TAG: "Women’s health"

In utero exposure to extreme morning sickness may result in neurological deficit


UCLA study suggests nutritional deficiency early in pregnancy may play a role.

By Kim Irwin, UCLA

Women who experience extreme morning sickness during pregnancy are three times more likely to have children with developmental deficits — including attention disorders and language and speech delays — than women who have “normal” nausea and vomiting, a UCLA study found.

The research was the first to look specifically at the relationship between in utero exposure to extreme morning sickness, also known as hyperemesis gravidarum or HG, and childhood neurologic developmental outcomes, said Marlena Fejzo, the study’s first author, and an associate researcher at the David Geffen School of Medicine at UCLA.

Fejzo said the correlation was especially apparent in women whose HG symptoms began very early, prior to five weeks gestation.

“These findings show that it is vital to take HG seriously so these pregnant women can get nutritional support right away,” Fejzo said. “An encouraging finding is that we did not find any association with medications to treat this disorder and neurodevelopmental delays, so I speculate that the neurodevelopmental outcomes are more likely caused by nutrient deficiency early in pregnancy rather than medication.”

The study was published online by the European Journal of Obstetrics and Gynecology and Reproductive Biology.

HG is the condition that the former Kate Middleton, Duchess of Cambridge, has experienced during both of her pregnancies. Its cause is unknown and the symptoms are intense — including continuous nausea and vomiting so violent that it can cause detached retinas, blown eardrums, cracked ribs and torn esophagi, Fejzo said. The symptoms can last for a month or two or for the entire pregnancy.

This study looked at 312 children born between 2007 and 2011 to 203 mothers with extreme morning sickness, and 169 children born to 89 mothers who did not have the disorder. Children born to women with HG had attention and sensory disorders, and learning, speech and language delays. Fejzo said the researchers do not yet know the mechanism that causes abnormal neurologic development in children of women with hyperemesis gravidarum.

The women in the study who had HG experienced nausea and vomiting so severe that they lost at least five pounds and needed intravenous fluids. Children exposed in utero to HG were 3.28 times more likely than the others to have neurodevelopmental delays, Fejzo said.

“There is an urgent need to address whether aggressive treatment that includes vitamin and nutrient supplementation in women with early symptoms of severe nausea and vomiting decreases that risk of neurodevelopmental delay,” she said.

Fejzo said HG is diagnosed in up to 2 percent of pregnant women worldwide, and it accounts for more than 285,000 hospitalizations in the U.S. every year.

Previous studies have shown that HG is associated with low birth weight babies, small size for gestational age and preterm births. Fejzo showed previously that children born to mothers who had extreme morning sickness were 3.6 times more likely to have behavioral or emotional disorders as adults.

Fejzo and her team are investigating the genetic basis of HG, and they hope to determine whether earlier treatment in women with symptoms limits or prevents the adverse outcomes identified in the study.

“A significant increase in neurodevelopmental and behavioral disorders in children exposed to
HG in utero was demonstrated which suggests HG may be linked to life-long effects on the exposed fetus,” the study states. “The cause for this is unknown, but may be due to maternal stress, abnormal hormone levels during fetal development and/or maternal-newborn bonding after birth, or malnutrition and vitamin deficiency.”

The study was conducted at UCLA and the University of Southern California, and it was funded in part by the Hyperemesis Education and Research Foundation.

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Simple dietary change may have big impact on public health


Overnight fasting may reduce breast cancer risk in women.

By Yadira Galindo, UC San Diego

A decrease in the amount of time spent eating and an increase in overnight fasting reduces glucose levels and may reduce the risk of breast cancer among women, report UC San Diego School of Medicine researchers in the journal Cancer Epidemiology, Biomarkers & Prevention.

The findings were presented at the American Association of Cancer Research’s annual meeting in Philadelphia.

“Increasing the duration of overnight fasting could be a novel strategy to reduce the risk of developing breast cancer,” said Catherine Marinac, UC San Diego doctoral candidate and first author on the paper. “This is a simple dietary change that we believe most women can understand and adopt. It may have a big impact on public health without requiring complicated counting of calories or nutrients.”

Women who fasted for longer periods of time overnight had significantly better control over blood glucose concentrations. The data show that each three-hour increase in nighttime fasting was associated with a 4 percent lower postprandial glucose level, regardless of how much women ate.

“The dietary advice for cancer prevention usually focuses on limiting consumption of red meat, alcohol and refined grains while increasing plant-based foods,” said co-author Ruth Patterson, Ph.D., UC San Diego Moores Cancer Center associate director for population sciences and program leader of the cancer prevention program. “New evidence suggests that when and how often people eat can also play a role in cancer risk.”

Women in the study reported eating five times per day with a mean nighttime fasting of 12 hours. Those who reported longer fast durations also indicated they consumed fewer calories per day, ate fewer calories after 10 p.m. and had fewer eating episodes.

Researchers recommend large-scale clinical trials to confirm that nighttime fasting results in favorable changes to biomarkers of glycemic control and breast cancer risk.

Co-authors include Loki Natarajan, Dorothy Sears and Sheri Hartman of UC San Diego; and Linda Gallo and Elva Arredondo of San Diego State University.

Funding for this research came, in part, from the National Cancer Institute-sponsored Ruth L. Kirschstein National Research Service Award (1F31CA183125-01A1), the NCI Centers for Transdisciplinary Research on Energetics and Cancer (1U54CA155435-01) and philanthropic support from Ms. Carol Vassiliadis and family.

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A mother’s genes can influence the bacteria in her baby’s gut


Research may have applications for protecting preemies from range of intestinal diseases.

