allows the student to learn about and interact with police, nurses, and social outreach workers as part of a comprehensive team. You sit in on interviews with victims when they come into the center, participate in the examination, and, importantly, provide reassurance and support to the person in their time of need. The experts at the center give valuable insight into the history of sexual assault response teams, as well as their insight into these crimes that has been developed over decades of experience. Feel free to contact me with any questions you may have.

Información Sobre Las Mamografías

By: Atieh Novin, MSII

¿Que es una mamografía?

Una mamografía es un imagen que se toma de su seno usando una radiografía. Este imagen se puede usar para averiguar la existencia de cáncer de ceno en mujeres que no tienen ningunas síntomas. En este proceso se toman dos imágenes de cada ceno . Si hay algún tumor en los senos se pueden ver en estos imágenes. La mamografía también puede mostrar depósitos de calcio que no son necesariamente cáncer.

¿Cuales son los beneficios de la mamografía?

La detección temprana de cáncer de seno significa que tratamientos comenzarán mas temprano, antes de que se propague a otras partes de su cuerpo. Investigaciones de salud han mostrado reducciones en mortalidad de cáncer de seno con detecciones tempranas como la mamografía.

Las recomendaciones:

-          Mujeres de edad 40 o mas deben hacer mamografías cada uno o dos anos.

-          Mujeres con diferentes formas de cáncer en su familia pueden tener mas riesgo de cáncer de seno. Es posible que tendrán que comenzar mamografías, mas temprano que la edad 40. Su doctor les puede decir si esto seria necesario. 

Autoexamen de los seno es un simple método que también se puede usar para prevenir complicaciones.

¿Cuanto cuesta una mamografía?

Para las mujeres con seguro de salud privada, generalmente se ofrece servicios de mamografía a ningún costo. Medicare ofrece mamografías gratis para mujeres mas de 40 anos de edad. Si necesita mas información sobre mamografías a bajo costo o gratis puede llamar a 1-800-4-CANCER (1-800-422-6237).

References:

http://www.komennyc.org/pdfs/SK_breast-self-exam_en_es.pdf

http://www.cancer.gov/cancertopics/factsheet/detection/mammograms

Case Examples of the ACA

Dr. Foster giving a seminar on teen
health and the Affordable Care Act

The Affordable Care Act has been on many people's minds as open enrollment closes in just 35 days. In fact our Women's Health Seminar Series last week discussed the topic. But many healthcare providers and potential buyers are still confused as to what it means, who is eligible and who stands to benefit. Philly.com recently posted a great article giving a doctor's analysis of what the ACA means for her patients. Jill Foster, MD of St. Christopher's Hospital for Children uses real patient examples to paint a picture of who does and who does not benefit from the ACA. However, you will not know for sure if you or your patients can benefit unless you to find out. The healthcare marketplace website, healthcare.gov has a plan estimator that allows users to get an idea of what they are eligible for in just a few minutes. Healthcare professionals should encourage all patients who are not covered by private insurance or medicaid to review their options instead of opting out. And if you are someone who is still unsure how the ACA can work for you make sure to visit the website and do some research before the deadline! There are several resources for contacting individuals to help get enrolled on the healthcare website.

Resources:
(Article) A doctor examines how Obamacare could affect her patients

Healthcare.gov

Contact a Healthcare.gov representative or find someone in your area

Drug Differences in Women & Men

There are many differences between men and women, but when it comes to medicine and research, There are times when there is little investigation past the obvious reproductive organs, with the assumption that everything else is the same. While sex and gender medical research is still fairly new, we are learning more and more that women and men are different in ways we never realized. One very important example drug reactions in the body. Research has shown that women and men's bodies respond to certain drugs in different ways; however there is currently only one drug in the US that recommends women take a different dosage than men. Many studies still choose to use only make test subjects, under the assumption that women and men will have the same reaction to a drug. Even in studies where both men and women are tested, some choose not to compare the findings between the two groups. CBS recently aired a segment called "Sex Matters: Drugs Can Affect Sexes Differently" that talks about the importance of drug differences and explains the problems behind lack of comparison testing and why it can be detrimental to both women and men. It is essential that additional steps are taken towards uncovering more sex and gender differences to provide tailored and useful care to everyone. Take some time to watch this interesting video!

