TAG: "Women’s health"

Bridge builder


Ellen Olshansky excels at forging bonds between university, community health organizations.

“My goal is to build partnerships with community-based groups,” says Ellen Olshansky, professor and founding director of nursing science at UCI. “I want to ask ‘How can we work together?’ It’s the difference between doing research ‘with’ and doing research ‘on.’” (Photo by Steve Zylius, UC Irvine)

Since joining UC Irvine in 2007 to launch the nursing science program, Ellen Olshansky has flourished as a highly respected county leader for community-based research and women’s health policy. And much of it started at her kitchen table five years ago.

There, in her University Hills home, Olshansky brought together Susan Bryant and Karol Gottfredson of UCI and Allyson Sonenshine and Stephanie Kight of Planned Parenthood of Orange & San Bernardino Counties to share ideas about what they could do to champion women’s health issues. Brainstorming over white wine, cheese and crackers, they outlined what would become the Orange County Women’s Health Project.

With aggressive planning and outreach by these five women, the OCWHP kicked off in 2011. In May 2012, it hosted the inaugural Orange County Women’s Health Policy Summit, at which a UCI alumna presented “A Snapshot of Women’s Health in Orange County” – the first-ever such survey.

The project’s partners have since formed task forces for breast and cervical cancer, teen reproductive health, and health and domestic violence. The work is paying dividends: Earlier this year, Blue Shield awarded the OCWHP $2 million to establish a countywide, integrated and collaborative system that will strengthen healthcare response to domestic violence and streamline service.

“Ellen was instrumental in getting the project off the ground – introducing the vision and doing the outreach and creating momentum,” says Sonenshine, OCWHP director. “We’ve developed a wonderful model that’s focused on data analysis, policy and education, and we play an increasingly important role.”

Now Olshansky is applying her bridge-building talents at UCI’s Institute for Clinical & Translational Science.

Supported by a prestigious Clinical & Translational Science Award from the National Institutes of Health, the ICTS is dedicated to advancing efforts to turn scientific discoveries into new methods, treatments and cures to improve public health. One of its most important objectives is community engagement, and that’s where Olshansky comes in.

“My goal is to build partnerships with community-based groups,” she says. “I want to ask ‘How can we work together?’ It’s the difference between doing research ‘with’ and doing research ‘on.’”

ICTS Director Dr. Dan Cooper says Olshansky is the perfect person at the perfect time to lead the community engagement push.

“Ellen has a long history of collaborating with the community, and her work is based upon having real dialogue and understanding among groups that don’t always speak the same language,” Cooper says. “She has remarkable skills in translating and expressing to faculty the community needs that impact health directly. Being a facilitator between these two groups is invaluable to us.”

To boost outreach, the ICTS is a founding partner of the Orange County Alliance for Community Health Research, which consists of the leaders of local, community-based organizations; practicing physicians; healthcare agencies; governmental representatives; community groups; and UCI researchers.

The alliance’s purpose is to create an infrastructure in Orange County that increases the ability of community organizations and universities to engage in health research that’s designed by the community to meet the needs of the community. Olshansky serves on its advisory board.

“At the heart of the alliance is the belief that the community first expresses its health needs, and then university researchers work with these partners to find solutions,” she says. “That’s what community-based research is all about, and I’ll be working diligently to further establish those relationships in Orange County.”

Earlier this year, Olshansky stepped aside from directing UCI’s Program in Nursing Science, where over seven years she oversaw the initiation of the bachelor’s program and the approval and initiation of the master’s and doctoral programs. She also spearheaded the effort to include nurse practitioner concentrations in the master’s program.

And during a recent sabbatical, Olshansky put the finishing touches on her latest book, Women’s Health & Wellness Across the Lifespan. Set for release on Dec. 11, it offers a historical and comprehensive look at women’s health – politically, socially, legally and medically – through contributions from leading experts across the country.

“This book is important because it explains the reasons why it’s necessary to have a focus on the issue of women’s health,” Olshansky says. “There has been such political push-back on sexual and reproductive health services, and we need to be sure that we continue to provide and strengthen these services.