Zachary Lewis (left) and David Mills, UC Davis

By Phyllis Brown, UC Davis

Researchers at UC Davis have found that a gene, which is not active in some mothers, produces a breast milk sugar that influences the development of the community of gut bacteria in their infants. The sugars produced by these mothers, called “secretors,” are not digested by the infant, but instead nourish specific bacteria that colonize their babies’ guts soon after birth.

Mothers known as “non-secretors” have a non-functional fucosyltransferase 2 (FUT2) gene, which alters the composition of their breast milk sugars and changes how the microbial community, or microbiota, of their infants’ guts develop.

The research may have applications in a clinical setting for protecting premature infants from a range of intestinal diseases including necrotizing enterocolitis (NEC), a condition that is the second most common cause of death among premature infants in the United States.

The researchers emphasized that the finding does not suggest that breast milk from mothers without an active copy of the gene is less nourishing or healthy. Rather, it conveys the subtle and elegant choreography of one part of the human microbiome: The relationships between the mothers’ genetics, the composition of her breast milk and the development of their infants’ gut microbiota. It also reveals clues for enriching desirable bacteria in populations at risk of intestinal diseases — such as preemies.

“In no way is the nonsecretor mother’s milk less healthy, and their babies are at no greater risk,” said David Mills, Peter J. Shields Endowed Chair in Dairy Food Science at UC Davis and senior study author. “What this work does show us is that the mother’s genotype matters, and that it influences the breast milk, which clearly drives the establishment of microbes in the intestines of their babies.”

The research examining the differences in infant gut microbial populations arising from differences in human milk oligosaccharides (sugars), “Maternal Fucosyltransferase 2 Status Affects the Gut Bifidobacterial Communities of Breastfed Infants,” is published online today (April 9) in the journal Microbiome, a BioMedCentral journal.

Varieties of Bifidobacterium inhabit the gastrointestinal tracts and mouths of mammals and are one of the major genera of bacteria that make up the microbial community of the infant colon. The relationship between human genetics, breast milk and Bifidobacterium appears to have developed throughout mammalian evolution.

Development of a healthy gut microbiota can have a lifelong effect on health, and early intervention in the establishment of that microbiota could have lifelong positive effects: The early establishment of bifidobacteria has been shown to be associated with improved immune response to vaccines, development of the infants’ immature immune system, and protection against pathogens.

Bifidobacterium are known to consume the 2′-fucosylated glycans (sugars) found in the breast milk of women with the fucosyltransferase 2 mammary gene. The study found that, on average, Bifidobacterium were established earlier and more frequently in infants fed by women with an active copy of the gene, the secretors, than without one, the non-secretors.

The authors found that the intestinal tracts of infants fed by non-secretor mothers are delayed in establishing a bifidobacteria-dominated microbiota. The delay, the authors said, may be due to difficulties in the infant acquiring a species of bifidobacteria that is geared toward consuming the specific milk sugar delivered by the mother.

The research was conducted using milk samples from 44 mothers in the UC Davis Foods for Health Institute Lactation Study and fecal samples from their infants at four different time points. The researchers determined the secretor status of the mothers: 12 were non-secretor and 32 were secretor mothers. They also measured the amount and type of breast milk sugars and the amount of lactate (a beneficial molecule produced by bifidobacteria) in the infant’s feces.

The researchers determined that more infants fed by secretor mothers had high levels of bifidobacteria — 60 percent of infants versus 37.5 percent at day 6 and 80 percent versus 50 percent at day 120 –- and that infants who had more bifidobacteria had lower amounts of milk sugars left over and higher amounts of lactate in their feces.

One question that remains is whether this pattern holds true in infants living in other places.

“We are beginning to observe that infants from different parts of the world have different patterns of colonization by microbes,” said lead study author Zachary T. Lewis, a postdoctoral fellow.

“The types and levels of bacteria encountered by infants in developing countries is different from the types and levels of bacteria encountered by the babies in our UC Davis cohort, and that might account for some of the differences,” he said.

Maternal secretor status is likely only one of the many factors that influence the infant gut microbiota, Lewis said. The researchers will explore this question further in future studies.

The researchers said that understanding the mechanism behind the observed secretor/non-secretor differences may prove critical to compensating for it in situations where the infants are vulnerable, such as by providing carefully chosen pre- or probiotics. For example, prebiotics and probiotics frequently are given to premature infants  to protect them against NEC, which causes portions of the bowel to necrotize, or die.

“This work significantly advances our efforts to decipher how human milk amazingly orchestrates colonization of the infant gut by helpful bacteria, which then protects and guides intestinal development in the early stages of life. Understanding this incredible sequence of events will provide examples for how to repair this process where it has been disrupted, such as in premature infants or colicky babies,” Mills said.

Other study authors include Jennifer T. Smilowitz, Evan Parker, Danielle G. Lemay and Carlito Lebrilla, all of UC Davis; Sarah M. Totten of UC Davis and Stanford University: Mina Popovic of University of Moedna and Reggio Emilia, Italy; and Maxwell Van Tassel Michael J. Miller and Young-Su Jin of the University of Illinois Urbana-Champagne.

The research was supported by the University of California Discovery Grant Program, the UC Davis Research Investments in the Sciences and Engineering (RISE) Program, the California Dairy Research Foundation, the Bill and Melinda Gates Foundation, National Institutes of Health awards R01HD059127, R01HD065122, 8R01HD061923, R21AT006180, R01AT007079 and the Peter J. Shields Endowed Chair in Dairy Food Science.

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Women, regardless of backgrounds, seek help for ‘got to go’ feeling


Study shows importance of providers discussing urinary incontinence with patients.

By Phyllis Brown, UC Davis

Regardless of their racial, ethnic, educational or socioeconomic background, women seek help for a frustrating — and ubiquitous — feature of becoming “a woman of a certain age:” the need be close to the women’s room.

