Main Category: Psychology / Psychiatry
Also Included In: Women’s Health / Gynecology;  Eating Disorders
Article Date: 11 May 2012 – 0:00 PDT

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Women with high family support and limited pressure to achieve the ‘thin and beautiful’ ideal have a more positive body image. That’s according to a new study looking at five factors that may help young women to be more positive about their bodies, in the context of a society where discontent with appearance is common among women.

The work by Dr. Shannon Snapp, from the University of Arizona in the US, and colleagues is published online in Springer’s journal, Sex Roles.

Many women in contemporary Western cultures are dissatisfied with their bodies, a risk factor for eating problems. Snapp and team examined factors that make women more resilient when it comes to their body image, in a bid to help those women at risk of eating disorders. They focussed on young college women who are likely to experience self-consciousness as they compare themselves with peers and become involved in social groups and organizations that place a high value on appearance.

A total of 301 first-year college women, from two universities in the US, completed questionnaires based on the Choate theoretical model. This model hypothesizes that family support and low levels of pressure to attain the thin ideal are related to the rejection of the superwoman ideal, positive views of physical competence, and effective stress-busting strategies. These factors are associated with well-being, which in turn is linked to positive body image in women. The researchers put this model to the test in a ‘real life’ situation.

They found that young women with high family support and low levels of perceived socio-cultural pressure from family, friends and the media regarding the importance of achieving a ‘thin and beautiful’ ideal had a more positive body image. These same women also rejected the superwoman ideal, had a positive physical self-concept, and were armed with skills to deal with stress.

Practical recommendations for prevention programs aimed at young women at risk of eating disorders include helping women to evaluate and become comfortable with the multiple and often contradictory expectations placed upon them in today’s society; teaching them to use effective coping skills; fostering a positive view of their physical competence through exercise and health; and promoting holistic well-being and balance in their lives.

The authors conclude: “It is particularly important for women to develop a sense of self-worth that is not solely based on appearance, and to build resilience to pressures they may receive from family, friends and the media.”

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Main Category: Sexual Health / STDs
Also Included In: HIV / AIDS;  Women’s Health / Gynecology
Article Date: 11 May 2012 – 1:00 PDT

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Safer indoor sex work spaces provide important and potentially life-saving benefits to sex workers including reduced exposure to violence and HIV and improved relationships with police, according to a study published by the Gender and Sexual Health Initiative of the BC Centre for Excellence in HIV/AIDS (BC-CfE) and the University of British Columbia (UBC).

The qualitative evaluation study published in the America Journal of Public Health interviewed 39 women living in low-threshold, supportive housing programs for sex workers in poverty and using drugs. These programs, operated by Atira Women’s Resource Society and RainCity Housing and Support Society in Vancouver, Canada, offer an innovative harm reduction model that promotes the health and safety of the most marginalized sex workers.

Security measures include women-only buildings (residents, staff), supportive guest policies (clients sign-in at front desk), video cameras onsite, staff available to call police in case of violence, and health and safety resources onsite, including bad date sheets and condoms. Based on the success of the programs to date, these models have now been extended to reach more sex workers across a number of housing programs in Vancouver.

Sex workers interviewed in the study had all previously worked on the street and described how supportive housing programs increased their control over negotiating sex work transactions, including the capacity to refuse unwanted services, negotiate condom use and avoid violent predators. Women’s accounts contrast the safety afforded by these environments with their very limited options to controlling their safety when seeing clients in cars, alleys and clients’ homes.

“This research shows that safer indoor sex work spaces dramatically reduce the risks to the health and safety of sex workers,” says Dr. Kate Shannon, senior author of the study, director of BC-CfE’s Gender and Sexual Health Initiative and assistant professor of medicine at UBC. “We have previously shown that displacement and lack of safer indoor options for street-based sex workers are directly associated with elevated rates of violence and HIV risk. The evidence is clear: We need to scale up access to safer sex work spaces and remove legal barriers to their formal implementation and evaluation.”