“But many people believe that’s all women’s health is about. In fact, it’s much more than that, and this book goes in depth into the many other important issues women face. It’s written mostly for primary care physicians and nurse practitioners, but I believe anyone interested in women’s health will benefit from reading it.”

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Betting big on women, girls


Melinda Gates explains Gates Foundation’s strategy to lift countries out of poverty.

Melinda Gates talks with NPR’s Morning Edition co-anchor Renee Montagne about the source of her passion for improving conditions for people in undeveloped countries.

By Peggy McInerny, UCLA

The Bill and Melinda Gates Foundation is betting big on women and girls to help developing countries lift themselves out of poverty, foundation co-chair Melinda Gates told a UCLA audience that filled Korn Convocation Hall on Nov. 5.

Gates sat down to talk with NPR’s Morning Edition co-anchor Renee Montagne at the 2014-2015 Arnold C. Harberger Distinguished Lecture on Economic Development of the UCLA Burkle Center for International Relations. Co-sponsored this year by UCLA’s Center for World Health and the Health and Human Rights Law Project of the School of Law, the annual event is intended to bring economic policy experts to discuss their views with UCLA students and faculty.

UCLA Distinguished Professor Emeritus of Economics Harberger, who founded and supports the lecture series, was in attendance. A pioneer in the field of development economics, he has trained scores of Latin American economists over his 30 years at UCLA, where he continues to teach.

Gates has worked assiduously to restore contraception to a major place on the global health agenda. Her efforts in this direction led to the 2012 London Summit on Family Planning, which brought together donors, national governments and the development community from around the world. The summit adopted the goal of providing contraception to 120 million women in the developing world by 2020.

Today, 15 developing nations have created national family planning action plans. “We funnel our money through those action plans,” said Gates, which includes support at both the policy and the project levels.

Yet, said the speaker, she quickly realized that contraception alone could not resolve culturally ingrained gender inequality. Soon she began to advocate a holistic approach to cultivate the “other half” of the population of developing countries and, in the process, reduce poverty levels and promote economic growth.

Gates’ focus on gender inequality has led the Gates Foundation to “bet big” on three core areas: health, decision making power and economic empowerment. Saying she saw incredible opportunities in these areas to change things for the better for women and girls, she emphasized that the contributions of many individuals to these causes could create palpable change in our lifetimes.

Gates went even further, saying that development as a whole needs to be looked at through a gender lens. She explained, for example, that agricultural projects often do not take into account that the primary farmers in many countries are women, who frequently seek to avoid cash crops because they lose power over cash resources.

Longstanding development data show that investments in women’s health and education lead to smaller families with healthier, better-educated children. Where women have economic opportunity and decision-making power over resources, more of those resources are also invested in their families, promoting overall economic development.

“We need men and boys in the conversation on all of these issues,” said Gates. Only by educating men first about how contraception and women’s access to economic resources benefit the health and well-being of their children and their wives, she emphasized can these things become culturally acceptable. Moreover, the way in which health education is delivered must be culturally appropriate and respond to gender-specific circumstances.

Focusing on solving today’s problems

The Gates Foundation, which has an endowment of $42 billion and has already disbursed over $30 billion in grants, is focused on solving contemporary problems of the present generation — and perhaps the next — said the speaker.

The development aid provided by the foundation is not intended to endure indefinitely, noted Gates. Neither is the foundation itself. She and her husband do not expect it to have a shelf life much beyond their own — perhaps 15–20 years at most. “We want to spend our energy and our lives doing this work for the problems of today’s society,” she remarked.

“We are trying to build capacity now, so we can funnel more and more resources through those mechanisms,” she explained. “[And] as we learn what mechanisms work in one area, we take them and try to apply them to other areas.”

At present, the foundation is deeply engaged in the health sector in developing countries, supporting vaccination programs, building governmental and human capacity in health care, and developing ways to measure the impact of interventions, particularly those designed to improve gender inequality.

“The way that Bill and I think about this is that the only role [of] a foundation is to be a catalytic wedge,” said Gates. That is, foundations are able to take the risks needed to prove what does and doesn’t work. “But,” she added, “it takes government money to scale those things up.”