Those are the findings of a large study by UC Davis of urinary incontinence in menopausal women, based on data from the Study of Women’s Health Across the Nation (SWAN), a nine-year investigation of diverse menopausal women from six sites across the United States. The study is published online today (April 7) in Obstetrics and Gynecology.

The study, of more than 3,302 study participants from such diverse locations as Oakland, Pittsburgh and Detroit, found that most women, regardless of their backgrounds, talked with their health care provider about urinary urgency incontinence — leaking with the immediate need to reach the restroom — or stress incontinence — leaking with “coughing, laughing or sneezing” — over the nine years they were followed.

All of the participants were transitioning through menopause. Some 68 percent of women reported monthly or more frequent urinary incontinence, either leakage with urgency or with coughing, sneezing or exercising.

Earlier studies have suggested that African-American women and women of lower socioeconomic backgrounds were less likely to seek treatment.

“Our study results do not support previous findings that black women or women with lower socioeconomic circumstances are either less likely to seek care only at a higher level of bother of urinary incontinence frequency than white women or women of higher socioeconomic resources,” said Elaine Waetjen, UC Davis professor in the Department of Obstetrics and Gynecology and lead study author.

Rather, Waetjen said, the strongest associations with seeking care were worsening and persistence of symptoms. That is important, Waetjen said, because urinary incontinence is readily treatable.

“By discussing their urinary incontinence with a health care provider, women can learn about the variety of treatment options available to them, from behavioral changes to medications and surgery,” she said.

Other study authors include Guibo Xing, Joy Melnikow and Ellen Gold, all of UC Davis and Wesley O. Johnson of UC Irvine.

The study was funded by the National Institutes of Health, including the Institute of Diabetes and Digestive and Kidney Disease, Office of Research on Women’s Health, Institute on Aging, and Institute of Nursing Research, including grants number DK092864, U01NR004061, U01AG012505, U012535, U01AG02531, U01AG02531, U01AG012539, U01AG012546, U01AG012553, U01AG012554, U01AG012495.

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Income inequality affects who get an underutilized test for breast cancer


UCLA-led study shows that economic factors may influence adoption of new technologies.

The study, led by UCLA’s Ninez Ponce, found that communities with greater gaps between high-income individuals and low-income individuals also had larger gaps in testing. (Photo by Shweta Saraswat, UCLA)

By Venetia Lai, UCLA

Wealthier women who live in communities with the greatest income divide between rich and poor had better access to a new genetic test that can determine the most effective form of treatment for early-stage breast cancer, according to a new study (link is password-protected) by the UCLA Center for Health Policy Research, Harvard Medical School’s Brigham and Women’s Hospital and Aetna. The study, published in the April issue of the journal Health Affairs, also indicated that only a small minority of women with breast cancer received the test at all.

“Our study shows that even among women who have insurance, where they live and how income is distributed in their community were closely linked to their chance of getting access to an effective innovation in the early years of its diffusion,” said Ninez Ponce, associate director of the UCLA Center for Health Policy Research and lead author of the study.

The Gene Expression Profiling test is an early example of a “precision medicine” genomic test that estimates a patient’s risk of having a recurrence of a disease. According to current medical evidence, a woman with early-stage, estrogen-receptor–positive, lymph-node–negative breast cancer with a low-risk GEP test score may not benefit from adding chemotherapy to her treatment plan, while a woman with a high-risk score would benefit and should consider including chemotherapy in her treatment. More than 100,000 women are diagnosed with this type of breast cancer every year.

The study is based on a survey of 1,847 women between the ages of 35 of 64 who were insured through an Aetna health plan and were newly diagnosed with breast cancer in 2006 and 2007. Of those, 235 (12.7 percent) had the GEP test.

The study found that the greater the gap between high-income individuals and low-income individuals within a community, the larger the gap in testing. In communities where there was greater equality in income — whether poorer or wealthier — the adoption and use of the tests was slower than in communities with unequal income levels.

“Income inequality is at an all-time high right now,” said Dr. Jennifer Haas, a co-author of the study and associate professor at Harvard Medical School’s Brigham and Women’s Hospital. “That it should have a bearing on who gets an innovative test and who doesn’t could lead to more social disparities in cancer care.”

The authors point to the need for more research to address the socioeconomic and other barriers that may prevent women from accessing GEP and other medical innovations.

The TRANSPERS Center for Translational and Policy Research on Personalized Medicine, the National Institutes of Health, Harvard Catalyst, the Harvard Clinical and Translational Science Center, and the National Research Service Award Primary Care Research Fellowship and Aetna supported this study.

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Study reveals treatment for breast cancer patients with cognitive difficulties


Mental training exercises developed at UCLA shown to help mitigate effects of ‘chemo brain.’

Patricia Ganz, UCLA

By Reggie Kumar, UCLA

UCLA researchers have developed a program that could improve the day-to-day lives of women with breast cancer by addressing post-treatment cognitive difficulties, sometimes known as “chemo brain,” which can affect up to 35 percent of women after their treatments.

An estimated 1 in 8 women will develop invasive breast cancer in their lifetimes, and following treatment, a mental fogginess can prevent them from being able to concentrate, staying organized and completing everyday activities, such as sticking to a schedule or planning a family gathering.

The new study, led by breast cancer research pioneer and UCLA Jonsson Comprehensive Cancer Center member Dr. Patricia Ganz, builds upon her earlier research that found a statistically significant association between neuropsychological test performance and memory complaints among women with early stage breast cancer following treatment.

“We invited the women to participate in a research study that assigned them to early or delayed treatment with a five-week, two-hour group training session, where a psychologist taught them strategies to help them with their memory and maintaining their ability to pay attention to things,” said Ganz, director of prevention and control research at the cancer center. “These are activities we call executive function and planning, or the things all of us do in order to organize our day.”