The publication of the study follows the landmark decision by the Ontario Court of Appeal that allows sex workers to legally work in safer indoor spaces starting next year. The court concluded that laws preventing sex workers from working together under one roof or hiring security staff fail to protect sex workers and exacerbate harms. While the decision is not currently binding outside Ontario, if upheld by the Supreme Court of Canada the government will be forced to ensure the laws are brought in line with the evidence.

“We have created policies and practices that support women’s choice and ensure their health and safety are protected,” says Amelia Ridgway, Manager of RainCity Housing. “Women have the right to govern their own bodies. We believe that housing is a human right and this is about providing women with the most basic human rights around protection from violence within a harm reduction framework.”

“This is about promoting and protecting the basic rights of women who do sex work and live in poverty,” adds Janice Abbott, CEO of Atira Women’s Resource Society. “The contradictory nature of Canada’s criminalized prostitution laws is that sex workers in higher-end neighbourhoods can operate largely free of persecution out of their own apartments, but the most marginalized women in sex work continue to be criminalized and victimized by restrictive and arbitrary policies and enforcement.”

The women interviewed said safer sex work spaces reduce some of the anonymity and isolation that mark street-level transactions, allowing onsite staff and workers to identify violent predators. They added that safer spaces where sex workers can bring clients indoors support increased solidarity between sex workers and promotes their ability to self-regulate safer industry standards.

Improved relationship between sex workers and police

An important finding of the study is improved relations between sex workers and police. “As evidence has shown time and time again, current criminalized laws and enforcement of these laws create an adversarial relationship between sex workers and police,” says Dr. Shannon. “These findings align with the new guidelines by Vancouver Police Department to not harass or arrest sex workers.”

As one sex worker in the study explains: “On the corner, doing it in the car, I used to be scared all the time, paranoid about cops, scared of getting charged. It is a lot easier now. I can come and go [to this safer space], and cops actually say hi to me. It is different.” Another sex worker adds, “Now police just check me out and help me be safe.”

“We need to view safer sex work spaces as an evidence-based public health imperative,” concludes Dr. Perry Kendall, BC’s Provincial Health Officer. “This research clearly demonstrates that safer sex work models bring street-based sex workers indoors and away from violent predators, and support their access to health, security and safety.”

“Safer sex work spaces support better health and safety, period,” said Dr. Patricia Daly, Chief Medical Health Officer, Vancouver Coastal Health. “We need to ensure that evidence-based safer sex work models are supported, and where possible expanded, to reach marginalized individuals.”

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Main Category: Sexual Health / STDs
Also Included In: Women’s Health / Gynecology;  HIV / AIDS
Article Date: 10 May 2012 – 0:00 PDT

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Women who have experienced multiple forms of violence, from witnessing neighborhood crimes to being abused themselves, are more likely to engage in risky sexual behavior, according to a new report in the Psychology of Violence.

Researchers from The Miriam Hospital’s Centers for Behavioral and Preventive Medicine say certain patterns of violence in both childhood and adulthood may make a woman more likely to take significant sexual risks, such as having unprotected sex or a high number of sexual partners.

The findings offer new insight on the known link between exposure to violence and HIV/STD risk behavior, particularly among low-income, urban women, who may experience high rates of violence.

“Sadly, our results show that many women must cope with multiple forms of violence, and that some combinations of violent experiences put women at risk for HIV, other STDs or unplanned pregnancy – not to mention the risks from the violence itself,” said lead author Jennifer Walsh, Ph.D., of The Miriam Hospital’s Centers for Behavioral and Preventive Medicine.

Although previous research has linked sexual risk behavior and diverse forms of violence – including childhood maltreatment and sexual abuse, intimate partner violence and exposure to community violence – very few studies have considered patterns of violence and their impact on sexual risk-taking, even though some women experience multiple types of violence.

The current study included 481 women attending an urban STD clinic who were assessed for previous history of violence and current sexual risk-taking behaviors. The women were primarily African American and most were socioeconomically disadvantaged. Overall, women reported high rates of exposure to violence compared to the general population. All types of violence were interrelated, with women who experienced one type of violence being more likely to experience other forms as well.