After helping create a global Vaccine Alliance (known as Gavi) and raising replenishment funds for it among wealthy nations, the Gates Foundation is now asking developing countries to make contributions to vaccination programs in their countries. Over time, these contributions are expected to increase until the programs become fully funded by those nations.

As a result of these programs, Gates noted that the governments of Ethiopia and Nigeria had built out basic-level primary health care systems in the form of “health posts.” (Ethiopia has built 15,000 such centers.)

“With basic supplies to help people and with basic trained health workers, usually two women, you can get unbelievable changes in maternal and child mortality,” observed Gates. The big lesson of the Ebola crisis is that investing in this primary level of health care provides an institutional bulwark against contagious diseases, which she predicted would continue to arise in perhaps more virulent form, she noted.

Nigeria, for example, was able to contain Ebola because after the first cases were reported, one of its polio clinics (supported by the Gates Foundation and the Centers for Disease Control and Prevention) was transformed into an Ebola emergency response clinic. Not only was the clinic able to trace the origin and spread of the disease in the country, the government was able to distribute appropriate behavior change messages throughout the system of health posts. In contrast, Liberia’s health system rapidly collapsed in the face of the Ebola crisis, having been greatly weakened by two decades of civil war.

Participating as an interlocutor, not an observer

Gates reflected that it was a great privilege to be able to travel for the foundation and learn firsthand about the concerns of men and women in the developing world. She traced her passion to making a difference in the world to the values of her parents, who encouraged all four of their children to attend college despite the serious financial burden this goal would impose.

A practicing Catholic, Gates said she attended a Catholic high school, but sought to transfer to an academically superior school in order to get into a good college. It took a while, she said, to understand that her parents sent her to the Catholic school because they believed in its values. “I was out serving in the courthouse … in the hospital, in a school two miles down the road,” she remarked. “These very liberal nuns showed us that we could make a change in the world.”

Asked if she had gotten pushback from Catholics about her support for contraception in developing nations, Gates said she had received surprisingly little criticism from people of faith. On the other hand, she noted, push back from Rome had been expected.

Whenever she travels to a development conference, the speaker said she makes a point to stop somewhere in Africa and meet people on the ground to remind herself what the work is about. Similarly, she takes a day or two to decompress after long stays in developing countries to let the stories she has heard wash through her, experience the grief sparked by them and decide what she wants to do.

“You don’t go to these countries and not let your heart break,” she said.

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Melinda Gates: Contraception needs to be on global health agenda


Gates Foundation co-chair delivers lecture at UCLA.

Renee Montagne, left, interviews Melinda Gates (Photo by Todd Cheney, UCLA)

The world has backed away from supporting contraception in the developing world because of politics, and it’s vital to put the issue back on the global health agenda, said Melinda Gates, co-chair of the Bill and Melinda Gates Foundation, in comments today (Nov. 5) at UCLA.

The nonprofit leader was the featured speaker at UCLA’s annual Arnold C. Harberger Distinguished Lecture on Economic Development. She spoke in conversation with Renée Montagne, the co-host of NPR’s Morning Edition.

Investing in women’s health and family planning supports the whole community in sometimes unexpected ways, Gates said.

“If we invest in that lowest level, the primary health care system … you can get unbelievable changes in maternal mortality and infant mortality,” she said. “If you don’t invest in that primary health care system, you don’t have a chance when something like Ebola comes along.”

Empowering women and girls in developing countries to decide whether and when to have a child is a key part of her work at the foundation, Gates said.

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Better education about prenatal testing leads to fewer tests


UCSF study shows importance of clear information on all prenatal testing options.

Miriam Kuppermann, UC San Francisco

A clinical trial led by UC San Francisco has found that when pregnant women are educated about their choices on prenatal genetic testing, the number of tests actually drops, even when the tests are offered with no out-of-pocket costs.

The findings underscore the need for clear information on all prenatal testing options and their possible outcomes, including the option of no testing, before pregnant women decide whether or not to have genetic testing, the authors said.

The study also suggests that some women may have undergone prenatal screening for Down syndrome without having full information about the implications of testing, the authors said.

The article is published in today’s (Sept. 24) issue of JAMA.