Dr. Linda Ercoli, an associate clinical professor of health sciences at the UCLA Semel Institute for Neuroscience and Human Behavior, was responsible for the development of the cognitive rehabilitation intervention program and either delivered the training or supervised other clinicians who provided the group training sessions.

“We gave women exercises on, for example, how to remember a ‘to-do’ list, remembering to buy items at the store, or planning a party and deciding what type of food should be served to guests,” said Ercoli, a co-author of the study. “Participants were given real-life tasks to complete that would use these types of strategies to improve cognitive function.”

The intervention program also included homework and practice activities that they would discuss at the weekly sessions. These exercises were designed to improve memory and cognitive function.

Women in the delayed group were offered the intervention after completion of their two-month follow-up testing and this occurred when the researchers had enough women to form a group to provide them the intervention.

All of the women who participated in the study, whether they received the intervention early or at a delayed time point, completed questions about their mood and mental functioning. The women also had detailed neurocognitive testing three times: before learning which group they would be in, immediately after the end of the five weeks of training and then again two months later. Most of the women also had resting EEG (brain wave) testing to see if this could measure changes in how the women fared throughout the study.

Ganz and Ercoli found that the 32 women in the early intervention group reported improvement in memory complaints and test functioning, while the 16 women in the delayed intervention control group did not improve in either their cognitive complaints or test performance. The intervention group participants showed continued improvement two months after completion of the rehabilitation program.

“The brain wave pattern in the intervention group actually normalized,” Ganz said. “We hope that this might be an effective biologic way to assess the cognitive effects of cancer treatment in the future.”

The next steps are for other researchers to test this cognitive rehabilitation program in larger numbers of patients, and potentially to develop strategies to provide intervention much earlier in the course of breast cancer treatment to either prevent difficulties or hasten recovery.

“This study will be added to the growing body of literature demonstrating the validity of patient complaints,” Ganz said. “Furthermore, the intervention results provided important encouragement that these complaints can improve with appropriate training.”

The study was funded by the Breast Cancer Research Foundation and the Jonsson Comprehensive Cancer Center Foundation.

The randomized clinical trial results are available online in the journal of Psycho-Oncology.

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CDC New Investigator Award goes to UC San Diego scientist


Jamila Stockman to receive award for domestic violence research.

Jamila Stockman, UC San Diego

By Bonnie Ward, UC San Diego

Jamila K. Stockman, Ph.D., M.P.H., assistant professor of medicine and global public health at the UC San Diego School of Medicine has been selected to receive the Linda E. Saltzman New Investigator Award. The national award, presented by the Centers for Disease Control and Prevention (CDC) Foundation and Futures Without Violence, a nonprofit organization dedicated to ending violence against women and children, recognizes an outstanding early career scientist working in the field of domestic violence.

“Jamila is a superb scientist, as demonstrated by her multiple National Institutes of Health grants, but this award really represents her commitment to use science to improve the lives of women living with violence, as well as to prevent violence,” said Anita Raj, Ph.D., professor of medicine and global public health and founding director of the Center on Gender Equity and Health at UC San Diego.

The Linda E. Saltzman New Investigator Award, presented every other year, recognizes an exceptional new investigator with two to 10 years of experience working in the field of domestic violence, violence against women or dating violence.

Stockman will receive the award during the National Conference on Health and Domestic Violence to be held March 19-21 in Washington, D.C.

An infectious disease epidemiologist, Stockman focuses her work on social and environmental factors contributing to intimate partner violence, particularly among low-income ethnic minority and substance abusing women. Along with exploring the factors influencing partner violence, Stockman seeks to create new and improved violence intervention strategies.

In addition to Stockman, UC San Diego scientist Elizabeth Reed, Sc.D., M.P.H., assistant professor of medicine and global public health, was also a finalist for the award.

Raj said the recognitions reflect the excellence and commitment of both researchers. “We at UC San Diego are enormously proud of these two scientists who, though early in their careers, are making important contributions in the field.”

One of Stockman’s current projects involves promoting safety planning strategies for methamphetamine-addicted women at risk for lethality by their intimate partner, who often have nowhere to turn during a crisis. Another effort looks at how underlying social and neighborhood environments, as well as an altered stress response, can influence behavioral risks for HIV infection among women with experiences of sexual violence.

Reed’s research focuses on how economic empowerment efforts can reduce women and girls’ vulnerabilities to violence. She is currently involved in a multi-agency study designed to reduce HIV-transmission and violence among vulnerable women in Tijuana through a microfinance loan and gender equity intervention program.

The CDC Foundation and Futures Without Violence created the new investigator biennial award in 2007 to honor senior scientist Linda E. Saltzman, Ph.D., who became one of the CDC’s top experts on violence, and one of the violence prevention movement’s most trusted allies, dedicating 20 years to the field of violence against women, before her death in 2005. Recipients are nominated by senior investigators in the field and selected by the Linda E. Saltzman New Investigator Award Selection Committee, comprised of representatives from the CDC, Futures Without Violence, and other experts in the field.

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UCLA, Apple team on app to track breast cancer survivors’ experiences


Share the Journey: Mind, Body and Wellness after Breast Cancer available now on iTunes.

Patricia Ganz, UCLA

By Reggie Kumar, UCLA

UCLA cancer research pioneer Dr. Patricia Ganz and collaborators Apple and Sage Bionetworks today (March 9) announced the launch of Share the Journey: Mind, Body and Wellness after Breast Cancer, a patient-centered mobile app that empowers women to be partners in the research process by tracking their symptoms and successes.

Available for download today at the iTunes App Store, Share the Journey was developed by UCLA’s Jonsson Comprehensive Cancer Center, Penn Medicine, Dana-Farber Cancer Institute and Sage Bionetworks. The app is an interactive research study that aims to understand why some breast cancer survivors recover faster than others, why their symptoms vary over time and what can be done to improve symptoms.

