Using the Medicine Wheel Model to Study Polycystic Ovary Syndrome in American Indian Women.

Developing a nursing research project with American Indian tribes and navigating the institutional review board approval process can appear daunting to investigators because of tribal research requirements in addition to academic requirements. Nurse investigators conducted a research project exploring experiences of American Indian women with polycystic ovary syndrome. After successful implementation of the project, a model emerged to guide researchers working with tribal communities through project development and the institutional review board process. The model is based on the American Indian medicine wheel with each quadrant aligned with a season of the year: spring, summer, fall, and winter. The seasonal approach divides project development into sections that can be developed independently or simultaneously. The model emphasizes collaborative relationships between the research team and tribe. Researchers can adapt and customize the model for their projects based on their objectives and targeted populations. The purpose of this article is to describe the medicine wheel model and, as an exemplar, demonstrate application of the model in a project involving American Indian women with polycystic ovary syndrome. Additionally, potential implications of the model for nursing research, education, and practice are presented.

Relationships between TCF7L2 genetic polymorphisms and polycystic ovary syndrome risk: a meta-analysis.

OBJECTIVE: This meta-analysis was performed to evaluate the relationships between genetic polymorphisms in the TCF7L2 gene and polycystic ovary syndrome (PCOS) risk. METHODS: The PubMed, Centralised Information Service for Complementary Medicine (CISCOM), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Web of Science, Google Scholar, EBSCO, Cochrane Library, and Common Biorepository Model (CBM) databases were searched for relevant articles published before November 1st, 2013, without language restrictions. Meta-analysis was conducted using the STATA 12.0 software. The relationships were evaluated by calculating the pooled odds ratios (ORs) and their 95% confidence intervals (CIs). Seven case-control studies with a total 2458 PCOS patients and 5109 healthy subjects' met our inclusion criteria for qualitative data analysis. Two common polymorphisms (rs7903146 C→T and rs12255372 G→T) in the TCF7L2 gene were assessed. RESULTS: The results of our meta-analysis suggested that TCF7L2 genetic polymorphisms might be strongly correlated with an increased risk of PCOS (allele model, OR=1.33, 95% CI=1.15-1.54, P<0.001; dominant model, OR=1.40, 95% CI=1.12-1.75, P=0.003), especially for the rs7903146 C→T polymorphism. A subgroup analysis was done to investigate the effect of ethnicity on an individual's risk of PCOS. Our results revealed positive significant correlations between TCF7L2 genetic polymorphisms and an increased risk of PCOS among Caucasians (allele model, OR=1.26, 95% CI=1.08-1.47, P=0.004; dominant model, OR=1.33, 95% CI=1.00-1.76, P=0.046) and Asians (allele model, OR=2.02, 95% CI=1.42-2.89, P<0.001; dominant model, OR=2.02, 95% CI=1.40-2.92, P<0.001), but not among Africans (all P<0.05). CONCLUSIONS: Our findings provide convincing evidence that TCF7L2 genetic polymorphisms may contribute to susceptibility to PCOS, especially for the rs7903146 C→T polymorphism among Caucasians and Asians.

Effects of omega-3 fatty acids supplementation on serum adiponectin levels and some metabolic risk factors in women with polycystic ovary syndrome.

OBJECTIVE: Polycystic ovary syndrome (PCOS) is a common female endocrine disorder associated with several risk factors of type 2 diabetes and cardiovascular diseases. The objectives of this study were to investigate the effects of omega-3 fatty acids on serum adiponectin levels and some metabolic risk factors in PCOS patients. METHODS: This double-blind randomized controlled clinical trial was conducted on 64 overweight or obese PCOS patients; aged 20-35 years. Subjects in omega-3 fatty acids (n=32) and placebo (n=32) groups were given 4 omega- 3 fatty acids capsules (each one contained 180 mg eicosapentaenoic acid and 120 mg docosahexanoic acid) or placebo daily for 8 weeks. Fasting blood samples, anthropometric measurements and 3-day, 24-hour dietary recalls were collected at the baseline and at the end of the trial. RESULTS: The study was completed by 61 subjects. Omega-3 fatty acids significantly increased serum levels of adiponectin (p=0.003) and decreased glucose (p<0.001), insulin (p=0.002), homeostatic model assessment for insulin resistance (p<0.001), total cholesterol (p=0.002) and low-density lipoprotein cholesterol (p=0.003) compared with placebo. Serum levels of triglyceride significantly decreased (p=0.024) and high-density lipoprotein cholesterol increased (p=0.018) in the omega-3 fatty acids group, in comparison with baseline values. No significant changes were shown in serum high sensitive C-reactive protein (hs-CRP) levels in both groups. CONCLUSION: Omega-3 fatty acids had some beneficial effects on serum adiponectin levels, insulin resistance and lipid profile in PCOS patients and may contribute to the improvement of metabolic complications in these patients.

Does the presence of polycystic ovary syndrome increase the risk of obstetrical complications in women with gestational diabetes?

OBJECTIVE: To determine whether women with both polycystic ovary syndrome (PCOS) and gestational diabetes mellitus (GDM) have an increased risk of obstetric complications compared with women with GDM alone. METHODS: A retrospective cohort study of maternal/fetal outcomes in women with GDM and PCOS was compared with women with GDM alone. Outcomes were compared using Fisher's exact test for categorical variables and t-test for continuous variables. Logistic regression models allowed for the calculation of odds ratios and 95% confidence intervals (CIs) for each outcome, adjusted for confounding. RESULTS: One hundred seventy one women were included in the study. Significantly more women with both GDM and PCOS had pregnancy-induced hypertension/preeclampsia (15.9% vs. 3.9%, p = 0.019, OR = 4.62, 95% CI = 1.38-15.41). Multiple logistic regression revealed that this increase persisted after controlling for body mass index (p = 0.028, OR = 4.43, 95% CI = 1.17-16.72) and parity (p = 0.050, OR = 3.45, 95% CI = 1.00-11.92). Women with GDM and PCOS tended to have more preterm deliveries (25.0% vs. 11.8%, p = 0.063). More infants of women with GDM and PCOS required phototherapy treatment for hyperbilirubinemia (25.0% vs. 7.9%, p = 0.0066, OR = 3.90, 95% CI = 1.52-9.98). Logistic regression revealed that this association persisted after controlling for preterm delivery (OR = 3.18, 95% CI = 1.14-8.82, p = 0.026). CONCLUSIONS: Mothers with both disorders should be monitored more carefully and counseled regarding their increased risk of both maternal and fetal complications.

Polycystic ovary syndrome in asian women.

There is substantial heterogeneity of symptoms and signs among women with polycystic ovary syndrome (PCOS). In addition to different diagnostic criteria used, the ethnic background of women with PCOS may affect the clinical, hormonal, and metabolic characteristics of this condition. We present here studies related to the clinical, hormonal, and metabolic characteristics and response to the treatment of PCOS in Asia, which may be different from those in Western countries. It is important to take into consideration the ethnic background of patients in future studies related to PCOS.