“Our findings show that prenatal testing is not appropriate for everyone, and that all women need information that is readily understood and unbiased to enable them to make informed choices reflecting their own preferences and values,” said lead author Miriam Kuppermann, Ph.D., M.P.H., professor and vice chair for clinical research at the UCSF Department of Obstetrics, Gynecology and Reproductive Sciences.

“Decisions about prenatal testing are personal and should be reflective of the patient’s own values and preferences, not those of her health care providers,” said Kuppermann.

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UC Davis names chief of maternal-fetal medicine


David Schrimmer joins from UC San Diego.

David Schrimmer, UC Davis

David B. Schrimmer, a highly respected obstetrician and gynecologist who is expert in the management of complex pregnancies, including multiple gestations and those requiring fetal therapy, has joined the faculty of the UC Davis School of Medicine in the Department of Obstetrics and Gynecology as professor and chief of the Division of Maternal-Fetal Medicine.

Before joining UC Davis, Schrimmer was professor of obstetrics and gynecology at UC San Diego, where he was founding director of the UCSD Fetal Surgery Program, which treats babies in utero. He also was founding director of the UCSD Multiples Program for women with multiple pregnancies.

“I am very excited about the opportunity to create a new division here for women with both straightforward and more complex pregnancies and providing a range of services with highly expert physicians, from conception to delivery,” Schrimmer said.

Schrimmer is highly regarded for treating women carrying multiple pregnancies, including the first set of healthy, surviving sextuplets successfully delivered in California. He also is a leader in treating fetuses with complex anomalies.

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SF celebrates 3 new hospitals with stars, lights and action


UCSF Hard Hat Walk, Lights On Festival draw thousands to Mission Bay.

San Francisco’s Mission Bay district became a melting pot of celebrities, civic dignitaries, community members and assorted creatures of unknown species with dazzling outfits and daring dance moves, as the city marked the upcoming opening of the new UCSF Medical Center.

Thousands joined in Saturday’s revelry, starting with the 5K Hard Hat Walk along the waterfront and through the Mission Bay neighborhood and ending with the Lights On Festival in the public plaza outside the medical center complex. The event culminated in a multicolor light show illuminating the windows of the three hospitals opening on Feb. 1, 2015: UCSF Benioff Children’s Hospital San Francisco, UCSF Bakar Cancer Hospital and UCSF Betty Irene Moore Women’s Hospital.

Donors and attendees of the celebration raised more than $525,000 for the new hospitals, exceeding the fundraising goal of $500,000.

Kicking off the Hard Hat Walk, UCSF Medical Center CEO Mark Laret paid tribute to the construction crew, staff and fundraisers. He urged the crowds to remind themselves that with “every step you take, think about a child whose life is going to be saved in that hospital and a mom who’s going to have an easier birth because of innovations here.”

There was plenty of levity to offset the serious moments.

A number of teams assembled for the walk dressed in fun costumes. UCSF Chief Information Officer Joe Bengfort nixed the sweats in favor of Luke Skywalker duds to lead his team, the Jedi Masters, which raised close to $12,000. The UCSF Cancer Crusaders donned superhero masks and capes; the Children’s Emergency Department team all wore rainbow tutus; and Remembering Maggie McDonald – one of the top patient fundraising teams – sported yellow hard hats in tribute to 19-year-old Maggie, a longtime patient of UCSF Benioff Children’s Hospital San Francisco who passed away earlier this year.

At the festival, families enjoyed pastries, tacos and other tasty treats from top local restaurants, while children got their faces painted, participated in wall art, played bungee run and danced to Vocal Rush, a teen a cappella group from the Oakland School for the Arts. Other participants decompressed with chair messages or a snuggle with a friendly possum from the San Francisco Zoo’s Zoomobile.

Adding razzle-dazzle to the event were Jesse Tyler Ferguson, star of the ABC television show “Modern Family,” Olympic champion figure skater Kristi Yamaguchi and San Francisco Giants home run king Barry Bonds, a longtime friend and supporter of UCSF Benioff Children’s Hospital San Francisco (“my brother from another mother,” according to Ferguson).

The midafternoon sun had segued into an early evening chill by the time celebrated singer and Bay Area native Michael Franti took the stage. But the audience warmed up dancing to his hits, “I’m Alive” and “Say Hey.”