Ganz, who is director of cancer prevention and control research at the Jonsson Cancer Center, was a key collaborator with Apple and Sage in developing Share the Journey, which marries science and technology by using surveys and sensor data on the iPhone to collect and track fatigue, mood and cognitive changes, sleep disturbances and reductions in exercise.

Share the Journey is one of five new apps being launched in conjunction with Apple’s ResearchKit, an open-source tool that serves as a streamlined hub for iOS apps that can help speed scientific progress toward cures by amplifying the patient voice in shaping research directions and outcomes.

Share the Journey shifts the center of care, healing and intervention into the hands of women who have survived breast cancer. Its creators say that collecting women’s experiences after breast cancer treatment will create a trove of data based on well-validated surveys and measurements that will be continuously improved upon based on the participants’ feedback.

Women who have undergone surgery, radiation or drug therapy to treat breast cancer often experience symptoms that affect their quality of life and impede recovery.

“We’re excited to use these new ResearchKit tools to expand participant recruitment and quickly gather even more data through the simple use of an app. The data it will provide takes us one step closer to developing more personalized care,” said Ganz, who also is a professor at the UCLA Fielding School of Public Health. “Access to more diverse patient-reported health data will help us learn more about long-term aftereffects of cancer treatments and provide us with a better understanding of breast cancer patients’ experience.”

Share the Journey is open to women between the ages of 18 and 80 who live in the United States, whether or not they have had breast cancer. Those who have not had breast cancer will contribute important data to the app that will help researchers understand which symptoms may be related to cancer treatment and which may be part of the normal aging process. The developers also are creating a Spanish-language version of the app and planning to expand the study to other countries.

“One reason to build these apps and run these studies is to see whether we can turn anecdotes into signals, and by generating signals find windows for intervention,” said Dr. Stephen Friend, president of Sage Bionetworks and a principal investigator for Share the Journey. “We’re most interested in disease variations and the hourly, daily or weekly ebb and flow of symptoms that are not being tracked and completely missed by biannual visits to the doctor.”

The platform is based on the concept that if individuals’ experiences were at the center of the research process, researchers working in virtual teams might be able to get efficient, inexpensive and ubiquitous ways of gathering information using websites, tablets or an app. This technology will allow Sage and other teams to include patients and other study participants as owners of their own data and equal partners.

“We need to better understand some of the long-term negative treatment effects, such as fatigue, that can be associated with the disease control benefits of cancer therapies. What are the biological mechanisms that underpin those effects and why some survivors are more vulnerable to those effects than others,” Ganz said.

“With Share the Journey, women can tell us when something’s wrong, and the app has the potential to capture valuable information on the patient experience. Our current cancer care system lacks the ability to predict or treat these chronic and enduring symptoms, but Share the Journey can set us on a path toward understanding why some people recover and some do not.”

In addition to Ganz, Apple and Sage were advised in development of Share the Journey by Drs. Ann Partridge and Judy Garber at Dana-Farber Cancer Institute, Dr. Kathryn Schmitz at the University of Pennsylvania Perelman School of Medicine and Dr. Susan Love at UCLA and the Dr. Susan Love Research Foundation.

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Curing cancer, one tax return at a time


Check a box and fund two UC-administered cancer research projects.

California taxpayers fund a number of health programs — some administered by UC — by designating a portion of their tax refund.

By Kate Rix, UC Newsroom

Those contribution lines on your 540 State Income Tax Return where you can fill in donation amounts for nearly 30 different California-based funds? Those are just nickel-and-dime funds without much impact, right?

Wrong.

Last year California taxpayers contributed more than $4 million to an inspiring range of worthy health, environmental and educational funds. Among the funds that get an important boost around tax time are the California Breast Cancer Research Program and the California Cancer Research Fund. Both funds are administered by the University of California, which distributes the money as direct grants to California researchers working on the cutting edge.

In other words, those contributions have a tangible impact in the fight against cancer, supporting work that ranges from personalized support for young cancer survivors to new low-radiation screening tools.

Protecting fertility for young cancer survivors

As treatments for breast cancer improve, the number of young women surviving the disease has grown. Of the 2.8 million cancer survivors in the U.S., 10 percent are under 45 at diagnosis. After enduring cancer therapies and one of the most frightening experiences of their lives, survivors often find themselves faced with a variety of worrisome long-term health issues.

During chemotherapy, menstrual periods often stop, and it is not uncommon for women — even very young women — to experience the symptoms of menopause, including hot flashes and vaginal dryness. Cancer fears become compounded by worries that they may never be able to have children and that their bodies will never be the same.

“Young breast cancer survivors and their health care providers want to learn about how to manage reproductive health after cancer,” said Dr. Irene Su, an assistant professor in the Division of Reproductive Endocrinology and Infertility at the UC San Diego School of Medicine.

Closing the knowledge gap

“There hasn’t been an emphasis on providing reproductive health information to young survivors,” Su said. Also, because many health care providers may not see that many young women with cancer, they may face knowledge gaps on providing reproductive health care for this population.

“Right now, there is a dearth of resources for disseminating reproductive health care information to patients and providers.”

Su is leading a project, funded by the California Breast Cancer Research Program, to help women and their medical providers — no matter where they are located — have access to up-to-date, evidence-based information to treat estrogen deprivation symptoms, improve sexual function and monitor fertility potential after cancer. CBCRP received nearly $400,000 through the tax check-off program last year.

With a grant of more than $750,000 over three years, the project will generate the Reproductive Survivorship Care Plan (SCP-R), a Web-based tool that offers the best current research on managing hot flashes, sexual problems, fertility concerns and contraception to young breast cancer patients and their providers. Information can be tailored to the patient, and focuses on specific issues. The SCP-R will be tested in a randomized controlled trial that launches this summer.