Using a statistical technique known as latent class analysis to find common patterns in the data, researchers identified four classes of women with different experiences of violence: women with low exposure to violence (39 percent); women who were predominantly exposed to community violence (20 percent); women who were predominantly exposed to childhood maltreatment (23 percent); and women who experienced multiple forms of violence (18 percent).

The team found women who reported experiencing multiple forms of violence and those who were exposed to community violence had the highest levels of sexual risk behavior, including lifetime number of sexual partners and alcohol and drug use before sex.

Walsh believes the study has several clinical implications. “Given the ties between multiple violent experiences and sexual risk-taking, clinicians working with women who experience violence or who are at risk for HIV/STDs may need to consider the overlap between the two in order to impact sexual health consequences,” she said.

She adds, “The clustering of different types of violence suggests clinicians who work with women who have experienced one type of violence should inquire about other types of violence in order to get a complete picture.”

With the understanding that multiple violence experiences are common for women with the highest sexual risk, Walsh also suggests interventionists working to reduce HIV risk may want to provide women with resources for coping with intimate partner and community violence, or for overcoming childhood maltreatment or abuse. Similarly, those working with women experiencing intimate partner violence or other forms of violence may want to address strategies for safer sex.

“These findings also highlight how social and community context influence individuals in complex ways, how social and health problems often cluster, and the need to broaden risk reduction programs to include couples as well as focusing on individuals,” notes Michael Carey, Ph.D., director of The Miriam Hospital’s Centers for Behavioral and Preventive Medicine and a co-investigator on the study.

Either way, the authors say further research is needed to better understand how and why violent experiences are associated with sexual risk behavior in order to develop more effective interventions.

Walsh says that the research is especially timely, coming on the heels of a recent Presidential memorandum establishing a working group known as “Intersection of HIV/AIDS, Violence Against Women and Girls, and Gender-related Health Disparities.” The working group aims to address both the rising incidence of HIV among women and girls as well as the increasing rates of domestic violence and sexual assault.

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Main Category: Sports Medicine / Fitness
Also Included In: Women’s Health / Gynecology
Article Date: 10 May 2012 – 0:00 PDT

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New research out of Michigan State University reveals female athletes and younger athletes take longer to recover from concussions, findings that call for physicians and athletic trainers to take sex and age into account when dealing with the injury.

The study, led by Tracey Covassin of MSU’s Department of Kinesiology, found females performed worse than males on visual memory tests and reported more symptoms post-concussion.

Additionally, high school athletes performed worse than college athletes on verbal and visual memory tests, and some of the younger athletes still were impaired up to two weeks after their injuries.

“While previous research suggests younger athletes and females may take longer to recover from a concussion, little was known about the interactive effects of age and sex on symptoms, cognitive testing and postural stability,” said Covassin, a certified athletic trainer at MSU.

“This study confirms that age and sex have an impact on recovery, and future research should focus on developing treatments tailored to those differences.”

The research funded by a two-year grant from the National Operating Committee on Standards for Athletic Equipment, appears in the current edition of the American Journal of Sports Medicine.

Between 2001 and 2005, federal statistics reveal more than 150,000 sport-related concussions occurred among youth ages 14 to 19. However, the actual number is likely much higher, as current statistics reflects only concussions that involved visits to the emergency departments.

The study led by Covassin looked at nearly 300 concussed athletes from multiple states over two years. All of the athletes had previously completed a baseline test before taking three different postconcussion tests, the same ones used in professional sports, after being injured.

When it comes to sex differences, Covassin – who has worked with thousands of young athletes across mid-Michigan since coming to MSU in 2005 – said what often is needed most is simple education.

“We need to raise awareness that yes, female athletes do get concussions,” she said. “Too often, when we speak with parents and coaches, they overlook the fact that in comparable sports, females are concussed more than males.”

Coupled with the fact that high school athletes take longer to recover than collegiate athletes, Covassin said the study reveals a real potential danger to younger athletes by not fully recovering after a concussion.

“Younger athletes appear more at risk for second-impact syndrome, where a second concussion can come with more severe symptoms,” she said. “While it is rare, there is a serious risk for brain damage, and the risk is heightened when athletes are coming back before they heal.”