At his invitation, a group of patients joined him on stage. The new hospitals were very personal to him, Franti explained, because his 15-year-old son had been a long-term patient at UCSF Benioff Children’s Hospital San Francisco. The audience nodded in unison, knowing the hospitals will play a key role in their health and that of their loved ones for generations to come.

David Chiu, president of the San Francisco Board of Supervisors, said it best when he addressed the crowd: “This is a moment in time so special for San Francisco.”

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Breastfeeding may delay onset of puberty in girls


Girls with early-onset puberty at risk for multitude of health challenges.

Julianna Deardorff, UC Berkeley

In a recent study, maternal and child health researchers at the UC Berkeley School of Public Health looked into the idea that breast feeding may serve as a protective mechanism to delay onset of puberty in girls. They found that, in some cohorts, girls who were predominantly breastfed (as opposed to predominantly formula fed) showed later onset of breast development.

Girls with early-onset puberty are at risk for a multitude of health challenges, including greater risks of obesity, hypertension and some cancers. Early maturation is also associated with lower self-esteem, higher rates of depression and norm-breaking behaviors, and lower academic achievement.

“These findings are unique in suggesting that exclusive breastfeeding may delay onset of girls’ pubertal timing,” says Julianna Deardorff, assistant professor of maternal and child health and co-author of the study. “Given the limited number of modifiable factors influencing puberty, this is a promising area of research for intervention.”

The study was led by Aarti Kale, M.P.H. ’11, who analyzed data from a population of 1,237 girls recruited across three geographic locations — New York City, Cincinnati and the San Francisco Bay Area. Breast feeding practices were assessed using self-administered questionnaires with the primary caregiver. The girls were seen on an annual basis to assess breast and pubic hair development. In addition to breastfeeding correlating with pubertal onset, duration of breastfeeding was also directly associated with age at onset of breast development. However, a stratified analysis showed the association only in the Cincinnati cohort.

“The results varied across the sites, suggesting that unique characteristics of these cohorts and their environments modify effects,” says Deardorff. “Further research into the contexts within which breastfeeding and girls’ development occur would potentially illuminate sources of variability.”

The study was published in the Journal of Maternal and Child Health.

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After ovarian cancer strikes daughter, mother raises money for research


Paulinda Babbini’s nonprofit raises money to fund ovarian cancer research at UCLA.

Paulinda Babbini and her late daughter, Robin Babbini, who died of ovarian cancer at 20. (Photo courtesy of Paulinda Babbini)

When Paulinda Babbini’s daughter, Robin, was diagnosed with ovarian cancer in 2004 at age 17, the mother’s first reaction was shock. Robin was a typical, active teenager and honor student, co-captain of the cheerleading squad, homecoming queen and involved in the dramatic arts.

How could her baby have cancer at 17 — worse, stage three ovarian cancer?

But Robin did have ovarian cancer, a disease that will strike nearly 22,000 American women this year alone, killing more than 14,000. Ovarian cancer accounts for 5 percent of cancer deaths among women, and causes more deaths than any other cancer of the female reproductive system.

Mother and daughter decided to fight and face the daunting disease together.

As part of her treatment, Robin underwent a total hysterectomy, followed by chemotherapy treatments. Unfailingly optimistic, Robin completed her classes, graduated from high school and began her freshman year at the University of California, Santa Barbara.

But six short months later, Robin’s cancer returned. She underwent another surgery, during which doctors discovered the cancer had spread. She fought on, joining the Kappa Kappa Gamma sorority and continuing her studies. She served as co-captain of her team at the American Cancer Society’s Relay for Life event. And despite her weakened condition, Robin gave a gut-wrenching, inspirational speech, hoping that one day there would be a cure found for ovarian cancer and no one would have to suffer like she had.

Just six weeks later, Robin lost her battle with ovarian cancer at 20.

“Losing a child is an anguish no parent should ever experience. It is utterly devastating. But how to move forward becomes the next challenge,” Babbini said. “I knew I had to shine a light on Robin’s memory and give her brief life a lasting purpose. Committing myself to fundraising to fight ovarian cancer keeps her in my heart.”