The resource is being developed with the participation of patients and caregivers recruited across the country and with the oversight of a stakeholder panel of clinicians, researchers and breast cancer survivors.

Young women who survive breast cancer often have questions about fertility. It isn’t unusual, for example, for a young woman’s periods to stop when she undergoes chemotherapy. Women who have not completed their families may worry that not menstruating means that they are infertile. “The SCP-R will provide relevant information on the natural course of ovarian recovery, when survivors usually get their periods back, types of blood tests that can help monitor ovarian function, and, equally importantly, what tests are not recommended and what we still don’t know,” Su said.

Women who have completed their families will need to consider effective contraception. In the United States, birth control pills are the most common reversible form of contraception. For a cancer survivor, however, it is crucial to keep estrogen levels low.

“The copper IUD is a great form of reversible birth control, because it is non-hormonal and highly effective,” said Su. “It would be great if a family practice physician or oncology provider had knowledge of how effective different birth controls are and what are recommended methods for breast cancer survivors.”

Lung cancer screenings as safe as chest X-rays

Lung cancer is the most deadly form of cancer in the U.S. While patients with other forms of cancer are living longer than before, the five-year survival rate for lung cancers hasn’t improved much in recent decades. More people die from lung cancer than from the next four cancers combined (including breast and prostate cancer). And while smoking is a leading cause of lung cancer, up to 15 percent of lung cancers have no relation to smoking; even smokers who quit smoking up to 15 years previously are still at risk of lung cancer.

One obstacle has been the lack of any screening test to detect lung cancer at an early stage. While imaging technology held some promise, it was unproven and there were some risks associated with being screened. But just a few years ago, a national lung screening trial found that at-risk patients who were screened using low-dose CT scanning technology had a 15-20 percent lower chance of dying of lung cancer than those who received a standard chest X-ray.

These results showed promise for a new tool, with dramatically reduced radiation, to detect the most deadly form of cancer.

With funding from the California Cancer Research Fund (administered by UC’s Tobacco-Related Disease Research Program), a team at UCLA is working to bring the level of radiation in an ultra-low-dose CT scan even lower. The TRDRP received nearly $445,000 through the tax check-off program last year.

“We know how to do the screening and the technology is pretty good,” said Michael McNitt-Gray, a professor of radiology at the UCLA School of Medicine. “We want to push that dose even lower. We’d like to get the same level as a single chest X-ray.”

Shorter times, improved images

Several aspects of CT scanning technology have improved dramatically. While low-dose CT screenings have been possible for nearly 20 years, technical limits have made them difficult to use effectively.

For example, an accurate image used to take up to 60 seconds to capture. Patients had to hold their breath during that entire time, something that most smokers can’t do.

The improvements being made at UCLA make the process faster — the actual scan takes just 5 seconds — and can allow finer detail in the image, showing suspicious objects in the lung as small as 5 mm.

The timing of the UCLA project couldn’t be better. Last year, private insurers began covering the cost of ultra-low-dose CT scans. In February, Medicare announced that it also would cover the screening, making the early detection tool available to the elderly and disabled who may be at risk of developing lung cancer.

“The test itself is very quick,” says McNitt-Gray. “The patient lies down, puts their arms above their head, and does some practice breathing. Based upon a planning view, the scanner adjusts to the patient’s anatomy so that just enough of the radiation dose is used to provide the necessary image quality to detect anything suspicious in the lungs.”

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Are we closing the gender gap?


UCLA report reveals marked inequalities in legal rights for women and girls around world.

The report found that although all but seven countries have made primary education tuition-free, 40 charge tuition before the end of secondary school. (Photo courtesy of UCLA's World Policy Analysis Center)

By Carla Denly, UCLA

On March 9, the United Nations will convene to evaluate the global community’s progress on gender equality in the 20 years since 189 countries adopted the Beijing Declaration and Platform for Action. The U.N. session will continue through March 20.

Closing the Gender Gap,” a new report by UCLA’s World Policy Analysis Center (World), reveals that more than 170 countries have legal barriers preventing women and girls from experiencing the same rights, protections and liberties as men and boys.

World’s new report and accompanying online resource bank take a heightened approach to global accountability and transparency by detailing the rights, laws and policies pertaining to gender equality in 197 countries and Beijing Platform signatories. The resource bank includes quantitatively analyzable data, policy briefs, mobile-friendly interactive maps, infographics, fact sheets and more.

Analysis by World shows that in most countries, gender inequality continues to be embedded in national constitutions, laws and policies:

  • More than 150 countries lack protections critical to ensuring women’s economic participation.
  • Sixty-one countries provide girls with less legal protection from early marriage than they do for boys.
  • Ninety-two countries guarantee paid leave to mothers of infants, but not to fathers, perpetuating inequalities in the burden of caregiving and limiting equal opportunities at work.

The U.S. is not immune from these concerns — here, for example, mothers are not ensured paid leave to care for their newborn children, making the U.S. the world’s only high-income country not to provide such a guarantee. And while more than 80 percent of countries in the world have a constitutional guarantee of gender equality, the U.S. does not.

Yet the report findings indicate that progress is possible. More than 95 percent of the 56 new national constitutions adopted around the world in the past 20 years legally guarantee gender equality. Good legislation and policies exist in all regions and at all country income levels.

“Citizens need and deserve to know their rights and how their country fares when compared to others,” said Dr. Jody Heymann, founding director of the World Policy Analysis Center and dean of the UCLA Fielding School of Public Health. “Only by getting data into the hands of citizens and leaders alike on what effective steps have been taken — and what haven’t — can we close the gender gap in our global community.”