The next steps, Covassin said, are to investigate sex and age differences at the youth sport level and whether treatment options needed to be tailored for an athlete’s age.

“If we can develop treatments that speak directly to sex and age, I think we can better protect athletes from the long-term side effects of concussions,” she said.

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Editor’s Choice
Main Category: Sexual Health / STDs
Also Included In: Women’s Health / Gynecology
Article Date: 10 May 2012 – 11:00 PDT

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A systematic review of 35 years of data published online in Europe’s leading reproductive medicine journal Human Reproduction shows that intrauterine devices (IUDs), commonly known as a ‘coil’ should be routinely used as emergency contraception, given that their failure rate is less than one per thousand and because it has proven more effective than the “morning after pill”. When left in place, IUDs also continue to protect women from unwanted pregnancy for many more years. 
 


The researchers analyzed data from 42 English and Chinese studies that were conducted between 1979 and 2011 in six countries. A 2006 report states that China has the highest IUD use in the world, with 43% of women using IUDs for contraception in comparison with 13% in the rest of the world. The studies involved 7,034 women and included eight different types of IUDs. 
 


An IUD is a small device made from plastic and copper that a doctor or trained nurse inserts into the woman’s womb. Depending on the brand, the device can remain in the womb for between five and ten years. In comparison with IUDs, which have been used as emergency contraception for over 35 years, scientists have also developed intrauterine systems (IUS) in recent years, which are small, plastic devices that release very low doses of the hormone progesterone.

First study author, Ms Kelly Cleland, a staff researcher at the Office of Population Research at Princeton University in the USA declared:

“Unintended pregnancies are a significant health problem worldwide. It is estimated that globally at least 36% of pregnancies are unintended. We already know from previous research that IUDs are very cost-effective forms of regular contraception. This study is the most comprehensive review to date of the efficacy of IUDs used for emergency contraception, and our results provide clear evidence that they are a highly effective method of emergency contraception, as nearly 100% of users overall did not become pregnant after unprotected sex when an IUD was inserted post-coitally.

In contrast, failure rates are at least 10-20 times as high for emergency contraceptive pills such as ulipristal acetate and levonorgestrel. IUDs also offer very effective ongoing contraception. Therefore, we conclude that IUDs should be included routinely as an emergency contraceptive option whenever feasible and appropriate.”



As an emergency contraception, IUDs should normally be inserted within about five days of unprotected intercourse, which occurred in 74% of the studies, however, the current review’s timeframe ranged from between two and ten days to more. 
 


A total of ten pregnancies occurred from 7,034 post-coital IUD insertions, six of which occurred amongst 5,629 women in China, whilst the other four pregnancies occurred in 200 women in one Egyptian study. 



According to the researchers, the Egyptian study’s unusual and abnormal results made it an “outsider” study, which may have been due to the way the women were selected and should therefore be ignored for the purposes of their review.

The researchers explain:

“This high failure rate can possibly be explained by the fact that women were specifically selected if they had had intercourse around the time of ovulation; in any event Egypt is a clear outlier. If the unusual results from the Egypt study were excluded, the overall failure rate would be 0.09% . . .; this is our preferred estimate.”


The “morning after pill” (ulipristal acetate) is the second most effective form of contraception, with a failure rate of about 1-2%, followed by levonorgestrel, with a failure rate of around 2-3%. Unlike IUDs, both pills, ulipristal acetate and levonorgestrel, become less effective the higher a woman’s body mass index (BMI) is. 
 


Although IUDs are evidently the most effective means of emergency contraception, studies have shown that both doctors and patients do not seem to be sufficiently aware of IUDs, which are therefore rarely used in this situation. According to a US study, 85% of clinicians never recommended IUDs as an emergency contraception and 93% require at least two visits in order to insert an IUD. 


Professor James Trussell, Professor of Economics and Public Affairs at Princeton University and Visiting Professor at The Hull York Medical School in York, UK, who was involved in the research, declared:

“This is an extremely difficult problem to deal with, especially as in many countries women can just go to their local pharmacy to obtain the ‘morning after pill’, but virtually no women know to ask for an IUD and many family planning clinics and surgeries do not offer same-day insertion. Offering same-day insertion would remove a huge barrier to the greater use of IUDs.”
 