Babbini vowed that her daughter would not die in vain. Single-handedly, the grieving mother in 2010 launched the nonprofit The Ovarian Cancer Circle/Inspired by Robin Babbini and set out to raise money for ovarian cancer research. All the money she raises goes to fund the work of Dr. Sanaz Memarzadeh, an associate professor of obstetrics and gynecology at UCLA and director of the G.O. Discovery Lab at UCLA.

The donations from The Ovarian Cancer Circle/Inspired by Robin Babbini have enabled Memarzadeh and her team to make critical steps in understanding why ovarian cancers are not detected early and why these tumors often relapse despite surgery and chemotherapy.

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How breast cancer usurps powers of mammary stem cells


Finding provides insight into how aggressive breast cancer might be treated.

Mammary cells found during pregnancy that express integrin beta3 (CD61) act as stem cells, capable of reconstituting a new mammary gland in mice. This property may be to blame for the more aggressive nature of beta3-expressing breast cancer cells. Shown is a section from a mammary “outgrowth” harvested at lactation and immuno-stained for the epithelial markers E-cadherin (brown) and alpha-SMA (red).

During pregnancy, certain hormones trigger specialized mammary stem cells to create milk-producing cells essential to lactation. Scientists at the UC San Diego School of Medicine and Moores Cancer Center have found that mammary stem cells associated with the pregnant mammary gland are related to stem cells found in breast cancer.

Writing in today’s (Aug. 11) issue of Developmental Cell, David A. Cheresh, Ph.D., Distinguished Professor of Pathology and vice chair for research and development, Jay Desgrosellier, Ph.D., assistant professor of pathology and colleagues specifically identified a key molecular pathway associated with aggressive breast cancers that is also required for mammary stem cells to promote lactation development during pregnancy.

“By understanding a fundamental mechanism of mammary gland development during pregnancy, we have gained a rare insight into how aggressive breast cancer might be treated,” said Cheresh. “This pathway can be exploited. Certain drugs are known to disrupt this pathway and may interfere with the process of breast cancer progression.”

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UC Riverside physicians to provide women’s services at RCRMC


Supervisors approve contract as UC Riverside School of Medicine’s role expands.

UCR Health, the clinical arm of the UC Riverside School of Medicine, will begin providing comprehensive women’s health services at the Riverside County Regional Medical Center under a new contract approved today (July 1) by the Riverside County Board of Supervisors.

The contract becomes effective July 15.

“Our partnership with UCR Health physicians is an important step in the development of a world-class medical system that will meet the needs of all Riverside County’s communities,” said Third District Supervisor Jeff Stone, chairman of the board. “Our county’s health care system has always been good. Now, it’s about to get a whole lot better.”

The contract calls for UCR Health to staff women’s health services with board-certified and board-eligible physicians to care for routine and high-risk obstetrics, including labor and delivery. The physicians, who will all be faculty of the UCR School of Medicine, also will provide an array of gynecological specialty services such as gynecological oncology, urogynecology and endocrinology.

“UCR Health is pleased to be providing these services to patients in the outpatient clinics and inpatient setting at RCRMC,” said John Heydt, M.D., senior associate dean for clinical affairs in the UCR School of Medicine. “This is one more example of the UCR medical school’s commitment to partner with Riverside County in meeting the health care needs of its residents.”

UCR Health expects to staff the women’s health service initially with eight physicians who will be medical school faculty, according to Heydt. Karen L. Noblett, M.D., will join the UCR School of Medicine faculty and become chair of obstetrics and gynecology at RCRMC in early September. Noblett is board-certified in obstetrics and gynecology specializing in urogynecology and pelvic reconstructive surgery. She is bilingual in Spanish and English. Noblett is currently the interim chief medical officer at the UC Irvine Medical Center.

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Few obstetricians counsel patients on environmental toxics


UCSF study finds most agree exposures can be reduced, but only half take patients’ histories.

Naomi Stotland, UC San Francisco

In the first national survey of U.S. obstetricians’ attitudes towards counseling pregnant patients about environmental health hazards, nearly 80 percent agreed that physicians have a role to play in helping patients reduce their exposures, but only a small minority use their limited time with patients to discuss how they might avoid exposure to toxics, according to a UC San Francisco-led study.