The study examined whether laws treat women and men equally, and whether concrete steps have been taken to reduce inequality. Among the findings:

Constitutions

  • Constitutional guarantees are nearly universal in newly passed constitutions. More than 95 percent of the 56 constitutions that have been adopted since 1995 include guarantees for gender equality, compared with just 79 percent enacted before then. These protections of equality provide a foundation to challenge discriminatory laws.
  • Thirty-two constitutions still do not explicitly guarantee gender equality.
  • Eleven constitutions allow customary or religious law to supersede constitutional protections of gender equality, potentially jeopardizing equal rights for women.
  • Despite constitutional guarantees, discriminatory laws remain in place in many countries around the world.

Families and marriage

  • Only 56 constitutions guarantee equality within marriage and there has been little change in the level of protection over the past 20 years.
  • Legislation also lags behind in this area. Sixty-one countries allow girls to be legally married younger than boys.
  • Inequalities in the law contribute to more girls being married young than boys: Nearly five times more girls than boys are married before the age of 18.
  • While large gaps remain, many countries have strengthened child marriage legislation since Beijing. Among 105 low- and middle-income countries, the percentage of countries that allow girls to be married before age 18 with parental consent fell from to 56 percent in 2013 from 80 percent in 1995.

Families and work

  • One hundred and eighty-eight countries guarantee paid leave for new mothers (the U.S. does not), but only 96 countries provide paid leave for new fathers. This legal inequality reinforces social norms that women are responsible for care and limits women’s economic opportunities, contributing to lower employment rates and wages for women.
  • Caregiving doesn’t end at infancy. Eighty-one countries provide no leave that can be used to meet children’s health needs and five other countries place the burden of meeting children’s health needs solely on women. In 143 countries, no leave can be used to meet children’s educational needs and two other countries place the burden of meeting children’s educational needs solely on women.
  • As the global population ages, leave to care for adult family members is increasingly important. Ninety-seven countries do not provide any leave to meet adult family members’ health needs. This gap disproportionately affects women who carry far more of the elder caregiving globally.
  • Countries that do guarantee paid leave for men and women exist in every region and income level.

Education

  • All but seven countries have made primary education tuition-free, but 40 countries continue to charge tuition before the end of secondary school.
  • When cost is a barrier, girls are more likely to be kept out of schools than boys. Unsurprisingly, the regions with the largest gaps in secondary enrolment for boys and girls are also those that are most likely to charge tuition.
  • Among those countries with available expenditure data, 43 percent that charge tuition before the completion of secondary school spend less than 4 percent of their gross domestic product on education.

Economy and work

  • Only 64 countries constitutionally guarantee women protection from discrimination at work or guarantee equal pay for equal work.
  • Only 40 countries have legislative protections from gender discrimination in hiring and pay.
  • Of constitutions adopted in the past 20 years, 38 percent guarantee protection from discrimination at work, compared to only 12 percent of those that existed previously.

World’s findings provide an opportunity to examine countries’ progress in closing the gender gap, especially in critical areas that impact the daily lives of women and girls — access to quality education and the ability to remain in school, protection from child marriage, equal rights in employment, and policies that ensure health at work and at home.

“When the status of women and girls improves, population health improves and the economic strength of companies and countries increases. Entire families, communities, and countries are lifted up,” Heymann said.

The Maternal and Child Health Equity research program at McGill University helped develop longitudinal data on child marriage, breastfeeding breaks and maternal leave for the study.

The Bill & Melinda Gates Foundation provided grant support for this work to improve the quantity and quality of comparative policy data available in partnership with the Bill, Hillary & Chelsea Clinton Foundation’s No Ceilings Initiative.

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UC complex contraception registry established to enhance family planning


UC collaborative taps into cross-campus searchable database to help improve patient care.

“You can have a big impact in a woman's life if you are able to identify that she has a need for more contraceptive counseling.” – Sheila Mody, UC San Diego

By Patti Wieser, UC San Diego

With support from the UC Office of the President, the family planning fellowship-trained specialists at the five UC medical center campuses – led by Sheila Mody, M.D., at UC San Diego – have established a UC-wide complex contraception registry.

“We are looking at how women with medical conditions access family planning specialists for contraception and how they make contraceptive decisions,” said Mody, the first family planning specialist at UC San Diego.

Last summer the Complex Contraception Registry–UC Family Planning Collaborative Study began recruiting patients with medical conditions such as diabetes, cardiovascular disease, epilepsy, migraines, cancer and organ transplants. Currently, 75 participants are enrolled in the registry, which is on ClinicalTrials.gov, a service of the National Institutes of Health. The registry contains demographics, diagnoses and contraceptive method.

Many women with complex medical conditions who do not wish to become pregnant are not receiving in-depth contraception counseling from their primary or subspecialty care clinicians, and often they are not using contraception, Mody said. Several, she added, have conditions that could worsen with pregnancy or for whom pregnancy could be complicated by the medical condition.

“You can have a big impact in a woman’s life if you are able to identify that she has a need for more contraceptive counseling. If the recommendation is for a patient to prevent pregnancy at this point in her life, we want to help her achieve that,” said Mody.

She is supported through an institutional NIH K12 award and mentored by UC San Diego Clinical and Translational Research Institute (CTRI) Executive Committee member Christina Chambers, Ph.D., M.P.H.

Groundbreaking work

“The work Dr. Mody is doing is groundbreaking in terms of preventing ‘preventable’ birth defects,” said Chambers, a professor of pediatrics at UC San Diego. “When we are prescribing medications known to have the potential to cause birth defects, it is essential to couple this with effective contraception counseling.”

A family planning fellowship-trained specialist can also recommend contraceptive methods that won’t interfere with therapy. For example, if a patient is taking medication for epilepsy and is concerned about drug-drug interactions, the specialist might recommend an intrauterine device rather than an oral contraceptive.