Furthermore, upfront costs of IUDs are comparatively high, with a cost from between $718 for the ParaGard IUD in the USA to about £10 for IUDs in the UK. However, over a certain time period IUDs prove more cost effective as compared with other forms of contraception, regardless of emergency or preventive contraception.


According to Prof Trussell:

“These initially higher costs are vastly offset by pregnancies prevented both in the contraceptive emergency itself and by pregnancies prevented by continued use of the IUD. ‘Morning after pills’ taken today protect against pregnancy from sex last night but not from sex a week from now.”
 


Ms Cleland concluded the study, saying:

“We hope that this study will encourage providers to consider IUDs for their patients requesting emergency contraception, and possibly to consider how to structure their clinic flow so that they are able to provide same-day insertions.”


Written By Petra Rattue
Copyright: Medical News Today
Not to be reproduced without permission of Medical News Today

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Main Category: Tropical Diseases
Also Included In: Women’s Health / Gynecology
Article Date: 10 May 2012 – 1:00 PDT

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A Cornell University scientist and designer from Africa have together created a fashionable hooded bodysuit* embedded at the molecular level with insecticides for warding off mosquitoes infected with malaria, a disease estimated to kill 655,000 people annually on the continent.

Though insecticide-treated nets are commonly used to drive away mosquitoes from African homes, the Cornell prototype garment can be worn throughout the day to provide extra protection and does not dissipate easily like skin-based repellants. By binding repellant and fabric at the nanolevel using metal organic framework molecules – which are clustered crystalline compounds – the mesh fabric can be loaded with up to three times more insecticide than normal fibrous nets, which usually wear off after about six months.

“The bond on our fabric is very difficult to break,” said Frederick Ochanda, postdoctoral associate in Cornell’s Department of Fiber Science & Apparel Design and a native of Kenya. “The nets in use now are dipped in a solution and not bonded in this way, so their effectiveness doesn’t last very long.”

The colorful garment, fashioned by Matilda Ceesay, a Cornell apparel design undergraduate from Gambia, debuted on the runway at the Cornell Fashion Collective spring fashion show on the Cornell campus. It consists of an underlying one-piece body suit, hand-dyed in vibrant hues of purple, gold and blue, and a mesh hood and cape containing the repellant. The outfit is one of six in Ceesay’s collection, which she said “explores and modernizes traditional African silhouettes and textiles by embracing the strength and sexuality of the modern woman.”

Ochanda and Ceesay, from opposite sides of the continent, both have watched family members suffer from the disease. Ceesay recalls a family member who was ailing and subsequently died after doctors treated her for malaria when she had a different sickness. “It’s so common back home, you can’t escape it,” Ceesay said.

“Seeing malaria’s effect on people in Kenya, it’s very important for me to apply fiber science to help this problem,” Ochanda added. “A long-term goal of science is to be able to come up with solutions to help protect human health and life, so this project is very fulfilling for me.”

Ultimately, Ceesay and Ochanda hope the outfit they developed will serve as a prototype to drive new technologies for fighting the spread of malaria. On the horizon, Ochanda said, is a fabric that releases repellant in response to changes in temperature or light – offering wearers more protection at night when mosquitoes are on the hunt. At minimum, they hope the technology can be applied to create longer-lasting insecticide-laden bed nets.

“Although there are already mosquito nets being used, the solution isn’t foolproof,” Ceesay said. “People are still getting sick and dying. We can’t get complacent. I hope my design can show what is possible when you bring together fashion and science and will inspire others to keep improving the technology. If a student at Cornell can do this, imagine how far it could go.”

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Main Category: Sexual Health / STDs
Also Included In: Women’s Health / Gynecology
Article Date: 09 May 2012 – 2:00 PDT

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Intrauterine devices (IUDs) should be used routinely to provide emergency contraception, according to the authors of the first systematic review of all available data from the past 35 years. They found that IUDs had a failure rate of less than one per thousand and were a more effective form of emergency contraception than the “morning after pill”. In addition, IUDs continued to protect women from unwanted pregnancy for many more years if they were left in place.