Only 1 in 5 of the 2,500 physicians surveyed said they routinely asked about these exposures, and just 1 in 15 said they had received training on the harmful reproductive effects of toxic chemicals that are ubiquitous in the bodies of pregnant women in the United States.

The doctors surveyed said they didn’t know enough or were too uncertain of the evidence to feel comfortable making firm recommendations to pregnant women. They also said their patients often have more pressing and immediate health concerns, such as poor diet, sedentary lifestyles, obesity and chronic medical conditions like diabetes. In focus groups, physicians said they were afraid of scaring their patients about the chemicals found in the workplace and in thousands of household and industrial products, since it’s almost impossible to avoid being exposed to them.

While acknowledging that the problem can seem overwhelming, the authors said there are still things that doctors can do to help patients, even those who may have little control over their living and working environments and cannot afford luxuries like organic food.

“Many environmental exposures are unavoidable,” said Naomi Stotland, M.D., an associate professor in the Department of Obstetrics, Gynecology, and Reproductive Sciences at UCSF, a physician at one of UCSF’s partner hospitals, San Francisco General Hospital and Trauma Center, and the study’s lead author. “So, we counsel women on the substances that we know are most likely to cause harm, while providing them with practical ways of reducing their exposures.”

The authors said that if physicians had better training and evidence-based guidelines, they could be more proactive, without fear of unduly alarming their patients. Previous studies have shown that women want to know about the adverse effects of the chemicals they’re exposed to and that they can react productively to this information.

“We have good scientific evidence demonstrating that pregnant women are exposed to toxic chemicals, and there’s a link between these exposures and adverse health outcomes in children,” said Tracey Woodruff, Ph.D., M.P.H., who directs the UCSF Program on Reproductive Health and the Environment at UCSF and is the study’s senior author. “But physicians are not offering this information to their patients.”

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Using bubbles to reveal fertility problems


New ultrasound procedure can identify blockages in fallopian tubes.

Sanjay Agarwal, UC San Diego

Many women struggling to become pregnant may suffer from some degree of tubal blockage. Traditionally, an X-ray hysterosalpingogram (HSG) that uses dye is the most common procedure to determine whether a blockage exists, but it can cause extreme discomfort to the patient. UC San Diego Health System’s doctors are the first fertility specialists in the county to use a new ultrasound technique to assess fallopian tubes by employing a mixture of saline and air bubbles that is less painful, avoids X-ray exposure and is more convenient to patients during an already vulnerable time.

Using the FemVue Sono HSG, the physician delivers the mixture of saline and air bubbles into the uterus through a small catheter, which then flows into the fallopian tubes. Under ultrasound, the air bubbles are highly visible as they travel through the tubes, allowing the physician to determine if a blockage exists.

“The traditional X-ray approach involves higher pressure and usually causes significant cramping as the dye is administered. The anticipated pain prevents some women from even attempting the test. Others cannot do the test because they are allergic to the dye. Assessing the tubes for a blockage is a key component of the diagnostic workup in fertile couples, and not doing so because of pain or allergy is a real concern,” said Sanjay Agarwal, M.D., director of fertility services in the Department of Reproductive Medicine at UC San Diego Health System. “The new approach is not only much more comfortable for patients, it also uses saline, so the issue of an allergy does not arise. We are also able to assess the cavity of the uterus at the same time – all without X-rays.”

Kristina, a mother who has been trying to conceive a second child for almost a year, agreed: “I was willing to do whatever it took to address the fertility issues we were facing, but after everything we had been through emotionally, it was a relief to undergo a procedure that wasn’t physically painful.”

The ultrasound is performed in the clinic, and at present, ideal candidates include those with a prior pregnancy and those at low risk for tubal disease.

“Like the traditional X-ray HSG, the new test should be performed after the period has ended but before ovulation. The fact that the patient can schedule this ultrasound-based test in the clinic and not in radiology prevents a delay in care and allows the patient’s physician to be more involved in the process,” said Agarwal, also director of the UC San Diego Center for Endometriosis Research and Treatment (CERT).

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