Resources:
(Video)Sex Matters: Drugs Can Affect Sexes Differently

Healthy Valentine's Day!

People celebrate Valentine's Day in many different ways, with not all of them being particularly healthy. The "perfect" day often is celebrated with food, candy, alcohol and sometimes too much money. Here are some health tips in addition to those released by the CDC to have a safe and healthy Valentine's Day. 

• Make Healthy Food Choices - Many people choose to go out for fancy dinners on Valentine's day while being surrounded by treats all day long. If you choose to make valentines a day for splurging on dinner, avoid snacks and candies that are often made appealing by their cute shape. If you are more into the v-day treats, think of healthier alternatives. Instead of buying boxes of chocolate, consider melting chocolate and dipping fruit in it. Little changes can really reduce the calorie load put on the body in one day. 
• Limit Alcohol consumption and be safe - With valentines day being on a Friday this year, many may go out for drinks. Be sure to always limit your alcohol consumption, never leave drinks unattended and always be in the company of at least one other person (or more depending on the size of your party) who will not be drinking. 
• Remember Your Mental Health and That of Others - Valentine's Day can also be very stressful and put pressure on people to make the day perfect. If you are exchanging gifts with someone this year, there are various things you can do if you feel that giving gifts is causing stress. Some alternatives are going somewhere special instead, like a day or weekend trip. You can also make fun rules ("who can get the most interesting thing for five dollars?") to encourage creativity and allow you and your partner to loosen up.  On another vein, some people can become sad or depressed if they do not think there is a way to make the day special. Be kind to others, and reach out to friends and family who may be having a difficult time 

In the end Valentine's Day is just another day, make sure to show the one's you love how you feel everyday and not just once a year. Have a great one!

Resources:

CDC Valentine's Day Tips 

Valentine's Day is also V-day, a day where the organization One Billion Rising for Justice raises awareness about domestic violence. For more information and how to get involved, click here 

Transmisogyny - Creating Awareness

Transmisogyny is a concept less commonly discussed than other types of prejudice and unequal treatment such as sexism, gender bias, homophobia and transphobia. In fact transmisogyny combines all four of these things and looks specifically at the disproportionate hate shown towards transwomen or those on the feminine spectrum of transgender. In the United States, over half of all trans hate crimes are directed towards transwomen. In addition, almost half of all transwomen reporting crimes have also faced maltreatment by law enforcement. They experience higher rates of poverty and homelessness in association with discrimination in the job and housing market. They are also highly profiled and routinely arrested for assumed involvement in illegal activities such as prostitution.

Why is this important? Transmisogyny devalues feminine qualities and marks transwomen as "exotic" or "freaky". It puts a hyper focus on genitalia and the classification of what a person "is" while forgetting who they are on the inside.  And it creates a world where transwomen are  disadvantaged and in danger just for being themselves. 

In 2012, Jenna Talackova
was the first Transgender
woman to participate in
Miss Universe Canada

Transwomen also face issues with access to healthcare, as the U.S. system predominately built on exclusively men's and women's health issues. For healthcare professionals, it is important to make all of your patients feel welcome and accepted, despite personal beliefs. It is also important to know where to find resources when your knowledge on patient issues is limited. For trans patients, your health is more important than the "comfort" of your provider. Make sure to disclose important information with your doctor. If you don't feel good about your current doctor, find a new one! There are many doctors out there who specialize or are notably comfortable with LGBTQ patients.  Make sure that you keep your health your #1 priority and know your rights as a patient. 

We have seen great strides in Trans-visibility in recent years in TV shows, prime time interviews and beauty pageants. At the same time, we are still not past the possibility of transwoman being the victim of a hate crime while just walking down the street. We need to be aware of the issue and spread acceptance instead of hate, so one day we can overlook the "trans" and allow transitioning females to be who they are.

Resources:

Read the Full article about this topic >> Everyday Feminism - Transmisogyny: What is it?

Transgender Healthcare Resources 

Top 10 Things Transgender People Should Discuss with their Healthcare Provider

Find a Provider approved by the GLMA: Health Professionals Advancing LGBT Equality

Transgender Healthcare Rights