The research, which is published online in Europe’s leading reproductive medicine journal Human Reproduction [1] today (Wednesday), analysed data from 42 studies carried out in six countries [2] between 1979 and 2011 and published in English or Chinese. IUD use in China is the highest in the world with 43% of women using them for contraception compared with 13% in the rest of the world, according to a 2006 report. The studies included eight different types of IUDs and 7034 women.

An IUD, sometimes known as a “coil” is a small plastic and copper device that is inserted into the womb by a trained doctor or nurse. It can be left in place for between five and ten years, depending on brand. In recent years, intrauterine systems (IUS) have been developed; these are small, plastic devices that release a very low dose of the hormone progesterone. The current study looked at IUDs only, which have been used for emergency contraception for at least 35 years.

The first author of the study, Ms Kelly Cleland, a staff researcher at the Office of Population Research at Princeton University, Princeton, USA, said: “Unintended pregnancies are a significant health problem worldwide. It is estimated that globally at least 36% of pregnancies are unintended. We already know from previous research that IUDs are very cost-effective forms of regular contraception. This study is the most comprehensive review to date of the efficacy of IUDs used for emergency contraception, and our results provide clear evidence that they are a highly effective method of emergency contraception, as nearly 100% of users overall did not become pregnant after unprotected sex when an IUD was inserted post-coitally. In contrast, failure rates are at least 10-20 times as high for emergency contraceptive pills such as ulipristal acetate and levonorgestrel. IUDs also offer very effective ongoing contraception. Therefore, we conclude that IUDs should be included routinely as an emergency contraceptive option whenever feasible and appropriate.”

When IUDs are used for emergency contraception they normally should be inserted within about five days of unprotected intercourse. The maximum timeframe in the current review ranged between two and ten days or more. However, in the majority of the studies (74%) insertion occurred within five days.

Out of the 7034 post-coital IUD insertions, there was a total of 10 pregnancies: six occurred among 5629 women in China, and the remaining four pregnancies in 200 women in one Egyptian study.

The researchers believe the unusual and abnormal results in the Egyptian study made it an “outlier” study, probably due to the way the women were chosen and, therefore, should be ignored for the purposes of their review. “This high failure rate can possibly be explained by the fact that women were specifically selected if they had had intercourse around the time of ovulation; in any event Egypt is a clear outlier,” write the authors. “If the unusual results from the Egypt study were excluded, the overall failure rate would be 0.09% . . .; this is our preferred estimate.”

By comparison, the “morning after pill” ulipristal acetate is the next most effective with a failure rate of approximately 1-2%, followed by levonorgestrel with a failure rate of approximately 2-3%. Both ulipristal acetate and levonorgestrel become less effective with increasing body mass index (BMI), but the researchers say that IUDs do not lose their effectiveness with increasing BMI.

Despite IUDs being the most effective means of emergency contraception, research shows that both doctors and patients have little awareness of them and they are rarely used in this situation. The researchers say a study in the USA showed that 85% of clinicians never recommended IUDs for emergency contraception and 93% require at least two visits for an IUD insertion.

Professor James Trussell, Professor of Economics and Public Affairs at Princeton University and Visiting Professor at The Hull York Medical School in York, UK, who was also involved in the research, said: “This is an extremely difficult problem to deal with, especially as in many countries women can just go to their local pharmacy to obtain the ‘morning after pill’, but virtually no women know to ask for an IUD and many family planning clinics and surgeries do not offer same-day insertion. Offering same-day insertion would remove a huge barrier to the greater use of IUDs.”

In addition, the upfront cost of IUDs is comparatively high, ranging between $718 for the ParaGard IUD in the USA [3] to about £10 for IUDs in the UK, although over a period of time they work out as more cost effective than other methods of contraception, emergency or otherwise.