Mody said bringing the five medical campuses together with inter-institutional support and resources has a greater impact on patient health. The collaborative partners include UC Davis, UC Irvine, UCLA, UC San Diego and UC San Francisco.

“In order to progress the research knowledge about family planning with these medical conditions, it is helpful to have the UCs work together so we can improve patient care,” Mody said.

The UC partnership is also important for tackling state-specific research questions and policy issues.

UC ReX employed for research data

The collaborative employed UC Research Exchange (UC ReX), an initiative of UC Biomedical Research, Acceleration, Integration, and Development (UC BRAID), a consortium of the five UC medical center campuses. The UC ReX Data Explorer is a secure online system that enables cross-institution queries of clinical aggregate data from 13.6 million de-identified records. The collaborative then used the UC systemwide IRB Reliance Registry to streamline its administrative processes. Reliance is a regulatory initiative that enables UC campuses to rely on the Institutional Review Board (IRB) approval received by another UC campus.

“We began by using UC ReX. We wanted to get numbers of potential participants with different diagnoses. UC ReX enables us to search by age, gender, medical condition or diagnosis, and we were able to get rough estimates,” Mody said.

Through CTRI, the researchers also used Research Electronic Data Capture (REDCap) for data entry. REDCap is a secure Web application for building and managing online surveys and databases.

“All of these tools have definitely helped us launch this project,” said Mody.

UCOP and each medical center campus provided funding for the study.

“We received a generous grant to do our first research together and develop the collaborative as a whole,” Mody said.

The effort included combining its family planning journal clubs and salary support for research assistants at five study sites.

“Seeing the concept come to life has been very fulfilling. Everyone’s hard work, dedication and vision for the study’s potential have really contributed to its success,” she said. “The key is not to work in silos.”

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$13M gift launches new maternal and child health center


UC Berkeley’s School of Public Health to launch Wallace Maternal and Child Health Center.

By Jose Rodriguez, UC Berkeley

Dr. Helen Wallace, a world-renowned professor, mentor and advocate known for her passion for improving the lives of women and children, has left a bequest valued at more than $13 million to UC Berkeley’s School of Public Health. The funds will launch the Wallace Maternal and Child Health Center, the campus announced today (March 2).

The new center will engage in innovative, evidence-based research aimed at creating healthier generations of women, mothers, children and families in the United States. It will focus on educating and training public health leaders primarily, but not exclusively, from states west of the Mississippi River through interdisciplinary scholarships and fellowships. The funds also will create a new endowed chair.

By fostering partnerships at every level of research, from discovery science to implementation and dissemination of evidence, the Wallace Center will complement the school’s existing maternal and child health (MCH) program — one of the pre-eminent MCH leadership training programs in the nation — and the Bixby Center for Population, Health and Sustainability.

Wallace, who died in 2013 at the age of 99, mentored generations of students as a professor and chair of the school’s MCH program from 1962 to 1980. She laid important groundwork in the field by fostering collaboration across disciplines at a time when it was rare to do so, and she implemented these practices within the school, in research partnerships and in her writing. She was particularly interested in infant health, maternal mortality, health systems that improved health outcomes, and expanded delivery of health care to mothers and children.

“We are extremely excited and gratified to move our work forward with greater focus and commitment in the arena of maternal and child health, which was the vision of Dr. Helen Wallace,” said Dr. Stefano Bertozzi, dean of the School of Public Health. “The School of Public Health has been taking a leadership role on these issues at the global level for some time now through the Bixby Center for Population, Health, and Sustainability. The new Wallace Maternal and Child Health Center will deepen our work and allow us to focus on attracting and supporting students from the western United States.”

The Wallace Center will embody the values of the School of Public Health: equity, excellence, diversity, innovation, impact and collaboration. By supporting and engaging faculty and students and attracting new talent, the center will play an important role in workforce development while sustaining UC Berkeley’s reputation as a game-changer at the forefront of public health.

Wallace is remembered for visionary efforts that brought together scholars from separate disciplines, such as public health and social welfare, to advance common research goals, and for attracting the school’s first maternal and child health training grant from the federal government.

“She was well-known for mentoring her students and ensuring that what they learned on campus was put to use to benefit society,” said Sylvia Guendelman, professor and chair of the maternal and child health program at UC Berkeley. “She inspired her students to be leaders, to make a positive difference in the world.”

Among the leaders Wallace trained was Dr. Peter van Dyck, who served as associate administrator of the U.S. Health Resources and Services Administration’s Maternal and Child Health Bureau from 1999 to 2011.

“Helen Wallace assured me and others at Berkeley that in maternal and child health, we could touch individual children as well as influence public health by implementing good policy,” said van Dyck. “She was correct. She was a great mentor.”

Guendelman, who will lead the planning effort, said that the center will allow new generations of students to see Wallace’s “vision, spirit and effort endure over time.”

Wallace received her bachelor’s degree from Wellesley College in 1933, her master’s in public health cum laude from the Harvard School of Public Health in 1943 and her medical degree from the Columbia University College of Physicians and Surgeons in 1937.

She was the author of 336 journal articles and 16 textbooks — most recently, ”Health and Welfare for Families in the 21st Century,” the second edition of which was published in 2003. Besides serving as the national health chair of the National Congress of Parents and Teachers, Wallace was secretary of the maternal and child health section and a member of the committee on child health of the American Public Health Association.

She was, in addition, assistant editor of the Journal of the American Women’s Medical Association, as well as a diplomate of both the American Board of Pediatrics and the American Board of Preventive Medicine. She consulted with the World Health Organization in many countries including Uganda, the Philippines, India, Turkey, Iran, Thailand, Burma, Sri Lanka and Nepal, and trained numerous physicians in Africa and Asia.

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