Prof Trussell said that “these initially higher costs are vastly offset by pregnancies prevented both in the contraceptive emergency itself and by pregnancies prevented by continued use of the IUD. ‘Morning after pills’ taken today protect against pregnancy from sex last night but not from sex a week from now.”

Ms Cleland concluded: “We hope that this study will encourage providers to consider IUDs for their patients requesting emergency contraception, and possibly to consider how to structure their clinic flow so that they are able to provide same-day insertions.”

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Featured Article
Academic Journal
Main Category: Cardiovascular / Cardiology
Also Included In: Women’s Health / Gynecology
Article Date: 09 May 2012 – 8:00 PDT

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A new study published in the May 9 issue of JAMA reveals that older women, especially those aged 75+, who receive the anticoagulant therapy warfarin after diagnosis of atrial fibrillation are more likely to suffer a stroke than men.

The researchers explained:

“Atrial fibrillation (AF) is the most common cardiac arrhythmia, accounting for approximately one-third of hospitalizations for cardiac rhythm disturbances. It has been estimated that 2.2 million people in the United States and 4.5 million in the European Union have paroxysmal or persistent AF.

Patients with AF have a five-fold increase in the risk of stroke compared with the general population; therefore, antithrombotic agents are prescribed to reduce this risk. Sex-based differences related to AF have been identified, the most concerning being that women with AF have an increased risk for cardiovascular events, including stroke.”

According to the researchers, underutilization of oral anticoagulant treatment among women may contribute to this increased risk.

In order to compare usage patterns of warfarin and subsequent stroke incidence, Meytal Avgil Tsadok, Ph.D., of the McGill University Health Center, Montreal and colleagues examined 39,398 men and 44,115 women aged 65+ diagnosed with AF in the province of Quebec, Canada, from 1998-2007.

The researchers used administrative data with linkage between physicians, hospital discharge, and prescription drug claims databases.

According to the authors, the women were older at admission (74.2% were older than 75 years) than men (61.4%). In addition, the women had a higher CHADS2 (congestive heart failure, hypertension, diabetes mellitus, age 75+, prior stroke or transient ischemic attack) score than men.

Furthermore, they found that 60.6% of women were prescribed warfarin compared with 58.2% of men, and that the women were also more likely to have more prescriptions filled for the medication within 30 days post-discharge.

When the team evaluated prescription rates within 1 year after discharge, they found that the proportions of prescriptions filled were slightly increased to 68% in both men and women. Generally, adherence to the treatment was relatively high and comparable in both women and men.

In addition, stroke rates were considerably higher in women (5.8%) than men (4.3%). The difference between sexes was primarily driven by the rates in patients aged 75+.

The researchers explained:

“Furthermore, older women had significantly higher rates of stroke than older men, regardless of warfarin use, and women had higher rates of stroke compared with men, regardless of adherence level.”

After adjusting for various factors, the team found that women were 14% more likely to suffer a stroke than men.

The authors stressed that exactly why women have a higher risk of stroke than men, in such cases, is still unknown.

“The increased risk may be attributable to physiology (such as uncontrolled hypertension), vascular biology, genetic factors, hormonal or thromboembolic factors, or psychosocial factors that differ between men and women. We were not able to identify these factors with our database.”

They concluded:

“Although epidemiologic studies have investigated sex differences in stroke occurrence, little is known about warfarin effectiveness between men and women in the real-world clinical setting.

Our results suggest that elderly women with AF may need to be targeted for more effective stroke prevention therapy. Clinicians should be aware of the elevated stroke risk in older women with AF, and new strategies should be applied to effectively prevent stroke equally in men and women.

Written by Christian Nordqvist

Copyright: Medical News Today
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Main Category: Women’s Health / Gynecology
Also Included In: Psychology / Psychiatry;  Melanoma / Skin Cancer
Article Date: 08 May 2012 – 3:00 PDT

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1. Evidence Review: Screening Women for Intimate Partner Violence May Have Benefits, Few Harms

Intimate partner violence, or IPV, includes a range of abusive behaviors perpetrated by someone who is in an intimate relationship with the victim. Abusive behaviors may include physical violence, sexual violence, rape, and psychological aggression – all of which have immediate health effects on the victim. While victims and perpetrators can be male or female, women are disproportionately victimized (up to 5.3 million women are affected each year in the U.S.). In 2004, the United States Preventive Services Task Force (USPSTF) found insufficient evidence to support screening women for IPV. To inform an update of its previous recommendation, the Task Force reviewed articles published since 2003 to determine the effectiveness of IPV screening and interventions for women in health care settings in reducing IPV and related health outcomes, the diagnostic accuracy of screening tools, and adverse effects of screening and interventions. The evidence shows that women assigned to screening versus usual care did not have statistically significant improvements in IPV or health outcomes. However, more women in the screened group discussed IPV with their clinician (44 percent versus 8 percent). Clinicians may use questionnaire or interview-type tools to screen women for IPV. According to published research, five of the 13 tools assessed demonstrated high diagnostic accuracy. Few studies reported adverse effects of screening and interventions for IPV, but a large randomized controlled trial indicated no difference in adverse effects between women who were screened and women who were not. But some women who are screened may experience discomfort, loss of privacy, emotional distress, and concerns about further abuse. These data will be used to develop an updated recommendation on screening for IPV.

2. Physician Counseling Increases Sun-Protective Behaviors Among Patients at Greatest Risk for Skin Cancer

Skin cancer is one of the most common types of cancer, affecting more than two million American each year. Having light skin, hair, and eyes increases a patient’s risk for skin cancer, as does over-exposure to ultraviolet rays at an early age. The United States Preventive Services Task Force (USPSTF) recommends that physicians counsel children, adolescents, and young adults aged 10 to 24 years who have fair skin about skin cancer prevention. Evidence published since its 2003 recommendation statement suggest that counseling interventions in the primary care setting moderately increase the use of sun-protective behaviors among younger patients. Low-intensity interventions based on appearance proved effective. For example, physicians showed patients photos taken with a UV camera to demonstrate the extent to which UV rays can damage the skin. The Task Force recommendation applies to asymptomatic patients between the ages of 10 and 24 years with no history of skin cancer. There is insufficient evidence to determine if counseling interventions are effective for changing behavior in older adults.

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Main Category: Women’s Health / Gynecology
Also Included In: Sexual Health / STDs;  Seniors / Aging
Article Date: 08 May 2012 – 2:00 PDT

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An intriguing clue to longevity lurks in the sexual maturation timetable of female mammals, Jackson Laboratory researchers and their collaborators report.

Jackson researchers including Research Scientist Rong Yuan, Ph.D., had previously established that mouse strains with lower circulating levels of the hormone IGF1 at age six months live longer than other strains. In research published in the Proceedings of the National Academy of Sciences, Yuan and colleagues report that females from strains with lower IGF1 levels also reach sexual maturity at a significantly later age.

“This suggests a genetically regulated tradeoff – delayed reproduction but longer life – that is at least partially mediated by IGF1,” Yuan says.

The researchers conclude that IGF1 may co-regulate female sexual maturation and longevity. They showed that mouse strains derived from wild populations carry specific gene variants that delay sexual maturation, and they identified a candidate gene, Nrip1, involved in regulating sexual maturation that may also affect longevity by controlling IGF1 levels.

Yuan notes that researchers in England recently showed that higher levels of IGF1 and other hormones in girls are associated with earlier age of menarche (onset of menstruation). In the newly published research, Yuan and colleagues used the biological benchmark of vaginal patency (VP) as indicator of sexual maturity in mice.

Mice from the inbred strain C57BL/6J, also known as “Black 6,” showed 9 percent lower IGF1, 6 percent delayed age of VP and 24 percent extended lifespan compared to a Black 6 substrain that carries a gene variation that increases IGF1.

Using a technique called haplotype mapping, the researchers screened genetic and physiological data for 31 different inbred mouse strains and found genes that regulate female sexual maturation and lifespan, on Chromosomes 4 and 16. They showed that wild-derived mouse strains share a genetic profile associated with delayed VP and increased longevity, and identified a candidate gene, Nrip1, that controls IGF1 and age of VP.

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